Dyspepsia and Peptic ulcer disease

Question 1

Define dyspepsia using the Rome III criteria

Answer 1

Rome III criteria (2006):

• epigastric pain or burning (epigastric pain syndrome)
• postprandial fullness (postprandial distress syndrome)
• early satiety (postprandial distress syndrome)

Question 2

Is dyspepsia more or less common if the pt is infected with H. pylori?

Answer 2

More

Question 3

Is dyspepsia more or less common if the pt uses NSAIDs?

Answer 3

More

Question 4

Causes of dyspepsia

Answer 4

Organic (25%) - Peptic ulcer disease, drugs (NSAIDs, CO2 inhibitors), gastric cancer

Functional (75%) - no evidence of culprit structural disease, associated with other functional gut disorders (eg. IBS)

Question 5

Examination findings of uncomplicated dyspepsia

Answer 5

epigastric tenderness only

Question 6

Examination findings of complicated dyspepsia

Answer 6

cachexia
mass
evidence of gastric outflow obstruction
peritonism

Question 7

Management of dyspepsia in the absence of alarm symptoms

Answer 7

• check H. pylori status
• eradicate if infected (cures ulcer disease, removes risk of gastric cancer)
• If H. pylori -ve, treat with acid inhibition as required

Question 8

What is functional dyspepsia?

Answer 8

No structural disease but ongoing symptoms

Question 9

What is peptic ulcer disease?

Answer 9

• a common cause of organic dyspepsia
• pain predominant dyspepsia (radiates to back)
• often also nocturnal
• aggravated or relieved by eating
• relapsing & remitting chronic illness
• predominate in lower social-economic groups
• family history common

Question 10

Does H. pylori more commonly cause GU or DU?

Answer 10

DU (90% compared to 60% of GU)

Question 11

What are the other causes of PUD?

Answer 11

NSAIDs (COX1, COX2, PGE [aspirin])

Question 12

When is H. pylori acquired?

Answer 12

Infancy

Question 13

How is H. pylori described?

Answer 13

Gram negative microaerophilic flagellated bacillus

Question 14

How is H. pylori spread?

Answer 14

Oral-oral/oral- faecal spread

Question 15

What is the % of people with H. pylori who end up with PUD?

Answer 15

20-40%

Question 16

Is H. pylori more common in the developing or developed world?

Answer 16

Developing

Question 17

How is H. pylori diagnosed?

Answer 17

Gastric biopsy #1 (urease test, histology, culture/sensitivity)
Urease breath test
Faecal antigen test

Serology (IgA antibodies) - no longer used

Question 18

Does H. pylori decrease the pH of it’s microenvironment?

Answer 18

No, it is increased

Question 19

Treatment for PUD

Answer 19

• ALL antisecretory therapy (PPI) - omeprazole
• ALL tested for presence of H pylori
• H pylori +ve - eradicate and confirm
• H pylori -ve - antisecretory therapy
• withdraw NSAIDs
• lifestyle changes - near impossible

Question 20

Is surgery frequently used in the treatment of PUD?

Answer 20

No

Question 21

Give examples of the anti-secretory therapy used in the treatment of PUD

Answer 21

4 H2RAs (cimetidine, ranitidine, famotidine and nizatidine)

PPIs including omeprazole, lansoprazole and pantoprazole are effective

Question 22

Is omeprazole or ranitidine more effective after 4 weeks use? In PUD

Answer 22

Omeprazole

Question 23

What is the eradication/triple therapy for H. pylori?

Answer 23

Omeprazole 20mg bd + clarithromycin 500mg bd + amoxicillin 1g bd/ metronidazole 400mg bd

Question 24

Complications of PUD

Answer 24

anaemia
bleeding
perforation
gastric outlet/duodenal obstruction - fibrotic scar

Question 25

DU follow up?

Answer 25

uncomplicated DU requires no f/u

Investigate and follow up only if ongoing symptoms

Question 26

GU follow up?

Answer 26

f/u endoscopy at 6-8 weeks ensure healing and no malignancy