Dyspepsia

Question 1

Symptoms

Answer 1

Upper abdominal pain
Feeling full/bloated
Burping/farting
Nausea
Burning sensation in chest after eating
Bringing up food/bitter tasting fluids

Question 2

Causes of dyspepsia

Answer 2

Indigestion
GORD (heartburn, acid regurgitation, oesophagitis)
Gastritis
Gastric or duodenal ulcers

Question 3

Urgent endoscopic referral

Answer 3

Anaemia
Loss of weight
Anorexia
Recently changed/unexplained new dyspepsia in 55+
Melaena (blood in stool), dysphagia, haematemesis or recurrent vomiting.

Question 4

Uninvestigated dyspepsia

Answer 4

1. Antacids (symptomatic relief)
2. PPI for 4 weeks (if symptoms persist)
3. H.pylori test (if no response to PPI)

Question 5

Investigated functional dyspepsia

Answer 5

• H.pylori tests
• PPI or H2 antagonist for 2 weeks

Question 6

Short term symptom relief

Answer 6

• Antacids
• Alginates

Question 7

Antacids - MoA

Answer 7

Neutralises stomach acid
Immediate symptom relief (15-30 mins)
Liquid preparations more effective than tablets

Question 8

Alginates

Answer 8

Forms viscous gel raft on top of stomach contents to prevent reflux

Question 9

Antacids - ingredients

Answer 9

Aluminum salt (constipating, long-acting)
Calcium salt (induce rebound acid secretion)
Magnesium salt (laxating, long-acting)
Potassium salt
Sodium salt

Question 10

Antacids - Low Na preparations

Answer 10

Maalox + Mucogel (co-magaldrox)
Altacite plus (simeticone + hydrotalcite)

Question 11

Alginates

Answer 11

Alginic acid
Sodium alginate

Question 12

How to take

Answer 12

Take after each main meal and at bedtime/PRN

Question 13

Antacid - Interactions

Answer 13

Impaired absorptions = tetracyclines, quinolones + bisphosphonates
Enteric coated = damages enteric coating by increasing gastric pH
High sodium content = fluid retention, hypertension, heart/liver/kidney failure + sodium restricted diet (e.g. lithium)

Question 14

PPIs

Answer 14

Inhibits gastric acid secretion by blocking hydrogen-potassium ATPase (proton pump) of the gastric parietal cell.
Most effective antisecretory drug
Use lowest effective dose for shortest period.

Question 15

PPIs - examples

Answer 15

Lansoprazole (30-60 mins before food)
Omeprazole (safe in pregnancy)
Pantoprazole
Rabeprazole
Esomeprazole

Question 16

PPIs - how to take

Answer 16

Swallow whole, do not chew or crush
Do not take indigestion remedies 2 hours before or after you take this.

Question 16

PPIs - Cautions

Answer 16

Masks symptoms of gastric cancer
Increased risk of fractures + osteoporosis
Increased risk of C.diff (due to reduced acidity)

Question 17

PPIs - side effects

Answer 17

GI upset - abdominal pain, constipation, diarrhoea, nausea
Long term use:
- Hypomagnesaemia (predispose to digoxin toxicity)
- Fractures
- Rebound acid secretion/protracted dyspepsia after stopping

Question 18

PPI - MHRA

Answer 18

Very low risk of subacute cutaneous lupus erythematosus
- Lesions occur, especially on sun exposed areas.
- Avoid sun exposure
- Consider stopping if occurs

Question 19

PPI - interactions

Answer 19

Omeprazole + clopidogrel = reduced antiplatelet effect.
Omeprazole + methotrexate = decreased clearance of methotrexate

Question 20

H2 receptor antagonists

Answer 20

Antisecretory drug
Reduces gastric acid secretion by blocking H2 receptors in gastric parietal cell.

Question 21

H2 receptor antagonist - examples

Answer 21

Famotidine
Cimetidine (enzyme inhibitor)
Nizatidine
Ranitidine (safe in pregnancy)

Question 22

H2 receptor antagonist - side effects

Answer 22

Headaches
Rashes
Dizziness
Diarrhoea
Psychiatric reactions (confusion, depression, hallucination in elderly)

Question 23

H2 receptor antagonists - caution

Answer 23

Masks symptoms of gastric cancer