Dyspepsia

Question 1

What is dyspepsia?

Answer 1

A non-specific term used to describe indigestion related symptoms:
Epigastric pain
Bloating
Heartburn

Question 2

What are the ALARMS symptoms of dyspepsia?

Answer 2

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms 
Melaena or haematemesis
Swallowing difficulty

Question 3

Causes of dypepsia

Answer 3

Inflammation: GORD, gastritis, PUD
Cancer: oesophageal, gastric
Functional: non-ulcer dyspepsia

Question 4

Management of new onset dyspepsia

Answer 4

OGD if >55 or ALARMS
Conservative measures for 4 weeks
- Stop drugs: NSAIDs, CCBs (relax LOS)
- Lose weight, stop smoking, avoid alcohol
- OTC: antacids: mg trisillicate/ alginates: gaviscon advance
Test for H.pylori if no improvement: breath or serology

Question 5

Management if +ve H.pylori

Answer 5

Eradication therapy

OGD if no improvement

Question 6

Management if -ve H.pylori

Answer 6

PPI for 4 weeks
OGD if no improvement
PPI can be used intermittently to control symptoms

Question 7

Management if proven GORD

Answer 7

Full dose PPI for 1-2mo

Then low dose PPI PRN

Question 8

Management if proven PUD

Answer 8

Full dose PPI for 1-2mo
H.pylori eradication therapy if positive
Endoscopy to check for resolution if GU
Then low dose PPI PRN