Upper GI conditions and treatment

Question 1

cause of gastritis

Answer 1

inflammation of gastric mucosa, 80% caused by H pylori

Question 2

risks with gastritis

Answer 2

40 x increase risk of PUD 6 x increased risk of gastric cancer

Question 3

causes of hiatus hernia

Answer 3

stomach pushed up through diaphragm prevents LOS closure and stomach contents escape

Question 4

causes of functional dyspepsia

Answer 4

• Dyspepsia with no organic disease - Four groups ○ Ulcer like ○ Dysmotility like ○ Reflux like - ongoing heartburn and reflux (GORD considered but endoscopy showed no organic disease) ○ Non-specific

Question 5

functional dyspepsia treatment

Answer 5

• HP eradication - dietary changes - PPI/H2 and monitoring

Question 6

causes of H Pylori

Answer 6

• Bacteria able to survive in acidic environments that protects themselves by hydrolysing urea to produce ammonia between mucus layer in antrum * Chronic inflammation - decreases somatostatin * Increases gastrin + acid

Question 7

how is H Pylori tested for

Answer 7

• Identified breath test or stool antigen test ○ Given radio labelled urea - broken down by H Pylori, so CO2 in breath will be radio labelled ○ Stool test (- 20 degrees before testing) § Avoid abx 4 weeks before!

Question 8

H Pylori risks

Answer 8

causes 90% of duodenal ulcers and 70-80% of stomach ulcers

Question 9

treatment for H Pylori

Answer 9

7 day PPI and 2 x abx depending on local guidelines (amox & metronidazole)

Question 10

epidemiology of PUD

Answer 10

• 10-15% of population - GU rare in <40s - DU in males 20-50

Question 11

factors causing PUD

Answer 11

• gastric hypersecretion in DU- reduced mucosal resistance in GU

Question 12

risk factors for PUD

Answer 12

• H pylori - NSAIDs - smokers - genetics - salt

Question 13

signs and symptoms of PUD

Answer 13

gastric - pain on eating duodenum - pain between meals relieved by eating - bloating - nausea - anorexia - belching

Question 14

PUD treatment

Answer 14

• eradicate HP - lifestyle/causative agent - H2 agonist/PPI for 4-8 weeks and retest - if recurrs - PPI

Question 15

drugs that cause dyspepsia

Answer 15

NSAIDSsulfasalazine iron corticosteroids potassium bisphosphonates

Question 16

causes of GORD

Answer 16

Defective lower oesophageal sphincter (LOS) may have an effect - diet - cigarettes - high oestrogen/progesterone - beta blockers, ccb, diazepam, contraceptivesMotility of oesophagus may be abnormal

Question 17

drugs that cause ulceration

Answer 17

• NSAIDs- bisphosphonate - clindamycin - clotrimazole - doxycycline

Question 18

main symptom of GORD

Answer 18

heartburn, potentially dysphagia or odynophagia

Question 19

diagnosis of GORD

Answer 19

endoscopy

Question 20

complications of GORD

Answer 20

Barrett’s oesophagus - cell lining changes to resemble that of intestine

Question 21

treatment for GORD

Answer 21

• remove causative agent - lifestyle changes - rafting product to promote healing

Question 22

lifestyle changes for GORD

Answer 22

• small meals - avoid foods that lower LOS pressure - avoid fatty foods - reduce alcohol - reduce tight clothes - raise head of the bed

Question 23

no organic disease present

Answer 23

functional dyspepsia

Question 24

heartburn and pain immediately with or after food

Answer 24

GORD

Question 25

Epigastric pain immediately with or after food

Answer 25

gastritis or gastric ulcer

Question 26

Epigastric pain between meals or at night relieved by eating

Answer 26

gastritis or duodenal ulcer

Question 27

how do antacids work

Answer 27

neutralise acid and increases LOS pressure by alkalisation - short term relief

Question 28

side effects of antacids

Answer 28

aluminium - constipation magnesium - diarrhoea

Question 29

interactions/ C/Is with antacids

Answer 29

enteric coated medicines reduced absorption of tetracyclines generally safe in pregnancy

Question 30

how do alginates work

Answer 30

form a high pH viscoid mass to trap acid in stomach

Question 31

how does dimethicone work

Answer 31

anti-foaming agent, reduces surface tension of intragastric air bubble - bubble escapes to reduce bloating

Question 32

moa of h2 agonists

Answer 32

competes for h2 receptors on parietal cells

Question 33

use of h2 agonists in pud

Answer 33

high healing rates but no relapse reduction

Question 34

use of h2 agonists in GORD

Answer 34

• After 12 weeks, 80-90% of patients with mild oesophagitis improved * Not effective in moderate to severe GORD

Question 35

side effects with h2 agonists

Answer 35

• headache and dizziness - cimetidine can cause gynaecomastia, impaired libido (CYP) - nizatidine can cause sweating, abnormal dreams and confusion

Question 36

moa of ppis

Answer 36

blocks hydrogen potassium ATPase to prolong suppression of acid secretion

Question 37

side effects of ppis

Answer 37

nausea, diarrhoea, flatulence, epigastric pain, dry mouth and headache and can cause rebound dose

Question 38

OTC PPI

Answer 38

omeprazole - 10/20mg for >18 y/o

Question 39

when to refer to gp with otc treatment

Answer 39

• 2 weeks with no relief - treatment required continuously for 4 weeks - over 45 with new symptoms

Question 40

how is metoclopramide and domperidone used for GI disturbances

Answer 40

increases gastric emptying and LOS tone

Question 41

how is sucralfate used for GI disturbances

Answer 41

Polymerizes below pH4 to form a sticky gel to form protective barrier over ulcer

Question 42

how is bismuth used for GI disturbances

Answer 42

• binds to ulcer craters to protect them, may blacken teeth and stools

Question 43

how is misoprostol used for GI disturbances

Answer 43

Promotes ulcer healing by stimulating protective mechanism - usually with NSAIDs