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3. Gastrointestinal disorders
Disorders of the stomach
and duodenum
Gastro-oesophageal reflux disease 3
Clinical features
B urn in g s to m a cha che o r hea rtb urn , gen era lly relieved b y a n ta cid s ; a cid
regurgita tio n
( o ften po s t ura l: w h ile s ittin g fo rw a rd o r lyin g d o w n ) . I n th e a b s en ce o f
d ys ph a gia
(o es o pha gea l s ten o s is ), thes e s ign s a re b en ign .
Treatment
G ive aluminium hydroxide PO : 1 .5 to 3 g/ d a y in 3 d ivid ed d o s es o n e ho ur a fter m e
– F irs t in s ta n ce, en co ura ge the pa tien t to a vo id a lco ho l a n d to b a cco us e.
1
or
oInmseptrrauzcotlethPeOpa:ti2en0 tmto gtao knec5e0d0a imly ign atht ethme toimrneion fgafopra3indfaulyas tta ck.
– If a n ta cid s a re in s ufficien t:
o r, if n o t a va ila b le, cimetidine PO : 4 0 0 m g o n ce d a ily a t b ed tim e fo r 3 d a ys
– In s m a ll child ren : n o d rug trea tm en t, res t a n d s leep o n a n in clin e (3 0 ° to 4 5 °).
Peptic ulcer diseases
Clinical features
B urn in g epiga s tric pa in o r epiga s tric cra m ps b etw een m ea ls , tha t w a ke the pa tien t
at
n ight. T hey a re m o s t ch a ra cteris tic w h en they o ccur a s epis o d es o f a few d a ys
an d
w hen a cco m pa n ied b y n a us ea a n d even vo m itin g.
T he m o s t co m m o n co m plica tio n s a re perfo ra tio n a n d b leed in g.
Treatment of non-complicated ulcers
– F o r a n is o la ted epis o d e:
• id en tify pa tien ts ta kin g N S A ID o r a cetyls a licylic a cid ; s to p trea tm en t
• en co ura ge pa tien ts to a vo id a lco ho l a n d to b a cco us e
• omeprazole PO : 2 0 m g o n ce d a ily in the m o rn in g fo r 7 to 1 0 d a ys
o r, if n o t a va ila b le, cimetidine PO : 8 0 0 m g o n ce d a ily a t b ed tim e fo r 7 to 1 0
d a ys
– AIfluthmeinipuamtiheyndrtoxhidaesmfareyqdeucerenastereacbusrorrepntiocneosf ,durungsretlaaketendattotheNsaSmeAtimIDe, leuasvee,atnhaintterrevqal uoifreat least
repea ted
trea tm en t w ith a n tiulcer d rugs : s ee era d ica tio n o f Helicobacter pylori, n ext pa ge.
1
Disorders of the stomach
and duodenum
Gastro-oesophageal reflux disease 3
Clinical features
B urn in g s to m a cha che o r hea rtb urn , gen era lly relieved b y a n ta cid s ; a cid
regurgita tio n
( o ften po s t ura l: w h ile s ittin g fo rw a rd o r lyin g d o w n ) . I n th e a b s en ce o f
d ys ph a gia
(o es o pha gea l s ten o s is ), thes e s ign s a re b en ign .
Treatment
G ive aluminium hydroxide PO : 1 .5 to 3 g/ d a y in 3 d ivid ed d o s es o n e ho ur a fter m e
– F irs t in s ta n ce, en co ura ge the pa tien t to a vo id a lco ho l a n d to b a cco us e.
1
or
oInmseptrrauzcotlethPeOpa:ti2en0 tmto gtao knec5e0d0a imly ign atht ethme toimrneion fgafopra3indfaulyas tta ck.
– If a n ta cid s a re in s ufficien t:
o r, if n o t a va ila b le, cimetidine PO : 4 0 0 m g o n ce d a ily a t b ed tim e fo r 3 d a ys
– In s m a ll child ren : n o d rug trea tm en t, res t a n d s leep o n a n in clin e (3 0 ° to 4 5 °).
Peptic ulcer diseases
Clinical features
B urn in g epiga s tric pa in o r epiga s tric cra m ps b etw een m ea ls , tha t w a ke the pa tien t
at
n ight. T hey a re m o s t ch a ra cteris tic w h en they o ccur a s epis o d es o f a few d a ys
an d
w hen a cco m pa n ied b y n a us ea a n d even vo m itin g.
T he m o s t co m m o n co m plica tio n s a re perfo ra tio n a n d b leed in g.
Treatment of non-complicated ulcers
– F o r a n is o la ted epis o d e:
• id en tify pa tien ts ta kin g N S A ID o r a cetyls a licylic a cid ; s to p trea tm en t
• en co ura ge pa tien ts to a vo id a lco ho l a n d to b a cco us e
• omeprazole PO : 2 0 m g o n ce d a ily in the m o rn in g fo r 7 to 1 0 d a ys
o r, if n o t a va ila b le, cimetidine PO : 8 0 0 m g o n ce d a ily a t b ed tim e fo r 7 to 1 0
d a ys
– AIfluthmeinipuamtiheyndrtoxhidaesmfareyqdeucerenastereacbusrorrepntiocneosf ,durungsretlaaketendattotheNsaSmeAtimIDe, leuasvee,atnhaintterrevqal uoifreat least
repea ted
trea tm en t w ith a n tiulcer d rugs : s ee era d ica tio n o f Helicobacter pylori, n ext pa ge.
1
