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Gastric Acid Disorders Flashcards

1
Q

Symptoms of dyspepsia.

How long are these typically present?

A

Upper abdominal pain
Heartburn
Gastric reflux
Bloating
Nausea and vomiting

Typically present for 4 or more weeks.

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2
Q

Causes of dyspepsia

A

GORD
Peptic ulcer disease
Gastro-oesophageal malignancy
Side effects of drugs
Pregnancy - GORD
Functional dyspepsia = no cause found

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3
Q

Which medication can cause dyspepsia?

A

Alpha-blockers
Antimuscarinics
Aspirin
Corticosteroids
Nitrates
NSAIDs
Theophylline
TCAs

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4
Q

Urgent referral symptoms of dyspepsia

A

Gastrointestinal bleeding
Aged 55 years +
Unexplained weight loss
Dysphagia

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5
Q

Non-drug treatment of dyspepsia

A

Healthy eating
Weight loss if obese
Avoiding trigger foods
Eating smaller meals
Eating the evening meal 3-4 hours before bed
Raising the head of the bed
Smoking cessation
Reducing alcohol consumption
Asses for anxiety or depression
Review medication

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6
Q

Short term drug treatment of dyspepsia

A

Antacids and/or alginates

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7
Q

Short term drug treatment of uninvestigated dyspepsia

A

PPI for 4 weeks first
Test for H. pylori if PPI doesn’t work – treat if positive

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8
Q

Drug treatment of functional dyspepsia

A

No infection/cause: 4 weeks of PPI or H2 receptor antagonist

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9
Q

Treatment of uninvestigated functional dyspepsia

A

Use PPI at lowest effective dose on a PRN basis

Patients require an annual medication review with a step down approach or stopping treatment should be encouraged

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10
Q

Management if patient has dyspepsia and is taking NSAIDs or aspirin

A

If using NSAID = switch to paracetamol or a selective COX-2 inhibitor

If taking aspirin = consider switching to another antiplatelet

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11
Q

Most common cause of H.pylori infection

A

Peptic ulcers

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12
Q

Diagnostic test for H.pylori

A

Urea (13C) breath test or stool helicobacter antigen test (SAT)

Stop PPI 2 weeks before test
Stop antibiotics 4 weeks before test

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13
Q

How long before testing for H.pylori should PPIs be stopped?

A

2 weeks

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14
Q

How long before testing for H.pylori should antibiotics be stopped?

A

4 weeks

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15
Q

Treatment of H.pylori infection

A

Triple therapy: PPI + 2 antibiotics

PPI: BD
Amoxicillin: 1000mg BD
Clarithromycin: 500mg BD
Metronidazole: 400mg BD

PAC, PAM or PCM

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16
Q

Duration of H.pylori treatment

A

7 days

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17
Q

What is GORD?

A

Chronic condition where there is reflux of gastric contents (bile, acid and pepsin) back into the oesophagus, causing heartburn or acid regurgitation

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18
Q

Less common symptoms of GORD

A

Chest pain
Hoarseness
Cough
Wheezing
Asthma
Dental erosions

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19
Q

What would the endoscopy show in non-erosive GORD?

A

Normal results

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20
Q

What would the endoscopy show in erosive oesophagitis GORD?

A

Oesophageal inflammation and mucosal erosions

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21
Q

Causes of GORD

A

Consuming fatty foods
Pregnancy
Hiatus hernia
Family history
Stress and anxiety
Obesity
Drug side effects
Alcohol
Smoking

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22
Q

Drugs that can cause GORD

A

a/b-blockers
CCBs
Anticholinergics
Benzos
Bisphosphonates
Corticosteroids
NSAIDs
Nitrates
TCAs

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23
Q

How do nitrates cause GORD?

A

Loosens up sphincter between windpipe and stomach = more acid bounce back in

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24
Q

Complications of GORD

A

Oesophageal inflammation
Ulceration
Haemorrhage and stricture formation
Anaemia due to chronic blood loss
Aspiration pneumonia
Barrett’s oesophagus

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25
Red flag symptoms of GORD
Gastrointestinal bleeding Aged 55 years + Unexplained weight loss Dysphagia
26
Lifestyle advice for GORD
Healthy eating Weight loss (if obese) Avoiding any trigger foods Eating the evening meal 3-4 hours before going to bed Raiding the head of the bed Smoking cessation Reducing alcohol consumption
27
Treatment of uninvestigated GORD
Treated the same as uninvestigated dyspepsia Use PPI at lowest effective dose on a PRN basis
28
Treatment of endoscopy confirmed GORD
PPI for 4-8 weeks
29
Treatment of severe oesophagitis
PPI for 8 weeks
30
Treatment of GORD in pregnancy
Dietary and lifestyle advice Antacid or an alginate Omeprazole or ranitidine (unlicensed)
31
Follow up management of GORD
Assess for new alarm symptoms Prescribing further course of the initial PPI for 1 month Double the initial dose of PPI for 1 month Reinforce lifestyle advice
32
Management of nocturnal symptoms of GORD
Addition of a H2-receptor antagonist at bedtime
33
Treatment if symptoms of diagnosed GORD recur after initial treatment
PPI at lowest effective dose on a PRN basis
34
Management of treatment failure of severe oesophagitis
Higher dose of same PPI or switch to a different PPI
35
What is a peptic ulcer?
Gastric or duodenal ulceration which is a breach in the epithelium or the gastric or duodenal mucosa
36
Symtpoms of a peptic ulcer
Abdominal pain Nasua Indigestion Heartburn Loss of appetite Weight loss Bloating
37
Causes of a peptic ulcer
NSAID use H.pylori infection Smoking Alcohol consumption
38
Complications of a peptic ulcer
GI perforation and haemorrhage
39
Risk factors of a peptic ulcer
>65 years High dose or prolonged NSAID use Other drugs which increase the risk of GI side effects (anticoagulants, corticosteroids, SSRIs) CVD, HTN, Diabetes, renal or hepatic impairment Heavy smoker Excessive alcohol consumption
40
Non-drug treatment of peptic ulcers
Healthy eating Weight loss if obese Avoid trigger foods Eating smaller meals Eating the evening meal 3-4 hours before going to bed Raising the head of the bed Smoking cessation Reducing alcohol consumption Assess for: stress, anxiety or depression
41
Red flag symptoms for peptic ulcers
Dysphagia Significant acute GI bleeding >55 years Unexplained weight loss Symptoms of upper abdominal pain Reflux Dyspepsia
42
Initial management of peptic ulcers
Review and stop drugs that induce peptic ulcers Antacids and/or alginates may be used in the short-term Test for H.pylori infection
43
Medications that can induce peptic ulcers
NSAIDs, aspirin, bisphosphonates, corticosteroids, potassium chloride, SSRIs, recreational drugs
44
Treatment of peptic ulcer with confirmed H.pylori infection
H.pylori eradication treatment
45
Treatment of peptic ulcer associated with NSAID use
PPI used for 8 weeks If H.pylori positive: followed by H.pylori eradication
46
Treatment of peptic ulcer with negative H.pylori test and no hx of NSAID use
PPI for 4-8 weeks
47
Follow up after treating peptic ulcer with confirmed H.pylori infection
Reviewed 6-8 weeks after starting eradication treatment and re-tested depending on the size of the lesion
48
Follow up after treating gastric ulcer with confirmed H.pylori infection
Repeat endoscopy 6-8 weeks after treatment to confirm ulcer healing, depending on the size of the lesion
49
Management once ulcer is healed and patient wishes to continue NSAID use
Discuss harm potential Review need 6 monthly PRN basis Reduce dose Substitute with paracetamol Consider COX-2 inhibitor instead of standard NSAID Co-prescribed gastric protection with PPI
50
Treatment if symptoms recur after initial treatment
PPI at lowest dose possible to control symptoms on PRN basis
51
Management of persistent or an unhealed ulcer
Reinforce lifestyle advice and adherence to medication Assess for other causes
52
Examples of antacids and their effects
Magnesium-containing antacids: laxative Aluminium-containing antacids: constipating Calcium-containing antacids: induces rebound acid secretion Semeticone: antifoaming agent which is added to antacid = relieves flatulence Alginates and antacid increases the viscosity of stomach content which forms a viscous gel (raft) that floats on the surface of the stomach contents
53
Interactions of antacids
Enteric coated drugs as they increase stomach pH Sodium content - lithium, HTN Impairs absorption of; bisphosphonates, tetracyclines, ciprofloxacin
54
Which antacids has low sodium content
Co-magaldrox (Magensium + Aluminium salt)
55
Examples of PPIs
Omep, esomep, lansop, rabeprazole
56
MHRA warning of PPIs
Low risk of subacute cutaneous lupus erythematosus
57
PPI side effects
Increase risk of fractures / osteoporsosis Hypomagnesaemia and hyponatraemia Increase risk of C.diff Mask symptoms of gastric cancer
58
PPI interactions
Esomep/Omep and clopi = use lansop instead Increase conc. of methotrexate, phenytoin, warfarin, and digoxin (enzyme inhibitor)
59
Examples of H2 antagonists
Ranitidine, cimetidine, famotidine, nizatidine
60
Examples of H2 antagonists
Ranitidine, cimetidine, famotidine, nizatidine
61
Cautions of H2 antagonists
May mask symptoms of gastric cancer Rule of alarm features of cancer before treatment
62
Side effects of H2 antagonists
Diarrhoea, headache, dizziness, rash, and tiredness
63
Cimetidine interactions
CYP450 enzyme inhibitor
64
Which PPI is safe to use in pregnancy?
Omeprazole

GI (15 decks)

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