Therapeutic Guidelines - Gastrointestinal

Antacids and acid suppressants
- Antacids
- Histamine H2-receptor antagonists
- Proton pump inhibitors
Laxatives
- Bulk-forming laxatives
- Osmotic laxatives
- Stool-softening laxatives
- Stimulant laxatives
Antidiarrhoeals
- Codeine
- Diphenoxylate
- Loperamide
Antiemetics
- Metoclopramide
- Prochlorperazine
- Domperidone
- 5-Hydroxytryptamine type 3 receptor antagonists
- Aprepitant
- Other antiemetics
Drugs used in gastrointestinal motility disorders
- Antispasmodics
  - Anticholinergic drugs
- Motility stimulants
  - Cisapride
  - Tegaserod
Drugs used in inflammatory bowel disease
- Aminosalicylates
- Corticosteroids
- Azathioprine and mercaptopurine
- Methotrexate
- Infliximab
- Cyclosporin
- Metronidazole
Drugs used in liver disease
- Antiviral drugs for infectious hepatitis
  - Interferons
  - Adefovir
  - Entecavir
  - Lamivudine
  - Ribavirin
- Drugs used in autoimmune hepatitis
- Other drugs used in liver disorders
  - Octreotide
  - Terlipressin
  - Ursodeoxycholic acid

Nausea and vomiting

Potential underlying causes and pharmacology
Motion sickness
Vestibular disturbances
Pregnancy
Gastroparesis
Drug-induced nausea and vomiting
- Noncytotoxic drugs
- Cytotoxic drugs
Radiotherapy-induced nausea and vomiting
Postoperative nausea and vomiting
Chronic nausea and vomiting

Disorders of the oesophagus

Gastro-oesophageal reflux
- Gastro-oesophageal reflux symptoms
- Treatment of mild intermittent symptoms (patients not requiring endoscopy)
- Gastro-oesophageal reflux disease
  - Initial therapy
  - Maintenance therapy
  - Patients where endoscopic findings are known
  - Safety of long-term acid suppression
  - Prokinetic agents
  - Surgical and endoscopic therapies for reflux disease
- Gastro-oesophageal reflux in pregnancy
  - Patients on acid suppression prior to pregnancy
- Gastro-oesophageal reflux in children
Barrett’s oesophagus
Functional heartburn
Disorders of oesophageal motility
- Achalasia
- Diffuse oesophageal spasm
  - Medical therapy
  - Other therapies
Oesophageal food impaction
Eosinophilic oesophagitis
Oesophageal infections
Drug-induced oesophageal injury

H. pylori in adults
- H. pylori gastritis and symptoms
- H. pylori and gastric cancer
- H. pylori and peptic ulcer disease
  - Clinical features
  - Principles of management
    - ‘Search-and-treat’ strategy for ulcer disease
    - ‘Test-and-treat’ strategy for dyspepsia
  - Therapy of ulcer disease
  - Eradication of H. pylori and ulcer healing
    - First-line therapy
    - Eradication therapy in penicillin hypersensitivity
    - Failure of eradication therapy
    - Testing for H. pylori after eradication therapy
  - Maintenance treatment to prevent ulcer relapse
H. pylori in children
NSAID-induced ulcers
- Risk factors for NSAID-induced ulcers
- Prevention of NSAID-induced ulcers
- Treatment of NSAID-induced ulcers
- Low-dose aspirin and peptic ulcers
Bleeding peptic ulcers
Prophylaxis of stress ulceration

Biliary and pancreatic disorders

Biliary disorders
- Biliary colic
- Acute cholecystitis
- Ascending cholangitis
Acute pancreatitis
- Clinical features and aetiology
- Management
  - Mild to moderate pancreatitis
  - Severe pancreatitis
  - Treatment of late complications of acute pancreatitis
Chronic pancreatitis
- Causes and investigations
- Pain in chronic pancreatitis
- Malabsorption in chronic pancreatitis
Pancreatic insufficiency and cystic fibrosis

Viral hepatitis

Acute viral hepatitis
- General management principles
- Acute hepatitis B
- Acute hepatitis C
Chronic viral hepatitis
- Chronic hepatitis B
  - Definition and natural history
  - Hepatitis B ‘e’ antigen positive chronic hepatitis
    - Mild to moderate disease on liver biopsy
    - Severe fibrosis or cirrhosis
  - Hepatitis B ‘e’ antigen negative chronic hepatitis
    - Mild to moderate disease on liver biopsy
    - Severe fibrosis or cirrhosis
    - Monitoring of patients on lamivudine
    - Management of lamivudine resistance
  - Hepatitis B-HIV co-infection
  - Hepatitis B surface antigen positive patients undergoing cancer chemotherapy or immunosuppression
- Chronic hepatitis C
  - Chronic hepatitis C and progression to liver fibrosis
  - General lifestyle advice to prevent disease progression
  - Antiviral therapy for chronic hepatitis C
  - Hepatitis C-HIV co-infection
- Prevention of viral hepatitis
  - Risk factor reduction to prevent hepatitis C
  - Vaccination
    - Hepatitis A
    - Hepatitis B
    - Hepatitis C
  - Needlestick injuries

Other liver disorders

Genetic haemochromatosis
Autoimmune chronic hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Nonalcoholic fatty liver disease
Drug-induced liver disease
Acute alcoholic hepatitis
Cholestasis of pregnancy
Pruritus in cholestatic liver disease

Complications of liver disease

Overview
Ascites
Spontaneous bacterial peritonitis
Hepatorenal syndrome
Bleeding oesophageal varices
Hepatic encephalopathy
Hepatocellular carcinoma

Small bowel disorders

Lactose intolerance
Coeliac disease
- Diagnosis
- Associated conditions
- Management
Bacterial overgrowth
Short bowel syndrome

Common disorders of vitamin and mineral metabolism

Vitamin deficiencies
- Vitamin A deficiency
- Thiamine deficiency
- Vitamin B12 deficiency
- Folate deficiency
- Vitamin D deficiency
  - Osteomalacia and rickets
  - Treatment of vitamin D deficiency
  - Prevention of vitamin D deficiency
- Vitamin K deficiency
Mineral deficiencies
- Calcium metabolism and osteoporosis
- Iron deficiency
- Zinc deficiency

Constipation

Definition and aetiology
Constipation in adults
- Management
  - Diet and lifestyle
  - Bulking agents
  - Other laxatives
    - Stool softeners
    - Osmotic laxatives
    - Stimulant laxatives
  - Combinations and rectal formulations
- Inappropriate use of laxatives
- Constipation in the older person
  - Contributory factors
  - Assessment of constipation in the older person
  - Management of constipation in the older person
- Bowel management in patients with spinal injury
Constipation in children
- Definition and assessment
- Management
- Chronic constipation and encopresis in children

Diarrhoea

Definition and aetiology
Infectious gastroenteritis
- Principles of management
  - Fluid and electrolyte therapy
  - Antimotility drugs
- Viral infections
  - Viral gastroenteritis in children
    - Prevention
    - Treatment—general principles
    - Treatment—rehydration
    - Transient lactose intolerance
- Bacterial infections
  - Antibiotic-associated diarrhoea
  - Campylobacter enteritis
  - Cholera
  - Enterohaemorrhagic Escherichia coli enteritis
  - Salmonella enteritis
  - Shigellosis
  - Yersinia enterocolitis
- Protozoal infections
  - Amoebiasis (Entamoeba histolytica)
  - Blastocystis hominis
  - Cryptosporidium parvum gastroenteritis
  - Giardiasis (Giardia lamblia or intestinalis)
- Traveller’s diarrhoea
  - Prevention
  - Treatment
    - Mild disease
    - Moderate to severe disease
  - Persistent diarrhoea in returned travellers
Chronic diarrhoea

Irritable bowel syndrome

Criteria and diagnosis
General measures
Nonpharmacological therapies
- Dietary therapy
- Cognitive behavioural therapy and hypnotherapy
Pharmacological therapies
- Diarrhoea-predominant IBS
- Constipation-predominant IBS
- Abdominal pain in patients with IBS

Diverticular disease

Diverticulosis
Diverticulitis
- Mild diverticulitis
- Severe or complicated diverticulitis
- Surgical management of diverticulitis
- Diverticular bleeding
  - Management

Inflammatory bowel disease

Definition and general approach to treatment
Ulcerative colitis
- Aims of therapy and drugs used
- Active proctitis or distal colitis
  - Choice of drug and formulation
  - Initial therapy
  - Unresponsive disease
- Extensive ulcerative colitis
  - Mild to moderate disease
  - Severe disease
  - Chronically active disease
- Maintenance therapy for ulcerative colitis
  - Pouchitis
- Diet and other measures in ulcerative colitis
Crohn’s disease
- Mild to moderate disease
- Severe disease
- Chronically active disease
- Maintenance therapy for Crohn’s disease
- Ileal malabsorption (bile acid diarrhoea, bacterial overgrowth)
- Perianal disease
- Smoking and Crohn’s disease
- Diet and other supportive measures in Crohn’s disease
- Children and Crohn’s disease
Pregnancy in inflammatory bowel disease
Osteoporosis and inflammatory bowel disease

Perianal disorders

Haemorrhoids
Anal fissure
Perianal haematoma
Pruritus ani
Perianal cellulitis
Anorectal abscess and fistula
- Abscess
- Fistula
Pilonidal sinus

Enteral nutrition, oral nutritional support and stoma management in the community

Enteral nutrition
- Re-feeding syndrome
  - Definition and manifestations
  - Prevention of re-feeding syndrome
- General enteral feeding advice
  - Methods of administration
  - Support services
Feeding tubes
- Gastrostomy tubes
  - Gastrostomy insertion
  - Routine gastrostomy tube care
- Jejunostomy tubes
- Management of feeding tube and site problems
- Management of complications of tube feeding
- Administration of drugs via enteral tubes
Ileostomies and colostomies
- Dietary management of a stoma
  - Ileostomies
  - Colostomies