dyspepsia Flashcards
symptoms include
- upper abdominal pain or discomfort
- heartburn
- gastric reflux
- bloating
- n/v
what is it?
- range of upper GI symptoms, typically present for 4 weeks or more
Symptoms may be attributed to underlying cause e.g.
- GORD
- peptic ulcer disease
- gastro-oesophageal malignancy
- SE from drugs e.g. NSAIDs, bisphosphonates, CCs, aspirin, ACs etc
What is functional dyspepsia
- endoscopy normal
- underlying cause cannot be identified
Most patients have which type of dyspepsia?
functional (normal endoscopy, unknown underlying cause)
What is uninvestigated dyspepsia
symptoms in pt who have not had an endoscopy
dyspepsia symptoms in pregnancy are commonly due to…
GORD
lifestyle measures that can improve symptoms
- healthy eating, weight loss if appropriate
- avoid trigger foods
- eat smaller meals
- evening meal 3-4h before bed
- raise head of bed
- smoking cessation
- reduce alcohol
- assess for stress, anxiety, depression as these can exacerbate symptoms
urgent endoscopy required in the following
- dysphagia
- significant acute GI bleed
- 55 and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia
drugs that can cause dyspepsia and should be reviewed - use lowest effective dose and if possible stop
- alpha blockers (doxazosin, tamsulosin, alfuzosin)
- antimuscarinics (oxybutynin, atropina, trospium, solifenacin, tolterodine)
- aspirin
- BZDPNs, diazepam, lorazepam, clonazepam
- BBs e.g. propranolol atenolol, bisoprolol
- bisphosphonates e.g. alendronate, risedronate
- CCBs
- CCs
- Nitrates e.g. isosorbide mononitrate, GTN
- TCAs e.g. amitriptyline, nortriptylline
- NSAIDs
what can be used for short term control of symptoms
- acids and/or alginates can be used for short term symptom control
- long term, continuous use not recommended
initial management - uninvestigated dyspepsia
- PPI 4 weeks
- Pt with dyspepsia should be tested for H pylori infection and treated if positive
- If high risk for H pylori, test first, or in parallel with course of PPI
initial management - functional dyspepsia
- test and treat for H pylori if positive
- if not infected by H pylori, give PPI or H2RA for 4 weeks
Follow up management for uninvestigated and functional dyspepsia
- for pt with refractory dyspepsia symptoms, new alarm symptoms should be assessed and alternative diagnosis should be considered
- check pt adherence to initial management
- reinforce lifestyle advice
- if symptoms persist or recover following initial management, give PPI/H2RA at lowest dose needed to control symptoms, or as prn treatment
follow up management: uninvestigated dyspepsia taking NSAID and unable to stop drug
- consider reducing NSAID dose and using long term GI protection with acid suppression therapy or switching to alternative to NSAID e.g. paracetamol or COX-2 inhibitor
follow up management: uninvestigated dyspepsia taking aspirin and unable to stop drug
consider switching to alternative anti platelet e.g. ticagrelor, prasugrel
Do patients treated with H pylori eradication therapy need routine retesting
No
but may be appropriate to retest in specific situations
if retesting positive, prescribe 2nd line eradication therapy
How often should pt with dyspepsia be reviewed to assess symptoms and treatment
annually
Refer to specialist for further investigations should occur in pt
- of any age with gastroesophageal symptoms that are unexplained or non-responsive to treatment
- in pt with H pylori infection that has not responded to 2nd line eradication therapy
