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For Patients
Please Note: This is intended only as medical education and is NOT intended to be medical advice. I have included resources to learn more linked with each topic.
Preparing For Your GI VisitAre you having GI issues? Have you scheduled an appt with a GI doctor? What can you expect?
GI doctors can help with many symptoms like heartburn/acid reflux, pain, nausea and vomiting, diarrhea, unexplained weight loss, and more. Leading up to your appointment, it may be helpful to keep a diary of your symptoms to help you better understand them and characterize them for your doctor. Like your triggers, remedies, and times of symptoms. Ask yourself questions like; if eating affects your symptoms, is it eating any foods or just certain foods? Keeping track of what you ate on the worst days can be very helpful too. Do not get discouraged if your doctor does not know exactly what is wrong after one visit. It is common to need additional tests, especially in GI, before finding a diagnosis. If you’ve HAD previous tests, having those available to your doctor can be very helpful and save a lot of time and energy. Something else to keep in mind: if you do not get along with your doctor or feel like they are not understanding your concerns, you can always seek another opinion to try and find a doctor that works well with you. |
GI Pearls of WisdomThis is not medical advice but rather interesting information I have learned in my fellowship. It is only intended to educate. Talk to your doctor if you have questions about any of this information.
PPIs (or proton pump inhibitors) usually work best if you take them 30 minutes before your first meal of the day. Please do not alter how you take any of your prescribed medicines without talking to your doctor. If you have a family member who has a family history of colon cancer, your recommended age for your first colonoscopy will often be different than for the average American. Talk to your doctor if you think this applies to you. For many GI symptoms, your GI doctor will often first look to see if any of your other medicines could be causing your symptoms. Constipation, trouble swallowing, nausea are all common medication side effects. Severe heartburn is commonly related to behaviors. It is triggered by intake of chocolate, caffeine, alcohol, cigarettes, spicy foods, sugary drinks, and citrus. Laying down within 3 hours of eating also commonly triggers heartburn. |
For Providers
Please Note: This is intended only as medical education and is NOT intended to be medical advice. I have included resources to learn more linked with each topic.
GI Pearls of Wisdom
Docusate is a commonly used stool softener but multiple randomized control trials performed from 1970-present show no difference in bowel movements compared to taking a placebo. Click here for an RCT showing no difference in stool habits/quality between docusate and senna versus placebo and senna.
Ondansetron can be a great medication for nausea but it often causes constipation, making it not an ideal therapy for patients who suffer from both. Ginger has been demonstrated effective for treatment of nausea in pregnancy and chemotherapy induced nausea and I have used it anecdotally in fellowship for nausea of unclear origin, with success.
In many, many cases, unexplained GI symptoms can be related to medications. Eliminating unneeded medications that have side effects of constipation, nausea, or trouble swallowing can often be effective in patients suffering from those symptoms (rather than simply adding new meds to treat the symptoms). Before escalating PPI dosing, ask your patients how they are taking the medicine. PPIs work best if taken 30 minutes prior to the first meal of the day. Learn more in the ACG guideline for GERD.
If a patient needs treatment for an H. Pylori infection, ask them if they have ever been treated with a macrolide (for any kind of prior infection). If yes, then their H. Pylori treatment regiment should not include clarithromycin. See the full ACG guideline to learn more.
Docusate is a commonly used stool softener but multiple randomized control trials performed from 1970-present show no difference in bowel movements compared to taking a placebo. Click here for an RCT showing no difference in stool habits/quality between docusate and senna versus placebo and senna.
Ondansetron can be a great medication for nausea but it often causes constipation, making it not an ideal therapy for patients who suffer from both. Ginger has been demonstrated effective for treatment of nausea in pregnancy and chemotherapy induced nausea and I have used it anecdotally in fellowship for nausea of unclear origin, with success.
In many, many cases, unexplained GI symptoms can be related to medications. Eliminating unneeded medications that have side effects of constipation, nausea, or trouble swallowing can often be effective in patients suffering from those symptoms (rather than simply adding new meds to treat the symptoms). Before escalating PPI dosing, ask your patients how they are taking the medicine. PPIs work best if taken 30 minutes prior to the first meal of the day. Learn more in the ACG guideline for GERD.
If a patient needs treatment for an H. Pylori infection, ask them if they have ever been treated with a macrolide (for any kind of prior infection). If yes, then their H. Pylori treatment regiment should not include clarithromycin. See the full ACG guideline to learn more.
Resources For Reference
Please note: this is intended only as medical education and is NOT intended to be medical advice.
ACG has many easy to understand guidelines (from Celiac disease diagnosis, to management of Cdiff, and beyond) that can be really helpful for any providers, GI or otherwise. Many of the guidelines include great flow charts and algorithms for diagnosis and treatment of common GI conditions. For liver conditions, AASLD has a series of guidelines that can be great for any provider to look through. They can help you understand a condition better, see how to start a workup before referral, and even initiate first steps in treatment if patients are resistant to see a specialist or if a specialist is not readily available. Curious about probiotics? This article has great information reviewing our current understanding and relevant studies. It notes that some studies have shown improvement in IBS symptoms with probiotics. Of note, currently the ACG does not recommend routine probiotic use in treatment of IBS . In general, more data is needed, on both safety and effectiveness. This is a great article on potential PPI long-term effects from a pharmacist that includes plenty of great references to learn more. |