Gastroenterology: Peptic Ulceration, Gastritis, Functional Dyspepsia Flashcards
Are duodenal ulcers uncommon in children?
Yes
When should a duodenal ulcer be considered?
Epigastric pain - particularly if it wakes patient at night
If the pain radiates to the back
Pain worse when hungry - acid washed straight into duodenum without being buffered by food
History of peptic ulcer in first degree relative
What is a strong predisposing factor for duodenal ulcers?
H pylori infection
Describe H pylori
It is a gram negative bacteria
Associated with a variety of GI problems - specifically peptic ulcer disease
What are the areas of the stomach?
Cardia
Fundus
Body
Pylorus - antrum and pyloric canal
Where in the stomach is H pylori typically found?
The antrum - it is less acidic
How does H pylori survive in the acidic environment of the stomach?
It releases urease, which converts urea to ammonia. Ammonia is basic, so locally neutralises the acidic environment
Why can H pylori cause peptic ulcers and gastritis?
The virulence factors it releases causes an inflammatory response that can damage the cells
How do you test for H pylori?
Urea breath test - patient consumes drink containing carbon isotope 13 enriched urea, urea broken down by H pylori urease, after 30 mins. patient exhales into glass tube, mass spectrometry calculates the amount of 13C CO2
Stool antigen test
Serum antibody
Gastric biopsy
Rapid urease test
How should children be treated when peptic ulceration is suspected?
PPI e.g omeprazole
If investigations suggest H pylori present - eradication therapy as well: amoxicillin and metronidazole or clarythromycin
What should be done for those who fail to respond to treatment or whose symptoms reoccur?
Upper GI endoscopy
If this is normal: functional dyspepsia diagnosed
What is functional dyspepsia?
Likely a variant of IBS
As well as having symptoms of peptic ulceration, also have non specific symptoms e.g early satiety, bloating. post pradial vomiting and may have delayed gastric emptying due to gastric dysmotility
No known cause can be found for the symptoms
What symptoms are associated with gastric ulcers?
Epigastric pain
Pain may be made worse on eating
Nausea, vomiting is infrequent but will often relive the pain
Weight loss
How is functional dyspepsia managed?
Difficult to treat
Some children respond to a hypoallergenic diet
