Dyspepsia, GORD, Antacids

Question 1

Dyspepsia

Answer 1

Umbrella term for:
Upper GI symptoms which typically show for 4 or + weeks
- Upper abdo Pain/Discomfort
- Heartburn
- Acid reflux
- NV
- Bloating

RED FLAGs:
55+, Dysphagia, Bleeding, Anaemia

Lifestyle advice:
- Healthy eating
- Reduce spicy/fatty foods
- Lose weight
- Avoiding food triggers
- Smaller meals
- Don’t eat close to bed time
- Raising head of bed
- Smoking cessation
- Reduce alcohol
- Don’t stress

Types:
Functional - NO ULCER, Have symptoms of dyspepsia but no underlying cause. Normal endoscopic findings

Uninvestigated - Symptoms present no investigation done.
MNEUMONIC - Dyspepsia is FUN (F-functional UN= Uninvestigated)

Causes:
Excess acid, Genetics, Poor diet/dietary habits, Obesity, Smoking, alcohol, AEs from drugs

DRUGS that cause:
A-blockers, Antimuscarinics, Aspirin, Benzos, B-Blocker, Bisphosphonates, CCBs, Corticosteroids, Nitrates, NSAIDs, Theophylline, TCAs.

• Review drugs - LOWEST effective dose should be used and if possible stopped.

TREATMENT
ANTACIDS/ALGINATES can be used as short term symptom control - Long term not advised.

INTIAL: (Both types)
- Lifestyle advice
- PPI 4 weeks ALT H2 antagonist
H.pylori test and treat if present. (13c breath test/ stool test)

• Leave 2 week gap after PPI/Antibiotics/Bismuth use then do H.pylori tests. - They can alter results i.e. fake negative.

Question 2

Patient with Uninvestigated dyspepsia unable to stop NSAIDs (EXAM Q)

Answer 2

Reduce NSAID dose and use long term gastroprotection with acid suppression therapy
OR switch to ALT like Paracetamol or COX2i (Have risk of CV event but less GI effects)

Patient on aspirin who cant stop using should switch to another antiplatelet.

Question 3

GORD

Answer 3

Symptoms
Heartburn, Acid regurgitation
- Less common symptoms [if acid reaches respiratory tract]
Chest pain, Hoarseness, Cough, Wheezing, Asthma

Causes
Same as dyspepsia but also hiatus hernia, straining/Coughing rough.

Complications
-oesophageal inflammation, Ulceration, Haemorrhage/Strictures, Anaemia due to chronic blood loss, Aspiration pneumonia, Barret’s oesophagus.

NON DRUG
- Same as DYSEPSIA

Drugs used for Treatment
Alginates, Antacids, PPI, H2 antagonist. (Initial drug and follow up similar to dyspepsia)

PREGNANCY GORD treatment:
1. DIET AND LIFESTYLE ALWAYS 1ST.
2. Antacids or alginates
3. OMEPRAZOLE [Severe] (only safe PPI in pregnancy) or Ranitidine (discontinued drug- cancer)
- For antacids try low sodium due to Pre eclampsia risk.

CHILDREN GORD treatment:
Infants - Change feeding habit i.e. frequency and volume. FEED THICKNER can be used.
Older - Same as adults <12 infant sachets Gaviscon etc.

Question 4

ANTACIDS - Sodium (EXAM Q)

Answer 4

Ingredient and sodium content vary:
- AVOID HIGH sodium forms in HTN, sodium restricted diet and liver/kidney failure.
- Sodium bicarbonate unsuitable for patients with high BP, salt restricted diets, fluid retention, and pts on lithium (they decrease lithium conc.) (ALWAYS GET LITHIUM QS in exam any topic)

AEs: Aluminium - Constipation. Magnesium - Diarrhoea.

Liquids more effective than tabs.

Give when symptoms occur or expected to occur (between meals, bed time) extra doses can be given.
- Antacids can damage EC with some MR tabs.

Affect absorption of certain drugs e.g., Tetracyclines (take after 2hrs.)

Mnemonic for antacid ingredients
- Provide relief in 15-30 mins and effect dont last long.
- ANTI- Antimixing with other meds as they affect absorption.

ANTACID Ingredients: (SCAM)
Sodium bicarbonate
Calcium carbonate
Aluminium hydroxide
Magnesium hydroxide

LOW SODIUM in antacid =:
<1mmol/tab or <10ml dose
Examples of low sodium antacid:
- CO-magaldrox = Al + Mg (MAALOX, MUCOGEL)
- CO-simalcite (ALTACITE plus = Simeticone + Hydrotalcite)
mnemonic = MMA - The CO are low Na+