Flashcards in Peptic Ulcer Disease Deck (19):
What is peptic ulceration?
Breach in the continuity of the epithelial lining of more than 5mm in diameter, with associated inflammation
What areas of the body does peptic ulceration affect?
Stomach, duodenum and lower oesophagus
What is used to treat peptic ulceration?
The same class of agents that are used to manage dyspepsia, reflux, ulcers and GORD
Gastro-oesophageal reflux disease (GORD)
- Produces chronic heartburn symptoms
- Affects 20% of population
- Refluc may cause chronic cough and laryngitis
- Symptomatic treatment
Common symptoms of dyspepsia, heartbutn and peptic ulcer
Pain and nausea
Alarm symptoms of dyspepsia, heartburn and peptic ulcer that need referral
- Loss of weight
- Recurrent problems (for <55yrs)
- Melaena/haematemesis (dark, sticky faeces)
- Swallowing problem
Antacids and alginates (What are they and how do they work?)
- Treatment for dyspepsia and GORD
- Reduce reflux and protect the oesophageal mucosa
Antacids and alginates (What are their side effects?)
Antacids usually contain aluminium, magnesium or calcium compounds
- Mg is a laxative
- Al causes constipation
Contains sodium bicarbonate which can also be bad
When should products containing sodium bicarbonate be avoided?
- If patient is on a salt restricted diet
- If patient has renal and cardiac conditions or hypertension
- During pregnancy
Antacids interactions (What are the consequences when antacids are taken simultaneously with other drugs)
- May reduce absorption of other drugs
- Raise pH of stomach and so damage enteric coatings
- Rarely affect pH dependent renal excretion
Histamine 2 antagonists (What are they and how do they work? Examples?)
- Heal duodenal and gastric ulcers when taken a high doses
- Used to treat GORD
- Examples: Cimetidine, Ranitidine, Famotidine, Nizatidine
Histamine 2 antagonists (What are their side effects?)
Headache, diarrhoea, dizziness
Histamine 2 antagonists (What does Cimetidine interact with?)
Inhibits metabolism of warfarin, phenytoin, carbamazepine, valproate, theophylline and sildenafil, increasing their plasma conc.
Helicobacter Pylori and peptic ulceration
- H. Pylori are associated with duodenal and gastric ulcers
- H. Pylori causes persistent infection in gastroduodenal mucosa
- Infection leads to gastritis
How is H. Pylori detected?
H. Pylori produces an antibody that is detectable in serum, saliva and urine
- Urea breath test kits = patient swallows 13C labelled urea solution
- Mucosal biopsies taken at gastroscopy
- High antibody = active infection
- Tests should not be done within 4 weeks of treatment with antibacterials
How is H. Pylori eradicated?
Combination of PPI (-prazole), clarithromycin and wither amoxicillin or metronidazole
What is the 1st PPI in the UK to be available as GSL?
Esomeprazole for reflux symptoms
Counseling points for treatment of H. Pylory
- Finish the course
- Eradication lasts 7 days