Study guide
Upper Gastrointestinal Disorders: Dyspepsia, GERD, PUD & H. pylori
AANPCB Adult-Gerontology Primary Care Nurse Practitioner A-GNP
Track your progress as you read
Finished sections get a check mark.
1 Exam Structure, APRN Foundations & Geriatric Assessment
A-GNP Exam Logistics, Blueprint & Scoring Structure APRN Scope of Practice, Consensus Model & Interprofessional Collaboration Comprehensive Health History & Subjective Assessment Across Adult Lifespan Comprehensive Physical Examination & Clinical Assessment Skills
2 Health Assessment, Diagnostic Reasoning & Clinical Procedures
Diagnostic Reasoning, Test Interpretation & Clinical Decision-Making Screening Guidelines & Evidence-Based Health Promotion (USPSTF) Comprehensive Geriatric Assessment (CGA), Frailty & Function In-Office Clinical Procedures, ECG Interpretation & Minor Surgical Skills
3 Cardiovascular & Peripheral Vascular Disorders
Essential Hypertension & Hypertensive Urgency/Emergency Management Coronary Artery Disease, Acute Coronary Syndromes & Post-MI Care Heart Failure (HFrEF & HFpEF) Diagnosis, Staging & 4-Pillar GDMT Arrhythmias (Atrial Fibrillation), Valvular Heart Disease & PAD
4 Respiratory, HEENT & Dermatological Disorders
Asthma Management across the Adult Lifespan (GINA Guidelines) Chronic Obstructive Pulmonary Disease (COPD) Staging & Management (GOLD Guidelines) Community-Acquired Pneumonia & Lower Respiratory Tract Infections Common HEENT Disorders: Otitis, Sinusitis, Pharyngitis, Glaucoma & Macular Degeneration
5 Endocrine, Metabolic & Renal/Genitourinary Disorders
Type 2 Diabetes Mellitus Management Thyroid Disorders: Hypothyroidism, Hyperthyroidism & Subclinical Disease Chronic Kidney Disease (CKD) Staging & Diabetic/Hypertensive Nephropathy Genitourinary Disorders: BPH, Urinary Incontinence, UTIs & Prostatitis
6 Gastrointestinal, Hematologic & Immunologic Disorders
Upper Gastrointestinal Disorders: Dyspepsia, GERD, PUD & H. pylori Lower Gastrointestinal Disorders: IBS, IBD, Diverticulitis & Colorectal Screening Liver, Biliary & Pancreatic Disorders: NAFLD/MASLD, Cirrhosis & Cholecystitis Hematologic & Immunologic Disorders: Anemias, Anticoagulation & Immunizations
7 Neurological, Cognitive & Psychiatric Disorders
Cognitive Assessment: Delirium, Dementia & Mild Cognitive Impairment Neurological Disorders: Stroke, TIA, Parkinson's Disease & Headache Syndromes Major Depressive Disorder & Anxiety Disorders in Adults & Older Adults Sleep Disorders, Insomnia & Restless Legs Syndrome
8 Geriatric Syndromes, Polypharmacy & Deprescribing
The Beers Criteria & STOPP/START Criteria for Potentially Inappropriate Medication Use Polypharmacy Management, Pharmacokinetics/Pharmacodynamics in Aging & Deprescribing Protocols Fall Risk Assessment (CDC STEADI), Gait/Balance & Mobility Impairments Pressure Injury Prevention/Staging, Urinary/Fecal Incontinence & Frailty Assessment
9 APRN Professional Practice, Ethics, Quality & Healthcare Policy
Musculoskeletal Disorders: Osteoarthritis, Osteoporosis, Gout & Back Pain Dermatological Disorders: Lesions, Skin Cancers, Infections & Rash Evaluation Palliative Care, Advance Care Planning, Pain Management & End-of-Life APRN Professional Practice, Quality Improvement, Ethics & Healthcare Policy
Upper Gastrointestinal Disorders: Dyspepsia, GERD, PUD & H. pylori
Key Takeaways Explain This Topic AI
Alarm features in upper GI symptoms (dysphagia, odynophagia, weight loss, anemia, hematemesis, persistent vomiting) mandate prompt esophagogastroduodenoscopy (EGD) rather than empiric trial therapy.
Uncomplicated GERD in patients under age 60 without red flags is initially managed with an 8-week trial of once-daily Proton Pump Inhibitor (PPI) therapy taken 30-60 minutes before breakfast.
Beers Criteria (2023) advises against PPI therapy beyond 8 weeks without a high-risk indication due to documented risks of C. difficile colitis, hip/spine fractures, hypomagnesemia, acute interstitial nephritis, and B12 deficiency.
Gastric ulcer pain classicly worsens immediately after food intake, while duodenal ulcer pain improves with food or antacids and recurs 2 to 5 hours postprandial or awakens the patient between 1 AM and 3 AM.
First-line empirical treatment for H. pylori eradication is 14-day Bismuth Quadruple Therapy; PPIs must be discontinued for 2 weeks and antibiotics/bismuth for 4 weeks prior to urea breath or stool antigen testing.
Last updated: July 2026
- Upper Gastrointestinal Disorders: Dyspepsia, GERD, PUD & H. pylori
- Dyspepsia & Clinical Evaluation
Dyspepsia is defined as epigastric pain or burning lasting at least 1 month, accompanied by postprandial fullness, early satiety, epigastric bloating, belching, or nausea. Clinical evaluation distinguishes functional (non-ulcer) dyspepsia from organic dyspepsia (peptic ulcer disease [PUD], GERD, gastric malignancy, medication toxicity).
Under Rome IV criteria, functional dyspepsia is subtyped into Epigastric Pain Syndrome and Postprandial Distress Syndrome. Joint American College of Gastroenterology (ACG) and Canadian Association of Gastroenterology guidelines establish diagnostic cutoffs:
Patients Aged >= 60 Years : New-onset dyspepsia requires prompt diagnostic esophagogastroduodenoscopy (EGD) to exclude upper gastrointestinal malignancy.
Patients Aged < 60 Years : In patients under age 60 without alarm features, non-invasive testing for Helicobacter pylori (stool antigen test or urea breath test) is recommended. If positive, eradication therapy is administered. If negative, an empiric 4- to 8-week PPI trial is initiated.
Gastroesophageal Reflux Disease (GERD)
GERD involves retrograde movement of gastric contents into the esophagus due to lower esophageal sphincter (LES) incompetence, transient LES relaxations, elevated intra-abdominal pressure, hiatal hernia, or smooth muscle relaxing medications (calcium channel blockers, nitrates, anticholinergics).
Clinical Presentation & Alarm Features
Classic symptoms include pyrosis (substernal burning pain) postprandially or when recumbent, and acidic regurgitation. Atypical extraesophageal manifestations include chronic non-productive cough, asthma, hoarseness, laryngitis, globus sensation, and dental enamel erosions.
In patients under age 60 without red flags, an empiric trial of lifestyle changes and once-daily PPI for 8 weeks is indicated. However, alarm features (red flags) mandate immediate referral for diagnostic EGD:
Progressive dysphagia (difficulty swallowing) or odynophagia (painful swallowing).
Unintentional weight loss (>5-10% of body weight).
Gastrointestinal bleeding: Hematemesis, coffee-ground emesis, melena, or unexplained iron deficiency anemia.
Persistent vomiting or palpable epigastric mass.
Management & PPI Safety (Beers Criteria 2023)
First-line lifestyle interventions include weight loss, elevating the head of the bed 6 to 8 inches using bed risers, avoiding meals within 3 hours of bedtime, eliminating trigger foods, and smoking cessation.
Pharmacologic therapy:
Mild GERD : H2-Receptor Antagonists (famotidine 20 mg BID or 40 mg at bedtime).
Moderate-to-Severe GERD : Proton Pump Inhibitors (omeprazole 20-40 mg daily or pantoprazole 40 mg daily) taken 30-60 minutes before breakfast to inhibit actively secreting H+/K+ ATPase pumps. Step-down therapy to the lowest effective dose should follow an 8-week course.
The AGS Beers Criteria (2023) recommends avoiding PPI use >8 weeks without high-risk indications (severe erosive esophagitis, Barrett's esophagus, chronic NSAID/anticoagulant use) due to documented systemic risks:
Clostridioides difficile colitis and enteric infections.
Osteoporosis and hip/spine fractures (impaired calcium ionization and intestinal absorption).
Hypomagnesemia and Vitamin B12 deficiency.
Acute interstitial nephritis and chronic kidney disease.
Complications of Uncontrolled GERD
Erosive Esophagitis and fibrotic peptic strictures presenting as progressive solid-food dysphagia.
Barrett's Esophagus : Metaplastic conversion of stratified squamous epithelium to specialized intestinal columnar mucosa with goblet cells, predisposing to Esophageal Adenocarcinoma. Surveillance EGD is required every 3 to 5 years for non-dysplastic lesions.
Peptic Ulcer Disease (PUD)
PUD involves mucosal defects extending through the muscularis mucosae, caused by H. pylori infection or chronic NSAID/aspirin use.
Gastric vs. Duodenal Ulcers
Feature Gastric Ulcer Duodenal Ulcer
Primary Pathophysiology Decreased mucosal protection (mucus, bicarbonate) Increased gastric acid and pepsin secretion
Peak Age 55 to 70 years 30 to 55 years
Relation to Food Pain worsens immediately with food Pain improves with food/antacids; recurs 2-5 hours postprandial
- Nocturnal Pain Uncommon Very common (awakens patient between 1 AM and 3 AM)
- Weight Impact Anorexia and weight loss common Weight gain common from frequent eating for pain relief
- Malignancy Risk Higher (requires EGD biopsy and healing confirmation) Low (almost exclusively benign)
NSAID-induced PUD results from systemic inhibition of COX-1, suppressing mucosal prostaglandin E2 synthesis. Co-prescribing a PPI or choosing a selective COX-2 inhibitor (celecoxib) reduces ulcer risk. In refractory PUD without NSAID use or H. pylori, Zollinger-Ellison Syndrome (gastrinoma) should be evaluated with fasting serum gastrin levels.
H. pylori Diagnostics & Eradication Protocols
H. pylori is a microaerophilic Gram-negative bacterium that produces extracellular urease, buffering gastric acid to create a protective alkaline microenvironment.
Diagnostic Modalities & Critical Testing Rules
Urea Breath Test (UBT) and Stool Antigen Test (SAT) : High sensitivity and specificity (>95%).
CRITICAL TESTING RULE : Patients must discontinue PPIs for at least 2 weeks and antibiotics/bismuth for at least 4 weeks prior to UBT or SAT to prevent false-negative results.
Serology (Anti-H. pylori IgG) : Detects past exposure but cannot confirm active infection or verify post-treatment cure.
Eradication Regimens (2026 ACG Guidelines)
Due to widespread clarithromycin resistance exceeding 15-20%, 14-day Bismuth Quadruple Therapy is the preferred first-line empirical regimen:
- PPI BID (e.g., omeprazole 20 mg BID)
- Bismuth Subsalicylate 525 mg PO QID
- Metronidazole 500 mg PO TID/QID
- Tetracycline 500 mg PO QID
Alternatively, 14-day Non-Bismuth Quadruple (Concomitant) Therapy (PPI BID + Amoxicillin 1g BID + Clarithromycin 500mg BID + Metronidazole 500mg BID) may be used. Eradication must be verified >= 4 weeks post-treatment using UBT or SAT.