dyspepsia

Question 1

What is dyspepsia ?

Answer 1

group of upper abdominal symptoms: upper abdominal pain, fullness, early satiety, bloating, belching, nausea

Question 2

What are the causes of dyspepsia ?

Answer 2

indigestion
GORD ( heartburn, acid regurgitation, oesophagitis )
gastritis
gastric or duodenal ulcers

Question 3

What are the alarm symptoms requiring urgent endoscopic referral ?

Answer 3

Anaemia ( as a result of GI bleeding)
Loss of weight
Anorexia
Recently-changed unexplained new dyspepsia in 55+, unresponsive to treatment
Malaena ( blood in stool), dysphagia, haematemesis or recccurent vomiting

Question 4

How can uninvestigated dyspepsia be treated ?

Answer 4

Antacids for some symptomatic relief.
PPI for 4 weeks, if symptoms persist.
Then H.pylori test if no response to PPI

Question 5

How can investigated functional dyspepsia be treated ?

Answer 5

H. Pylori test

PPI or H2 antagonist for 4 weeks

Question 6

How does antacids work ?

Answer 6

Neutralise stomach acid, provides immediate symptom relief in 15-30 min

Question 7

How does alginates work ?

Answer 7

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

Question 8

Name antacids available ?

Answer 8

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

Question 9

Which antacids have low sodium ?

Answer 9

Co-magaldrox ( maalox, mucogel)
Altacite plus ( simeticone with hydrotalcite)

Question 10

Name alginates available ?

Answer 10

alginic acid

sodium alginate

Question 11

How should antacids be taken ?

Answer 11

take after each main meal, and at bedtime when required

Question 12

What are the interactions of antacids ?

Answer 12

impaired absorption of drugs-leave a 2 hour gap.
Tetracyclines, quinolones, bisphosphonates
Damages enteric coatings by increasing gastric pH
High sodium content: fluid retention, thus avoid in hypertension, heart, liver or kidney failure.
Avoid in sodium restricted diet: e.g Lithium

Question 13

How does Proton pump inhibitors work ?

Answer 13

inhibits gastric acid secretion by blocking hydrogen-potassium ATpase of the gastric parietal cell.

Question 14

Name all the PPI available ?

Answer 14

Esomeprozole
Lansoprazole ( take 30-60 min before food)
Omeprazole ( safe in pregnancy )
Pantoprazole
Rabeprazole

Question 15

How should PPI be taken ?

Answer 15

Swallow whole, do not chew or crush.

Do not take indigestion remedies 2 hours before or after you take PPI.

Question 16

What are the cautions of PPI?

Answer 16

Mask symptoms of gastric cancer
Increased risk of fractures and risk of osteoporosis
Increased risk of GI infections - c.difficile ( reduced acidity )

Question 17

What are the side effects of PPI?

Answer 17

Abdominal pain; constipation; diarrhoea; dizziness; dry mouth; gastrointestinal disorders; headache; insomnia; nausea; skin reactions; vomiting

Question 18

What is MHRA advice about PPI’s?

Answer 18

Very infrequent cases of subacute cutaneous lupus erythematosus (SCLE) have been reported in patients taking PPIs. Drug-induced SCLE can occur weeks, months or even years after exposure to the drug.
If a patient treated with a PPI develops lesions—especially in sun-exposed areas of the skin—and it is accompanied by arthralgia:

advise them to avoid exposing the skin to sunlight;
consider SCLE as a possible diagnosis;
consider discontinuing PPI treatment unless it is imperative for a serious acid-related condition; a patient who develops SCLE with a particular PPI may be at risk of the same reaction with another;
in most cases, symptoms resolve on PPI withdrawal; topical or systemic steroids might be necessary for treatment of SCLE only if there are no signs of remission after a few weeks or months.

Question 19

What are the long term side effects of PPI ?

Answer 19

hypomagnesaemia ( predisposes to digoxin toxicity)
fractures
rebound acid secretion, protracted dyspepsia after stopping.

Question 20

Why should omeprazole not be given with methotrexate and clopidogrel ?

Answer 20

clopidogrel: reduced anti platelet effect
Methotrexate: decreased clearance of methotrexate

Question 21

How does H2 receptor antagonists work ?

Answer 21

reduces gastric acid secretion by blocking H2 receptors in the gastric parietal cell.

Question 22

Name H2 receptor antagonists ?

Answer 22

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

Question 23

What are the side effects of H2 receptor antagonists ?

Answer 23

headaches, rashes, dizziness, diarrhoea

psychiatric reactions: confusion, depression, hallucinations in the elderly or very ill patients