Dyspepsia and peptic ulcer disease Flashcards
what is dyspepsia?
constellation of symptoms
- epigastric pain or burning
- postprandial fullness (postprandial distress syndrome)
- early satiety (postprandial distress syndrome)
what are the organs of the foregut? where do they cause pain?
oesophagus stomach duodenum pancreas gallbladder Pain in the epigastric region
how common is dyspepsia?
affects 20-40% of people globally
More common in H.pylori infection and NSAID use
PPI = most commonly prescribed drug
what causes dyspepsia?
organic causes: - peptic ulcer disease - drugs (NSAIDs, COX2 inhibitors) - gastric cancer functional causes: - idiopathic, NU dyspepsia = 75% of cases - no evidence of culprit structural disease - can be associated with IBS etc
why is history important in dyspepsia?
differentiate between dyspepsia and reflux
how is dyspepsia examined?
if uncomplicated = epigastric tenderness only
if complicated =
- cachexia
- mass
- evidence gastric outflow obstruction (crushing splash?)
- peritonism
how is dyspepsia managed?
Monitor for alarm features
If ALARM features present = urgent GI referral
If ALARM features abscent = lifestyle advice , check for H. pylori infection
what is functional dyspepsia?
Presence of dyspepsia symptoms with no evidence of structural disease that is likely to explain the symptoms
Complicated interaction between the gut and the brain
what are the symptoms of peptic ulcer disease?
pain predominant dyspepsia (to back)
often also nocturnal
aggravated or relieved by eating (duodenal aggrevated by eating)
is peptic ulcer disease acute or chronic?
chronic
relapsing and remitting
who is peptic ulcer disease more common in?
lower socioeconomic groups
family history
what is the most common cause of peptic ulcer disease?
H. pylori
NSAIDs cause most of the rest
what is H. pylori and how is it acquired?
gram -ve microaerophilic flagellated bacillus
oral-oral/faecal-oral spread
usually acquired in infancy
when do the consequences of H.pylori infection arise?
later in life
what are the possible consequences of H. pylori infection?
Majority = no pathology 20-40% = peptic ulcer disease 1% = gastric cancer adenocarcinoma and lymphoma)
what has been attributed to the lower prevalence of H.pylori in the developed world and in the young?
sanitation, housing, hygiene etc
how is acid produced in the stomach?
food increases pH in stomach, stimulating G cels, releasing gastrin into the bloodstream which stimulated parietal cells to produce acid
When pH drops again this signal stops
Negative feedback system
H. pylori signals the g cells to produce gastrin which causes an overproduction of acid by parietal cells = hyperacidic state = increased acid flowing into duodenum = gastric metaplasia, duodenum van get infected?
ability to produce acid is reduced > pH of stomach rises > G cells pump out lots of gastrin to try and compensate, this high gastrin as well as atrophy is thought to be gastric cancer risk factor
how can you differentiate between a complicated and uncomplicated peptic ulcer?
uncomplicated = clear edges, yellow fuzzy centre complicated = darker, dot in the middle indicates risk of bleeding, looks deeper, irregular edges
what do NSAID induced ulcers look like?
skipping ulcers down the tract
what are some physical signs of gastric problems?
acute gastritis = red inflamed ruggae
chronic gastritis = lots of little bumps
Atrophy = flat and featurless
how is H.pyori infection diagnosed?
most commonly = faecal antigen testing (FAT) urease breath test gastric biopsy: - urease test - histology - culture/sensitivity serology (IgA antibodies)
H.pylori decreases the pH of its environment, true or false?
false
increases the pH of its environment
what does H.pylori look like histologically?
bacilli sitting on top of the epithelium
how is peptic ulcer disease treated?
All get PPI All are tested for H.pylori - +ve = eradicate and confirm - -ve = antisecretory therapy (PPI) withdraw NSAIDs lifestyle advice Non H.pylori/non NSAID ulcer = nutrition and optimise comorbidities rarely surgery
what is first line for H. pylori?
Triple therapy
PPI + Amoxicillin 1g + Clarythromicin 500mg
OR
PPI + metronidazole 400mg + clarithromycin 250mg
2 week regimen
If still symptomatic - retest
what are the possible complications of peptic ulcer disease?
anaemia
bleeding
perforation
gastric outlet/duodenal obstruction - fibrotic scar
when is a duodenal ulcer follow up required?
only if ongoing symptoms
Not needed if uncomplicated
when is gastric ulcer follow up required?
follow up endoscopy at 6-8 weeks
ensure healing and no malignancy
what are the side effects of Hpylori triple therapy?
nausea
diarrhoea
