Dyspepsia and antacids

Question 1

list some of the symptoms of dyspepsia (5)

Answer 1

1) Upper abdominal pain
2) Fullness
3) Early satiety
4) Bloating
5) Nausea

Question 2

list 3 reasons why dyspepsia might occur

Answer 2

1) Gastric and duodenal ulceration
2) Gastric cancer
3) Most commonly it is of uncertain origin

Question 3

Urgent endoscopic investigation is required if dyspepsia is accompanied by which ‘alarm features? (5)

Answer 3

1) Bleeding
2) Dysphagia
3) Recurrent vomiting
4) Weight loss
5) > 55 years with unexplained, recent-onset dyspepsia not responded to treatment

Question 4

Patients with dyspepsia should be advised about lifestyle changes. Outline some of the advice that should be provided

Answer 4

1) Avoidance of excess alcohol and of aggravating foods such as fat
2) Weight reduction
3) Smoking cessation
4) Raising the head of the bed
5) If possible stop medications that cause dyspepsia

Question 5

what pharmacological treatments are available for the treatment of dyspepsia?

Answer 5

1) Antacids may provide symptomatic relief
2) PPI: Up to 4 weeks in uninvestigated dyspepsia. PPIs can also be used intermittently long term
3) H2-receptor antagonist

Question 6

How should patients with uninvestigated dyspepsia, who do not respond to an initial trial with a proton pump inhibitor be managed?

Answer 6

1) Tested for Helicobacter pylori and given eradication therapy if present
2) Alternatively, in populations where H. pylori infection is likely, the ‘test and treat’ strategy can be used before trial with PPI

Question 7

If H. pylori is present in patients with functional (investigated, non-ulcer) dyspepsia, eradication therapy should be provided. how should patients be managed if symptoms still persist?

Answer 7

Treatment with either a PPI or a H2-receptor antagonist can be given for 4 weeks.

Question 8

what are antacids such as gaviscon and peptac indicated for?

Answer 8

1) Relieve symptoms in ulcer dyspepsia

2) Gastro-oesophageal reflux disease (GORD)

Question 9

When should antacids be taken during the day?

Answer 9

Best given when symptoms occur or are expected, usually between meals and at bedtime, although additional doses may be required

Question 10

what benefit can antacids provide in those suffering with ulcers?

Answer 10

Liquid magnesium-aluminium antacids promote ulcer healing (less well than antisecretory drugs)

Question 11

what side effects do magnesium and aluminium-containing antacids cause?

Answer 11

1) Magnesium-containing antacids: laxative

2) Aluminium-containing antacids: constipating

Question 12

Why are bismuth-containing antacids not recommended in dyspepsia?

Answer 12

Absorbed bismuth can be neurotoxic, causing encephalopathy; they tend to be constipating

Question 13

What problems can calcium-containing antacids cause?

Answer 13

1) Can induce rebound acid secretion

2) Prolonged high doses also cause hypercalcaemia and alkalosis, and can precipitate the milk-alkali syndrome

Question 14

why is simeticone added to antacid preparations?

Answer 14

1) Antifoaming agent to relieve flatulence.

2) These preparations may also be useful for the relief of hiccup in palliative care

Question 15

Outline the mechanism by which antacids and alginates relieve symptoms of dyspepsia

Answer 15

1) Antacids work by buffering stomach acids
2) Alginates increase the viscosity of the stomach , which reduces the reflux of stomach acid into the oesophagus. They form a floating ‘raft’, which separates the gastric contents from the gastro-oesophageal junction to prevent mucosal damage

Question 16

why might preparations of antacids not be freely interchangeable?

Answer 16

Amount of additional ingredient or antacid in individual preparations vary widely, as does the sodium content

Question 17

which patients should antacids be used in caution with?

Answer 17

1) Sodium- and potassium-containing preparations should be used with caution in patients with fluid overload or hyperkalaemia (e.g. renal failure).
2) Some preparations contain sucrose, which can worsen hyperglycaemia in people with diabetes

Question 18

Paediatric formulations such as gaviscon infant are used to manage GORD in infants. What should these compound preperations not be given in combination with?

Answer 18

Thickened milk preparations: They can lead to excessively thick stomach contents that cause bloating and abdominal discomfort.

Question 19

Antacids can reduce serum concentrations of many drugs, so doses should be separated by 2 hours. Which drugs does this typically apply to?

Answer 19

1) ACE inhibitors
2) Some antibiotics (e.g. cephalosporins, ciprofloxacin and tetracyclines)
3) Bisphosphonates
4) Digoxin
5) levothyroxine
6) Proton pump inhibitors (PPIs)

Question 20

why does gaviscon increase the excretion of aspirin and lithium?

Answer 20

By increasing the alkalinity of urine, antacids can increase the excretion of aspirin and lithium