Dyspepsia

Question 1

Dyspepsia is considered a combination of which 3 symptoms?

Answer 1

• epigastric pain/ burning
• postprandial fullness
• early satiety

Question 2

What can make dyspepsia more common in a patient?

Answer 2

• H pylori infected

- NSAID use

Question 3

Dyspepsia can be ORGANIC or FUNCTIONAL. Describe the differences between the two and what causes them?

Answer 3

ORGANIC (25%)

• peptic ulcer disease
• drugs (esp NSAIDs, COX2 inhibitors)
• gastric cancer

FUNCTIONAL (75%)

• idiopathic
• i.e. no cause known
• associated with other functional disorders such as IBS

Question 4

If a patient does NOT display any of the alarm symptoms, how do we test and treat for dyspepsia?

Answer 4

Non-invasive ‘test and treat’:

• check H pylori status
• eradicate if infected:
  - cures ulcer disease
  - removes risk of gastric cancer
• if HP –ve, treat with acid inhibition as required

Question 5

Describe the main symptoms present in peptic ulcer disease?

Answer 5

• pain predominant dyspepsia (radiates to back)
• often also nocturnal
• pain aggravated or relieved by eating
• relapsing & remitting chronic illness
• FHx common

Question 6

NSAIDs cause the majority of peptic ulcers. TRUE/FALSE?

Answer 6

FALSE

• H.Pylori infection causes 90% duodenal ulcers and 60% of gastric ulcers
• NSAIDs are thought to cause the rest

Question 7

H Pylor infection is acquired in infancy. TRUE/FALSE?

Answer 7

TRUE

• Acquired in infancy
• Oral-oral / faecal oral spread
• Consequences of infection do not arise until later in life

Question 8

How can H. Pylori infection be diagnosed?

Answer 8

• Serology => IgA antibodies (Must test before giving PPI)
• Urease Breath Test
• FAT (faecal antigen test)
• Gastric biopsy (urease test/ histology/culture)

Question 9

How is peptic ulcer disease treated?

Answer 9

• antisecretory therapy (PPI)
• ALL tested for presence of H pylori
  (If H pylori +ve - eradicate and confirm)
• withdraw NSAIDs
• lifestyle (difficult)

Question 10

PPIs such as omeprazole are more effective at healing ulcers than H2 receptor antagonists. TRUE/FALSE?

Answer 10

TRUE

• Omeprazole heals ulcers more rapidly than standard doses of H2RAs
• BUT the advantage after 4 weeks of therapy is small.

Question 11

What “triple therapy” is used in an attempt to eradicate H. Pylori?

Answer 11

Either:

• PPI + amoxicillin + clarithromycin
• OR PPI + metronidazole + clarithromycin

Given for 1 week
S/E such as nausea and diarrhoea are common, so check patient compliance

Question 12

What are the potential complications of peptic ulcer disease?

Answer 12

• anaemia
• bleeding
• perforation
• gastric outlet/duodenal obstruction - fibrotic scar

Question 13

How are duodenal and gastric ulcers followed up?

Answer 13

DU:

• uncomplicated DU requires no follow up
• only if ongoing symptoms

GU:

• endoscopy at 6-8 weeks
• ensure healing and no malignancy