Dyspepsia

Question 1

Dyspepsia

Answer 1

Any symptom of the upper GI tract, present for 4 weeks or more, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea or vomiting

Question 2

community pharmacists should consider

Answer 2

• Are there ALARM features that warrant an early referral?
  
  • Can medication, such as NSAIDs be implicated?
    Could there be another cause for the symptoms?

Question 3

ALARM

Answer 3

• Dysphagia
  
  • Upper abdominal mass consistent with stomach cancer
  • 55+ with weight loss and upper abdominal pain, reflux or dyspepsia
  • Haematemesis
  • 55+ with treatment resistant dyspepsia, upper abdominal pain with low haemoglobin levels or raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
    Nausea/vomiting with: weight loss, reflux, dyspepsia or upper abdominal pain

Question 4

Medications implicated in dyspepsia

Answer 4

• Aspirin
  
  • NSAIDs
  • Steroids
  • Bisphosphonates
  • Iron
  • SSRIs
  • Erythromycin
  • Metformin
  • Orlistat
  • Potassium
• Nicorandil

Question 5

Lifestyle advice

Answer 5

• Avoid eating large meals, especially late at night
  
  • Raise the head of the bed using blocks rather than pillows
  • Lose weight
  • Avoid tight clothing
  • Avoid heavy lifting and bending from the waist
  • Avoid fatty, spicy foods, caffeine, mint, chocolate and alcohol
    Discourage smoking

Question 6

OTC treatment

Answer 6

• Antacids- neutralising acid and coating the gastric mucosa and acting as a mechanical barrier to acid
  
  • Alginates- increase the viscosity of stomach contents (raft) thus reducing reflux and protecting the oesophageal lining
  • Liquids and powders have a higher neutralising capacity
  • But they empty from the stomach quicker than tablets and thus have a shorter duration of action
    PPIs- licensed in over 18s. Treatment duration is up to 2 weeks, if symptoms persist after 2 weeks patient should see GP

Question 7

referral

Answer 7

• Those over 55 yrs of age who present with these symptoms for the first time or whose symptoms have recently changed
  
  • Those aged 45 years or over with long term recurrent symptoms of indigestion or heartburn should be advised to see their doctor at regular intervals. Those taking remedies everyday should inform pharmacist/doctor
  • Those over 55 yrs who present with unexplained dyspepsia that have not responded to treatment
  • People who have taken indigestion or heartburn remedies continuously for 4 weeks or more to control their symptoms
  • Heartburn sufferers who are pregnant/breastfeeding
  • Persistent vomiting
  • Jaundiced
  • Have had gastric ulcer surgery
  • Long term recurrent symptoms
  • Breathing difficulties
    ALARM symptoms