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Medication Causes of Dyspepsia

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161. Antenatal care - uncomplicated pregnancy

pregnancy but should avoid scuba diving and sports that may cause abdominal trauma, falls, or excessive joint stress. Working — most women can continue working during pregnancy. To allow a pregnant woman to continue working after 33 weeks, her GP or midwife must inform her employer that she may continue to do so. The law states that a women is not allowed to return to employment in the 2 weeks following childbirth. Maternity benefits — including information on entitlement to take time off work (...) have been updated in line with the Department of Health publication Alcohol Guidelines Review - report from the Guidelines development group to the UK Chief Medical Officers (2016). April to May 2016 — reviewed. A literature search was conducted in April 2016 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. No major changes to clinical recommendations have been made. Previous changes

2019 NICE Clinical Knowledge Summaries

162. Pyelonephritis - acute

pyelonephritis (acute): antimicrobial prescribing. September 2017 — minor update. SPC update on quinolones to align all CKS topics prescribing advice. Prostatitis – chronic, Gonorrhoea, Pyelonephritis, Diarrhoea – prevention and advice for travellers, Dyspepsia – unidentified cause, Dyspepsia – proven functional, Dyspepsia – proven peptic ulcer, Diverticular disease, Gastroenteritis and Scrotal pain and swellings. December 2016 — minor update. The adverse effects section for ciprofloxacin has been updated (...) . People with megaloblastic anaemia or other blood dyscrasias. Premature infants or children aged under 4 months. Women who are pregnant. Prescribe trimethoprim with caution in people: With impaired renal function. With hyperkalaemia, or taking medication that is known to cause hyperkalaemia. With acute porphyria. Predisposed to folate deficiency — because of the potential anti-folate effect of trimethoprim, there is a risk of further exacerbating folate deficiency in people who are folate deficient

2019 NICE Clinical Knowledge Summaries

163. Gastroenteritis

– unidentified cause, Dyspepsia – proven functional, Dyspepsia – proven peptic ulcer, Diverticular disease, Gastroenteritis and Scrotal pain and swellings. November 2016 — minor update. Adverse effects of loperamide have been updated to include information in a U.S. Food and Drug Administration (FDA) Drug safety communication, warning that exceeding the maxium dose can cause serious cardiac problems including QT interval prolongation, Torsades de Pointes or other ventricular arrhythmias, syncope, and cardiac (...) Seeking medical advice if symptoms do not resolve within the expected time frames The information on the duration of vomiting and diarrhoea is based on the National Institute for Health and Care Excellence (NICE) guideline, Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment, and management in children younger than 5 years [ ]. NICE states that even when a presumptive diagnosis of gastroenteritis has been made, it is important to reconsider the diagnosis if the subsequent course

2019 NICE Clinical Knowledge Summaries

164. Polymyalgia rheumatica

Polymyalgia rheumatica Polymyalgia rheumatica - NICE CKS Share Polymyalgia rheumatica: Summary Polymyalgia rheumatica (PMR) is a chronic, systemic rheumatic inflammatory disease characterized by aching and morning stiffness in the neck, shoulder, and pelvic girdle. The cause of PMR is unknown, although genetic and environmental factors are thought to contribute to disease susceptibility and severity. Risk factors include: Older age — the highest incidence is in people older than 65 years of age (...) for people diagnosed with PMR if: It is not possible to reduce corticosteroids at reasonable intervals without causing relapse. Corticosteroids are required for more than 2 years. Have I got the right topic? Have I got the right topic? From age 40 years onwards. This CKS topic is based on published guidelines from the British Society for Rheumatology (BSR) and British Health Professionals (BHPR) in Rheumatology for the management of polymyalgia rheumatica (PMR) [ ; ]. This CKS topic covers the management

2019 NICE Clinical Knowledge Summaries

165. NSAIDs - prescribing issues

anti-inflammatory drugs [ ], the European Medicines Agency (EMA) review Updated advice on the use of high-dose ibuprofen [ ], a U.S. Food and Drug Administration (FDA) drug safety communication FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes [ ], expert opinion in a medical textbook Medical Pharmacology at a glance [ ], and a narrative review Non-steroidal anti-inflammatory drugs (NSAIDs) [ ], the British National Formulary (...) ), and include ibuprofen, indometacin, mefenamic acid, and naproxen. Diclofenac, etodolac, meloxicam, and nabumetone, are also nonselective NSAIDs, but are thought to have a preference for COX-2. Coxibs — these are COX-2 specific NSAIDs, and include celecoxib and etoricoxib. When prescribing an NSAID, individual risk factors for adverse effects should be taken into account and include any contraindications, drug interactions, medical history, and any monitoring requirements. If an NSAID is indicated

2019 NICE Clinical Knowledge Summaries

166. Pelvic inflammatory disease

effective. Adherence rates for existing two week PID treatment regimens are poor. The addition of azithromycin has the potential to cause early discontinuation of medication due to gastrointestinal adverse effects. Ofloxacin and moxifloxacin should be avoided in women who are at high risk of gonococcal PID because of high levels of quinolone resistance. Treatments not recommended Replacing intramuscular ceftriaxone with an oral cephalosporin (for example cefixime) is not recommended because (...) Pelvic inflammatory disease Pelvic inflammatory disease - NICE CKS Share Pelvic inflammatory disease: Summary Pelvic inflammatory disease (PID) is a general term for infection of the upper genital tract. PID is almost always due to a sexually transmitted infection (STI). Chlamydia trachomatis is the most common causative organism, accounting for 14–35% of cases. Other causative organisms include Neisseria gonorrhoeae (2–3% of cases) , Mycoplasma genitalium, and organisms in normal vaginal flora

2019 NICE Clinical Knowledge Summaries

167. Dementia

assessment has been undertaken to establish the likely causes and influences that may generate, aggravate, and improve the behaviour(s), covering: Physical health Depression Possible undetected pain or discomfort Side effects of medication Individual biography, including beliefs, spiritual and cultural identity Psychosocial factors Physical environmental factors Specific behavioural and functional analysis conducted by trained professionals in conjunction with family carers and care workers (...) or adverse effects of medication. Early-onset (or young onset) dementia is generally defined as dementia that develops before 65 years of age. Mild cognitive impairment is cognitive impairment that does not fulfil the diagnostic criteria for dementia, for example, because only one cognitive domain is affected, or deficits do not significantly affect ADLs. [ ; ; ; ; ; ] Causes What causes it? The most common subtypes of dementia are: Alzheimer’s disease (50–75% of cases) The pathological features

2019 NICE Clinical Knowledge Summaries

168. Anticoagulation - oral

in secondary care consists of stopping treatment and general haemostatic measures, such as mechanical compression and surgical haemostasis with bleeding control procedures, fluid replacement and haemodynamic support, blood products (packed red cells or fresh frozen plasma, depending on associated anaemia or coagulopathy), or platelets. People taking oral anticoagulants should be advised: To seek immediate medical advice if spontaneous bleeding occurs and does not stop, or recurs. This includes bruising (...) , bleeding gums, nosebleeds, prolonged bleeding from cuts, blood in the urine or stools, haemoptysis, subconjunctival haemorrhage, and vaginal bleeding in a postmenopausal woman. To seek medical advice if they get sudden severe back pain (which may indicate spontaneous retroperitoneal bleeding). Not to take over-the-counter medicines such as nonsteroidal anti-inflammatory drugs. What to do if there has been a missed dose or if a double dose has been taken. The duration of treatment with oral

2019 NICE Clinical Knowledge Summaries

169. Diarrhoea - prevention and advice for travellers

update. Prescribing information updated with information regarding azithromycin interacting with colchicine. September 2017 — minor update. SPC update on quinolones to align all CKS topics prescribing advice. Prostatitis – chronic, Gonorrhoea, Pyelonephritis, Diarrhoea – prevention and advice for travellers, Dyspepsia – unidentified cause, Dyspepsia – proven functional, Dyspepsia – proven peptic ulcer, Diverticular disease, Gastroenteritis and Scrotal pain swellings. March 2013 — reviewed (...) fragilis [ ]. Parasitic pathogens tend to cause more prolonged symptoms, therefore travellers' diarrhoea due to parasites such as Giardia more often needs post-travel medical care [ ; ]. Helminth infection is an uncommon cause of travellers' diarrhoea, although it may be caused by acute heavy hookworm infection or schistosomiasis [ ; ]. Risk factors What are the risk factors for travellers' diarrhoea? The risk of travellers' diarrhoea is influenced by a number of factors [ ], including: Destination

2019 NICE Clinical Knowledge Summaries

170. GORD in children

be suspected in children over 1 year who present with heartburn, retrosternal pain, or epigastric pain. Same-day admission should be arranged if the child has: Haematemesis (not caused by swallowed blood from a nosebleed or ingested from a cracked maternal nipple). Melaena. Dysphagia. Specialist assessment by a paediatrician or paediatric gastroenterologist should be arranged if there is: An uncertain diagnosis or 'red flag' symptoms which suggest a more serious condition. Persistent faltering growth (...) , to be in line with recommendations from NICE. The recommendation to eliminate cows' milk protein from the diet as a treatment option has been removed. A recommendation to consider a 4 week trial of omeprazole or ranitidine has been inserted. A prescribing information section has been added. May 2014 — minor update. Changes to the text to reflect advice from the European Medicines Agency (EMA) regarding metoclopramide and domperidone. Both are no longer recommended to treat dyspepsia or gastro-oesophageal

2019 NICE Clinical Knowledge Summaries

171. Prostatitis - chronic

, Diarrhoea – prevention and advice for travellers, Dyspepsia – unidentified cause, Dyspepsia – proven functional, Dyspepsia – proven peptic ulcer, Diverticular disease, Gastroenteritis and Scrotal pain and swellings. December 2016 — minor update. The adverse effects section for ciprofloxacin has been updated to include vision disorders [ ]. Uveitis, severe liver injury and exfoliative dermatitis have been added as possible adverse effects of ofloxacin, in line with the manufacturer's updated Summary (...) in the perineum, lower abdomen, penis (especially at the tip), testis, rectum, or and the lower back. Urinary symptoms (including dysuria, frequency, hesitancy, urgency, and poor stream). An enlarged, tender, or normal prostate on rectal examination. A diagnosis of chronic prostatitis should be made based on the man's history and the exclusion of other conditions that may be causing symptoms such as: Urinary tract infection. Urethritis. Epididymo-orchitis. Epididymitis. Benign prostatic hypertrophy. Cancer

2019 NICE Clinical Knowledge Summaries

172. LUTS in men

during the night (more than 35% of the 24-hour urine production). Nocturnal polyuria can be caused by: Medical conditions (such as diabetes mellitus, diabetes insipidus, adrenal insufficiency, hypercalcaemia, liver failure, polyuric renal failure, chronic heart failure, pyelonephritis, and chronic venous stasis). Drugs (such as calcium channel blockers, diuretics, and selective serotonin reuptake inhibitor [SSRI] antidepressants). [ ] Stress urinary incontinence What are the causes of stress urinary (...) and examination Experts recommend a complete medical history and examination for men with lower urinary tract symptoms (LUTS) [ ; ]. According to NICE [ ]: Diagnosis of the underlying cause of LUTS in men is of paramount importance and is central to clinical treatment. A differential diagnosis allows focused investigation and management before a firm diagnosis is reached and a management plan formulated. According to the EAU [ ]: The aim of a medical history is to identify the potential causes of LUTS as well

2019 NICE Clinical Knowledge Summaries

173. Diabetes - type 2

in the following groups: Children and young people (younger than 18 years of age). Pregnant women or women who are two months postpartum. People with symptoms of diabetes for less than 2 months. People at high diabetes risk who are acutely ill. People taking medication that may cause hyperglycaemia (for example corticosteroids). People with acute pancreatic damage, including pancreatic surgery. People with end-stage chronic kidney disease. People with HIV infection. HbA1c should be interpreted with caution (...) in people with: Abnormal haemoglobin. Anaemia (any cause). Altered red cell lifespan (for example post-splenectomy). A recent blood transfusion. [ ; ] Basis for recommendation Basis for recommendation These recommendations are largely based on the World Health Organization (WHO) reports Definition, diagnosis and classification of diabetes mellitus and its complications [ ] and Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus [ ], and the British Medical Journal (BMJ) review

2019 NICE Clinical Knowledge Summaries

174. Erectile dysfunction

dysfunction was a disease of old age; however, available evidence suggests a growing incidence in men younger than 40 years of age [ ; ; ; ]: In a cross-sectional real-life study of men seeking first medical help for new-onset erectile dysfunction, 1 in 4 of the men was younger than 40 years, with almost half complaining of severe erectile dysfunction [ ]. Erectile dysfunction in younger men was initially thought to be entirely psychogenic in nature. However, several studies have identified organic causes (...) starting a drug treatment and onset of erectile dysfunction (within two weeks of drug introduction). However, it is not always possible to discontinue the treatment as many medications that cause erectile dysfunction are essential for managing the underlying illness for which they were prescribed [ ]. Erectile dysfunction as a result of radical prostatectomy may be reversible depending on pre-operative erectile function, the nerve sparing nature of the procedure, and how soon after the procedure pro

2019 NICE Clinical Knowledge Summaries

175. MI - secondary prevention

MI - secondary prevention MI - secondary prevention - NICE CKS Share MI - secondary prevention: Summary Myocardial infarction (MI) is necrosis of myocardial tissue following occlusion of a coronary artery and subsequent ischaemia. MI is a major manifestation of coronary heart disease (CHD). Death rates from CHD have fallen considerably in the UK since the late 1970s. However, CHD remains one of the most common causes of death in the UK, responsible for approximately 66,000 deaths in 2016 (...) . The British Heart Foundation (BHF) estimates that in 2016, 2.3 million people in the UK were living with a diagnosis of CHD and around 1 million people had survived an MI. The commonest cause of MI is an atheromatous plaque rupturing or eroding in a coronary artery; this causes a coronary thrombus to form, which partially or completely obstructs the artery. MIs are divided into 2 types, depending on the ECG changes. ST-segment elevation myocardial infarction (STEMI), which is generally caused by complete

2019 NICE Clinical Knowledge Summaries

176. Neuropathic pain - drug treatment

initial and maximum daily dosage is recommended (see ). Has diabetes — pregabalin may cause weight gain. Adjustment of anti-diabetic medication may be necessary. Is elderly and at risk of falls — pregabalin has been associated with dizziness and somnolence, and there have been post-marketing reports of loss of consciousness, confusion, and mental impairment with pregabalin. Has heart failure — congestive heart failure has been reported in some people on pregabalin. This is most commonly seen (...) Neuropathic pain - drug treatment Neuropathic pain - drug treatment - NICE CKS Share Neuropathic pain - drug treatment: Summary Neuropathic pain is a symptom that develops as a result of damage to, or dysfunction of, the nervous system. The pain may be constant or intermittent, and it is typically described as shooting, stabbing, burning, tingling, numb, prickling, or itching. The causes of neuropathic pain are complex and diverse and include diabetic neuropathy, trigeminal neuralgia, stroke

2019 NICE Clinical Knowledge Summaries

177. Leg ulcer - venous

Leg ulcer - venous Leg ulcer - venous - NICE CKS Share Leg ulcer - venous: Summary ​​​​​​A leg ulcer is a break in the skin below the knee which has not healed within 2 weeks. A venous leg ulcer occurs in the presence of venous disease and is the most common type of leg ulcer, accounting for 60–80% of cases. It typically occurs in the gaiter area of the leg (from the ankle to mid-calf). Other causes of leg ulceration and/or delayed wound healing include arterial disease, diabetes, rheumatoid (...) arthritis, vasculitis, sickle cell disease, malignancy, and drugs (such as nicorandil, corticosteroids, and nonsteroidal anti-inflammatory drugs). Venous leg ulceration is caused by sustained venous hypertension, which results from chronic venous insufficiency due to venous valve incompetence or an impaired calf muscle pump. Risk factors include obesity, immobility, increasing age, varicose veins, and a history of deep vein thrombosis (DVT). The estimated prevalence of venous leg ulcers in the UK

2019 NICE Clinical Knowledge Summaries

178. Scrotal pain and swelling

[ ] and BMJ Best Practice, Testicular torsion [ ]. The advice that examination of the testes should be performed in all male patients presenting with abdominal pain has been added. September 2017 — minor update. SPC update on quinolones to align all CKS topics prescribing advice. Prostatitis – chronic, Gonorrhoea, Pyelonephritis, Diarrhoea – prevention and advice for travellers, Dyspepsia – unidentified cause, Dyspepsia – proven functional, Dyspepsia – proven peptic ulcer, Diverticular disease (...) . History of penetrative anal intercourse. Recent urological instrumentation or catheterization. For information on testing for sexually transmitted infections, see the CKS topics on and . Also consider testing for trichomoniasis, HIV, hepatitis, and syphilis. For more information, see the CKS topics on and . Consider other causes, such as mumps orchitis (parotid swelling may be present), Behçet's syndrome, tuberculosis, or the medication, amiodarone. If mumps orchitis is suspected, see the CKS topic

2019 NICE Clinical Knowledge Summaries

179. Chronic obstructive pulmonary disease

, wheeze or quiet breath sounds, and peripheral oedema. Post-bronchodilator spirometry should be measured to confirm the diagnosis of COPD. In COPD, the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC ratio) is less than 0.7. Severity should be assessed in terms of the: Degree of airflow obstruction according to reduction in FEV 1 . Degree of breathlessness according to the Medical Research Council (MRC) dyspnoea scale. Frequency of exacerbations. Presence of cor (...) treatment such as a short-acting beta- 2 agonist or a muscarinic antagonist — additional treatments may be added depending on the person's response. Referral should be considered, if appropriate: To a respiratory specialist, for assessment for oxygen therapy if symptoms are severe or refractory, if an occupational cause is suspected, or if there are symptoms of cor pulmonale. For pulmonary rehabilitation if the person is functionally disabled by COPD, or has had a recent hospitalization for an acute

2019 NICE Clinical Knowledge Summaries

180. Heart failure - chronic

) Chronic heart failure diagnosis and management [ ], and the European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 [ ]. Reviewing drugs which may cause or worsen heart failure The recommendation to review drugs which may cause or worsen heart failure is pragmatic and based on what CKS considers to be good medical practice. Prescribing diuretics The recommendation to prescribe and titrate diuretics to relieve symptoms of heart failure (...) categories with either a reduced or preserved ejection fraction. Symptoms are classified according to severity using the New York Heart Association (NYHA) functional classification. The most common underlying cause is coronary artery disease. Complications include arrhythmias, depression, cachexia, chronic kidney disease, sexual dysfunction, and sudden cardiac death. About 50% of people with heart failure die within 5 years of diagnosis, and about 40% of people admitted to hospital with heart failure die

2019 NICE Clinical Knowledge Summaries

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