Dyspepsia And Peptic Ulcer Disease Flashcards
Symptoms
Epigastric pain often related to hunger Specific food, time of day, fullness after meals, heartburn retrosternal pain, tender epigastrium Beware ALARMS symptoms A anaemia L loss of weight A anorexia R recent onset/progressive symptoms M melaena/haematemesis S swallowing difficulty
When to refer for endoscopy
Dysphagia
Age over 55
ALARMS symptoms
Treatment refractory dyspepsia
Treatment for h pylori
Triple therapy
1 PPI - lansoprazole
2 antibiotics - clarithromycin and amoxicillin
Age do you ‘test and treat’ for h pylori
Under 55
What to do if test is negative
Given PPI alone
What do you need to not take for 2 weeks before the test is done for h pylori
PPI
This is to ensure the treatment is given only when needed prevent antimicrobial resistance and c diff
Tests done for h pylori
Invasive CLO test Histology Culture Non invasive C breath test Stool antigen Serology (does not need 2 weeks off PPI)
Differential diagnoses for dyspepsia
Non ulcer dyspepsia Oesophagitis/GORD Duodenal/gastric ulcer Duodenitis Gastric malignancy Gastritis
Types of peptic ulcers
Gastric ulcer and duodenal ulcer
Major risk factors for duodenal ulcers
H pylori
Drugs - NSAIDS, steroids, SSRI
minor risk factors for duodenal ulcers
Inc gastric acid secretion, increased gastric emptying lowering ph of duodenum, blood group O, smoking
Diagnosis of peptic ulcers
GI endoscopy - look for malignancy
In gastric ulcers take multiple biopsies from ulcer rim base histology and h pylori. Repeat endoscopy in 6-8 weeks time to confirm healing and exclude malignancy
Also want to test for h pylori
Measure gastric concentration when off PPI if Zollinger-Ellison syndrome is suspected
Symptoms and signs of peptic ulcer
A symptomatic or epigastric pain relieved by antacids +- dec weight
Epigastric tenderness
Risk factors for gastritis
Alcohol NSAIDS h pylori Reflux/hiatus hernia Atrophic gastritis Granulomas - crohns CMV Zollinger ellison Syndrome menetriers disease
Symptoms of gastritis
Epigastric pain
Vomiting
Tests for gastritis
Can do upper GI endoscopy if suspicious
Treatment for dyspepsia and peptic ulcers disease
Conservative - lifestyle dec alcohol and smoking
Drugs if h pylori triple therapy
Reduce acid PPI, H2 antagonist
Drug induced ulcers stop drug if possible use PPI
Misoprostol use in prophylaxis in NSAID use or the treat other ulcers
Surgery remove the ulcers take for histology and repair rarely happens electively due to PPI use now making surgery not needed some emergency
Complications of ulcers
Bleeding
Perforation
Malignancy
Dec gastric outflow
Functional non ulcer dyspepsia
Common after all other possibilities ruled out PPIs Psychotherapy Low dose amitriptyline Antacids Anti spasmodic Less evidence for other treatments
