Gastroenterology in General Practice Gastroenterology n Dyspepsia n

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Gastroenterology in General Practice

Gastroenterology in General Practice

Gastroenterology n Dyspepsia n n Altered Bowel Habit n n n Ulcer disease Non-ulcer

Gastroenterology n Dyspepsia n n Altered Bowel Habit n n n Ulcer disease Non-ulcer dyspepsia Helicobacter pylori Constipation Diarrhoea Jaundice

Gastroenterology n GI Cancer n n Oesophageal Gastric Colorectal Pancreatic

Gastroenterology n GI Cancer n n Oesophageal Gastric Colorectal Pancreatic

Acid Suppressor Therapy n n n Appropriate Use in General Practice H 2 RAs

Acid Suppressor Therapy n n n Appropriate Use in General Practice H 2 RAs Proton Pump Inhibitors

Life before PPIs n The history of dyspepsia n Surgery and diet n n

Life before PPIs n The history of dyspepsia n Surgery and diet n n n Vagotomy/Pyloroplasty Steamed fish and milk puddings H 2 -receptor antagonists n n Tagamet & SKF Zantac & Glaxo

Proton Pump Inhibitors n n Losec (Omeprazole)(Astra) Zoton (Lansoprazole)(Wyeth) Pariet (Rabeprazole)(Janssen) Nexium (Esomeprazole)(Astra)

Proton Pump Inhibitors n n Losec (Omeprazole)(Astra) Zoton (Lansoprazole)(Wyeth) Pariet (Rabeprazole)(Janssen) Nexium (Esomeprazole)(Astra)

NICE Guidance n n Issued in 2000 Targeted use to make best use of

NICE Guidance n n Issued in 2000 Targeted use to make best use of resources

Dyspeptic Symptoms n Diagnosed or not? n Non-ulcer Dyspepsia n n Peptic Ulceration n

Dyspeptic Symptoms n Diagnosed or not? n Non-ulcer Dyspepsia n n Peptic Ulceration n n Lifestyle factors: STRAWS Helicobacter screening techniques GORD n n Mild/Moderate Severe/Complicated

Dyspeptic Symptoms n Investigations: n n n Endoscopy C 13 -Urea Breath Testing Barium

Dyspeptic Symptoms n Investigations: n n n Endoscopy C 13 -Urea Breath Testing Barium Swallow/Meal

Peptic Ulceration n Helicobacter-related? n n ERADICATE NSAID-related? n Co-Prescribe PPI if cannot stop

Peptic Ulceration n Helicobacter-related? n n ERADICATE NSAID-related? n Co-Prescribe PPI if cannot stop NSAID

Gastro-Oesophageal Reflux n Mild n n Severe n n n alternative Rx: antacid, alginate,

Gastro-Oesophageal Reflux n Mild n n Severe n n n alternative Rx: antacid, alginate, H 2 RA healing dose PPI until symptoms controlled maintenance dose to prevent recurrence Complicated n n stricture, ulcer, haemorrhage etc full dose maintained

Non-ulcer Dyspepsia n Use Acid Suppressor n n H 2 RA NOT PPI Step-up

Non-ulcer Dyspepsia n Use Acid Suppressor n n H 2 RA NOT PPI Step-up or Step-down Modify lifestyle factors n n n smoking diet weight

Investigation n n Over 55 Alarm Symptoms n n n ENDOSCOPY dysphagia anaemia progressive

Investigation n n Over 55 Alarm Symptoms n n n ENDOSCOPY dysphagia anaemia progressive weight loss Under 45 45 -55 NO INVESTIGATION DEBATABLE

Inflammatory Bowel Disease n n Crohns Disease Colitis n n n Ulcerative Pseudomembranous Diverticular

Inflammatory Bowel Disease n n Crohns Disease Colitis n n n Ulcerative Pseudomembranous Diverticular Disease

Altered Bowel Habit n Investigations: n n n Faecal Occult Blood CEA/CA 19 -9

Altered Bowel Habit n Investigations: n n n Faecal Occult Blood CEA/CA 19 -9 Sigmoidoscopy Barium Enema Colonoscopy

Jaundice n Pre-hepatic n n Intra-hepatic n n n haemolysis hepatitis, drugs (flucloxacillin, chlorpromazine)

Jaundice n Pre-hepatic n n Intra-hepatic n n n haemolysis hepatitis, drugs (flucloxacillin, chlorpromazine) cirrhosis, tumour Post-hepatic n n gallstones pancreatic tumour