Treatment of Upper Gi Disease Flashcards
What dyspepsia?
Hard or difficult digestion
Where does dyspepsia occur?
Between umbilical region (above belly button) and epigastric region (up to breast bone)
What is dyspepsia caused by?
H.Pylori
Smoking
Stress
Spicy/fatty foods
Medications
Alcohol
Which medications can cause dyspepsia?
NSAIDs
Corticosteroids
Aspirin
Bisphosphonates
What is investigated dyspepsia?
Endoscope
BUT invasive
What are “alarm” symptoms suggestive of?
Cancer
What is dysphagia?
Difficulty swallowing
What is haematemesis?
Vomiting blood
When do you investigate with patients if they are over 55 + weight loss?
Upper abdominal pain
Reflux
Dyspepsia
What does a barium meal do?
Shows structure of GI tract
How to treat investigated dyspepsia?
No signs of problems
Treat + test for H.Pylori
Offer low does of PPI or H2RA for 4 weeks
If symptoms recur restart PPI at lowest dose
What is a common PPIs?
Omeprazole
What are common H2RA?
Cimetidine
Ranitidine
Why do we not really use ranitidine anymore?
Inhibits cytochrome P450 enzymes = lots of drug interactions
What are the different tests for H.Pylori?
Stool Test
Breath test
Blood test inaccurate
Describe how you would do the breath test
Give patient drink of urea
Radio ligand C13 can be tracked
H.Pylori (urease) converts to CO2 + NH3
Which patient breathes out
How do you test for uninvestigated dyspepsia?
Offer full dose for 4 weeks
If symptoms return, give lowest dose PPI
Offer H2RA if inadequate response to PPI
What do antacids do?
Only give short term relief to dyspepsia
How do you treat dyspepsia if no penicillin allergy?
High dose of PP1 + 2 antibiotics
eg. amoxicillin + clarithromycin or metronidazole
How do you treat dyspepsia if there is a penicillin allergy?
Can’t take amoxicillin
What can happen if there’s a long term PPI use?
Rebound hypersecretion
Osteoporotic fractures
Drug interactions
What is rebound hypersecretion?
Increase pH of stomach
= synthesise more proton pumps
= increase gastrin + histamine
So STOP PPI everything has increased
What is osteoporotic fractures?
More likely to break bones due to reduction in Ca2+
What is drug interactions?
Clopidogrel = platelet drug = stops strokes
Pro-drug = has to be biologically activated
2C19 cytochrome inhibited by omeprazole
What is gastro oesophageal reflux disease (GORD)?
Get a bit of acid + food come up
What can GORD be identified with?
Investigative dyspepsia
= endoscope
What does Barret’s oesophagus show?
Pre-cancerous cells
= increased chance of cancer
What are the causes of GORD?
Drugs
Over weight
Certain foods
All to do with lower oesophageal sphincter
How is GORD treated?
Lifestyle advice
Full dose of PPI 4-8 weeks
If symptoms reoccur, offer lower dose
What was used in old days to treat GORD?
Prokinetic agents
What is some lifestyle advice for patients with GORD?
Lose weight
Stop smoking
Avoid medication/food that relax LOS
