Gastric Acid Disorders + Ulceration Flashcards
what is dyspepsia
indigestion
symptoms of dyspepsia
- upper abdominal pain
- heartburn
- gastric reflux
- bloating
- N+V
red flags / urgent referral symptoms of dyspepsia
- GI bleeding
- 55+
- unexplained weight loss
- dysphagia
uninvestigated dypepsia tx
- PPI for 1st 4 weeks
- test for H.pylori if PPI didn’t work
investigated but no cause present
functional dyspepsia
recurrent
- test for h.pylori
- not infected = 3 weeks of PPI or H2 receptor antagonist
what is most common cause of peptic uclers
h.pylori
how is H.pylori diagnosed
- with urea (13C) breath test or Stool Helicobacter Antigen Test (SAT)
what should be stopped before testing for h.plyori
- PPI stopped 2 weeks before
- antibiotics 4 weeks before
tx of h.pylori
- PPI = BD
- Amoxicillin = 1000mg BD
- Clarithromycin = 500mg BD
- Metronidazole = 400mg BD
Duration of H.pylori tx
7 days
Gastro-Oseophageal Reflux Disease
urgent / red flags of GORD
- GI bleeding
- 55+
- unexplained weight loss
- dysphagia
what increases GORD symptoms
- fatty foods
- pregnancy
- hiatus hernia
- family history
- stress, anxiety
- obesity
- medication s/e
- smoking + alcohol
hiatus hernia = part of stomach moves to chest
which medications increases GORD as a s/e
- ablocker
- bblocker
- CCB
- anticholingeric
- benzo
- bisphosphates
- corticosteroids
- NSAIDs
- nitrates
- TCA
GORD 1st line
offer lifestyle advice first
- healthy eating
- weight loss (obese)
- avoid triggering food
- smaller meals
- evening meals 3-4hr before sleep
- raising head of bed
- smoking cessation
- less alcohol consumption
uninvestigated + confirmed GORD
tx of GORD
- medication review if taking exacerbating drugs
- uninvestigated GORD = 4WK PPI + test for h.pylori
- confirmed GORD = 4-8WK of PPI
GORD + Pregnancy tx
-lifestyle + dietary
-antacid / alginate
-omeprazole or ranitidine
what are the different types of antacids and what does it cause
- mg containing (diarrhoea)
- aluminium containg (constipation)
- calcium containing (induces rebound acid secretion)
what is added to antacids and why
simeticone (antifoaming agent) to relieve flatulence
how does alignates and antacids works
- increases viscosity of stomach content
- forms viscous gel (raft) that floats on surface of stomach content
interactions of antacids
- increases pH of stomach (more alkali) which damages enteric coated capsules before reaching intestine
- check Na content of antacid - interacts with Lithium in hypertension
- do not take with other drugs = impair absorption e.g. bisphosphonates, tetracyclines or ciprofloxacin
which antacid contains low sodium
co-magaldrox
examples of PPI
- omeprazole
- esomeprazole
- lansoprazole
- rabeprazole
PPI MHRA warning
low risk of subacute cutaneous lupus erythematosus
PPI risks
- increases risk of factures/oestoprosis = due to hypomagnaesmia
- high risk of c.diff
- masks symptoms of gastric cancer
