GASTRIC ACID DISORDERS + ULCERATION Flashcards
Dyspepsia
Upper abdominal pain
heartburn
gastric reflux
bloating
nausea and vomiting
Dyspepsia - red flags
- Gastrointestinal Bleeding
- Aged 55 Years +
- Unexplained Weight Loss
- Dysphagia
GAUD
Uninvestigated dyspepsia
describes symptoms in patients who have not had an endoscopy.
Uninvestigated Dyspepsia - Treatment
- PPI for 4 weeks first
- Test for H. pylori if PPI didn’t work - treat if positive
Functional Dyspepsia (investigated but no cause present)
Test for H. pylori - treat if positive
Not infected: 3 weeks of PPI or H2 receptor antagonist
H.Pylori
Most common causes of peptic ulcer disease
H.pylori - when do you test pt?
- uncomplicated dyspepsia who are unresponsive to lifestyle changes and antacids, following 4 week PPI
- high risk of H. pylori infection (such as older people, individuals of North African ethnicity, and those living in a known high risk area)
- Previously untested patients with a history of peptic ulcers or bleeds;
- Prior to initiating NSAIDs in patients with a prior history of peptic ulcers or bleeds;
- Patients with unexplained iron-deficiency anaemia after endoscopic investigation has excluded malignancy, and other causes have been investigated.
H.Pylori - diagnosis
Urea (13C) breath test
Stool Helicobacter Antigen Test (SAT)
PPI stopped 2 weeks before test
Abx stopped 4 weeks before test
H.Pylori - triple therapy treatment
Treated with Triple Therapy (PPI and 2 of the antibiotics):
- PPI: BD
- Amoxicillin: 1000mg BD
- Clarithromycin: 500mg BD
FOR 7 DAYS
- Metronidazole: 400mg BD
PAC
PAM
PCM
GORD
Gastro-Oesophageal Reflux Disease
GORD - risk factors
Increased with:
* Consuming Fatty Foods
* Pregnancy
* Hiatus Hernia
* Family History
* Stress And Anxiety
* Obesity
* Drug Side-effects
* Smoking, Alcohol
GORD - red flags
SAME URGENT REFERRAL
CRITERIA AS DYSPEPSIA
GORD - which drugs have a side effect of GORD?
a/b-blockers, CCBs, anticholinergics, benzos, bisphosphonates, corticosteroids, NSAIDs, nitrates, and TCAs, alendronic acid
GORD - non-drug treatment
1st line: lifestyle advice
Healthy eating
Weight loss (if obese)
Avoiding any 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
uninvestigated GORD - treatment
Medicine review if taking a drug that exacerbates GORD
* PPI for 4 weeks first
* Test for H. pylori if PPI didn’t work - treat if positive
Confirmed GORD - treatment
treated with 4-8 weeks of PPI
Dyspepsia - pregnancy
Dyspepsia symptoms in pregnancy are commonly due to gastro-oesophageal reflux disease (GORD)
Dyspepsia in pregnancy - treatment
- 1st line: Dietary and lifestyle advice
- No response = an antacid or an alginate can be used.
- If this is ineffective or symptoms are severe omeprazole or ranitidine (unlicensed)
Antacids - examples
Magnesium-containing antacids: Laxative
Aluminium-containing antacids: Constipating
Calcium-containing antacids: Induces rebound acid secretion
Simeticone (antifoaming agent) added to antacid →
relieves flatulence
Alginates + antacid
increases the viscosity of stomach content
form a viscous gel (‘raft’) that floats on the surface of the stomach contents
Antacids Interactions
- Increase the stomach pH (more alkali) meaning enteric coated capsules are damaged before reaching the intestine
- Check sodium content of antacid - not to be taken with lithium / in hypertension
> Low sodium: co-magaldrox - Antacids not to be taken with other drugs due to impairing absorption
Bisphosphonates, Tetracyclines, Ciprofloxacin
Antacids and enteric coated capsules
Increase the stomach pH (more alkali) meaning enteric coated capsules are damaged before reaching the intestine
Antacids and sodium
- Check sodium content of antacid - not to be taken with lithium / in hypertension
> Low sodium: co-magaldrox
