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Medication Causes of Dyspepsia

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121. Diet and the Gut

those who suffer from gastrointestinal ailments—rightly perceive their diet as being a major determinant of such symptoms and seek guidance on optimal dietary regimens. Many medical practitioners, including gastroenterologists, are unfortunately often ill-prepared to deal with such issues. This is a reflection of the lack of education on the topic of diet and nutrition in many curricula. Dietary changes have the potential to alleviate symptoms, but they may also result in regimens (...) that are nutritionally deficient in one or more respects. It is vital, therefore, that whenever possible the medical practitioner should engage the services of a skilled nutritionist/dietitian to evaluate a given individual’s nutritional status, instruct the patient on new diet plans, and monitor progress. It is also incumbent on gastroenterologists to become educated on modern dietary practices as they relate to gastrointestinal health and disease. We hope that this guideline will become a valuable resource

2018 World Gastroenterology Organisation

122. Pharmacological treatment for memory disorder in multiple sclerosis

of the central nervous system (CNS) and can cause both neurological and neuropsychological disability. Both demyelination and axonal and neuronal loss are believed to contribute to MS‐related cognitive impairment. Memory disorder is one of the most frequent cognitive dysfunctions and presents a considerable burden to people with MS and to society due to the negative impact on function. A number of pharmacological agents have been evaluated in many existing randomised controlled trials for their efficacy (...) characteristics We searched medical databases for randomised controlled trials (where participants were randomly allocated to one of two or more treatment groups) of adults with MS. Neither patients nor researchers were told which treatment was given. Doctors had diagnosed MS and memory impairment using standard methods. Key results and quality of evidence Up to July 2013, we found only seven studies with 625 participants that met our requirements although the quality of the included studies was overall low

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2018 European Academy of Neurology

123. Erectile Dysfunction

help with assessment of ED severity. Available here. ED can be classified as organic (Table 1), psychogenic (Table 2) or mixed. Premature ejaculation: Patients reporting weak erections may have premature ejaculation rather than erectile dysfunction Delayed or inhibited ejaculation: No difficulty acquiring and maintaining an erection but cannot climax and ejaculate. May be caused by certain medications, e.g. SSRIs. Lack of libido (sexual desire) – may be associated but most patients with ED do (...) arrhythmias Poor control or recent emergence of symptoms of potentially contributing conditions (e.g. diabetes, hypertension) Medication therapy which has the potential to cause or exacerbate erectile dysfunction (Table 3).There is a strong temporal relationship between starting a drug and appearance of ED. If this relationship is not evident (eg. no medication changes in several months prior to emergence of ED), ED is unlikely to be medication-induced. Consider making a recommendation to the doctor

2018 medSask

124. Dysmenorrhea

occurs with ovulatory cycles. Primary dysmenorrhea is most common in young women and less so in women beyond their late 20's. This decrease in incidence and severity may be related to pregnancy because, during late pregnancy, uterine adrenergic nerves virtually disappear and only a portion regenerate after childbirth. Secondary dysmenorrhea is painful menstruation caused by another condition, such as endometriosis, pelvic inflammatory disease, fibroids, or incorrect IUD insertion. Dysmenorrhea (...) is the most common gynaecological symptom reported by women. It affects between 50% and 90% of menstruating women. The wide variation in reported prevalence rates is probably due to differences in definition. In a longitudinal survey of 404 nurses with primary dysmenorrhea, mild symptoms were present in 53%, moderate symptoms in 20%, and severe symptoms in 2%. May cause absence from school or work; 13-51% of women report ever having been absent and 5–14% report being frequently absent because

2018 medSask

125. Paediatric Urology

al. Reduced bacterial colonisation of the glans penis after male circumcision in children--a prospective study. J Pediatr Urol, 2013. 9: 1137. 30. Larke, N.L., et al. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control, 2011. 22: 1097. 31. Thompson, H.C., et al. Report of the ad hoc task force on circumcision. Pediatrics, 1975. 56: 610. 32. American Academy of Pediatrics: Report of the Task Force on Circumcision. Pediatrics, 1989. 84: 388. 33. Elalfy (...) in Henoch-Schonlein purpura. Eur Radiol, 2001. 11: 2267. 130. Diamond, D.A., et al. Neonatal scrotal haematoma: mimicker of neonatal testicular torsion. BJU Int, 2003. 91: 675. 131. Ha, T.S., et al. Scrotal involvement in childhood Henoch-Schonlein purpura. Acta Paediatr, 2007. 96: 552. 132. Hara, Y., et al. Acute scrotum caused by Henoch-Schonlein purpura. Int J Urol, 2004. 11: 578. 133. Klin, B., et al. Acute idiopathic scrotal edema in children--revisited. J Pediatr Surg, 2002. 37: 1200. 134. Krause

2018 European Association of Urology

126. Male Sexual Dysfunction

dysfunction. J Sex Med, 2010. 7: 445. 27. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA, 1993. 270: 83. 28. Feldman, H.A., et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol, 1994. 151: 54. 29. Fisher, W.A., et al. Erectile dysfunction (ED) is a shared sexual concern of couples I: couple conceptions of ED. J Sex Med, 2009. 6: 2746. 30. Salonia, A., et al. Is erectile dysfunction a reliable proxy (...) . part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol, 2014. 65: 124. 98. Maggi, M., et al. Hormonal causes of male sexual dysfunctions and their management (hyperprolactinemia, thyroid disorders, GH disorders, and DHEA). J Sex Med, 2013. 10: 661. 99. Laumann, E.O., et al. The epidemiology of erectile dysfunction: results from the National Health and Social Life Survey. Int J Impot Res, 1999. 11 Suppl 1: S60. 100. Miner, M., et al. Cardiometabolic risk

2018 European Association of Urology

127. Management of Non-neurogenic Male LUTS

: 563. 16. Ficarra, V., et al. The role of inflammation in lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and its potential impact on medical therapy. Curr Urol Rep, 2014. 15: 463. 17. He, Q., et al. Metabolic syndrome, inflammation and lower urinary tract symptoms: possible translational links. Prostate Cancer Prostatic Dis, 2016. 19: 7. 18. Drake, M.J. Do we need a new definition of the overactive bladder syndrome? ICI-RS 2013. Neurourol Urodyn, 2014. 33: 622. 19 (...) : 827. 77. Mochtar, C.A., et al. Post-void residual urine volume is not a good predictor of the need for invasive therapy among patients with benign prostatic hyperplasia. J Urol, 2006. 175: 213. 78. Jorgensen, J.B., et al. Age-related variation in urinary flow variables and flow curve patterns in elderly males. Br J Urol, 1992. 69: 265. 79. Kranse, R., et al. Causes for variability in repeated pressure-flow measurements. Urology, 2003. 61: 930. 80. Reynard, J.M., et al. The ICS-’BPH’ Study

2018 European Association of Urology

128. HRT – Practical prescribing

> Combined only > Combined and IUS > Combined only > Combined only Implants and patches no longer available Gel (off licence) Estrogen Progestogens Testosterone T ypes of HRT Routes of therapy Estradiol – equivalent doses HRT – Practical prescribing BRITISH MENOPAUSE SOCIETY T ool for clinicians Information for GPs and other health professionals 2 of 2 Authors: Mrs Elaine Stephens in collaboration with Mrs Kathy Abernethy, Dr Julie Ayres, Dr Heather Currie, Mr Nick Panay and the medical advisory council (...) of the British Menopause Society. PUBLICATION DATE: AUGUST 2018 REVIEW DATE: AUGUST 2020 Estrogen only Estrogen and progestogen > Sequential/cyclical preparations > Continuous combined > 3 monthly bleeds Tibolone Duavive conjugated estrogen + bazodoxifene > Hysterectomised patients > If uterus is present > Perimenopausal women > Post menopausal women > Perimenopausal women Estrogen > Fluid retention > Breast tenderness > Bloating > Nausea / Dyspepsia > Headaches Progestogens > Fluid retention > Breast

2018 British Menopause Society

129. Gastroesophageal Reflux Disease (GERD) - Guidelines for Prescribing H2RAs and PPIs

, shoulder, or down the arm. Often associated with breathlessness/sweating Peptic ulcer disease, malignancy - see alarm symptoms below in "When to Refer" Medication-induced reflux - see list above of medications which increase the risk of GERD Medication-induced esophagitis - use of bisphosphonates, clindamycin, ethanol, iron, NSAIDs (including ASA and celecoxib), quinidine, potassium chloride, tetracyclines Functional dyspepsia - symptoms such as abdominal pain and fullness in addition to heartburn (...) affect children and infants as well as adults Classic symptoms are heartburn and regurgitation Caused by a number of mechanisms, the most important being a transient relaxation of the lower esophageal sphincter. Increased lower abdominal pressure, reduced lower esophageal sphincter tone, delayed gastric emptying, and impaired esophageal clearance may also be involved Risk factors: Being overweight or obese Diet Pregnancy Smoking Other conditions: crohn’s disease, celiac disease, hypothyroidism

2018 medSask

130. Should PPIs be routinely co-prescribed with long-term NSAIDs?

the PPIs. What were the results? Comparing PPI vs placebo on total endoscopic ulcers for patients taking NSAIDs: 8 weeks or longer: risk ratio 0.34 (95% CI 0.28 to 0.42), P < 0.00001 Other results: PPIs might cause more diarrhoea: risk ratio 1.66 (95% CI 0.85 to 3.22), P = 0.13 PPIs probably reduce dyspepsia: risk ratio 0.50 (95% CI 0.30 to 0.82), P = 0.0059 One small study looked at “clinical ulcers”. Although a statistically significant result wasn’t found, clinical ulcers were observed only (...) Health District and Ingham Institute of Applied Medical Research. The Unit provides targeted primary care services to vulnerable populations in South Western Sydney, medical education, research, and health services development, especially in integrated care. He is also a Conjoint Senior Lecturer of the School of Public Health and Community Medicine, UNSW Sydney. Michael's clinical interest is in comorbid substance use disorder and mental health disorders. His research interests are in integrated care

2017 Morsels of Evidence

131. Should PPIs be routinely co-prescribed with long-term NSAIDs?

the PPIs. What were the results? Comparing PPI vs placebo on total endoscopic ulcers for patients taking NSAIDs: 8 weeks or longer: risk ratio 0.34 (95% CI 0.28 to 0.42), P < 0.00001 Other results: PPIs might cause more diarrhoea: risk ratio 1.66 (95% CI 0.85 to 3.22), P = 0.13 PPIs probably reduce dyspepsia: risk ratio 0.50 (95% CI 0.30 to 0.82), P = 0.0059 One small study looked at “clinical ulcers”. Although a statistically significant result wasn’t found, clinical ulcers were observed only (...) Health District and Ingham Institute of Applied Medical Research. The Unit provides targeted primary care services to vulnerable populations in South Western Sydney, medical education, research, and health services development, especially in integrated care. He is also a Conjoint Senior Lecturer of the School of Public Health and Community Medicine, UNSW Sydney. Michael's clinical interest is in comorbid substance use disorder and mental health disorders. His research interests are in integrated care

2017 Morsels of Evidence

132. Prescribing patterns of dependence forming medicines

and Drug Addiction) as well as research grants from (last 3 years) NIHR (National Institute on Health Research), MRC (Medical Research Council) and Pilgrim Trust. He has also worked with WHO (World Health Organization), UNODC (United Nations Office on Drugs and Crime), EMCDDA, FDA (US Food and Drug Administration) and NIDA (US National Institute on Drug Abuse) and with other international government agencies. His employer (King’s College London) has registered intellectual property on an innovative (...) medication supply from iGen and Braeburn and also discussions with various companies about medications potentially applicable in the treatment of addictions and related problems. This includes exploration of the potential for - and consideration of research trials of - improved medications with less abuse liability, longer duration of action (e.g. implant or depot formulations) and also novel non-injectable emergency medications. JS works with the charity Action on Addiction, and also with the Pilgrim

2017 Public Health Research Consortium

133. Anticoagulants in non-valvular atrial fibrillation

95 9.2.3 Patient selection 95 9.2.4 Definition of clinical variables and medications 97 9.2.5 Statistical analysis 100 9.3 RESULTS 101 9.3.1 Prescription of oral anticoagulants in general practice in the general population and validation of proxies for the CHA2DS2-VASc and CHADS2 scores (part 1) 101 4 Anticoagulants in non-valvular atrial fibrillation KCE Report 279 9.3.2 Trends in prescriptions of OACs in general practice in people with atrial fibrillation (part 2)107 9.4 CONCLUSIONS 125 9.4.1 (...) ) 79 Table 21 – Overview of Belgian studies 88 Table 22 – Total and monitoring costs: Belgian studies 88 Table 23 – Incremental outcomes: Belgian studies 89 Table 24 – Incremental Cost-effectiveness Ratios (ICERs): Belgian studies 90 Table 25 – Definition of oral anticoagulants, based on the ATC code 97 Table 26 – Definition of medications recorded (=2 prescriptions in a year) 97 Table 27 – Definition of variables used in CHA2DS2-Vasc and CHADS2 scores 98 Table 28 – Definition of clinical

2017 Belgian Health Care Knowledge Centre

134. BSR guideline Management of Adults with Primary Sjögren's Syndrome

presenting with symptoms suggestive of SS are referred to a specialist centre for evaluation and treatment. In addition this guideline does not cover the detailed management of patients with secondary Sjögren’s. Where patients have secondary SS their systemic management should address the primary disease but the advice on topical management contained in these guidelines is applicable to sicca symptoms from any cause. This guideline does not cover the detailed management of patients with lymphoma, who (...) in these guidelines is applicable to sicca symptoms from any cause. Exclusion criteria Sicca symptoms can result from a variety of causes, some of which may be reversible if addressed. Drugs are a common cause of sicca and many different drug groups have been implicated. Potential causative agents include those with anti-cholinergic activity such as anti-depressants, anxiolytics and anti-psychotics; muscarinic anatagonists such as tamsulosin hydrochloride and ipratropium hydrochloride; anti-histamines; opiates

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2017 British Society for Rheumatology

135. CRACKCast E095 – Large Intestine

of the above plus metabolic imbalance or medication administration (eg, narcotics, phenothiazines (think methylene blue), calcium channel blockers, alpha-2-adrenergic agonists, epidural analgesics) Don’t forget about other causes of colonic dilatation: mechanical or toxic megacolon! 2) Compare AXR findings in SBO with LBO According to : SBO Abdominal radiographs are only 50-60% sensitive for small bowel obstruction. In most cases, the abdominal radiograph will have the following features: Dilated loops (...) ! IBS Diverticular disease Volvulus Large bowel obstruction IBD Intussusception Colonic ischemia Radiation proctocolitis 1) List features that are typical for IBS. This is a chronic, non-life threatening disorder – causing abdo pain and weird bowel habits. 10-15% prevalence, and it is thought to impair one’s QOL more than diabetes or renal failure!!! Its defined as a “functional, somatic syndrome” because there are no physical or lab features that clinch the diagnosis! No known cause. Testing shows

2017 CandiEM

136. CRACKCast E089 – Esophagus, Stomach & Duodenum

/ gastritis causing foods/lifestyle choices/meds Reasons to referral to GI: Age >55 yrs with: New onset Dyspepsia Progressive weight loss Persistent vomiting Iron deficiency anemia Epigastric mass 14) How are prostaglandins used the setting of GI disorders? Prostaglandins protect the gastric mucosa! (Inhibit acid secretion, increase mucous/bicarbonate/stimulate blood flow). Misoprostol (an analogue of prostaglandin) – used for high risk patients – to prevent progression of NSAID-induced ulcers. 15) What (...) to section: throat-esophagus and then stomach. 1) List the the types of dysphagia. What is an ED approach to this condition? Swallowing is divided into oral, pharyngeal, and esophageal phases. Failure at any one of these levels results in dysphagia, which literally means “difficulty Swallowing.” When it comes to causes, just think M&M. The problem is either a mechanical block or a motility problem. The upper swallowing action is very complex neuro-muscular action that involves the lips, tongue, pharynx

2017 CandiEM

137. Upper Gastrointestinal Cancer (Suspected) - Esophagus and Stomach

and inflammatory/hyperplastic polyps ? Birth in a country where gastric cancer is common (e.g. Japan) ? Previous partial gastrectomy ? H. pylori 7,8 ? Intestinal metaplasia 22 Family Practice Oncology Network Upper Gastrointestinal Cancer – Part 1 (2016) 3 DIAGNOSIS The gold standard for diagnosis is endoscopy, however, an upper GI series may be considered as an adjunct investigation where endoscopy is not readily available. Patients referred for endoscopy may continue any acid suppression medication (...) , including PPIs or H 2 -receptor antagonists. Check with your local endoscopy office with respect to recommendations for other medications including anticoagulation, diabetes medication, etc. ! Indications for Urgent Referral to a Specialist The presence of the following alarm symptoms alone or in combination should prompt urgent referral to a specialist: ? (Progressive) difficulty in swallowing ? Pain on swallowing ? Food obstructions ? Early satiety ? Persistent vomiting ? Unexplained weight loss

2016 Clinical Practice Guidelines and Protocols in British Columbia

138. Alcohol: Adult Unhealthy Drinking

, patient-centered manner that—based on the screen—you are concerned they “may be” or “are” drinking at an unhealthy level. Use “may be” if the patient screens positive but is not reporting drinking above recommended limits. Provide feedback linking drinking to health Describe how the drinking might impact the patient’s medical conditions (e.g., hypertension, hepatitis C, depression), symptoms (e.g., insomnia, dyspepsia), or risks (e.g., breast cancer, liver disease). Offer advice Advise the patient (...) Alcohol: Adult Unhealthy Drinking © 1996 Kaiser Foundation Health Plan of Washington. All rights reserved. 1 Unhealthy Drinking in Adults Screening and Intervention Guideline Summary of Changes as of October 2016 2 Background 3 Role of Primary Care 3 Definitions 4 Alcohol Screening and Brief Interventions in Primary Care 6 Screening with the AUDIT-C 8 Brief Interventions 10 Assessment for Alcohol Use Disorder 12 Management of Alcohol Use Disorder in Primary Care 13 Medication Management

2016 Kaiser Permanente Clinical Guidelines

139. Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents

for 14 days or bismuth- based quadruple therapy is recommended. Success of therapy should be monitored after 4 to 8 weeks by reliable noninvasive tests. Conclusions: The primary goal of clinical investigation is to identify the cause of upper gastrointestinal symptoms rather than H pylori infection. Therefore, we recommend against a test and treat strategy. Decreasing eradication rates with previously recommended treatments call for changes to ?rst-line therapies and broader availability of culture (...) or molecular-based testing to tailor treatment to the individual child. Key Words: adolescents, antibiotic susceptibility, 13 C-urea breath test, children, eradication, Helicobacter pylori, triple therapy (JPGN 2017;64: 991–1003) H elicobacter pylori infection is acquired in childhood and remains an important cause of peptic ulcer disease (PUD) and gastric cancer (1). In comparison with adults, children and adolescents, however, infrequently develop these complications of infection. FurthermoreHpylori

2017 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

140. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Gui

to signify an event that can be reversed, usually by cardiopulmonary resuscitation (CPR), administration of medications and/or defibrillation or cardioversion. SCA and SCD can result from causes other than VA, such as bradyarrhythmias, electromechanical dissociation, pulmonary embolism, intracranial hemorrhage, and aortic dissection; however, the scope of this document includes only SCA and SCD due to VA. This guideline includes indications for ICDs for the treatment of VA and prevention of SCD (...) Catheterization or CT Angiography e222 3.3.2. Electrophysiological Study for VA e223 4. Therapies for Treatment or Prevention of VA e223 4.1. Medication Therapy e223 4.2. Preventing SCD With HF Medications e225 4.3. Surgery and Revascularization Procedures in Patients With Ischemic Heart Disease e225 4.3.1. Surgery for Arrhythmia Management e226 4.4. Autonomic Modulation e226 5. Acute Management of Specific VA e226 6. Ongoing Management of VA and SCD Risk Related to Specific Disease States e228 6.1. Ischemic

2017 American Heart Association

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