Flashcards in Dyspepsia and Peptic Ulcer Disease Deck (44)
What are some of the symptoms of dyspepsia
Epigastric pain or burning
Combination or separate symptoms
What are the structures of the foregut and where does it start and end
Starts at the cricopharyngeus to the ampulla of Vater
Describe the epidemiology of Dyspepsia
Very common (20-40% global)
No consistence association with sex/age/ socioeconomic status/ smoking or alcohol
More common if H pylori infected
More common if using NSAIDs
Overlap with IBS / GORD
What are the 2 main classes of causes of Dyspepsia and how common is each one
Organic (25%) and Functional (75%)
What are some of the organic causes?
Peptic ulcer disease
Drugs (NSAIDs, COX2 inhibitors)
What are some of the functional causes?
Associated with other functional gut disorder such as IBS
No evidence of culprit structural disease
What is it really important to differentiate between in diagnosing dyspepsia
Heartburn, reflux or dyspepsia
What is the only examination finding in dyspepsia
Epigastric tenderness only
If the dyspepsia is complicated, what else can it cause
Evidence of gastric outflow obstruction
How do we manage a patient with no alarm symptoms
Non invasive test and treat strategy
Test for H pylori
If a patient is H pylori positive what course of action should be taken?
Prescribe course of antibiotics
If H pylori negative what course of action should be taken?
Use PPI and other acid suppression and monitor the patient symptomatically if under 55
If the patient is over 55, we use ore active treatment and consider a referral to specialist
What other factors can affect functional dyspepsia?
Visceral hypersensitivity (MAIN CONTRIBUTOR)
Disrupted gut-immune interactions
Abnormal upper GI motor and reflex functions
Psychosocial factors (gut changes with stress)
Altered brain-gut interactions
What is peptic ulcer disease
Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum
What are the common syptoms of peptic ulcer disease?
Pain radiating to the back
Aggrevated or relieved by eating
Relapsing and remitting chronic illness
More common in lower socio-economic groups
Past family history
What are the 2 main causes of peptic ulcers
H pylori and NSAIDs
What is happening to the ratio of NSAID: H pylori?
It is rising
Describe H pylori
Acquired in infancy
Gram negative microaerophilic flagellated bacillus
Oral-oral/ faecal oral spread
Consequences of infection do not arise until later in life
What are the 2 main consequences of H Pylori
Peptic Ulcer disease
Describe the prevalence of H Pylori around the world
In the developing world, the prevelance is very high at an early age
In the Western world, there is a greater prevalence as the age increases. Older generations were brought up in a less clean and more poorly sanitised environments.
There is a higher prevalence of H pylori in lower social economic areas
What are the 2 different outcomes of an H Pylori infection
An increase in acid secretion of a decrease in acid secretion.
An increase causes an increased risk of duodenal ulcer
A decrease causes atrophy which results in Gastric Cancer
What is a typical endoscopic finding of a duodenal NSAID induced ulcer
Multiple white erosions all on one side of the tube
What do we need to worry about if an ulcer is irregular in shape and deep with raw edges?
Cancer - biopsy is required!
What is a typical sign of a gastric ulcer?
Raw edges on an ulcer
What 4 ways can we diagnose H pylori infection?
Urease Breath Test
Faecal Antigen test
Serology (IgA antibodies)
What might give you a false reading of H pylori?
If the patient is taking PPIs
What does H pylori do?
Increases the pH of its microenvironment
What would H pylori look like in terms of histology?
Black dots in the crypt area of the stomach