Indigestion and heartburn Flashcards

1
Q

**

Outline what indigestion is and causes

A
  • A pain or discomfort which occurs when food/drink is not digested properly medically known as dyspepsia
  • Food
  • Smoking
  • Stress
  • Undiagnosed gastrointestinal condition
  • Medicines
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2
Q

Outline signs and symptoms of indigestion

A
  • Discomfort in the stomach
  • Pain in the chest
  • Loss of appetite
  • Bloated sensation or feeling
  • Heartburn (see later slides for comparison)
  • Nausea and vomiting
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3
Q

Outline what heartburn is

A
  • 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
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4
Q

Outline signs and symptoms of hearburn

A
  • 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
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5
Q

Outline when to refer of indigestion and heartburn 1

A
  • Symptoms not related to food and drink
  • First onset of symptoms in middle age
  • Symptoms after exercise
  • Pain in chest and particularly left arm
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6
Q

2

A
  • Unexplained weight loss
  • Recurrent or continuous symptoms for 5 days
  • Blood in vomit or stools
  • Treatment failure
  • Children
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7
Q

Outline other potential causes/concerns of indigestion

A
  • Ulcers
  • Gallstones
  • Gastro-oesophageal reflux
  • Irritable bowel syndrome
  • Angina
  • Cancer
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8
Q

Outline other potential causes/concerns of heartburn

A
  • Heart attack
  • Oesophagitis
  • Dysphagia
  • Regurgitation
  • Pregnancy
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9
Q

Outline patients who are most likely to be affected by indigestion and heartburn

A
  • 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)
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10
Q

Outline 1 type of treatment option for indigestion and hearburn

A
  • 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
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11
Q

Outline the recommended dose for 2 common antacids

A
  • 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
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12
Q

Outline the recommended dose for the other 2 common antacids

A
  • 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.
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13
Q

Outline the concerns of antacids

A
  • 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
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14
Q

Outline another treatment option for indigestion and heartburn

A

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

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15
Q

Outline the recommended dose for 2 common alginates

A
  • 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.
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16
Q

Outline the recommended dose for 2 other common alginates

A
  • 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
17
Q

Outline the concern of alginates

A
  • Taste and viscosity can affect compliance
  • Mechanism poorly understood by patients can reduce effectiveness
  • Have high levels of potassium or sodium
18
Q

Outline another tratment option for indigestion and heartburn

A

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

19
Q

Outline another tratment option for indigestion and heartburn

A
  • 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
20
Q

Outline the recommended dose for PPIs

A

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
21
Q

Outline another tratment option for indigestion and heartburn

A

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

22
Q

Outline the recommended dose for bismuth compounds

A

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.

23
Q

Outline potention concerns with bismuth compounds

A
  • 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
24
Q

Outline lifestlyle advice for indigestion and heartburn

A
  • 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