Updated H. Pylori Regimens – Quadruple Therapy

Due to increasing resistance (~15% in some locales) of H pylori to clarithromycin, triple therapy (PPI + 2 abx) is no longer recommended.  QUADRUPLE therapy (options below) are now recommended. From Prescriber's Letter: Select an initial regimen based on prior macrolide exposure, allergies, dosing convenience, and cost. All PPIs are equally effective. Regimen Combinations Comments… Continue reading Updated H. Pylori Regimens – Quadruple Therapy

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Acute Pancreatitis

Adapted from NEJM 11/17/2016 review article "Acute Pancreatitis": CAUSES: Gallstones EtOH (must be chronic use, 4-5 drinks/d x >5y) Usu acute-on-chronic pancreatitis Binge drinking does not cause acute pancreatitis Drugs (<5%) azathioprine 6-mercaptopurine valproic acid ACEIs mesalamine Idiopathic more frequent with age NON-CAUSES: Sphincter of Oddi dysfunction Pancreas divisum Binge EtOH use (in absence of… Continue reading Acute Pancreatitis

Harms of Colonoscopy

Clinical Question:What are the harms of colonoscopy?Bottom Line:Overall, the harms per 100,000 colonoscopies were 50 perforations, 260 bleeds, and 3 deaths. Among patients undergoing screening colonoscopy, the likelihood of a bleeding complication was 240/100,000 and the likelihood of a perforation was 30/100,000. (LOE = 1a)Reference:Reumkens A, Rondagh EJ, Bakker CM, Winkens B, Masclee AA, Sanduleanu… Continue reading Harms of Colonoscopy

Proton Pump Inhibitors in Acute GI Bleed – Why Do We Do It?

From Life in the Fast Lane:   PROTON PUMP INHIBITOR: Pantoprazole 80 mg IV loading dose, followed by 8 mg/hour for 72 hours. ACG: Why we do it: "PPI therapy may be considered to decrease the proportion of patients who have higher risk stigmata of hemorrhage at endoscopy and who receive endoscopic therapy. If endoscopy… Continue reading Proton Pump Inhibitors in Acute GI Bleed – Why Do We Do It?

Amylase and Lipase – Interpretation

Amylase is secreted throughout the entire GI tract.  Lipase is secreted only in the pancreas, and to some extent in the duodenal C loop.  Hence: High amylase + high lipase and LUQ pain = pancreatitis. Normal amylase + high lipase and R-sided abdominal pain = duodenitis High amylase + normal lipase and diffuse/non-specific GI symptoms… Continue reading Amylase and Lipase – Interpretation

Treatment of Ascites

Presentation in rounds by Dr Amy Hills: Prognosis:  Treatment does not improve survival.  But...it makes the patient feel better, may lower risk of SBP and cellulitis of the abdomen, and the patient expends fewer calories heating the fluid! Treatment:  Consider diagnostic/therapeutic paracentesis. Stop drinking EtOH! < 2 gram NaCl restriction Fluid restrict if Na <… Continue reading Treatment of Ascites