cptp - pud + altered bowel habit

8/10/2019 CPTP - PUD + ALTERED BOWEL HABIT

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Dyspepsia

Therapeutic pathway for proven Non-ulcer dyspepsia

Test and treat for HP

4 weeks low dose PPI

If symptoms recur step down PPI/H2RA to lowest dose to control symptoms.

Peptic ulceration

NICE guidelines

<55 years “Test and Treat”

Test for H. pylori – C

13

Urea breath test or stool antigen (2 week washout post PPI) 4 weeks full dose PPI

55 years with unexplained, persistent symptoms – URGENT endoscopy referral

Don‟t prescribe PPI pre-endoscopy as need to be off acid suppression medication for >2 weeks prior to

endoscopy

General advice

Stop smoking

Reduce alcohol intake

Lose weight

Increase exercise

Reduce fatty/spicy foods

Eat small regular meals

H. Pylori infection

Di i



Diagnosis

Dyspepsia,

peptic ulcerMechanism of actions Indications Adverse effects

ANTACIDSAluminium

hydroxide

neutralize gastric acid

Alginate-containing

antacids form a „raft‟ thatfloats on the surface of the

stomach contents to reduce

reflux and protect the

gastro-oesophageal

mucosa

Symptomatic relief in dyspepsia, gastro-

oesophageal reflux and peptic ulceration

Magnesium-containing antacids tend to be laxative,

whereas aluminium-containing antacids may be

constipating; antacids containing both aluminium andmagnesium may reduce these colonic side-effects.

Antacids may interfere with the absorption of other drugs

and in general other drugs should be given at least 1 hour

before or after each dose of antacid

H2-

RECEPTOR

ANTAGONIST

RANITIDINE

Reduce gastric acid

secretion as a result of

histamine H2-receptor

blockade.

Prevention of gastroduodenal damage in

patients requiring intensive care. PPIs are

more effective

Diarrhoea, altered liver biochemistry, headache, dizziness, rash

PROTON

PUMP

INHIBITORS

OMEPRAZOLE

Inhibit gastric acid secretion

by blocking the

hydrogen/potassium-

adenosine triphosphate

enzyme system (the „proton

pump‟) of the gastric

parietal cell.

GORD; healing of peptic ulcers; prevention

of NSAID-induced peptic ulcers; in

combination with antibacterials for

eradication of H. pylori; intravenously

Drugs for dyspepsia and peptic ulceration

and after endoscopic therapy to reduce

re-bleeding rates in patients with bleeding

peptic ulcers; inhibition of gastric acid in

pathological hypersecretory conditions

Gastrointestinal disturbance (diarrhoea, nausea, vomiting),

liver dysfunction, hypersensitivity reactions, headache, skin

reactions, increased risk of gastrointestinal infections (due

to reduced gastric acidity). Increased risk of C difficile and

infective diarrhoea

may reduce the Therapeutics ability of clopidogrel to

inhibit platelet aggregation

Omeprazole may decrease the effect of warfarin,

phenytoin and diazepam

LANSOPRAZOLELansoprazole may increase the effect of warfarin, phenytoin

and theophylline.



DIARRHOEA

&

COSTIPATION

MECHANISM OF ACTIONS INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT

D

I A R R H O E A

Loperamide

• Opiate GI specific

• Antimotility agent

• Reduces GI smooth muscle

tone and reduces peristalsis

mild infective diarrhea

irritable bowel syndrome

chronic IBD diarrhea

high output stomas

Severe ulcerative colitis or C.diff

– increases the risk of Toxic

megacolon

Severe infective diarrhoea

Dysentry (bloody stool)

Liver disease (risk ofaccumulation)

Constipation, abdominal cramps,

dizziness

C O N S T I P A T I O N

ISGHULA

HUSK

Bulk-forming laxatives.

Absorb water and increase faecal

mass, which stimulates peristalsis.

Slow-transit constipation and

bulking of stool in patients with a

colostomy, diverticular disease and

irritable bowel syndrome.

Maintain adequate fluid intake to

prevent faecal impaction;

contraindications (see above).

Flatulence, abdominal distension.

SENNA

Increase peristalsis

Stimulant laxatives.

Increase colonic motor activity.

Usually required for opioid-

induced constipation.

constipated patients and those

undergoing 'bowel prep' to

clear the bowel before a

medical intervention

Abdominal cramps, diarrhoea and

hypokalaemia.

Sodium

Docusate

Stool softener. Allow water to enter

stool more readily.

Adjuvant therapy. Use as

prophylaxisDo not take with mineral oil

Lactulose

Osmotic laxatives. Attract or retain

water in the intestinal lumen,

leading to softer stools and

improved propulsion.

Treatment of constipation.

Lactulose is used in the

treatment of hepatic

encephalopathy. Phosphate

enemas are used to evacuate

the bowel before radiological

procedures, flexible

sigmoidoscopy and surgery

Abdominal distension, colic, nausea,

local irritation after phosphate

enema.

May also cause electrolyte

disturbance. Use with caution in

hepatic and renal impairment.

Although magnesium ions are

absorbed poorly, similar to all

osmotic ions some absorption does

occur, which can cause problems in

patients with abnormal renal

function.

Macrogols

cptp - pud + altered bowel habit

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