Keith NoackAlfred Hospital

Cabrini Brighton & Malvern

Reflux and Ulcer Disease

CommonLifelongLifestyle

Drugs Work

Reflux Disease

Is Barrett’s present?(Uncommon)

Safety of PPI’s?(Safe)

Refractory Symptoms?(Common)

Reflux-Concerns

History (Be Specific)Response to PPI in 2 weeks

(Diagnostic Test)

Gastroscopy (Invasive)pH study

(Pts hate these)

Reflux-Diagnosis

Refractory symptomsDysphagia

New symptoms after 40ishFamily Hx UGI cancer

Indigestion + Colonoscopy

Who to Scope?

GastroparesisBile reflux

Volume refluxNon Pepetic disease

Rapid Metabolizer of PPI

Refractory Symptoms?

PPI daily vs BDDiet Change

TazacMotilium

Sucralfate slurryFundoplication

Reflux Treatment

Not a cureReduces reliance on medication

80% great result10% OK result

10% Poor result(Key=good, high volume surgeon)

Reflux-Fundoplication

95% DU = Helicobacter35% GU = Helicobacter

NSAID/Aspirin

Duodenal - Come and GoGastric - Develop within 1-2

months of starting NSAID/Aspirin

Ulcer Disease-Natural History

Almost AnythingUlcer Disease-Symptoms

“Gastroscopy”

Ulcer disease Diagnosis

Heal the Ulcer 2/12 on PPIPrevent Recurrence

-Clear Helicobacter-Stop NSAID/Aspirin-Restart NSAID +PPI

Ulcer disease Treatment

Nexium HP-7Levofloxacin

Bismuth Subcitrate1 vs 2 weeks

“How Aggressive?”

Ulcer-Helicobacter Rx

Amoxil 1gm BD*Clarithromycin 500mg BD

PPI BD2 Weeks

(*Doxycycline 100mg BD)Success =70-80%

HP Rx- Clarithromycin

Amoxil 1gm BD*Levofloxacin 500mg BD

PPI BD2 Weeks

(*Doxycycline 100mg BD)Success=80-90%

HP Rx- Levofloxacin

Trimedwww.trimed.com.au

(08)-9388-1444info@trimed.com.au

Levofloxacin Access

Reflux - PPI prn

Ulcer Dz – Clear HPAvoid NSAID

Reflux & Ulcer Disease(Long Term Solution)

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