H. Pylori related diseases:Where are we at & where are we going?

There is no controversy that H. Pylori (HP) causes gastritis. However, to date, there is no direct evidence that HP causes any ulcers. There is good statistical correlation between ulcer diseases and HP yet statistical correlation does not imply causality. HP induced gastritis is associated with hypochlorohydria and increased bicarbonate secretion seen with gastric ulcer (GU). Low acid and high bicarbonate secretion associated with HP has been found to be protective against the development of reflux oesophagitis (GORD). This is believed to be the reason why GORD develops for the first time after eradication of HP for duodenal ulcers (DU)(1).Despite greater than 90% correlation of HP and DU, paradoxically acid secretion is increased and bicarbonate secretion is decreased in DU. Yet HP eradication reduces relapse of DU although not to the extent it was believed in the past. Recent meta-analysis of randomized trials indicate a relapse rate of 20% of DU 6 months after HP eradication(2).So what shall we do? The following are my suggestions:

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ERCP (Endoscopic Retrograde Cholangiopancreatography): Who needs it and who doesn’t?

ERCP is essentially a therapeutic procedure for the management of mainly biliary and to a lesser extent pancreatic disorders. ERCP mostly involves a sphincterotomy ( a cut ) to open the duodenal ampulla to remove stones from the bile duct, stenting of bile duct to relieve obstruction from inoperable cholangiocarcinoma , pancreatic cancer or metastatic tumour, removal of pancreatic duct stone, obtain brush cytology from probable malignant stricture of the bile duct and pancreatic duct stenting following sphincterotomy for type 2 sphincter of Oddi dysfunction.

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The low down on Irritable Bowel Syndrome

Introduction: Irritable bowel syndrome (IBS) is the most common referral to a gastroenterologist.The prevalence is between 14% to 24% in women and 5% to 19% in men in the US and Britain. It cost US $1.6 billion in 1998 mostly in medication and diagnostic tests.

While volumes have been written, which make stimulating reading, on the pathogenesis of IBS namely brain gut neural dysfunction, visceral hypersensitivity, sympathetic and parasympathetic imbalance, role of gut infection etc., purpose of this review is to focus on practical management of IBS.

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Rising Incidence of Oesophageal Cancer: Risk factors & Management

Five year survival of oesophageal cancers is approximately 10% globally. Early cancers are operable. Of the two types of oesophageal cancers we see, incidence of squamous cell carcinomas (SCC) is declining while there is progressive rise of the incidence of the adenocarcinoma (AC) of the oesophagus. This article focuses on the identification of at risk individuals.

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Pancreatic Cancer: The Surreptitious killer

The poor outcome of pancreatic cancer (PC) is reflected by the overall less than 5% five year survival. Eighteen hundred people are diagnosed with PC every year in Australia. Approximately 33,730 new cases were expected to be diagnosed in USA in 2006 with 32,300 expected deaths. Mortality closely follows incidence as demonstrated in the 2002 Australian graph (page 2). However, appropriate attention to certain risk factors has the potential to reduce mortality by early diagnosis. Pancreatic cancer is rare before the age of 45 and slightly more common in the male than in the female (1.3:1).

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Hereditary Haemochromatosis:Diagnosis and Management

Hereditary Haemochromatosis (HH) is a common autosomal recessive disorder occurring at a frequency of 1 in 200-250 among Anglo-Celtic Caucasian population in Australia. Most general practices, depending on the size, will have few to several of these patients . Most patients present with abnormal iron studies and or elevated liver tests and some with family history and can be managed at the general practice .

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Helicobacter Pylori (HP) Eradication: 2012 Update

Helicobacter Pylori (HP) eradication continues to pose some challenges as “standard” treatment fails. Treatment failure is said to be due to resistance of HP to the antibiotics used in this regimen. Before we examine the advances in treatment options, let us briefly review treatment indications.

The prevalence of HP infection in the Australian community is approximately 20% or less. Only a small minority of the infected population get symptoms. Also we need to be cognizant of the probable beneficial effect of HP in reflux oesophagitis, Barrett’s oesophagus, asthma, atopic diseases and side effects of eradication therapy.

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Colorectal Cancers (CRC): Risk Factors and Protective Factors: What’s Myth & What’s N

This article will specifically focus on well known and not so well known risk factors for the development of CRC and adenomas. Also, since we live in an era when substantial misinformation is apparently legally disseminated in the field of preventive medicine by various stake holders, it is appropriate to identify protective factors scientifically proven to work towards prevention of CRC and adenomas.

Colorectal cancers (CRC) are the 3rd largest cause of death in Australia after cardiovascular diseases and lung cancer. Over 3,800 patients died of CRC in Australia in 2006.

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