Dyspepsia and Peptic Ulcer Disease Flashcards
What is dyspepsia?
General term for indigestion. Caused when stomach acid penetrates mucous layer of stomach or oesophagus, leading to irritation and potentially corrosion of lining.
What are some symptoms of dyspepsia?
- Upper abdominal pain or discomfort
- heartburn
- bloating
- nausea and/or vomiting
What are some causes of dyspepsia?
- Lifestyle
- Gastro-oesophageal reflux disease (GORD)
- peptic ulcer disease
- helicobacter pylori infection
- side effects from drugs
- gastro-oesophageal malignancy
What is gastro-oesophageal reflux disease (GORD)?
Occurs when there is reflux in gastric contents back into oesophagus, causing predominant symptoms of heart burn and acid regurgitation
What are some risk factors for developing GORD?
- stress and anxiety
- smoking and alcohol
- foods like coffee and chocolate
- obesity
- pregnancy
- drugs that decrease lower oesophageal sphincter tone
What is peptic ulcer disease?
Includes gastric or duodenal ulceration (breach in the epithelium of the gastric or duodenal mucosa)
What are the symptoms of peptic ulcer disease?
Main symptom is abdominal pain but others include:
- nausea
- indigestion
- heartburn
What are the high risk NSAIDs?
piroxicam and ketoprofen
What are the immediate risk NSAIDs?
Diclofenac, naproxen and ibuprofen (dose over 1.2g/day)
What are the low risk NSAIDs?
ibuprofen (dose 1.2g/day or under)
What are ant-acid compounds?
Work by neutralising excess asid in stomach helping to relieve symptoms being caused by acid.
What are ant-acid compounds used for?
Used for mild dyspepsia and GORD, usually on a PRN basis.
What are the main points about aluminium and magnesium containing ant-acids?
Relatively insoluble and long acting. Magnesium containing ant-acids tend to cause diarrhoea whilst aluminium antacids tend to cause constipation. Both may reduce colonic side-effects.
What are the main points about antacids containing sodium salts?
Not taken on their own for dyspepsia. Highly soluble, make them quick but short acting. Should be used with caution in patients with:
- kidney disease
- high blood pressure or heart failure
- liver disease
- low salt diets
What are the main points about antacids containing potassium salts?
Hight soluble.
What are the main points about antacids containing calcium salts
Quick but short acting. Can cause constipation and rebound excess acid with high doses.
What are the main points about antacids containing alginates?
Work by forming a ‘raft’ which floats at top of stomach contents, prevents from rising back up
What are the main points about antacids containing simethicone?
Added to some antacids to relieve bloating and flatulence
What are Histamine H2 receptor antagonists?
H2 antagonist used to treat symptoms of dyspepsia or GORD in patients with no response to antacids. Used to treat peptic ulcer disease including NSAID induced ulcers, proton pump inhibitors tried first.
How does the H2 antagonist work?
Reduce secretion of acid by blocking the histamine H2 receptor on parietal cell - found in the lining of the stomach, responsible for pumping acid into the stomach. Has a histamine H2 receptor on its surface. When histamine binds to H2 receptor, triggers proton pump to pump acid to stomach
How do proton pump inhibitors work?
Block proton pump in gastric parietal cell, prevent it from secreting acid in gastric lumen.
What are the main points about Proton Pump Inhibitors?
Used to treat gastric and duodenal ulcers. High dose can be given by IV. Can also be used for treatment of dyspepsia and GORD. Dose depends on indicator. PPIs are more effective at suppressing acid secretion than H2 antagonists
What are some severe problems when taking PPIs
- increased risk of bone fractures and osteoporosis
- risk of imbalance of electrolytes
- increase risk of GI infections as acid usually protects from infections
- masking symptoms of gastric cancers
What is helicobacter pylori?
Bacterium found in GI tract.
What is the treatment for H.pylori infection?
Treated using triple therapy: combination of PPI and 2 antibiotics taken for at least 7 days:
- lansoprazole 30mg twice daily
- amoxicillin 1g twice daily
- clarithromycin 500mg twice daily
If treatment fails, usually due to poor adherence or antibiotic resistance.
