Coeliac Disease, Food Allergy, Exocrine Secretion And H2 Antagonists

Question 1

Chronic Bowel Disorders - List 4 examples

Answer 1

1) Coeliac disease
2) diverticulosis,diverticular disease and diverticulitis
3) Inflammatory bowel syndrome
4) Short bowel syndrome

Question 2

Bowel Disorder ADRs always are ….

Answer 2

• Abdominal Pain
• Diarrhoea
• Rectal Bleeding

Question 3

What is Coeliac disease?

Answer 3

• Autoimmune condition associated with chronic inflammation of the small intestine
• Immune response triggered by dietary protein - Gluten - found in RYE,WHEAT,BARLEY
• Gluten activates an abdominal immune response in the intestine which leads to malabsorption of nutrients ( CALCIUM, VITAMIN d, FOLIC ACID)
  Treatment is aimed at eliminating symptoms

Question 4

Symptoms of Coeliac

Answer 4

Abdominal pain
Bloating
Constipation
Diarrhoea
- Reduce complications from nutrient malabsorption ( eg, calcium deficiency, vitamin d Deficiency) eg osteoporosis/bone disease

Question 5

Non drug treatment of Coeliac

Answer 5

• A strict gluten free diet - this is the only effective treatment

Question 6

Drug treatment

Answer 6

• Supplementation with calcium,vitamin D,folic acid
• Advice patients to not self medicate with OTC vitamins or minerals - this should be discussed with healthcare professionals
• Osteoperosis and bone density treatment
• Confirmed cases of refractory coeliac disease (risk of cancer) - should be referred to specialist centre
• prednisolone (initial management - while waiting for specialist )

Question 7

What is the difference between **FOOD ALLERGY ** AND food intolerance

Answer 7

• Food allergy is an adverse response to a food, more frequently associated with GI reactions and respiratory reactions and less to do with respiratory and anaphylaxis
• food allergy is immunological - whilst intolerance is not

Question 8

What are common allergens

Answer 8

COWS MILK, Hens Eggs, Soy, Wheat , Peanuts. Fish, Shell fish

Question 9

MANAGEMENT OF FOOD ALLERGIES

Answer 9

• Strict avoidance of the food itself
• Sodium cromoglicate (given as an adjunct to dietary avoidance) - Opticrom or tabs
• Educate patients about allergies
• Drug treatment - Chlorphenamine maleate is license for symptomatic control of food allergy
• for food induced anaphylaxis - adrenaline is the first line (EpiPen)

Question 11

Antimuscarinics and antispasmodics - What do they do in the gi?

Answer 11

• relax intestinal smooth muscle ( useful for IBS)
• Reduce intestinal mobility
• Antimuscarincs eg, Dicycloverine hydrochloride and hyoscine butylbromide (buscopan) - different from hyoscine hydrobromide ( remember hydro = water = boat and travel ) - KWELLS

Question 12

Antimuscarinics Side effects?

Answer 12

Can’t see - Blurred vision
Can’t Pee(urinary retention)
Can’t Shit (constipation)
Can’t Spit (Dry Mouth)

Question 13

Reduced exocrine secretions

Answer 13

-Exocrine pancreatic insufficiency - Reduced secretion of pancreatic enzymes into duodenum

Symptoms-
- maldigestion and malnutrition ( low levels of nutrients, fat soluble vitamins and lipoproteins)
- Diarrhoea
-Abdominal cramps
-Steatorhhea - fatty poop

Question 14

What can cause exocrine secretion issues?

Answer 14

• chronic pancreatitis
• cystic fibrosis
• coeliac disease
• zollinger - Ellison syndrome
• pancreatic tumours
• Gi surgery

Question 15

Aim of exocrine insuffiency treatment

Answer 15

To relive GI symptoms and achieve normal nutritional status

Question 16

Exocrine insuffiency treatment drugs-

Answer 16

• Main treatment is pancreatic enzyme replacement therapy with pancreatin( eg. Creon, pancrex v, Nutrizym 22)
• Inactivated by gastric enzymes ( take with food) and avoid heat
• pancreatin contains 3 groups of enzymes - lipase, amylase and protease - which will assist in the digestion of fats, carbohydrates and proteins

Question 17

Non - Drug treatment

Answer 17

• Provide Dietary advice
• Distribute food intake between 3 main meals a day and 2 or 3 snacks
• avoid hard to digest food such as legumes eg. Peas beans,lentils and high fibre food)
• reduced fat diets not recommended
• avoid alcohol completely
• NB - Ensure hydration for patients on high strengths of pancreatin

Question 18

Gastroprotective complexes and chelations - protect the stomach lining

Answer 18

• Chelates - eg. Succraflate - protect the mucosa from acid-pepsin attack in gastric and dudodernal ulcers
• complexes of aluminium hydroxide and sulphate sucrose ) SUCRAL - sucrose and aluminium
  Has minimal antacid properties
• caution with intensive care patients - Bezoar formation - solid indigestible mass - caution is advised in seriously ill patients following reports of bezoar formation - especially those with concomitant external feeds or those with predisposing conditions such as delayed gastric emptying (blocks in feeding tube)
• give 1 hour before meal

Question 19

Sucralfate

Answer 19

-Sucralfate - ATE
- 1 Hour before you ATE
- Take LATE - at bed time
- Take 1 hour before meals or external feeds and at bed time - take on rising and at bedtime

Question 20

H2 Receptor antagonist

Answer 20

H2 receptor antagonist (rantidine,famotidine, cimetidine)

Heals gastric and duodenal ulcers
Relieves GORD symptoms

Should not be used for Zolinger elision syndrome - stomach tumors, producing too much gastric acid

Question 21

Rantidine

Answer 21

Safe in pregnancy - but discontinues at the moment

Question 22

Cimetidine

Answer 22

Potent enzyme inhibitors - interacts with many drugs

Question 23

Caution of H2

Answer 23

Masks gastric cancers - be alert with patients presenting with alarming signs

Common side effects - diarrhoea,dizziness,headaches,constipation,fatigue,myalgia