Your next patient in clinic is a 38-year old man who has been referred by his GP with treatment-resistant dyspepsia.
He tells you that for the last 6 months he has been experiencing a burning sensation in the upper abdomen, bloating, and belching which occurs mainly after eating and can last up to an hour. He finds that Omeprazole 20mg helps with his symptoms, but as soon as he stops taking this, his symptoms return.
He does not experience acid reflux, vomiting, and has not lost any weight.
He is a computer programmer, and his job is quite sedentary. His diet is varied, but he admits that it could be healthier, and he is trying to cut back on his alcohol intake – he currently drinks around 20 units per week (mainly ale). He does not smoke. His BMI is 26. He does not take any regular or irregular medications. He has struggled with low mood for some time and has received some psychological therapy for this over the last couple of years.
His GP has been struggling to manage his symptoms. Investigations to date include bloods (all normal). He and his GP wonder if an endoscopy might be helpful. The patient is worried about his symptoms, and although he has no family history of gastric cancer, he worries about this. He also wants to know what is causing his symptoms and worries about taking medication long-term.
Black, C.J., Paine, P.A., Agrawal, A., Aziz, I., Eugenicos, M.P., Houghton, L.A., Hungin, P., Overshott, R., Vasant, D.H., Rudd, S. and Winning, R.C., 2022. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut, 71(9), pp.1697-1723.
NICE 2014 Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Available at https://www.nice.org.uk/guidance/cg184/resources/gastrooesophageal-reflux-disease-and-dyspepsia-in-adults-investigation-and-management-pdf-35109812699845
NICE 2018 Oesophago-gastric cancer: assessment and management in adults. Available at https://www.nice.org.uk/guidance/ng83/resources/oesophagogastric-cancer-assessment-and-management-in-adults-pdf-1837693014469
PHE (Public Health England), 2017 Test and treat for H.Pylori in dyspepsia, available at https://www.gov.uk/government/publications/helicobacter-pylori-diagnosis-and-treatment
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Which tests would be helpful to carry out in primary care in this patient prior to referral?CorrectIncorrect
Which of the following tests should not be used first line in the community to assess for Helicobacter pylori infection?CorrectIncorrect
How many weeks should you leave between completing a course of antibiotics and testing for H Pylori?CorrectIncorrect
On reviewing the clinical system further, you note that he has been tested for H Pylori, and this has come back as negative.
At this stage, the patient asks if he will have an endoscopy. How do you respond?CorrectIncorrect
Roughly what proportion of endoscopies carried out for patients with dyspepsia are normal (ie. no organic pathology found)?CorrectIncorrect
The Rome IV criteria recognises to main categories of dyspepsia. These are (tick all that apply):CorrectIncorrect
Having discussed with the patient what functional dyspepsia is, and explored lifestyle factors he could address (such as stress management, increasing activity levels, and maintaining a healthy, varied diet) you discuss medications. Which of the following drugs would you use first-line in someone with dyspepsia (tick all that apply)?CorrectIncorrect
This patient has been using PPIs intermittently and is finding that they are only partially effective. Which of the following would be considered 2nd line interventions (tick all that apply)?CorrectIncorrect