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Ascites in Cirrhosis

Gastroenterology Forum authors: Prof Reid Ally, Dr Keith Pettengell and Dr John Wright Ascites’ development heralds the onset of liver decompensation and poor long-term outcome without transplantation. Causes The main contributing factor to ascites in cirrhosis is splanchnic vasodilation. As portal hypertension progresses due to increased intra-hepatic resistance, blood is shunted into the systemic circulation. This […]

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What the eye does not see

Dr Keith Pettengell Some medical reports are inherently more accepted and believed than others. One has the feeling that abdominal CAT scan reports by a newly qualified radiologist should be taken rather more seriously than an EEG report by a professor of electrophysiology. Endoscopy reports are rated quite highly in the believability stakes. However, where upper […]

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Are PPIs Safe in the Long Term?

Gastro forum authors: Prof Reid Ally, Dr Keith Pettengell and Dr John Wright In the last 30 years, five proton pump inhibitors (PPIs) have become available in SA (omeprazole, esomeprazole sodium, lansoprazole, pantoprazole, rabeprazole and their associated generics). The differences between these molecules are well described in the literature and promotional material, but the clinical significance […]

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Explanations for PPI Failure in Heartburn

Reports suggest that between 10%-40% of patients with gastro oesophageal reflux disease (GORD) fail to respond symptomatically, either partially or completely, to a standard proton pump inhibitor (PPI) dose. It is interesting to note that the number of patients on double-dose PPI has increased dramatically, without evidence that such practices have improved patients’ symptoms. Failure […]

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Occult Bleeding – A Multifaceted Clinical Challenge

Gastro forum authors: Prof Reid Ally, Dr Keith Pettengell and Dr John Wright Occult gastrointestinal bleeding is bleeding of which a patient is unaware and includes those with a positive faecal occult blood and/or iron deficiency anaemia. The prevalence of the problems is unknown and seeing that most people in the community are not tested for […]

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Guidelines in IBD: A Conspiracy?

Gastro forum authors: Prof Reid Ally, Dr Keith Pettengell and Dr John Wright In order to improve and standardise treatment for difficult conditions, it has become common to design guidelines for clinicians to follow. In spite of these good intentions, the care given to patients is often suboptimal for the individual. The reasons for this are […]

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Acute Severe Alcoholic Hepatitis

Prof Reid Ally would like to acknowledge Dr Nazeer Ahmed Ismail Chopdat and the Department of Medical Gastroenterology, Chris Hani Baragwanath Academic Hospital, for contribution to this article Alcoholic liver disease remains a challenging problem for both basic scientists and clinicians. The true prevalence of alcoholic hepatitis is not well defined. In the US alone, it is estimated […]

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Investigating Minimal Rectal Bleeding: Weighing the Options

Gastro forum authors: Prof Reid Ally, Dr Keith Pettengell and Dr John Wright   The passage of small quantities of bright red blood per rectum is a common problem, although many sufferers never become patients. In a community-based study of people aged between 20 and 64, it was found that 13% had experienced some blood on the […]

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Are SA Doctors Behind the Curve in Treating Crohn’s Disease?

Gastro forum authors: Prof Reid Ally, Dr Keith Pettengell and Dr John Wright There was a fundamental change in the management of Crohn’s disease in 1990 when the value of immunosuppression with azathioprine was generally accepted. In 1998, the whirlwind of infliximab hit the profession after the US Food and Drug Administration approved its use in […]

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Role of the Gut Microbiota in Health

Gastro forum authors: Prof Reid Ally, Dr Keith Pettengell and Dr John Wright   It had been known, from early in the history of microbiology, that the gut of humans and other animals is inhabited by microbial species, mostly bacteria and fungi. Louis Pasteur expressed his views to the French Academy of Sciences in 1885 on the […]

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