Dyspepsia And Peptic Ulcer Disease

Question 1

Symptoms

Answer 1

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

Question 2

When to refer for endoscopy

Answer 2

Dysphagia
Age over 55
ALARMS symptoms
Treatment refractory dyspepsia

Question 3

Treatment for h pylori

Answer 3

Triple therapy
1 PPI - lansoprazole
2 antibiotics - clarithromycin and amoxicillin

Question 4

Age do you ‘test and treat’ for h pylori

Answer 4

Under 55

Question 5

What to do if test is negative

Answer 5

Given PPI alone

Question 6

What do you need to not take for 2 weeks before the test is done for h pylori

Answer 6

PPI

This is to ensure the treatment is given only when needed prevent antimicrobial resistance and c diff

Question 7

Tests done for h pylori

Answer 7

Invasive 
CLO test 
Histology
Culture
Non invasive C breath test 
Stool antigen
Serology (does not need 2 weeks off PPI)

Question 8

Differential diagnoses for dyspepsia

Answer 8

Non ulcer dyspepsia
Oesophagitis/GORD
Duodenal/gastric ulcer 
Duodenitis 
Gastric malignancy 
Gastritis

Question 9

Types of peptic ulcers

Answer 9

Gastric ulcer and duodenal ulcer

Question 10

Major risk factors for duodenal ulcers

Answer 10

H pylori

Drugs - NSAIDS, steroids, SSRI

Question 11

minor risk factors for duodenal ulcers

Answer 11

Inc gastric acid secretion, increased gastric emptying lowering ph of duodenum, blood group O, smoking

Question 12

Diagnosis of peptic ulcers

Answer 12

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

Question 13

Symptoms and signs of peptic ulcer

Answer 13

A symptomatic or epigastric pain relieved by antacids +- dec weight
Epigastric tenderness

Question 14

Risk factors for gastritis

Answer 14

Alcohol 
NSAIDS
h pylori
Reflux/hiatus hernia
Atrophic gastritis
Granulomas - crohns
CMV
Zollinger ellison Syndrome
menetriers disease

Question 15

Symptoms of gastritis

Answer 15

Epigastric pain

Vomiting

Question 16

Tests for gastritis

Answer 16

Can do upper GI endoscopy if suspicious

Question 17

Treatment for dyspepsia and peptic ulcers disease

Answer 17

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

Question 18

Complications of ulcers

Answer 18

Bleeding
Perforation
Malignancy
Dec gastric outflow

Question 19

Functional non ulcer dyspepsia

Answer 19

Common after all other possibilities ruled out 
PPIs
Psychotherapy
Low dose amitriptyline
Antacids 
Anti spasmodic 
Less evidence for other treatments