Dyspepsia Flashcards
Dyspepsia describes a range of upper gastro-intestinal symptoms, which are typically present for _______ or more weeks.
4
What are the symptoms of dyspepsia? (6)
- Upper abdominal pain and discomfort
- Heartburn
- Gastric reflux
- Bloating
- Nausea and or vomiting
- Early satiety
What are the causes of dyspepsia? (5)
- GERD
- PUD
- Gastro-esophageal malignancy
- Side effects of medication
- Functional dyspepsia (majority of patients)
Uninvestigated dyspepsia describes symptoms in patients who have not had ______________
an endoscopy
The majority of patients with dyspepsia are likely to have __________ dyspepsia
functional; an underlying cause cannot be identified and endoscopy findings are normal
Dyspepsia symptoms in pregnancy are commonly due to ____________
GERD
Patients with dyspepsia should be advised regarding which lifestyle measures? (9)
- Healthy eating
- Weight loss (if obese)
- Avoid triggering foods
- Eating smaller meals
- Eating the evening meal 3-4 hours before bed
- Raising the head of the bed
- Smoking cessation
- Reducing alcohol intake
- Manage stress, anxiety, and depression if present
Urgent endoscopic investigation is required in which patients with symptoms of upper abdominal pain, reflux, or dyspepsia? (3)
Patients with…
- Dysphagia
- Significant acute GI bleeding
- Age 55 and over with unexplained weight loss
__________________ is required for patients with dysphagia, significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia
Urgent endoscopic investigation
Which drugs are associated with dyspepsia? (12)
- Alpha-blockers
- Anti-muscarinics
- Aspirin
- Benzos
- Beta-blockers
- Bisphosphonates
- CCBs
- Corticosteroids
- Nitrates
- NSAIDs
- Theophyllines
- TCAs
_____________ and/or ____________ may be used for short-term symptom control of dyspepsia, but long-term, continuous use is not recommended.
Antacids
alginates
In patients with uninvestigated dyspepsia, a _______________ should be taken for 4 weeks
PPI
In patients with uninvestigated dyspepsia, a PPI should be taken for _____________
4 weeks
Patients with dyspepsia should be tested for _______________
Helicobacter pylori (H. pylori) infection, and treated if positive
Public Health England recommends that patients who are at high risk for H. pylori infection should be tested for H. pylori ______________ (before/in parallel with/after) a course of proton pump inhibitor
first, or in parallel with
Public Health England recommends that patients who are _______________ should be tested for H. pylori first, or in parallel with a course of proton pump inhibitor
at high risk for H. pylori infection
For patients with functional dyspepsia, patients should be tested for ____________
H.pylori and treated if positive
In patients with functional dyspepsia who are not infected with H. pylori, a _____________ or a _____________ should be taken for 4 weeks
proton pump inhibitor
histamine2-receptor antagonist (H2-receptor antagonist)
How should patients with refractory dyspepsia symptoms be managed? (4)
- New alarm symptoms should be assessed
- Alternative diagnoses should be considered
- Patients adherence to initial management should be checked
- Lifestyle advice should be reinforced
In patients with uninvestigated dyspepsia taking an NSAID and unable to stop the drug, consider _________________, or _______________
reducing the NSAID dose and using long-term gastro-protection with acid suppression therapy
switching to an alternative to the NSAID, such as paracetamol or a selective cyclo-oxygenase (COX)-2 inhibitor
In patients with uninvestigated dyspepsia taking aspirin and unable to stop the drug, consider ________________
switching from aspirin to an alternative antiplatelet drug
Do patients treated with H.pylori eradication therapy require routine retesting?
No; although there are specific situations in high retesting may be appropriate and if positive, second-line eradication therapy should be prescribed
How often should patients with dyspepsia be reviewed to assess their symptoms and treatment?
Annually; a ‘step down’ approach, or stopping treatment, should be encouraged if possible and clinically appropriate. A return to self-treatment with antacid and/or alginate therapy may be appropriate
A __________ approach, or __________ treatment, should be encouraged in patients with uninvestigated or functional dyspepsia if possible and clinically appropriate. A return to self-treatment with __________ and/or ___________ therapy may be appropriate
‘step down’
stopping
antacid
alginate
Referral to a specialist for further investigation of dyspepsia should occur in patients of any age with _____________ symptoms that are unexplained or non-responsive to treatment, or in patients with _____________ that has not responded to second-line eradication therapy
gastro-oesophageal
H. pylori infection
