Dyspepsia and Peptic Ulcer Disease Flashcards
What is dyspepsia?
Indigestion and it presents with a constellation of symptoms: Epigastric pain/burning (epigastric pain syndrome) Postprandial fullness (postprandial distress syndrome) Early satiety (postprandial distress syndrome)
Associations with dyspepsia?
No consistent association with sex, age, socioeconomic status, smoking or alcohol
More common if H. pylori infected and if their is NSAID use
2 categories of dyspepsia causes?
Organic causes for 25% of cases:
Peptic ulcer disease
Drugs, e.g: NSAIDs, COX2 inhibitors
Gastric cancer
Functional causes, i.e: idiopathic, for 75% of cases:
Definition is the same but there is no evidence of a culprit disease
Assoc. with other function gut disorders, e.g: IBS
What must dyspepsia be differentiated from?
GORD (heartburn)
However, sometimes dyspepsia and GORD can co-exist
What are the symptoms in uncomplicated dyspepsia?
Epigastric tenderness only
What are the symptoms in complicated dyspepsia?
Cachexia
Epigastric mass
Evidence of gastric outflow obstruction, e.g: abdominal distension and succussion splash (heard with stethoscope in epigastrium when patient is shaken at the flanks)
Peritonism
Management of dyspepsia?
If alarm symptoms are present, refer to a hospital specialist to ensure there is no gastric cancer
In the absence of alarm symptoms:
Check for H. pylori and eradicate if infected; this will cure ulcer disease and remove risk of gastric cancer. If dyspepsia is still a problem, despite eradication, refer to specialist
If H. pylori negative, consider a referral to specialist (over 55 years) or manage as functional dyspepsia (below 55 years)
Criteria for functional dyspepsia diagnosis?
Presence of at least one of: Bothersome post-prandial fullness Early satiation Epigastric pain Epigastric burning
and
No evidence of structural disease (inc. at upper endoscopy) that is likely to explain the symptoms
Factors influencing functional dyspepsia?
Visceral hypersensitivity Altered brain-gut interactions Genetic factors Psychosocial factors Abnormal upper GI motor and reflex functions Disrupted gut-immune interactions
Symptoms of peptic ulcer disease?
Common cause of organic dyspepsia: Epigastric pain (to the back) that often wakens people at night (not the case with functional dyspepsia); it is either aggravated/relieved by eating
It may be a relapsing/remitting problem and an FH may be common; more common with lower socioeconomic status
Which ulcers tend to be aggravated by eating and which are relieved?
Gastric ulcer - often relieved by eating (dilutes acid)
Duodenal ulcer - often aggravated by eating, which stimulated entry of chyme into the duodenum
What are the causes of peptic ulcer disease?
H. pylori causes 90% of duodenal ulcers and 60% of gastric ulcers
NSAIDS, inc. COX1, CO2 and PGE
What is H. pylori?
Gram negative microaerophilic flagellated bacillus
It is acquired in infancy via oral-oral/faecal-oral spread, but the consequences of infection do not arise until later in life
Consequences of H. pylori infection?
No pathology
Peptic ulcer disease
Gastric cancer:
Almost all are non-cardia gastric adenocarcinomas
Low grade B-cell gastric lymphomas (MALToma)
However, may reduce gastric cardia adenocarcinoma and oesophageal adenocarcinoma
2 ways that H, pylori affects acid production?
- Increased acid production will normally cause gastric ulcers; but gastric mucosa can develop in the duodenum and H. pylori can colonise it, leading to duodenal ulcers
- Promotes gastric atrophy and a decrease in parietal cells; this decreases acid secretion and it is a risk factor for gastric cancer
