Dyspepsia-collection of diseases.

- Symptoms:
o Chest pain
o Heart burn
o Nausea
o Gastric reflux
o Vomiting
o Upper ab pain/discomfort
- Epidemiology

Patho

- Defensive
o Hiatal hernia- increases risk of GORD
o Diminished ablity of esophagus to clear the contents- higher risk
- Aggressive
o More acidic stomach = more problesm
o Stomach clearing delayed

Intial treatment

- Eating habits (coffee,)

- Have a diary and to see what causes the problem
- Smaller meals and not eating before going to bed
- Elevate head of the bed
- Loose clothing might help

Antacids

- Reacts with protons in the stomach to neutralize stomach acid

Alginates

- Sodium alginate
o Increases viscosity of stomach contents
o Forms a top/raft on the stomach contents

Histamine 2 recpetor antagonist

- Ranitidine, cimetidine
- Antagonize to H2 receptor. When histamine binds to it, atp converts to camp, drives the H-
pump which pumps protons into the stomach.

When to refer to gp

- Severe or resistant to OTC

- Over 55
- Dysphagia
- Unexplained weightloss
 - Jaundice
- Melaena
- Haematemesis

Further investigations

- Cancer -> endoscopy

- Trial of med: H2Rblocker or PPI
- Need to stop treatment 2 weeks before endoscopy

Grades of esophagitis

PPI

- Works directly on the pump = less acid pumped into the stomach

Failure to respond to PPI

- WHY? Are they actually taking it the way its supposed to be taken
- Bile reflux
- Hypersensitivity

Adherence

- 60-70% take ppis properly

Other invesitgatonis

- Oesophageal oh monitoring
- OesophageaL MANOMETRY
- BARIUM SWALLOW

Surgery for GORD

- If ppis not tolerated, not effective

Laparoscopic nissen

- Tie lower end to the upper end of the esophagus

Peptic ulcer disease

- Can be duodenal or gastric

- Etiology is the same as GORD

H. Pylori

- gram- bacteria.
- increases the risk of GI cancers
- ABLE to survive in the stomach.
o Burrows down into the mucous layer and then it produces ureases to make urea and
CO2.
 o Causes damage to the mucous layer. Acid in contact with the lining of the stomach =
ulcers, cancers
- H.pulori testing
o Urea breath test
o Stool antigen test
o Lab-based serology

Pylori eradication

- Triple therapy
o Lanso
o Claritthro
o Amoxi

Functional dyspepsia

- The collection of the symptoms but no underlying disease.

- Syndrome, no structural abnormalities.
- Treatment: lifestyle changes