GI

Question 1

Celiac Disease Diagnosis/Testing

Answer 1

1) Duodenal biopsy showing intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. Biopsy is not completely specific so need:

+

2) +ve response to gluten-free diet.

Serologic:

1) Test anti-TTG —> if N or absent + high suspicion, measure IgA levels —> if low test IgG deaminated gliadin peptide
2) If suspicion high, do biopsy regardless of all other results. Also, biopsy if chronic diarrhea, iron deficiency, or weight loss, irrespective of other testing.

Question 2

Celiac Foods

Answer 2

• Bad: wheat, rye, barley
• Good: rice, corn, millet, buckwheat, quinoa, pure oats

Question 3

H. Pylori

When to test, which test to use

Answer 3

• test if PUD (not in GERD)
• if no hx prev do blood test (stays positive)
• if hx prior do Urea Breath Test (goes away with eradication)

Question 4

H. Pylori Tx

Answer 4

• amoxicillin 1 g BID (Flagyl 500 mg BID if pen allergic) + Clarithro 500 mg BID + PPI x 10-14d
  
  • if asymptomatic and uncomplicated, no further testing
  • if symptomatic or complicated (hx ulcer, MALT lymphoma) –> do Urea breath test 30d after tx for test of cure
• if failed then quad therapy: bismuth subsalicylate 524 mg QID + Flagyl 250 mg QID + tetracycline 500 mg QID (or doxy 100 mg BID) x 10-14d

Question 5

Rome Criteria for IBS

Answer 5

• Recurrent AP at least 3d/month for past 3 months with 2 of the following:
  
  • improvement with defecation
  • onset associated with change in freq of stool
  • onset associated with change in appearance of stool

Question 6

IBS Treatment

Answer 6

• All
  
  • FODMAPS diet
  • TCA/SSRI: best evidence for desipramine 50-150 mg QHS
  • peppermint oil
  • probiotics (weak evidence)
  • antispasmodics
  • Buscopan, Dicetel, Bentyl
• IBS-D
  
  • loperamide: 2 mg QID, 45 min before meals (max 16 mg/d)
  • rifaximin: 2 week course if unresponsive to loperamide + antispasmodicst
• IBS-C
  
  • PEG
  • lubiprostone (Amitiza) - for women > 18, not responding to PEG (chloride secretor)
  • linaclotide (Constella) - men & women >18 , not responding to PEG (chloride, bicarb secretor)
  • high-fibre diet (psyllium)