Gastrointestinal Problems.ppt

Gastrointestinal Problems Claire Nowlan MD Peptic Ulcers Ulceration of either the gastric or duodenal mucosa Risk factors for Peptic Ulcers H. Pylori (cause of 70%-90% of ulcers) NSAIDs (Steroids and Bisphosphonates) Alcohol Smoking Ages 30-50 Stress Medical conditions Hyperparathyroidism Zollinger Ellison Syndrome Renal Dialysis Etiology Imbalence of Aggressive/protective factors H. Pylori produces urease urea ammonia and CO2 This invokes immune response and starts inflammation cascade infection increases with age and poor socioeconomic conditions only 20% of infected develop disease Etiology NSAIDs reduced mucosal prostaglandin production, resulting in impaired prostaglandin dependent mucosal defense and repair mechanisms Inflammation cascade Complications Depends on depth of ulcer More common in the elderly Perforation Hemorrhage - more serious if patient on anticoagulants Pyloric stenosis Carcinomatous transformation Signs and Symptoms Variable Red flags - vomiting, bloody or tarry stools, new ab pains in an elderly person, signs of blood loss (pale, lightheaded, orthostatic hypotension) Lab findings Serology or 13C 14C urea breath tests for H. Pylori Barium swallow Endoscopy Medical treatment Eradication of H. Pylori usually cures ulcer Regiments – 7 to 14 days of: PPI (Omeprazole/Lansoprazole/Pantoprazole) PLUS 2 antibiotics (Clarithromycin/Metronidazole/Amoxicillin/Tetracycline) PLUS/MINUS Pepto-Bismol Stop NSAIDs Dental Management If active, untreated disease - refer If possible, NSAIDs should be avoided in patients with Previous GI bleeding Previous peptic ulcers Age 75 years Avoid longer courses of NSAIDs in Age 60 - 75 Patients on steroids May use COX-2 selective inhibitors or preventive medication in above patients Cyclo-oxygenase-2 (COX-2) inhibitors Vioxx/Celebrex(not in patients with Sulfa allergy)/Mobicox Similar efficacy to older NSAIDs Early trials suggested decreased endoscopic ulceration Recent trials show little if any efficacy (1.8