GERD
These three lifestyle factors are strongly associated with GERD and should be addressed.
What is smoking, obesity, large meals, late-night meals, exercise after eating, fried/fatty foods, alcohol or caffeine?
A practical definition of dyspepsia per the 2017 ACG guidelines includes epigastric pain lasting for at least this long.
What is >1mo?
This is the world-wide prevalence of H.pylori.
What is 50%?
The standard pharmacologic therapy for functional dyspepsia (h.pylori neg).
What is PPI trial for 6-8 wks?
H.pylori testing should be performed in these patients.
What is all patients with dyspepsia symptoms?
PPIs should be continued indefinitely in GERD patients with this grade of esophagitis even if repeat EGD is normal.
What is LA Grade C or D esophagitis?
The most important risk factor for gastric cancer in dyspeptic patients.
What is H.pylori infection?
Besides gastritis, H.pylori is associated with this disease.
What is gastric adenocarcinoma (OR=2.5-49) or MALT (mucosa associated lymphoma)?
Three reasons to avoid long-term PPI therapy unless indicated.
What are risk of CKD, osteoporosis, c.difficile, pneumonia, or B12 deficiency
This symptom helps to differentiate dyspepsia from GERD.
What is epigastric pain versus heartburn/regurgitation?
These three medication classes can worsen GERD symptoms.
What are NSAIDS, anticholinergics, calcium channel blockers, nitrates, and progesterone?
Name at least 3 alarm symptoms in dyspepsia.
What are weight loss, GI bleeding, Anemia (Fe deficiency), dysphagia, anorexia/early satiety?
These are two causes of false-negative urea breath tests.
What are recent PPI use or recent abx/bismuth use (2wks)?
These symptoms of dyspepsia do not typically respond to PPI therapy.
What are dysmotility symptoms (fullness, nausea, bloating)?
A basic workup for dyspepsia should includes these 3 tests after age 60.
What is H.pylori testing, CBC, and EGD?
Barrett's screening should be performed if reflux symptoms have been present for this long.
These two conditions are strongly associated with functional dyspepsia.
What is GERD (50%) and IBS (35%)?
Because h.pylori is a group 1 carcinogen, eradication should be proven with this test.
What is a noninvasive h.pylori test, preferably the same test as used for diagnosis (Urea Breath Test or PCR-based stool antigen)?
Name the four components of bismuth quadruple therapy.
What are Metronidazole, Tetracycline, Bismuth, PPI?
If alarm symptoms are present and the EGD is unrevealing, this test should be performed in patients with dyspepsia.
What is a CT abd?
The next pharmacologic step if moderate-severe GERD fails to respond to initial PPI therapy.
What is doubling the PPI dose or switching to another PPI and reassessing in 4wks?
ROME IV criteria for functional dyspepsia specify these symptoms and findings must be present for at least 3mo with symptoms beginning at least 6mo ago.
What are bothersome postprandial fullness, early satiation, epigastric pain or burning, and no structural disease to explain the symptoms?
Barry Marshall bucked the "science" in the 1980s doing this to prove h.pylori caused gastritis, resulting in a Nobel Prize.
What is self-ingesting h.pylori broth?
Name two treatments for dyspepsia that is unresponsive to PPI therapy.
What is tricyclic (amitriptyline NNT=6), prokinetic (reglan), buspar, Iberogast, or CBT?
The presence of this finding on physical exam may suggest malignancy in a dyspeptic patient.
What is Virchow's node?