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.
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 .
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.
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.
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.
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.
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.
Colorectal cancer(CRC) is the 2nd leading cause of cancer death in Australia following lung cancer. CRC will develop in 5-6% of the adult population without family history and half will die as a consequence. Hence the importance for screening for CRC. Following table summarises risk groups and screening methods.
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.
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.