Gastric Acid Disorders And Ulcerations Flashcards
What is meant by dyspepsia
Upper abdominal pain, heartburn, gastric reflux, bloating, nausea and vomiting
What are the urgent referral symptoms of dyspepsia
Gastrointestinal bleeding
Aged 55 years +
Unexplained weight loss
Dysphagia
What is the drug treatment of dyspepsia
Univestigated dyspepsia
- PPI for 4 weeks first
- test for h.pylori if ppi doesnt work- treat if positive
Functional dyspepsia ( investigated but no cause present)
- test for H.pylori- treat if positive
Not infected: 3 weeks of PPI of H2 receptor antagonist
What is h.pylori infection
It is the most common cause of peptic ulcers
Diagnosis:
- diagnosed with Urea (13c) breath test or stool helicobacter antigen (SAT)
- PPIs should have ben stopped 2 weeks before the test
-antibiotics should have been stopped 4 weeks before the test
What is the drug treatment of h.Pylori
Treated with triple therapy (PPI and 2 other antibiotics)
-PPI twice daily
Amoxicillin: 1000mg BD (use other two in penicillin allergy)
Clarithromycin: 500mg BD for 7 days
Metronidazole: 400mg BD for 7 dats
The different combination ( P= PPI A= amoxicillin. M=metrondiazole )
PAC
PAM
PCM
What increases gastro-oesophageal reflux disease
Increased with:
- consuming fatty foods
Pregnancy
Hiatus hernia
Family history
Stress and anxiety
Obesity
Drug side effects ( a/b blockers, CCBs, anticholinergics, benzodiazepines, bisphosphonates, corticosteroids, NSAIDs, nitrates and TCAs
Smoking
Alcohol
It has the same urgent referral as dyspepsia
Why does nitrates cause GORD
As it loosen up the sphincter leading to more acid in the oesophagus
What is the non-drug treatment for GORD
Offer lifestyle advice first
- healthy eating
Weight lose if obese
Avoid triggering 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
What is the drug treatment of GORD
Do a medicine review if taking a drug that exacerbates GORD
-univestigated GORD treated the same as uninvestigated dyspepsia
Confirmed GORD treated with 4-8 weeks of PPI
What is the treatment of GORD if someone is pregnant
Dietary and lifestyle advice
Antacids or an alginate
Omperazole or ranitidine
What are antacids and what do they cause
Magnesium containing antacids: laxatives
Aluminium containing antacids: constipating
Calcium containing antacids: induces rebound acid secretion
Simeticone (antifoaming agent) added to antacid - relieves flatulence
Alginates + antacids increases the viscosity of stomach content
- forms a viscous gel (‘raft’) that floats on the surface of the stomach contents
What are antacids interactions
Increase the pH (more alkaline) meaning enteric coated capsules are damaged before reaching the intestine
-check sodium contents of antacids- not to be taken with lithium or in hypertension
- low sodium: co-magaldrox
Antacids should not be taken with other drugs due to causing impairing absorption
-biphosphonates, TCAs, Ciprofloxacin
What are PPIs
Omeprazole, esomeprazole, lansoprazole, rabeprazole
What are the MHRA warnings of PPIs
Low risk of subacute cutaneous lupus erthematosus
What are the side effects of PPIs
Increase risk of fractures/ osteoporosis
- due to hypomagnesaemia
There is an increase risk of C.DIffe
Can mask the symptom of gastric cancer
