Week 2.7 - Dyspepsia

Question 1

What is dyspepsia?

Answer 1

not a diagnosis but a broad description of symptoms

Question 2

What symptoms are categorised as dyspepsia?

Answer 2

epigastric pain, burning sensation, early satiety, bloating, nausea, sickness, heartburn, discomfort

Question 3

What is epigastric pain?

Answer 3

pain in upper abdomen under ribcage

Question 4

What is organic vs functional disease?

Answer 4

• organic has cause that can be objective with tests, scans and imaging. GORD, ulcer, gastritis, cancer
• functional may be due to another systemic disease - cardiac or metabolic issues

Question 5

How do we diagnose a patient with dyspepsia?

Answer 5

• history
• examination
• drug history
• lifestyle
• BMI
• Bloods full count, coeliac serology, ferritin, U&E, calcium, glucose

Question 6

What are alarm symptoms in a patient displaying dyspepsia?

Answer 6

ALARMS
- anaemia
- loss of weight
- anorexia
- recent onset and >55
- melena and mass
- swallowing difficulty - dysphagia

Question 7

When do you urgently refer a patient with dyspepsia to endoscopy?

Answer 7

• red flag symptoms or ALARMS
• include mass, vomiting>2wks, dysphagia and odynophagia, unexplained weight loss.

Question 8

How common is dyspepsia?

Answer 8

very common - 80% of us have it but only 5% get referred and 1% have serious issue

Question 9

What is an endoscopy? How do you prepare?

Answer 9

imaging to diagnose or for therapy of GI. use local anaesthetic of throat or sedate, and make sure fasted for a day. very low risk of bleeding or reaction to drugs.

Question 10

What is the general steps for a patient presenting with dyspepsia?

Answer 10

• look for red flags - if present urgent referral
• if none give advice on lifestyle and PPI/H2RA
• do H-pylori test - if present treat and if not give 1 month PPI trial
• if h.pylori treatment ineffective do second line. if symptoms ongoing do breath urease test. if positive treat h.pylori again. if negative do PPI trial.
• If PPI trial ineffective check age. over 55 urgent refer. under 55 give PPi and H2RA. If responds well give back minimum dosage. if doesnt give routine referral