Minor Ailments - Upper GI Tract

Question 1

Question: What is the definition of indigestion?

Answer 1

Answer: Persistent or recurrent pain or discomfort in the upper abdomen due to a disorder of digestive function.

Question 2

Question: Define Gastro-Oesophageal Reflux Disease (GORD) or heartburn.

Answer 2

Answer: A digestive disorder involving the lower oesophageal sphincter (LOS), causing the reflux of gastric contents, particularly acid, into the oesophagus.

Question 3

Question: What is indigestion often a sign of?

Answer 3

Answer: Indigestion is often a sign of an underlying issue, such as gastro-oesophageal reflux disease (GORD) or ulcers, and may share similar symptoms with other more serious conditions.

Question 4

Question: Who can be affected by indigestion, and when is a referral recommended?

Answer 4

Answer: Anyone can be affected by indigestion, but a referral is recommended if it’s the first time and the person is over 50 years old.

Question 5

Question: What are the symptoms of indigestion?

Answer 5

Answer:

•	Confirm exactly what the symptoms are.
•	Epigastric discomfort or chest pain with or without.
•	A feeling of fullness after eating.
•	Heartburn.
•	Abdominal distension – bloating.
•	Flatulence – burping/passing wind.
•	Acidic taste.
•	Nausea and vomiting.

Question 6

Question: What are the danger symptoms associated with indigestion?

Answer 6

Answer:

•	Persistent abdominal pain.
•	Anorexia.
•	Unexplained weight loss.
•	Blood in vomit (looks like coffee grounds) or stools (black tarry appearance).
•	Severe pain in the upper or lower abdomen.
•	Vomiting with or without blood, along with other danger symptoms.
•	Difficulty swallowing.

Question 7

Question: When should indigestion symptoms prompt a referral based on duration?

Answer 7

Answer:

•	If symptoms persist for more than 5 days - REFER.
•	Recurrent symptoms should also prompt a referral

Question 8

Question: What are some possible differential diagnoses for indigestion?

Answer 8

Answer:

•	Ulcer.
•	Gallstones.
•	Gastric cancer.
•	Angina.
•	Heart attack (MI).

Question 9

Question: Why is it important to inquire about the action already taken for indigestion?

Answer 9

Answer:

•	It is crucial to know what the patient has taken for the problem, both over-the-counter (OTC) and prescribed, and if it has worked in the past.
•	This information will influence the choice of treatment/advice

Question 10

Question: Why is it important to know about the medication being taken for indigestion?

Answer 10

Answer:

•	Knowing the patient’s medication, both over-the-counter (OTC) and prescription (Rx), can explain the symptoms experienced.
•	Medications like NSAIDs, iron, erythromycin, steroids, oestrogens, and oral contraceptives may aggravate symptoms.
•	It influences the choice of products to treat symptoms.
•	Some drugs interact with antacids, such as tetracyclines, ketoconazole, chlorpromazine, and enteric-coated formulations

Question 11

Question: What are some over-the-counter (OTC) treatment options for indigestion?

Answer 11

Answer:

•	Antacids are available in various formulations, such as liquids and tablets, and work by physically neutralizing stomach acid.
•	Best taken one hour after meals as gastric emptying is slowed.
•	Sodium salts should be avoided if sodium intake is restricted; they are fast-acting with short duration.
•	Aluminium salts can be constipating.
•	Magnesium salts may cause diarrhea.
•	Calcium salts are fast-acting with a long duration.

Question 12

Question: What are some over-the-counter (OTC) treatment options for indigestion that help break up and release trapped wind?

Answer 12

Answer: Deflatulents such as dimethicone, simeticone, and peppermint oil serve this purpose

Question 13

Question: What are Histamine H2 antagonists and how do they work as over-the-counter (OTC) treatment for indigestion?

Answer 13

Answer:

•	Histamine H2 antagonists, such as ranitidine and famotidine, reduce the amount of acid produced in the stomach.
•	They inhibit both basal and stimulated gastric acid secretion, reducing acid and, to a smaller extent, pepsin content, and volume of gastric juice.
•	These medications have a rapid onset of action and a relatively long duration, up to 12 hours.
•	Note: Currently, all OTC H2 antagonists (ranitidine, nizatidine, famotidine) are unavailable due to contamination issues, but they are expected to return to the market in the near future.

Question 14

Question: What are Proton Pump Inhibitors (PPIs) and how do they function as over-the-counter (OTC) treatment for indigestion?

Answer 14

Answer:

•	PPIs are specific inhibitors of the acid pump in parietal cells, inhibiting the enzyme H+K+ATPase – the final stage in the production of hydrochloric acid in the stomach.
•	They result in the inhibition of acid secretion within 1 - 2 hours and have a long duration of action (24 hours), allowing for once-daily dosing.
•	Common examples include omeprazole, pantoprazole, and esomeprazole.

Question 15

Question: What are some non-drug advice and counseling points for managing indigestion?

Answer 15

Answer:

•	Opt for small, frequent meals to avoid aggravation from eating too much or too fast.
•	Eat with your mouth closed and drink after meals instead of during.
•	Consider weight loss.
•	Reduce alcohol consumption.
•	Quit smoking.
•	Identify and avoid trigger factors (e.g., spicy foods) by keeping a food diary.
•	Attempt to avoid stressful situations.

Question 16

Question: Who can be affected by GORD, and when is a referral recommended? Answer:

Answer 16

Answer: GORD can affect anyone, but a referral is recommended if it’s the first time and the person is over 50 years old.

Question 17

Question: What are the symptoms of GORD?

Answer 17

Answer:

•	Confirm the exact symptoms.
•	Burning pain in the chest between the stomach and throat, with or without:
•	Pain.
•	Flatulence

Question 18

Question: What are some causes of GORD?

Answer 18

Answer:

•	Dietary habits such as large portions, specific foods or drinks, and eating before bed.
•	Lifestyle habits including being overweight, smoking, wearing tight-fitting clothes/belts, lying down or bending over especially after eating, and stress.
•	Medical causes like pregnancy, hiatus hernia, and certain medications.

Question 19

Question: What are some danger symptoms associated with GORD?

Answer 19

Answer:

•	Difficulty swallowing (dysphagia).
•	Severe pain radiating to the back and arms.
•	Pain aggravated by exercise.

Question 20

Question: When should symptoms of Gastro-Oesophageal Reflux Disease (GORD) prompt a referral based on duration?

Answer 20

Answer:

•	If symptoms persist for more than 1 week - REFER.
•	Recurrent symptoms should also prompt a referral.
•	Severe radiating pain - REFER.

Question 21

Question: What are some possible differential diagnoses for GORD?

Answer 21

Answer:

•	Tumor.
•	Heart diseases such as atypical angina or a heart attack (MI).

Question 22

Question: Why is it important to inquire about the action already taken for Gastro-Oesophageal Reflux Disease (GORD)?

Answer 22

Answer:

•	Knowing what the patient has taken for the problem is crucial and will influence the choice of treatment/advice.

Question 23

Question: How does the medication being taken (OTC + Rx) impact the symptoms of GORD?

Answer 23

Answer:

•	It can explain the symptoms experienced by the patient.
•	Similar to indigestion, anticholinergics (e.g., hyoscine), tricyclics, calcium channel blockers, nitrates, theophylline, and caffeine can relax the sphincter muscle, leading to regurgitation.
•	This information affects the choice of products to treat symptoms.

Question 24

Question: What are some non-drug advice and counseling points for managing Gastro-Oesophageal Reflux Disease (GORD)?

Answer 24

Answer:

•	Similar to indigestion advice.
•	Additionally, avoid bending.
•	Raise the head of the bed.
•	Implement dietary changes.
•	Consider health promotion strategies.

Question 25

Question: What are some OTC treatment options for GORD that neutralize/reduce acid production and have additional properties?

Answer 25

Answer:

•	Similar to indigestion treatments.
•	Additionally, rafting agents like alginates (e.g., Gaviscon) work by floating on top of stomach contents, providing protection to the lining of the esophagus if reflux occurs.