OTC - dyspepsia

Question 1

Symptoms?

Answer 1

Dyspepsia is an umbrella term for a group of upper abdominal symptoms caused by:

• indigestion (functional dyspepsia)
• GORD (heartburn)
• gastritis
• gastric or duodenal ulcers

Symtpoms:

• vague abdominal pain above belly button (epigastric pain)
• bloating, belching, flatulence
• early satiety (feeling full too early)
• fullness
• n+v
• heartburn (classic symptom of GORD)

Question 2

Referral?

Answer 2

ALARM

• anaemia (iron deficieny)
• loss of weight
• anorexia
• recently changed or new, unexplained dyspepsia in over 55 years unresponsive to treatment
• malaena (black stools), haematemesis (vomiting blood), persistent vomiting, dysphagia (difficulty swallowing)
• ruling out peptic ulcers: persistant gnawing, boring pain from one point in the abdomen
• gastric ulcers = pain aggrevated by food; usually 30 mins after eating
• duodenal ulcers = pain when stomach is empty; 2-3 hours after eating and keeps awake at night
• cardiovascular problems: pain radiating to jaw, back and arms (heart attack? can be confused with heartburn)
• pain precipitated by exercise and not relieved by antacids (angina?)

Question 3

OTC products?

Answer 3

ANTACIDS (rennies, tums, gaviscon)

ALGINATES - raft on top of stomach contents (gaviscon range)

H2 RECEPTOR ANTAGONIST - acid suppresor
- ranitidne 16+, max use 14 days

PPIS (omeprazole/pantoprazole/esomeprazole)

Question 4

ANTACID INTERACTIONS?

Answer 4

• Impairs absorption of other drugs = do not take at the same time, leave 2 hour gap (tetracyclines, quinolones, bisphosphonates)
• high sodium content = fluid retention. avoid in hypertension, heart/kidney or liver failure. also avoid in sodium-restricted diets e.g. lithium or coronary heart disease
• low Na+ preps: mucogel and maalox
• damage enteric coatings by increasing stomach pH

Question 5

Antacids?

Answer 5

ANTACIDS - neutralises stomach acid
(rennies, tums, gaviscon)
- immediate symptom relief in 15-30 min. lasts 3 hrs
- liquids are most effective and act quicker than tablets 
- sodium salts = fluid retention
- potassium salts
- aluminium salts = constipating 
- magnesium salts = laxating 
- calcium salts = rebound acid secretion

How to take = after each main meal and at bedtime OR when required

Question 6

Alginates?

Answer 6

ALGINATES - raft on top of stomach contents (gaviscon range)

• suitable in pregnancy
• first line if GORD: heartburn

How to take = after each main meal and at bedtime OR when required

Question 7

H2 antagonists?

Answer 7

• acid suppressors
• onset 1 hour, lasts up to 9 hours
• ranitidine 16+ max use 14 days
• take one 75mg tablet when symptoms occur, if they persist for more than one hour or return, take another tablet (max 4 in 24 hours)
• side effects: headaches, rashes, dizziness and diarrheoa, masks symtpoms of gastric cancer
• not recommended in pregnancy or breastfeeding

*discontinued

Question 8

PPIs?

Answer 8

• inhibit gastric acid secretion in the stomach by blocking the hydrogen potassium adenosine triphosphatase enzyme
• used for recurrent heartburn
• may take 1-3 days to provide full therapeutic effect (during which antacids can be used)
• PPIs may inhibit P450 and so can interact with other medicines e.g. omeprazole can delay elimination of warfarin, phenytoin and diazepam
• side effects: headache, abdominal pain, constipation, diarrhoea, flatulence, n/v
• nexium etc