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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
Q

Red flag symptoms of GORD

A

Gastrointestinal bleeding
Aged 55 years +
Unexplained weight loss
Dysphagia

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26
Q

Lifestyle advice for GORD

A

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
Q

Treatment of uninvestigated GORD

A

Treated the same as uninvestigated dyspepsia

Use PPI at lowest effective dose on a PRN basis

28
Q

Treatment of endoscopy confirmed GORD

A

PPI for 4-8 weeks

29
Q

Treatment of severe oesophagitis

A

PPI for 8 weeks

30
Q

Treatment of GORD in pregnancy

A

Dietary and lifestyle advice
Antacid or an alginate
Omeprazole or ranitidine (unlicensed)

31
Q

Follow up management of GORD

A

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
Q

Management of nocturnal symptoms of GORD

A

Addition of a H2-receptor antagonist at bedtime

33
Q

Treatment if symptoms of diagnosed GORD recur after initial treatment

A

PPI at lowest effective dose on a PRN basis

34
Q

Management of treatment failure of severe oesophagitis

A

Higher dose of same PPI or switch to a different PPI

35
Q

What is a peptic ulcer?

A

Gastric or duodenal ulceration which is a breach in the epithelium or the gastric or duodenal mucosa

36
Q

Symtpoms of a peptic ulcer

A

Abdominal pain
Nasua
Indigestion
Heartburn
Loss of appetite
Weight loss
Bloating

37
Q

Causes of a peptic ulcer

A

NSAID use
H.pylori infection
Smoking
Alcohol consumption

38
Q

Complications of a peptic ulcer

A

GI perforation and haemorrhage

39
Q

Risk factors of a peptic ulcer

A

> 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
Q

Non-drug treatment of peptic ulcers

A

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
Q

Red flag symptoms for peptic ulcers

A

Dysphagia
Significant acute GI bleeding
>55 years
Unexplained weight loss
Symptoms of upper abdominal pain
Reflux
Dyspepsia

42
Q

Initial management of peptic ulcers

A

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
Q

Medications that can induce peptic ulcers

A

NSAIDs, aspirin, bisphosphonates, corticosteroids, potassium chloride, SSRIs, recreational drugs

44
Q

Treatment of peptic ulcer with confirmed H.pylori infection

A

H.pylori eradication treatment

45
Q

Treatment of peptic ulcer associated with NSAID use

A

PPI used for 8 weeks

If H.pylori positive: followed by H.pylori eradication

46
Q

Treatment of peptic ulcer with negative H.pylori test and no hx of NSAID use

A

PPI for 4-8 weeks

47
Q

Follow up after treating peptic ulcer with confirmed H.pylori infection

A

Reviewed 6-8 weeks after starting eradication treatment and re-tested depending on the size of the lesion

48
Q

Follow up after treating gastric ulcer with confirmed H.pylori infection

A

Repeat endoscopy 6-8 weeks after treatment to confirm ulcer healing, depending on the size of the lesion

49
Q

Management once ulcer is healed and patient wishes to continue NSAID use

A

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
Q

Treatment if symptoms recur after initial treatment

A

PPI at lowest dose possible to control symptoms on PRN basis

51
Q

Management of persistent or an unhealed ulcer

A

Reinforce lifestyle advice and adherence to medication

Assess for other causes

52
Q

Examples of antacids and their effects

A

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
Q

Interactions of antacids

A

Enteric coated drugs as they increase stomach pH

Sodium content - lithium, HTN

Impairs absorption of; bisphosphonates, tetracyclines, ciprofloxacin

54
Q

Which antacids has low sodium content

A

Co-magaldrox (Magensium + Aluminium salt)

55
Q

Examples of PPIs

A

Omep, esomep, lansop, rabeprazole

56
Q

MHRA warning of PPIs

A

Low risk of subacute cutaneous lupus erythematosus

57
Q

PPI side effects

A

Increase risk of fractures / osteoporsosis
Hypomagnesaemia and hyponatraemia
Increase risk of C.diff
Mask symptoms of gastric cancer

58
Q

PPI interactions

A

Esomep/Omep and clopi = use lansop instead

Increase conc. of methotrexate, phenytoin, warfarin, and digoxin (enzyme inhibitor)

59
Q

Examples of H2 antagonists

A

Ranitidine, cimetidine, famotidine, nizatidine

60
Q

Examples of H2 antagonists

A

Ranitidine, cimetidine, famotidine, nizatidine

61
Q

Cautions of H2 antagonists

A

May mask symptoms of gastric cancer

Rule of alarm features of cancer before treatment

62
Q

Side effects of H2 antagonists

A

Diarrhoea, headache, dizziness, rash, and tiredness

63
Q

Cimetidine interactions

A

CYP450 enzyme inhibitor

64
Q

Which PPI is safe to use in pregnancy?

A

Omeprazole

GI (15 decks)

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