dyspepsia Flashcards
What is dyspepsia ?
group of upper abdominal symptoms: upper abdominal pain, fullness, early satiety, bloating, belching, nausea
What are the causes of dyspepsia ?
indigestion
GORD ( heartburn, acid regurgitation, oesophagitis )
gastritis
gastric or duodenal ulcers
What are the alarm symptoms requiring urgent endoscopic referral ?
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
How can uninvestigated dyspepsia be treated ?
Antacids for some symptomatic relief.
PPI for 4 weeks, if symptoms persist.
Then H.pylori test if no response to PPI
How can investigated functional dyspepsia be treated ?
H. Pylori test
PPI or H2 antagonist for 4 weeks
How does antacids work ?
Neutralise stomach acid, provides immediate symptom relief in 15-30 min
How does alginates work ?
forms viscous gel raft on top of stomach contents to prevent reflux
Name antacids available ?
aluminium salt ( constipating-long acting)
Calcium salt ( induce rebound acid secretion)
Magnesium salt ( laxating- long acting)
Potassium salt
Sodium salt
Which antacids have low sodium ?
Co-magaldrox ( maalox, mucogel) Altacite plus ( simeticone with hydrotalcite)
Name alginates available ?
alginic acid
sodium alginate
How should antacids be taken ?
take after each main meal, and at bedtime when required
What are the interactions of antacids ?
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
How does Proton pump inhibitors work ?
inhibits gastric acid secretion by blocking hydrogen-potassium ATpase of the gastric parietal cell.
Name all the PPI available ?
Esomeprozole Lansoprazole ( take 30-60 min before food) Omeprazole ( safe in pregnancy ) Pantoprazole Rabeprazole
How should PPI be taken ?
Swallow whole, do not chew or crush.
Do not take indigestion remedies 2 hours before or after you take PPI.
What are the cautions of PPI?
Mask symptoms of gastric cancer
Increased risk of fractures and risk of osteoporosis
Increased risk of GI infections - c.difficile ( reduced acidity )
What are the side effects of PPI?
Abdominal pain; constipation; diarrhoea; dizziness; dry mouth; gastrointestinal disorders; headache; insomnia; nausea; skin reactions; vomiting
What is MHRA advice about PPI’s?
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.
What are the long term side effects of PPI ?
hypomagnesaemia ( predisposes to digoxin toxicity)
fractures
rebound acid secretion, protracted dyspepsia after stopping.
Why should omeprazole not be given with methotrexate and clopidogrel ?
clopidogrel: reduced anti platelet effect
Methotrexate: decreased clearance of methotrexate
How does H2 receptor antagonists work ?
reduces gastric acid secretion by blocking H2 receptors in the gastric parietal cell.
Name H2 receptor antagonists ?
Cimetidine ( enzyme inhibitor)
Famotidine
Nizatidine
Ranitidine ( safe in pregnancy )
What are the side effects of H2 receptor antagonists ?
headaches, rashes, dizziness, diarrhoea
psychiatric reactions: confusion, depression, hallucinations in the elderly or very ill patients
