Dyspepsia + Peptic Ulcer

Question 1

What percentage of gastric ulcers are caused by H. Pylori?

Answer 1

60%

Question 2

What percentage of duodenal ulcers are caused by H. Pylori?

Answer 2

80%

Question 3

What is eradication therapy?

Answer 3

PPI + 2 Antibiotics

Question 4

What percentage of dyspepsia is caused by H. Pylori?

Answer 4

5%

Question 5

What is Functional Dyspepsia?

Answer 5

Dyspepsia, but no structural cause for symptoms at upper GI endoscopy

Question 6

What are the alarm features in a person with dyspepsia?

Answer 6

Weight loss
Dysphagia or odynophagia
Persistent vomiting
Haematemesis or melaena
Palpable epigastric mass
Family history of gastric cancer
Dyspepsia onset over age of 45-55 years

Question 7

What Are the Potential Causes of Dyspepsia?

Answer 7

Gastro-oesophageal reflux disease in ~13%
Peptic ulcer in ~8%
Gastric cancer in <1%

But ~80% of people with dyspepsia will have a normal endoscopy. This is so-called functional dyspepsia

Question 8

How common is dyspepsia?

Answer 8

Prevalence of 20% to 40% in community surveys

Question 9

Name 2 rarer causes of peptic ulcer disease.

Answer 9

Crohn’s disease (upper GI type)

Zollinger-Ellison syndrome (endocrine disorder - pancreatic tumour)

Question 10

Signs + Symptoms of Peptic ulcer?

Answer 10

Epigastric pain:
- May come on after eating
- May be relieved by antacids, eating, or drinking milk
Epigastric tenderness
Nausea
Anorexia
Weight loss

Question 11

Which two physiological signs may be observed in someone with a bleeding peptic ulcer?

Answer 11

raised pulse, low BP

Question 12

What may a blood test show in someone with a bleeding peptic ulcer?

Answer 12

low haemoglobin, raised urea (caused by digestion of large amounts of blood protein)

Question 13

Why do H. Pylori produce urease?

Answer 13

• Converts urea to ammonia and water
• A cloud of ammonia neutralises the acidic pH of the stomach
• Allows H. pylori to survive

Question 14

How is H. Pylori infection diagnosed, without endoscopy?

Answer 14

Carbon urea breath test
Stool antigen test
Serology (IgG based blood test)

Question 15

How is H. Pylori infection diagnosed, during endoscopy?

Answer 15

Rapid urease test (positive is magenta)

histological examination of biopsy specimens

Question 16

For what conditions is the treatment a PPI + ABX combination for people who test positive for H. Pylori?

Answer 16

Peptic ulcer
Gastric lymphoma
Previous gastric cancer
Functional dyspepsia
Family history of gastric cancer

Question 17

What are three complications of peptic ulcer?

Answer 17

Perforation
Bleeding
Gastric outlet obstruction (pyloric stenosis)

Question 18

How do you treat perforation or pyloric stenosis?

Answer 18

Surgery - probably partial gastrectomy

Question 19

How do you treat peptic ulcer bleeding?

Answer 19

Endoscopy

• thermal coagulation
• adrenaline injection

Question 20

What are the signs of a bleeding peptic ulcer?

Answer 20

Haematemesis (vomiting red blood)
Coffee-ground vomiting
Melaena
Rectal bleeding
Tachycardia
Hypotension