DOCSLIB.ORG

Practice Parameters for the Surgical Treatment of Ulcerative Colitis Howard Ross, M.D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Practice Parameters for the Surgical Treatment of Ulcerative Colitis Howard Ross, M.D PRACTICE PARAMETERS Practice Parameters for the Surgical Treatment of Ulcerative Colitis Howard Ross, M.D. • Scott R. Steele, M.D. • Mika Varma, M.D. • Sharon Dykes, M.D. Robert Cima, M.D. • W. Donald Buie, M.D. • Janice Rafferty, M.D. Prepared by the Standards Practice Task Force of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Surgeons the most common surgical indication for UC. Whether is dedicated to assuring high-quality patient care it is secondary to an inability to control symptoms, poor Tby advancing the science, prevention, and manage- quality of life, risks/side effects of chronic medical therapy ment of disorders and diseases of the colon, rectum, and (especially long-term corticosteroids), noncompliance, or anus. The Standards Committee is composed of Society growth failure, patients may opt for surgery in the elective members who are chosen because they have demonstrat- or semielective setting.3 Complete removal of all the poten- ed expertise in the specialty of colon and rectal surgery. tial disease-bearing tissue is theoretically curative in UC. This Committee was created to lead international efforts Operative options include an abdominal colectomy or total in defining quality care for conditions related to the co- proctocolectomy with either a permanent end ileostomy or lon, rectum, and anus. This is accompanied by develop- surgical construction of a “new” rectum through an IPAA ing Clinical Practice Guidelines based on the best available that restores GI continuity.4,5 All these procedures may evidence. These guidelines are inclusive, and not prescrip- be performed by using open or minimally invasive tech- tive. Their purpose is to provide information on which niques.6,7 Although various treatment options are available decisions can be made, rather than dictate a specific form for UC, this parameter will focus on the surgical manage- of treatment. These guidelines are intended for the use of ment for the patient with UC. all practitioners, health care workers, and patients who desire information about the management of the condi- tions addressed by the topics covered in these guidelines. METHODOLOGY It should be recognized that these guidelines should not These guidelines are built on the last set of the American be deemed inclusive of all proper methods of care or ex- Society of Colon and Rectal Surgeons Practice Parameters clusive of methods of care reasonably directed to obtain- for treatment of UC published in 2005.8 An organized ing the same results. The ultimate judgment regarding the search of Medline, PubMed, and the Cochrane Database of propriety of any specific procedure must be made by the Collected Reviews was performed through July 2013. Key- physician in light of all of the circumstances presented by word combinations included inflammatory bowel disease, the individual patient. ulcerative colitis, ileal pouch-anal anastomosis, ileostomy, proctocolectomy, colorectal neoplasm, surgery, colectomy, ileoproctostomy, immunomodulator, infliximab, steroids, STATEMENT OF THE PROBLEM and related articles. Directed searches of the embedded ref- Ulcerative colitis (UC) is characterized by a chronic inflam- erences from the primary articles also were accomplished. matory condition that affects the rectum and extends prox- The final grade of recommendation was performed using imally into the colon for varying distances. Although many the Grades of Recommendation, Assessment, Develop- patients are treated effectively by a wide variety of medica- ment, and Evaluation (GRADE) system (Table 1).9 tions, approximately 15% to 30% of patients will require or elect operative intervention. Surgical indications vary from INDICATIONS FOR SURGERY acute colitis to malignancy and often have a dramatic im- pact on morbidity, mortality, and quality of life.1,2 Failure Acute Colitis to respond to medical therapy (ie, intractability) remains 1. Patients with clinical evidence of actual or impending Dis Colon Rectum 2014; 57: 5–22 perforation should undergo urgent surgery. Grade of DOI: 10.1097/DCR.0000000000000030 Recommendation: Strong recommendation based on © The ASCRS 2013 moderate-quality evidence, 1B. DISEASES OF THE COLON & RECTUM VOLUME 57: 1 (2014) 5 6 ROSS ET AL: PRACTICE PARAMETERS FOR SURGICAL TREATMENT OF ULCERATIVE COLITIS TABLE 1. The GRADE system-grading recommendations Methodological quality of supporting Description Benefit vs risk and burdens evidence Implications 1A Strong recommendation, Benefits clearly outweigh RCTs without important limitations Strong recommendation, can high- risk and burdens or or overwhelming evidence from apply to most patients in quality evidence vice versa observational studies most circumstances without reservation 1B Strong recommendation, Benefits clearly outweigh RCTs with important limitations Strong recommendation, can moderate-quality risk and burdens or (inconsistent results, apply to most patients in evidence vice versa methodological flaws, indirect or most circumstances without imprecise) or exceptionally strong reservation evidence from observational studies 1C Strong recommendation, Benefits clearly outweigh Observational studies or case series Strong recommendation but may low- or very-low- risk and burdens or change when higher-quality quality evidence vice versa evidence becomes available 2A Weak recommendation, Benefits closely balanced RCTs without important limitations Weak recommendation, best high- with risks and burdens or overwhelming evidence from action may differ depending quality evidence observational studies on circumstances or patients’ or societal values 2B Weak recommendations, Benefits closely balanced RCTs with important limitations Weak recommendation, best moderate-quality with risks and burdens (inconsistent results, action may differ depending evidence methodological flaws, indirect or on circumstances or patients’ or imprecise) or exceptionally strong societal values evidence from observational studies 2C Weak recommendation, Uncertainty in the Observational studies or case series Very weak recommendations; low- or very-low- estimates of benefits, other alternatives may be quality evidence risks and burden; equally reasonable benefits, risk and burden may be closely balanced GRADE = Grades of Recommendation, Assessment, Development, and Evaluation; RCT = randomized controlled trial. Adapted from Guyatt G, Gutermen D, Baumann MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians Task Force. Chest. 2006;129:174–181. Used with permission. The diagnosis of severe colitis is based on the criteria of tual perforation.17,19,20 Likewise, localized peritonitis may Truelove and Witts10 and is defined as colitis with more reflect local inflammation or may be a sign of impend- than 6 bloody stools per day, fever (temperature, >37.5°C), ing perforation.21 Perforation may also occur without di- tachycardia (heart rate, >90 beats per minute), anemia lation; these patients often do not exhibit classic signs of (hemoglobin, <75% of normal), and elevated sedimen- peritonitis.16 tation rate (>30 mm/h).11 Toxic or fulminant colitis is The development of multisystem organ failure characterized by more than 10 bloody stools per day, fe- (MSOF) is an ominous sign. In a series of 180 patients ver (>37.5°C), tachycardia (>90 beats per minute), ane- with toxic colitis, 11 (6%) developed MSOF. The overall mia requiring transfusion, elevated sedimentation rate mortality in the entire group was 6.7%; however, of the 12 (>30 mm), colonic dilation on radiography, and abdomi- patient deaths, 8 occurred in patients with MSOF.22 nal distention with tenderness.11 When the colonic disten- 2. For patients with moderate to severe colitis, early tion of the transverse colon exceeds 6 cm, the diagnosis surgical consultation should be obtained. Grade of becomes toxic megacolon.12,13 Surgery is required in 20% to Recommendation: Strong recommendation based on 30% of patients with toxic colitis, and typically consists of low-quality evidence, 1C. a subtotal colectomy with end ileostomy. 14,15 Perforation in patients with toxic colitis is associ- Although most physicians agree that an urgent surgical ated with a high mortality rate (27%–57%), regardless consultation should be obtained in patients with sepsis of whether the perforation is contained or free.16,17 The or fulminant/toxic colitis, there is no high-quality litera- mortality rate also increases as the time interval between ture depicting the appropriate timing for surgical consul- perforation and surgery increases.16,18 Signs of impending tation in patients with a lesser degree of disease. Recent perforation may be masked by ongoing medical therapy. consensus statements from surgical and gastroenterology Persistent or increasing colonic dilation, pneumatosis experts have suggested that a failure of primary therapy or coli, worsening local peritonitis, and the development of those patients being considered for monoclonal antibody multiple organ failure can be signs of impending or ac- or cyclosporine therapy warrant surgical consultation.23 It DISEASES OF THE COLON & RECTUM VOLUME 57: 1 (2014) 7 is important to keep in mind that, even in those patients poorly to medical therapy and are at increased risk for the who have a good initial response to medical therapy, the development of megacolon.47 Prolonged observation of eventual need for colectomy ranges from 20% to 80%.24–27 these patients
Load more

Recommended publications
  • Topical Budesonide for Treating Giant Rectal Pseudopolyposis
    ANTICANCER RESEARCH 25: 2961-2964 (2005) Topical Budesonide for Treating Giant Rectal Pseudopolyposis CHARALAMPOS PILICHOS1, ATHENA PREZA1, MARIA DEMONAKOU2, DIMITRIOS KAPATSORIS1 and CONSTANTINOS BOURAS1 1First Department of Internal Medicine and 2Department of Pathology, Sismanogleion Hospital, Athens, Greece Abstract. Pseudopolyps are a frequent finding in the course of Case Report inflammatory bowel disease. They are non-neoplastic lesions resulting from a regenerative and healing process that leaves A 45-year-old male patient was admitted to our service in July inflamed colonic mucosa in polypoid configuration. Data about 2002 for acute rectal bleeding. All laboratory tests were their management is lacking. "Giant" pseudopolyps can be normal, except an increase of aminotransferases level (>10 N) mistaken for adenocarcinomas and, as they rarely regress with and a serological profile consistent with acute hepatitis B or a medical management alone, a surgical resection is often required. flare of chronic hepatitis B (HbsAg +, HbsAb –, HbeAg –, A case of giant pseudopolyposis treated non-surgically, in a patient HbeAb +, HbcAb-IgM +). The patient underwent lower with concomitant ulcerative colitis and chronic hepatitis B, is gastro-intestinal endoscopy and multiple biopsies were taken reported, representing a co-morbidity complicating an eventual from a bulky rectal mass lesion (Figure 1). Histological study conservative treatment. The clinical implementation of topical revealed alterations compatible with inflammatory bowel budesonide was originally tested, resulting in clinical, endoscopic disease (IBD) with no dysplasia (Figure 2). Because of the and histological remission. Budesonide seems a promising therapy atypical macroscopic features and the high suspicion of rectal for IBD, particularly when a comorbidity with viral hepatitis exist.
    [Show full text]
  • 8-GI Drugs Final
    Gastrointestinal Drugs Subcommittee: Prozialeck, Walter (Chair) [email protected] Escher, Emanuel [email protected] Garrison, James C. [email protected] Henry, Matthew, [email protected] Weber, Donna R [email protected] Recommended Curriculum Equivalent: 1.5 h Acid Reducers and Drugs for the Treatment of Peptic Ulcer Disease Proton pump inhibitors First generation Second generation OMEPRAZOLE ESOMEPRAZOLE LANSOPRAZOLE PANTOPRAZOLE RABEPRAZOLE Learning Objectives Physiology and pathophysiology Describe the synthesis and mechanism of H+ secretion by the parietal cells Mechanism of action Describe the mechanism of action of proton pump inhibitors and why they are selective for the parietal cell proton pump. Actions on organ systems Describe the pharmacological effects of the drugs on gastric function. Are there effects on other organ systems? Pharmacokinetics Describe the pharmacokinetics of proton pump inhibitors? Are there significant differences among the different drugs in this class? Adverse effects, drug interactions and contraindications Describe the principal adverse effects of proton pump inhibitors. Describe the clinically important drug interactions of proton pump inhibitors. Describe the principal contraindications of proton pump inhibitors. Therapeutic uses Describe the current therapeutic uses of proton pump inhibitors. 1 Clinical Pharmacology Omeprazole is perceived to be the most potent of this drug class in inhibiting CYP2C19 activity and is proposed to have potential drug interactions with other drugs metabolized by this P450 isoform. Concern has been raised about potential inhibition of clopidogrel activation in patients taking both drugs concurrently. Current consensus is that in such patients clopidogrel with pantoprazole may be a safer choice to reduce the probability of a drug interaction involving CYP2C19.
    [Show full text]
  • European Evidence Based Consensus on Surgery for Ulcerative Colitis Tom Øresland*, Willem A
    Journal of Crohn’s and Colitis, 2015, 4–25 doi:10.1016/j.crohns.2014.08.012 ECCO Guidelines/Consensus Paper ECCO Guidelines/Consensus Paper European evidence based consensus on surgery for ulcerative colitis Tom Øresland*, Willem A. Bemelman, Gianluca M. Sampietro, Antonino Spinelli, Alastair Windsor, Marc Ferrante, Philippe Marteau, Oded Zmora, Paulo Gustavo Kotze, Eloy Espin-Basany, Emmanuel Tiret, Giuseppe Sica, Yves Panis, Arne E. Faerden, Livia Biancone, Imerio Angriman, Zuzana Serclova, Anthony de Buck van Overstraeten, Paolo Gionchetti, Laurents Stassen, Janindra Warusavitarne Michel Adamina, Axel Dignass, Rami Eliakim, Fernando Magro, André D’Hoore, On behalf of the European Crohn's and Colitis Organisation (ECCO) Received July 14 2014; revised August 23 2014; accepted August 27 2014. ⁎Corresponding author at: Clinic for Surgical Sciences, Univ. of Oslo at Dept. of Digestive Surgery, Akershus Univ. Hospital, 1478 Lorenskog, Norway. Keywords: ulcerative colitis; surgery; ileal pouch-anal anastomosis; cancer 1. Introduction and also for all national representatives of ECCO for the second vot- ing procedure. The WGs finally met in Belgrade on September 25th The goal of this consensus initiated by the European Crohn's and 2013 for a final face-to-face discussion and to vote and consent on Colitis Organisation (ECCO) was to establish European consensus the statements. Technically this was done by projecting the statements guidelines for the surgical treatment of ulcerative colitis. The strategy and revising them on screen until a consensus was reached. Consensus to reach the consensus involved several steps and follows the standard was defined as agreement by more than 80% of participants, termed a operating procedures for consensus guidelines of ECCO.
    [Show full text]
  • Malta Medicines List April 08
    Defined Daily Doses Pharmacological Dispensing Active Ingredients Trade Name Dosage strength Dosage form ATC Code Comments (WHO) Classification Class Glucobay 50 50mg Alpha Glucosidase Inhibitor - Blood Acarbose Tablet 300mg A10BF01 PoM Glucose Lowering Glucobay 100 100mg Medicine Rantudil® Forte 60mg Capsule hard Anti-inflammatory and Acemetacine 0.12g anti rheumatic, non M01AB11 PoM steroidal Rantudil® Retard 90mg Slow release capsule Carbonic Anhydrase Inhibitor - Acetazolamide Diamox 250mg Tablet 750mg S01EC01 PoM Antiglaucoma Preparation Parasympatho- Powder and solvent for solution for mimetic - Acetylcholine Chloride Miovisin® 10mg/ml Refer to PIL S01EB09 PoM eye irrigation Antiglaucoma Preparation Acetylcysteine 200mg/ml Concentrate for solution for Acetylcysteine 200mg/ml Refer to PIL Antidote PoM Injection injection V03AB23 Zovirax™ Suspension 200mg/5ml Oral suspension Aciclovir Medovir 200 200mg Tablet Virucid 200 Zovirax® 200mg Dispersible film-coated tablets 4g Antiviral J05AB01 PoM Zovirax® 800mg Aciclovir Medovir 800 800mg Tablet Aciclovir Virucid 800 Virucid 400 400mg Tablet Aciclovir Merck 250mg Powder for solution for inj Immunovir® Zovirax® Cream PoM PoM Numark Cold Sore Cream 5% w/w (5g/100g)Cream Refer to PIL Antiviral D06BB03 Vitasorb Cold Sore OTC Cream Medovir PoM Neotigason® 10mg Acitretin Capsule 35mg Retinoid - Antipsoriatic D05BB02 PoM Neotigason® 25mg Acrivastine Benadryl® Allergy Relief 8mg Capsule 24mg Antihistamine R06AX18 OTC Carbomix 81.3%w/w Granules for oral suspension Antidiarrhoeal and Activated Charcoal
    [Show full text]
  • Appendix 1 – Protocol for Preventing Or Reversing Chronic Disease The
    Appendix 1 – Protocol for Preventing or Reversing Chronic Disease The first author has developed a protocol over the past decade for preventing or reversing chronic disease based on the following systemic medical principle: “at the present time, removal of cause is a necessary, but not necessarily sufficient, condition for restorative treatment to be effective”[1]. The protocol methodology refines the age-old principles of both reducing harm in addition to providing treatment, and allows better identification of factors that contribute to the disease process (so that they may be eliminated if possible). These contributing factors are expansive and may include a combination of Lifestyle choices (diet, exercise, smoking), iatrogenic and biotoxin exposures, environmental/occupational exposures, and psychosocial stressors. This strategy exploits the existing literature to identify patterns of biologic response using biomarkers from various modalities of diagnostic testing to capture a much broader list of potential contributing factors. Existing inflammatory bowel diseases (IBD) Biomarker Identification to Remove Contributing Factors and Implement Treatment The initial protocol steps are diagnostic. The main output of these diagnostics will be identification of the biomarker levels and symptoms that reflect abnormalities, and the directions of change required to eliminate these abnormalities. In the present study, hundreds of general and specific biomarkers and symptoms were identified from the core IBD literature. The highest frequency (based on numbers of record appearances) biomarkers and symptoms were extracted, and are listed in Table 1 (highest frequency items first, reading down each column before proceeding to the next column). They are not necessarily consensus biomarkers. They are biomarkers whose values were altered by a treatment or contributing factor, and reported in the core IBD literature.
    [Show full text]
  • Estonian Statistics on Medicines 2016 1/41
    Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole
    [Show full text]
  • Malta Medicines List 25 7 07
    Defined Daily Doses Pharmacological Dispensing Active Ingredients Trade Name Dosage strength Dosage form ATC Code Comments (WHO) Classification Class Glucobay 50 50mg Alpha Glucosidase Inhibitor - Blood Acarbose Tablet 300mg A10BF01 PoM Glucose Lowering Glucobay 100 100mg Medicine Carbonic Anhydrase Inhibitor - Acetazolamide Diamox 250mg Tablet 750mg S01EC01 PoM Antiglaucoma Preparation Parasympatho- Powder and solvent for solution for mimetic - Acetylcholine Chloride Miovisin® 10mg/ml Refer to PIL S01EB09 PoM eye irrigation Antiglaucoma Preparation Zovirax™ Suspension 200mg/5ml Oral suspension Medovir 200 200mg Tablet Virucid 200 Zovirax® 200mg Dispersible film-coated tablets 4gAntiviral J05AB01 PoM Zovirax® 800mg Aciclovir Aciclovir Medovir 800 800mg Tablet Virucid 800 Virucid 400 400mg Tablet Zovirax® Cream 5% w/w Cream Refer to PIL Antiviral D06BB03 PoM Medovir Zovirax® Eye Ointment 3% w/w Eye ointment Refer to PIL Antiviral S01AD03 PoM Neotigason® 10mg Retinoid - Acitretin Capsule 35mg D05BB02 PoM Neotigason® 25mg Antipsoriatic Acrivastine Benadryl® Allergy Relief 8mg Capsule 24mg Antihistamine R06AX18 OTC Antidiarrhoeal and Activated Charcoal Biocarbon® 0.25g Tablet 5g A07BA01 OTC Antiflatulent Dentinox® Infant Colic 42mg/ml Oral suspension Drops Antifoaming agent - Activated Dimethicone Aero-OM® 100mg/ml Oral drops emulsion Refer to PILPreparation for colic A02X OTC or wind pain Aero-OM® 40mg Tablet Activated dimeticone, Antacid and Asilone Antacid Tablets 270mg 500mg Tablet Refer to PIL A02AB10 OTC Dried aluminium hydroxide Antiflatulent
    [Show full text]
  • With Thanks & Gratitude
    WITH THANKS & GRATITUDE Th is patient guide was made possible thanks to a donation by the Tabor Family in loving memory their daughter, sister and friend, Tracy Tabor Finstad. CONTENTS ..................................................................................................................1 WELCOME! Welcome Letter ...............................................................................................................3 Important Th ings to Know Up Front ...............................................................................4 Meet Your Crohn’s & Colitis Team ................................................................................6 HOW TO CONTACT US IBD Clinic Schedule .......................................................................................................9 Physician and Nurse Contact Information ....................................................................10 Appointment Scheduling and Other Contact Information ............................................11 THE BASICS OF IBD Basic Information about Infl ammatory Bowel Disease (IBD) ........................................12 Frequently Asked Questions about Infl ammatory Bowel Disease (IBD ..........................15 20 Questions to Ask Your Doctor about Infl ammatory Bowel Disease (IBD) ...............17 TESTING IN IBD Colonoscopy and Flexible Sigmoidoscopy ......................................................................18 Upper Endoscopy ..........................................................................................................19
    [Show full text]
  • 1010 5Th Ave New York, New York 10028 Mount Sinai Medical Center 1
    JOEL J. BAUER, MD CURRICULUM VITAE NAME: Joel J. Bauer, MD 2nd PLLC ADDRESS: 1010 5th Ave New York, New York 10028 Mount Sinai Medical Center 1 Gustave Levy Place, Box 1259 New York, NY 10029 TELEPHONE: (646)-859-1400 CITIZENSHIP: USA EDUCATION: Bachelor of Arts, cum laude 1963 University of Vermont Doctor of Medicine 1967 New York University Medical School POSTDOCTORAL TRAINING: Intern in Surgery 1967-68 The Mount Sinai Hospital New York, NY Resident in Surgery 1968-72 The Mount Sinai Hospital New York, NY Chief Resident in Surgery 1972-73 The Mount Sinai Hospital New York, NY General Surgeon 1973-74 US Air Force, Rickenbacker Air Force Base Chief of Surgery 1974-75 US Air Force, Rickenbacker Air Force Base CERTIFICATION: American Board of Surgery Certificate 20025 April 1, 1974 LICENSURE: New York 102125 HONORS: Kidder Award, 1963 (Senior, First in Scholarship, Leadership & Character) Phi Beta Kappa, 1963 President, Boulder Society, 1963 “Best Doctors in New York” New York Magazine, 1998-00, 2004- 2008 “Top 100 Doctors: Minimally Invasive” New York Magazine, 2002 “One Thousand Great Americans” International Biographical Centre “The Lifetime of Achievement One Hundred” IBC, 2003 “America’s Top Doctors” Castle Connolly, 2001, 2003-2008 “Guide to America’s Top Surgeons” Castle Connolly, 2003-2004, 2006, 2008 “America’s Top Surgeons”, by the Consumer Research Council of America, 2002, 2003, 2008, 2010, 2014, 2015 1 JOEL J. BAUER, MD “Top Doctors: New York Metro Area” Castle Connolly American Biographical Society, 2005 Robert Paradny Award
    [Show full text]
  • 1. Gastro-Intestinal System
    1 1. Gastro-intestinal system Also see Appendix 1B Guidance on Management of Dyspepsia http://www.fifeadtc.scot.nhs.uk/formulary/1-gastro-intestinal/appendix-1b-management-of- dyspepsia.aspx Also see SIGN 68 – Dyspepsia, March 2003 www.sign.ac.uk/guidelines/fulltext/68/index.html. Also see NICE CG17 - Dyspepsia – Management of Dyspepsia in Adults in Primary Care, August 2004 http://www.nice.org.uk/guidance/CG17 1.1 - Dyspepsia and gastro-oesophageal reflux disease 1.1.1 Antacids and simeticone Aluminium- and magnesium-containing antacids Co-magaldrox (Mucogel®) Simeticone alone Infacol® Prescribing Points Lifestyle changes are often required, such as raising the head of the bed, weight reduction, reduction of alcohol, smoking cessation and avoidance of aggravating foods. Antacids are suitable for mild indigestion and reflux. A mixture of aluminium hydroxide and magnesium hydroxide balances the tendency of aluminium to constipate against that of magnesium to cause diarrhoea. Liquid preparations are normally more effective than tablets and quicker acting. Antacids, taken at the same time as other drugs, may impair their absorption. They may also damage enteric coatings designed to prevent irritant drugs from dissolving in the stomach Mucogel® has a low Na+ content (less than 1mmol of Na+ per tablet/10ml) and is sugar-free. There is no evidence that simeticone containing products like Infacol® are any more effective than placebo in reducing colic episodes. An unlicensed mixture containing antacid + oxetacaine (previously marketed as Mucaine®) is approved for use in patients presenting with mucositis after treatment with radiotherapy. 1.1.2 Compound alginates and proprietary indigestion preparations 1st Choice Acidex® 2nd Choice Gaviscon Advance® Child Gaviscon Infant® sachets Prescribing Points Compound alginate preparations contain multiple ingredients; prescribe by brand name to avoid any confusion.
    [Show full text]
  • Alphabetical Listing of ATC Drugs & Codes
    Alphabetical Listing of ATC drugs & codes. Introduction This file is an alphabetical listing of ATC codes as supplied to us in November 1999. It is supplied free as a service to those who care about good medicine use by mSupply support. To get an overview of the ATC system, use the “ATC categories.pdf” document also alvailable from www.msupply.org.nz Thanks to the WHO collaborating centre for Drug Statistics & Methodology, Norway, for supplying the raw data. I have intentionally supplied these files as PDFs so that they are not quite so easily manipulated and redistributed. I am told there is no copyright on the files, but it still seems polite to ask before using other people’s work, so please contact <[email protected]> for permission before asking us for text files. mSupply support also distributes mSupply software for inventory control, which has an inbuilt system for reporting on medicine usage using the ATC system You can download a full working version from www.msupply.org.nz Craig Drown, mSupply Support <[email protected]> April 2000 A (2-benzhydryloxyethyl)diethyl-methylammonium iodide A03AB16 0.3 g O 2-(4-chlorphenoxy)-ethanol D01AE06 4-dimethylaminophenol V03AB27 Abciximab B01AC13 25 mg P Absorbable gelatin sponge B02BC01 Acadesine C01EB13 Acamprosate V03AA03 2 g O Acarbose A10BF01 0.3 g O Acebutolol C07AB04 0.4 g O,P Acebutolol and thiazides C07BB04 Aceclidine S01EB08 Aceclidine, combinations S01EB58 Aceclofenac M01AB16 0.2 g O Acefylline piperazine R03DA09 Acemetacin M01AB11 Acenocoumarol B01AA07 5 mg O Acepromazine N05AA04
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 7438,929 B2 Beckert Et Al
    US007438929B2 (12) United States Patent (10) Patent No.: US 7438,929 B2 Beckert et al. (45) Date of Patent: *Oct. 21, 2008 (54) MULTI-PARTICULATE FORM OF (56) References Cited MEDICAMENT, COMPRISING AT LEAST U.S. PATENT DOCUMENTS TWO DIFFERENTLY COATED FORMS OF PELLET 4,600,577 A 7/1986 Didriksen 4,720,387 A 1/1988 Sakamoto et al. (75) Inventors: Thomas Beckert, Warthausen (DE): 6,897.205 B2 * 5/2005 Beckert et al. .............. 514f159 Hans-Ulrich Petereit, Darmstadt (DE): Jennifer Dressman, Frankfurt (DE); Markus Rudolph, Neu-Isenburg (DE) OTHER PUBLICATIONS (73) Assignee: Roehm GmbH & Co. KG, Darmstadt Schmidt, C., "A Multiparticulate Drug-delivery System Based on (DE) Pellets Incorporated into Congealable Polyethylene Glycol Carrier (*) Notice: Subject to any disclaimer, the term of this Materials'. International Journal of Pharmaceutics 216 (2001) 9-16, patent is extended or adjusted under 35 Elsevier. U.S.C. 154(b) by 614 days. * cited by examiner This patent is Subject to a terminal dis claimer. Primary Examiner Johann Richter Assistant Examiner Danielle Sullivan (21) Appl. No.: 10/949,323 (74) Attorney, Agent, or Firm Oblon, Spivak, McClelland, (22) Filed: Sep. 27, 2004 Maier & Neustadt, P.C. (65) Prior Publication Data (57) ABSTRACT US 2005/OO53660 A1 Mar. 10, 2005 The invention relates to a multiparticulate drug form suitable Related U.S. Application Data for uniform release of an active pharmaceutical ingredient in the Small intestine and in the large intestine, comprising at (63) Continuation of application No. 10/239.209, filed as least two forms of pellets A and B which comprise an active application No.
    [Show full text]