Reflux and Ulcer Disease€¦ · Not a cure Reduces reliance on medication ... (Key=good, high...
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Keith Noack Alfred Hospital Cabrini Brighton & Malvern Reflux and Ulcer Disease
Transcript of Reflux and Ulcer Disease€¦ · Not a cure Reduces reliance on medication ... (Key=good, high...
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
Reflux - PPI prn
Ulcer Dz – Clear HPAvoid NSAID
Reflux & Ulcer Disease(Long Term Solution)
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