Dyspepsia and GERD Flashcards
what is dyspepsia?
epigastric pain or discomfort originating from upper GI tract
umbrella term to describe many possible symptoms and causes
what is functional dyspepsia?
dyspeptic symptoms with no abnormalities found
what is gastroesophageal reflux disease?
reflux of gastric contents into the esophagus
described as heartburn
what is peptic ulcer disease?
an ulcer formed in the gastric or duodenal mucosa
what are some possible mechanisms of functional dyspepsia?
gastric motility and compliance
visceral hypersensitivity
H. pyrlori infection
altered gut microbiome
duodenal inflammation
psychosocial dysfunction (anxiety/depression)
what are the main causes of dyspepsia?
- functional dyspepsia (70%)
- GERD (15%)
- gastric erosions (6%)
- duodenal erosions (3.9%)
- duodenal ulcer (2.9%)
- gastric ulcer (2%)
- gastro-esophageal malignancy (0.2%)
what are some risk factors for dyspepsia?
dietary indiscretion (overeating)
medications
H. pylori infection
anxiety
IBS
?smoking or alcohol use
which drugs commonly cause dyspepsia?
acetylcholinesterase inhibitors
bisphosphonates*
corticosteroids
dabigatran
DHP-CCBs
diabetes medications: acarbose, GLP1 agonists, metformin
herbal products
iron*
NSAIDs*
oral antibiotics
orlistat
potassium*
theophylline
what are some symptoms of dyspepsia?
epigastric pain or discomfort**
fullness or early satiety**
nausea
upper abdominal bloating
excessive burping or belching
heartburn or regurgitation
what symptoms indicate that dyspepsia is caused by GERD?
heartburn and regurgitation
how long do symptoms have to be present for for it to be considered dyspepsia?
> 1 month
what are 4 main alarm symptoms of dyspepsia? what are the 2 other important symptoms to watch for?
main 4:
- vomiting
- bleeding/anemia
- abdominal mass or unexplained wt loss
- dysphagia or odynophagia
other important symptoms:
- chest pain (non cardiac)
- choking
what is dysphagia and odynophagia
dysphagia: difficulty swallowing
odynophagia: painful swallowing
what is the systemic approach in patients with dyspepsia?
- other possible causes
- upper GI location?
- new onset symptoms (other than reflux/heartburn) >50 (++>60) or red flag symptoms? –> endoscopy
- NSAID use?
- reflux or regurgitation as main symptom?
- H. pylori present?
what are some other possible causes of dyspeptic symptoms?
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
what is the mechanism of GERD?
reflux of stomach acid contents into esophagus, possibly leading to reflux (non-erosive) esophagitis or erosive esophagitis
what are some potential causes of GERD?
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
what are some risk factors for GERD?
obesity
pregnancy
family history
smoking
increased age (>65)
hiatal hernia
stress and anxiety
medications
diet
what is the mechanism behind drugs that can cause GERD?
slow peristalsis or directly cause relaxation of the sphincter
what are some drugs that can cause GERD?
alpha blockers
anticholinergics*
benzodiazepines
beta-agonists
DHP-CCBs
nicotine
opioids*
theophylline
tetracycline
what are some dietary contributors to GERD?
over eating**
fatty foods
chocolate
coffee
alcohol
carbonated drinks
acidic juices
what are the esophageal symptoms of GERD?
main symptoms: heartburn and regurgitation
belching
hypersalivation (water brash)
non-cardiac chest pain
what are some extra-esophageal symptoms of GERD?
chronic cough
throat clearing
SOB or wheezing
laryngitis
oropharyngeal symptoms (lump in throat feeling)
dental erosions