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Questions and Answers
Dietary adjustments are unnecessary for patients with dyspepsia.
False
Antacids neutralize stomach acid by increasing the levels of H+ ions.
False
Smaller, more frequent meals may help reduce symptoms of dyspepsia.
True
Simeticone is primarily used to increase stomach acid production.
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Diarrhea is a common adverse effect of aluminum-based antacids.
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Antacids can impair the absorption of certain medications if taken simultaneously.
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It is safe to use antacids continuously for more than two weeks without medical advice.
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Raising the head of the bed can be beneficial for individuals experiencing dyspeptic symptoms.
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Rennie Deflatine should be taken in doses of up to fifteen tablets a day for adults.
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Stress reduction and adequate sleep may improve digestive symptoms in dyspeptic patients.
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Sodium alginate should be administered before meals to be effective.
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H2 antagonists provide long-term relief from dyspepsia symptoms.
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Proton pump inhibitors require taking them at least half an hour after meals for maximum effect.
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H2 antagonists are safe to use in children under 16 years of age without any restrictions.
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Alginates can be safely used during pregnancy and breastfeeding without medical advice.
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Proton pump inhibitors often require several days to provide maximum relief.
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All OTC proton pump inhibitors have an age limit of over 18 years.
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H2 antagonists can be used safely during pregnancy and breastfeeding without needing a doctor’s advice.
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The mechanical barrier formed by sodium alginate is primarily due to its ability to increase stomach content viscosity.
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Proton pump inhibitors suppress acid secretion only when stimulated by certain foods.
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The lower oesophageal sphincter (LOS) is responsible for the movement of food from the stomach to the oesophagus.
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Dyspepsia is universally accepted to have a singular, clear definition.
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Parietal cells in the stomach secrete approximately 2L of hydrochloric acid each day.
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Only 20% of dyspepsia cases can be attributed to functional dyspepsia.
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Gastro-oesophageal reflux disease (GORD) is a very rare cause of dyspepsia.
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Patients on long-term therapy with proton pump inhibitors (PPIs) should never be referred to a specialist.
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Common symptoms of dyspepsia include nausea and early satiety.
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The term 'dyspepsia' implies a diagnosis rather than a range of symptoms.
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Flatulence is not considered a symptom of dyspepsia.
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It is common to find esophageal or gastric cancers as a cause of dyspepsia in patients over 55 years old.
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Study Notes
Gastrointestinal Tract Anatomy
- The lower oesophageal sphincter (LOS) regulates the movement of food from the oesophagus to the stomach.
- The stomach secretes hydrochloric acid (HCl), approximately 2L per day.
- HCl aids digestion, kills bacteria and creates the ideal pH for the digestive enzyme, pepsin.
Dyspepsia
- "Bad digestion"
- No universally agreed upon definition.
- Describes symptoms of the upper gastrointestinal tract and is a complex group of symptoms rather than a single diagnosis.
Dyspepsia Symptoms
- Upper abdominal pain or discomfort
- Heartburn, gastric acid reflux
- Heaviness or ache
- Fullness, abdominal bloating, belching
- Flatulence
- Nausea, vomiting, early satiety
- Symptoms may be associated with eating
Dyspepsia Causes
- 80% of cases are functional dyspepsia (unknown origin)
- Gastro-oesophageal reflux disease (GORD)
- 20% of cases are peptic ulcer, duodenal ulcer or erosive oesophagitis
- Oesophageal and gastric cancers are rare causes (less than 1%.)
Dyspepsia Red Flags
- Patients over 55 years old who experience dyspepsia for the first time
- Patients experiencing weight loss
- Patients on long term PPI therapy (need to see a specialist.)
- Patients on medications known to worsen dyspepsia symptoms or cause bleeding (e.g. NSAIDs)
Dyspepsia Non-Pharmacological Treatment Options
- Weight management
- Exercise
- Improve posture
- Avoid tight fitting clothes
- Avoid smoking and alcohol
- Raise the head of the bed (not with extra pillows)
- Avoid potential triggers: coffee, chocolate, fatty/spicy foods or eating late at night
- Smaller, more frequent meals
- Getting adequate sleep and reducing stress can improve digestive symptoms
- Identify potentially exacerbating medications.
Dyspepsia Pharmacological Treatment Options: Antacids
- Aluminium hydroxide, magnesium carbonate, magnesium trisilicate, calcium carbonate, sodium bicarbonate.
- Aluminium or magnesium salts are preferred.
- Neutralise stomach acid by balancing pH.
- Provide symptomatic relief.
- Taken as needed (PRN) when symptoms are expected (e.g. 1 hour after a meal and/or prior to bedtime.)
- Only for ages 12 and above with maximum use of 2 weeks. Seek medical advice if symptoms persist after 7 days.
Antacids Adverse Effects
- Diarrhoea (Mg)
- Constipation (Al or Ca)
- Belching
- Sodium content should be considered for all products.
Antacid Advice
- Safe in pregnancy and breastfeeding.
- Do not take at the same time as other medications as absorption may be impaired.
- Medications to avoid with antacids: iron supplements, calcium supplements, antibiotics, levothyroxine, phenytoin, digoxin, aspirin, thiazide diuretics, bisphosphonates, tuberculosis therapy, HIV therapy.
Dyspepsia Pharmacological Treatment Options: Simeticone
- Antifoaming agent to relieve trapped wind.
- Causes gas bubbles to coalesce and disperse, releasing trapped wind.
- Added to antacids to relieve flatulence.
- Safe in pregnancy and breastfeeding.
- Maximum use is 2 weeks. Seek medical advice if symptoms persist after 7 days.
Dyspepsia Pharmacological Treatment Options: Alginates
- Sodium Alginate (e.g., Gaviscon)
- Forms a protective layer on the stomach and oesophageal walls, creating a mechanical barrier.
- Increases viscosity of stomach contents.
- Safe in pregnancy and breastfeeding if clinically indicated.
- Seek medical advice if symptoms do not improve after 7 days.
- Adults and children over 12.
- Take after meals and at bedtime.
Dyspepsia Pharmacological Treatment Options: H2 (Histamine Receptor 2) Antagonists
- Inhibit H2 receptor on parietal cells, competitively reducing the production of acid.
- Short term relief of heartburn, indigestion (dyspepsia) and excess acid.
- Prevents symptoms associated with meals, including nocturnal symptoms.
H2 Antagonist Advice
- Twice daily dosing: before meals and at bedtime.
- Maximum treatment duration is 2 weeks OTC.
- Avoid for children under 16 years.
- Avoid in pregnancy and breastfeeding unless prescribed by a doctor.
- May interact with other medications (WWHAM), consider antacid interactions.
Dyspepsia Pharmacological Treatment Options: Proton Pump Inhibitors (PPIs)
- Esomeprazole, Omeprazole, Pantoprazole.
- Available OTC.
- Block the "proton pump" to suppress acid secretion, regardless of the stimulus.
- Provide prolonged acid suppression, generally dosed once daily.
- Take at least 30 minutes before food, ideally before breakfast.
- Enteric coated, meaning they should be taken on an empty stomach.
- Most OTC products are for over 18 (exception: Losec control does not have an age limit.)
PPI Advice
- Takes 3 days for maximum relief.
- Refer to GP if symptoms are not relieved or persist beyond the licence duration.
- Drug interactions include clopidogrel, some Hep C/HIV antivirals and pH dependent absorption drugs.
OTC PPIs in Pregnancy and Breastfeeding
- Antacids and Alginates can be provided OTC.
- H2 antagonists and PPIs require medical advice from a doctor.
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Description
Explore the anatomy of the gastrointestinal tract, focusing on the lower oesophageal sphincter and the stomach's role in digestion. This quiz also delves into dyspepsia, its symptoms, and potential causes, offering insights into upper gastrointestinal disorders.
