Indigestion and heartburn Flashcards
Describe the difference(s) between indigestion and heartburn and any other terms used to describe them
- indigestion (dyspepsia) occurs after eating, excess acid is produced in the stomach
- heartburn (acid reflux): excessive acidic contents of stomach escape back up to oesophagus due to weakened or malfunctioning sphincter (valve)
What causes the symptoms in indigestion and heartburn?
Acid contacts oesophagus lining, causing irritation and associated symptoms
If treatment hasn’t been successful, after what period of time should a patient be referred to their GP?
If symptoms not responded to treatment, refer to GP after:
7 days for heartburn
5 days for indigestion
List the symptoms of indigestion
bloated feeling churning stomach stomach cramp pain (though usually less than heartburn) excess acid (leaving a nasty taste) dull stomach ache wind
List the symptoms of heartburn
severe pain in upper chest burning in the back of the throat taste of acid in the mouth burning pain rising up the throat stabbing pain in the chest excess acid symptoms worse after eating food
Questions to ask patient with suspected heartburn or indigestion
Could you explain where the pain starts and where you feel it?
Describe to me how your symptoms progress through the day?
Is the pain waking you at night? (Duodenal ulcer)
Red flag symptoms for indigestion and heartburn
list them
- symptoms persistent or recurrent (>2x in one week or lasting >5 days)
- severe pain or pain radiating to arms
- failed treatment or ADR
- pain or difficulty swallowing, dysphagia, or on effort
- regurgitation
- bleeding in vomit or stool
- unintentional weight loss
- anaemia (fatigue, pale skin)
- persistent vomiting
- shortness of breath
- children
- first time symptoms in those aged 45+
Indigestion and heartburn danger elimination
how to make sure it’s not an MI/angina?
pain radiating down the arm or pain on exertion?
Do they have nausea, vomiting, sweating or clammy skin? Crushing pain?
Indigestion and heartburn danger elimination
Oesophagitis
blood-stained vomit/stools
Indigestion and heartburn danger elimination
duodenal ulcers
gnawing, hunger-like pain, relieved by eating then recurs, causes sufferer to wake, blood in vomit or stools
Indigestion and heartburn danger elimination
gastric/peptic ulcer
worse after eating,nausea, salivation, bloating, weight loss, loss of appetite
Indigestion and heartburn danger elimination
gastric cancer
loss of appetite
anaemia
blood in stools/vomiting
unexplained weight loss
Indigestion and heartburn danger elimination
gallstones
stones form in gall bladder and block the bile duct in the liver, severe pain in upper abdomen which can be confused with a duodenal ulcer
Indigestion and heartburn danger elimination
IBS
colon spasms
alternating constipation and diarrhoea
Pain in lower abdomen and sometimes upper so confused with heartburn
How do histamine 2 receptor blockers work in the treatment of indigestion and heartburn?
block the histamine receptors in parietal cells to decrease the amount of acid produced
How do PPIs work in the treatment of indigestion and heartburn?
PPI=protein pump inhibitor
Shuts down proton pumps in parietal cells, preventing the acid from being secreted into the stomach
Lifestyle advice for indigestion and heartburn
- raise the bed or use an extra pillow as symptoms are worse when horizontal or bending
- stop smoking and reduce alcohol and caffeine intake
- avoid spicy and oily foods, or avoid specific known trigger foods, or large, heavy and fatty meals
- chemicals in fatty foods, chocolate, alcohol and coffee and smoking make heartburn worse
- avoid tight, restrictive clothing e.g. belts
- pregnant women also suffer from heartburn but this is due to the growing baby pushing internal organs upwards, including the stomach and its contents
common age range for heartburn and indigestion
triggers for it?
Common in over 55 years of age
Common in overweight individuals
Triggers include: heavy meals, spicy foods, alcohol, smoking, NSAIDs (irritate stomach lining)
Gaviscon original drug, symptoms
directions
formulations
Sodium alginate with calcium carbonate and sodium bicarbonate
GI acid reflux, heartburn, indigestion
Children 6-11: 5-10mL
Over 12s: 10-20mL
Take it after meals and at bedtime
Note: children 6-12 can only take this under medical supervision
Gaviscon original warnings
check allergies
contains sodium and calcium so be careful if on salt diet
Do not give if patient has high blood pressure
Do not use if taking citrate salts
Gaviscon original pregnancy and diabetes?
fine for both pregnant women and diabetics
Counselling for gaviscon
Can have aniseed or peppermint flavourrs
Different types of gaviscon: double action, advanced etc.
Children 6-12: under medical supervision
Rennie for use in indigestion and heartburn
Directions for use
1-2 tablets up to TDS, PRN
take before food
Maximum of 10 tablets/day
different flavours available
Rennie for use in indigestion and heartburn
Side effects and warnings
Side effects: GI disturbances
Warnings: Not for children, only for over 12s
Fine in pregnant women
Ranitidine for indigestion and heartburn
Drug class?
Symptoms/Licence?
H2 antagonist
Short term relief (2 weeks) of dyspepsia, hyperacidity, heartburn
Ranitidine for indigestion and heartburn
directions for use
16+ and elderly: 1-2 tablets PRN
If symptoms persist after 1 hour, take another tablet.
No more than 2 tablets per 24 hour period.
Not to be taken for more than 6 days unless under the advice of a doctor or pharmacist
Ranitidine for indigestion and heartburn
warnings
Not for under 16s
No more than 2 tablets in a 24 hour period
Not to be taken for more than 6 days unless under the advice of a doctor or pharmacist
Not to be used in pregnant or breastfeeding women
Do not use in hepatic or renal impairment
Caution if taking NSAIDS, antacids, sucralfate (for ulcers)
Check interactions
Do not drink alcohol
Ranitidine for indigestion and heartburn Counselling
Not for under 16s
Do not drink alcohol
Work longer than antacids like Rennie- 8-9 hours duration
Try to take 1 hour before food
Omeprazole drug class and symptoms it treats
PPI
Heartburn
Indigestion
Omeprazole for heartburn and indigestion, directions for use
1-2 tabs OD for 2 weeks
10-20mg OD for 2 weeks according to response
Omeprazole for heartburn and indigestion,
side effects
abdominal pain constipation diarrhoea headache nausea vomiting
Omeprazole for heartburn and indigestion
suitability in pregnancy?
age restrictions
Fine for pregnancy and breastfeeding patients
Not for under 12s
Pepto-Bismol liquid suspension
indication
doses
heartburn/indigestion, diarrhoea, upset stomach
Up to 8 doses in 24 hours
1 dose= 30mL,
repeat dose every 30-60 mins if needed
Pepto-bismol suitability for pregnancy and breastfeeding
warnings
Ok to take in pregnancy, but must check with doctor first
Under 12s: must be under doctor’s advice
Warning: take for no longer than 2 days.
How toes pepto-bismol work in the treatment of indigestion and heartburn? What the active compound in it?
contains bismuth subsalicylate which coats the lining of the stomach and prevents irritation and lessens nausea
Antacid
