risk factors, presentation, diagnosis of the peptic ulcer spectrum, investigation and current management

1. DYSPEPSIA, UPPER GI ULCERS,
UPPER GI PATHOLOGY
Dr Makanga
Sunday, November 13, 2022

2. Presentation
• Bloating
• Dysphagia
• Odynophagia
• Retrosternal pain (heart burn)
• Epigastric pain
• Postprandial pain
• Vomiting
• Hematemesis

3. Differentials
• Peptic ulcer disease
– Gastritis
– GU/DU
– GERD
• Cholecystitis
• Food poisoning, gastroenteritis
• Upper GI malignancy
– Esophagus
– Stomach
– Pancreas
• Upper GI bleeding (ulcer vs varices)
• Conversion syndrome
• Non-UGI disease e.g. chest, heart, kidney disease

4. Elementaita Percentage Nairobi Percentage P value
Normal 1058 37% 1023 34%
Gastritis 962 33% 598 20%
Esophagitis/GERD 64 2% 73 2.4%
Duodenitis 56 1.9% 88 2.7%
Duodenal ulcer 280 9.5% 314 9.8%
Gastric ulcer 54 1.9% 258 8.5%
G.O.O 53 1.8% 35 1.2%
Esophageal tumor 125 4.3% 217 7.1%
Gastric tumor 56 1.9% 42 1.4%
G.E.J tumor 39 1.4% 28 0.9%
Esophageal
candidiasis
75 2.6% 88 2.9%
Hiatus hernia 15 0.5% 156 5%
Esophageal varices 19 0.66% 63 2%
Other 38 1.3% 71 2.3%

5. Our approach
• History and exam
– Is it GI disease? Or disease elsewhere?
– How serious?
– Is it malignancy?

6. • Lab tests
– Blood count
– H pylori
– Malaria
– HIV test
– Urine and stool
– LFTs

7. Our approach
• OGD
– Ensure 6 hour starvation
– Kids may require sedation
• Radiology
– Abdominal U/S
– CXR
– ECG

11. Treatment
• PUD
– Triple therapy (PPI, Amoxil, Flagyl)
• Non-ulcerative peptic disorder
– Antacid, low dose PPI
• Refer to surgeon if you suspect/confirm
– Malignancy
– Gall bladder disease
– Gastric outlet obstruction
– Active GI bleeding

12. Treatment 2
• Refer to physician if you suspect/confirm
– Cardiac/renal/liver disease
– HIV related opportunistic disease
• Kaposis
• Candidiasis

13. Thank you