This was conducted ,recorded and published in Feb 99.
Medicine.
Is yet not pure science. It is a psychosocial scientific discipline. Patient’s satisfaction is essential, may be by drugs or by lip service.
Etiology of Upper GIT Symptoms.
Systemetic approach should be developed about one of the following causes.
· Dismotility Disorders.
· Hypersecretion.
· Obstruction
·
Inflammatory causes like
~Gasteritis
~Duedenal Ulcers
~Cholecystitis
~Pancreatitis.
Reflux Oesophagitis.
v Life long
v Maintain on minimal medicine.
v Before medicine adopt simple measures like raising the head end of the bed.
v Rule out use of NSAIDS
v Start with antacids, cisapride, and move to sucraflate and H2 antagonists and in the end to PPIs.Stepwise approach should be adopted.
Duedenal Ulcer.
Please remember it is a disease with periodicity. Episodes don’t last longer than 4-6 weeks. Any complaint lasting longer than this period is not duedenal ulcer. If it has to be duedenal ulcer, than it is complicated DUwhich may be due to
· Scarring
· Gastric outlet obstruction
· Penetration into Pancreas.
Common Indications for Endoscopy.
¨ New dyspepsia after the age of 50.
¨ Dyspepsia changing it’s character at 30 –40 yrs.
¨ Pain persisting for longer than 8 weeks.
¨ Unexplained upper GIT symptoms
¨ Unexplained iron deficiency anaemia.
¨ Weight loss
¨ Persisting loose motions.
On Helicobacter Pylori
ü All strains are not pathogenic.
High prevalence in normal healthy subjects. According to Dr Ghias’s
ü research in about 60 % of normal population.
ü
His research in Pakistan shows
97% patients of DU are positive for H Pylori, and even 100 % if use of NSAIDS is
excluded.
90 % positive in Gastric Ulcer.
75 % positive in-patients of Gasteritis.
ü For practical purposes all cases of DU should be treated for H pylori infection.
ü Reflux Oesophagitis is not associated with this infection.
ü Route of infection is feco-oral. Uncooked cold meals are usaully responsible. Decent heating sterlizes this microrganism.
ü Reinfection rates are around 20 % according to his research.
ON TREATMENT of H Pylori Infection.
His research shows following results in Pakistan.
~30-35% resistence exists against Clarithromycin.
~10-15 % resistence against Metronidazole is present.
~Combination therapy consisting of
Lansoprazole 30 mgs
Metronidazole 400 mgs
Clarithromycin 500 mgs
~BID/ for oneWeek showed success rate of 65 %.
On use of drugs
Ø H2 antagonists are being overused.
Ø Inapproriate dose is being followed.
Ø Are being used for shorter periods of time.
Long term use of PPIs makes patients prone to more infections,
Ø especially bacterial overgrowth, Salmonella infections and Giarhdesis.
Ø If drugs have to be combined, this should be logical combination.
Ø Sucraflate and H2 antagonists are almost equally effective, but their combination is quite logical.
His important Messages on
ON Hep C
Please be acutely aware of this possibility. Pick up cases as early as possible. Fat intolerence, mild low grade fever off and on or on mild exertion should raise the possibility.
On Pancreatitis
Sub clinical pancreatitis is more common than Ac Pancreatitis is.
Serum amylase is positive in 80 % of cases of Pancreatitis.If combined with Lipase 97 % cases are positive.
On Gastrobiliary Desease
It is on rise. Many more cases of subclinical Pancreatitis are coming up.
Incidence of CA head of Pancreas and Ampulla is increasing.
Pick up cases as early as possible.
On Management of Emergencies in Melena or Hemetemesis.
Please don’t rush them to Lahore unless vital signs are stable. Many patients die on roads.