1. Cologuard
Where It Fits In

3. Cologuard Screening test for colorectal cancer
FIT-DNA : composite of tests :(1) hemoglobin (2) molecular assays for DNA mutations (3) methylation biomarkers

4. Colorectal Neoplasms
DNA shed into stool may reveal genetic mutations (KRAS) and epigenetic changes

5. Test Procedure
Patient collects a stool sample in a special collection kit
No dietary or medication restrictions
Kit mailed back in 72 hours or less
Repeat testing every 3 years (if negative)
If positive, refer for colonoscopy

6. Who is a Candidate? Average risk patients
Should not be used if: (1) history of colonic adenomas or cancer (2) history of IBD (3) family history of colon cancer/ Lynch Syndrome/FAP

7. Effectiveness Sensitivity (confirmed by colonoscopy) for CRC 92%
Not affected by CRC stage or location of lesion
Specificity for CRC was 87%
Significance of a (+) Cologuard followed by a (-) colonoscopy is unknown

8. Colonoscopy “Gold Standard”-but not a perfect test
prep needed and complications possible
“Miss rate” of 2% with large adenomas (>10mm), 25% <5 mm

9. Positive Cologuard
Changes screening colonoscopy to diagnostic colonoscopy

10. Proton Pump Inhibitors

11. Potential Risks of PPI’s
Proton pump inhibitors have been used on millions of patients since Prilosec was introduced in the USA in 1989

12. PPI’s Changed GI Medicine

13. Mechanism of Action
Binds to the H-K- ATPase on the luminal surface of the parietal cell
Most effective after a prolonged fast and when the parietal cell is stimulated after a meal

14. Clinical Uses GERD-especially erosive esophagitis Peptic ulcer disease
Eradication of H. pylori
Zollinger-Ellison syndrome
Prevention NSAID ulcers

15. Potential Adverse Effects
Increased risk of Clostridium difficile infection
Calcium malabsorption and fracture risk
Pneumonia
Dementia
Death

16. Kidney Disease and PPI’s
PPI’s can cause acute interstitial nephritis
Weak association with PPI’s and chronic kidney disease (CKD)

17. Potential Malabsorption
Iron malabsorption
Magnesium malabsorption
Vitamin B12 malabsorption

18. Why Use PPI’s
Inhibit gastric acid secretion much more effectively than H2 RA’s
Once-daily dosing decreases gastric acid secretion by 66%

19. Shortest Duration/< Dose

20. Any Clinical Difference?
rabeprazole
omeprazole
esomeprazole
lansoprazole
pantoprazole

21. PPI’s and H2 Blockers
H2RA’s suppress acid much less effectively, but work more quickly- better for prn use
Taking them at the same time renders the PPI less effective