Dyspepsia & Peptic Ulcer Disease Chad Byworth

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.”

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

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

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

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

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 https://www.nice.org.uk/guidance/cg184

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 95% 95% Stool antigen 95% 94% Serology 92% 83% Histology 95% 95%