Dyspepsia

Question 1

Symptoms

Answer 1

• Abdominal pain above belly button
• Bloating
• Flatulence
• Heartburn

Question 2

Referral

Answer 2

ALARM:
- Anaemia
- Loss of weight
- Anorexia
- Recently changed or new, unexplained dyspepsia in >55y
- Melaena, persistent vom, dysphagia

• Treatment >4 weeks
• NSAIDs

Question 3

Ruling out peptic ulcers

Answer 3

Persistent boring pain from 1 point in abdomen

• Gastric ulcers: pain aggravated by food, 30 mins after eating
• Duodenal ulcers: pain when stomach is empty, 2-3H after eating

Question 4

Treatment: Antacids

Answer 4

Neutralises stomach acids
(gaviscon, rennies, tums)

• Immediate symptom relief in 15-30 min, lasts 3H
• Liquid most effective + quicker

Question 5

Treatment: Alginates

Answer 5

Raft on top of stomach contents

• Suitable in pregnancy
• First line: GORD
• After each main meal + bedtime or prn

Question 6

Antacids interactions

Answer 6

Impairs abs of other drugs (tetracyclines, quinolones, bisphosphonates) - don’t take same time, 2H gap

High sodium content = fluid retention: avoid if HPT, kidney + liver failure
- low Na+ prep: mucogel + maalox

Damage enteric coatings by inc stomach pH

Question 7

Treatment: H2 receptor antagonist

Answer 7

Onset 1H + lasts 9H

Ranitidine 16+
- Max 14 day use
- One 75mg tab when symptoms occur, if symptoms persist more than 1H/returns, take another
- Max 4 tabs in 24h
- S/e: headache, di
- NOT pregnancy/BF

Question 8

Treatment: PPI

Answer 8

Onset 1-3 days, lasts 24H

18+, max supply 14 days, max use 4 weeks

• OD, don’t take another acid suppressor, can take antacids whilst waiting for PPI to work
• NOT in pregnancy/BF
• Refer: >2 weeks OTC failure, >4 weeks continuous use
• S/e: osteoporosis + hypomagnesaemia

Interactions - enzyme inhibitor
- Warfarin - enhanced anticoag
- Phenytoin - risk toxicity
- Clopidogrel - red antiplatelet effect

Question 9

Advice

Answer 9

• Smoking cessation
• Avoid excess alcohol
• Take evening meal 3H before bed