scott@vtx-cpd.com

Replying to Julie S. 23/03/2022 - 14:51

Hello Julie.

I am so sorry for the delay in getting back to you. No idea how I missed this! I hope you have had a lovely weekend and you are enjoying the course.

One of the natural products that has some evidence regarding nausea in people is ginger. I could find one paper (quite old) that used it in dogs for chemotherapy induced nausea:

https://pubmed.ncbi.nlm.nih.gov/9254112/

There does seem to be quite a bit of evidence in the human literature:

https://pubmed.ncbi.nlm.nih.gov/23638927/

Ginger is not something I have experience of giving as a stand alone supplement. The other option for GI cases would be to use a probiotic. Less evidence for vomiting, nausea, reflux, but not likely to do any harm.

I know some veterinary diets will contain ginger, which might be interesting to discuss more.

I would be interested to hear the experience of others?

Hope that helps.

Scott 🙂

I have had the following back from Danielle:

”Hi Scott,

Good Qs.

As far as I know, still no NP wet – unless Steph can correct me.

I would usually try a pro-biotic or symbiotic course before a hydrolysed diet trial for this reason. I don’t know about VSL#3 instead – but I know a lady who will know…

Dxx”

I will speak to Silke at Edinburgh regarding the Forti flora too.

Scott 🙂

Replying to Natalie H. 01/04/2022 - 12:23

Hello Natalie.

I hope you are safe and well.

Regarding diet with chronic enteropathy. Generally if there is no response after 2 weeks I would recommend trying a different diet. Generally if there is going to be a positive response you will see this quite quickly. The longer diet trials are more appropriate for dermatological conditions.

Hope that helps. Have a lovely weekend!

Scott 🙂

Replying to konstantinos C. 11/03/2022 - 18:09

Konstantinos,

I hope you are well. Thank you for your great question. Overall, it is probably not helpful to give omeprazole/gastroprotectants before giving NSAIDS. There was actually a recent study looking at this in patients with neoplasia:

https://pubmed.ncbi.nlm.nih.gov/34337965/

Bacterial overgrowth can have deleterious consequences when PPIs are administered with other drugs that can injure the small intestinal (SI) mucosa. It is common to prescribe PPIs in patients at risk for upper GI injury from nonsteroidal anti-inflammatory drugs (NSAIDs), but PPIs can alter the SI microbiome, increasing the risk of injury to the intestinal epithelium caused by NSAIDs. This effect is acid-independent and unrelated to gastric mucosa injury caused by NSAIDs. Inhibition of intestinal cyclooxygenase 1 and 2 (COX-1, COX-2) enzymes injures the SI mucosa. Enterohepatic recycling of NSAIDs likely plays a role whereby high concentrations of NSAIDs in bile are secreted into the duodenum in close proximity to the major duodenal papilla. Some of the most serious intestinal lesions in dogs caused by NSAIDs occur in this region. Small intestinal injury may be caused by increased numbers of gram-negative facultative anaerobic bacteria that flourish in the SI of patients treated with PPIs. Lesions are characterized by loss of villi, erosions, and multifocal ulcers distributed throughout the small bowel. Anaemia also may occur. Whereas some bacteria play a protective role against intestinal mucosal injury by NSAIDs, the intestinal dysbiosis arising from PPI administration increases the risk of NSAID-induced intestinal injury.

I hope that helps!

Scott 🙂

Hello again!

I replied to this one on the other thread. Let me know if you can’s see it.

Thanks again.

Scott 🙂

Replying to Julie S. 21/03/2022 - 13:53

Hello Julie.

I hope you are well. Interesting question. Do you mean as an alternative to the PPI?

Scott 🙂

Hello Rachel.

I hope you are safe and well. This is a brilliant question regarding sucralfate. Coadministration of the following drugs with sucralfate results in a substantially decreased bioavailability of single doses of the drug: ciprofloxacin, theophylline, tetracycline, doxycycline, minocycline, phenytoin, and digoxin. The bioavailability of digoxin, tetracycline, doxycycline, and phenytoin was not decreased when they were given 2 hours before sucralfate. Sucralfate impairs absorption of ciprofloxacin in humans and dogs when administered concurrently, but the bioavailability of ciprofloxacin is markedly increased when administration of sucralfate is delayed by 2 hours. Interestingly, no significant difference in bioavailability was documented for enrofloxacin coadministered with sucralfate in dogs.

So, I know it is a massive pain, but it really should be 2 hours!

The silver lining is that there is a relatively narrow spectrum of use of sucralfate, so I would be asking myself whether it is really necessary before prescribing!

Regarding the Entyce, as far as I am aware, this is the only way of getting it in UK:

https://www.ramanpharma.com/

I will ask around and see if I can find an alternative. I really hope you are enjoying the course!

Scott 🙂