DYSPEPSIA

Question 1

DYSPEPSIA
Define Dyspepsia

What is it often caused by?

Answer 1

-A term used to describe a collection of symptoms including upper abdominal discomfort and pain, heartburn, acid reflux, nausea and vomiting related to eating.

-Non-ulcer dyspepsia
-GORD
-peptic ulcer disease(gastric or duodenal)
-Hiatus hernia

Question 2

DYSPEPSIA
What are red flag symptoms associated with dyspepsia?

Answer 2

gastro-intestinal bleeding(coffee grounds in vomit -A+E

-Abdominal pain radiating to the back(possible Aortic Aneurysm) A+E

-dysphagia-urgent referral to GP

-dark black faeces (maleana)

-persistent vomiting

-iron deficiency anaemia

-progressive unintentional weight loss- Urgent GP referral

-Cardiac pain- pain travelling down the arm which is not relieved by antacids- A+E

• Night waking with acid in throat-Routine GP referral

Symptom severity is a poor indicator of an underlying disease. In presence of such symptoms should be investigated to exclude oesophageal and gastric carcinoma

Question 3

DYSPEPSIA
Differential diagnosis

What are differential diagnosis of dyspepsia?

Answer 3

Cardiac pain- pain travelling down the arm which is not relieved by antacids
Patients on NSAIDS, iron, Bisphosphonates
IBS
Biliary colic

Question 4

What are treatment options for dyspepsia?

Answer 4

Simple antacids-remain in stomach for longe, therefore have longer to act. Ideally not to be taken at same time as other drugs as they may impair absorption.

PPI-

Question 5

DYSPEPSIA
What are practical tips against dyspepsia?

Answer 5

If overweight- lose weight
smoking cessation
Avoid trigger foods- chocolate, alcohol, caffeine, rich, spicy or fatty foods

Question 6

GORD:
Define GORD

Answer 6

An unpleasant burning feeling, felt behind the breath bone (heartburn) often accompanied by sour or bitter taste in throat, caused by reflux of Gastroduadenal contents into the oesophagus. If heartburn is experienced regularly may need investigation.

Question 7

GORD:
What can GORD lead to?

Answer 7

May lead to complications such as oesophageal stricture or Barrett’s oesphagus, which long standing and untreated may lead to ulcer and a higher tendency to undergo malignant change.

Question 8

GORD:
What are trigger symptoms?

Answer 8

-Foods:
Fatty foods, citrus fruits, onions, coffee
-Drugs which relax the lower oesophageal sphincter, e.g. calcium channel
blockers, theophylline and nitrates
-Smoking
-Alcohol
-Obesity
-Genetic factors

Question 9

GORD:
How do PPIs work

Answer 9

They inhibit gastric acid secretion by blocking the hydrogen-k+Adenosine triphosphatase enzyme system(proton pump) of the gastric parietal call. It is more effective at healing ulcers rather than for relieving symptoms of GORD.

Question 10

What can antacids be used in infants?

Answer 10

Reduce the frequency of regurgitation but care must be taken with the high sodium content and not recommended in pre-term infants.