Rx Note

Introduction Heartburn is a form of dyspepsia, or more formally known as gastro-oesophageal reflux disease (GERD) . Symptoms are caused when there is reflux of gastric contents, particularly acid, into the oesophagus, which irritate the sensitive mucosal surface (esophagitis). Symptoms Patients will often describe the symptoms of heartburn - typically a burning/pain felt in the stomach, passing upwards behind the breastbone (retrosternally). Regurgitation is defined as the perception of flow or refluxed gastric content into the mouth or hypopharynx. It is often brought on by bending or lying down, which make leakage of acid up the oesophagus more likely. Aggravating Factors Alcohol, caffeine, smoking, overweight, stress, a large meal and medications are known to aggravate heartburn. Moreover, half of all pregnant women are estimated to suffer from heartburn (often begins in mid-to-late pregnancy). Referral Referral for further investigation is recommended: In patients aged <18 y...

Introduction Proton pump inhibitors (PPI) is commonly prescribed in government hospital setting to treat GERD and peptic ulcers, especially after ranitidine product recall . In an overview, all PPIs are similar in terms of efficacy and adverse effects but might be different in terms of potential to cause drug interactions (e.g. PPIs with clopidogrel). There are two distinct peaks for dexlansoprazole delayed-release capsule due to the dual-release formulation: an initial peak between 1 and 2 hours and a second higher peak between 4 and 5 hours. Method of Administration Since meal is the main stimulus of proton pump activity, oral PPI should be taken about 30 minutes before a meal . NOTE: Dexilant (dexlansoprazole) delayed release capsule can be taken without regards to meals due to its dual delayed-release formulation. Precautions If a patient develops symptoms such as black stools or vomit that looks like coffee ground , they should seek immediate medical attention. What we worried is...

Introduction Helicobacter pylori infection is one of the most common causes of peptic ulcer disease , with 95% of duodenal and 70-80% of gastric ulcers associated with it. Helicobacter pylori is a spiral-shaped gram-negative bacterium transmitted through the oral to oral (more common) or faecal to oral route. Eradication of H. pylori infection reduces the possibility of developing gastric carcinomas. Diagnosis The presence of H. pylori should be confirmed before starting eradication treatment ( "test and treat" strategy ). Test for Helicobacter pylori infection in patients with a current or prior documented peptic ulcer or gastric malignancy, and Consider testing in patients with uninvestigated dyspepsia, patients on long-term low-dose aspirin, patients with unexplained iron deficiency anaemia and patients with idiopathic thrombocytopenic purpura. Diagnosis may involve the 13 C-urea breath test Most accurate non-invasive test Stool Helicobacter Antigen Test (SAT) Antibody te...