Managing Drug-induced GORD, Oesophagitis and Heartburn
Gastro-oesophageal reflux disease (GORD) is a chronic gastrointestinal disorder characterised
by a recurrent retrograde flow of gastric contents into the oesophagus and sometimes into the
oropharynx. The use of certain medications has been linked to the onset or worsening of GORD
symptoms. A common and effective treatment of oesophagitis and GORD is to reduce gastric acid
secretion with a proton pump inhibitor (PPI).
Recognition and Management of Resistance to Therapy
Diagnosis of gastro-oesophageal reflux disease depends on recognising the cardinal symptoms of heartburn and regurgitation, with faulty diagnosis contributing to apparent failures of medical management. Proton pump inhibitors (PPIs) are the mainstay of treatment for most patients with gastro-oesophageal reflux disease, but 20 to 30% of patients remain symptomatic despite therapy. Management of persistent reflux symptoms, including heartburn, regurgitation and chest pain, that are not well controlled by medical therapy may require insightful physiological management. Systematic reviews have
found that minimally invasive laparoscopic antireflux surgery is superior to medical management in treating refractory reflux disease.
GLP-1 Agonists’ Impact on Bowel Preparation for Colonoscopy
Colonoscopy has been widely used as a valuable tool for screening and treating colorectal disease in in type 2 Diabetes Mellitus, often accompanied by gastrointestinal discomfort and an increased risk of malignant colorectal tumours. Successful colonoscopy depends on good bowel preparation. Emerging evidence indicates that GLP-1 receptor agonists and DPP-4 inhibitors may significantly affect the gastrointestinal motor system, which in turn influences the bowel cleaning quality necessary for a successful colonoscopy.
Modern Medicine – Issue 4, 2025
Good Bowel Preparation Helps Adenoma Detection
Colorectal cancer (CRC) is the fourth most common cancer in South Africa, and the sixth most lethal. Approximately 25% of patients will have synchronous metastatic disease at the time of their primary CRC diagnosis. Five-year overall survival rates for CRC are 93.2% for stage I, 72.2 – 84.7% for stage II, 52.3 – 83.4% for stage III and 8.1% for stage IV.1 Early adenoma detection is possible with colonoscopy, which is dependent on adequate bowel preparation.
Modern Medicine – Issue 6 2023
Inflammatory Bowel Disease: Causes, Symptoms and Treatment
Inflammatory bowel disease (IBD) is characterised by chronic inflammation of the gastrointestinal tract. The recognition of alarm symptoms, raised levels of inflammatory markers or an elevated faecal calprotectin level should prompt referral to a gastroenterologist for appropriate assessment and treatment. New treatment targets and improved therapies are available. Patients with IBD are often under- or inappropriately treated. Anxiety and depression are common in patients with IBD and should be addressed as a part of multidisciplinary and individualised management.
Modern Medicine – Issue 6 2023
Screening for Colorectal Cancer Pays Off
Colorectal cancer (CRC) is the third most common tumour in men and the second in women, accounting for 10% of all tumour types worldwide. Incidence is 25% higher in males and differs greatly between countries. With more than 600 000 deaths estimated each year, CRC is the fourth most common cancer related cause of death globally.
Modern Medicine – Issue 4 2023
Reverse the Far-reaching Effects of Dysbiosis
The possibility of modifying the gut microbiota to replace harmful bacteria with more favourable microbiota has been widely explored since 1907, when observations that consumption of fermented products containing Lactobacillus bulgaricus was associated with longevity and good health. The advent of modern molecular techniques has provided evidence that the gut microbiota plays a pivotal role in health and disease.
Modern Medicine – Issue 2 2023
Iron Deficiency: Excluding serious causes
Iron deficiency is a common issue among patients presenting to general practice. Management requires oral or intravenous iron replacement coupled with clinical assessment and consideration of further investigations to exclude serious causes.
Modern Medicine – Issue 2 2023
GI Disruption May Underlie Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction which can have a considerable impact on quality of life. Following diagnosis, timely evidence-based management is vital to the care of patients with IBS, aiming to improve outcomes, and enhance patient satisfaction.
Modern Medicine – Issue 3 2022
The Tricky Task of Bowel Preparation for Colonoscopy
Colonoscopy procedures are routinely used for evaluating the colon, mostly for screening and early detection of colorectal cancer, which has a high incidence and mortality rate. Extensive data show that adequate bowel preparation is instrumental for the success of any colonoscopy procedure. Poor bowel preparation accounts for nearly 20% of failed colonoscopies, limiting the procedure’s diagnostic/therapeutic value.
Modern Medicine – Issue 2 2022
