Dyspepsia

17.10.05

Symptoms:
• Epigastric discomfort.
• Anorexia.
• Retrosternal pain.
• Nausea.
• Vomiting.
• Fullness.
• Early satiety.
• Heartburn.

Aetiology:
• GORD - 15-25%.
• Ulcers - 15-25%.
• Stomach cancer - 2%.
• NUD - 60%.

Alarm signs:
• Anorexia.
• Loss of weight.
• Anaemia.
• Rapid progression.
• Malaena.
• Dysphagia/odynophagia.

Treating dyspepsia
Antacids:
• Weak alkalis.
• Relieve symptoms.
• Increase gastric emptying (short action).
• Heal ulcers at high doses.

Histamine H2 antagonists: block action of histamine.

H+ pump inhibitors:
• Inhibit H+/K+ ATPase H+ pump.
• Decrease acid secretion (blocks H+ transport)
• Irreversible inhibition of enzyme.
• Promotes ulcer healing (including refractory - Zollinger Ellison).

Antibiotics:
• Chronic H. pylori gastritis.
• Increased gastrin release.
• Strongly associated with peptic ulcer disease (especially duodenal ulcers).
• Recurs despite treatment if not eradicated.

Mucosal protection:
• Coats base of ulcer craters.
• Must be given on empty stomach.
• Bismuth, sucralfate.
• Only administered to unconscious