Indigestion and heartburn

Question 1

Describe the difference(s) between indigestion and heartburn and any other terms used to describe them

Answer 1

• indigestion (dyspepsia) occurs after eating, excess acid is produced in the stomach
• heartburn (acid reflux): excessive acidic contents of stomach escape back up to oesophagus due to weakened or malfunctioning sphincter (valve)

Question 2

What causes the symptoms in indigestion and heartburn?

Answer 2

Acid contacts oesophagus lining, causing irritation and associated symptoms

Question 3

If treatment hasn’t been successful, after what period of time should a patient be referred to their GP?

Answer 3

If symptoms not responded to treatment, refer to GP after:
7 days for heartburn
5 days for indigestion

Question 4

List the symptoms of indigestion

Answer 4

bloated feeling
churning stomach
stomach cramp
pain (though usually less than heartburn)
excess acid (leaving a nasty taste) 
dull stomach ache
wind

Question 5

List the symptoms of heartburn

Answer 5

severe pain in upper chest 
burning in the back of the throat 
taste of acid in the mouth
burning pain rising up the throat
stabbing pain in the chest
excess acid 
symptoms worse after eating food

Question 6

Questions to ask patient with suspected heartburn or indigestion

Answer 6

Could you explain where the pain starts and where you feel it?
Describe to me how your symptoms progress through the day?
Is the pain waking you at night? (Duodenal ulcer)

Question 7

Red flag symptoms for indigestion and heartburn

list them

Answer 7

• symptoms persistent or recurrent (>2x in one week or lasting >5 days)
• severe pain or pain radiating to arms
• failed treatment or ADR
• pain or difficulty swallowing, dysphagia, or on effort
• regurgitation
• bleeding in vomit or stool
• unintentional weight loss
• anaemia (fatigue, pale skin)
• persistent vomiting
• shortness of breath
• children
• first time symptoms in those aged 45+

Question 8

Indigestion and heartburn danger elimination

how to make sure it’s not an MI/angina?

Answer 8

pain radiating down the arm or pain on exertion?

Do they have nausea, vomiting, sweating or clammy skin? Crushing pain?

Question 9

Indigestion and heartburn danger elimination

Oesophagitis

Answer 9

blood-stained vomit/stools

Question 10

Indigestion and heartburn danger elimination

duodenal ulcers

Answer 10

gnawing, hunger-like pain, relieved by eating then recurs, causes sufferer to wake, blood in vomit or stools

Question 11

Indigestion and heartburn danger elimination

gastric/peptic ulcer

Answer 11

worse after eating,nausea, salivation, bloating, weight loss, loss of appetite

Question 12

Indigestion and heartburn danger elimination

gastric cancer

Answer 12

loss of appetite
anaemia
blood in stools/vomiting
unexplained weight loss

Question 13

Indigestion and heartburn danger elimination

gallstones

Answer 13

stones form in gall bladder and block the bile duct in the liver, severe pain in upper abdomen which can be confused with a duodenal ulcer

Question 14

Indigestion and heartburn danger elimination

IBS

Answer 14

colon spasms
alternating constipation and diarrhoea
Pain in lower abdomen and sometimes upper so confused with heartburn

Question 15

How do histamine 2 receptor blockers work in the treatment of indigestion and heartburn?

Answer 15

block the histamine receptors in parietal cells to decrease the amount of acid produced

Question 16

How do PPIs work in the treatment of indigestion and heartburn?

Answer 16

PPI=protein pump inhibitor

Shuts down proton pumps in parietal cells, preventing the acid from being secreted into the stomach

Question 17

Lifestyle advice for indigestion and heartburn

Answer 17

• raise the bed or use an extra pillow as symptoms are worse when horizontal or bending
• stop smoking and reduce alcohol and caffeine intake
• avoid spicy and oily foods, or avoid specific known trigger foods, or large, heavy and fatty meals
• chemicals in fatty foods, chocolate, alcohol and coffee and smoking make heartburn worse
• avoid tight, restrictive clothing e.g. belts
• pregnant women also suffer from heartburn but this is due to the growing baby pushing internal organs upwards, including the stomach and its contents

Question 18

common age range for heartburn and indigestion

triggers for it?

Answer 18

Common in over 55 years of age
Common in overweight individuals
Triggers include: heavy meals, spicy foods, alcohol, smoking, NSAIDs (irritate stomach lining)

Question 19

Gaviscon original drug, symptoms
directions
formulations

Answer 19

Sodium alginate with calcium carbonate and sodium bicarbonate
GI acid reflux, heartburn, indigestion
Children 6-11: 5-10mL
Over 12s: 10-20mL
Take it after meals and at bedtime
Note: children 6-12 can only take this under medical supervision

Question 20

Gaviscon original warnings

Answer 20

check allergies
contains sodium and calcium so be careful if on salt diet
Do not give if patient has high blood pressure
Do not use if taking citrate salts

Question 21

Gaviscon original pregnancy and diabetes?

Answer 21

fine for both pregnant women and diabetics

Question 22

Counselling for gaviscon

Answer 22

Can have aniseed or peppermint flavourrs
Different types of gaviscon: double action, advanced etc.
Children 6-12: under medical supervision

Question 23

Rennie for use in indigestion and heartburn

Directions for use

Answer 23

1-2 tablets up to TDS, PRN
take before food
Maximum of 10 tablets/day
different flavours available

Question 24

Rennie for use in indigestion and heartburn

Side effects and warnings

Answer 24

Side effects: GI disturbances
Warnings: Not for children, only for over 12s
Fine in pregnant women

Question 25

Ranitidine for indigestion and heartburn Drug class? Symptoms/Licence?

Answer 25

H2 antagonist | Short term relief (2 weeks) of dyspepsia, hyperacidity, heartburn

Question 26

Ranitidine for indigestion and heartburn | directions for use

Answer 26

16+ and elderly: 1-2 tablets PRN If symptoms persist after 1 hour, take another tablet. No more than 2 tablets per 24 hour period. Not to be taken for more than 6 days unless under the advice of a doctor or pharmacist

Question 27

Ranitidine for indigestion and heartburn | warnings

Answer 27

Not for under 16s No more than 2 tablets in a 24 hour period Not to be taken for more than 6 days unless under the advice of a doctor or pharmacist Not to be used in pregnant or breastfeeding women Do not use in hepatic or renal impairment Caution if taking NSAIDS, antacids, sucralfate (for ulcers) Check interactions Do not drink alcohol

Question 28

Ranitidine for indigestion and heartburn Counselling

Answer 28

Not for under 16s Do not drink alcohol Work longer than antacids like Rennie- 8-9 hours duration Try to take 1 hour before food

Question 29

Omeprazole drug class and symptoms it treats

Answer 29

PPI Heartburn Indigestion

Question 30

Omeprazole for heartburn and indigestion, directions for use

Answer 30

1-2 tabs OD for 2 weeks | 10-20mg OD for 2 weeks according to response

Question 31

Omeprazole for heartburn and indigestion, | side effects

Answer 31

``` abdominal pain constipation diarrhoea headache nausea vomiting ```

Question 32

Omeprazole for heartburn and indigestion suitability in pregnancy? age restrictions

Answer 32

Fine for pregnancy and breastfeeding patients | Not for under 12s

Question 33

Pepto-Bismol liquid suspension indication doses

Answer 33

heartburn/indigestion, diarrhoea, upset stomach Up to 8 doses in 24 hours 1 dose= 30mL, repeat dose every 30-60 mins if needed

Question 34

Pepto-bismol suitability for pregnancy and breastfeeding | warnings

Answer 34

Ok to take in pregnancy, but must check with doctor first Under 12s: must be under doctor's advice Warning: take for no longer than 2 days.

Question 35

How toes pepto-bismol work in the treatment of indigestion and heartburn? What the active compound in it?

Answer 35

contains bismuth subsalicylate which coats the lining of the stomach and prevents irritation and lessens nausea Antacid