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Lactose intolerance

A bloated belly, “wind”, stomach ache and diarrhoea: not being able to digest dairy (milk) products properly can cause great discomfort – and a lot of inconvenience, too. Up to 1 in 5 adults, teenagers and children in northern Europe are affected by symptoms like these. They are often thought to be caused by lactose intolerance, but that might not always be true. Some people who are over-sensitive to milk might actually have another problem. It is important to get the diagnosis right before deciding to make major changes to your diet, especially in children, teenagers and people who need more calcium.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 2, 2012

Lactose malabsorption and intolerance: a systematic review on the diagnostic value of gastrointestinal symptoms and self-reported milk intolerance

BACKGROUND: When lactose malabsorption gives rise to symptoms, the result is called 'lactose intolerance'. Although lactose intolerance is often bothersome for patients, once recognized it may be managed by simple dietary adjustments. However, diagnosing lactose intolerance is not straightforward, especially in primary care.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Systematic review: pancreatic enzyme treatment of malabsorption associated with chronic pancreatitis

The authors concluded that enzyme supplementation improved coefficient of fat absorption compared to placebo but may not abolish steatorrhoea. This was a generally well-conducted review, but the small number of available studies and participants, and the clinical heterogeneity between the included trials, mean that the authors' conclusions may be over stated.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

SeHCAT [tauroselcholic (selenium-75) acid] for the investigation of bile acid malabsorption and measurement of bile acid pool loss: a systematic review and cost-effectiveness analysis

BACKGROUND: The principal diagnosis/indication for this assessment is chronic diarrhoea due to bile acid malabsorption (BAM). Diarrhoea can be defined as the abnormal passage of loose or liquid stools more than three times daily and/or a daily stool weight > 200 g per day and is considered to be chronic if it persists for more than 4 weeks. The cause of chronic diarrhoea in adults is often difficult to ascertain and patients may undergo several investigations without a definitive cause being identified. BAM is one of several causes of chronic diarrhoea and results from failure to absorb bile acids (which are required for the absorption of dietary fats and sterols in the intestine) in the distal ileum.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Lactose Intolerance and Health

We systematically reviewed evidence to determine lactose intolerance (LI) prevalence, bone health after dairy-exclusion diets, tolerable dose of lactose in subjects with diagnosed LI, and management.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: February 2010
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Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet]

Alcohol is the most widely used psychotropic drug in the industrialised world; it has been used for thousands of years as a social lubricant and anxiolytic. In the UK, it is estimated that 24% of adult men and 13% of adult women drink in a hazardous or harmful way. Levels of hazardous and harmful drinking are lowest in the central and eastern regions of England (21–24% of men and 10–14% of women). They are highest in the north (26–28% of men, 16–18% of women). Hazardous and harmful drinking are commonly encountered amongst hospital attendees; 12% of emergency department attendances are directly related to alcohol whilst 20% of patients admitted to hospital for illnesses unrelated to alcohol are drinking at potentially hazardous levels. Continued hazardous and harmful drinking can result in dependence and tolerance with the consequence that an abrupt reduction in intake might result in development of a withdrawal syndrome. In addition, persistent drinking at hazardous and harmful levels can also result in damage to almost every organ or system of the body. Alcohol-attributable conditions include liver damage, pancreatitis and the Wernicke’s encephalopathy. Key areas in the investigation and management of these conditions are covered in this guideline.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: 2010
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Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet]

This guideline covers areas relevant to the diagnosis and management of irritable bowel syndrome (IBS) reflecting the complete patient journey, from the person presenting with IBS symptoms, positive diagnosis and management, targeted at symptom control. The guideline incorporates Cochrane reviews, published NICE clinical and public health guidance, Health Technology Assessment reports, systematic and health economic reviews produced by the National Collaborating Centre for Nursing and Supportive Care. Recommendations are based on clinical and cost effectiveness evidence, and where this is insufficient, the GDG used all available information sources and experience to make consensus recommendations using nominal group technique.

NICE Clinical Guidelines - National Collaborating Centre for Nursing and Supportive Care (UK).

Version: February 2008
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Drug Class Review: HMG-CoA Reductase Inhibitors (Statins) and Fixed-dose Combination Products Containing a Statin: Final Report Update 5 [Internet]

In the United States, coronary heart disease and cardiovascular disease account for nearly 40% of all deaths each year. Coronary heart disease continues to be the leading cause of mortality and a significant cause of morbidity among North Americans. In 2006, coronary heart disease claimed 607 000 lives, translating into about 1 out of every 5 deaths in the United States. High levels of cholesterol, or hypercholesterolemia, are an important risk factor for coronary heart disease. The 3-hydroxy-3-methylglutaryl-coenzyme (HMG-CoA) reductase inhibitors, also known as statins, are the most effective class of drugs for lowering serum low-density lipoprotein cholesterol concentrations. They are first-line agents for patients who require drug therapy to reduce serum low-density lipoprotein cholesterol concentrations. The purpose of this review is to compare the benefits and harms of different statins in adults and children with hypercholesterolemia.

Drug Class Reviews - Oregon Health & Science University.

Version: November 2009
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Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update [Internet]

Given the number of medications available for type 2 diabetes mellitus, clinicians and patients need information about their effectiveness and safety to make informed choices. The objective of this review was to summarize the benefits and harms of medications (metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 [DPP-4] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists), as monotherapy and in combination, for the treatment of adults with type 2 diabetes.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2011
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Screening for Osteoporosis: Systematic Review to Update the 2002 U.S. Preventive Services Task Force Recommendation [Internet]

Osteoporosis and related fractures are common in older individuals and lead to premature mortality, loss of function and independence, reduced quality of life, and high costs. Despite its importance, osteoporosis is under detected in the United States. This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: July 2010
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Screening for Lipid Disorders in Children and Adolescents [Internet]

Dyslipidemias, disorders of lipid metabolism, are important risk factors for coronary heart disease (CHD). Identification of children with dyslipidemias could lead to interventions aimed at decreasing their risk of CHD as adults.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: July 2007
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Drug Class Review: Proton Pump Inhibitors: Final Report Update 5 [Internet]

Proton pump inhibitors decrease secretion of gastric acid. They act by blocking the last enzyme in the system that actively transports acid from gastric parietal cells into the gastrointestinal lumen, hydrogen–potassium adenosine triphosphatase, also known as the proton pump. Omeprazole, the first drug in this class, was introduced in 1989. Since then, 4 other proton pump inhibitors have been introduced: lansoprazole (1995), rabeprazole (1999), pantoprazole (2000), and esomeprazole (2001). In 2003 omeprazole became available over-the-counter in the United States. The purpose of this review is to compare the benefits and harms of different PPIs.

Drug Class Reviews - Oregon Health & Science University.

Version: May 2009
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Use of Aspirin and NSAIDs to Prevent Colorectal Cancer [Internet]

The purpose of this report was to systematically review the literature on the effectiveness of aspirin (ASA), non-aspirin nonsteroidal anit-inflammatory drugs (non-ASA NSAIDs), and cyclooxygenase-2 inhibitors (COX-2 inhibitors) for the chemoprevention of colorectal cancer (CRC) and CRC-related mortality in average-risk individuals. The review also assessed the harms associated with the use of these agents and their cost effectiveness.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: March 2007
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Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence

This clinical guideline on alcohol-use disorders was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out the evidence for the treatment and management of harmful drinking and alcohol dependence in adults and in young people aged 10 to 17 years.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2011
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Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care

It is almost 200 years since James Parkinson described the major symptoms of the disease that came to bear his name. Slowly but surely our understanding of the disease has improved and effective treatment has been developed, but Parkinson’s disease remains a huge challenge to those who suffer from it and to those involved in its management. In addition to the difficulties common to other disabling neurological conditions, the management of Parkinson’s disease must take into account the fact that the mainstay of pharmacological treatment, levodopa, can eventually produce dyskinesia and motor fluctuation. Furthermore, there are a number of agents besides levodopa that can help parkinsonian symptoms, and there is the enticing but unconfirmed prospect that other treatments might protect against worsening neurological disability. Thus, a considerable degree of judgement is required in tailoring individual therapy and in timing treatment initiation. It is hoped that this guideline on Parkinson’s disease will be of considerable help to those involved at all levels in these difficult management decisions. The guideline has been produced using standard NICE methodology and is therefore based on a thorough search for best evidence.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: 2006
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Last Days of Life (PDQ®): Health Professional Version

Expert-reviewed information summary about care during the last days to last hours of life, including common symptoms, ethical dilemmas that may arise, and the role of the oncologist in caring for patients and their families during this time.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 16, 2014

Hematopoietic Stem-Cell Transplantation in the Pediatric Population [Internet]

Assess comparative benefits and harms of hematopoietic stem-cell transplantation (HSCT) versus standard therapies or disease natural history in pediatric (age ≤21 years) patients with malignant solid tumors, inherited metabolic diseases, or autoimmune diseases.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: February 2012
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Prostate Cancer: Diagnosis and Treatment

Prostate cancer is one of the commonest cancers in men. Each year there are about 27,773 new cases in England and Wales, and 9161 deaths. Prostate cancer is predominantly a disease of older men but around 20% of cases occur in men under the age of 65. Over the past 10 to 15 years there have been a number of significant advances in its management but also a number of major controversies, especially about the clinical management of patients with early, non-metastatic disease. These uncertainties clearly cause anxieties for patients and their families. There is evidence of practice variation around the country and of patchy availability of certain treatments and procedures. A clinical guideline will help to address these issues and offer guidance on best practice.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: February 2008
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Genetics of Endocrine and Neuroendocrine Neoplasias (PDQ®): Health Professional Version

Expert-reviewed information summary about the genetics of endocrine and neuroendocrine neoplasias. This summary contains information about the MEN1 gene, the RET gene, genetic testing, and clinical interventions. Psychosocial issues associated with genetic testing and counseling of individuals who may have a hereditary medullary thyroid cancer syndrome are also discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 17, 2014

Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This guideline addresses the diagnosis and management of children and young people with type 1 diabetes. It has been developed with the aim of providing guidance on: initial management at diagnosis (including consideration of admission criteria and initial insulin regimens); continuing care of children and young people with type 1 diabetes; ongoing monitoring of glycaemic control (including the role of home glucose monitoring and the frequency of HbA1c measurement); management of hypoglycaemia (insufficient blood sugar) and hypoglycaemic coma; prevention and management of diabetic ketoacidosis (including the management of intercurrent illness, that is, illness that occurs alongside type 1 diabetes, for example, influenza); peri-operative management of children and young people with type 1 diabetes; and surveillance for complications. The guideline also addresses the special needs of young people (adolescents) and the interface between paediatric and adult services.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: September 2004
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  • Malabsorption
    Malabsorption is difficulty absorbing nutrients from food.
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