0. Dyspepsia & Peptic Ulcer Disease
Chad Byworth

1. 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.”

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

3. ALARM-Symptoms → Upper GI Endoscopy A L A R M S nemia oss of weight
ALARMS or > 55
→ Upper GI Endoscopy
oss of weight
norexia
ecent onset of progressive symptoms
asses & Melaena/haematemesis
wallowing difficulty

4. Acid Secretion Cl- K+ H+ K+ PG-E2 Somato- statin Acetyl- choline
Arachidonic
Acid
PPIs K+
NSAIDs
PG-E2
Somato-
statin
H2-R Antagonist
Acetyl-
choline
Histamine (H2)
Gastrin

5. Peptic Ulcers Gastric Ulcers Duodenal 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

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

7. Sensitivity Specificity
13C Breath Test
The 13C 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.
Why do we use the
13C Breath Test?
Sensitivity Specificity
13C Breath Test % %
Stool antigen % %
Serology % %
Histology % %