Gastro

Question 1

ALARMS Symptoms

Answer 1

Anaemia
Loss of weight
Anorexia
Relative GI Ca / Recent onset of progressive symptoms
Mass/Malaena/Haematemesis
Swallow issues

Question 2

Define Dyspepsia

Answer 2

Upper GI symptoms
typically present >|4 weeks
Upper abdo pain heartburn acid reflux nausea vomiting

Question 3

Which drugs cause or worsen dyspepsia (can you name 5!?)

Answer 3

alpha-blockers, anticholinergics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, NSAIDs, theophyllines, and TCAs

Question 4

Common Lifestyle Advice for Dyspepsia

Answer 4

Lose weight
Avoid any trigger foods, such as coffee, chocolate, tomatoes, and fatty or spicy foods.
Eat smaller meals and eat their evening meal 3–4 hours before going to bed, if possible.
Stop smoking
Reduce alcohol consumption to recommended limits
Stress / Anxiety / Depression can worsen

Question 5

Important things to check before H Pylori Test (Urea breath or stool)

Answer 5

ensure the person has not taken a PPI in the past 2 weeks, or antibiotics in the past 4 weeks

Question 6

H Pylori Eradication Regime

Answer 6

NICE recommend the following PPI doses:
Lansoprazole 30 mg, omeprazole 20–40 mg, esomeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg.

If a person tests postive for H. pylori, offer a 7-day triple therapy regimen of:
BD PPI + Amox 1g bd + Clari 500 bd or metro 400 bd
A PPI twice-daily and amoxicillin 1 g twice-daily and
Or Clari + metro if pen allergic
Or if had clari before then PPI + Metro + Tetracycline Hydrochloride 500mg QDS + Bismuth Subsalicylate 525mg QDS

Question 7

Consider offering re-testing for H. pylori, using clinical judgement, if

Answer 7

• There has been poor compliance to first-line eradication therapy, or the initial test was performed within 2 weeks of proton pump inhibitor (PPI) or 4 weeks of antibiotic therapy.
• Aspirin or an NSAID is indicated, especially if there is a history of peptic ulcer disease.
• There is a family history of gastric malignancy.
• There are severe, persistent, or recurrent symptoms.
• The person requests re-testing (for example if there is anxiety about whether H. pylori has been eradicated).

Should be at leasr 4 weeks / ideally 8 weeks after initial Rx - breath test first line

Question 8

Arrange OGD for Dyspepsia if

Answer 8

Refractory or recuttent symptoms depsite opitmal Mx in pr care
Second line h pylori rx ot worked
Limited optinos for h py treatment due to hypersensitivity

stop ppi at leats 2 weeks before OGD