FN: Dyspepsia

Question 1

Definition

Answer 1

􏰀 Non-specific group of symptoms
􏰀 Epigastric pain
􏰀 Bloating
􏰀 Heartburn

Question 2

ALARM Symptoms

Answer 2

􏰀 Anaemia
􏰀 Loss of wt.
􏰀 Anorexia
􏰀 Recent onset progressive symptoms
􏰀 Melaena or haematemesis
􏰀 Swallowing difficulty

Question 3

Causes

Answer 3

􏰀 Inflammation: GORD, gastritis, PUD
􏰀 Ca: oesophageal, gastric
􏰀 Functional: non-ulcer dyspepsia

Question 4

Mx of New Onset Dyspepsia

Answer 4

OGD if >55 or ALARMS
Step 1: Trial measures
Step 2: H. pylori eradication

Question 5

Try Conservative measures for 4 weeks

Answer 5

􏰁 Stop drugs: NSAIDs, CCBs (relax LOS) 􏰁 Lose wt., stop smoking, ↓ EtOH
􏰁 Avoid hot drinks and spicy food
􏰁 OTC
􏰃 Antacids: magnesium trisilicate
􏰃 Alginates: gaviscon advance

Question 6

Step 2:

Answer 6

􏰁 +ve → eradication therapy
􏰃 Consider OGD if no improvement 􏰁 -ve → PPI trial for 4wks
􏰃 Consider OGD if no improvement
􏰃 PPIs can be used intermittently to control
symptoms.

Question 7

Proven GORD

Answer 7

􏰁 Full dose PPI for 1-2mo 􏰁 Then, low-dose PPI PRN

Question 8

Proven PUD

Answer 8

􏰁 Full dose PPI for 1-2mo
􏰁 H. pylori eradication if positive
􏰁 Endoscopy to check for resolution if GU 􏰁 Then, low-dose PPI PRN

Question 9

Eradication Therapy

Answer 9

􏰀 7 days Rx
􏰀 NB. PPIs and cimetidine → false –ve C13 breath tests
and antigen tests 􏰄 stop >2wks before.

Question 10

PAC 500

Answer 10

􏰀 PPI: lansoprazole 30mg BD
􏰀 Amoxicillin 1g BD
􏰀 Clarithromycin 500mg BD

Question 11

PMC 250

Answer 11

􏰀 PPI: lansoprazole 30mg BD
􏰀 Metronidazole 400mg BD
􏰀 Clarithromycin 250mg BD

Question 12

Failure of eradication

Answer 12

􏰀 95% success
􏰀 Mostly due to poor compliance
􏰀 Add bismuth
􏰁 Stools become tarry black