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What is a common symptom of dyspepsia?
Dyspepsia is considered a disease.
False
Name one lifestyle factor that can contribute to dyspepsia.
Smoking
Dyspepsia can relate to several conditions such as ulcers, GERD, and ___.
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Match medications with their potential impact on dyspepsia:
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Which of the following is a red flag symptom related to dyspepsia?
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What is functional dyspepsia?
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Obesity can put pressure on the stomach and contribute to dyspepsia.
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Which of the following medications is a PPI used for treating dyspepsia?
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H2-antagonists are considered first-line treatments for dyspepsia.
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What role does Simethicone play in treating dyspepsia?
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The combination of PPI with two antibiotics in treatment of H.Pylori is known as _____ therapy.
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Match the following treatments with their classification:
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What age group is most commonly affected by peptic ulcers?
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Acid reflux can potentially lead to Barrett’s Oesophagitis or cancer.
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Name one symptom that may indicate a peptic ulcer.
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Dark or tarry stools may indicate __________.
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Which type of ulcer pain might radiate to the back?
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Match the symptom to its correct condition:
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Over 60s account for 50% of peptic ulcer fatalities.
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What is one social factor that can aggravate dyspeptic symptoms?
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Which of the following is a common cause of gastroesophageal reflux disease (GERD)?
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Heartburn is relieved by bending forward.
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What lifestyle measures can be taken to alleviate dyspepsia?
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Gaviscon is an example of an __________ used for treating indigestion.
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Match the following medications with their class:
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Which dietary item is recommended to be avoided to manage dyspepsia symptoms?
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Antacids neutralize stomach acid.
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Name a side effect associated with magnesium salt antacids.
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Study Notes
Dyspepsia (Indigestion)
- Very common condition, with similar prevalence rates for men and women.
- Only 25% of sufferers seek medical advice.
- High potential for over-the-counter (OTC) management.
- Characterized by upper abdominal discomfort or pain, often occurring after eating or drinking.
- Not a disease, but a symptom.
Dyspepsia Symptoms
- Group of symptoms including: heartburn, flatulence, bloating, feeling of fullness quickly during or after eating, nausea.
- Symptoms tend to occur in bouts (come and go) and are linked to eating.
- Symptoms can occur even after consuming small meals.
Dyspepsia Aetiology
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Disease/Condition:
- Ulcers
- Gastroesophageal reflux disease (GERD)
- Stomach cancer (rare)
- Gastroparesis (stomach does not empty properly)
- Stomach infections
- Irritable bowel syndrome (IBS)
- Chronic pancreatitis
- Thyroid disease
- Pregnancy: hormones affect sphincter muscle tone, and the size of the baby can put pressure on the stomach.
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Medications:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Aspirin
- Steroids
- Calcium antagonists
- Nitrates
- Theophyllines
- Estrogen
- Bisphosphonates
- Thyroid medications
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Lifestyle:
- Smoking: chemicals in smoke relax sphincter muscles.
- Heavy drinking: alcohol irritates the mucosal lining.
- Posture: bending over, sitting hunched up, lying down.
- Overweight: obesity places pressure on the stomach.
- Eating too much, eating too fast, eating high-fat foods (relaxant effect on the sphincter), or eating during stressful situations.
- Psychological: anxiety, depression, stress.
- Foods that cause dyspepsia: peppermint, tomato, chocolate, spices, hot drinks, coffee, alcohol.
- Functional dyspepsia: This is referred to as persistent indigestion not related to any of the above factors.
Red Flag Symptoms
- Unintentional weight loss
- Recurrent vomiting
- Dysphagia (difficulty swallowing)
- Evidence of gastrointestinal bleeding
- Loss of appetite
- Severe abdominal pain
Dyspeptic Symptoms - Questions & Relevance
- Family History & Medication Use: always inquire about both.
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Age:
- Dyspepsia: common in young adults.
- Over 50s: other pathologies more likely.
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Location of the pain:
- Dyspepsia: above umbilicus/central (epigastric).
- Heartburn: behind the sternum.
- Below umbilicus: IBS, diverticulitis etc.
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Pain Radiation:
- Cardiovascular: MI (heart attack).
- Angina.
- Biliary colic (gallstones)
- Severity of pain: Dyspepsia typically mild to moderate pain.
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Other symptoms:
- Persistent vomiting (+/- blood): could indicate ulcer/cancer.
- Black/tarry stools: GI bleed.
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Factors that aggravate or relieve symptoms:
- Food: can either provide relief or worsen symptoms.
- Antacids: may ease pain.
- Caffeine/alcohol: trigger or worsen symptoms.
- Social Factors: Fast food, excess alcohol, stress.
Peptic Ulcer
- More common in individuals aged 30-50 years.
- Over 60s account for 15% of cases, but lead to 80% fatality.
-
Helicobacter pylori:
- 25% of the population has been infected at some point.
- 3/20 infected individuals develop an ulcer.
- In others, it lives harmlessly.
Peptic Ulcer (Gastric vs. Duodenal - Characteristic Pain)
- Intermittent upper abdominal pain: a common feature in both types.
- Feeling of hunger: many patients experience this.
- Pain radiating to the back: more common with duodenal ulcers.
-
Pain occurrence:
- May wake you up at night (more common with duodenal ulcers).
- Generally occurs 2-3 hours after meals.
- Pain also felt before meals as acid passes into the duodenum.
- Increased pain with eating: more common with gastric ulcers.
-
Pain relief:
- Improved by food, eased by antacids (duodenal).
- Exacerbated by food (gastric).
- Weight loss: loss of appetite and weight loss can occur.
- Evidence of bleeding: perforated or bleeding ulcer.
Gastric/Oesophageal Cancer - Alarm Symptoms
- Dark/tarry stools (GI bleeding)
- Persistent vomiting
- Loss of weight
- Altered bowel habit
- Dysphagia (difficulty swallowing): early sign, may indicate stricture (narrowing of the esophagus).
- Fatigue
- Barrett's Oesophagitis: cell changes in the esophagus due to long-standing acid reflux – potentially cancerous.
Gastroesophageal Reflux Disease (GERD)
- Definition: Backward regurgitation of gastric contents into the esophagus.
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Symptoms:
- Heartburn: burning sensation in the upper abdomen (retrosternal), radiating to the left shoulder and side of the neck. Pain increases when bending forward and lying down, but is relieved by standing.
- Coughing.
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Causes: Relaxation of the lower esophageal sphincter (LOS), triggered by:
- Gastric distension.
- Meals containing high fat, chocolate, smoking.
- Pregnancy.
- Obesity.
- Hiatus hernia.
Dyspepsia - Treatment
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Lifestyle Measures (non-pharmacological):
- Avoid precipitating factors: bending, alcohol, tea, coffee, fatty foods, spicy foods, chocolate, onion, garlic, citrus fruits.
- Eat smaller meals.
- Do not eat before bedtime.
- Weight reduction.
- Reduce stress.
- Eat slowly, avoid gulping air.
- Avoid tight belts and clothing.
- Avoid smoking (reflux).
- Sleep with head raised (reflux).
Dyspepsia - Treatment (OTC)
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Alginates:
- Float on top of stomach contents like a raft.
- E.g., Gaviscon.
-
Antacids:
- Neutralize stomach acid (alkalis).
- Relatively fast-acting (1 hour).
- Absorption interactions.
Dyspepsia Treatment - Antacids - Specific Types
-
Magnesium Salts (hydroxide):
- E.g., Rennie, Epicogel, Maalox.
- Side effects: diarrhea, sodium content.
-
Aluminium Salts (hydroxide):
- E.g., Maalox, Epicogel.
- Side effects: constipation.
-
Calcium Salts (carbonate):
- E.g., Rennie, Glycodal.
- Side effects: constipation.
-
Bismuth Salts:
- Side effects: constipation.
-
Sodium Bicarbonate:
- E.g., Pharocola, Fawar Fruit.
- High sodium content, caution advised in people with hypertension, CHF (congestive heart failure), or kidney disease.
Dyspepsia - Treatment
-
H2 antagonists:
- Block the action of histamine, which usually signals cells in the stomach to release HCl acid.
- Relatively fast-acting (1 hour).
- E.g., Ranitidine, famotidine, cimetidine.
Dyspepsia - Treatment
-
PPIs (Proton Pump Inhibitors):
- Inhibit the H/K-ATPase enzyme of parietal cells, which usually secretes HCl acid.
- Potent.
- For recurrent symptoms.
- E.g., Omeprazole, pantoprazole, esomeprazole.
Dyspepsia - Treatment
-
Simethicone:
- Reduces surface tension of gas bubbles.
- Defoaming agent in many antacid preparations.
- E.g., Simethicone capsules and syrups.
Dyspepsia - Treatment: Choosing the Appropriate Treatment
- Simple antacids + alginates: 1st line.
- H2 antagonists: 2nd line.
- PPIs: 2nd line.
H.pylori Treatment - Ulcers
- Triple therapy: PPI + 2 antibiotics (amoxicillin, clarithromycin, metronidazole).
- See BNF (British National Formulary) or USP-NF (United States Pharmacopeia and National Formulary) for specific details.
Community Pharmacist Role
- Offer simple lifestyle advice: healthy eating, weight reduction, smoking cessation.
- Help with prescribed medicines, provide advice when to consult a doctor, especially for red flag symptoms.
- Provide guidance on the use of OTC medications and educate patients about their condition.
- Provide patients with access to educational materials to support their care.
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Description
Test your knowledge on dyspepsia, a common digestive condition characterized by discomfort in the upper abdomen. This quiz covers symptoms, potential causes, and management options. Understand how lifestyle and other factors can influence dyspepsia management.
