dyspepsia, reflux etc.

Question 1

how does the C13-urea breath test work

Answer 1

The subject ingests 13C urea, which is converted to 13CO2 in the presence of urease (excess production of urease occurs when H.pylori is present as it needs acidic conditions to survuve)

Question 2

what is dyspepsia

Answer 2

indigestion - chronic symptoms centred on the epigastric area and attributed to the gastroduodenal region

Question 3

dyspepsia presentation

Answer 3

1. pain/discomfort
2. belching
3. nausea/vomiting
4. rumination (regurgitating and chewing again previously swallowed food)

Question 4

examples of causes of acute epigastric pain (i.e. not dyspepsia) - 6

Answer 4

acute => not dyspepsia!

1. acute pancreatitis
2. perforated peptic ulcer
3. peptic ucler
4. acute cholecystitis
5. biliarycolic
6. acute cholangitis
   etc.

Question 5

5 main causes of dyspepsia

Answer 5

1. GORD
2. peptic ulcer
3. functional
4. oesophageal cancer
5. gastric cancer

Question 6

if a pt presents w chronic epigastric pain and dysphagia what is this indicative for

Answer 6

cancer

Question 7

why might reflux changes not be seen in an upper GI endoscopy (2)

Answer 7

1. non-erosive disease
2. changes have reversed due to PPI use

Question 8

examples of oesophageal-gastric cancer presentation (5)

Answer 8

1. dysphagia
2. loss of weight
3. epigastric pain
4. dyspepsia
5. reflux

Question 9

when is a dyspepsia pt referred for endoscopy

Answer 9

if >55yro

Question 10

if a dyspepsia pt does not require endoscopy what should be done (3)

Answer 10

1. stop any NSAIDs (if they need to continue them then do endoscopy)
2. non-invasive H.pylori test (faecal antigen, urea breath test)
3. empirical acid suppression (standard dose PPI for 4 weeks)

Question 11

what investigation is needed to follow up a barium swallow test

Answer 11

endoscopy

Question 12

what is an OGD

Answer 12

OesophagoGastroDuodenoscopy - a narrow flexible tube is used to look into the upper GI system

Question 13

alginates MOA

Answer 13

Alginate-based raft-forming formulations commonly contain sodium or bicarbonate -> bicarbonate ions are converted to carbon dioxide in presence of gastric acid and get entrapped within the gel precipitate, converting it into a foam which floats on the surface of the gastric contents -> The “raft” has a near neutral pH due to carbon dioxide and floats on the stomach contents and potentially functions as a barrier to impede gastroesophageal reflux

Question 14

what drugs can be used to treat dyspepsia (8)

Answer 14

1. antacids
2. alginates
3. H2 receptor antagonists (cimetidine, ranitidine etc.)
4. PPIs
5. abx (HP eradication)
6. misoprostol
7. sucralfate
8. antiemetics

Question 15

why cant misoprostol be given to pregnant women

Answer 15

induces labour and also used in abortion

Question 16

misorpstol MOA

Answer 16

synthetic prostaglandin E1 analog that stimulates prostaglandin E1 receptors on parietal cells in the stomach to reduce gastric acid secretion

Question 17

when might a gastric ulcer be suspicious for cancer

Answer 17

if it still hasn’t healed after 8 weeks on a repeat endoscopy

Question 18

peptic ulcer 1st line mgx (3)

Answer 18

1. PPI BD
2. amoxicillin 1g BD
3. clarithromycin 500mg BD

Question 19

peptic ulcer 2nd line mgx (after 2 weeks) - 5

Answer 19

1. ezomeprazole 40mg BD
   + 3 of:
2. amoxicillin 1g BD
3. levofloxacin 500mg OD
4. metronidazole 400mg TDS
5. tetracycline 500mg QDS

Question 20

what is functional dyspepsia

Answer 20

recurring indigestion with no obvious cause