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home - Stomach - Clinical Presentations of Gastric Conditions - Dyspepsia Guidelines Written by Dr Sebastian Zeki
Nausea and Vomiting:
Understands the pathophysiology of vomiting.
Appreciates the gastrointestinal conditions that cause nausea and
vomiting as well as the range of extra-intestinal causes

Recognises the influence of neurological conditions and metabolic
derangements such as diabetes

Understands the physiology of gastric emptying and how this is
affected by disease, toxins and drugs

Abdominal Pain:
Knows the causes of acute and chronic abdominal pain that arise
from upper gastrointestinal, biliary and pancreatic diseases

Understands the clinical presentations of the various conditions
causing pain and the means by which they can be diagnosed and
treated

Weight Loss:
Knows the significance of weight loss as a consequence of upper
gastrointestinal disease, knows those conditions that present with
loss of weight and how they are managed

Skills
Makes a detailed clinical assessment of patients presenting with
symptoms indicating possible upper gastrointestinal disease,
construct a management plan and be aware of the various avenues
of treatment

Behaviours
Evaluates patients in a structured and timely manner, carries out
appropriate investigations and formulates management plan.

Dyspepsia Guidelines

Dyspepsia Causes: Peptic ulcer disease. Gastritis/duodenitis. GORD. Other causes of epigastric pain apart from GI. Functional dyspepsia. Indications for refer-ral of dyspepsia:Alarm symptoms.More than 55 with dyspepsia - recent onset/persistent symptoms/ unexplained.Any age if no response despite test and treat/full dose PPI for one month/ maintenance PPI or prn PPI or H2 antagonists. Rome criteria types:Ulcer-like dyspepsia (burning epigastric pain, treatment: PPI).Dysmotility-like dyspepsia (nausea/satiety, upper abdominal pain, treatment: Domperidone/Hyoscine.Unspecified dyspepsia. Treatments - PPI. Proposed mechanisms:Gastric motor function (delayed emptying in 30%/ increased in 10%/ less gastric compliance in 40%).Visceral sensitivity.Helicobacter pylori infection (although NNT=17).Psychosocial factors. Treatments for functional dyspepsia: Dietary and psychosocial advice as needed. Trial of acid suppression for 4-8 weeks (works in reflux-like symptoms) if not improving with lifestyle advice. H. pylori eradication- benefits only a minority of patients (number needed to treat around 17). Low dose antidepressant eg. amitriptylline if fail PPI. Prokinetics-for 4 weeks. Rome criteria: One or more of Bothersome postprandial fullness/Early satiation /Epigastric pain /Epigastric burning. No organic disease. No IBS. Criteria should be fulfilled for the last 3 m with symptom onset >6m before diagnosis. Theories of Aetiology:Postinfectious aetiology —As in IBS.Duodenal eosinophilia — Spuriously connected.Psychosocial factors — Such as anxiety, somatization, neuroticism, and depression are increased in this group compared with healthy controls.There is a link between self-reported childhood abuse and functional gastrointestinal disorders. Functional Dyspepsia Written by Dr Sebastian Zeki

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