Upper GI conditions and treatment Flashcards
cause of gastritis
inflammation of gastric mucosa, 80% caused by H pylori
risks with gastritis
40 x increase risk of PUD 6 x increased risk of gastric cancer
causes of hiatus hernia
stomach pushed up through diaphragm prevents LOS closure and stomach contents escape
causes of functional dyspepsia
- 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
functional dyspepsia treatment
- HP eradication - dietary changes - PPI/H2 and monitoring
causes of H Pylori
- 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
how is H Pylori tested for
- 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!
H Pylori risks
causes 90% of duodenal ulcers and 70-80% of stomach ulcers
treatment for H Pylori
7 day PPI and 2 x abx depending on local guidelines (amox & metronidazole)
epidemiology of PUD
- 10-15% of population - GU rare in <40s - DU in males 20-50
factors causing PUD
- gastric hypersecretion in DU- reduced mucosal resistance in GU
risk factors for PUD
- H pylori - NSAIDs - smokers - genetics - salt
signs and symptoms of PUD
gastric - pain on eating duodenum - pain between meals relieved by eating - bloating - nausea - anorexia - belching
PUD treatment
- eradicate HP - lifestyle/causative agent - H2 agonist/PPI for 4-8 weeks and retest - if recurrs - PPI
drugs that cause dyspepsia
NSAIDSsulfasalazine iron corticosteroids potassium bisphosphonates
causes of GORD
Defective lower oesophageal sphincter (LOS) may have an effect - diet - cigarettes - high oestrogen/progesterone - beta blockers, ccb, diazepam, contraceptivesMotility of oesophagus may be abnormal
drugs that cause ulceration
- NSAIDs- bisphosphonate - clindamycin - clotrimazole - doxycycline
main symptom of GORD
heartburn, potentially dysphagia or odynophagia
diagnosis of GORD
endoscopy
complications of GORD
Barrett’s oesophagus - cell lining changes to resemble that of intestine
treatment for GORD
- remove causative agent - lifestyle changes - rafting product to promote healing
lifestyle changes for GORD
- small meals - avoid foods that lower LOS pressure - avoid fatty foods - reduce alcohol - reduce tight clothes - raise head of the bed
no organic disease present
functional dyspepsia
heartburn and pain immediately with or after food
GORD
Epigastric pain immediately with or after food
gastritis or gastric ulcer
Epigastric pain between meals or at night relieved by eating
gastritis or duodenal ulcer
how do antacids work
neutralise acid and increases LOS pressure by alkalisation - short term relief
side effects of antacids
aluminium - constipation magnesium - diarrhoea
interactions/ C/Is with antacids
enteric coated medicines reduced absorption of tetracyclines generally safe in pregnancy
how do alginates work
form a high pH viscoid mass to trap acid in stomach
how does dimethicone work
anti-foaming agent, reduces surface tension of intragastric air bubble - bubble escapes to reduce bloating
moa of h2 agonists
competes for h2 receptors on parietal cells
use of h2 agonists in pud
high healing rates but no relapse reduction
use of h2 agonists in GORD
- After 12 weeks, 80-90% of patients with mild oesophagitis improved * Not effective in moderate to severe GORD
side effects with h2 agonists
- headache and dizziness - cimetidine can cause gynaecomastia, impaired libido (CYP) - nizatidine can cause sweating, abnormal dreams and confusion
moa of ppis
blocks hydrogen potassium ATPase to prolong suppression of acid secretion
side effects of ppis
nausea, diarrhoea, flatulence, epigastric pain, dry mouth and headache and can cause rebound dose
OTC PPI
omeprazole - 10/20mg for >18 y/o
when to refer to gp with otc treatment
- 2 weeks with no relief - treatment required continuously for 4 weeks - over 45 with new symptoms
how is metoclopramide and domperidone used for GI disturbances
increases gastric emptying and LOS tone
how is sucralfate used for GI disturbances
Polymerizes below pH4 to form a sticky gel to form protective barrier over ulcer
how is bismuth used for GI disturbances
- binds to ulcer craters to protect them, may blacken teeth and stools
how is misoprostol used for GI disturbances
Promotes ulcer healing by stimulating protective mechanism - usually with NSAIDs
