Dyspepsia management

  • Created by: MazzaW
  • Created on: 07-12-19 16:45


Increase pH of stomach to neutralise stomach acid, bind to and inactivate pepsin

1st line: aluminium hydroxide, magnesium carbonate, magnesium trisilicate

Aluminium salts may cause constipation

Magnesium salts may cause diarrhoea

Hydroxides are contraindicated in people with hypophosphataemia

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H2 receptor antagonists

Examples: ranitidine, (cimetidine)

Competitively block action of histamine to decrease acid production.

Cimetidine is a CYP450 inhibitor

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Proton pump inihibitors

Examples: omeprazole, lansoprazole

Irreverible inhibition of H/K ATPase responsible for H secretion


  • C. difficile risk with PPIs and Abx
  • electrolyte disturbance
  • drug interactions (e.g. with clopidogrel)
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H. pylori eradication

Test for H. pylori with carbon 13 urea breath test (can also do faecal Ag, serum Ab or rapid urease test on endoscopic samples)

Triple therapy = PPI/amoxicillin/clarithromycin OR PPI/amoxicillin/metronidazole

If eradication failure, quadruple therapy = omeprazole/tetracycline/metronidazole/bismuth chelate

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PUD treatment

Heal ulcer:

  • antisecretory medication (PPI): 4-8wks if H. pylori negative, 8wks if H. pylori positive
  • IV PPI if upper GI bleed
  • gastric ulcer: repeat endoscopy 6-8wks post-treatment (risk of gastric cancer)
  • duodenal ulcer: no repeat endoscopy required

H. pylori eradication: reduces recurrence, retest for H. pylori 6-8wks post-treatment

Stop NSAID use if possible

Surgery if: failed medical/endoscopic management in upper GI bleed, complications of PUD

May need long-term PPI if using NSAIDs and: age >65, history of PUD (especially with complications), high-dose NSAIDs (especially in combo with aspirin/SSRIs/anticoagulants), or in any elderly patient taking aspirin

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GORD treatment

Full-dose PPI for 4-8wks then low-dose PPI maintenance

Long-term full-dose PPI maintenance if:

  • severe oesophagitis
  • oesophageal stricture

Consider OGD surveillance of patients with Barrett's oesophagus with evidence of dysplasia

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