Archive for the ‘Gastroenterology’ Category

What meds to avoid before a urea breath test?   Leave a comment

1 month before:

  • antibiotics: amoxicillin, clarithromycin, doxycycline, metronidazole
  • Losec HP7, Klacid HP7, Nexium HP7: all contain amoxicillin & clarithromycin
  • bismuth-containing compounds

1 week before:

  • proton pump inhibitors

36 hours before:

  • sucralfate

9 hours before:

  • H2-receptor antagonists

when fasting:

  • antacids incl. Mylanta, Gaviscon

Ref:

  1. from Laverty Pathology, Australia: http://www.laverty.com.au/files/LP_UreaBreathTest_DL.pdf
  2. from SA Pathology, Australia: http://www.imvs.sa.gov.au/wps/wcm/connect/d8730263-e0fd-4921-9341-47a965904b73/PUB-0267+v2.pdf?MOD=AJPERES

Posted July 1, 2013 by absinthemisia in Gastroenterology

How may GERD be treated in an empirical trial of treatment without OGD?   Leave a comment

Uninvestigated typical reflux symptoms (heartburn, acid regurgitation)

  • alarm features* present: refer for OGD
  • alarm features* absent: PPI therapy 4w (review 2-4w)
    • symptoms persist: stop PPI for 1w and refer for OGD
    • symptoms respond: trial of stopping PPI
      • relapse: restart PPI, on-demand therapy
      • frequent relapses, or alarm features*: refer for OGD

 

*What are the alarm features that would prompt an OGD?

  • weight loss
  • anaemia
  • anorexia
  • progressive dysphagia
  • odynophgia
  • vomiting
  • family history of upper GI cancer
  • GERD symptoms in older patients (>40 years) in areas with a high prevalence of gastric cancer

 

Ref:

  1. From promotional material, AstraZeneca: Fock KM et al. Jour Gastroenterol Hepatol 2008;(23):8-22.

Posted October 28, 2011 by absinthemisia in Gastroenterology

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Nexium Dosage Guide (from AstraZeneca)   Leave a comment

** refers to oral dosage only

GERD

  • endoscopy positive: 40mg om 4-8w, then 20mg om for maintenance
  • endoscopy negative: 20mg om until symptom controlled, then 20mg on demand

Peptic ulcers

  • H. pylori associated: 20mg bd (as part of triple therapy) 7d
  • NSAIDs associated: 20mg om 4-8w, then 20mg om for maintenance

Zollinger-Ellison Syndrome

  • 40mg bd initially, majority may be kept on 80-160mg/d
  • doses above 80mg to be divided bd

Posted October 28, 2011 by absinthemisia in Gastroenterology

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