W3 L5 - Intro to Upper GI Therapeutics (SDL) Flashcards
(11 cards)
What defines functional dyspepsia, GORD, and peptic ulcer disease?
- Functional dyspepsia: Epigastric discomfort without structural cause; related to motility, sensitivity, CNS processing, and stress.
- GORD: Reflux of gastric contents; associated with cough, laryngitis, and complications like Barrett’s oesophagus.
- PUD: Sores in stomach/duodenum due to imbalance in protective vs. aggressive factors; causes include H. pylori and NSAIDs.
What symptoms suggest a problem in the upper gastrointestinal tract?
- Symptoms include upper abdominal discomfort, heartburn, bloating, early satiety, nausea, vomiting, and flatulence.
- Many symptoms overlap, requiring careful clinical evaluation.
What diagnostic steps and red flags are essential for assessing upper GI conditions?
Initial history: age, pain characteristics, associated symptoms, medication and social history.
ALARMS signs: Anaemia, Loss of weight, Anorexia, Recent symptoms, Melaena/haematemesis, Swallowing issues.
Other red flags: persistent pain, vomiting, night pain, referred pain.
Investigations: blood tests, H. pylori testing, endoscopy.
How are upper GI disorders specifically diagnosed and classified?
FD: Diagnosed symptomatically in absence of red flags; symptoms >8 weeks.
GORD: Based on heartburn/reflux symptoms ± endoscopic findings (erosive vs. non-erosive).
PUD: Diagnosed with gastroscopy showing ulceration; gastric ulcer pain relieved by food, duodenal worse at night.
How can lifestyle changes support management of functional dyspepsia and GORD?
Smoking cessation, healthy eating, avoiding trigger foods, limiting alcohol/caffeine, weight loss, and stress reduction.
Specific strategies for GORD: raise head of bed, avoid eating late.
Regular exercise is beneficial for FD.
Which medications can worsen symptoms and what pharmacological treatments are used?
Review and manage medications like NSAIDs, aspirin, corticosteroids, anticholinergics.
Main pharmacological treatment: acid-suppressing drugs – primarily PPIs.
What are the benefits and risks of PPIs in GI disease treatment?
PPIs reduce gastric acid production; effective for symptom relief and healing.
Short-term: generally safe; long-term risks include infection, cancer, osteoporosis, and nutrient malabsorption.
Best practice: use lowest effective dose, shortest duration, review regularly.
How do BNF treatment summaries guide management of GI disorders - GORD + Dyspepsia?
Dyspepsia
- Lifestyle changes: Weight loss, avoid trigger foods, no late meals, reduce alcohol/caffeine, stop smoking.
- First-line treatment: Short course of a proton pump inhibitor (PPI).
- If symptoms persist: Test and treat for H. pylori.
GORD (Gastro-oesophageal reflux disease)
- Lifestyle changes: As above (especially weight loss and bed elevation).
- Treatment: Start with a PPI for 4–8 weeks.
- Long-term cases: Use lowest effective dose, consider H2-receptor antagonist if PPIs not tolerated.
- Surgery (e.g., fundoplication) if severe or unresponsive to meds.
What are the causes and pathophysiology behind peptic ulcer disease (PUD)?
H. pylori: Infects gastric mucosa, causing inflammation and ulceration.
NSAIDs: Impair mucosal defences via prostaglandin inhibition; direct and indirect damage mechanisms.
PUD leads to pain and is a major cause of GI bleeding.
What is the recommended approach to treating NSAID-induced peptic ulcers?
First-line: Stop NSAID if possible; test for H. pylori.
Treatment: Full-dose PPI or H2 antagonist for 8 weeks; if H. pylori positive, follow with eradication therapy.
If NSAID needed long-term: consider dose reduction, switch to safer agent (e.g. ibuprofen), and prescribe gastroprotection (PPI/misoprostol).
What does the BNF recommend for managing peptic ulcer disease, especially NSAID-related cases?
Stop NSAIDs if possible — promotes ulcer healing.
Start a PPI (e.g., omeprazole 20 mg daily) — for treatment and prevention.
Test for and treat H. pylori if present — use triple therapy with a PPI + antibiotics.
Use alternative pain relief — consider paracetamol, topical NSAIDs, or COX-2 inhibitors if NSAIDs are essential.
Prevent ulcers in high-risk patients — co-prescribe a PPI with NSAIDs in the elderly or those with ulcer history.
