Dyspepsia and peptic ulcer disease Flashcards
What is dyspepsia?
Epigastric pain or burning
Postprandial fullness
Early satiety
What are the 2 ends of the foregut?
Cricopharyngeus to the ampulla of vater
What are the organic causes of dyspepsia?
Peptic ulcer disease
Drugs (NSAIDS and COX2 inhibitors)
Gastric cancer
What are the functional causes of dyspepsia?
No evidence of culprit structutral disease
Associated with other functional gut disorders (IBS)
What is it important to differentiate between in a history of dyspepsia?
Dyspepsia and heartburn/reflux
What can be found upon examination?
Epigastrric tenderness Cachexia Mass Evidence gastric outflow obstruction - vomiting, swishing of gastric contents Peritonism
What are the ALARM symtoms?
Dysphagia Evidence of GI blood loss Persisting vomiting Unexplained weight loss Upper abdominal mass
What should be done in the management of dyspepsia in the absence of alarm symptoms?
Non invasive test and treat - check H. Pylori status and eradicate if infected to remove the risk of gastric cancer
If HP negative, trerat with acid inhibition as required
What is the critera foro functional dyspepsia?
Bothersome postprandial fullness Early satiation Epigastric pain Epigastric burning No evidence of structural disease
What can cause functional dyspepsia?
Visceral hypersensitivity Altered brain-gut interactions Genetic factors Pychosocial factors Abnormal upper GI motor and reflex functions Disrupted gut-immune interactions
What is peptic ulcer disease?
A common cause of organic dyspepsua Pain predominant dyspepsia (to back) Often nocturnal Aggravated or relieved by eating Relapsing and remitting chronic illness Family history common
What can cause peptid ulcer disease?
H pylori
NSADS, COX1, BOX22, PGE
Gastric motility
Outflow obstruction
What is H. Pylori?
A gram negative microaerophilic flagellated bacillus that is acquired in infancy. It spreads via oral-oral/ faecal oral spread
What are the consequences of H. Pylori?
Peptic ulcer disease (duodenal ro gastric) and gastric cancer
What types of gastric cancer can H. Pylori cause?
Non-cardia gastric adenocarcinoma
Low grade B-cell gastric lymphomas
How do peptic ulcers arise?
Food stimulates G cells to release gastrin which then stimulates parietal cells to produce HCl in the gastric fundus. When H. Pylori is present, is will overstimualte G cells and therefore produce a hyperacidic state.
How is a H. Pylori infection diagnosed?
Gastric biopsy (urease test, histology, cultire/sensitivity)
Urease breath test
FAT (faecal antigen test)
Serology (IgA antibodies) - not accurate with increasing patient age
How does H. Pylori increase the pH of its microenvironment?
It breaks down urea into ammonium bicarbonate via urease
What are examples of PPIs?
Ompreazole, esomeprazole, lansoprazole, dexlansoprazolle
How are PUDs treated?
All antisecretory therapy (PPI) All test for presence of H. Pylori If positive treat Withdraw NSAIDs Lifestyle Non-HP/ non-NSAID ulcers - nutrition and optimise comoridities
How is H. Pylori treated?
Triple therapy for 1 week (PPI + amoxicillin + clarithomycin)
What are common complications of PUD?
Anaemia
Bleeding
Perforation
Gastric outlet/duodenal obstruction
When is gastric cancer suspected?
Dyspepsia with alarm symptoms (weight loss, anaemia, mass, recurrent vomiting)
What can increase the risk of gastric cancer?
Achlorhydria
Family history
What is the histology of gastric cancer?
Body = predominant or pangiastritis
Atrophy
Intestinal metaplasia
What is the bacteriology of gastric cancer?
H. Pylori disappear
Mixed bacterial growth
How does H. Pylori inhibit gastric acid secretion?
Direct effect of bacterial produce (ammonia)
Effect of body inflammation induced by H. Pylori 0 IL-B which is a powerful inihibitor of acid secretion
