Dyspepsia, GORD & PUD Flashcards
What is Dyspepsia?
Basically indigestion which causes abdominal pain
What are some symptoms of dyspepsia?
Persistent or recurrent pain or discomfort in upper abdomen, nausea and vomiting, heartburn etc
What are some causes of dyspepsia?
lifestyle factors, medication and diseases
What is GORD?
Gastro-oesophageal reflux disease occurs when gastric contents move up into the oesophagus
What are some causes of GORD?
obesity, lifestyle, genetics, medication and age
What are some symptoms/ complications of GORD?
chronic cough or laryngitis, linked to asthma, can lead to stricture, Barrett’s oesophagus etc
What happens during gastro-oesophageal reflux?
Lower oesophageal sphincter relaxation causing reflux of gastric contents into oesophagus
What is a peptic ulcer?
open sores / ulceration that occurs on the inner lining of the oesophagus, stomach upper portion of SI
What causes peptic ulcers?
H pylori, NSAIDs, lifestyle factors & genetic factors
What are some complications of peptic ulcers?
upper GI bleed
What are the initial symptoms of peptic ulcers?
upper abdominal pain, heartburn/reflux, bloating, early satiety, nausea and vomiting
What is the difference in symptoms of a gastric ulcer and a duodenal ulcer?
With gastric ulcer the pain radiates to the back, occurs mainly at night, is aggravated by food and causes weight loss but with duodenal ulcers you’ll experience epigastric pain anytime even on an empty stomach, the pain is relieved by food/antacids and you’ll gain weight
How do you assess for a peptic ulcer?
take a detailed medical and social history, review medication, blood tests, H pylori testing, X ray and endoscopy
What are some peptic ulcer warning signs?
ALARMS: Anaemia, loss of weight, anorexia, recurrent problems, melaena (blood in stools), swallowing problems
What are some lifestyle measures used to manage dyspepsia, GORD and PUD?
smoking cessation, healthy eating, avoiding known precipitants that cause dyspepsia such as fatty, acidic or fried foods, reducing or exclusion of chocolate and caffeine, avoid eating late, reduce stress, raising the head of the bed (GORD)
What medication is used to manage these conditions?
Antacids (+alginates), PPIs, H2 receptor antagonists, Misoprostol
What are some side effects of antacids?
often contain magnesium or aluminium compounds and those that are magnesium containing cause a laxative effect and aluminium containing cause constipation
Why should you be aware of the sodium content of some antacids?
patient may be on a salt restricted diet, undesirable in those with: liver/renal/cardiac conditions, those with hypertension and in pregnancy
What is the definition of low sodium?
less than 1mmol per tablet or 10ml dose
What are some problems caused by interaction with antacids?
may impair absorption of other drugs, may damage enteric coating by raising pH
What drug is used in combination with antacids and what is its purpose?
alginates, increases viscosity of stomach contents
What do histamine receptor antagonists do?
Reduce gastric acid output by blocking histamine H2 receptor
What are H2 receptor antagonists licensed for?
GORD, NSAID prophylaxis, functional dyspepsia, stress ulcers, peri-operatively for those who are nil to mouth
Give 4 drugs that Cimetidine interacts with
warfarin (inhibits metabolism, increases INR), phenytoin (inhibits metabolism, increases plasma conc) , theophylline (inhibits metabolism, increases plasma conc), sildenafil (increases plasma conc)
What do PPIs do?
block final pathway in production of gastric acid so block gastric H,K-ATPase, inhibiting gastric acid secretion
What are some indications of PPIs?
dyspepsia, GORD, treatment of gastric and duodenal ulcers, maintenance treatment, NSAID prophylaxis, excessive gastric excretion, stress ulcer prophylaxis
Long term PPI therapy can cause achlorhydria and this is associated with increased risk of what conditions?
gastric cancer, H pylori, pneumonia. C difficile infection, bacterial overgrowth and reduced calcium absorption leading to hip fracture
What drugs to PPIs interact with?
antiretrovirals, methotrexate, citalopram, omeprazole
What is H. Pylori?
a gram negative bacteria which causes persistent infection in the gastro duodenal mucosa. A common cause of PUD
How is H. Pylori detected?
It produces an antibody response detectable in serum, saliva or urine and an antigen response which is detected in stool
What methods are used to test for H. Pylori?
urea breath test kits, stool test, mucosal biopsies, lab based serology, careful drug history
What are the characteristics of H. Pylori treatment?
simple, well tolerated, cost effective, easy to comply with
Describe H. Pylori treatment
First line is triple therapy which consists of a twice daily course of a PPI and 2 ABs. for example: PPI full dose BD, Amoxicillin BD, Clarithromycin BD or Metronidazole
What are the risk factors for an NSAID bleed?
60 years old, multiple NSAIDs, smoker, H pylori infection, concurrent medication including steroids & anticoagulants, higher dose/ longer duration
Describe the mechanism for NSAID induced ulcers
synthesis of prostaglandin is inhibited which impairs the mucosal defenses and causes an erosive breach of the protective layer of the GIT, the epithelial barrier.
How is NSAID induced PUD managed?
– stop NSAID if possible, test for H pylori, give full dose PPI or H2 receptor antagonist for 8 week, if H pylori present give eradication therapy, if you can’t stop NSAID then discuss potential harm and review regularly or reduce dose or select an alternative treatment.
What is Misoprostol and what is it used for?
a prostaglandin analogue with antisecretory and cytoprotective effects, good at preventing NSAID induced PUD
