Dyspepsia

Question 1

Initial reflux approach

Answer 1

• screen for red flags / bleeding -> endoscopy
• think about cardiac, respiratory, biliary DDx
• stop nsaids / change to Cox 2 inhibitors
• 4 week trial of ppi if no red flags
• if no response, either ogd, or 2 week washout ppi and test for h pylori
• if symptoms recur after initial ppi response, reintroduce at low dose
• h pylori 10-14 days > 7 days
• Amox + metro/Clary
• Clari + metro