Dyspepsia and peptic ulcers

Question 1

What is dyspepsia?

Answer 1

No consistent definition. Often used as a synonym for indigestion. Epigastric pain and burning sensation.

Question 2

What percentage of gastric ulcers are caused by Helicobacter?

Answer 2

60%

Question 3

What percentage of duodenal ulcers are caused by Helicobacter?

Answer 3

80%

Question 4

What percentage of dyspepsia is associated with Helicobacter?

Answer 4

5%

Question 5

What type of cancer has a strong association with dyspepsia?

Answer 5

Gastric

Question 6

What are the subdiagnoses of dyspepsia?

Answer 6

Dyspepsia with red flags (alarm symptoms)
Uncomplicated (or simple) dyspepsia (no red flags)
Uninvestigated dyspepsia
Functional (non-ulcer) dyspepsia, i.e. no structural cause found on upper GI endoscopy

Question 7

What are the alarm symptoms (red flags)?

Answer 7

Weight loss
Dysphagia or odynophagia
Persistent vomiting
Coffee ground vomitus or haematemesis
Melaena
Palpable epigastric mass
Family history of gastric cancer
Onset over age 45-55

Question 8

Why are alarm symptoms important?

Answer 8

The presence of any of these symptoms warrant a referral for upper GI endoscopy.

Question 9

What are the potential causes of dyspepsia?

Answer 9

Gastro-oesophageal reflux disease (GORD) - 13%
Gastric ulcer - 8%
Gastric cancer

Question 10

What is the ‘test and treat’ approach to dyspepsia?

Answer 10

Testing everyone who presents for H.pylori and treating if present. Also treating with PPI. If symptoms persist upper GI endoscopy warranted. Cost-effectiveness depends on population prevalence of H.pylori. Method preferred if >10% prevalence.

Question 11

List potential causes of peptic ulcer disease

Answer 11

H.pylori, NSAIDS (most common)

Zollinger-Ellison syndrome, Crohn’s (rarer)

Question 12

Describe the signs and symptoms of peptic ulcer disease.

Answer 12

Epigastric pain (may come on after eating, may be relieved by antacids, eating or drinking milk)
Epigastric tenderness
Nausea
Anorexia
Weight loss
If bleeding - anaemia, coffee ground vomitus, haematemesis, melaena, hypotension and tachycardia

Question 13

How may H.pylori infection be diagnosed?

Answer 13

Carbon urea breath test
H.pylori serology
H.pylori stool antigen
Rapid urease test (invasive - done at endoscopy)
Biopsy

Question 14

How is H.pylori treated and under what circumstances?

Answer 14

PPI + two Abx from the following: amoxicillin, clarithromycin, metronidazole
Treated in individuals with peptic ulcer, gastric lymphoma, Hx of gastric cancer, functional dyspepsia, FHx of gastric cancer

Question 15

What are the potential complications of peptic ulcers?

Answer 15

Perforation (treated surgically)
Haemorrhage (treated via endoscopy)
Pyloric stenosis (treated surgically)