Dyspepsia and Peptic Ulcer Disease

Question 1

What is the rome 3 criteria of dyspepsia?

Answer 1

epigastric pain or burning (epigastric pain syndrome)
postprandial fullness (postprandial distress syndrome)
early satiety (postprandial distress syndrome)

(indigestion, bloating etc)

Question 2

When is dyspepsia more common?

Answer 2

If H pylori infected

If NSAID use

Question 3

What are some causes of dyspepsia?

Answer 3

peptic ulcer disease
drugs (esp NSAIDs, COX2 inhibitors)
gastric cancer

Functional dyspepsia - idiopathic, could be associated with other functional gut disorders (IBS)

Question 4

What might you find on an uncomplicated examination of someone with dyspepsia?

Answer 4

Epigastric tenderness only

Question 5

What might you find on a complicated examination of someone with dyspepsia?

Answer 5

Cachexia - weakening ad wasting of the body due to chronic illness
Mass
Evidence gastric outflow obstruction
Peritonism

Question 6

How would you treat someone complaining of dyspepsia?

Answer 6

Check Alarm features - dysphasia, evidence of GI bleed, Persistent vomiting, unexplained weight loss, upper abdo mass

If not then try lifestyle or antacids

If continuation carry out a H.Pylori test - if found, eradicate

Question 7

What is the rome 3 diagnostic criteria for function dyspepsia?

Answer 7

Presence of at least one of the following
- Bothersome postprandial fullness - feeling full after meals
- Early satiation - feeling full after little intake of food
- Epigastric pain
- Epigastric bruning
AND
No evidence of structural disease that is likely to explain the symptoms

Must be going on for 3 months with symptom onset at least 6 months before diagnosis

Question 8

What is peptic ulcer disease?

Answer 8

A common cause of organic dyspepsia

Consists of the break down in the superficial epithelial cells penetrating down to the muscular mucosa of either the stomach or duodenum

Question 9

What are the causes of peptic ulcer disease?

Answer 9

H.Pylori infection
NSAIDS

Gastric dysmotility

Question 10

What is H.Pylori?

Answer 10

Usually acquired in infancy
Gram -ive microaerophilic flagellated bacillus

Oral-oral/feacal oral spread

Consequences of infection do not arise until later in life

Question 11

What Gram is H.pylori?

Answer 11

Gram negative
Microaerophillic
Flagellated bacillus

Question 12

How does H.Pylori spread?

Answer 12

Oral -oral

Feacal - oral

Question 13

What do H.Pylori do in the intestines?

Answer 13

It colonises the mucous layer of the stomach

Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. These may bleed, cause infections, or keep food from moving through your digestive tract.

Question 14

What are the consequences of H.Pylori?

Answer 14

No pathology - the majority of people who have H.Pylori

Peptic ulcer disease - Mostly DU 95%, some GU 75%

Gastric cancer - 1%

• adenocarcinoma
• MALT-omas

Question 15

Where is the prevalence of H.Pylori most common?

Answer 15

Developing world

Question 16

Where are G cells found?

Answer 16

Commonly in the pyloric antrum

Question 17

Where are parietal cells commonly found?

Answer 17

In the funds and body of the stomach?

Question 18

Describe the role of G cells and Parietal cells in the stomach?

Answer 18

G cells secrete Gastrin

Gastrin causes the secretion of HCL by parietal cells

Question 19

How might H.Pylori cause a duodenal ulcer?

Answer 19

The inflammatory response caused by bacteria colonizing near the pyloric antrum induces G cells in the antrum to secrete the hormone gastrin, which travels through the bloodstream to parietal cells in the funds.

Gastrin stimulates the parietal cells to secrete more acid into the stomach lumen, and over time increases the number of parietal cells, as well.

The increased acid load damages the duodenum, which may eventually result in ulcers forming in the duodenum.

Question 20

How might H.pylori cause gastric cancer?

Answer 20

In people producing normal or reduced amounts of acid, H. pylori can also colonize the rest of the stomach.

When H. pylori colonizes other areas of the stomach, the inflammatory response can result in atrophy of the stomach lining and eventually ulcers in the stomach.

This also may increase the risk of stomach cancer

Question 21

How do you diagnose H.Pylori?

Answer 21

Gastric biopsy - urease test (h.p gives off urease enzymes) histology, culture/sensitivity

Urease breath test

FAT (faecal antigen test)

Serology (IgA antibodies) not accurate with increasing patient age

Question 22

Does H.pylori increase or decrease the pH of its microenvrionemtn?

Answer 22

Increases the pH

Question 23

How do you treat peptic ulcer disease?

Answer 23

PPI (omeprazole)
test for H.pylori - eradicate if positive
Withdraw NSAIDs

Lifesyle

Question 24

How do you treat H.Pylori?

Answer 24

Triple therapy (2 weeks better eradication, 1 week common)

PPI + amoxycillin + clarithromycin

Question 25

What are some complications of peptic ulcer diseases?

Answer 25

Anaemia
Bleeding
Perforation
Gastric outlet/duodenal obstruction - fibrotic scar

Question 26

What should the post therapy follow up be for DU and GU?

Answer 26

Du - only follow up if ongoing symptoms

GU - endoscopy at 6-8 weeks to ensure healing and no malignancy

Question 27

What might be the symptoms suggesting a duodenal ulcer?

Answer 27

Epigastric pain typically before meals or at night, received by eating or drinking milk

Question 28

What might be the symptoms suggesting a gastric ulcer?

Answer 28

Mainly in the elderly on lesser curve

Asymptomatic
Epigastric pain related to meals +/- relieved by antacids
weight loss maybe due to not eating due to pain

Question 29

What might be some differential diagnosis of dyspepsia?

Answer 29

No-ulcer dyspepsia
GORD 
Gastritis 
Peptic ulcer 
Duodenitis
Gastric malignancy