Indigestion and heartburn Flashcards
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Outline what indigestion is and causes
- A pain or discomfort which occurs when food/drink is not digested properly medically known as dyspepsia
- Food
- Smoking
- Stress
- Undiagnosed gastrointestinal condition
- Medicines
Outline signs and symptoms of indigestion
- Discomfort in the stomach
- Pain in the chest
- Loss of appetite
- Bloated sensation or feeling
- Heartburn (see later slides for comparison)
- Nausea and vomiting
Outline what heartburn is
- When acid from the stomach escapes and moves back up in to the oesophagus
- The acid then causes pain, irritation and discomfort from bottom of chest and maybe up to back of throat
- Known as gastro-oesophageal reflux
Outline signs and symptoms of hearburn
- Painful or tightening sensation in the throat
- Taste of acid in the back of the throat
- Taste of regurgitated food in the back of the throat
- Burning sensation in the chest
Symptoms made worse by bending or lying down
Outline when to refer of indigestion and heartburn 1
- Symptoms not related to food and drink
- First onset of symptoms in middle age
- Symptoms after exercise
- Pain in chest and particularly left arm
2
- Unexplained weight loss
- Recurrent or continuous symptoms for 5 days
- Blood in vomit or stools
- Treatment failure
- Children
Outline other potential causes/concerns of indigestion
- Ulcers
- Gallstones
- Gastro-oesophageal reflux
- Irritable bowel syndrome
- Angina
- Cancer
Outline other potential causes/concerns of heartburn
- Heart attack
- Oesophagitis
- Dysphagia
- Regurgitation
- Pregnancy
Outline patients who are most likely to be affected by indigestion and heartburn
- People who eat hot and spicy food
- Overweight people
- Pregnant women
- Elderly People
- People who take certain medications (e.g. ibuprofen/aspirin etc.)
- People who eat larger meals (particularly late at night)
Outline 1 type of treatment option for indigestion and hearburn
- Antacids which work by neutralising the excess acid
in the stomach - Common antacids include:
Calcium carbonate,
Magnesium salts,
Sodium bicarbonate - E.g. Rennie, Gaviscon, Peptac
Outline the recommended dose for 2 common antacids
- Rennie (calcium carbonate, magnesium carbonate)
- 2 tablets sucked or chewed 1 hour before eating or bed. Max 10 tabs per day
- Gaviscon tablets (Sodium Alginate, Sodium Hydrogen Carbonate and Calcium Carbonate).
- 2 to 4 tablets after meals and at bedtime
Outline the recommended dose for the other 2 common antacids
- Peptac (sodium alginate, sodium bicarbonate and calcium carbonate)
- 10-20ml after meals and at bedtime
- Bisodol tablets (Sodium Bicarbonate, Calcium Carbonate and light Magnesium Carbonate)
- Suck or chew one or two tablets as required.
Outline the concerns of antacids
- Side effects: Constipation or diarrhoea
- Calcium based products can cause kidney problems if misused
- Very high amounts of salt in sodium based products
- Can affect other medications
- Risk of osteoporosis if certain types misused
Outline another treatment option for indigestion and heartburn
Alginates which works by forming a layer on top of the oesophagus and the
excess stomach acid
Common examples are:
* Potassium Alginate
* Sodium Alginate
* E.g. Gaviscon Advance
Outline the recommended dose for 2 common alginates
- Gaviscon original (500mg sodium alginate, 267mg sodium bicarbonate and 160mg calcium carbonate)
- Take 10-20ml (two to four 5ml spoonfuls) after meals and at bedtime.
- Gaviscon Double Action (500mg Sodium alginate, 213mg Sodium bicarbonate and 325mg Calcium
carbonate.) - Take 10-20ml (two to four 5ml spoonfuls) after meals and at bedtime, up to four times a day.
Outline the recommended dose for 2 other common alginates
- Gaviscon Advance (sodium alginate 1000 mg and potassium hydrogen carbonate 200 mg)
- Take 5-10 ml (one to two 5 ml spoonfuls) after meals and at bedtime. Shake well before use.
- Peptac (sodium alginate, sodium bicarbonate and calcium carbonate)
- 10-20ml after meals and at bedtime
Outline the concern of alginates
- Taste and viscosity can affect compliance
- Mechanism poorly understood by patients can reduce effectiveness
- Have high levels of potassium or sodium
Outline another tratment option for indigestion and heartburn
PPI’s more favourable
* Not suitable for long term use
* May mask side effects of other medicines
* Do not provide rapid relief
* Not recommended for pregnancy or breastfeeding
Outline another tratment option for indigestion and heartburn
- Proton Pump inhibitors (PPIs) which work on the same acid production pathway as H2 antagonists but at a
different site in the stomach to reduce acid production - Highly effective treatment that can last
up to 24 hours
Examples include - Nexium Control
- Guardium
- Pyrocalm Control
- Pantoloc control 20mg
Outline the recommended dose for PPIs
Guardium and Nexium (esomeprazole 20mg)
* Take 1 tablet per day. Do not exceed this dose
Pyrocalm Control (generic omeprazole 20mg)
* Take 1 tablet per day. Do not exceed this dose
Pantoloc control 20mg (pantoprazole 20mg)
* Take 1 tablet per day. Do not exceed this dose
- May take 2-3 days to work
- Not suitable for long term use
- May mask side effects of other medicines
- Do not provide rapid relief
- Not recommended for pregnancy or breastfeeding
Outline another tratment option for indigestion and heartburn
Bismuth compounds which creates a thick coating to the lining of the stomach
to relieve burning sensation
* Product contains aspirin derivatives
Examples include
* Pepto-bismol
Outline the recommended dose for bismuth compounds
Pepto-Bismol Liquid (Bismuth Subsalicylate)
* 30ml in dosing cup and swallow. Repeat dosage every half to 1 hour
as needed. No more than 8 doses to be taken in 24 hours.
Outline potention concerns with bismuth compounds
- Same risks as with aspirin if taken by children
- Cant be taken by users of aspirin
- Can worse gout
- Not to be used during pregnancy and breastfeeding
- Can cause tongue and stools to darken or go black
- Can cause nausea and vomiting
- Tastes absolutely vile
- Superior products are available
Outline lifestlyle advice for indigestion and heartburn
- Antacids should be taken regularly whilst in use
- Help the patient choose the right formulation
- Avoid lying down after eating
- Avoid oily/spicy foods
- Avoid eating late at night
- Reduce alcohol consumption
- Stop smoking
- Raise head of bed whilst sleeping
- Food diaries may be helpful in identifying triggers
