dyspepsia

Question 1

Dyspepsia is a

Answer 1

group of upper abdominal symptoms
~ abdo pain
~ fullness
~ early satiety
~ bloating
~ belching
~ nausea

Question 2

Causes of dyspepsia

Answer 2

~ indigestion (functional or uncertain origin)
~ GORD (heartburn, regurgitation, esophagitis)
~ gastritis
~ gastric / duodenal ulcers

Question 3

urgent endoscopic referral symptoms

Answer 3

ALARM
Anemia (due to GI bleed)
Loss of weight
Anorexia
Recently-changed, unexplained new dyspepsia in 55+ unresponsive to tx
Melaena (blood in stool), dysphagia, hematemesis, vomiting

Question 4

uninvestigated dyspepsia tx

Answer 4

~ antacids
~ PPI for 4 weeks (if no responsive H.Pylori test)

Question 5

Investigated dyspepsia tx

Answer 5

~ H.pylori test
~ PPI or H2 antagonists for 4 weeks

Question 6

antacids MOA

Answer 6

~ neutralise stomach acid
~ immediate relief in 15-30mins

Question 7

Alginates MOA

Answer 7

~ forms viscous gel raft on top of stomach contents to prevent reflux

Question 8

antacids

Answer 8

Aluminium (constipating ~ long acting)
~ calcium (induce rebound acid secretion)
~ magnesium (laxating ~ long acting)
~ potassium salts
~ sodium salts

Question 9

antacids interactions

Answer 9

~ impaired drug absorption ~ leave 2h gap !! e.g. tetracyclines, quinolones, bisphosphonates
~ damages EC by increasing gastric pH
~ High Na content (fluid retention, HTN, Heart, Liver, Kidney failure = avoid or in sodium restricted diet i.e. lithium)

Question 10

PPIs

Answer 10

inhibit gastric acid secretion by blocking H-K ATP-ase of gastric parietal cell

Question 11

PPI examples

Answer 11

~ Esomeprazole
~ Lansoprazole (30-60 mins before food)
~Omeprazole (safe in preg.)
~ Pantoprazole (available as IV)

Question 12

How to take PPI

Answer 12

~ swallow whole
~ do not take indigestion remedies 2h before or after you take this med

Question 13

PPI cautions

Answer 13

~ masks gastric cancer symptoms
~ increased fracture risk + osteoporosis
~ increased GI infection ~ c.diff

Question 14

PPI SEs

Answer 14

~ GI upset: abdo pain, C, D, N

Question 15

Long-term PPI use

Answer 15

~ hypomagnesaemia (predispose to digoxin toxicity)
~ fractures
~ rebound acid secretion, protracted dyspepsia after stopping

Question 16

MHRA PPI alert

Answer 16

~ SCLE SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS
~ lesions after sun exposure, with arthralgia

Question 17

PPI interactions

Answer 17

OMEPRAZOLE
~ clopidogrel = reduced anti-platelet effect, discourage concomitant use
~ Methotrexate = decreased clearance of methotrexate

Question 18

H2 antagonists MOA

Answer 18

reduce gastric acid secretion by blocking H2 receptors in gastric parietal cell

Question 19

H2 antagonists examples

Answer 19

cimetidine (enzyme inhibitor)
Famotidine
Ranitidine (Safe in pregnancy)
Nizatidine

Question 20

H2 antagonists SEs

Answer 20

headache
rash
dizziness
diarrhoea
psychiatric reactions: confusion, depression, hallucinations in elderly or very ill patients

Question 21

H2 antagonists caution

Answer 21

masks symptoms of gastric cancer