Dyspepsia

Question 1

What is dyspepsia?

Answer 1

Upper abdominal pain or discomfort that may encompass:

bloating
nausea and vomiting
early satiety

Question 2

What are some common causes of dyspepsia?

Answer 2

oesophagitis 10-17%
    duodenal ulcer 10-15%
    gastric ulcer 5-10%
    gastritis, duodenitis, and hiatus hernia 30%
    non-ulcer dypepsia 30-50%
    gastric cancer 2%

Question 3

What are some differential diagnoses of dyspepsia?

Answer 3

1. PUD
2. GORD
3. Cancer of stomach/pancreas
4. Gallstones
5. Acute/chronic pancreatitis
6. Drug induced gastritis e.g. aspirin/iron preparations

Question 4

What are the main clinical features of dyspepsia?

Answer 4

upper abdominal pain or discomfort
    early satiety
    abdominal bloating
    nausea and vomiting
    heartburn

Question 5

In dyspepsia you must first review the patient’s drug history. Which drugs may cause dyspepsia?

Answer 5

1. NSAIDs
2. Bisphosphonates
3. Corticosteroids
4. Calcium channel antagonists

Question 6

Which clinical features warrant a 2 week wait referral for suspected oesophageal carcinoma?

Answer 6

• with dysphagia or
• aged 55 and over with weight loss and any of the following:
  upper abdominal pain
  reflux
  dyspepsia

Question 7

Which clinical features warrant a 2 week wait referral for suspected stomach carcinoma?

Answer 7

• Upper abdominal mass
• or with dysphagia or
• aged 55 and over with weight loss and any of the following:
  upper abdominal pain
  reflux
  dyspepsia

Question 8

What interventions are used in uninvestigated dyspepsia?

Answer 8

• PPI or testing for a treating H. pylori

NB/ a 2- week washout period following PPI use is necessary before testing for H. pylori with a breath test or a stool antigen test