Indigestion and Heartburn Flashcards
what are the symptoms of indigestion and heartburn?
Indigestion and heartburn have very similar symptoms and the terms are often used interchangeably.
- Indigestion refers to pain from the chest to the upper abdomen, with some symptoms felt in the lower abdomen.
- Heartburn is a burning pain which passes upwards through the oesophagus and can be felt underneath the neck. An acidic taste in the mouth can also be experienced.
red flag symptoms of indigestion and heartburn?
○ Children
○ New symptoms in patients >55 years of age (cancer)
○ Patients over the age of 55 years taking indigestion remedies on a daily basis
○ Previous gastric ulcer
○ Previous gastrointestinal surgery
○ Severe liver disease
○ Dysphagia
○ Regurgitation
○ Pain radiating to arms and/or back, especially if still there
after antacid use
○ Persistent vomiting
○ Gradual weight loss
○ Jaundice
○ Persistent pain in a specific part of the abdomen
○ Patient taking indigestion/heartburn remedies for a total of 4 weeks or longer
○ Over-the-counter medication failure
○ Patients taking drugs that can cause heartburn/indigestion as side effects
lifestyle advise for indigestion and heartburnt?
● Smoking cessation may help to reduce symptoms
● If a patient is overweight, symptoms may improve following weight loss.
● Raising the head of the bed or sleeping on more pillows may help prevent night-time
symptoms, so long as pressure is not increased to the waist
● Advise patients that bending, lying down or slumping in a chair may aggravate symptoms
○ It may be of use to avoid these positions, or to take preventative drugs before being in these positions, e.g.15-30 minutes before bed
● Tight clothing, especially belts, can aggravate symptoms, it may be advantageous for patients to try to wear looser clothes
● Small meals eaten regularly can be of benefit compared to eating larger meals
○ This reduces gastric distention (the enlargement of the stomach). This will mean
less stimulation of the secretion of stomach acid as a result.
● Avoidance of trigger foods can be of benefit, including:
○ Rich, spicy or fatty foods
■ Fatty foods take longer to digest and delay gastric emptying. They
therefore are exposed to stomach acid for a longer period than other foods.
○ Chocolate
○ Alcohol
○ Caffeine
what are the treatment options for indigestion and heartburn?
Antacids: Rennie®
Alginates: Gaviscon®
H2-antagonists: Ranitidine
Proton pump inhibitors (PPIs): Omeprazole, Esomeprazole, Pantoprazole
how do antacids work?
- Can be used to provide symptomatic relief and/or as prevention if taken before meals or before bedtime
- Combination antacid products are best taken to avoid gastrointestinal upset
○ Antacids containing magnesium salts alone may cause diarrhoea
○ Antacids containing aluminium salts alone may cause constipation
how do aliginates work?
● Prevent reflux and protect the oesophageal mucosa
● Form a raft on the contents of the stomach
when should aliginates be avoided?
○ Patients undertaking a low-sodium diet (e.g. those with heart failure or hepatic or renal impairment)
○ Patients undertaking a low-potassium diet
○ Hypercalcaemia
when should gaviscon not be used/
○ Children under 12 years of age
○ Patients with renal failure, nephrocalcinosis or kidney stones
how do H2-antagonists work?
- Histamine receptor antagonists
● Suppress the action of stomach acid
when should Ranitidine not be used?
Children under the age of 16 years ○ Pregnant women ○ Breastfeeding women ● Ranitidine should not be used in: ○ Children under the age of 12 ● OTC use is limited to 14 days
how do proton pump inhibitors work?
● Act by inhibiting the secretion of gastric acid via the blockage of the potassium adenosine triphosphatase enzyme system (the proton pump)
● Can be used in recurrent heartburn
● Can be used when required (PRN) and must be swallowed whole
which drugs can PPI delay the elimination of?
○ Clopidogrel ○ Methotrexate (this is a severely dangerous reaction as it would decrease the clearance of methotrexate, leading to toxic levels) ○ SSRIs ○ Diazepam ○ Digoxin ○ Warfarin ○ Tacrolimus ○ Itraconazole and ketoconazole
