Dyspepsia, reflux, and Helicobacter pylori — KFP-style written assessment

KFP 1 (10 marks)

A 47-year-old woman presents with three months of epigastric pain and early satiation. She has no dysphagia, no vomiting, no bleeding, normal blood count, and is not on NSAIDs. Her sister recently had gastric cancer diagnosed at 60. ^[3]

1. List the alarm features that would have mandated urgent endoscopy regardless of age. (4) ^[1]
2. In her case, what is the recommended pathway and which tests are acceptable? (3) ^[1]
3. What does the endoscopy literature predict she would find if scoped — quote the prevalence data. (3) ^[3]

Model answers

1. Dysphagia; persistent vomiting; GI bleeding or iron-deficiency anaemia; unintentional weight loss; epigastric mass; new or worsening symptoms despite treatment. New dyspepsia at 55+ with anaemia, raised platelets, nausea/vomiting, weight loss or family history of upper GI cancer also warrants endoscopy. ^[1]
2. Under 60 without alarm features: test-and-treat. Urea breath test (pooled sensitivity 0.96, specificity 0.93) or monoclonal stool antigen test (sensitivity 0.94, specificity 0.97); serology alone is unacceptable because it cannot distinguish active from past infection. Stop PPIs two weeks before testing. ^{[1] [4]}
3. More than 85% of endoscopies in uninvestigated community dyspepsia are completely normal; erosive oesophagitis is the most common abnormality (pooled prevalence 11.0%), peptic ulcer next (4.4%); gastro-oesophageal cancer is rare (below 0.4%) and equally prevalent with and without dyspepsia. ^[3]