Week 4 - upper GI GORD/FD/ Gastritis / Gastric ulcer Flashcards
What are the main symptoms of GORD
Heart burn - ( pain during or right after food)
Dysphagia
What is GORD caused by?
Gastric juice in the oesphagus
What physiological factors can affect GORD?
A Defective Lower oesphageal Sphincter can allow stomach acid up
What drugs affect a LOS?
- Anti-cholinergic
-Nitrates
CCB
B2 antagonist
Name the drugs that can cause oesphageal ulcers?
- Doxycline
NSAID - potassium
biphosphates
What is the difference between Functional dyspepsia and GORD?
GORD can be diagnosed with an endoscopy and is an organic disease
Functional dyspepsia is th epresence of chronic dypepsia and sensitivity to gastric acid / heartburn with no organic disease
Describe the symptoms for Gastritis / Gastric ulcer
Epigastric pain - ( pain between meals can be relieved with food
or pain can be w or immediatly after food
Describe symptoms of Gastritis / duodenum ulcer
Epigastric pain BUT pain between meals or at night and is relieved by food
Describe the management and treatment for stomach/ Duodenum ulcer
- Test and eradicate HP ( H pylori)
- aim to reduce gatric acid production to reduce gastritis
- H2 antagonists provided or PPI
Describe the non-pharmacuetical management of GORD
Lifestyle advice:
- LEss fatty + spicy + acidic foods
- avoid drugs lowering LOS pressure
- avoid eating twithin 2 hrs of bed
- reduce alcohol
- stop smoking
What is gastric cytoprotection?
The prevention of suto-digestion by a thing layer of mucus and bicarbonate ( ph 7) on the mucosa surface
How do NSAIDs affect gastric cytoprotection?
They affect prostaglandin ( somatostatin ) synthesis
Name and Describe how prostaglandins aid in gastric cytoprotection
Somatostatin a Prostaglandin increases mucus secretion —> increases bicabonate—> increases blood flow ——> decreases acid production
Describe how gastritis leads to ulceralation
H . pylori triggers inflammatory repose from GI mucosa leads to chronic gastritis —-> PUD—–> Gastric cancer
Describe where H pylori colonises and how it affects the GI tract
In the antrum and can cause chronic inflammation by triggering an inflammatory response as well as decrease somatostatin synthesis meaning increased gastrin and increased acid
Increased stomach acid means increased inflammation in duodenum leading to D ulcers
How can H pylori be tested for?
- Breath test against radioactive urea
- Stool antigen test
What are the two types of ulcers in PUD and how do they differ?
Duodenum ulcer - higher levels of acid output
Gastric Ulcer- less mucosal resistance can be caused by smoking
What risk factors are associated with PUD ?
- Smoking decreases mucus layer increased likelyhood of acid auto digestion irritation
What drugs induce dyspepsia ?
- NSAIDS
- Bisphophates
- Nitrates
- sulfasalazine
Describe the symptoms of PUD
- EPigastric pain
- Localised pain at night or between meals
bloated/nausea
Describe drugs that induce dyspepsia
- NSAIDS risk increased in elderly, smokers
- Sulfasalazine
corticosteroids bisphosphonates - nitrates
Why do NSAIDS induce dyspepsia ?
- NSAiDs inhibit protsglandin production via COX 1 pathway which is the pathway for GI protective prostaglandins ( non- selective NSAIDs affect COX 1 pathway more than COX 2 selective )
( flow of COX1 inhibiton consequences) - synthesis such as somatostatin which usually in hibits gastrin production as gastrin increases this is ligand for parietal cell for HCL produced . dudodenum inflammation
What are antacids and how do they work?
Are basic salts ( inc magnesium, calcium salts ) which neutralise stomach acid
MOA- Increase prostaglandin synthesis and increase LOS pressure by neutralization on gastric acid
Which form of antacids are faster acting and what are th counselling points for antacids ?
- liquid form faster acting ( short acting)
- heartburn / indigestion relief
- ONLY is SHORT TERM relief
- AVOIDED IN HYPERTENSION/CVD patient — increased sodium —–> increased BP
What are the side effects of antacids?
- Constipation
- diarrhoea
- neurotoxicity ( absorption of aluminium salt)
- Osteoporosis - aluminium binding to gut
- Rebound gastric acid
-potentially increased bp should not be used in hypertensive patients
What are Alginates and how do they work?
- formed using a alginates
- form a layer over stomach acid
- intragastric air bubble and CO2 from antacid trapped in prevent mucosal damage
What is Dimeticone and how does it work ?
- Anti-foaming agent
- reduces bloating by releasing trapped intragastric air bubbles
What are H2 receptor antagonists?
- Competitive inhibitor for H2 receptor on parietal cells
What are examples of H2 antagonists and what are their indications?
- Cimetidine
- famotidine
- ranitidine
- nizatidine
PUD
Mild GORD
What are the side effects of H2 antagonists?
- headache
- dizziness
Cimetidine - Gynaecomastia
Nizatidine - sweating
What drug interaction are there with H2 antagonists?
Cimetidine - Theophylline & warfarin
Name an example of OTC H2 antagonists
- Ranitidine
- relieves heartburn dyspepsia
What Proton Pump Inhibitors and how do they work ?
- Suppress acid secretion by Blocking H-potassium ATPAse enzyme
coated preparation is digested in small intestine
Name some Proton pump inhibitors
- omeprazole
- lansoprazole
- esomeprazole
What is the first line treatment of GORD and why ?
PPIs are used as first line treatment in GORD over H2 antagonists as they also heal ulcers faster than H2 antagonists
What are the side effects of PPIs?
- nausea
- diarrhoea
- epigastric pain
- increase risk of bacterial infection due to overgrowth ( H pylori / salmonella)
What are some OTC PPIs? And when would a referral be made
Omeprazole 10/20mg
- reflux symptoms
20mg daily until symptoms improve then 20mg
- 2 weeks use and still no improvement
- Patient over 45 with new or changed symptom
What treatment is given in the presence of Functional dyspepsia, Gastritis or PUD ?
Functional Dyspepsia / Gastritis / PUD-
- PPIs and H2 antagonists
- Removal of cause so dietary changes
Which treatment is given to patients with GORD?
- NOT H2 ANTAGONISTS!!
- PPIs prolong acid secretion
When would a patient need to be referred?
- Continual of symptoms
- Patient over 45 with new or changed symptom
- weight loss loss of appetite
- dysphagia
- blood in vomit or stool
