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 55ENDOSCOPY Alarm SymptomsENDOSCOPY dysphagia anaemia progressive weight loss Under 45NO INVESTIGATION 45-55DEBATABLE

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