Disorders Of Gastric Acid Amd Ulceration Flashcards
What are the symptoms of dyspepsia?
Upper abdominal pain Fullness Early satiety Bloating Belching Nausea
What causes dyspepsia?
Indigestion
GORD
Gastritis
Gastric or duodenal ulcers
What symptoms need urgent endoscopic referral?
Anaemia
Loss of weight
Anorexia
Recently changed, unexplained new dyspepsia in 55+ unresponsive to treat,met
Malaena, dysphagia, haematemesis, recurrent vomiting
What do you use to treat uninvestigated dyspepsia?
Antacids
PPI for 4 weeks if symptoms persist
H. Pylori test if unresponsive to PPI
What do you use for investigates functional dyspepsia?
H. Pylori test
PPI or H2 antagonist for 4 weeks
How do antacids work?
Neutralises stomach acid
Provides immediate symptom relief in 15-30 mins
How do the alginates work?
Forms viscous gel raft on top of stomach contents to prevent reflux
What are the antacids?
Aluminium salt - constipating Calcium salt Magnesium salt - laxatimg Potassium salt Sodium salt
Which antacids have low sodium?
Maalox
Mucogel
Altacite plus
What are the alginates?
Albinos acid
Sodium alginate
How do you take antacids?
After each main meal and at bedtime when required
What are the antacid interactions that impair the absorption of drugs?
Tetracyclines
Quinolones
Bisphosphonates
Leave a 2 hour gap
What are the antacid interactions?
Damage enteric coatings by increasing gastric pH
High sodium content - fluid retention, avoid in hypertension, heart, liver or kidney failure
Avoid in sodium restricted diet e.g. lithium
How do PPIs work?
Inhibits gastric acid secretion by blocking hydrogen-potassium ATPase of the gastric parietal cell
It is the most effective antisecretory drug
What are the PPIs?
Esomeprazole Lansoprazole Omeprazole Pantoprazole Rabeprazole
Which PPI needs to be taken 30-60 mins before food?
Lansoprazole
What PPI is safe in pregnancy?
Omeprazole
How do you take PPIs?
Swallow whole
Do not crush
Do not take indigestion remedies 2 hours before or after you take this medicine
What is the dose for PPIs?
Lowest effective dose for shortest period
What are the side effects of PPIs?
GI upset
Hypomagnesaemia
Fractures
Rebound acid secretion, protracted dyspepsia
What is the MHRA advice for PPIs?
Very low risk of subacute cutaneous lupus erythematosus
Avoid sun exposure
What are the interactions with omeprazole?
Clopidogrel- reduced antiplatelet effect
Methotrexate- decreased clearance of methotrexate
How do H2 receptor antagonists work?
Reduces gastric acid secretion by blocking H2 receptors in the gastric parietal cell
Antisecretory drug
What are the H2 receptor antagonists?
Cimetidine - enzyme inhibitor
Famotidine
Nizatidine
Ranitidine
What are the side effects of the H2 antagonists?
Headaches Rashes Dizziness Diarrhoea Psychiatric reactions
What are the cautions in H2 receptor antagonists?
Masks symptoms of gastric cancer
Can misoprostol be used in pregnancy?
No. Teratogenic
Can misoprostol be used in duodenal ulceration?
Yes
What are the side effects of misoprostol?
Colic and diarrhoea are dose limiting side effects
Diarrhoea is common and can occasionally be severe and require withdrawal
Can sucralfate be used in duodenal ulcers?
Yes
What are the side effects of sucralfate?
Bezoar formation
1 hour before meals / 1 hour gap between enteral feeds
What is used to treat H. Pylori ulcers?
1 week triple therapy
PPI BD + Clarithromycin + amoxicillin or metronidazole
If a patient is penicillin allergic how do you treat H. Pylori?
PMC
PPI
Metronidazole
Clarithromycin
If a patient has recently been treated with a macrolide how do you treat H. Pylori?
PPI
Amoxicillin
Metronidazole
If a patient has recently been treated with metronidazole how do you treat H. Pylori?
PPI
Amoxicillin
Clarithromycin
How do you treat NSAID induced ulcers?
Withdraw NSAID
PPI or H2 antagonist/misoprostol
What do you use for prophylaxis of NSAID induced ulcers?
PPI if at risk
PPI with cox-2 selective NSAID
How do you treat mild GORD symptoms?
Antacid + alginate
H2 receptor antagonists/PPI
How do you treat severe symptoms of GORD?
PPI for 4-6 weeks
How do you treat GORD in pregnancy ?
Antacids or alginates
Omeprazole for complicated GORD
How do you treat GORD in children?
Common in infant and resolves after age 12-18 months
Mild-moderate GORD thickened feeds or alginates
How do you diagnose H. Pylori?
C-urea breath test kits
Do not perform test within 4 weeks of antibacterial
Or 2 weeks treatment with antisecretory drug
