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.
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.
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.
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.
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.
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.
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.
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.