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Dyspepsia & Peptic Ulcer Disease Chad Byworth. What is dyspepsia? A non-specific group of symptoms that relate to the upper GI tract: ●Epigastric pain.

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Presentation on theme: "Dyspepsia & Peptic Ulcer Disease Chad Byworth. What is dyspepsia? A non-specific group of symptoms that relate to the upper GI tract: ●Epigastric pain."— Presentation transcript:

1 Dyspepsia & Peptic Ulcer Disease Chad Byworth

2 What is dyspepsia? A non-specific group of symptoms that relate to the upper GI tract: ●Epigastric pain ●Feelings of bloating or fullness ●Heartburn Rome II Definition: “Dyspepsia refers to pain or discomfort centred in the upper abdomen.”

3 What can cause dyspepsia? ●Peptic ulcers ●GORD ●Non-ulcer dyspepsia ●Gastritis/duodenitis ●Gastric malignancy!

4 ALARM-Symptoms ALARMSALARMS nemia oss of weight norexia ecent onset of progressive symptoms asses & Melaena/haematemesis wallowing difficulty ALARMS or > 55 → Upper GI Endoscopy

5 Acid Secretion H+H+ K+K+ Cl - K+K+ Histamine (H2) GastrinAcetyl- choline Somato- statin PG-E2 Arachidonic Acid NSAIDs PPIs H2-R Antagonist

6 Peptic Ulcers Gastric UlcersDuodenal Ulcers -4 times more common Pain after eating, often relieved by antacids Epigastric pain relieved by eating H. Pylori (80%), smoking, NSAIDs, stress, delayed emptying H. Pylori (90%) & NSAIDs/aspirin/steroids

7 Management Dyspepsia > 55 or ALARM Symptoms = Endoscopy Stop drugs eg NSAIDs Lifestyle changes OTC Antacids Review after 4 weeks If no improvement: Test for H. Pylori Treatment to eradicate H. Pylori Review after 4 weeks If no improvement: Repeat test if + ive re-treat If - ive consider endoscopy PPI or H2-R antagonist treatment for 4 weeks + ive - ive NICE Guidance https://www.nice.org.uk/ guidance/cg184

8 13 C Breath Test Why do we use the 13 C Breath Test? Sensitivity Specificity 13 C Breath Test 95% 95% Stool antigen 95% 94% Serology 92% 83% Histology 95% 95% The 13 C breath test is the most likely test to give a true result - it has the highest sensitivity & specificity. Note that histological sample is as effective however because this is an invasive test (endoscopic procedure) it is not used first-line.


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