CG184 I

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1/15

I>, =@= =@ @>I>, =@= =@ @>

I= = @

#@>: 1 &= 2014

.=.@

A@ > =A@ > =

!ICE @> =!ICE @> = = >@= >@ = @> = >@= >@ = @>

= >=>. = >=>.

> = > @ >, =@= =@ @> > > @

!ICE @ 184.

> > @ > !ICE =@ 2004.

D#e& hi& i"f#%!ai#" a$$, # !e?

++>>, @ = @ :

@ >> >, =@= /= =@

@ @ B=='> >@>.

!!, @ =:

@= 18 => ==

@ = > = >@>.

% NICE 2014. All righ! reer#ed. Page 1 of 15

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8/18/2019 CG184 I

2/15

++@= = @= =

A = =>>> >> = => = = >@=

@= =. > @ @ =>, =>>, >> @=>> >>>.

W#%ki"g *ih ,#

+@= = >@ @ @ >, =@= =@. >@

>>, => = >@= @ >@ = > @ = > >

= @. +@= = == >>, @ @ =.

= > > > @ @> @ @= = .

+@ > = !ICE'> = = @ # = @ !H&>=>. > >> @ @> >@ @> !H&. * >

= = !ICE > @ @> > = >=>.

& => = = >= = & => = = >= = >@ = >@ = @. I @. I @ @ @=@=

= > > , = > > , @= = .@= = .

& =>& =>

I @ >, =@= /= =@, => > @:

@ = @= >>

> @ @ '=--@=' @ =>=. = , >

>

@ >@ > @= G#

> = =>= @= G#.

+@ >@' > =@= = =>. A@ >>

>= =, ' @= =.

H H @ =@ @ =@ @= >>@= >>

*= @ > @= G# = @= => @ @= >>, >@ @

= @ > @ >@ @ =. > @

Indige!ion, hear!b"rn and re&"$ in ad"l!


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8/18/2019 CG184 I

3/15

, > @'= =, > >. >@ >

@ > > => , , >, @>

@= >> =>.

& => = = > 3 @=>

= > .

& G#& G#

I @ > G#, = > >@ > @ @= >> = @ @>

= , >@ > = = = = =. +@= G# >@

> > @ = = = > @> > >, =

, ->= -= =@> (!&AID>), @> >.

+@= G# == @ = > >. #> > I= @ >

@ =. I @ > >, @ ' = @>> @

>>.

+@= G# >@> > > = Heic#bace% $,#%i @

@> @= >>. #> > I= @ H= = @ =.

I @ =@ @ () @ >=, @= G# >@ == @

> > > >>.

+@= = == @ > = @== >> @ >> '

=> = = = @. H=@= > > =, >

@ @@>@ >> = @ ' = = =, @= G# == @

>>.

B === >> > >>= B === >> > >>= @ @ =; , > =; , >

=== === ' ' = =..



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8/18/2019 CG184 I

4/15

I>I>

Wha i& i"dige&i#"?

I> > = >= > = > >> > =

= =. "= >> @ , @=, = = >.

= = > > >>.

T%ea!e" f#% i"dige&i#"

D=@ =D=@ =

+@= G# >@ = @ @=> = = @ = (##I= >=). @=> >@ > = 4 >.

= == = Heic#bace% $,#%iHeic#bace% $,#%i

+@= >> @> = Heic#bace% $,#%i (H $,#%i = >=).

+@= G# >@> > > @ H $,#%i , @ , = @=> =

= . #> > I= @ H= = @ =.

I I @= >> @= >>

I @= >> = @' > ##I, @= G# >@ = ##I

> > >> = @= >>. >@ >@>> @

@= >>.

I ##I >I ##I >' =' =

I ##I >' , @= G# = = >, H2 =.

%= @ >@' > =@= = =>. A@

>> >= =, ' @= =.



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8/18/2019 CG184 I

5/15

H=@= =@H=@= =@

Wha i& %e-+?

%@ > > > > @ >@> =>

@. * > >, => =@= @= >> >

@> '> >. > > =>,

@ => =. "= >> @ @> > @

> =>.

%@ > > =@ = >=-> =@ >> (G"%D).

T%ea!e" f#% %e-+

D=@ =D=@ =

+@= G# >@ = @ @=> = = @ = (##I

= >=). @=> >@ > = 4 = 8 >, >= =@

> =>.

I I @= >> @= >>

I @= >> = @' > ##I, @= G# >@ = ##I

> > >> = @= >>. >@ >@>> @

@= >>.

I ##I >I ##I >' =' =

I ##I >' , @= G# = = H2 =.

T%ea!e" f#% &ee%e #e$hagii& (i"-a!!ai#")

I =@ > @> >= == @= >@> (

= > > >>), @= = >@ = @ @=> = ##I = 8 >.



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8/18/2019 CG184 I

6/15

I I @= >> @= >>

I @= >> = @' > ##I, @= G# >@ = @ =

> = = = ##I. +@ = =

= @= >>.

I ##I >I ##I >' =' =

I ##I >' , @= G# >@ == @ = @= >>, >

=>. = = ##I = > > >> (=

, = >==> - = >>> '> > >>).

S%ge%,

+@= = @ @ >@== = =@. &@== == =

-=, = = > @> > > = =

.

> >@== = =@ > => @. > >

>@== @= >> > >, @> =

>@> > >, = >= . > =@ @

> > =-= >@>.

I @= = > >@== @ , = > >@>> > @ =

.

%= @ >@' > =@= = =>. A@

>> >= =, ' @= =.

## @= @=

Wha i& a $e$ic ce%?

A @= > = ( >=) > = @= = >

>. # @=> @> > >>. = '' > = >

() >. I >, > = =@ > .

!=, ' > > @> > => > >= >.

B@ > > , > @> @=.



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8/18/2019 CG184 I

7/15

T%ea!e" f#% a $e$ic ce%

I @ @=, @= G# >@ = > > @ =

Heic#bace% $,#%i (H $,#%i = >=). I @ , @ >@ @=> = =

(> I= @ H= = @ =). A= =, @

= > > =.

I I @ = !&AID@ = !&AID

I @ = !&AID = = , @= G# >@ >@> @ > @>

!&AID> @> @=> = =>.

I @ !&AID @ @=, @= = >@ = @= = @ = (##I = >=) = H2 = = 8 >. I @

H $,#%i, @= = >@ = @=> = = = ##I = (>

I= @ H= = @ =).

I @ == = =>@ @= !&AID = @= @= > , @= G# >@

@ @ !&AID> = @= >. +@= G# >@ =@= = @ >

!&AID. +@ >@ = = @ (

@ !&AID = > ). "= @= = @ = > @

, = @> = = = = > !&AID.

I @ == !&AID>, @= = >@ = @ = @=

> >@>> = !&AID.

I I @ = !&AID@ = !&AID

I @ ' H $,#%i @ = !&AID, @= G# >@ = @ =

= ##I = H2 = = 4 8 >.

I I @= >> @= >>

I @= >> = =, @= G# >@ = @ ##I > >

>> = @= >>. >@ >@>> @ =

@= >>.



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8/18/2019 CG184 I

8/15

I = >I = >' =' =

I @ = ##I => @ >' , @= G# >@ = @ H2 = >.

I @= @= >' > >, > @ @>:

@ H $,#%i @ ' > >

@'= > > =>=

@'= = > @ @> >> = @ = >

!&AID>

@ = @ @> >>.

I I @ @ '@ >> '@ >>' (> '-@= >>' (> '-@= >>')')

Wha i& f"ci#"a d,&$e$&ia?

I @ > >> @ @> @ @= >, => >

'@ >>'. I @> '-@= >>'. D=> @> = '@'

@> = > = @ > >> '> @>

>>, == = > >, = , @=.

T%ea!e" f#% f"ci#"a d,&$e$&ia

+@= >> @> = Heic#bace% $,#%i (H $,#%i = >=).

+@= G# >@> > > @ , @ , = @=> = =

. #> > I= @ H= = @ =.

I @ ' H $,#%i @= >> = > =, @= G# >@ = @ 4- @=> = = = @ = (##I = >=) = H2 =.

I >> @ = I >> @ =

I @= >> == = = @' > =, @= G# >@ =

@ =>= = ##I = H2 = > > >> = @= >>,

>@ >@>> @ = @= >>.



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8/18/2019 CG184 I

9/15

%= @ >@' > =@= = =>. A@

>> >= =, ' @= =.

I I @ @ B=='> >@> B=='> >@>

Wha i& Ba%%e'& #e$hag&?

B=='> >@> > > @= > = =

>@>. I > @> -= =@, >> > =@= (> H=@=

=@ @ =). "= , > @> > >

>@>, @ = =@>, = > > =>

=@>.

I @ B=='> >@> ( > = > == >>),

@= = @ @ > = = . +@= G#

>@ @ = @ > . I , !ICE > =@

B=='> >@> (> "= !ICE @ = >).

E"d#&c#$, # diag"#&e Ba%%e'& #e$hag&

+@ >@ = = > > @ B=='> >@>, @ @== >@>> @ @ >> G"%D (>= = >=-> =@

>>), => >@ >:

@= ==>

@' >> =

@' >>

8/18/2019 CG184 I

10/15

I= @ >I= @ >

Wha i& a" e"d#&c#$,?

A > > =@= > >> == @ > > >>

@ > @> . I > @> > ( ==, @ =

> ), > > >@> >. => = > =

=@=, /= > @ =. > > @

=>'> = = >.

I @= = > > @ @ @= >, = > >@ @

@ > .

I @ > @ = !&AID>, @= = >@ > @ >

!&AID> @ = =@=.

I= @I= @ Heic#bace% $,#%iHeic#bace% $,#%i

Wha i& Heic#bace% $,#%i?

Heic#bace% $,#%i (= H $,#%i = >=) = = @= >. @> > @=> , @=, @> >> >. +@= =

@ @ > > @= >> @ @> H $,#%i.

Te&&

H $,#%i > @> = > = > >, = >> >.

+@= G# >@ = @ > , = @ >@ > @=

= >.

T%ea!e"

I @ H P,#%i, @= = >@ = @ @=> = = .

= > ##I > > > = 7 >. +@= =

@ > @ =>= >, = @

= = .

I @ > >> = =, @ > @=>.



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8/18/2019 CG184 I

11/15

+@= G# >@ @ @ > @ = >

==, > >> =>=.

* = >* = >' =?' =?

I @' 2 @=>> H $,#%i = @ > H $,#%i , @= =

>@ = = >> (= , = >==>).

LL-= =-= =

I @ @ > > = , @= G# >@ == @ @

= @ @'= . >@ >@>> = @ @ =@ = >

=. I >> = @ = @= >> =--@==> @ .

%= @ >@' > =@= = =>. A@

>> >= =, ' @= =.

%>> > >>%>> > >>

+@= G# >@ >@>> > >> :

@ >> = , = = > =

@= =

@ =@ = @ >@==

@ > Heic#bace% $,#%i = 2 @=>> = = .

$@>> > @ > =@$@>> > @ > =@

> > @ >@>> @= = => @ =

@= = .

Ab# ,#% c#"dii#"

C @ = @ >, =@= =@?

* >> > > ?



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8/18/2019 CG184 I

12/15

* I >?

* >> I ?

* = >> ?

*= > == @? * I >?

H I @ I > >>?

H =>@> > >>?

* I =?

='> >= > = > = . &@ I ==?

C @ = @ B=='> >@> > =>>?

T%ea!e"&

C @ @ = > =?

* = => > > =?

H ? * >> = ? * >=

=> I ?

* I =?

H ?

* = >' ?

A= = =>> >> > =?

H I > = =?

* = = > = =?

&@ I = I' > =@=?

I> = > = = ( , DD = > I ) @

= I ?



8/18/2019 CG184 I

13/15

Side effec&

* >@ I I > >?

A= = -= > > =?

F##*i"g $ #" ,#% %ea!e"

* >@ I >= = >@ I I ' >= = ?

H -@ > ?

A= = = => I @ =?

D> = > @== = ?

H >@ = =?

=> =>

Agi"ae&

> = = > > =@ =@ =

@ > > .

A"acid&

> =@ >> > > >

.

H2 b#cke%

A> H2 == >> = H2%A> > > > > =@

@ . > =@> = , @ >> ==

> @> >. H2%A> = = @ =>= @ => (##I>),

>> =@ =@ > .



8/18/2019 CG184 I

14/15

NSAID

!&AID >> = ->= -= =@. # !&AID> = > >@ >

==>, > =>.

Oe$hag& (#% ge)

@ = @ > >>>.

P%##" $!$ i"hibi#%& (PPI&)

##I> > > = =@ @ . > =@> =

, @ >> == > @> >.

U$$e% ga&%#i"e&i"a ca"ce%

= >=> = >@>>@> (@), > = => =

> (@@).

&@=> >@=&@=> >@=

B=='> ">@> C, 020 8346 0171

://.==>.=.@

C"%E: F @ = >>, 020 7486 0341

://.==.=.@

F "> %@ =

://.==.=.@

H=@= C= A=>> >@=

://.->.=

"> #> A>>, 0121 704 9860

://..=.@

+@ > !H& C> = = =.

!ICE > =>> = =>>.



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8/18/2019 CG184 I

15/15

"= !ICE @"= !ICE @

D=@ =. !ICE @ 183 (2014).

A@ @= >=> . !ICE @ 141 (2012).

B=='> >@>. !ICE @ 106 (2010).

> =. !ICE @ 76 (2009).

%== @> = >@> =. !ICE @ 27 (2005).

I&B!: 978-1-4731-0718-2

Acc%ediai#"


% NICE 2014 All righ! reer#ed Page 15 of 15
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Documents

CG184 I