Dyspepsia and Peptic ulcer disease Flashcards
Define dyspepsia using the Rome III criteria
Rome III criteria (2006):
- epigastric pain or burning (epigastric pain syndrome)
- postprandial fullness (postprandial distress syndrome)
- early satiety (postprandial distress syndrome)
Is dyspepsia more or less common if the pt is infected with H. pylori?
More
Is dyspepsia more or less common if the pt uses NSAIDs?
More
Causes of dyspepsia
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)
Examination findings of uncomplicated dyspepsia
epigastric tenderness only
Examination findings of complicated dyspepsia
cachexia
mass
evidence of gastric outflow obstruction
peritonism
Management of dyspepsia in the absence of alarm symptoms
- 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
What is functional dyspepsia?
No structural disease but ongoing symptoms
What is peptic ulcer disease?
- 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
Does H. pylori more commonly cause GU or DU?
DU (90% compared to 60% of GU)
What are the other causes of PUD?
NSAIDs (COX1, COX2, PGE [aspirin])
When is H. pylori acquired?
Infancy
How is H. pylori described?
Gram negative microaerophilic flagellated bacillus
How is H. pylori spread?
Oral-oral/oral- faecal spread
What is the % of people with H. pylori who end up with PUD?
20-40%
Is H. pylori more common in the developing or developed world?
Developing
How is H. pylori diagnosed?
Gastric biopsy #1 (urease test, histology, culture/sensitivity)
Urease breath test
Faecal antigen test
Serology (IgA antibodies) - no longer used
Does H. pylori decrease the pH of it’s microenvironment?
No, it is increased
Treatment for PUD
- 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
Is surgery frequently used in the treatment of PUD?
No
Give examples of the anti-secretory therapy used in the treatment of PUD
4 H2RAs (cimetidine, ranitidine, famotidine and nizatidine)
PPIs including omeprazole, lansoprazole and pantoprazole are effective
Is omeprazole or ranitidine more effective after 4 weeks use? In PUD
Omeprazole
What is the eradication/triple therapy for H. pylori?
Omeprazole 20mg bd + clarithromycin 500mg bd + amoxicillin 1g bd/ metronidazole 400mg bd
Complications of PUD
anaemia
bleeding
perforation
gastric outlet/duodenal obstruction - fibrotic scar
DU follow up?
uncomplicated DU requires no f/u
Investigate and follow up only if ongoing symptoms
GU follow up?
f/u endoscopy at 6-8 weeks ensure healing and no malignancy
