Dyspepsia

Question 1

What are the common differentials for heartburn?

Answer 1

GORD, peptic ulcer disease, upper GI cancer

Question 2

What are indications for urgent investigation of dyspepsia?

Answer 2

ALARM Symptoms
A-Anaemia
L-Loss of weight
A-Anorexia
R-recent onset symptoms
M-Melena
S-Swallowing difficulty

Question 3

What are the histological types of oesophageal cancer?

Answer 3

Distal oesophagus is most commonly adenocarcinoma
Middle third most common location
Used to be squamous cell carinoma but now adenocarcinoma most common

Question 4

What is the treatment of oesophageal carcinoma?

Answer 4

Can be treated surgically with recection, only curative option. This is combined with adjuvant (after) or neo adjuvant (before) chemo
Palliative is an option with oesophageal stent and chemo to slow progression

Question 5

What is the treatment for dyspepsia?

Answer 5

If alarm symptoms present then requires urgent upper GI endoscopy
If not present then stop drugs causing dyspepsia and offer over the counter antacids e.g. magnesium tricilicate
If this does not work test for H pylori and eradicate if found, if not found offer PPIs or H2 antagonists (ranitidine) or prokinetics such as metoclopramide