Dyspepsia Flashcards
What do goblet cells secrete?
Mucus (protects stomach lining)
What do parietal cells secrete?
Gastric acid (e.g. HCl)
What do chief cells secrete?
Pepsinogen (protease precursor)
What do D cells secrete?
Somatostatin (inhibits acid secretion)
What do G cells secrete?
Gastrin (stimulates acid secretion)
What has positive effect on parietal cells?
Histamine, gastrin and ACh –> increases gastric acid production
What is ACh released by?
Enteric neuron
What is effect of somatostatin?
Inhibitory on gastric acid secretion (parietal cells), histamine and gastrin (G cells)
How do proton pump inhibitors and H2 blockers reduce gastric acid secretion?
Inhibit pathways
What are the different dyspepsia terms?
- Dyspepsia with alarm symptoms: Dyspepsia with “red-flag” features
- Uncomplicated (or simple) dyspepsia: Dyspepsia without “red-flag” features
- Uninvestigated dyspepsia: Dyspepsia presenting to a physician for the first time
- Functional (“non-ulcer”) dyspepsia: Dyspepsia, but no structural cause for symptoms at upper GI endoscopy
What are the alarm features of dyspepsia?
Weight loss Dysphagia or odynophagia Persistent vomiting Haematemesis or melaena Palpable epigastric mass Family history of gastric cancer Dyspepsia onset over age of 45-55 years
What are the potential causes of dyspepsia?
- Gastro-oesophageal reflux disease
- Peptic ulcer
- Gastric cancer
But ~80% of people with dyspepsia will have a normal endoscopy –> This is so-called functional dyspepsia
How is dyspepsia with alarm symptoms managed?
Urgent endoscopy (but accuracy poor in predicting upper GI cancer)
What are individuals with dyspepsia tested for?
H. pylori (eradication therapy for positives)
How do we decide which approach to use for dyspepsia?
- Prompt endoscopy:
Is best in terms of effect on symptoms
But, costs much more per patient
Not cost-effective - “Test & treat” for H. pylori or empirical PPI therefore preferable:
Effect on both symptoms and costs very similar
Which to use depends on population prevalence of H. pylori
If prevalence >10%, “test and treat” preferred
Symptoms of peptic ulcer?
- Epigastric pain (May come on after eating, May be relieved by antacids, eating, or drinking milk)
- Epigastric tenderness
- Nausea
- Anorexia
- Weight loss
What are the causes of peptic ulcers?
Commonest causes:
H. pylori
Non-steroidals and aspirin
Rarer causes:
Zollinger-Ellison syndrome
Crohn’s disease
How often are peptic ulcers present in endoscopies for dyspepsia?
<10%
What is H. pylori (Helicobacter Pylori)?
- Causally implicated in peptic ulcer disease: 60% of gastric and 80% of duodenal ulcer
- Classed as a human carcinogen by WHO:
- Strong association with gastric cancer
- 5% of dyspepsia attributable to H. pylori
What is eradication therapy for H. pylori?
Proton pump inhibitor (PPI) combined with two antibiotics e.g. amoxicillin, clarithromycin, metronidazole
How does H. pylori survive?
Bacterium produces urease:
- Converts urea to ammonia and water
- A cloud of ammonia neutralises the acidic pH of the stomach
- Allows H. pylori to survive
How can H. pylori be diagnosed non-invasively?
- Carbon urea breath test
- H Pylori serology
- H Pylori stool antigen test (can also confirm its eradication)
How can H. pylori be diagnosed invasively?
- Rapid urease test
- Histological examination of biopsy specimens
What are complications of peptic ulcer?
- Perforation (ulcer erodes through stomach or duodenum wall)
- Bleeding
- Gastric outlet obstruction (pyloric stenosis)
How can bleeding caused by peptic ulcer be treated?
Endoscopy –> Injection of adrenaline / heat to bleeding vessel) / surgery
How is gastric outlet obstruction (pyloric stenosis) treated?
Bypass procedure (surgery)
What are the symptoms of peptic ulcer bleeding?
Haematemesis Coffee-ground vomiting Melaena Rectal bleeding Tachycardia Hypotension
As H. pylori prevalence decreases, so does what?
Ulcer incidences
