Gastric acid and ulceration Flashcards
What are symptoms of dyspepsia?
- abdominal pain
- fullness
- early satiety
- bloating
- nausea
How do you treat uninvestigated dyspepsia?
- Antacids for symptom relief
- PPI for 4 weeks if symptoms persist
- H. Pylori test if no response to ppi
How do you treat investigated dyspepsia?
- H. Pylori test
- PPI or H2 antagonist for 4 weeks
Which antacids can cause constipation?
Aluminium
Which antacids can sometimes be a laxative?
Magnesium
What interacts with antacids?
- Tetrracyclines
- Quinolones (ciprofloxacin)
- Bisphosphonates
Leave 2 hour gap
What can prolonged high doses of calcium containing antacids cause?
Hypercalcaemia
When should you avoid antacids?
- In a sodium restricted diet e.g. lithium
What are examples of alginates and how do they work?
- Alginic acid
- Sodium alginate
- Forms viscous gel raft on top of stomach to prevent reflux
How do PPIs work?
- Inhibit gastric secretion by blocking the proton pump
e.g. lanso (30-60 mins before food)
omeprazole
How long before or after taking PPIs should you not take indigestion remedies?
2 hours
What cautions come with PPIs?
- Mask symptoms of gastric cancer
- Increase risk of fractures and osteoporosis
- Increase risk of GI infections - c diff
What are the side effects of PPIs?
- Abdominal pain
- Constipation
- Diarrhoea
- Nausea
What can occur as long term effects of PPIs?
- Hypomagnasaemia
- Fractures
- Rebound acid secretion
What interacts with PPIs?
Omeprazole
- Clopidogrel - reduced antiplatelet effect
- Mtx - decreased clearance of mtx
What are examples of H2 receptor antagonists?
- Cimetidine
- Ranitidine
- Famotidine
- Nizatidine
What are the side effects of H2 receptor antagonists?
- Headache
- Rash
- Dizziness
- Diarrhoea
- Psychiatric reactions
What is the initial treatment for H. Pylori?
- Triple therapy (1 week) - PPI (bd) + clarithromycin + amox or metronidazole
if a pt has been treated with metro or clarithro for other infections, use the opposite one when treating this
What can be given as an alternative to metronidazole in the treatment of H Pylori?
- Tinidazole
How would you diagnose H. Pylori?
- C-Urea breath test kits
- Do not perform within 4 weeks of treatment with antimicrobial
Usually routine testing to confirm eradication of H Pylori is not needed. On which occasions would this be necessary?
- gastric MALT lymphoma
- If pt has ulcer
How do you treat NSAID-induced ulcers?
- Withdraw NSAID if possible
- PPI or H2 antagonist
- Test for H. Pylori on healing - if positive then triple therapy
- If history of upper GI bleed - give PPI and switch to paracetamol
Which patients are at high risk of developing NSAID induced ulceration?
- 65+
- previous history
- taking certain meds that increase GI complications
- Co morbidities - liver, kidney, heart, diabetes
What is given as prophylaxis treatment for NSAID induced ulcers?
- PPI or H2 antagonist/misoprostol
What would you do if a pt had 3 or more risk factors for developing an NSAID induced ulcer?
- PPI with COX-2 selective NSAID
What are symptoms of GORD?
- heartburn
- acid reflux
- sometimes difficulty swallowing
- ulceration
How do you treat mild symptoms of GORD?
- Antacids + alginates
- H2 receptor antagonist/PPI
How do you treat severe symptoms of GORD?
- PPI for 4-6 weeks
- Maintain remission with lower dose PPI, intermittent PPI or substitute with H2 receptor antagonist
What would you give for GORD in pregnancy?
- Antacids or alginates
- If ineffective - ranitidine
How would you treat mild to moderate GORD in children?
- Increase the volume of feed (e.g. with a feed thickener)
- alginate containing preparation
