Dyspepsia

Question 1

Dispersable P.P.I. formulations can be absorbed sublingually

True or False

Answer 1

False

Question 2

Alginates principley work as rafting agents

True or false

Answer 2

True

Question 3

Antacids should be taken before food

True or false

Answer 3

False

Question 4

In undiagnosed dyspepsia H2 antagonist should be offered prior to test and treatment for H.pylori
True or False

Answer 4

False

Question 5

Which of the following is associated rarely with P.P.I. use
Hyperkalemia
Lymphoma
Psoriasis
Clostridium Difficile

Answer 5

Clostridium Difficile

Question 6

What is the dose of OTC Omprezole medication and how effective is it.

Answer 6

OTC omprezole is licenced at short course of 10mg daily. Half the recommended starting dose of prescription dose 20mg od

Question 7

What are Alarm (Red flag) symptoms

Answer 7

Dysphagia, Epigastric mass, Anaemia, Melena, Weight loss, Persistent vomiting Haematemesis

Question 8

What drugs can be associated with Dyspepsia

Answer 8

Nitrates, Nsaids, Theophylline, Ca+ antagonists, Corticosteroid’s Bisphonates

Question 9

What lifestyle choices are associated with dyspepsia

Answer 9

Smoking, Alcohol, Caffeine, Diet, Weight loss, Timing of meals

Question 10

What is the treatment pathway for Dyspepsia (6 Steps)

Answer 10

1. Alarm Symptoms referred for urgent OGD
2. Review drug causes
3. Lifestyle advice
4. Either treat empirically with 1 month of PPI or test and treat for H. Pylori
5. If one fails try the other
6. H2 antagonist (Ranitidine etc)
   Don’t leave patient on meds long term

Question 11

What year were the NICE guidelines for Dyspepsia released

Answer 11

2014

Question 12

Why are NSAIDS bad for the gut

Answer 12

They interfere with the arachidonic acid, prostaglandin pathway which inhibits COX1 and COX2 production These enzymes promote gut protection

Question 13

Why are steroids bad for the gut

Answer 13

They inhibit wound healing and create erosions in the mucosa in older people (Caution with aspirin, anticoag’s or NSAID’s)

Question 14

Which antidepressants can cause G.I. Bleeding

Answer 14

SSRI can cause bleeding because seritonin is a factor in platelet production risk is doubled if they are on Aspirin also

Question 15

Why should a patient not take PPI prior to OGD investigations for H pylori

Answer 15

Because acid suppression of the ammonia producing bacteria will give false negative result

Question 16

The cost of one months treatment of PPI is cheaper than test and treat of H pylori. True or False

Answer 16

False they are a comparable cost

Question 17

What are the 3 pathways of producing stomach acid

Answer 17

1. Histamine stimulated by hormones.
2. Gastrin produced by G cells triggered by peptides
3. Acetycholine Para sympathetic system (i.e. the smell of food) these last two can also be a trigger for the 1st

Question 18

What are the 4 types levels of treatment of dyspepsia

Answer 18

1. Antacids
2. Alginates/ Raft medication
3. H2 antagonist
4. P.P.I.

Question 19

What cautions are there with antacids

Answer 19

1. Reduced absorption (of medications)
2. Enteric meds are made to dissolve in the alkaline environment of the small bowel may dissolve in the stomach in the presence of antacid
3. raised Na and Mg which may be an issue in renal conditions and a consideration in heart failure

Question 20

What cautions are there with P.P.I.’s

Answer 20

Clostridium Difficile NNH 500
Osteopetrosis NNH 2000
Rarely Hypo magnesia