Gastroenterology in General Practice
Gastroenterology
Dyspepsia
Ulcer disease Non-ulcer dyspepsia Helicobacter pylori
Constipation Diarrhoea
Altered Bowel Habit
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 Tagamet & SKF Zantac & Glaxo
H2-receptor antagonists
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
Mild/Moderate Severe/Complicated
GORD
Dyspeptic Symptoms
Investigations:
Endoscopy C13-Urea Breath Testing Barium Swallow/Meal
Peptic Ulceration
Helicobacter-related?
ERADICATE
Co-Prescribe PPI if cannot stop NSAID
NSAID-related?
Gastro-Oesophageal Reflux
Mild
alternative Rx: antacid, alginate, H2RA
healing dose PPI until symptoms controlled maintenance dose to prevent recurrence stricture, ulcer, haemorrhage etc full dose maintained
Severe
Complicated
Non-ulcer Dyspepsia
Use Acid Suppressor
H2RA NOT PPI
Step-up or Step-down Modify lifestyle factors
smoking diet weight
Investigation
Over 55 Alarm Symptoms
ENDOSCOPY ENDOSCOPY
dysphagia anaemia progressive weight loss
Under 45 45-55
NO INVESTIGATION 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
hepatitis, drugs (flucloxacillin, chlorpromazine) cirrhosis, tumour gallstones pancreatic tumour
Intra-hepatic
Post-hepatic