CLINICAL


dySPEPSIa aNd RElatEd cONdItIONS


dySPEPSIa IS a gENERal tERm USEd tO cOVER a RaNgE Of cONdItIONS Of thE UPPER gaStROINtEStINal (gI) tRact SUch aS INdIgEStION, gaStRIc REflUx aNd/OR NaUSEa/VOmItINg (1)


. It IS thIS gROUP Of


SymPtOmS that PRESENt aNd alERt dOctORS tO INVEStIgatE aNd cONSIdER dISEaSE Of thE UPPER gI tRact.


by gareth mccabe S


ymptoms generally present for four or more weeks prior to diagnosis, however dyspepsia


itself is not a diagnosis (2). It is


estimated that dyspepsia affects between twelve and 41 per cent of the general population and is the cause of between 1.2 and 4 per cent of consultations in primary care in the Uk (3)


.


Indigestion is pain or discomfort in the stomach and under the ribs. this usually occurs after eating or drinking and symptoms include (4)


:


• feeling uncomfortably full or bloated


• feeling nauseous • Belching or flatulence • acidic taste • Rumbling stomach • heartburn


after eating and drinking, the stomach is stimulated to produce acid to aid in the digestion of the food and drink. however, this acid can sometimes irritate the lining of the stomach, the top part of the bowel and into the oesophagus. this causes the burning sensation associated with indigestion. also after a large meal the stomach naturally stretches and can cause acid reflux where acid enters the oesophagus.


treatment for indigestion will vary depending on what's causingit and


38 - PhaRmacy IN fOcUS


how severe your symptoms are. most people are able to manage their indigestion by making simple diet and lifestyle changes, or taking medication such as antacids. keeping a food diary is a good way to help identify foods or food groups that cause indigestion.


Some people presenting with diagnosis of indigestion may have gastro-oesophageal reflux disease.


gastro-oesophageal reflux disease (gORd) is a diagnosable disease that causes persistent heartburn. this is caused by the failure of the gastro- oesophageal sphincter leading to a reflux of gastric contents into the oesophagus (1) (5)


. Over time this


repeated irritation by the stomach acid causes heartburn and painful swallowing. those diagnosed with gORd will have undergone an endoscopy to determine either oesophagitis or endoscopy negative reflux disease. Oesophagitis is inflammation of the mucosal lining of the oesophagus; endoscopy negative reflux disease is the presence of symptoms but no inflammation (5)


.


It may not always be clear what causes gORd, however there are a number of risk factors than can be attributed to having gORd: • Being overweight/obese: causes increased pressure on the stomach and can weaken the muscles at the bottom of the oesophagus


• Smoking, alcohol, coffee and chocolate: may weaken the muscles at the bottom of the oesophagus • Eating large amounts of fatty foods: this causes the stomach to produce more acid to help aid digestion and it takes longer to get rid of the excess acid. this increase in acid production and decrease in its removal can cause excess acid to leak back up into the oesophagus. • hiatus hernia: this occurs when part of the stomach pushes through the thin layer of muscle between the stomach and the diaphragm. • gastroparesis: this is a delay in the normal emptying of the stomach which can lead to a build-up of excess acid which may leak up into the oesophagus (6)


.


• certain medication can cause these symptoms. (See table 1)


treatments of gORd are similar to that for indigestion. Initially diet and lifestyle changes are recommended, by losing weight, becoming more active and avoiding trigger foods (3)


.


following that, over the counter (Otc) medication can help alleviate the symptom. an antacid or alginate type medication is recommended. antacids work by neutralising the acid in the stomach with common ingredients including aluminium hydroxide, magnesium carbonate and magnesium trisilicate. alginate medication forms a raft/barrier on top of the stomach acid and protects the oesophagus from acid reflux (7)


. the


use of a Proton Pump Inhibitor (PPI) for four-eight weeks should be offered and then to be reduced and used as a ‘when required/PRN’ dose. If proven to be unsuccessful then a >


Table 1: Some medicines, whose common side effect profile, can cause dyspepsia symptoms (1) (4) (14)


• NSaIds • aspirin (including 75mg) • corticosteroids • Iron • antibiotics • Slow release potassium • calcium antagonists • Nitrates • theophyllines • Bisphosphonates • anticholinergic drugs (eg, tricyclic antidepressants, drugs for urinary incontinence)


• Selective serotonin reuptake inhibitors (SSRIs)


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