Dyspepsia

Question 1

alarm signs

Answer 1

weight loss, vomiting, haematemesis, anaemia or dysphagia at any age require urgent referral for endoscopy

Question 2

non alarm sign indication for endoscopy

Answer 2

55 years and older unexplained and persistent recent-onset dyspepsia

Question 3

medications to review for possible causes

Answer 3

calcium antagonists, nitrates, theophyllines, bisphosphonates, corticosteroids + NSAIDs

Question 4

other systems to consider in differential

Answer 4

cardiac

billiary

Question 5

management

Answer 5

4 wks empirical treatment full-dose PPI or test + treating H. pylori

Question 6

preparing for H.pylori test

Answer 6

two-week washout period following PPI use, also stop bismuth

Question 7

types of H.pylori test in primary practice

Answer 7

13 C urea breath test

stool antigen

Question 8

H.pylori erradication

Answer 8

only with positive test result

Question 9

assessing erradication

Answer 9

breath test is only test validated in primary care

Question 10

CLO test

Answer 10

Campylobacter -like organism test: H.pylori secretes urease catalysing urea -> ammonia + CO2

Question 11

when is the CLO test performed

Answer 11

at gastroscopy biopsy of mucosa from antrum -> medium containing urea and indicator e.g. phenol red -> incr pH = change in colour of medium (yellow -> red = +ve)