Dyspepsia And GORD Flashcards
Dyspepsia symptoms
Upper GI symtpoms
Upper abdominal pain/discomfort
Acid reflux, heartburn
Nausea and vomiting
Dyspepsia is causes by
Increased acid
How long do symptoms of dyspepsia last
Usually 4 weeks
Lifestyle management of dyspepsia
Smoking cessation
Sleep with raised head of bed
Stress/anxiety management
Avoid spicy foods, alcohol
Weight loss
Red flags of dyspepsia
These would require what management?
55+ with new onset or not responding to treatment
Bleeding
Dysphagia
Recurrent vomiting
Weight loss
ENDOSCOPY
Describe the 2 types of dyspepsia
Functional - symptoms present but no ulcers/ cause
Uninvestigated - symptoms present but not had an endoscopy yet
Which drugs cause dyspepsia
Aspirin
NSAIDs
Alpha blockers
Beta blockers
CCB
Antimuscarinics
Bisphosphonates
Corticosteroids
Benzodiazepines
Nitrates
TCA
How long can antacids/ alginates be used for
Short term use only
Functional dyspepsia treatment
Lifestyle measure
Offer PPI/ H2 antagonist prn
Test for H.pylori and treat if present
Uninvestigated dyspepsia treatment
Test for H.pylori and treat if present, if not present:
Offer PPI or H2 antagonist for 4 weeks
Why do we leave a 2 week period between taking a PPI and testing for H.pylori
Washout period
Whats a washout period in dyspepsia
Leaving a 2 week interval between stopping PPI and testing for H.pylori
A patient has dyspepsia but is on NSAIDs, he cant stop these NSAIDs. What do you do
Switch to paracetamol or cox2 inhibitor
Or
Reduce dose and use long term PPI/H2 antagonist alongside
Whats are examples of a Cox 2 inhibitor, what risk is associated with them
Etoricoxib
Celecoxib
Risk if CV events
In patients with uninvestigated dyspepsia unable to stop aspirin ……
Switch to alternative antiplatelet- clopidogrel, pyridamole
What is GORD
Acid regurgitation/ heart burn
Red flags of GORD
What causes them
Chest pain
Cough
Wheezing
Asthma
Hoaresness of voice
Caused by acid moving to the lungs
Complications of GORD
Barretts oesophagus
Oesophagus inflammation
Anaemia due to blood loss
Aspiration pneumonia
Stricture
Ulceration
Bleeding
Treatment of GORD
PPI, anatacids, alginates, H2 antagonist
Treatment of GORD in pregnancy
Lifestyle
Low sodium antacids, alginates
Omeprazole or ranitidine
Which PPI is the only safe one in pregnancy
Omeprazole
When is Omeprazole used in GORD in pregnancy
Severe symptoms
GORD infants treatment <12 yrs and > 12 yrs
<12 yrs - change freq and volume of feed, use thickner
> 12 yrs - treat like adults
GORD counselling and patient advice
Eat small meals slowly and not at bedtime
Avoid precipitating factors
Sleep with head raised
Lose weight
Which groups of patients would you avoid high sodium antacids
Pregnant
Hypertension
Liver or kidney failure
Sodium restricted diet
Which antacid would you avoid in a constipated patient
Aluminium containing
What antacid would you avoid in diarrhoea
Magnesium containing
Which are more effective- liquid or tablet antacids
Liquid
Can you give antacids with other medication
Leave 2 hrs between as can affect absorption if other meds and can damage enteric coating in some MR tabs
Avoid sodium bicarbonate in those taking ……. Or have these conditions ……
Lithium
High BP, salt restricted diet, fluid retention
Lithium and sodium bicarbonate interaction
Sodium bicarbonate reduces lithium concentration
Which antacids provide quick relief (how long?) But its effects dont last long
SCAM
Sodium bicarbonate
Calcium bicarbonate
Aluminium hydroxide
Magnesium hydroxide
What is low sodium content? Values
< 1mmol/ tablet or
10ml dose
Which antacids have low sodium content
MAM
Co- magaldrox (MAALOX and mucogel)
Co- simalcite (altacite plus)
What drugs are in co- magaldrox
Magnesium and aluminium
What drugs are in co simalcite
Simethicone and hydrotalcite
Which antacids have high sodium content
Sodium alginate with potassium bicarbonate- gaviscon advance
Gaviscon advance and normal gaviscon difference
Gaviscon advance has double sodium
PPI examples
Omeprazole
Esomeprazole
Lansoprazole
Monitoring requirements for PPI
Monitor serum magnesium when using other drugs causing hypomagnesia or with digoxin
PPI MHRA warning
May cause lupus (skin reactions)
- lesions on skin when exposed to sun
A patient is on Omeprazole and develops lupus, what do you do?
Reduce or stop (reversible when PPI stopped)
Hypomagnasaemia symptoms
Convulsions
Muscle pain/ weakness
PPI cautions
MC GOLF
magnesium (causes hypomagnesia)
Cancer (masks symptoms)
GI infections - c.diff risk increased
Osteoporosis (maintain vit D and calcium)
Lupus
Fractures
Omeprazole interactions
AVOID CLOE
Clopidogrel interacts with omeprazole and esomeprazole - they decrease clopidogrels efficency
Decreases METHOTREXATE clearance- use with caution or avoid
Digoxin- monitor magnesium
Which PPI can u use in breastfeeding
All but with caution
H.pylori symptoms
Burning pain in stomach
Tests used to diagnose h.pylori
Stool antigen test
Urea 13C- most common
Washout periods of h.pylori prevent false negatives, explain this
Wait 4 weeks after stopping antibx before getting tested
Wait 2 weeks after stopping PPI before getting tested
Duration of antibx treatment for h.pylori
7 days - 1st and 2nd line
10 days - 3rd line
Treatment used for h.pylori in non penicillin allergy
Triple therapy for 7 days otherwise refer
- PPI + amoxicillin + metronidazole or clarithromycin
- PPI + amoxicillin + tetracycline (if metro or clarithromycin recently used)
- PPI + bismuth + 2 antibx not used before or with rifabutin or furazolidone
Treatment for H.pylori in penicillin allergy
- PPI + metronidazole + clarithromycin
- PPI + metronidazole + tetracycline + bismuth (if clarithromycin recently used)
- PPI + metronidazole + levofloxacin
All used for 7 days each
What is bismuth subsalicylate
Anti diarrhoeal drug
Rifabutin and furazolidone are…..
Used in…..
Antibiotics used in h.pylori
Clarithromycin + ciclosporin interaction
Increases concentration of ciclosporin
Cimetidine and phenytoin interaction
Increases concentration of phenytoin
PPI doses in H.pylori
Omeprazole 20-40mg BD
rabeprazole 20mg BD
Esomeprazole 20mg BD
lansoprazole 30mg BD
Pantoprazole 40mg BD
GI protectors and chelators protect …..
Describe an example
Protect stomach lining
Sucralfate is a chelate. It contains sucrose and aluminium and is given late (bedtime).
Given 1hr before meal or enteral feeds
Sucralfate - be careful in which patients and why
Intensive care as they can cause bezoar formation which is a solid indigestible mass which blocks enteral feeding tubes
Whats a bezoar formation
Solid indigestible mass
H2 receptor antagonist examples
Ranitidine
Famotidine
Cimetidine
H2 receptor antagonist MOA
Heal gastric/ duodenal ulcers
Relieves GORD symptoms
Avoid H2 receptor antagonists in which syndrome
What is it and what can be given as an alternative
Zollinger ellisone syndrome (stomach tumour causing increased acid)
PPI more effective
Which h2 receptor antagonist is safe in pregnancy
Ranitidine
Famotidine and cimetidine- avoid unless essential and benefit outweighs risk
H2 receptor antagonist caution!!
Masks symptoms of GI cancer
SE of h2 receptor antagonist
Diarrhoea
Constipation
Dizziness
Headaches
Myalgia
Fatigue
What is misoprostol
Indication
Caution
Synthetic prostaglandin analogue
- helps heal duodenal and gastric ulcers
Caution in child bearing women, exclude pregnancy and ensure contraception is in place - teratogenic
