PP4 DYSPEPSIA, H. PYLORI, GASTRITIS, PUD, GASTROPARESIS| TOP SCORES MADE SIMPLE | TRUSTED TEST SOLUTIONS!

PP4 DYSPEPSIA, H. PYLORI, GASTRITIS, PUD,
GASTROPARESIS| TOP SCORES MADE SIMPLE | TRUSTED
TEST SOLUTIONS!
Dyspepsia is a symptom complex characterized by Answer: •postprandial fullness,
early satiety, epigastric pain, and/or epigastric burning

Organic dyspepsia refers to symptoms attributable to Answer: an identifiable structural,
inflammatory, or biochemical abnormality.

most common causes of dyspepsia Answer: •Peptic ulcer disease (gastric or
duodenal), often related to Helicobacter pylori infection or NSAID use

•Helicobacter pylori–associated gastritis

•Gastroesophageal reflux disease (GERD), which may overlap symptomatically with
dyspepsia

•Pancreaticobiliary disorders, including chronic pancreatitis, pancreatic cancer, or biliary
tract disease

•Medication-related mucosal injury, most commonly from nonsteroidal anti-inflammatory
drugs (NSAIDs)

•Upper gastrointestinal malignancies, particularly gastric and esophageal cancer
sx of dyspepsia include Answer: •Postprandial fullness

•Early satiety (inability to finish a normal sized meal)

•Epigastric pain / discomfort or burning

•Abdominal discomfort of dyspepsia often associated with belching, nausea and/or
bloating; occurs around food intake

alarm features in dyspepsia Answer: unintentional wt loss, dysphagia, odynophagia,
unexplained iron deficiency anemia, persistent vomiting, palpable mass or
lymphadenopathy, family hx of upper GI cancer

dyspepsia PE Answer: •Often normal, may have mild epigastric tenderness to palpation

dyspepsia abnormal PE findings suggestive of organic pathology include: Answer:
•Significant abdominal tenderness or a palpable abdominal mass
•Lymphadenopathy

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,•Bruit, suggesting vascular pathology

•Ascites, which may indicate malignancy or advanced liver disease

•Succussion splash

- Performed by auscultating the abdomen while gently shaking or tapping the
epigastrium

- A positive splash heard several hours after eating is concerning for gastric outlet
obstruction

•Skin: jaundice (hepatobiliary or pancreatic disease), pallor (suggesting anemia)

Functional Dyspepsia
Rome IV diagnostic criteria sx include one or more of the following:

sx requirements: Answer: •Symptoms must include one or more of the following :

•Postprandial fullness

•Early satiety

•Epigastric pain

•Epigastric burning

Symptom Requirements
•Symptoms present for the last 3 months

•Symptom onset ≥6 months before diagnosis

•No evidence of structural disease (including at upper endoscopy if indicated) that
explains the symptoms

functional dyspepsia diagnosis key points Answer: •Nausea, bloating, and belching
may be present but are not required for diagnosis

•Heartburn-dominant symptoms suggest GERD, not functional dyspepsia

•Functional dyspepsia is a diagnosis of exclusion

dyspepsia lab testing Answer: •Complete blood count

- If anemia noted on CBC à obtain iron studies, folate, vitamin B12 to assess source of
anemia

•Comprehensive metabolic panel (CMP)
- Assess liver enzymes

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, - Assess electrolytes and renal function

•+/- Lipase/amylase

•+/- Hemoglobin A1C (or other testing for diabetes mellitus)

H. pylori testing Answer: •All patients with dyspepsia regardless of age need testing,
if positive needs treatment

•If performing EGD, H. pylori should be tested via taking biopsies during upper
endoscopy (via Sydney protocol)

•If not performing EGD, H. pylori testing can be done via urea breath test or stool
antigen test

•Serology is NOT used as has a low positive predictive value

dyspepsia indications for EGD

pts >/= 60yo Answer: •Upper endoscopy (EGD) with biopsy is recommended for new-
onset dyspepsia

•Perform H. pylori testing at time of endoscopy via biopsy
dyspepsia indications for EGD

pts <60yo Answer: •Proceed with upper endoscopy if any of the following are present:

•Clinically significant weight loss

•Overt GI bleeding

•Rapidly progressive alarm features

•2 or more alarm features

functional dyspepsia first line tx Answer: •Exclusion of organic disease (done in work-
up)

•First-line therapy: acid suppression

•Initiate a proton pump inhibitor (PPI) at a standard dose
•Trial duration: 4–8 weeks

•Most effective for epigastric pain/burning–predominant symptoms

functional dyspepsia second line tx Answer: •Second-line therapy: Neuromodulators

•If symptoms persist after an adequate PPI trial:
•Discontinue PPI

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