dyspepsia

Question 1

symptoms include

Answer 1

• upper abdominal pain or discomfort
• heartburn
• gastric reflux
• bloating
• n/v

Question 2

what is it?

Answer 2

• range of upper GI symptoms, typically present for 4 weeks or more

Question 3

Symptoms may be attributed to underlying cause e.g.

Answer 3

• GORD
• peptic ulcer disease
• gastro-oesophageal malignancy
• SE from drugs e.g. NSAIDs, bisphosphonates, CCs, aspirin, ACs etc

Question 4

What is functional dyspepsia

Answer 4

• endoscopy normal
• underlying cause cannot be identified

Question 5

Most patients have which type of dyspepsia?

Answer 5

functional (normal endoscopy, unknown underlying cause)

Question 6

What is uninvestigated dyspepsia

Answer 6

symptoms in pt who have not had an endoscopy

Question 7

dyspepsia symptoms in pregnancy are commonly due to…

Answer 7

GORD

Question 8

lifestyle measures that can improve symptoms

Answer 8

• healthy eating, weight loss if appropriate
• avoid trigger foods
• eat smaller meals
• evening meal 3-4h before bed
• raise head of bed
• smoking cessation
• reduce alcohol
• assess for stress, anxiety, depression as these can exacerbate symptoms

Question 9

urgent endoscopy required in the following

Answer 9

• dysphagia
• significant acute GI bleed
• 55 and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia

Question 10

drugs that can cause dyspepsia and should be reviewed - use lowest effective dose and if possible stop

Answer 10

• alpha blockers (doxazosin, tamsulosin, alfuzosin)
• antimuscarinics (oxybutynin, atropina, trospium, solifenacin, tolterodine)
• aspirin
• BZDPNs, diazepam, lorazepam, clonazepam
• BBs e.g. propranolol atenolol, bisoprolol
• bisphosphonates e.g. alendronate, risedronate
• CCBs
• CCs
• Nitrates e.g. isosorbide mononitrate, GTN
• TCAs e.g. amitriptyline, nortriptylline
• NSAIDs

Question 11

what can be used for short term control of symptoms

Answer 11

• acids and/or alginates can be used for short term symptom control
• long term, continuous use not recommended

Question 12

initial management - uninvestigated dyspepsia

Answer 12

• PPI 4 weeks
• Pt with dyspepsia should be tested for H pylori infection and treated if positive
• If high risk for H pylori, test first, or in parallel with course of PPI

Question 13

initial management - functional dyspepsia

Answer 13

• test and treat for H pylori if positive
• if not infected by H pylori, give PPI or H2RA for 4 weeks

Question 14

Follow up management for uninvestigated and functional dyspepsia

Answer 14

• for pt with refractory dyspepsia symptoms, new alarm symptoms should be assessed and alternative diagnosis should be considered
• check pt adherence to initial management
• reinforce lifestyle advice
• if symptoms persist or recover following initial management, give PPI/H2RA at lowest dose needed to control symptoms, or as prn treatment

Question 15

follow up management: uninvestigated dyspepsia taking NSAID and unable to stop drug

Answer 15

• consider reducing NSAID dose and using long term GI protection with acid suppression therapy or switching to alternative to NSAID e.g. paracetamol or COX-2 inhibitor

Question 16

follow up management: uninvestigated dyspepsia taking aspirin and unable to stop drug

Answer 16

consider switching to alternative anti platelet e.g. ticagrelor, prasugrel

Question 17

Do patients treated with H pylori eradication therapy need routine retesting

Answer 17

No
but may be appropriate to retest in specific situations
if retesting positive, prescribe 2nd line eradication therapy

Question 18

How often should pt with dyspepsia be reviewed to assess symptoms and treatment

Answer 18

annually

Question 19

Refer to specialist for further investigations should occur in pt

Answer 19

• of any age with gastroesophageal symptoms that are unexplained or non-responsive to treatment
• in pt with H pylori infection that has not responded to 2nd line eradication therapy