Dyspepsia

Question 1

Prior to endoscopy, what advice should be given if a patient is taking a PPI or H2 receptor blocker?

Answer 1

Stop at least 2w prior to endoscopy
Could mask underlying pathology e.g. gastric cancer.

Question 2

List 3 indications for urgent referral for dyspepsia

Answer 2

All with dysphagia

All with upper abdo mass consistent with stomach cancer

> ,55’s with WL, AND any of the following: upper abdo pain, reflux, dyspepsia

Question 3

Which patients require non-urgent referral for dyspepsia?

Answer 3

Those with Haematemesis
Those >,55 with certain features

Question 4

Which features in >,55s warrant non-urgent referral?

Answer 4

Tx-resistant dyspepsia
OR
upper abdo pain with low Hb levels
OR
Raised platelet count with any of the following: N+V, WL, reflux, dyspepsia, upper abdo pain
OR
N/V with any of the following: WL, reflux, dyspepsia, upper abdo pain

Question 5

Describe management of patients with dyspepsia not meeting the referral criteria

Answer 5

1. Review DH for possible causes of dyspepsia
2. Lifestyle advice
3. Trial of full-dose PPI for 1 month OR a ‘test + treat’ approach for H. pylori
4. If Sx persist after either of the above approaches then the alternative approach should be tried

Question 6

Describe the test and treat approach for H.pylori

Answer 6

1. Initial dx: Carbon-13 urea breath test or stool antigen test, or laboratory-based serology
2. Triple therapy
3. Test of cure:
   No need to check for eradication if Sx have resolved following test + treat
   If repeat testing is required then a carbon-13 urea breath test should be used

Question 7

Describe triple therapy for eradication of H.pylori

Answer 7

PPI + Amoxicillin + (Clarithromycin OR Metronidazole)

If pen allergic: PPI + Metronidazole + Clarithromycin