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Gastroenterology in General Practice

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					Gastroenterology in
General Practice
Gastroenterology
   Dyspepsia
       Ulcer disease
       Non-ulcer dyspepsia
       Helicobacter pylori
   Altered Bowel Habit
       Constipation
       Diarrhoea
   Jaundice
Gastroenterology
   GI Cancer
       Oesophageal
       Gastric
       Colorectal
       Pancreatic
Acid Suppressor Therapy

                 Appropriate Use in
                  General Practice
                 H2RAs
                 Proton Pump
                  Inhibitors
Life before PPIs
   The history of dyspepsia
       Surgery and diet
            Vagotomy/Pyloroplasty
            Steamed fish and milk puddings
       H2-receptor antagonists
            Tagamet & SKF
            Zantac & Glaxo
Proton Pump Inhibitors
   Losec (Omeprazole)(Astra)
   Zoton (Lansoprazole)(Wyeth)
   Pariet (Rabeprazole)(Janssen)
   Nexium (Esomeprazole)(Astra)
NICE Guidance
   Issued in 2000
   Targeted use to make best use of
    resources
Dyspeptic Symptoms
   Diagnosed or not?
       Non-ulcer Dyspepsia
            Lifestyle factors: STRAWS
       Peptic Ulceration
            Helicobacter screening techniques
       GORD
            Mild/Moderate
            Severe/Complicated
Dyspeptic Symptoms
   Investigations:
       Endoscopy
       C13-Urea Breath Testing
       Barium Swallow/Meal
Peptic Ulceration
   Helicobacter-related?
       ERADICATE
   NSAID-related?
       Co-Prescribe PPI if cannot stop NSAID
Gastro-Oesophageal Reflux
   Mild
       alternative Rx: antacid, alginate, H2RA
   Severe
       healing dose PPI until symptoms controlled
       maintenance dose to prevent recurrence
   Complicated
       stricture, ulcer, haemorrhage etc
       full dose maintained
Non-ulcer Dyspepsia
   Use Acid Suppressor
       H2RA
       NOT PPI
   Step-up or Step-down
   Modify lifestyle factors
       smoking
       diet
       weight
Investigation
   Over 55                       ENDOSCOPY
   Alarm Symptoms                ENDOSCOPY
       dysphagia
       anaemia
       progressive weight loss
   Under 45              NO INVESTIGATION
   45-55                     DEBATABLE
Inflammatory Bowel Disease
   Crohns Disease
   Colitis
       Ulcerative
       Pseudomembranous
   Diverticular Disease
Altered Bowel Habit
   Investigations:
       Faecal Occult Blood
       CEA/CA19-9
       Sigmoidoscopy
       Barium Enema
       Colonoscopy
Jaundice
   Pre-hepatic
       haemolysis
   Intra-hepatic
       hepatitis, drugs (flucloxacillin, chlorpromazine)
       cirrhosis, tumour
   Post-hepatic
       gallstones
       pancreatic tumour

				
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posted:4/11/2008
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