DYSPEPSIA, PEPTIC ULCER DISEASE, AND FUNCTIONAL DYSPEPSIA

Question 1

what is the function of the stomach?

Answer 1

• Reservoir for food
• Digests food — Antrum mixesandgrindsupthefood
• Controls passage of food into the small intestine — Pylorus regulates the size of particles and controls passage of food (chyme) into the small intestine
• Gastric acid secretion

Question 2

what are the 3 part of the stomach that is important for gastric motility?

Answer 2

• Fundus acts as a food storage
• Body and antrum mix food
• Pylorus contracts to limit the exit of chyme.

Question 3

what is the main role of gastric acid?

Answer 3

The gastricacid mainroleistosterilizefood (main role of gastric acids)

Question 4

stomachenvironmenthostiletobacteriaexcept which bacteria?

Answer 4

Helicobacterpylori because its ability to cause disease.

Question 5

what are the protective factors from gastric acids?

Answer 5

• Mucus layer Bicarbonate secretion
• Epithelial barrier regenerates rapidly
• Prostaglandins
• Mucosal blood flow (sweeps hydrogen ions away)

Question 6

What is Dyspepsia?

Answer 6

Dyspepsia describes indigestion, it is a symptom of an underlying problem.

Question 7

what is dyspepsia associated with?

Answer 7

• maybe associated with post‐prandial fullness

- maybe associated with early satiety (i.e. full earlier than usual after a meal)

Question 8

What is the cause of dyspepsia?

Answer 8

• Functional dyspepsia accounts for 75%
• The remaining 25%
  – Peptic ulcer disease
  – GORD
  – Coeliac disease
  – Biliary and pancreatic diseases
  – Diabetes
  – Medications

Question 9

what is peptic ulcer disease?

Answer 9

Ulceration in the stomach caused by NSAID or H.pylori.

Question 10

what is H.pylori?

Answer 10

Gram‐negative bacteria. Burrows into mucus lining of the stomach where it is less acidic

Question 11

what is the mechanism of NSAID causing peptic ulcers?

Answer 11

• NSAIDs and aspirin can cause gastric and duodenal ulceration
• This is mainly via systemic (rather than topical) effects
• MainmechanismisinhibitionofCOX‐1(cyclo‐oxygenase 1), an enzyme involved in the synthesis of prostaglandins which is responsible for gastric protection.

Question 12

what symptoms can peptic ulcers cause?

Answer 12

Dyspepsia/epigastric pain
Bleeding
Perforation
Obstruction

Question 13

What is functional dyspepsia?

Answer 13

there are no structural or histological abnormalities to explain their symptoms

Question 14

what are the diseases included in functional GI disorders?

Answer 14

Functional GI disorders include irritable bowel syndrome and are characterized by negative investigations

Question 15

what is the proposed mechanism of functional dyspepsia?

Answer 15

• Impaired stomach emptying / motility/ impaired peristalsis
• Hypersensitivity - this when the stomach is behaving normally but the patient excessively aware of the sensation of food in their stomach leading to symptoms.
• Altered gut microbiome - the balance of the bacterium in the gut can affect another parts of the gut.
• Psychosocial dysfunction are often more symptomatic when they are going through periods of pyschological stress.

Question 16

How to treat functional dyspepsia?

Answer 16

• Proton pump inhibitor (if not already trialled)
• Prokinetics e.g.domperidone
• Low dose tricyclic anti‐depressant
• Cognitive behavioural therapy/psychotherapy/hypnotherapy

Question 17

what are the alarming features associated with dyspepsia?

Answer 17

• Overt GI bleeding (haematemesis or melaena)
• Vomiting
• Iron deficiency signs of ulcer bleedings
• Age>50 yearsand new onset — indication of cancer
• Strong family history of upper GI cancer — indication of cancer
• Weight loss — always an alarmed symptoms.