Treatment of Upper Gi Disease

Question 1

What dyspepsia?

Answer 1

Hard or difficult digestion

Question 2

Where does dyspepsia occur?

Answer 2

Between umbilical region (above belly button) and epigastric region (up to breast bone)

Question 3

What is dyspepsia caused by?

Answer 3

H.Pylori
Smoking
Stress
Spicy/fatty foods
Medications
Alcohol

Question 4

Which medications can cause dyspepsia?

Answer 4

NSAIDs
Corticosteroids
Aspirin
Bisphosphonates

Question 5

What is investigated dyspepsia?

Answer 5

Endoscope
BUT invasive

Question 6

What are “alarm” symptoms suggestive of?

Answer 6

Cancer

Question 7

What is dysphagia?

Answer 7

Difficulty swallowing

Question 8

What is haematemesis?

Answer 8

Vomiting blood

Question 9

When do you investigate with patients if they are over 55 + weight loss?

Answer 9

Upper abdominal pain
Reflux
Dyspepsia

Question 10

What does a barium meal do?

Answer 10

Shows structure of GI tract

Question 11

How to treat investigated dyspepsia?

Answer 11

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

Question 12

What is a common PPIs?

Answer 12

Omeprazole

Question 13

What are common H2RA?

Answer 13

Cimetidine
Ranitidine

Question 14

Why do we not really use ranitidine anymore?

Answer 14

Inhibits cytochrome P450 enzymes = lots of drug interactions

Question 15

What are the different tests for H.Pylori?

Answer 15

Stool Test
Breath test
Blood test inaccurate

Question 16

Describe how you would do the breath test

Answer 16

Give patient drink of urea
Radio ligand C13 can be tracked
H.Pylori (urease) converts to CO2 + NH3
Which patient breathes out

Question 17

How do you test for uninvestigated dyspepsia?

Answer 17

Offer full dose for 4 weeks
If symptoms return, give lowest dose PPI
Offer H2RA if inadequate response to PPI

Question 18

What do antacids do?

Answer 18

Only give short term relief to dyspepsia

Question 19

How do you treat dyspepsia if no penicillin allergy?

Answer 19

High dose of PP1 + 2 antibiotics
eg. amoxicillin + clarithromycin or metronidazole

Question 20

How do you treat dyspepsia if there is a penicillin allergy?

Answer 20

Can’t take amoxicillin

Question 21

What can happen if there’s a long term PPI use?

Answer 21

Rebound hypersecretion
Osteoporotic fractures
Drug interactions

Question 22

What is rebound hypersecretion?

Answer 22

Increase pH of stomach
= synthesise more proton pumps
= increase gastrin + histamine
So STOP PPI everything has increased

Question 23

What is osteoporotic fractures?

Answer 23

More likely to break bones due to reduction in Ca2+

Question 24

What is drug interactions?

Answer 24

Clopidogrel = platelet drug = stops strokes
Pro-drug = has to be biologically activated
2C19 cytochrome inhibited by omeprazole

Question 25

What is gastro oesophageal reflux disease (GORD)?

Answer 25

Get a bit of acid + food come up

Question 26

What can GORD be identified with?

Answer 26

Investigative dyspepsia
= endoscope

Question 27

What does Barret’s oesophagus show?

Answer 27

Pre-cancerous cells
= increased chance of cancer

Question 28

What are the causes of GORD?

Answer 28

Drugs
Over weight
Certain foods
All to do with lower oesophageal sphincter

Question 29

How is GORD treated?

Answer 29

Lifestyle advice
Full dose of PPI 4-8 weeks
If symptoms reoccur, offer lower dose

Question 30

What was used in old days to treat GORD?

Answer 30

Prokinetic agents

Question 31

What is some lifestyle advice for patients with GORD?

Answer 31

Lose weight
Stop smoking
Avoid medication/food that relax LOS