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GI Assessment and Treatment GI Assessment and Treatment Dr. Paul S. Anderson ConsultDrA Webinar © PS Anderson and www.ConsultDrA.com 2020 (c) PS Anderson - www.ConsultDrA.com 2020 1 CE Accreditation Note: ALL of these webinars will have AANP CE Accreditation. • The certificate at the end (last slide) will have the total and Pharm hours. • The AANP Accreditation has applied for ALL US States to date. • All webinars for the past 12 months have active AANP CE (for example this is 02-2020 so 03-2019 through this webinar are all active). • Past webinars will be re-accredited based on their viewership due to the high cost of re-accreditation of all the webinars. WE WILL DENOTE THIS ON THE WEBSITE AS WE RE-ACCREDIT WEBINARS. (c) PS Anderson - www.ConsultDrA.com 2020 2 Conflict of interest: • None –I have no financial connection to ANY lab, product or company mentioned –Specific products (IF mentioned) are examples of items I use commonly in practice • © Images will be credited. If no credit given, they are (a) mine or (b) in the public domain (c) PS Anderson - www.ConsultDrA.com 2020 3 Next Webinars All are Tuesday PM – 5:30 – 7:00 PM Pacific Time NOTE – All are third Tuesday of the month unless noted “*” 08-04-2020: IM/SQ Injection Update *08-17-2020 Mon: Toxins, Immune Function and Cancer 09-15-2020: 10-20-2020 (c) PS Anderson - www.ConsultDrA.com 2020 4 Past Webinars Available 19. Autoimmunity-2: Management 1. EBV diagnosis and Treatment 36. Organic Acid Testing 57. Benzodiazepine Rx and 2. Histamine – CNS 20. Chronic Infections – Testing, Management assessment and re-assessment 37. Migraine 3. Cortisol 38. PCOS 58. Anti-ID Rx Pharmacology 21. Lyme Illness – A top down approach 4. Iodine & T3 39. Fluoroquinolone Toxicity 5. Biofilms (#1) 22. Chronic Infection Bundle 40. GI Absorption and Rx 59. Eclectic and Low Dose Botanicals 6. Desiccated Thyroid 23. Oral Chelation 41. Dysautonomia and EDS 60. Natural Medicines for Chronic 7. Autoimmunity 24. Pain Medication Weaning 42. Low Dose Immunotherapy Infections 8. Histamine – Peripheral 43. Detox of Unusual Metals 25. Assessment of Chronic Cases 9. Mitochondria 44. NAD 61. Metabolic Toxins 10. ReDox and Inflammation 26. Nutrigenomic basics 45. Lab testing for B6, B12 and Folates 62. Adrenal Assessment and 11. IV and Injection Q&A 27. IV Therapy Q&A and Latest Updates 46. Acute Use of Thyroid and Adrenal-Rx Therapeutics: Clinical Diagnosis 12. Sulfation Pathways 28. ADHD Medications and Weaning 47. Assessing the Complex Patient and Management 13. Antidepressant Rx and Taper 48. Optimizing 21st Century 14. Pediatric Rx and dose 29. Seizure Medications and Weaning ND/Integrative Medicine 63. Red Flags and Critical Diagnoses adjustment 30. Low Dose Naltrexone – 49. Nasal & Respiratory Therapies 64. COVID-19 Updates 15. Renal Rx and Dose pharmacology, uses and cases 50. USP-FDA 2019 Update adjustments 31. Medical Cannabinoids 51. Bipolar Medications 65. Managing Comorbidities in 16. Biofilms #2 52. HBOT-2 Cancer and Neuro Chronic Illness 17. Cardiac Rx dosing and tapering 32. Neurological Inflammatory Therapies 53. Neuro-AI Part-1 18. Steroids and Respiratory Med’s 33. Food Allergy and Sensitivity 66. Repurposed Drugs in Oncology 54. Neuro AI Part-2 34. Hyperbaric Oxygen Therapies 55. Interrelationships in Chr-Dz 67. Immunology: Clinician Update 35. Kidney and Liver Functions – Effect 56. Neuro Manifest. Chron. Illness on Rx and Labs 68. Controversies in Oncology 69. Natural Immunologic Agents (c) PS Anderson - www.ConsultDrA.com 2020 5 A quick note: If you are “reading the slides” only you’ll miss a lot as most of what I attempt to transmit is done verbally (the slides are a prop to keep me on track and(c) PS toAnderson -tell www.ConsultDrA.com stories 2020 that 6 illustrate my points (I mean, please do read the slides as sometimes there are things on there that I don’t say – but know that the audio is more than 50% of the presentation.) (c) PS Anderson - www.ConsultDrA.com 2020 7 Abstract The gastrointestinal tract is often considered to be of paramount importance in long term health and disease prevention. “Treat the gut first” is common advice given and for good reason. In this CE Dr. Anderson will contrast normal GI function with how that function breaks down and the disorders associated with it. Natural and Pharmacological therapeutics will be discussed. (c) PS Anderson - www.ConsultDrA.com 2020 8 Outline I. Key Concepts in GI Function II. GI Testing III. GI Pharmacology IV. Concepts in Correcting Imbalances V. Therapeutics (c) PS Anderson - www.ConsultDrA.com 2020 9 Key concepts in GI function (c) PS Anderson - www.ConsultDrA.com 2020 10 GI TRACT : STRUCTURE Mucosa and Smooth muscle (operated by autonomic and local signals) with differing functions throughout the GI tract 1. Digestion 2. Absorption 3. Metabolism 4. Immunity (c) PS Anderson - www.ConsultDrA.com 2020 11 GI TRACT : INNERVATION (And – why is this important?) • EXTRINSIC INNERVATION – Parasympathetic NS • Excitatory • Carried by Vagus and Pelvic Splanchnic nerves – Sympathetic NS • Inhibitory • Carried by prevertebral ganglia (T-8 – L-2) • INTRINSIC INNERVATION – AKA: Enteric Nervous System (Local reflexes) – Two Plexi: • Myenteric (Auerbach’s) Plexus: MOTILITY • Submucosal (Meissner’s) Plexus: SECRETION & BLOOD FLOW. (c) PS Anderson - www.ConsultDrA.com 2020 12 GI Regulation (Or: The orchestration of digestion) • Stomach: – Histamine: [Stimulates Gastric H+] – G cells = Gastrin: [Stim. H+ and Gastr.Mucosa] • (+) Amino Acids; St. Distention; Vagal (parasymp). • (-) Gastric Acid; Secretin; GIP • Duodenum / Jejunum: – I cells = CCK: [Stim GB contraction and Oddi Relaxation; Panc Enz and Bicarb. secretion – Inhibits Gastric Emptying]. • (+) Amino Acids, Fatty Acids – S cells = Secretin: [Stim Panc. And GB Bicarb. Secretion – Inhibits Gastric Emptying]. • (+) H+ and Fatty Acids in the Duodenum – GIP: [Stim Insulin Secretion – Inhibits Gastric Acid Secretion]. • (+) Oral Glucose, Amino Acids and Fatty Acids (c) PS Anderson - www.ConsultDrA.com 2020 13 GI Testing (c) PS Anderson - www.ConsultDrA.com 2020 14 Just Talking Points: • Food allergy: – See webinar noted below. Consider the MOA being tested always. • Don’t forget stool metals assessment: – What does this tell us? • Why O&P suck – What if O&P does find something??? • Nothing is perfect: – Combine micro / PCR / Culture etc. for best yield. (c) PS Anderson - www.ConsultDrA.com 2020 15 Miscellaneous Lab Thoughts: • IgA ideas –IgA elevation only? • Implications of resistant H. pylori and ASO (c) PS Anderson - www.ConsultDrA.com 2020 16 Digestive System Drugs (c) PS Anderson - www.ConsultDrA.com 2020 17 H2 Blockers MOA Uses Adverse Effects Other Cimetidine H-2 Blocade: Blockshistamine PUD, GERD Small chemical so can Causes P450 [Tagamet] from activating cAMP pathway IN cross the BBB, think of system to PARIETAL CELLS (and antihistamine side effects accelerate THEN elsewhere). Also decreased libido, decelerate; impotence and Contraindicated with gynecomastia kidney or liver failure Ranitidine H-2 Blocade: Less CNS and sexual Less inhibition of [Zantac] effects than Cimetidine P450 system Etc… (c) PS Anderson - www.ConsultDrA.com 2020 18 Proton Pump MOA Uses Adverse Effects Other Inhibitors Omeprazole Block proton pump to inhibit PUD, Headache, diarrhea, Interact with (Prilosec) H+, K+ and ATPase and GERD abdominal pain, drugs that blocks the formation of nausea, require low Lansoprazole gastric acid vomiting, gastric pH for (Prevacid) constipation, absorption flatulence, Rabeprazole URI, (Aciphex) rash Pantoprazole (Protonix) Esomeprazole (Nexium) (c) PS Anderson - www.ConsultDrA.com 2020 19 FDA - Safety Announcement • [3-2-2011] The U.S. Food and Drug Administration (FDA) is informing the public that prescription proton pump inhibitor (PPI) drugs may cause low serum magnesium levels (hypomagnesemia) if taken for prolonged periods of time (in most cases, longer than one year). – In approximately one-quarter of the cases reviewed, magnesium supplementation alone did not improve low serum magnesium levels and the PPI had to be discontinued. • [02-08-2012] The U.S. Food and Drug Administration (FDA) is informing the public that the use of stomach acid drugs known as proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile– associated diarrhea (CDAD). A diagnosis of CDAD should be considered for patients taking PPIs who develop diarrhea that does not improve. (c) PS Anderson - www.ConsultDrA.com 2020 20 https://medicine.uiowa.edu/iowaprotocols/proton-pump-inhibitor- side-effects-ppi-considerations [04-27-2019] Proton Pump Inhibitor Side Effects PPI Considerations… 2016 Schoenfeld and Grady classified adverse effects: • Kidney Disease • Hypomagnesemia • Infections / Cardivascular Events • Fractures • And to this scheme additional sections on malignant change, B12 absorption, and dementia are added. *** The link above has an excellent database. (c) PS Anderson - www.ConsultDrA.com 2020 21 They do fine ON acid blockers (or even the triple GI healing formula) and Sx return when off them? • Every case I have seen there is another reason for the “fire”: – H. pylori or other infection – Food allergy or sensitivity – Gastric or maybe other cancer – Occasionally sneaky hypothyroid states… • Your work up and treatment combined with the patient compliance is the only thing that can change this. (c) PS Anderson - www.ConsultDrA.com 2020 22 Miscellaneous MOA Uses Adverse Effects Other Metoclopramide Stimulates motility of GERD, pre-op Diarrhea, Extrapyramidal [Reglan] upper
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