Dyspepsia
The ACG recommends testing for ____ in the initial evaluation of dyspepsia in a patient < 60 years with 1 alarm symptom.
What is H. Pylori Testing?
Name 2 Ways PPI can lead to anemia
What is decreased iron and B12 absorption?
What is the treatment for daily heartburn symptoms without alarm symptoms? (include duration)
When can GERD be managed surgically?
What is: PPI failure or with intolerable side effects, desire to stop medication, hiatal hernia
When patients are started on a PPI, how do you counsel them about the timing of taking the medication?
30-60 minutes before eating
Name 2 subtypes of functional dyspepsia
What are post prandial distress syndrome and epigastric pain syndrome?
What are common side effects of PPI that you should counsel patients on? (hint: these common side effects are not related to absorption)
What are headache, dyspepsia, diarrhea, constipation, bloating?
Provide 3 lifestyle modifications in the management of GERD
What is: weight loss, elevation of head, do not eat the last meal close to bedtime, avoid recumbency immediately after meals. Removal of certain foods may or may not be helpful.
What are three alarm symptoms with heartburn that would prompt evaluation with an EGD? (Must name at least 3 of 4)
What is: dysphagia, weight loss, food impaction, hematemesis, and melena?
What labs should you check on patients who are on a PPI? (Name 3)
What are creatinine, B12, magnesium, CBC, ferritin
Sallie is a 47 yo F with 2 months of epigastric pain associated with nausea. Her stool antigen test is negative for Hpylori. What is the next step in management?
What is an empiric PPI trial?
PPIs cause this type of kidney injury
What is AIN?
Which is the best for the treatment of GERD: esomeprazole, omeprazole, or pantoprazole?
What is non-inferiority?
PPIs vary based on their pharmacokinetics but overall are equally effective on equipotent doses. If patients are refractory on one PPI, it is reasonable to trial a different PPI.
After ___ years, patients with longstanding GERD (in the absence of other alarm symptoms) need evaluation with an EGD.
What is longstanding GERD of more than 5 years?
Maggies is a 50 year old female who has recently lost 30 lbs and wants to try to stop some of her medications as she feel her GERD has improved. She wants to stop her omeprazole that she takes 40 mg daily. What do you recommend?
A 30-year-old man is evaluated for epigastric pain that is more severe with eating and has progressively worsened over the past 6 months. He has diminished oral intake, as well as occasional nausea and diarrhea. Family history includes stomach cancer in his father. A Helicobacter pylori test is negative, and proton pump inhibitor therapy with omeprazole has been ineffective. His only other medication is loperamide.
On physical examination, vital signs are normal. BMI is 24. The abdomen is tender to palpation. No guarding is noted.
Upper endoscopy findings are normal, as are biopsy specimens obtained from the stomach (for H. pylori) and duodenum (for celiac disease). Omeprazole is discontinued. What is the next best step?
What is a TCA?
Question source: MKSAP 19 qBank
Experts believe the evidence for PPI side effects like osteoporosis, CKD, and dementia is weak because this type of study was conducted?
What are retrospective observational studies?
What are the three indications for lifelong PPI therapy? (Must answer all 3 correctly)
What is peptic stricture, Barretts esophagus, and significant esophagitis?
Susie has metaplasia without dysplasia on her histopathology from her EGD. When should she get her next EGD?
What is a surveillance endoscopy every 3-5 years?
A 35 y/o patient presents with relatively sudden onset heartburn and nausea and you want to test for H. pylori. They started OTC omeprazole 3 weeks ago. What do you recommend about testing for H. pylori in the setting of being on a PPI? How would you test in our clinic?
The yield for H. Pylori while on a PPI is low. PPI should be stopped for 2 weeks prior to testing. Test with H. pylori stool study. (We do not have urea breath testing at SIM)
FINAL JEOPARDY. Place a wager.
These two Australian pathologists identified H. Pylori as a cause of peptic ulcers by drinking H. Pylori broth.
(1/2 credit for 1 of 2 pathologists named)