Dyspepsia and Peptic Ulcer Disease

Question 1

Symptoms of dyspepsia and peptic ulcer disease.

Answer 1

EPigastric pain often related to hunger, specific foods, or time of day.

Fullness after meals, heartburn (retrosternal pain)

Tender epigastrium

Beware of ALARM symptoms.

Question 2

Explain ALARM symptoms.

Answer 2

Anaemia

Loss of weight

Anorexia

Recent onset/progressive symptoms

Malaena/haematemesis

Swallowing difficulties

(Related to cancer)

Question 3

Different dyspeptic disease.

Answer 3

H. pylori

Duodenal ulcer

Gastric ulcer

Gastritis

etc…

Question 4

Tx of H. pylori.

Answer 4

PPi + 2 antibiotics like clarithromycin and amoxicillin.

Question 5

Tests for H. pylori

Answer 5

Invasive = CLO test, histology, culture

Non-invasive - breath test, stool antigen, serology

Question 6

Differential diagnoses of dyspepsia.

Answer 6

Non-ulcer dyspepsia

Oesophagitis/GORD

Duodenal/gastric ulcers

Gastric malignancy

Duodenitis

Gastritis

Question 7

What is more common, duodenal or gastric ulcers?

Answer 7

Duodenal ulcers are 4 times more common than gastric ulcers.

Question 8

Risk factors of duodenal ulcers.

Answer 8

H.pylori (90%)

NSAIDs, steroids and SSRIs.

Increased gastric acid secretion

Increased gastric emptying

Blood group 0

Smoking

Question 9

Symptoms of duodenal ulcers.

Answer 9

Asymptomatic or epigastric pain (after a meal)

Meals can sometimes make it better

Releived by antacids.

Epigastric tenderness.

Question 10

Investigations of duodenal ulcers.

Answer 10

Upper GI endoscopy

Test for H.pyloria

Gastrin conc. measure when off PPis for Zollinger-Ellison syndrome.

Question 11

Where do gastric ulcers (GU) occur?

Answer 11

Mainly in the elderly on the lesser curve of the stomach.

Ulcers elsewhere are more often malignant.

Question 12

Risk factors of GU.

Answer 12

H. pylori (80%)

Smoking

NSAIDs

Reflux of duodenal contents

Delayed gastric emptying

Stress due to neurosurger or burns

Raised ICP

Question 13

Symptoms of GU.

Answer 13

Asymptomatic or epigastric pain relieved by antacids +/- weight loss.

Question 14

Investigations of GU.

Answer 14

Upper GI endoscopy to exclude malignancy

Mutliple biopsies from ulcer rim and base

H. pylori testing

Rpeated endoscopy after 6-8 weeks to confirm healing and exclude malignancy.

Question 15

Risk factors of gastritis.

Answer 15

Alcohol

NSAIDs

H. pylori

Reflux/hiatus hernia

Atrophic gastritis

Granulomas from Crohn’s or sarcoidosis e.g.

CMV

Zollinger-Ellison syndrome

Menetrier’s disease

Question 16

Symptoms of gastritis.

Answer 16

EPigastric pain

Vomiting

Question 17

Investigations of gastritis.

Answer 17

Upper GI endoscopy only if suscpiocuous features.

Question 18

Treatment of gastritis and ulcers.

Answer 18

Lifestyle = reduce alcohol and tobacco

Treat H. pylori

Drugs to reduce acid such as PPis or H2 blockers.

Stop any drugs that may be the culprit of an ulcer.

Surgery

Question 19

Give an NSAID sparing medication that can be used.

Answer 19

Misoprostol

Question 20

Complications of ulcers and gastritis.

Answer 20

Bleeding

Perofration

Malignancy

Decreased gastric outflow