GORD

Question 1

Urgent direct access OGD if >55 with weight loss and any of the following

Answer 1

Upper abdo pain
Reflux
Dyspepsia

If not weight loss then just routine

Question 2

If >40 get an urgent direct access OGD if….

Answer 2

FH of GORD or
Area of increased gastric cancer (south ear Asian countries)

Question 3

If >60 with a do pain and weight loss consider…

Answer 3

Urgent direct access CT abdo

Question 4

Should you stop NSAIDs before endoscopy?

Answer 4

If possible- some evidence it masks cancer at endoscopy

Also NSAIDs may be fuelling an ulcer/ulcerating cancer

Question 5

What does this suggest?
>8 weeks fo epigastric pain or burning
Early satiation and/or fullness after eating
Absence of alarm symptoms/signs

Answer 5

Functional dyspepsia

Question 6

For uninvestigated dyspepsia what is the treatment?

Answer 6

EITHER
Full dose PPI for one month
Test for H pylori

Question 7

What is the treat and test method for dyspepsia

Answer 7

Full dose PPI for one month
If still symptomatic test for H pylori (stop PPI 2 weeks before stool/breath test)

Question 8

What is test and treat for dyspepsia

Answer 8

Test for h pylori. If positive eradicate. If negative give one month full dose PPI

Question 9

What are the 3 R options after test/treat level of dyspepsia?

Answer 9

Resolved: self-care, unless indication for long term acid suppression, annual review if on treatment
Relapse- low dose acid suppression as needed
No réponse- H2 receptor antagonist for one month. If response then low dose acid suppression as needed, if no response then review and consider referral

Question 10

Prior to H pylori testing how long should PPI be stopped?

Answer 10

2 weeks

Question 11

Prior to H pylori testing how long should antibiotics/bismuth be stopped?

Answer 11

4 weeks

Question 12

When testing for H pylori and therefore stopping PPI and there is a flare, what can you cover with

Answer 12

H2RA

Question 13

Treatment for H pylori ( Pen OK)

Answer 13

The following three:
Clarithromycin/Metronidazole
Amoxicillin
Twice daily PPI

With clarity/metro if previously used one the use the other.

Question 14

If treatment for H pylori fails (Penicillin OK)

Answer 14

Amoxiliccin
Twice daily PPI
Clarithronycin/ Metronidazole (use the one not used previously)

If previous clarithronycin or metronidazole before eradication and used the other one for first line eradication then use tetracycline and if CI levofloxacin

Question 15

What to do if first and second line treatment for h pylori fails?

Answer 15

Gastro advice

Question 16

H pylori treatment Pen allergy, not had clairthromycin before

Answer 16

Clarithromycin
Metronidazole
Twice daily PPI

Question 17

H pylori treatment Pen allergy, has had clairthromycin before

Answer 17

Bismuth
Metronidazole
Tetracycline
Twice daily PPI

Question 18

What is the important question before first line treatment for H pylori eradication in pen allergic patient

Answer 18

Have you had clairthyrmocjn before? Will change treatment arm

Question 19

What is the important question before second line treatment for H pylori eradication in pen allergic patient

Answer 19

Have you had quinolones? Will change treatment arm

Question 20

H pylori treatment Pen allergy, second line, has had quinolones before

Answer 20

Bismuth
Metronidazole
Tetracycline
Twice daily PPI

Question 21

H pylori treatment Pen allergy, second line, has NOT had quinolones before

Answer 21

Levofloxacin
Metronidazole
Twice daily PPI

Question 22

Name some indications to continuing long term PPI

Answer 22

History of severe oesophagitis/oesophageal ulcer or peptic/oesophageal stricture
Zollinger - Ellison syndrome
High risk of GI bleeding
History of eosinophiloic oesophagitis or idiopathic pulmonary fibrosis
Patient not ameanable to stopping PPI
History of gastric or duodenal ulcer

Question 23

What is the follow up for indefinite dysplasia

Answer 23

PPI + OGD every 6 months