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| Management of Dyspepsia and Heartburn |
On September 30, 2004, Vioxx (rofecoxib) was withdrawn from the U.S. and worldwide market due to safety concerns of an increased risk of cardiovascular events. See the U.S. Food and Drug Administration (FDA) Web site for more information. Subsequently, on December 23, 2004, the FDA issued a public health advisory concerning the use of non-steroidal anti-inflammatory drug products (NSAIDs) including the COX-2 selective agents Celebrex (celecoxib), Bextra (valdecoxib) and a non-selective NSAID, naproxen (sold as Aleve, Naprosyn and other trade name and generic products). See the FDA web site for more information.
Alternative analgesics/anti-inflammatories should be considered first. Co-therapy may be required to prevent adverse effects (eg, dyspepsia, gastrointestinal bleeding) in selected at-risk patients, The COX-2 drugs listed above should only be used after careful consideration of the risks, benefits and costs related to each specific patient where this choice is made. |
| Frequently Asked Questions |
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What is dyspepsia?
Dyspepsia is a general term used to describe pain or discomfort in your upper abdomen. You might experience this as bloating, nausea and premature fullness after eating.
Heartburn is usually experienced as a burning sensation radiating from the upper abdomen towards the throat. This is a different symptom from simple dyspepsia; it can be there on its own or with dyspepsia. |
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What causes dyspepsia?
For many people dyspepsia can appear after simply eating or drinking too much, or too much of a particular thing (e.g. alcohol). Some medications, including pain relieving non-steroidal anti-inflammatory drugs (NSAIDS such as diclofenac or ibuprofen), may also cause dyspepsia.
About half of the people with dyspepsia will have a stomach or bowel disorder known as functional dyspepsia (FD). FD is believed to be related to an increased sensitivity of the stomach and bowel to normal digestive processes.
A smaller number of people with dyspepsia may have a peptic ulcer (in the stomach or intestine). Other conditions can also cause dyspepsia, although these usually also cause other symptoms which can be identified by your doctor. |
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What causes heartburn?
Heartburn can be caused by acid from the stomach entering the oesophagus (gullet). This is known as gastro-oesophageal reflux disease (GORD). This is caused by the valve at the lower end of the oesophagus permitting acid and food to come back into the oesophagus; the acid produces the burning. |
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What should I do about dyspepsia?
Sometimes some simple alterations to your lifestyle are all that is required to bring relief from dyspepsia symptoms. These can include:
- Moderating alcohol intake
- Stopping smoking
- Avoiding rich or fatty foods
- Losing weight (if applicable).
You can self-medicate (at least initially) with antacids or acid lowering medications which are available without prescription in pharmacies and supermarkets.
If symptoms are severe or persistent for more than a few weeks, you should consult your doctor. Symptoms that should always be assessed by your doctor include:-
Unexplained weight loss
- Food blocking when swallowing
- Vomiting of blood or coffee ground-like material
- Passage of black bowel motions
- Symptoms associated with taking NSAIDS.
All symptoms should be regarded as more serious when they are experienced for the first time by people aged over 50, and those with a family history of stomach cancer who first exhibit symptoms when aged below 50. |
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What can my doctor do?
Your doctor will assess your symptoms in the light of your medical history and decide on an appropriate management strategy. This may include:
- Giving lifestyle advice: Attention to diet, eating habits, weight, smoking, alcohol intake, and psychosocial stresses. Some people taking medications which can cause dyspepsia, especially NSAIDS, will have their medicines reviewed.
- Prescribing simple antacids or acid lowering medications for a short course of treatment.
- Testing for the bacteria Helicobactor pylori (H. pylori). This germ may be linked to peptic ulceration and can be detected by laboratory testing your blood or faeces. Testing for H. pylori and treating people who have a positive test can be useful in areas and groups where the germ is common, (e.g. South and West Auckland, Maori, Polynesian and Asian populations).
If the test is positive, you will need to take a medicine containing an acid lowering agent and two antibiotics for one week to treat H. pylori. You need to follow the instructions of your doctor closely to avoid the bacteria losing their sensitivity to antibiotics.
- Motility modifying drugs including domperidone or metoclopramide.
- Prescribing acid lowering agents. These include ranitidine and famotidine, and omeprazole or pantoprazole. These will be prescribed initially for a defined period (e.g. one month). These are the drugs of choice in heartburn but may also be effective in some people with dyspepsia.
- Ordering investigations. In some circumstances your doctor will consider it important to do some tests to help him or her make a more definitive diagnosis. This may initially be simple blood tests. You may also be referred for a procedure (called oesophago-gastro-duodenoscopy [OGD]). This involves a slim tube being passed through your mouth to check the appearance of your oesophagus, stomach and duodenum (upper intestine).
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How long will I need to take medications?
In most cases, you will only need to take medication for a short time. If treatment needs to be prolonged to control symptoms (continuously over 3 months), it may be better to come to a definitive diagnosis (with a procedure such as an OGD).
Once a diagnosis is established, most people can be treated with one of the medications described above using the lowest dose which controls the symptoms. Many people will be able to stop their medications altogether.
A minority of people will have ulcers and require H. pylori eradication. A small minority will be advised to stay on long-term potent acid suppression (e.g. those with severe GORD, complicated ulcers who do not have H. pylori, and those on NSAIDS who cannot change to other medications).
15 April 2004 |
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