Heartburn and indigestion

Question 1

What are symptoms of heartburn and indigestion?

Answer 1

Heartburn: burning discomfort
pain felt all the way in the stomach (behind breastbone) to oesophagus
acid taste in mouth

Indigestion: pain from the chest to upper abdomen and lower ab symptoms

Question 2

What age is heartburn and indigestion common in?

Answer 2

55 years of age and pregantn women

Question 3

When to refer?

Answer 3

• children
• when pain radiates to the back and arms check for any underlying conditions
• difficulty swallowing
• regurgitation
• drugs can cause symptoms - antidepressants, CCBs, NSAIDs, caffeine
  persistent pain that originates from one point in the abdomen
• new or recent changes in pt over 55
• pt over 5 taking OTC emeds should inform docto
• previous gastric ulcer
• pts taking symptomatic tx of indigestion or heartburn for 4 or more weeks
• pt with jaundice or liver disease

Question 4

Tx?

Answer 4

Antacids - neutralise excess acid
Alginates - raft that sits on the surface of the stomach contents prevents reflux
H2 antagonist - short term max 14 days, effects last up to 9 hours
PPIs, takes 1-3 days for full effect, inhibit CYP450 so interact with warfarin, phenytoin, diazepam

Question 5

What are side effects?

Answer 5

H2 antagonists causes headache, dizziness, diarrhoea, skin rashes - uncommon

PPIs - headache, abdominal pain, constipation, diarrhoea, flatulence, N/V

Question 6

What are OTC preps?

Answer 6

Gaviscon, Peptac, rennies, tums
zantac, pantoloc
Nexium control

Question 7

Counselling points?

Answer 7

H/I - triggered by bending, lying down or even slumping in a chair - avoid these positions

• raising head of the bed or using pillows to lift body helps to prevent acid reflux whilst sleeping
• tight clothing triggers symptoms
• excess weight increases risk of symptoms
• pregannt women, elderly and HTN pts wih HB - a sodium free or low sodium antacid prep containing alginate
• small meals eaten frequently are better than large meals, high fat meals take longer to digest
• smoking, alcohol, caffeine, chocoalte

Question 8

What age can antacids be used?
what can they interact with?
P/BF?

Answer 8

> 12 years
tetracyclines/quinolones, phenytoin, penicillamine, biphosphonates, imidazoles

ok

Question 9

What age are alginates used?

Answer 9

> 12 years ok in BF/P

Question 10

What age are h2 antaognists used

ok in bf/p?

Answer 10

> 16 years

ok

Question 11

age for PPI?

ok in bf and P?

Answer 11

> 18 years

avoid