The Ins and Outs of Diverticular Disease
Diverticular disease is a common condition that increases in prevalence with age. Management is multidisciplinary and can range from outpatient treatment to emergency surgery. Diverticular disease is thought to be prevalent in developed countries, but contrary to this belief, an increasing trend in prevalence has been noted in Africa over the past four decades.
Modern Medicine – Issue 4 2019
The Gut Microbiome’s Role in MS
Multiple sclerosis (MS) is a neurodegenerative autoimmune disorder of the CNS. Recent experimental and clinical evidence suggests the presence of microbial imbalances in the gut of MS sufferers. The gut microbiome is defined as the summation of all the microbial entities as well as their genes, proteins and metabolic products in a given space and time. Studies show the MS gut microbiome as having general alterations in specific taxa, some associated with the promotion of inflammatory cytokines and overall inflammation.
Modern Medicine – Aug/Sept 2018
Managing Acid-related Disorders
Proton pump inhibitors (PPIs) were clinically introduced more than 25 years ago and have since proven to be invaluable, safe and effective agents for the management of a variety of acid-related disorders
Modern Medicine – June/July 2018
The Stepwise Approach to Chronic Constipation
Chronic constipation (CC) is an extremely common disorder with an estimated prevalence ranging between 2% and 24%. The prevalence of CC increases with age and may reach 80% in nursing home residents. Constipation has severe consequences for the quality of life of those affected and costs to individual patients and to society in general are significant.
Modern Medicine – June/July 2018
The Gut Dysbiosis – Hypertension Link – MM1703
Recent studies have revealed that many health maladies are as a result of significant perturbation in core gut microbial communities and many parameters
such as host-microbe crosstalk which are intrinsically linked to the microbial ecology and gut functionality. The influence of gastro-intestinal microbiota
composition and their possible link to obesity, diabetes, neural disorders, brain development, insulin resistance and other metabolic disorders have been
well documented. However, recent data suggest that it may also play a role in the development and maintenance of cardiovascular disease.
Modern Medicine – February 2017
Investigation of Nausea How Far to go Before Referral – MM1609
Nausea is a common clinical presentation. If the patient’s history and examination are normal then usually the diagnosis will be functional or idiopathic nausea. This is a diagnosis of exclusion and a few basic tests will often rule out serious pathology. Organic causes are usually apparent from a patient’s history and physical examination. A few basic investigations will rule in or out most underlying causes. Referral of patients to a gastroenterologist should be considered when the diagnosis is in doubt, there is the suspicion of an underlying gastrointestinal cause or to reassure the patient. Consider anxiety as an underlying or contributing factor to nausea.
Modern Medicine – September 2016
Sodium Phosphate, a More Acceptable Bowel Cleanser – MM1608
Colorectal cancer is one of the most common malignancies worldwide. In 2012 the crude incidence of colorectalcancer in Sub-Saharan Africa for both sexes was found to be 4.04 per 100 000 population (4.38 for men and 3.69 for women).
Currently, colonoscopy has been identified as a highly recommended method for cancer surveillance and diagnosis of the large intestine, owing to its cost-effectiveness and exclusive function that allows direct observation and biopsy synchronously. As is well recognized, an adequate bowel cleansing is essential for colon mucosa assessment during the examination procedure, while an incomplete preparation prolongs the procedure time and increases the likelihood of missing lesions with cancerous potential. Accordingly, bowel preparation evaluation is proposed as a crucial quality indicator of colonoscopy.
Modern Medicine – August 2016
Barrett’s Oesophagus Does it Matter? – MM1607
Barrett’s oesophagus is a premalignant condition characterised by the replacement of normal stratified squamous epithelium of the oesophagus with metaplastic columnar epithelium. It can predispose patients to oesophageal adenocarcinoma, in whom the frequency has increased sevenfold in the past four decades. Most patients with heartburn do not have Barrett’s oesophagus.
Although Barrett’s oesophagus is a premalignant condition, the risk of progression to malignancy is low and surveillance intervals should be guided by the presence and degree of dysplasia. There is currently insufficient evidence to support routine medical or surgical intervention for regression or prevention of progression of disease.
Modern Medicine – July 2016
Ulcerative Colitis | Unravelling the uncertainty in diagnosis and management – MM1603
Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon characterised by a relapsing–remitting pattern in most patients. UC affects men and women equally, and the age at onset is between the ages of 15 and 30 years in most patients, with a smaller second peak in patients over 50 years. Although the cause of UC remains unknown, the pathogenesis is likely to be multifactorial with interplay between genetic, microbial and other environmental factors.
Prompt diagnosis of UC and timely management of flares are crucial to good patient outcomes. GPs play an important role in identifying new cases, the ongoing management of mild to moderately active UC and also in identifying and referring acutely unwell patients for specialty care.
Modern Medicine – March 2016
Bowel State Impacts Colonoscopy Efficacy – MM1509
Bowel preparation is one of the most frequent reasons for patients objecting to participating in screening colonoscopies with inadequate preparation being a major obstacle to achieving a high quality colonoscopy.
Modern Medicine – September 2015
