TREATMENT OF UPPER GI DISEASE Flashcards
pharmacy year 2
What is dyspepsia?
had or difficult digestion
subjective feeling of pain or discomfort located primarily in the upper abdomen
what group of symptoms may indicate disease in the upper GI tract ?
feeling full too soon
feeling of discomfort around the abdomen
name a few causes of dyspepsia
h-pylori
stress
smoking
alcohol
medicines such as NSAIDS
iron or potassium supplements
fried foods
what are the different types of dyspepsia
acute dyspepsia
chronic dyspepsia
invested dyspepsia
uninvestigated dyspepsia
acute dyspepsia
every ow and again
chronic dyspepsia
a period of more than 4 weeks
investigated dyspepsia
use of an endoscope to take pictures
the camera is swallowed by the person and it takes photographs of the inside of the stomach and abdomen
when to investigate?
if there are alarm symptoms present
such as dysphagia haematemis
in patients aged 55 years and over with weight loss and upper abdominal pain
reflux
dyspepsia
in people aged 55 years or over with
treatment -resistent dyspepsia
upper abdominal pain with low haemoglobin levels
raised platelet count with any of the following , nausea vomiting weight loss, reflux, dyspepsia upper abdominal pain
nausea and vomiting with any of the following weight loss, reflux, dyspepsia , upper abdominal pain
what is haematemis?
throwing up darker blood
what is a barium swallow?
when an endoscope cannot be done so liquid full of barium sulphate is used which is radioactive so an x-ray can be done
investigated dyspepsia
treat any underlying pathology PUD or malignancy
what is functional idiopathic dyspepsia?
many investigations don’t reveal any problems
if there is no known cause of dyspepsia
treat and test for H-pylori
offer low dose
offer low dose PPI or H2RA for 4 weeks
if symptoms re-start the PPI over H2RA at lowest dose possible
avoid long-term frequent use of antacids
what is PPI
proton pump inhibitor
name examples of proton pump inhibitors
omeprazole pantoprazole, lansoprazole, rabeprazole,
which 2 PPI’s are most common
omeprazole and lansoprazole
which H2RA used to be used but was stopped due to cancer warning?
ranitidine
name the H2RAs
Famotidine, histamine , ranitidine, cimetidine
H.pylori testing
h.pylori has an enzyme unique to it
blood test to detect h.pylori antigens
stool test-antigens in patients stool
uninvestigated dyspepsia
offer h.pylori test and treat to people making sure to leave an appropriate wash out period
offer full-dose PPI therapy for 4 weeks
if symptoms return, step down PPI to the lowest dose needed to control symptoms even PRN therapy ?
offer H2RA therapy if there is an inadequate response to a PPI
Do antacids/alginates have a role?
too much acid in the stomach stop acid from being secreted
examples of antacids
gaviscon-contains lots of potassium which can causes dehydration
long term- large doses of magnesium causes diarrhoea
antacids can have aluminium which causes constipation
asinine antacid- works straight away doesn’t last very long
Rennie- takes 12hours for it to work
causes of GORD
Being overweight,
certain drugs can cause gord
management of gord
routine h.Pylori testing is not required
for proven GORD
Lifestyle advice
a full dose ppi for 4-8 weeks depending on severity
in severe diseases consider a full dose PPI long-term as maintenance step down where possible
if symptoms reoccur after initial treatment , offer a PPI at the lowest possible dose to control symptoms even PRN
in refractory cases a double dose of PPI or the addition of H2RA usually at night to a PPI can be tried on a short-term basis
name 3 prokinetic agents
metoclopramide
bethanechol
cisapride
what are prokinetic agents
used to given to increase sphincter pressure
what do pro kinetic agents do?
increase LOS pressure
stimulate the motility of GI tract without altering gastric acid secretion
ineffective at healing erosive oesophagus
now seldom used in treatment of GORD
what is gastro oesophageal reflux disease
in the retrograde passage of gastric contents from the stomach into the oesophagus
Barrett oesophagus
30 times more likely to develop oesophageal cancer
symptoms of oesophageal reflux disease
include heartburn pyrosis, regurgitation of gastric contents into the throat , early satiety , belching , hiccups and nausea and vomiting
what are therapeutic goals?
to relieve symptoms promote oesophageal healing and avoid long-term complications
safety of long-term PPI use
rebound hypersection
osteoporotic fractures
hypomagnesaemia
community and hospital acquired pneumonia
drug interactions
metabolic drug interactions
enzymes
PPI’s can interact with digoxin and citalopram and escitalopram
Clostridium difficile colitis
anaerobic bacteria releases bad toxins which release really bad toxins
kept in check by other bacteria in the colon. if good bacteria is destroyed this may cause problems
dyspepsia treatment PPI
esomeprazole
lansoprazole
omeprazole
pantoprazole
rabeprozole
summary
dyspepsia and good are relatively common conditions we see in primary care
a number of medications can cause dyspepsia as well as contributing to good
important to think about H.pylori eradication therapy , as well as possible alarm symptoms
the proton pump inhibitors as well as the histamine-2 receptor antagonists are important therapies for these conditions
