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.

Read more

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.

Read more

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.

Read more

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 .

Read more

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.

Read more

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.

Read more

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.

Read more

Quality in Colonoscopy- Colonoscopist’s Adenoma Detection Rate(ADR)

While colonoscopy and polypectomy reduced incidence of bowel cancer in 76% and reduced bowel cancer related mortality in 53% in a cohort of post-polypectomy pa- tients ( National bowel cancer study), the magnitude of such prevention depends on your colonoscopist’s adenoma detection rate (ADR). Colonoscopist’s ADR is de- fined as the percentage of consecutive screening (asymptomatic) patients who had at least one adenoma removed. A colonoscopist’s ADR is inversely proportional to post-colonoscopy missed cancers and adenomas. Higher the ADR less the missed colorectal cancers (CRC) and polyps (adenomas) for these patients in the post – polypectomy years.

Read more