Dyspepsia & GORD

Question 1

What 2 conditions is dyspepsia an umbrella term for?

Answer 1

1. GORD: Gastro-oesophageal reflux disease

2. PUD: Peptic ulcer disease

Question 2

What are the symptoms of dyspepsia?

Answer 2

1. Acid reflux
2. Nausea
3. Heart burn
4. Upper abdominal pain/discomfort

Question 3

What are some risk factors of dyspepsia?

Answer 3

1. Genetics
2. Behavioural & lifestyle
3. BMI & pregnancy

Question 4

What causes GORD?

Answer 4

When sphincters of the stomach are weakened/impaired, causing acid to travel back up to the oesophagus.

Question 5

What is gastroparesis?

Answer 5

It is delayed gastric emptying; food stays in the stomach longer and causes stomach expansion & more relaxation of the pyloric & lower oesophageal sphincters (LOS)

Question 6

What are the 5 possible treatments for dyspepsia?

Answer 6

1. Lifestyle changes
2. Antacids: Na/Ca carbonate, Mg/Al hydroxide
   - Act as buffers on stomach acid
   - Acid (H+) combines with bicarbonate ions of antacids to form salt + water
3. Alginates: Na alginates (Gaviscon)
   - Increase viscosity of contents by forming a protective raft on top
4. H2 receptor antagonists: cimetidine, ranitidine, famotidine, nizatidine
   - To relieve symptoms of GORD by acting on H2 receptors, blocking acid production
5. PPI’s: omeprazole, lansoprazole
   - Inhibit proton pump (H+/K+ATPase enzyme pump) to reduce H+ release

Question 7

What is endoscopy and what are the different grades it shows?

Answer 7

It is when a camera is passed through the mouth to assess the mucosal lining. 
Grade A (few lesions) - grade D (mucosal breakage >75%)

Question 8

What are the 3 possible investigations that can be carried out to test for dyspepsia?

Answer 8

1. pH monitoring: nasal tube measures pH of the oesophagus
2. Manometry: pressure monitored of the LOS for its contractions
3. Barium swallow: which shows the narrowing of the LOS on x-ray

Question 9

What are the 2 types of peptic ulcer disease?

Answer 9

1. Duodenal

2. Pyloric

Question 10

What does H.pylori do in the stomach?

Answer 10

It produces the urease enzyme which converts urea into CO2 + ammonia

Question 11

What are the invasive and non-invasive testings for H.Pylori?

Answer 11

Invasive:
1. Rapid urease test

Non-invasive:

1. Faecal antigen test
2. Lab serology
3. Urea breath test

Question 12

What is the treatment for H.Pylori?

Answer 12

TRIPLE THERAPY
Amoxicillin + clarithromycin + lansoprazole
Use metronidazole instead if penicillin allergy present

Question 13

What is the ROME III criteria for dyspepsia?

Answer 13

Must have >1 of the following for min. 3 months:

1. Bothersome fullness
2. Epigastric burning/pain
3. Early satiation