A Snap Shot and Update on Common Issues in Gastroenterology

In this issue of Gastroenterology Update, I have focused on common issues of gastroenterology and endeavored to bring you an update on these issues.

Haemostasis

Haemospray(TC-325): once sprayed on the bleeding surface, it swells with moisture and stimulates platelet aggregation. Primary haemostasis has been reported in 85% of ulcer and variceal bleeding. I have used this agent recently and is now available in both Pindara and Allamanda private hospitals and presumably also in the public hospitals.

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Early diagnosis for and Prevention of Colorectal Cancer( CRC) and Polyps

We have a barrage of tests such as faecal occult blood (FOB), faecal DNA, flexible sigmoidoscopy, colonoscopy and virtual CT colonography (CTC) to address the possibility of significant colorectal neoplasia. Where do these tests fit and when should these be used individually or in combination? Before we can address this question, we need to understand the demographics of CRC.

Vast majority (65-85%) of CRC occur in people who have no family history and they are referred to as average risk category patients.

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To stop or not to stop Clopidogrel, to bridge or not to bridge Warfarin, that is the question: Antithrombotic Therapy and Endoscopy.

There is increasing use of warfarin and antiplatelet agents in the aging population for various indications. These patients are often referred for endoscopy for investigation of abdominal pain, dyspepsia, change of bowel habit, family history of bowel cancer, positive faecal occult blood, anaemia, polyp surveillance etc.

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Irritable Bowel Syndrome: What’s New in 2011?

I would agree if you were to say irritable bowel (IBS) is not the sexiest topic in medicine. Indeed it would not surprise me if IBS had made the bottom ten at an academy awards night for medicine. Yet IBS constitutes at least 30% of all gastrointestinal consultations. This year’s Digestive Diseases Week at Chicago has high lighted new developments in IBS which I would like to share with you.

An Approach to the Management of Constipation

Prevalence of constipation is reported to be 20%. In the U.S.A, $800 million are spent yearly on laxatives. Constipation in the U.S.A account for 20,000 hospitaliza- tions and 2.5 million out-patient consultations per year.

Definitions: Stool frequency 2 or less per week, straining, hard stools and a feel- ing of incomplete evacuation are all features used by the Rome consensus criteria to define constipation.

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Dyspepsia: who and when to endoscope?

Introduction: One quarter of the population in the Western countries suffer from dyspepsia. Thus, if every patient with dyspepsia were to be endoscoped, then the cost to community and the individual would be substantial and the work load of the endoscopist would be large. In this article, I hope to address the evidence for and against endoscopy as first line investigation for dyspepsia vis-à-vis other modalities of treatment such as trial PPI (proton pump inhibitor) therapy and H.Pylori eradication.

Definition: The Rome III committee defined dyspepsia as one or more of the fol- lowing :a) postprandial fullness, b) early satiety, or c) epigastric pain or burning. Dyspeptic symptoms are most commonly caused by non-ulcer dyspepsia, peptic ulcer, reflux oesophagitis or rarely malignancy. However, the same symptoms can be caused by medication side effects, biliary or pancreatic disorder and motility disorder.

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Early diagnosis for and Prevention of Colorectal Cancer (CRC) and Polyps

We have a barrage of tests such as faecal occult blood(FOB), faecalDNA, flexible sigmoidoscopy, colonoscopy and virtual CT colonography (CTC) to address the possibility of significant colorectal neoplasia. Where do these tests fit and when should these be used individually or in combination? Before we can address this question, we need to understand the demographics of CRC.

Vast majority (65-85%) of CRC occur in people who have no family history and they are referred to as average risk category patients. Some 10-30% of CRC occur in patients who have a family history of CRC and they are referred to as moderate risk category. Remaining 5-6% of CRC occur in high risk patients such as those with non-polyposis colorectal cancer syndrome (HNPCC) and rarely in adenoma- tous polyposis coli or similar rare syndromes.

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Obscure Gastrointestinal bleeding: Investigation of the small bowel – The Last Frontier

Introduction: Obscure gastrointestinal bleeding (OGIB) is increasingly becoming a common problem in the aging population. These patients, typically, had at least one set of normal gastroscopy and colonoscopy without being able to detect a site of blood loss in the upper or lower gastrointestinal tract.

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Eosinophilic Oesophagitis – Not an Uncommon cause of Dysphagia in Adults

Eosinophilic oesophagitis (EO) has been sporadically reported since the 1970s in the children as a cause of dysphagia. In recent times, more and more cases of EO are being reported as a cause of dysphagia and food bolus obstruction in the adult. EO can cause oesophageal strictures and stiffness and is defined by more than 20 eosinophils per high power field in the proximal oesophageal biopsies.

Incidence in the children has been reported to be in the range of 1.2 to 1.3 per 10,000 children. Incidence has not been worked out in the adults although some 20% cases of dysphagia or food bolus obstruction would be associated with EO. EO mainly affects the male sex in the 3rd to 4th decade in the adults . Some 7% have family history.

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Virtual colonoscopy (CT Colonography) – Is it ready for prime time?

Virtual colonoscopy includes CT Colonography (CTC) and MR (magnetic resonance) colonography. MR colonography is very much in the developmental phase and is not available in Australia and therefore, will not be discussed here.

Technique: CTC involves

a) bowel cleansing,

b) air or CO2 insufflation of the co- lon,

c) CT scanning and

d) image processing and interpretation.

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