Dyspepsia and Peptic Ulcer Disease

Question 1

what is dyspepsia

Answer 1

an epigastric pain or burning
postprandial fullness
early satiety
different from reflux

Question 2

epidemiology of dyspepsia

Answer 2

very common (seen with H.pylori infection)
no associations with sex/age/smoking etc.
overlaps with IBS/GORD

Question 3

causes of dyspepsia

Answer 3

organic
function (idiopathic)

Question 4

organic causes of dyspepsia

Answer 4

peptic ulcer disease
drugs - NSAIDS, COX2 inhibitors)
gastric cancer

Question 5

functional causes of dyspepsia

Answer 5

same as organic causes but no evidence of culprit structural disease
associated with other functional gut disorders

Question 6

signs of dyspepsia

Answer 6

epigastric tenderness

Question 7

alarm symptoms of dyspepsia

Answer 7

dysphagia 
evidence of GI blood loss
persistent vomiting 
unexplained weight loss
upper abdominal mass

Question 8

treatment for non-alarming dyspepsia

Answer 8

non-invasive test and treat;
lifestyle modifications
drug therapy
check H.pylori status - treat accordingly

Question 9

drug therapy for non-alarming dyspepsia

Answer 9

symptoms relief;

antacids/H2 receptor antagonists

Question 10

what is functional dyspepsia

Answer 10

presence of at least one of the following;
bothersome postprandial fullness
early satiation 
epigastric pain
epigastric burning 

no evidence of structural disease

Question 11

causes of functional dyspepsia

Answer 11

visceral hypersensitivity 
disrupted gut-immune interactions 
abnormal upper GI motor and reflex functions 
psychosocial factors
genetic factors
altered brain-gut interactions

Question 12

describe peptic ulcer disease pain

Answer 12

predominant dyspepsia (to back) and often nocturnal
aggravated or relieved by eating

Question 13

describe peptic ulcer disease

Answer 13

a relapsing and remitting chronic illness

Question 14

epidemiology of peptic ulcer disease

Answer 14

seen more in lower socio-economic groups

family history common

Question 15

causes of peptic ulcer disease

Answer 15

H.pylori

NSAIDs use

Question 16

describe H.pylori

Answer 16

acquired in infancy - consequences of infection do not arise until later in life
gram negative flagellated bacillus
oral-oral/faecal oral spread
increases pH of its microenvironment

Question 17

consequences of H.pylori infection

Answer 17

majority of people have no consequences
peptic ulcer disease
gastric cancer (1%)

Question 18

duodenal ulcers caused by H.pylori infection

Answer 18

no atrophy 
increase in;
duodenal acid load
gastrin release (decreased somatostatin)
acid secretion (increased parietal cell mass)

Question 19

consequences of increased duodenal acid load due to H.pylori infection

Answer 19

gastric metaplasia
H.pylori colonisation
ulceration

Question 20

tests for H.pylori infection

Answer 20

gastric biopsy
urease breath test
faecal antigen test
serology (IgA) - not accurate with older patients

Question 21

treatment for peptic ulcer disease

Answer 21

anti secretory therapy - proton pump inhibitors
test for presence of H.pylori - treat accordingly
withdraw NSAIDs
lifestyle modifications
surgery - infrequent

Question 22

lifestyle modification for peptic ulcer disease

Answer 22

nutrition (no form dietary recommendations) and optimise co-morbidities

Question 23

treatment of H.pylori infeciton

Answer 23

1 week therapy;
proton pump inhibitors
amoxicillin
clarithromycin

Question 24

treatment of H.pylori infection - penicillin allergic

Answer 24

1 week therapy;
proton pump inhibtor
metronidazole
clarithromycin

Question 25

complications of peptic ulcer disease

Answer 25

anaemia
bleeding
perforation
gastric outlet/duodenal obstruction - fibrotic scar