Dyspepsia and Peptic Ulcer Disease Flashcards
What is the rome 3 criteria of dyspepsia?
epigastric pain or burning (epigastric pain syndrome) postprandial fullness (postprandial distress syndrome) early satiety (postprandial distress syndrome)
(indigestion, bloating etc)
When is dyspepsia more common?
If H pylori infected
If NSAID use
What are some causes of dyspepsia?
peptic ulcer disease
drugs (esp NSAIDs, COX2 inhibitors)
gastric cancer
Functional dyspepsia - idiopathic, could be associated with other functional gut disorders (IBS)
What might you find on an uncomplicated examination of someone with dyspepsia?
Epigastric tenderness only
What might you find on a complicated examination of someone with dyspepsia?
Cachexia - weakening ad wasting of the body due to chronic illness
Mass
Evidence gastric outflow obstruction
Peritonism
How would you treat someone complaining of dyspepsia?
Check Alarm features - dysphasia, evidence of GI bleed, Persistent vomiting, unexplained weight loss, upper abdo mass
If not then try lifestyle or antacids
If continuation carry out a H.Pylori test - if found, eradicate
What is the rome 3 diagnostic criteria for function dyspepsia?
Presence of at least one of the following
- Bothersome postprandial fullness - feeling full after meals
- Early satiation - feeling full after little intake of food
- Epigastric pain
- Epigastric bruning
AND
No evidence of structural disease that is likely to explain the symptoms
Must be going on for 3 months with symptom onset at least 6 months before diagnosis
What is peptic ulcer disease?
A common cause of organic dyspepsia
Consists of the break down in the superficial epithelial cells penetrating down to the muscular mucosa of either the stomach or duodenum
What are the causes of peptic ulcer disease?
H.Pylori infection
NSAIDS
Gastric dysmotility
What is H.Pylori?
Usually acquired in infancy
Gram -ive microaerophilic flagellated bacillus
Oral-oral/feacal oral spread
Consequences of infection do not arise until later in life
What Gram is H.pylori?
Gram negative
Microaerophillic
Flagellated bacillus
How does H.Pylori spread?
Oral -oral
Feacal - oral
What do H.Pylori do in the intestines?
It colonises the mucous layer of the stomach
Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. These may bleed, cause infections, or keep food from moving through your digestive tract.
What are the consequences of H.Pylori?
No pathology - the majority of people who have H.Pylori
Peptic ulcer disease - Mostly DU 95%, some GU 75%
Gastric cancer - 1%
- adenocarcinoma
- MALT-omas
Where is the prevalence of H.Pylori most common?
Developing world
Where are G cells found?
Commonly in the pyloric antrum
Where are parietal cells commonly found?
In the funds and body of the stomach?
Describe the role of G cells and Parietal cells in the stomach?
G cells secrete Gastrin
Gastrin causes the secretion of HCL by parietal cells
How might H.Pylori cause a duodenal ulcer?
The inflammatory response caused by bacteria colonizing near the pyloric antrum induces G cells in the antrum to secrete the hormone gastrin, which travels through the bloodstream to parietal cells in the funds.
Gastrin stimulates the parietal cells to secrete more acid into the stomach lumen, and over time increases the number of parietal cells, as well.
The increased acid load damages the duodenum, which may eventually result in ulcers forming in the duodenum.
How might H.pylori cause gastric cancer?
In people producing normal or reduced amounts of acid, H. pylori can also colonize the rest of the stomach.
When H. pylori colonizes other areas of the stomach, the inflammatory response can result in atrophy of the stomach lining and eventually ulcers in the stomach.
This also may increase the risk of stomach cancer
How do you diagnose H.Pylori?
Gastric biopsy - urease test (h.p gives off urease enzymes) histology, culture/sensitivity
Urease breath test
FAT (faecal antigen test)
Serology (IgA antibodies) not accurate with increasing patient age
Does H.pylori increase or decrease the pH of its microenvrionemtn?
Increases the pH
How do you treat peptic ulcer disease?
PPI (omeprazole)
test for H.pylori - eradicate if positive
Withdraw NSAIDs
Lifesyle
How do you treat H.Pylori?
Triple therapy (2 weeks better eradication, 1 week common)
PPI + amoxycillin + clarithromycin
What are some complications of peptic ulcer diseases?
Anaemia
Bleeding
Perforation
Gastric outlet/duodenal obstruction - fibrotic scar
What should the post therapy follow up be for DU and GU?
Du - only follow up if ongoing symptoms
GU - endoscopy at 6-8 weeks to ensure healing and no malignancy
What might be the symptoms suggesting a duodenal ulcer?
Epigastric pain typically before meals or at night, received by eating or drinking milk
What might be the symptoms suggesting a gastric ulcer?
Mainly in the elderly on lesser curve
Asymptomatic
Epigastric pain related to meals +/- relieved by antacids
weight loss maybe due to not eating due to pain
What might be some differential diagnosis of dyspepsia?
No-ulcer dyspepsia GORD Gastritis Peptic ulcer Duodenitis Gastric malignancy
