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Questions and Answers
A patient presents with chronic epigastric pain and postprandial fullness. According to the provided information, which of the following additional criteria would classify these symptoms as Postprandial Distress Syndrome (PDS) based on the Rome IV criteria?
A patient presents with chronic epigastric pain and postprandial fullness. According to the provided information, which of the following additional criteria would classify these symptoms as Postprandial Distress Syndrome (PDS) based on the Rome IV criteria?
- Symptoms resolving with antacid use.
- Symptoms occurring at least once a month.
- Symptoms associated with documented weight loss.
- Symptoms occurring at least three times a week. (correct)
A patient is diagnosed with functional dyspepsia (FD) and reports symptoms of early satiety and postprandial fullness. Which dietary modification would be MOST appropriate as an initial step in managing their symptoms?
A patient is diagnosed with functional dyspepsia (FD) and reports symptoms of early satiety and postprandial fullness. Which dietary modification would be MOST appropriate as an initial step in managing their symptoms?
- Increasing intake of high-fiber foods.
- Consuming larger, less frequent meals.
- Adopting smaller, more frequent meals. (correct)
- Eliminating gluten from the diet.
A patient with dyspepsia is being evaluated to differentiate between functional and organic causes. Which of the following findings would be MOST indicative of organic dyspepsia?
A patient with dyspepsia is being evaluated to differentiate between functional and organic causes. Which of the following findings would be MOST indicative of organic dyspepsia?
- Structural abnormalities are identified during an endoscopic examination. (correct)
- Symptoms are intermittent and related to specific foods.
- Symptoms improve with dietary changes.
- Symptoms are associated with anxiety and stress.
Which of the following best describes the underlying mechanism of functional dyspepsia (FD)?
Which of the following best describes the underlying mechanism of functional dyspepsia (FD)?
A patient with persistent dyspepsia despite initial management is being considered for further investigations. Which of the following alarm symptoms, if present, would necessitate urgent upper endoscopy?
A patient with persistent dyspepsia despite initial management is being considered for further investigations. Which of the following alarm symptoms, if present, would necessitate urgent upper endoscopy?
A patient with dyspepsia is diagnosed with H. pylori infection. After successful eradication, the patient continues to experience dyspeptic symptoms. How should this condition be classified?
A patient with dyspepsia is diagnosed with H. pylori infection. After successful eradication, the patient continues to experience dyspeptic symptoms. How should this condition be classified?
A 45-year-old patient presents with new-onset dyspepsia. Which of the following is considered an alarm symptom requiring prompt investigation?
A 45-year-old patient presents with new-onset dyspepsia. Which of the following is considered an alarm symptom requiring prompt investigation?
Which of the following is a second-line pharmacological treatment option for functional dyspepsia?
Which of the following is a second-line pharmacological treatment option for functional dyspepsia?
In managing functional dyspepsia, which of the following best describes the role of establishing a strong doctor-patient relationship?
In managing functional dyspepsia, which of the following best describes the role of establishing a strong doctor-patient relationship?
Which class of medications includes examples such as amitriptyline, imipramine, and nortriptyline, sometimes used at low doses in the management of functional dyspepsia?
Which class of medications includes examples such as amitriptyline, imipramine, and nortriptyline, sometimes used at low doses in the management of functional dyspepsia?
According to the Rome IV criteria, what minimum duration of consistent symptom presentation is required to diagnose Mixed Postprandial Distress Syndrome (PDS)/Epigastric Pain Syndrome (EPS)?
According to the Rome IV criteria, what minimum duration of consistent symptom presentation is required to diagnose Mixed Postprandial Distress Syndrome (PDS)/Epigastric Pain Syndrome (EPS)?
A patient diagnosed with functional dyspepsia is found to have no organic pathology after thorough investigation. Which of the following factors is now considered central to the pathophysiology of their condition?
A patient diagnosed with functional dyspepsia is found to have no organic pathology after thorough investigation. Which of the following factors is now considered central to the pathophysiology of their condition?
A patient with suspected functional dyspepsia undergoes upper endoscopy, which reveals no structural abnormalities. However, biopsies are taken and reveal Helicobacter pylori infection. What is the MOST appropriate next step in managing this patient?
A patient with suspected functional dyspepsia undergoes upper endoscopy, which reveals no structural abnormalities. However, biopsies are taken and reveal Helicobacter pylori infection. What is the MOST appropriate next step in managing this patient?
A patient with functional dyspepsia who has not responded to dietary modifications and PPI therapy is being considered for neuromodulators. Which of the following factors would MOST strongly influence the choice against using a tricyclic antidepressant (TCA)?
A patient with functional dyspepsia who has not responded to dietary modifications and PPI therapy is being considered for neuromodulators. Which of the following factors would MOST strongly influence the choice against using a tricyclic antidepressant (TCA)?
A patient is diagnosed with Epigastric Pain Syndrome (EPS) subtype of functional dyspepsia. Which of the following best describes the frequency and characteristics of their predominant symptom, according to the Rome IV criteria?
A patient is diagnosed with Epigastric Pain Syndrome (EPS) subtype of functional dyspepsia. Which of the following best describes the frequency and characteristics of their predominant symptom, according to the Rome IV criteria?
A patient with long-standing dyspepsia presents with new-onset dysphagia. According to the algorithm for diagnosis and treatment, what is the MOST appropriate next step?
A patient with long-standing dyspepsia presents with new-onset dysphagia. According to the algorithm for diagnosis and treatment, what is the MOST appropriate next step?
A 30-year-old female who has been experiencing dyspeptic symptoms is diagnosed with functional dyspepsia. She expresses concern about the impact of her symptoms on her social life and work. What is the MOST crucial element in initially managing this patient?
A 30-year-old female who has been experiencing dyspeptic symptoms is diagnosed with functional dyspepsia. She expresses concern about the impact of her symptoms on her social life and work. What is the MOST crucial element in initially managing this patient?
A patient with refractory functional dyspepsia is being considered for treatment with a combination of flupenthixol and melitracen. What is the primary mechanism of action of this combination?
A patient with refractory functional dyspepsia is being considered for treatment with a combination of flupenthixol and melitracen. What is the primary mechanism of action of this combination?
Following an initial negative workup for dyspepsia, a patient is diagnosed with functional dyspepsia. Several months later, the patient reports the onset of unintentional weight loss. How should this new development influence the management plan?
Following an initial negative workup for dyspepsia, a patient is diagnosed with functional dyspepsia. Several months later, the patient reports the onset of unintentional weight loss. How should this new development influence the management plan?
A patient's dyspeptic symptoms improve 8 months post H. pylori eradication therapy. How should this condition be classified?
A patient's dyspeptic symptoms improve 8 months post H. pylori eradication therapy. How should this condition be classified?
Flashcards
Dyspepsia Definition
Dyspepsia Definition
Difficult digestion, characterized by pain or discomfort in the upper abdomen.
Functional Dyspepsia (FD)
Functional Dyspepsia (FD)
Disorder of gut-brain interaction; 10-40% in Western countries and 5–30% in Asia.
FD Diagnosis
FD Diagnosis
Exclusion of organic, systemic or metabolic diseases through routine investigations, including endoscopy.
Postprandial Distress Syndrome (PDS)
Postprandial Distress Syndrome (PDS)
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Epigastric Pain Syndrome (EPS)
Epigastric Pain Syndrome (EPS)
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Dyspepsia Diet Management
Dyspepsia Diet Management
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Alarm Symptoms
Alarm Symptoms
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Exclusion of Organic Diseases
Exclusion of Organic Diseases
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Description & reassurance/Diet and life-style instruction
Description & reassurance/Diet and life-style instruction
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H. pylori associated with dyspepsia
H. pylori associated with dyspepsia
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Organic Dyspepsia
Organic Dyspepsia
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Symptoms of Dyspepsia
Symptoms of Dyspepsia
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Alarm Features in Dyspepsia
Alarm Features in Dyspepsia
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Mixed PDS/EPS
Mixed PDS/EPS
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Acotiamide
Acotiamide
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Itopride
Itopride
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Clidinium/chlordiazepoxide
Clidinium/chlordiazepoxide
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Flupenthixol
Flupenthixol
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Study Notes
- Dyspepsia refers to difficult digestion, marked by pain or discomfort in the upper abdomen
- Pain or discomfort is identified as chronic or recurring epigastric pain, epigastric burning, postprandial fullness, early satiety, reflux symptoms, nausea, vomiting, or belching
- Prevalence of dyspepsia in the Western world is between 20% and 25%
Types of Dyspepsia
- Functional dyspepsia involves no structural abnormalities in the GI tract
- Organic dyspepsia involves structural abnormalities in the GI tract
Functional Dyspepsia (FD)
- Involves unidentified pathophysiological or microbiological abnormalities, as well as abnormal motor or sensory function, such altered gastric emptying, fundic dysaccommodation, or gastroduodenal hypersensitivity
- Defined as "disorder of gut-brain interaction (DGBI)"
- 10–40% in Western countries, 5–30% in Asia.
- FD diagnosis requires excluding organic, systemic, or metabolic diseases through investigations, including endoscopy
Types of FD (Rome IV classification)
- Postprandial Distress Syndrome (PDS) is characterized by early satiation or postprandial fullness, occurring at least 3 times a week, represents 67% of FD cases
- Epigastric Pain Syndrome (EPS) is characterized by epigastric pain or burning, at least once a week, represents 28% of FD cases
- Mixed PDS/EPS accounts for 12% of FD cases
- For diagnosis, symptoms must be present for 3 months, with onset at least 6 months prior
Alarm Symptoms & Signs of Dyspepsia
- Require urgent investigation, are any signs of chronic gastrointestinal bleeding, progressive unintentional weight loss, dysphagia, persistent vomiting, iron-deficiency anemia, epigastric mass, or lymphadenopathy
Investigations of Dyspepsia
- Involve exclusion of organic diseases through upper gastrointestinal endoscopy, ultrasound or CT scan of the abdomen and H. pylori testing
- Alarm feature investigations: complete blood counts, electrolytes, sugar and creatinine levels, thyroid and liver function tests, stool tests, colonoscopy, and ultrasound or CT scans
Management of Functional Dyspepsia
- Includes adopting mindful eating behaviors such as eating slowly and regularly, smaller, more frequent meals, avoiding high-fat meals, ultra-processed foods, spicy foods, carbonated drinks, alcohol, citric acid, caffeine
- Establishing a strong patient-physician relationship by obtaining the patient’s psychosocial background information
- Acid suppressants: H2 receptor antagonists (H2RAs) like Famotidine and proton pump inhibitors (PPIs) like Pantoprazole, or Potassium-competitive acid blockers (P CABs) like Vonoprazan
- Prokinetics like Acotiamide or Itopride
- Neuromodulators: Tricyclic antidepressants (TCAs) like amitriptyline, antipsychotics like sulpiride, Gabapentinoid and Mirtazapine
- Treatment for Refractory FD: Clidinium/chlordiazepoxide, Flupenthixol with melitracen, Gabapentin with PPIs, caraway oil with L-menthol and behavioral therapies
Algorithm for Diagnosing and Treating Functional Dyspepsia
- Interview to learn about blood tests, age, alarm signs, etc, check for organic disease
- If there is a reason to suspect organic disease, perform an endoscopy to find issues
- Where there are no issues explaining symptoms, test for H. pylori
- If there is no organic diseases involved, explanation/reassurance and diet and lifestyle instruction should be introduced
- If the H. pylori test is positive then curative therapy should be gives, if negative the process will continue
- If symptoms do not change and patient is H. pylori associated then they may have dyspepsia, where other diseases need to also considered
- If initial first line treatment shows no change, move onto second line treatment
- If the symptoms are reoccurring then diagnostic imaging is required to check for abnormalities
- If there are no more findings then a GI test to look at possible psychosocial factors
- If there is no change in symptoms, the use of psychotherapy may be beneficial
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