Gastroenterology in General Practice

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Gastroenterology in General Practice
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Gastroenterology

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

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Gastroenterology

• GI Cancer
• Oesophageal
• Gastric
• Colorectal
• Pancreatic

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Acid Suppressor Therapy

• Appropriate Use in General Practice
• H2RAs
• Proton Pump Inhibitors

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Life before PPIs

• The history of dyspepsia
• Surgery and diet
• Vagotomy/Pyloroplasty
• Steamed fish and milk puddings
• H2-receptor antagonists
• Tagamet SKF
• Zantac Glaxo

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Proton Pump Inhibitors

• Losec (Omeprazole)(Astra)
• Zoton (Lansoprazole)(Wyeth)
• Pariet (Rabeprazole)(Janssen)
• Nexium (Esomeprazole)(Astra)

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NICE Guidance

• Issued in 2000
• Targeted use to make best use of resources

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Dyspeptic Symptoms

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

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Dyspeptic Symptoms

• Investigations
• Endoscopy
• C13-Urea Breath Testing
• Barium Swallow/Meal

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Peptic Ulceration

• Helicobacter-related?
• ERADICATE
• NSAID-related?
• Co-Prescribe PPI if cannot stop NSAID

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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

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Non-ulcer Dyspepsia

• Use Acid Suppressor
• H2RA
• NOT PPI
• Step-up or Step-down
• Modify lifestyle factors
• smoking
• diet
• weight

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Investigation

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

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Inflammatory Bowel Disease

• Crohns Disease
• Colitis
• Ulcerative
• Pseudomembranous
• Diverticular Disease

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Altered Bowel Habit

• Investigations
• Faecal Occult Blood
• CEA/CA19-9
• Sigmoidoscopy
• Barium Enema
• Colonoscopy

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Jaundice

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