Disease Management Project Gastroenterology ChaptersThe Disease Management Project is an online medical reference, designed to provide nationally established treatment guidelines for the most commonly seen diseases and conditions. Disease Management Project Chapters
The Merck Manual for Health Care Professionals Sections Gastrointestinal Disorders
GastroenterologyWeb is an independently produced e-publication created by and for practicing, teaching and student gastroenterologists as a comprehensive source of new information, practical knowledge, and educational resources pertinent to the evolving field of gastroenterology.
American College of Gastroenterology Monograph
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 Source: gi.org |
| Clinical Resource: Monograph |
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The resources which are available for this therapeutic topic can be accessed via the menu on the left-hand side of the page. The e-learning home page suggests ways in which you may like to use the wide variety of e-learning materials.
| Source: webarchive.org.uk |
| Clinical Resource: e-Learning |
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| Last Checked: 24/04/15 | Link Error: Report It |
Gastro-oesophageal reflux disease (GORD) is defined as symptoms or mucosal damage (oesophagitis) resulting from the exposure of the distal oesophagus to refluxed gastric contents.
| Source: europepmc.org |
| Clinical Resource: Journal Article |
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| Last Checked: 07/04/14 | Link Error: Report It |
University of Michigan Health System Guideline for Gastroesophageal Reflux Disease
| Source: med.umich.edu |
| Clinical Resource: Guideline |
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| Last Checked: 31/07/13 | Link Error: Report It |
Guidance for primary care on how to test for and treat Helicobacter pylori (H. pylori) in dyspepsia
| Source: gov.uk |
| Clinical Resource: Guidance |
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| Last Checked: 23/02/15 | Link Error: Report It |
Review Articles
| Source: eu.wiley.com |
| Clinical Resource: Supplement |
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| Last Checked: 31/07/13 | Link Error: Report It |
This article discusses the current management of Helicobacter pylori infection in patients with dyspepsia with or without endoscopic abnormalities. We take an evidence based approach when possible and consider recent guidelines from national and international bodies pertaining to primary and secondary care.
| Source: europepmc.org |
| Clinical Resource: Journal Article |
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| Last Checked: 07/04/14 | Link Error: Report It |
| Source: sign.ac.uk |
| Clinical Resource: Guideline |
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| Last Checked: 18/05/15 | Link Error: Report It |
This bulletin summarises the current evidence regarding some drugs less well known to increase the risk of GI bleeding including clopidogrel, selective serotonin reuptake inhibitors (SSRI’s), tricyclic antidepressants & calcium channel blockers.
| Source: druginformation.co.nz |
| Clinical Resource: Drug Information Service Bulletin |
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| Last Checked: 30/07/13 | Link Error: Report It |
To describe risk factors and review appropriate management strategies for patients who experience nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) adverse events.
| Source: amcp.org |
| Clinical Resource: Supplement |
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| Last Checked: 30/07/13 | Link Error: Report It |
Non-steroidal anti-inflammatory drugs (NSAIDs) are usually thought to pose a dilemma for doctors wishing to prescribe them. Their anti-inflammatory and analgesic properties have led to their widespread use for rheumatoid and (much more commonly) other conditions often regarded as more trivial.
| Source: europepmc.org |
| Clinical Resource: Journal Article |
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| Last Checked: 07/04/14 | Link Error: Report It |
This article summarises current evidence of relative CV and GI risks for non-aspirin NSAIDs and highly selective COX-2 inhibitors (coxibs), and provides prescribing advice which is consistent with previous advice from the Commission on Human Medicines.
| Source: webarchive.org.uk |
| Clinical Resource: National Prescribing Centre Publication |
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| Last Checked: 24/04/15 | Link Error: Report It |
| Source: wales.nhs.uk |
| Clinical Resource: Guideline |
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| Last Checked: 22/04/13 | Link Error: Report It |
Proton Pump Inhibitors (PPIs) – Prescribing Guidance
North of Tyne Area Prescribing Committee
Evidence suggests that the use of proton pump inhibitors may be associated with Clostridium difficile, pneumonia, bone fractures and hypomagnesaemia. In order to limit the occurrence of these adverse effects, the prescribing of PPIs should be limited to the following indications
| Source: northoftyneapc.nhs.uk |
| Clinical Resource: Guidance |
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| Last Checked: 22/11/16 | Link Error: Report It |
This article will review the evidence for long-term PPI safety and efficacy, describe current FFS utilization trends, communicate FFS PPI policy changes, and present guidance to assist with weaning patients off of long-term PPIs.
| Source: oregonstate.edu |
| Clinical Resource: Newsletter |
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| Last Checked: 23/10/15 | Link Error: Report It |
The 4 questions addressed for this topic are:
| Source: cme.medicine.dal.ca |
| Clinical Resource: CE / CPD / CME / Learning |
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Key Questions for the DERP drug class review were:
| Source: oregonstate.edu |
| Clinical Resource: Newsletter |
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| Last Checked: 19/08/15 | Link Error: Report It |
Although studies exist comparing different PPIs, and some may suggest superiority of one agent over another, current NICE guidance does not recommend any particular PPI.
Of the five PPIs licensed for use in the UK (esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole), only lansoprazole and omeprazole are included on the NHSGGC Formulary. When choosing a PPI it should be noted that the licensed indications and the potential for interactions may differ between individual drugs.
| Source: ggcprescribing.org.uk |
| Clinical Resource: Bulletin |
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| Last Checked: 28/11/16 | Link Error: Report It |
Data currently available suggest that omeprazole is not teratogenic in humans. While information on other PPIs is limited, a systematic review of the evidence suggests that they are also not teratogenic.
| Source: europepmc.org |
| Clinical Resource: Journal Article |
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| Last Checked: 07/04/14 | Link Error: Report It |
A: Cross-reactivity among the proton-pump inhibitors (PPIs) has been documented in several case reports. With the exception of lansoprazole, the product labeling for each of these agents describes them as contraindicated in patients with known hypersensitivity to PPIs or other substituted benzimidazoles.
| Source: duq.edu |
| Clinical Resource: Pharmaceutical Information Centre Publication |
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| Last Checked: 15/04/14 | Link Error: Report It |
The interaction between clopidogrel and PPIs has been examined recently in systematic reviews and metaanalyses. In general, the studies included in these reviews, investigate the effects of PPIs as a class on the incidence on major adverse cardiac events in patients who are treated with clopidogrel and include patients taking any PPI.
| Source: ggcprescribing.org.uk |
| Clinical Resource: Bulletin |
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| Last Checked: 22/04/13 | Link Error: Report It |
American Association for the Study of Liver Diseases Practice Guidelines
| Source: aasld.org |
| Clinical Resource: Guidelines |
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| Last Checked: 31/07/13 | Link Error: Report It |
Canadian Liver Foundation Position Statements
| Source: liver.ca |
| Clinical Resource: Postion Statements |
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| Last Checked: 31/07/13 | Link Error: Report It |
The Disease Management Project is an online medical reference, designed to provide nationally established treatment guidelines for the most commonly seen diseases and conditions.
Disease Management Project Hepatology Chapters
| Source: clevelandclinicmeded.com |
| Clinical Resource: Medical Reference |
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| Last Checked: 31/07/13 | Link Error: Report It |
Acute liver failure is a complex multisystemic illness that evolves quickly after a catastrophic insult to the liver leading to the development of encephalopathy. The underlying aetiology and the pace of progression strongly influence the clinical course. The commonest causes are paracetamol, idiosyncratic drug reactions, hepatitis B, and seronegative hepatitis. The optimal care is multidisciplinary and up to half of the cases receive liver transplants, with survival rates around 75%–90%. Artificial liver support devices remain unproven in efficacy in acute liver failure.
| Source: europepmc.org |
| Clinical Resource: Journal Article |
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| Last Checked: 07/04/14 | Link Error: Report It |
Liver dysfunction in a pregnant woman may be caused by the pregnancy, it may be unrelated to the pregnancy, or it may be a chronic condition that existed before the pregnancy. In any case, the clinical clues of liver dysfunction in pregnancy are not specific, and certain ''abnormalities'' in liver function tests may represent benign changes of pregnancy.
| Source: mdedge.com |
| Clinical Resource: Journal Article |
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| Last Checked: 19/06/17 | Link Error: Report It |
| Source: easl.eu |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
Royal College of Obstetricians and Gynaecologists Guideline on Obstetric Cholestasis
| Source: rcog.org.uk |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
| Source: easl.eu |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
The Division of Viral Hepatitis (DVH) is part of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at Centers for Disease Control and Prevention. In collaboration with domestic and global partners, DVH provides the scientific and programmatic foundation and leadership for the prevention and control of hepatitis virus infections and their manifestations.
For Health Professionals
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
| Source: cdc.gov |
| Clinical Resource: Various |
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CCO believes the way to optimize clinicians’ competence in providing the highest standards of evidence-based medicine are through effective education and the availability of the latest clinical information, whenever and wherever it is needed. CCO is dedicated to improving patient care by providing superior-quality, relevant educational content and clinical knowledge as delivered through its innovative and integrated online and mobile platforms, which provide comprehensive and personalized information solutions.
| Source: clinicaloptions.com |
| Clinical Resource: Various |
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| Last Checked: 08/04/14 | Link Error: Report It |
This site is intended for health care workers involved with the care of patients at risk for infection with hepatitis.
Case Based Modules
Hepatitis A
Hepatitis B
Hepatitis C
Common Management Issues
| Source: washington.edu |
| Clinical Resource: Case Based Modules |
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| Last Checked: 31/07/13 | Link Error: Report It |
Royal College of General Practitioners Drug Misuse Training Programme
Royal College of General Practitioners Sex, Drugs and HIV Task Group
Substance Misuse Management in General Practice
This paper contains guidance on how screening and immunisation should be carried out and suggests criteria to facilitate audits.
| Source: smmgp.org.uk |
| Clinical Resource: Guidance |
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| Last Checked: 22/04/14 | Link Error: Report It |
| Source: easl.eu |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
Management of chronic hepatitis B: Consensus guidelines
Canadian Consensus Guidelines
| Source: bccdc.ca |
| Clinical Resource: Guideline |
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| Last Checked: 31/07/13 | Link Error: Report It |
This publication reviews current understanding about hepatitis B and provides a framework for optimal management of the disease by health professionals.
| Source: britishlivertrust.org.uk |
| Clinical Resource: Publication |
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| Last Checked: 22/11/13 | Link Error: Report It |
| Source: basl.org.uk |
| Clinical Resource: Consensus Statement |
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| Last Checked: 31/07/13 | Link Error: Report It |
Chronic Hepatitis B in Pregnancy: Consensus Recommendations
New consensus recommendations for the evaluation and management of pregnant women with hepatitis B are featured in Part 1 and Part 2 of The Female Patient. The recommendations resulted from a workshop that the Hepatitis B Foundation convened with prominent practitioners to help improve hepatitis B–related outcomes during and after pregnancy.
| Source: hepb.org |
| Clinical Resource: Consensus Recommendations |
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| Source: basl.org.uk |
| Clinical Resource: Consensus Statement |
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| Last Checked: 31/07/13 | Link Error: Report It |
Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Management of Hepatitis C
| Source: sign.ac.uk |
| Clinical Resource: Guideline |
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| Last Checked: 18/05/15 | Link Error: Report It |
| Source: easl.eu |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
European Association for the Study of the Liver Recommendations on Treatment of Hepatitis C
| Source: easl.eu |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
Royal College of General Practitioners Substance Misuse Unit
Royal College of General Practitioners Sex, Drugs & HIV Task Group
Substance Misuse Management in General Practice
Hepatitis C Trust
UK Hepatitis C Resource Centre
Release
This guidance has been produced to aid medical practitioners and others in the management of hepatitis C infection in primary care.
| Source: rcgp.org.uk |
| Clinical Resource: Guidance |
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| Last Checked: 02/12/16 | Link Error: Report It |
| Source: nhs.uk |
| Clinical Resource: Various |
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| Last Checked: 31/07/13 | Link Error: Report It |
This booklet provides up-to-date information about hepatitis C and injecting drug use. It has been designed for professionals working with injecting drug users (IDUs).
| Source: britishlivertrust.org.uk |
| Clinical Resource: Publication |
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| Last Checked: 22/11/13 | Link Error: Report It |
The goal of HIVandHepatitis.com is to produce high-quality, accurate, and timely online information about treatment, management, and prevention of HIV, hepatitis B and C, HIV/HBV and HIV/HCV coinfection, and related conditions.
Since the website's founding in 1999, our editors and contributors have sought to offer cutting-edge information -- including coverage of relevant conferences and summaries of medical literature -- in a format useful to both clinicians and people living with HIV and viral hepatitis.
| Source: hivandhepatitis.com |
| Clinical Resource: Various |
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| Last Checked: 20/05/14 | Link Error: Report It |
| Source: kdigo.org |
| Clinical Resource: Guideline |
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| Last Checked: 21/08/15 | Link Error: Report It |
This web site was established in 2010 by members of the Department of Pharmacology at the University of Liverpool to offer a resource for healthcare providers, researchers and patients to be able to understand and manage drug-drug interactions.
| Source: hep-druginteractions.org |
| Clinical Resource: Various |
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| Last Checked: 25/04/16 | Link Error: Report It |
HCV guidelines including specific information for treating patients with HIV/HCV co-infection HCV (NS5b polymerase inhibitor & NS3/4A protease inhibitor included)
| Source: nynjaetc.org |
| Clinical Resource: Table |
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| Last Checked: 20/05/14 | Link Error: Report It |
| Source: easl.eu |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
| Source: easl.eu |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
This article reviews the important cutaneous manifestations of specific liver diseases. We focus first on skin conditions that may represent liver disease, and then we discuss several major liver diseases and their typical cutaneous manifestations.
| Source: mdedge.com |
| Clinical Resource: Journal Article |
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| Last Checked: 19/06/17 | Link Error: Report It |
Off-Label Drug Uses
Ondansetron: Cholestatic Pruritus (Adults)
| Source: thomasland.com |
| Clinical Resource: Journal Article |
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| Last Checked: 26/11/15 | Link Error: Report It |
| Source: easl.eu |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
A number of pitfalls can be encountered in the interpretation of common blood liver function tests. These tests can be normal in patients with chronic hepatitis or cirrhosis.
| Source: aafp.org |
| Clinical Resource: Journal Article |
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| Last Checked: 13/03/14 | Link Error: Report It |
Management of Abnormal LFT in Adult Asymptomatic Patients
Western Sussex Hospitals NHS
These guidelines are aimed at Gastroenterologists and General Practitioners who manage patients with no symptoms, vague symptoms, or symptoms not attributable to liver disease who are found to have abnormal LFTs.
| Source: gp.westernsussexhospitals.nhs.uk |
| Clinical Resource: Guideline |
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| Last Checked: 19/08/15 | Link Error: Report It |
This local guideline is revised from the Newcastle, North Tyneside and Northumberland guidelines based on previous Newcastle West PCT guidance. It relates to adults with only vague or no symptoms or signs of liver disease, found to have abnormal LFTs.
| Source: northoftyneapc.nhs.uk |
| Clinical Resource: Guideline |
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| Last Checked: 22/11/16 | Link Error: Report It |
The Model for End-Stage Liver Disease (MELD) is a reliable measure of mortality risk in patients with end-stage liver disease. It is used as a disease severity index to help prioritize allocation of organs for transplant.
| Source: mayoclinic.org |
| Clinical Resource: Calculators |
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| Last Checked: 11/05/15 | Link Error: Report It |
This page contains a set of clinical calculators
Clinical Calculators
| Source: bsg.org.uk |
| Clinical Resource: Calculators |
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| Last Checked: 17/05/13 | Link Error: Report It |
The Child-Pugh or Child-Turcotte-Pugh grading scale utilizes five criteria to estimate the severity of liver disease.
| Source: duq.edu |
| Clinical Resource: Pharmaceutical Information Centre Publication |
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| Last Checked: 17/02/14 | Link Error: Report It |
LIVERTOX is a freely available website that provides up-to-date, comprehensive and unbiased information about drug induced liver injury caused by prescription and nonprescription drugs, herbals and dietary supplements.
LiverTox is a joint effort of the Liver Disease Research Branch of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Division of Specialized Information Services of the National Library of Medicine (NLM), National Institutes of Health.
| Source: nih.gov |
| Clinical Resource: Database |
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| Last Checked: 17/02/14 | Link Error: Report It |
As the liver is responsible for the metabolism of many compounds, knowledge of a patient's hepatic function is required for the safe prescribing of many drugs. Assessing liver function by way of a patient history, examination and blood tests such as serum albumin and bilirubin, as well as prothrombin time, is recommended before prescribing some medications.
| Source: nps.org.au |
| Clinical Resource: Journal Article |
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| Last Checked: 08/08/16 | Link Error: Report It |
Drugs that are predominantly hepatically cleared may require dosage adjustment in the presence of significant liver impairment. This bulletin discusses the general principles of the assessment of liver impairment with respect to drug metabolism, and the subsequent adjustment of drug doses.
| Source: druginformation.co.nz |
| Clinical Resource: Drug Information Service Bulletin |
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| Last Checked: 17/02/14 | Link Error: Report It |
The classic view on the pathogenesis of drug-induced liver injury is that the so-called parent compounds are made hepatotoxic by metabolism (formation of neo-substances that react abnormally), mainly by cytochromes P-450 (CYP), with further pathways, such as mitochondrial dysfunction and apoptosis, also playing a role. Risk factors for drug-induced liver injury include concomitant hepatic diseases, age and genetic polymorphisms of CYP.
| Source: nih.gov |
| Clinical Resource: Journal Article |
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| Last Checked: 30/07/13 | Link Error: Report It |
Drugs are an important cause of liver injury. More than 900 drugs, toxins, and herbs have been reported to cause liver injury, and drugs account for 20-40% of all instances of fulminant hepatic failure.
| Source: medscape.com |
| Clinical Resource: Article |
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| Last Checked: 30/07/13 | Link Error: Report It |
Twenty to thirty percent of all acute liver failure is drug-induced. It ranges from reversible changes in liver enzyme function tests (LFTs) to fatal hepatic necrosis.
| Source: adr.org.uk |
| Clinical Resource: Factsheet |
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| Last Checked: 30/07/13 | Link Error: Report It |
Dosing in Renal Insufficiency (Including with chronic ambulatory peritoneal dialysis and hemodialysis)
Dosing in Hepatic Impairment
| Source: ashm.org.au |
| Clinical Resource: Table |
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| Last Checked: 21/08/15 | Link Error: Report It |
| Source: nccc.ucsf.edu |
| Clinical Resource: Table |
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| Last Checked: 21/08/15 | Link Error: Report It |
| Source: washington.edu |
| Clinical Resource: Table |
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| Last Checked: 05/01/15 | Link Error: Report It |
In this article we review the data on statin-induced hepatotoxicity and offer our recommendations on the use of statins in patients with chronic liver disease, which are based on data from patients without liver disease and on our own clinical experience.
| Source: mdedge.com |
| Clinical Resource: Journal Article |
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| Last Checked: 19/06/17 | Link Error: Report It |
The three key anti-tuberculosis drugs, viz isoniazid, pyrazinamide and rifampicin, are potentially hepatotoxic. Deaths due to fulminant liver necrosis have been reported, albeit rare in occurrence. With the changing demographics and clinical characteristics of tuberculosis patients in many parts of the world, hepatotoxicity is of increasing concern in the treatment of this disease.
| Source: fmshk.org |
| Clinical Resource: Bulletin |
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| Last Checked: 29/04/13 | Link Error: Report It |
Assessing and Managing the Risk of Liver Disease in the Treatment of LTBI
| Source: heartlandntbc.org |
| Clinical Resource: Flow Diagram |
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| Last Checked: 19/08/15 | Link Error: Report It |
| Source: espen.org |
| Clinical Resource: Guideline |
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| Last Checked: 31/07/13 | Link Error: Report It |
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center
| Source: surgicalcriticalcare.net |
| Clinical Resource: Guideline |
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| Last Checked: 21/08/15 | Link Error: Report It |
This review emphasises the various manifestations that patients with chronic pancreatitis may have and describes recent advances in medical and surgical therapy.
| Source: europepmc.org |
| Clinical Resource: Journal Article |
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| Last Checked: 07/04/14 | Link Error: Report It |
Reports of drug-induced acute pancreatitis (AP) have been published since the 1950s, and each year the list of drugs associated with AP increases. There are many etiological risk factors for AP, including a history of alcohol abuse, gallstones, endoscopic retrograde cholangiopancreatography and manometry, trauma or surgical procedures near the pancreas, certain medications, hyperlipidemia, infection, and chronic hypercalcemia. Knowledge of the true incidence of drug-induced AP is dependent on clinicians excluding other possible causes and reporting the event.
| Source: baylorhealth.edu |
| Clinical Resource: Journal Article |
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| Last Checked: 30/07/13 | Link Error: Report It |
| Source: espen.org |
| Clinical Resource: Guideline |
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| Last Checked: 31/07/13 | Link Error: Report It |
Pain reportedly occurs in up to 94% of patients with chronic pancreatitis. The pain is burning, intermittent, and shooting, suggesting that it has both inflammatory and neuropathic components. The pain is caused by sustained peripheral sensitization secondary to both inflammatory and neuropathic damage to nerve endings in the pancreas, as well as central sensitization. Pancreatic fibrotic strictures and calcifications develop, increasing ductal and interstitial pressure.
| Source: iasp-pain.org |
| Clinical Resource: Newsletter |
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| Last Checked: 07/05/15 | Link Error: Report It |
| Source: sign.ac.uk |
| Clinical Resource: Guideline |
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| Last Checked: 28/09/17 | Link Error: Report It |
| Source: acpgbi.org.uk |
| Clinical Resource: Guideline |
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| Last Checked: 27/08/13 | Link Error: Report It |
| Source: acpgbi.org.uk |
| Clinical Resource: Position Statement |
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| Last Checked: 27/08/13 | Link Error: Report It |
| Source: acpgbi.org.uk |
| Clinical Resource: Position Statements |
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| Last Checked: 27/08/13 | Link Error: Report It |
| Source: acpgbi.org.uk |
| Clinical Resource: Position Statements |
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| Last Checked: 27/08/13 | Link Error: Report It |
Haemorrhoids (piles) treatment in Breastfeeding Mothers
| Source: breastfeedingnetwork.org.uk |
| Clinical Resource: Drug Information Factsheet |
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| Last Checked: 08/08/16 | Link Error: Report It |
European Crohn's and Colitis Organisation Guidelines
| Source: ecco-ibd.eu |
| Clinical Resource: Guidelines |
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| Last Checked: 07/05/13 | Link Error: Report It |
This content of the FREE virtual lecture was derived from a live, educational teleconference/webcast presented by the Crohn’s & Colitis Foundation of America on Thursday, May 7, 2009.
At the conclusion of this activity, participants should be better able to:
| Source: ccfa.org |
| Clinical Resource: CE / CPD / Learning |
| Register to Access Content: Yes - registration is FREE |
| Last Checked: 01/08/13 | Link Error: Report It |
The College and the ACG Institute published a new evidence-based systematic review on the management of Inflammatory Bowel Disease as a supplement to The American Journal of Gastroenterology (AJG) for April 2011This clinical monograph, based on a comprehensive meta-analysis, offers new graded recommendations on medical management of IBD by distinguished expert Task Force lead by Nicholas J. Talley, M.D., Ph.D., FACG with contributions from a talented group of IBD experts.
| Source: gi.org |
| Clinical Resource: Monograph |
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| Last Checked: 01/08/13 | Link Error: Report It |
Inflammatory bowel disease (IBD) refers to a group of conditions characterised by inflammation in the intestinal tract. Crohn disease (CD) and ulcerative colitis (UC) account for the majority of these conditions. The aim of this article is to review recent breakthroughs in IBD investigation and management.
| Source: racgp.org.au |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
Inflammatory bowel disease (IBD) is a relapsing-remitting gastrointestinal (GI) disorder involving areas from the mouth to the anus. Crohn's disease (CD) is a chronic form of IBD that can extend through the various layers of the GI tract, resulting in intestinal and extraintestinal complications. Another form of IBD is ulcerative colitis (UC), which primarily affects the rectum and colon; however, this article will address only CD.
| Source: uspharmacist.com |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
Treatment options for CD include anti-inflammatory agents (eg, sulfasalazine, mesalamine) and corticosteroids for the induction of response in patients with mild-to-moderate CD. Immunomodulators, antibiotics, and biologic agents may be used for the maintenance of remission.
| Source: modernmedicine.com |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
Drugs used to maintain or induce remission in inflammatory bowel disease (IBD) should always be started by a specialist but they may be continued and monitored by a GP under a shared-care protocol. To help inform the decision making around these arrangements, this Bulletin considers some common questions in primary care around medicines used for IBD. It focuses particularly on the role and use of aminosalicylates, corticosteroids and tumour necrosis factor alpha (TNF) inhibitors in both ulcerative colitis and Crohn’s disease. It does not consider other management options, such as immunosuppressants, nor is it a comprehensive review of the management of IBD.
| Source: webarchive.org.uk |
| Clinical Resource: National Prescribing Centre Bulletin |
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| Last Checked: 24/04/15 | Link Error: Report It |
Available formulations have differences in licensed indications, tablet strengths, dose frequency, interactions, pharmaceutical, pharmacological and pharmacokinetic properties.
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
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| Last Checked: 22/09/16 | Link Error: Report It |
| Source: fsrh.org |
| Clinical Resource: Guidance |
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| Last Checked: 10/06/15 | Link Error: Report It |
This review discusses the rationale for currently recommended vaccinations, as well as issues pertaining to vaccine safety and immunogenicity in immunosuppressed patients with inflammatory bowel disease and their household contacts.
| Source:
eu.wiley.com |
| Clinical Resource: Journal Article |
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| Last Checked: 22/04/14 | Link Error: Report It |
Patients receiving immunosuppressive therapies may be at increased risk for complications of vaccine preventable diseases, including influenza, varicella, and pneumococcus. However, studies suggest that patients with chronic illness may be inadequately immunized. In part, this is because of a paucity of formal vaccine studies in immune compromised populations. This review discusses the methods one uses to assess vaccine efficacy and provides an update on currently known data on the vaccine antibody responses in immune compromised hosts.
| Source: eu.wiley.com |
| Clinical Resource: Journal Article |
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| Last Checked: 22/04/14 | Link Error: Report It |
Off-Label Drug Uses
Nicotine (Transdermal): Ulcerative Colitis
| Source: thomasland.com |
| Clinical Resource: Journal Article |
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| Last Checked: 26/11/15 | Link Error: Report It |
This article discusses the causes, diagnosis and management of IBS.
| Source: racgp.org.au |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
In order to critically evaluate the rapidly expanding research about IBS and to assess the evidence of efficacy of new IBS drugs and treatments, an ACG IBS Task Force lead by Nicholas J. Talley, M.D, Ph.D., FACG, in 2008 performed a comprehensive meta-analysis of the evidence on therapies for IBS. The group updated its 2002 evidence-based position statement on IBS therapies. This Systematic Review on the Management of Irritable Bowel Syndrome was published in January 2009 as a supplement to The American Journal of Gastroenterology. These peer-reviewed recommendations were adopted by the College and offer clinicians new graded recommendations on testing and treatment.
| Source: gi.org |
| Clinical Resource: Monograph |
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| Last Checked: 01/08/13 | Link Error: Report It |
This article discusses the use of complementary medicines in the treatment of IBS.
| Source: racgp.org.au |
| Clinical Resource: Journal Article |
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| Last Checked: 24/02/14 | Link Error: Report It |
Off-Label Drug Uses
Naltrexone: Irritable Bowel Syndrome
| Source: thomasland.com |
| Clinical Resource: Journal Article |
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| Last Checked: 26/11/15 | Link Error: Report It |
Constipation and laxative use is a huge problem, one that Bandolier is looking to expand upon. This is the first attempt to gather together material for this site.
| Source: bandolier.org.uk |
| Clinical Resource: Evidence Based Abstracts |
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| Last Checked: 13/06/17 | Link Error: Report It |
This bulletin describes the management of constipation using a case-based approach. It provides an overview of the management of constipation in adults based on the Clinical Knowledge Summaries (CKS) review of this topic. It briefly discusses management in children, pregnant and breastfeeding women and outlines some issues for healthcare professionals to consider. NICE guidance on the diagnosis and management of constipation in children and young people is also used to highlight any differences from the conventional management of adults. A detailed review of the causes of constipation, its prevalence, and its management in other situations (e.g. when associated with irritable bowel syndrome, or in palliative care patients) are not covered by this bulletin.
| Source: webarchive.org.uk |
| Clinical Resource: National Prescribing Centre Bulletin |
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| Last Checked: 24/04/15 | Link Error: Report It |
Gastrointestinal motility is a complex process, which is often altered during critical illness, an effect that can lead to constipation.
| Source: virginia.edu |
| Clinical Resource: Journal Article |
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| Last Checked: 25/04/16 | Link Error: Report It |
Our series Prescribing in older people gives practical advice for successful management of the special problems experienced by this patient group. Here, the authors define constipation and describe assessment and management in older patients.
| Source: eu.wiley.com |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
This paper will briefly review the evidence for nutrients as a cause or cure for constipation.
| Source: virginia.edu |
| Clinical Resource: Journal Article |
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| Last Checked: 25/04/16 | Link Error: Report It |
This article discusses the most common medications associated with constipation and diarrhea as well as diagnosis, treatment and prevention of the disorder; the diagnosis is especially important when the offending medication cannot be discontinued.
| Source: practicalgastro.com |
| Clinical Resource: Journal Article |
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| Last Checked: 30/07/13 | Link Error: Report It |
The first part of this review explains the mechanisms involved in drug-induced diarrhoea and gives examples of drugs commonly involved.
This second part of the review explains the mechanisms of drug-induced constipation and presents examples of drugs commonly associated with this abnormality of bowel function.
| Source: shpa.org.au |
| Clinical Resource: Journal Articles |
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| Last Checked: 30/07/13 | Link Error: Report It |
Infectious Diseases Society of America Practice Guidelines for the Management of Infectious Diarrhea
| Source: idsociety.org |
| Clinical Resource: Guideline |
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| Last Checked: 15/05/15 | Link Error: Report It |
Diarrhoea is an alteration of normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Diarrhoea needs to be classified according to the trends over time (acute or chronic) and to the characteristics of the stools (watery, fatty, inflammatory). Secretory diarrhoeas, mostly acute and of viral aetiology in more than 70% of cases, are by far the most important subtype of diarrhoeas in terms of frequency, incidence and mortality (over 2.5 million deaths/year in developing countries).
| Source: nih.gov |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
Antibiotic-associated diarrhoea (AAD) is a common side effect. The incidence varies between antibiotics, and has been estimated to occur in 15% of patients taking beta-lactams (although up to 25% of those taking amoxicillin/clavulanate), 2 to 5% of those taking cephalosporins, fluoroquinolones or macrolides. Rates with intravenous administration (particularly if a drug undergoes enterohepatic circulation) are similar to those with oral administration.
| Source: druginformation.co.nz |
| Clinical Resource: Drug Information Service Bulletin |
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| Last Checked: 30/07/13 | Link Error: Report It |
Diarrhoeal disease is an important cause of morbidity worldwide and represents a leading cause of childhood death in the developing world. In the developed world, the mortality rate has fallen sharply, due to a decline in illness caused by Clostridium perfringens and Salmonellas. The elderly remain especially susceptible to the complications of diarrhoea and account for 85% of related deaths.
| Source: rcpe.ac.uk |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
Diarrhoea (Acute) and Breastfeeding Mothers
| Source: breastfeedingnetwork.org.uk |
| Clinical Resource: Drug Information Factsheet |
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| Last Checked: 08/08/16 | Link Error: Report It |
| Source: idsociety.org |
| Clinical Resource: Guideline |
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| Last Checked: 15/05/15 | Link Error: Report It |
Clostridium difficile-associated diarrhoea is the most common cause of nosocomial diarrhoea and has a high morbidity and mortality among infected patients. Its prevalence and recurrence rates increase with age. Influencing local antibiotic practice can have an impact on infection rates, and this and other specific strategies to reduce the incidence and relapse rates of C. difficile-associated diarrhoea are needed. Reduction of C. difficile-associated diarrhoea rates would have enormous positive resource implications for health services, primarily by reducing length of hospital stay, and would also reduce mortality and morbidity in hospital inpatients.
| Source: rcpe.ac.uk |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
Diarrhea is a common complication of antibiotic therapy occurring within several days of starting therapy to weeks after the antibiotic has been discontinued. Any antibiotic can induce diarrhea but broad spectrum antibiotics such as ampicillin, amoxicillin, cephalosporins, and clindamycin are the major culprits.
| Source: ufl.edu |
| Clinical Resource: Publication |
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| Last Checked: 01/08/13 | Link Error: Report It |
The findings from a recent meta-analysis show that some probiotics significantly reduce the development of antibiotic associated diarrhoea (AAD). There are various different preparations of probiotics that are available but very few have evidence of effectiveness supported by controlled trials.
| Source: auspharmlist.net.au |
| Clinical Resource: Pharmacy E-Bulletin |
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| Last Checked: 01/08/13 | Link Error: Report It |
The normal gut microflora, aside from aiding digestion, provides protection against pathogenic organisms. Probiotics have been manufactured with the idea of maximising the effect of gut microflora, also known as “good bacteria”, thus reducing the risk of infection. This theory has proved scientists right on several occasions however stronger evidence is necessary to establish the efficacy, safety and cost-effectiveness of these products.
| Source: mcppnet.org |
| Clinical Resource: Journal Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
Probiotic supplementation is widely used to increase the number of beneficial bacteria and/or yeast in the digestive tract. If the “good” bacteria start to decline, it leaves opportunity for “bad” bacteria to overgrow and causes illness.
| Source: uwyo.edu |
| Clinical Resource: Newsletter |
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| Last Checked: 01/08/13 | Link Error: Report It |
| Source: patient.co.uk |
| Clinical Resource: Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
| Source: idsociety.org |
| Clinical Resource: Guideline |
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| Last Checked: 15/05/15 | Link Error: Report It |
Several factors can alter the absorption of drugs taken orally in patients with a compromised digestive system. The most important determinations are the length of bowel available for drug absorption, and which section of the bowel has been removed.
| Source: badgut.org |
| Clinical Resource: Article |
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| Last Checked: 30/08/16 | Link Error: Report It |
An ostomy is a surgically made opening from the inside of an organ to the outside. Stoma is the greek for mouth or opening. The stoma is the part of the ostomy attached to the skin. A stoma bag is then attached to the opening in the case of colostomies, ileostomies and urostomies so that either faeces or urine drain into this bag.
| Source: patient.co.uk |
| Clinical Resource: Article |
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| Last Checked: 01/08/13 | Link Error: Report It |
A package for GPs has been produced by Stomal Therapists from Austin Health, Northern Health & Eastern Health. This package contains information on:
| Source: nevdgp.org.au |
| Clinical Resource: Information Package |
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| Last Checked: 01/08/13 | Link Error: Report It |
Loperamide has been used in the management of colostomies or ileostomies, to reduce the volume of discharge and is preferred to opiate drugs (for example, codeine phosphate) as it is not sedative, addictive, and does not cause fat malabsorption.
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
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| Last Checked: 22/09/16 | Link Error: Report It |
The causes of nausea and vomiting are multifarious and a full clinical history is required before commencing treatment. Our Drug review discusses the diagnosis and the available drug options and their properties, followed by sources of further information.
| Source: eu.wiley.com |
| Clinical Resource: Journal Article |
| Register to Access Content: No |
| Last Checked: 16/05/13 | Link Error: Report It |
Erythromycin is a macrolide antibiotic that has been available since the 1950s. It is rarely used as an antibiotic today and is primarily used for its “prokinetic” effect on the gastrointestinal (GI) tract. It has been used successfully off-label for the treatment of gastroparesis and other GI hypomotility disorders.
| Source: ufhealth.org |
| Clinical Resource: Drug and Therapy Bulletin |
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| Last Checked: 01/08/13 | Link Error: Report It |
A: Gastroparesis is a condition of delayed gastric emptying often seen in patients with long-standing diabetes. Injury to the vagus nerve is the most likely cause of gastroparesis in diabetics. Other etiologies of gastroparesis include post-viral syndromes, anorexia nervosa, Parkinson’s disease, amyloidosis, scleroderma, hypothyroidism, and medications such as anticholinergic agents and opiates.
| Source: duq.edu |
| Clinical Resource: Pharmaceutical Information Centre Publication |
| Register to Access Content: No |
| Last Checked: 01/08/13 | Link Error: Report It |
This is part 1 of a two-article series that is aimed to address how pharmacotherapy is affected by bariatric surgery. The current article is aimed to provide a detailed review of process and factors that affect drug absorption from the gastrointestinal tract. The discussion may help clinicians better predict how bariatric procedures may affect oral drug absorption and pharmacotherapy.
Drug Therapy-Related Issues in Patients Who Received Bariatric Surgery (Part II)
This is part 2 of a two-article series that is aimed to address how pharmacotherapy is affected by bariatric surgery. The focus of this article is to review how each of the established bariatric procedures can affect pharmacokinetics based on information available in the literature. Other pertinent pharmacotherapy-related issues in patients with bariatric surgery, such as the risk of pill esophagitis, hormonal contraception, anticoagulant therapy, will be also addressed.
| Source: virginia.edu |
| Clinical Resource: Journal Articles |
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| Last Checked: 25/04/16 | Link Error: Report It |
A: Obesity is an increasing epidemic and estimated to affect about 30 percent of the American population. Many obese patients elect to undergo surgery after failed attempts at other alternatives for weight loss. There are three types of bariatric or gastric bypass surgery.
| Source: duq.edu |
| Clinical Resource: Pharmaceutical Information Centre Publication |
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| Last Checked: 17/02/14 | Link Error: Report It |
The aim of this booklet is to increase awareness of acute IF and to provide advice on its prevention and management. The facilities, training and expertise that we believe are required for successful and cost-effective management of patients with acute IF are highlighted, as well as criteria which define the group of patients for whom referral to a specialised centre should be considered.
| Source: asgbi.org.uk |
| Clinical Resource: Publication |
| Register to Access Content: No |
| Last Checked: 03/01/13 | Link Error: Report It |
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