Management Flashcards
What are the three main management strategies for gastric/duodenal ulcers?
Identify and eradicate H pylori if necessary
Stop inappropriate therapies
Reduce acid production to reduce gastritis and enable the mucosa to repair
What therapy is required for H pylori eradication?
2 antibiotics and a PPI (Triple therapy for 7 days)
Antibiotics of choice are usually Amoxicillin plus Metronidazole or Clarithromycin (taking into account patient’s history with Metronidazole and Clarithromycin due to increased resistance and local resistance patterns, allergies, interactions with other medications)
How effective is the triple therapy regime?
Eradicates 85% of H pylori infections
What does stopping inappropriate therapies involve for ulcers?
As NSAIDs are known to precipitate ulcers, where this is known to having contributed to their development, having a discussion with both the GP and the patient regarding their use in relation to:
Are they necessary?
What are the risks of the drugs?
Are there any alternatives with lower risks?
In patients where it is believed an NSAID has caused an ulcer what is the appropriate management?
Prescribe a H2 antagonist or PPI for 8 weeks, after which test for H pylori infection.
If present then eradicate, if not can be stopped.
If a ulcer is not attributed to either NSAIDs or another inappropriate therapy or H pylori what is the appropriate management?
Prescribe PPI or H2 antagonist for 4-8 weeks
What are some of the reasons for unhealed ulcers following these management plans?
Adherence (have they completed the course and taken as indicated?)
NSAIDs still be taken OTC
Other diseases are present (Crohn’s, malignancy)
If a patient heals but symptoms reoccurs what is the appropriate management options?
Low dose PPI for symptomatic control
What are the three main management options for GORD?
Remove the causative agent
Rafting product use to reduce acid production to enable recovery of oesophageal mucosa
What does removal of the causative agent involve?
Removal of anything that lowers the LOS pressure (dietary and drugs)
Non-pharmacological advice
Which drug is recommended as a rafting product?
Gaviscon
What are some of the non-pharmacological dietary interventions?
Dietary:
Smaller meals
Avoid foods that lower LOS pressure (alcohol and caffeine)
Avoid eating fatty foods (slows gastric motility)
Avoid eating within 4 hours of going to bed and drinking alcohol within 2 hours of going to bed
Don’t lie down after eating
Aside from diet, what are some of the other non-pharmacological interventions?
Avoid tight fitting clothes
Weight reduction
Avoid drugs that lower LOS pressure/cause oesophageal ulcers
Avoid bending from the waist, squat instead
Raise the head of the bed to avoid nocturnal heartburn (15-23cm)
Stopping smoking
Limit alcohol
What is the management for symptomatic dyspepsia?
Neutralise acid
Reduce flatulence
Prevent dislocation of acid
Which can be provided OTC medicine, ensuring no alarm symptoms are present
