Cologuard -

Cologuard -

Cologuard Where It Fits In Cologuard Screening test for colorectal cancer FIT-DNA : composite

of tests :(1) hemoglobin (2) molecular assays for DNA mutations (3) methylation biomarkers Colorectal

Neoplasms DNA shed into stool may reveal genetic mutations (KRAS) and epigenetic changes Test Procedure

Patient collects a stool sample in a special collection kit No dietary or medication restrictions Kit mailed back in 72 hours or less Repeat testing every 3 years (if negative) If positive, refer for colonoscopy Who is a Candidate?

Average risk patients Should not be used if: (1) history of colonic adenomas or cancer (2) history of IBD (3) family history of colon cancer/ Lynch Syndrome/FAP

Effectiveness Sensitivity (confirmed by colonoscopy) for CRC 92% Not affected by CRC stage or location of lesion Specificity for CRC was 87% Significance of a (+) Cologuard followed by a (-) colonoscopy is unknown

Colonoscopy Gold Standard-but not a perfect test prep needed and complications possible Miss rate of 2%

with large adenomas (>10mm), 25% <5 mm Positive Cologuard Changes screening colonoscopy to

diagnostic colonoscopy Proton Pump Inhibitors Potential Risks of PPIs Proton pump inhibitors have been

used on millions of patients since Prilosec was introduced in the USA in 1989 PPIs Changed GI Medicine

Mechanism of Action Binds to the H-KATPase on the luminal surface of the parietal cell Most effective after a prolonged fast and when the parietal

cell is stimulated after a meal Clinical Uses GERD-especially erosive esophagitis Peptic ulcer disease Eradication of H.

pylori Zollinger-Ellison syndrome Prevention NSAID ulcers Potential Adverse Effects

Increased risk of Clostridium difficile infection Calcium malabsorption and fracture risk Pneumonia Dementia Death Kidney Disease and PPIs

PPIs can cause acute interstitial nephritis Weak association with PPIs and chronic kidney disease (CKD)

Potential Malabsorption Iron malabsorption Magnesium malabsorption Vitamin B12 malabsorption Why Use PPIs

Inhibit gastric acid secretion much more effectively than H2 RAs Once-daily dosing decreases gastric acid secretion by 66%

Shortest Duration/< Dose Any Clinical Difference? rabeprazole omeprazole esomeprazole

lansoprazole pantoprazole PPIs and H2 Blockers H2RAs suppress acid much less effectively, but work more quickly-better

for prn use Taking them at the same time renders the PPI less effective

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