Quick Reference
DDx:
Diagnostics:
>50 or w/ alarm sx = EGD (w/ biopsy and rapid urease)
<50 = Hy. Pylori test and treat (urea breath test)
Stop NSAIDs
Use PPI 6-8 weeks
Quadruple Therapy (10-14 Days)
- PPI
- Metronidazole
- Tetracycline
- Bismuth Subsalicylate
Alarm Features in Dyspepsia
| Age >55 with new onset symptoms |
| Family history of upper GI malignancy |
| Early satiety |
| Unintended weight loss |
| Previously documented ulcer |
| GI bleeding or iron deficiency anemia |
| Progressive dysphasia |
| Odynophagia |
| Persistent vomiting |
| Palpable mass or adenopathy |
pathophysiology
- Defects in mucosal lining of stomach or duodenum → formation of ulcers
- MC: H. pylori = gram negative
- → Bacteria use their flagella to burrow through mucosal layer to find a less acidic environment
- releases urease ⇒ converts urea to ammonia ⇒ increase local pH for survival
- release toxins:
- CagA → disrupts epithelial cell junctions, causing inflammation, gastritis, and increased HCl production by stimulating gastrin release.
- VacA induces epithelial cell death, exposing the mucosal layer to acid
- NSAIDs:
- becomes weak acid in stomach ⇒ physical epithelial cell injury
- inhibits COX-1 → inhibits prostaglandin production → decreased protective mechanisms of gastric mucosa
- MC: H. pylori = gram negative
- Risk Factors:
- NSAIDs use
- Alcohol
- Smoking
- H. pylori
- → 95% of duodenal ulcer
- → 70% of gastric ulcers
clinical features
~70% are asymptomatic
Epigastric pain
→ gnawing, dull, empty, hunger-like
→ can radiate to RUQ or LUQ
Gastric ulcer
- Eating → exacerbate pain
- +/- weight loss
- Nausea
- Anorexia
Duodenal ulcer
- Eating → alleviates pain
-
- +/- weight gain
-
- Can return 2-4 hrs after meal
Alarm sx:
- Melena
- Hematemesis
- Hemoccult pos+ stools
- Unexplained Anemia
- Persistent vomiting
- Early satiety
- Radiation to the back
Complications:
- Bleeding
- Perforation
- Gastric outlet obstruction
- Gastric cancer