Dyspepsia

Question 1

What can dyspepsia be caused by? Which part of abdomen?

Answer 1

• Upper abdominal symptoms

Caused by:

• Indigestion (functional dyspepsia)
• GORD (heartburn)
• Gastritis
• Gastric or duodenal ulcers

Question 2

When to refer for dyspepsia?

Answer 2

ALARM:

Anaemia
Loss of weight
Anorexia
Recently new unexplained dyspepsia in 55+ unresponsive to treatment
Malaena (black stools), Haematemesis, Persistent vomit, dysphagia

• Symptomatic treatment 4 weeks +
• Refuse PPI, H2 blockers if due for endoscopy/c-urea test in 14 days
• Previous gastric ulcer/ GI surgery
• Children
• Regurgitation (Oesophagitis? Peptic stricture?)
• Jaundice or severe liver disease

Question 3

Dyspepsia symptoms

Answer 3

Epigastric pain (abdo pain above belly button_

Bloating, belch, flatulence
Early satiety
Fullness
N+V
Heartburn

Question 4

Which meds are adr and need to refer in dysphagia?

Answer 4

NSAIDS, CCBs, Theophylline, Corticosteroids, Nitrates, Iron Bisphosphonates, SSRIs, Metformin, Warfarin

Question 5

OTC for Dyspepsia?

Answer 5

Antacids, Alginates, H2 blockers, PPI

Question 6

What is Rennies, Tums, Gavision?

Answer 6

Antacids

Question 7

How do antacids work? How long it takes to work and lasts how long? Liquid vs tablets?

Side effects of antacids?
(Salts: sodium, potassium, aluminium, magnesium, calcium)

Answer 7

Immediate symptom relief in 15-30 minutes - Lasts 3 hours
Liquids are most effective and act quicker than tablet
- Sodium salts : fluid retention
- Potassium salts
- Aluminium salts = constipating
- Magnesium salts = laxating
- Calcium salts = rebound acid secretion

Question 8

Alginates are used for what? Is it okay for pregnancy? How to take?

Answer 8

1st line for GORD

Suitable in pregnancy

Take after each main meal and at bedtime OR when required

Question 9

Antacid interactions?

Answer 9

Impairs absorption of other drugs

• Do not take at same time - LEAVE 2 HOUR GAP
• Tetracyclines, quinolones, bisphosphonates

High Sodium content = fluid retention

• Avoid in hypertension, heart, kidney or liver failure
• Avoid in sodium-restricted diets: Lithium or coronary heart disease
• Low Na+ : Mucogel and Maalox

Damage enteric coatings by increasing stomach ph

Question 10

What’s ranitidine? (Zantac 75) Age restriction? Max days?

How to take? Max dose.

Answer 10

H2 receptor blocker

16+, Max use 14 days

ONE 75mg tab when symptoms occur. If persist more than one hour, take another tablet. Max 4 tabs in 24 hours.

Question 11

Ranitidine Side effects, pregnancy breastfeeing?

Answer 11

headaches, rashes, dizziness + diarrhoea.
masks symptoms of gastric cancer

not recommended in pregnancy or breastfeeding

Question 12

PPI - onset, lasts how long?
Used for what?
Max supply? Max use duration?
How to take?
Preg or breastfeeding?

Answer 12

Onset 1-3 days, Lasts 24 hours

For reflux. 18+. Max supply 14 days. Max use 4 weeks.

Take once daily, swallow whole, do not take with other acid suppressor (H2 antagonist). Can take antacids while waiting for PPI to work.

Not rec in preg or breast

Omeprazole (Boots Acid reflux)
Esomeprazole (Nexium)
Pantoprazole (Pantoloc Control)

Question 13

When taking PPI, how long until refer to GP?

Answer 13

2 weeks OTC failure

4 weeks continuous use

Question 14

PPI side effect

Long term

Answer 14

Abdo pain, nausea, diarrhoea, vomiting, farts.
Masks symptoms of gastric cancer

Long term = osteoporosis and hyPOmagnesaemia

Question 15

PPI interactions

Answer 15

Omeprazole in an ENZYME INHIBITOR

warfarin = up anticoag effect
phenytoin = risk of toxicity, narrow therapeautic drug
clopidogrel = reduced antiplatelet effect

Question 16

Advice for dyspepsia

Answer 16

Smoking cessation
Avoid excess alcohol, caffeine, chocolate
avoid bending over, lying down, slumping
raise head of bed, take evening meal 3 hours before bed
small frequent meals
avoid aggravating fatty or spicy food
weight reduction
avoid tight clothing e.g. belts