Dyspepsia and GERD

Question 1

what is dyspepsia?

Answer 1

epigastric pain or discomfort originating from upper GI tract
umbrella term to describe many possible symptoms and causes

Question 2

what is functional dyspepsia?

Answer 2

dyspeptic symptoms with no abnormalities found

Question 3

what is gastroesophageal reflux disease?

Answer 3

reflux of gastric contents into the esophagus
described as heartburn

Question 4

what is peptic ulcer disease?

Answer 4

an ulcer formed in the gastric or duodenal mucosa

Question 5

what are some possible mechanisms of functional dyspepsia?

Answer 5

gastric motility and compliance
visceral hypersensitivity
H. pyrlori infection
altered gut microbiome
duodenal inflammation
psychosocial dysfunction (anxiety/depression)

Question 6

what are the main causes of dyspepsia?

Answer 6

1. functional dyspepsia (70%)
2. GERD (15%)
3. gastric erosions (6%)
4. duodenal erosions (3.9%)
5. duodenal ulcer (2.9%)
6. gastric ulcer (2%)
7. gastro-esophageal malignancy (0.2%)

Question 7

what are some risk factors for dyspepsia?

Answer 7

dietary indiscretion (overeating)
medications
H. pylori infection
anxiety
IBS
?smoking or alcohol use

Question 8

which drugs commonly cause dyspepsia?

Answer 8

acetylcholinesterase inhibitors
bisphosphonates*
corticosteroids
dabigatran
DHP-CCBs
diabetes medications: acarbose, GLP1 agonists, metformin
herbal products
iron*
NSAIDs*
oral antibiotics
orlistat
potassium*
theophylline

Question 9

what are some symptoms of dyspepsia?

Answer 9

epigastric pain or discomfort**
fullness or early satiety**
nausea
upper abdominal bloating
excessive burping or belching
heartburn or regurgitation

Question 10

what symptoms indicate that dyspepsia is caused by GERD?

Answer 10

heartburn and regurgitation

Question 11

how long do symptoms have to be present for for it to be considered dyspepsia?

Answer 11

> 1 month

Question 12

what are 4 main alarm symptoms of dyspepsia? what are the 2 other important symptoms to watch for?

Answer 12

main 4:
- vomiting
- bleeding/anemia
- abdominal mass or unexplained wt loss
- dysphagia or odynophagia

other important symptoms:
- chest pain (non cardiac)
- choking

Question 13

what is dysphagia and odynophagia

Answer 13

dysphagia: difficulty swallowing

odynophagia: painful swallowing

Question 14

what is the systemic approach in patients with dyspepsia?

Answer 14

1. other possible causes
2. upper GI location?
3. new onset symptoms (other than reflux/heartburn) >50 (++>60) or red flag symptoms? –> endoscopy
4. NSAID use?
5. reflux or regurgitation as main symptom?
6. H. pylori present?

Question 15

what are some other possible causes of dyspeptic symptoms?

Answer 15

abdominal or pancreatic cancer
abdominal wall pain
biliary pain
CHO malabsorption
celiac disease
diabetes
hypercalcemia/kalemia
IBD
medications (other than NSAIDs)
pancreatitis
parasites
thyroid disorders

Question 16

what is the mechanism of GERD?

Answer 16

reflux of stomach acid contents into esophagus, possibly leading to reflux (non-erosive) esophagitis or erosive esophagitis

Question 17

what are some potential causes of GERD?

Answer 17

defective lower esophageal sphincter
increased intra-abdominal pressure (i.e., over eating, obesity, pregnancy)
hiatal hernia
impaired esophageal peristalsis
delayed gastric emptying
excessive gastric acid production

Question 18

what are some risk factors for GERD?

Answer 18

obesity
pregnancy
family history
smoking
increased age (>65)
hiatal hernia
stress and anxiety
medications
diet

Question 19

what is the mechanism behind drugs that can cause GERD?

Answer 19

slow peristalsis or directly cause relaxation of the sphincter

Question 20

what are some drugs that can cause GERD?

Answer 20

alpha blockers
anticholinergics*
benzodiazepines
beta-agonists
DHP-CCBs
nicotine
opioids*
theophylline
tetracycline

Question 21

what are some dietary contributors to GERD?

Answer 21

over eating**
fatty foods
chocolate
coffee
alcohol
carbonated drinks
acidic juices

Question 22

what are the esophageal symptoms of GERD?

Answer 22

main symptoms: heartburn and regurgitation

belching
hypersalivation (water brash)
non-cardiac chest pain

Question 23

what are some extra-esophageal symptoms of GERD?

Answer 23

chronic cough
throat clearing
SOB or wheezing
laryngitis
oropharyngeal symptoms (lump in throat feeling)
dental erosions