dyspepsia Flashcards
(38 cards)
what is dyspepsia?
Dyspepsia is a complex range of symptoms:
– Epigastric pain
– ‘Heartburn’
– ‘Indigestion’
– Pain worse/better with eating
– NOT a diagnosis
what could be possible differential diagnosis of dyspepsia?
Upper gastrointestinal malignancy
* Gallbladder or hepatobiliary disease
* Pancreatic disease
* Cardiac disease
* Gastroenteritis
* Coeliac disease
* Crohn’s disease
* Irritable bowel syndrome
* Small intestine bacterial overgrowth —may also present with
weight loss, chronic diarrhoea, and malabsorption.
* Abdominal aortic aneurysm (rare).
when someone presents with dyspepsia, what should be initially investigated?
Ask about any alarm symptoms
* Assess the frequency, duration, and pattern of symptoms, and the
impact on the person’s quality of life.
* Ask about any family history of upper gastrointestinal malignancy.
* Ask about any lifestyle factors Obesity, trigger foods, Smoking
status
* Assess for stress, anxiety, and depression
* Review the person’s medication
* Consider other clinical features
* Examine the person, to assess for:
* Weight loss by checking serial weight and body mass index (BMI)
measurements.
* Signs of anaemia.
* Abdominal masses and tenderness.
* Consider arranging a full blood count, to check for anaemia and/or a
raised platelet count
when would a patient be refered for endoscopy?
For people presenting with dyspepsia together with significant acute gastrointestinal bleeding, refer them immediately (on the same day) to a specialist.
What medications may be a possible cause of dyspepsia?
calcium antagonists, nitrates, theophyllines, bisphosphonates, corticosteroids and
non-steroidal anti-inflammatory drugs [NSAIDs])
why is age important in dyspepsia?
refer as per nice guidelines on age
what are the alarm symptoms of dyspepsia?
Abdominal distension
* Abdominal, pelvic or rectal mass
* Abdominal or pelvic pain
* Change in bowel habit
* Dyspepsia
* Dysphagia
* Nausea or vomiting
* Reflux
* Haematemesis
* Rectal bleeding
* Weight loss
* Anaemia
* Raised platelet count
why would reflux, with weight loss and 55 yrs above be a cause for concern?
– Possible Oesophageal or stomach cancer
– Offer urgent direct access upper gastrointestinal
endoscopy (to be performed within 2weeks)
what should you do if a patient has a raised platelet count or n/v, 55 and over?
– Possible Oesophageal or stomach
– Endoscopy
what lifestyle advice should you give to someone with dyspeptic symptoms?
Lifestyle advice, healthy eating, weight reduction and smoking cessation.
* Advise people to avoid known precipitants smoking, alcohol, coffee, chocolate, fatty foods and being overweight.
* Raising the head of the bed and having a main meal well before going to bed may help some people.
* Addressing stress, anxiety and depression
what should you encourage people who are on long term management?
to reduce their use of prescribed
medication stepwise: trying ‘as-needed’ use when appropriate, and by returning to self-treatment with antacid and/or alginate therapy (unless there is an underlying condition or comedication that needs continuing treatment)
what is it classified when a patient has not undergone an endoscopy?
uninvestigated dyspepsia
– Common (40% of UK population)
how should you manage uninvestigated dspepsia?
- Prescribe a full-dose proton pump inhibitor (PPI) for 1 month or
- Test for Helicobacterpylori infection if the person’s status is not known
oruncertain.
If the person tests positive forH. pylori infection,
prescribe first-line eradication therapy.
what should you do if symptoms persist for uninvestigated dyspepsia?
Switch to thealternative strategy (for example, offer a full-dose PPI for 1 month if the person has been tested forH. pylori infection and vice
versa).
what should you do if you detect h.pylori?
A carbon-13 urea breath test or stool antigen test —ensure the
person has nottaken a PPIin the past 2 weeks, or antibiotics in the
past 4 weeks,
what is first line H.Pylori eradication?
proton pump inhibitor (PPI) together with a combination of antibiotics (taking into account previous exposure to clarithromycin or
metronidazole).
eg lansoprazole 30mg
what triple therapy regime should be given for h.pylori?
offer a 7-day triple therapy regimen of:
* A PPI twice-daily and amoxicillin 1 g twice-
daily and
* Either clarithromycin 500 mg twice-daily or
metronidazole 400 mg twice-daily.
if a person is allergic to penicillin, what should you give in a triple therapy regime to eradicate h.pylori?
A PPI twice-daily and clarithromycin 500 mg
twice-daily and metronidazole 400 mg twice-
daily.
what If the person is allergic to penicillin and has had previous exposure to clarithromycin,
offer a 7–10 day triple therapy regimen of?
A PPI twice-daily and metronidazole 400 mg
twice-daily and levofloxacin 250 mg twice-
daily.
what should you do with patients with persistent or recurrent dyspepsia despite initial management?
- Assess for alarm symptoms
- Consider an alternative diagnosis
- Check the person’s adherence to initial management
and reinforce lifestyle advice. - Consider H2- antagonist
- Consider the need for long-term acid suppression
therapy - Review NSAIDs/antiplatelets
when would you consider h.pylori re-testing?
- 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 a NSAID is indicated
- 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. pylorihas been
eradicated).
what are the possible diagnosis following endoscopy?
– Functional dyspepsia (Functional dyspepsiais defined as the presence of dyspeptic symptoms in the absence of an
organic cause that readily explains them)
– Gastro-oesophageal reflux disorder (GORD)
– Peptic ulcer disease (PUD)
– Malignancy
what is functional dyspepsia?
(also known as non-ulcer dyspepsia) refers to people with dyspepsia symptoms
and normal findings on endoscopy (gastric or duodenal ulcer, gastric malignancy, or oesophagitis have been excluded)
what are the two subtypes of functional dyspepsia?
- Epigastric pain syndrome, where intermittent or burning pain is localized to the epigastrium.
- Post-prandial distress syndrome, where there is post-prandial fullness or early satiety.
