can i take gaviscon before an endoscopy

Many people are taking medication like PPIs that arent working. NO SMOKING. They can only say 'no', in which case you are no worse off, but they might say it will be fine, and then you won't have a fortnights suffering. Adults with indigestion or heartburn may need to have a test for an infection called Helicobacter pylori ( H pylori for short), which can cause stomach and duodenal ulcers (the duodenum is the section of intestine immediately after the stomach). If your heartburn doesn't get better after you've been taking Gaviscon for seven days, talk to your healthcare provider. Impact of procedural multimedia instructions for pH BRAVO testing on patient comprehension: a prospective randomized study. Finding out that you dont have acid reflux is also important. The capsule measures pH levels in the esophagus and transmits readings to a receiver (about the size of a pager) worn on your belt or waistband. Do not take this medicine for longer than 2 weeks unless your doctor tells you to. The effects can last for up to four hours. Chew the tablets, do not swallow them whole. If your baby or child has problems with reflux or indigestion, talk to your doctor as soon as you can. Yes, taking Gaviscon should not affect your ability to drive or ride a bike. Anyone had to stop meds for such a test? This can irritate your stomach lining and make your symptoms worse. x]mon a?Zpeqp$is>/.z~%l'wf$sW/2X2yvvvvvUUTU>3!O7c?~,b/,i&xuWgo_g\Eb83x$,' I've was diagnosed with limited systemic sclerosis 5 years ago although I've had symptoms for a lot longer, including reflux for 30 years and swallowing problems when eating for about 5. You'll usually take Gaviscon after meals and at bedtime. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. I find those medications make me worse and long term they inhibit mineral absorption causing weak bones etc, so now is your cahance to come off. <> I had endoscope twice, the second time while using Omeprazole 20 mg a day. Just leave out the missed dose and take your next dose as normal. They will tell you about possible complications or side effects. The effect of 1 dose should last for around 4 hours. It was booked at short notice so I phoned them up beforehand as I could not come off PPIS for 2 weeks prior as requested as it was only a week away when the booking was made. It's helps to be informed when you go to your appointment. Generic name: aluminum hydroxide and magnesium trisilicate [a-LOO-mi-num-HYE-drox-IDE-AND-mag-NEE-zee-um-TRYE-sil-i-kate] You might feel like something is in your throat. Read our editorial policy. So I got some Gaviscon Advance in, but I was wondering what my doctor meant by 'keep downing the Gaviscon', how much of this can I take safely, and whether there are any other things I can do to try and keep these symptoms as mild as possible. I did phone the unit and ask about PPIs and was told that I should stop if I could. Gaviscon are antacids that can lower the acidity of stomach acid. At 4 pm, mix the Golytely powder with one gallon of water and refrigerate. if your symptoms have improved, you can take it for another 2 weeks if your symptoms have not improved or they are worse, speak to a doctor before taking any more pantoprazole Do not take pantoprazole for more than 4 weeks without speaking to your doctor first. Omeprazole can cause this among other side effects. This is more in relation to the Gastroscopy, as Omeprazole can create a mucus layer over the stomach lining that can obstruct the viewing of the stomach and lining during the Gastroscopy. 20 mg is not a large amount , I would continue until told to stop , I was on 60 ml for 4 weeks , be brave acid can be terrible. The liquid is usually one to two 5ml spoonfuls, up to 4 times a day. Start eating a low-fiber diet. It's best to have a drink afterwards. I remember when I worried about the veins coming up all over Can Raynauds cause symptoms elsewhere in body? Next review due: 10 August 2024. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. I kept to a bland diet and used peptac liquid. I've and 3 PH monitoring episodes2 before my Nissen and 1 afterward, on the request of my asthma doc. You must chew the chewable tablet before you swallow it. If you often have heartburn or indigestion, take Gaviscon regularly after meals and at bedtime, up to 4 times a day, whether or not you have symptoms. I have been on 40mg a day for 2 weeks. Symptoms include sore throat and an irritated larynx (voice box). Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. You should feel the benefit of taking Gaviscon soon after taking it, and it will last for around 4 hours. It is not a medicine that requires this such as antidepressants where the withdrawal symptoms may be severe. I have learnt what foods cause me the problems and stay clear of them. There are no known problems with taking herbal remedies and supplements alongside Gaviscon. Can You Use Baking Soda for Heartburn Relief? Visit Yellow Card for further information. you guys may need new doctors. Hello, i used to be on omeprazole and had to stop taking it for my endoscopy. Did you get to speak with gastroenterology specificallist after the endoscopy if it was under the NHS? being on medicine isn't going to change the look of an ulcer or the condition of the walls. Yes, Acidex and Peptac are similar to Gaviscon. 2016;43(8):899-909. doi:10.1111/apt.13567. Rarely, people having this test might feel some discomfort when they swallow, chest pain or back pain. For 10 days, should have been 2 weeks yet I was only got my date 10 days before hand. H pylori infection is detected using a breath or stool test, or sometimes a blood test. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. If you get occasional mild heartburn or indigestion, only take Gaviscon when you need it. Would the results be unreliable if I continued with omeprazole? To ensure the greatest effectiveness, take Gaviscon after meals. If you've taken Gaviscon regularly for a long time, talk to your doctor before you stop taking it. You just have to get over the gag reaction, I kept thinking it was just food going down. Most of the time, the PPIs are the first things you go off, but you can take H2Blockers a little longer, and the last thing you can takeare antacids/Tums, etc. Thanks. Here is the Cleveland Clinic's information, including the medication protocol. Maybe once every two months on average after indulging in foods I know I shouldn't eat! Look at the positive and try not to think negative. These include damage to the tissue of your esophagus or intestines, possible bleeding or aspiration (breathing in) of the capsule. Yes, it is a generic equivalent, I get on prescription from my GP. The dose depends on the type of Gaviscon you're taking. They can tell you about oherbs too such as Fennel/liquorice/chamomille. I am also constipated most likely because of omeprazole. appropriate medical assistance immediately. However, I suspect I will get much more notice of the next appointment and will have to come off the esomeprazole for 2 weeks. I do believe it is not ideal to stay on ppi's for too long and they do more damage than good! Other drugs may affect Gaviscon, including prescription and over-the-counter medicines, vitamins, and herbal products. Gaviscon seems to work ok for me but is there anything even better that is a basic antacid? The most common reason for doing capsule endoscopy is to explore unexplained bleeding in the small intestine. It's best to take it after meals and at bedtime. Gaviscon is an over-the-counter (OTC) antacid. Thanks that's helpful to know. Take 10-20 millilitres (0.34-0.68 fl oz), 4 times a day. I guess all I can do is hit the gaviscon and mylanta for the next . By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Your provider will work with you to develop a plan to manage your symptoms. If you've been taking Gaviscon for more than 7 days and you're still feeling uncomfortable or in pain, talk to your doctor. Gaviscon may start working as soon as 10 minutes after you take it. The capsule might fail to stay in place for the full testing period. I'm going for endoscopy soon. I have been on 40mg a day for 2 weeks. It contains aluminum hydroxide and magnesium carbonate, which neutralize stomach acid, and sodium bicarbonate and alginic acid, which create a protective foam barrier between the stomach and esophagus. Is the Gaviscon I buy the same as on prescription? Would appreciate any help. Some medicines must not be taken at the same time as Gaviscon. If you want to throw some dates and yourself in public is my main worrys. Call your doctor if your symptoms do not improve, or if you have acid indigestion more than 2 times per week. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in Mix Gaviscon powder (for babies and children under 2) with cool, boiled water or formula milk. Medication can be taken 4 hours before examination with little sips of water. Who can and cannot take omeprazole How and when to take omeprazole Side effects of omeprazole Pregnancy, breastfeeding and fertility while taking omeprazole Taking omeprazole with other medicines and herbal supplements Common questions about omeprazole www.barrettscampaign.org.uk www.cardcharity.co.uk Guts UK: charity gutscharity.org.uk Aliment Pharmacol Ther. To make sure this medicine is safe for you, tell your doctor or pharmacist if you have: Never give Gaviscon to children under 12, unless their doctor prescribes it. This will cause the disposable pH capsule to detach and pass through the digestive tract in seven to 10 days on average. PPIs like Nexium (esomeprazole) or Prilosec (omeprazole) are available over the counter, while others like pantoprazole require a prescription. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Side effects tend to be mild and may include indigestion, nausea, and belching. Especially in the run up to Xmas, social occasions were spoilt because my already restricted diet was even more restricted. I will try a 20mg next two days in hopes I can rapidly wean myself off but fear without a long tapering off I will get rebound. Call your doctor for medical advice about side effects. Plus trying to cut out chocolate, sugar, carbs. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. So i got my gallbladder removed last december. Food particles and other digestive juices can also splash back. Follow with a glass of water. These can make your symptoms worse. Read our. I had been on it for a while prior to taking it but i was fine for the 2 weeks stopping it possibly due to the fact it may still have been in my system. Six hours before the monitoring period, don't take antacids (such as Alka-Seltzer, Gaviscon, Maalox, Milk of Magnesia, Mylanta, Phillips, Riopan, Tums or any other brands). I have clear instructions to come off Omeprazole 2 weeks before my scopes. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. The other issue with omeprazole is constipation. Patient is a UK registered trade mark. You may take Pepcid or Zantac, two tablets if needed. In studies, the effects of Gaviscon tend to last longer than those of traditional antacids. For milder cases, Gaviscon may be used on its own. They work in the same way as Gaviscon, by reducing acid in your stomach and preventing excess acid escaping into your food pipe. Reflux suppressants like Gaviscon contain alginic acid which is made from seaweed. Unreported complication of Bravo pH capsule dislodged into the pyriform sinus. Gaviscon also contains sodium bicarbonate and alginic acid. Heartburn Treatment: Natural Antacids, Medication, and More, Causes and Management of Constant Heartburn. Gaviscon can make it harder for your body to absorb other medicines you take by mouth. If you do get a side effect, it's likely to be mild and will go away when you stop taking Gaviscon. I finally got a date for my endoscopy for this week Wednesday. Medically reviewed by Drugs.com on Jun 27, 2022. endobj This is because the medicine will be passed out of your stomach within about 20 minutes of taking it. Last reviewed by a Cleveland Clinic medical professional on 04/02/2021. Now I know that every specialist has the right to have their own requirements and restrictions, but Cleveland Clinic is always rated#1 or #2 for GI issues, and they don't require such a stringent protocol. The alginic acid gives the foam a sticky, gel-like consistency. I have heard that i will need to stop omeprazole 2 weeks before the endoscopy but really don't want to given the reaction last time. I had diarrhoea, really bad trapped wind, my right leg went numb, extreme nausea. More recently as I have had didnt work. 7 years ago, Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The tablets are usually 2 to 4 tablets, up to 4 times a day. If you usually take Gaviscon regularly but forget to take a dose, do not double your dose the next time. Do not follow the instructions on the Golytely bottle. .Gaviscon is also used to provide temporary relief from heartburn and acid indigestion caused by acid reflux. Did you suffer similar side effects and was your dose reduced after 4 weeks, I now have terrible constipation, nothing seems to work , I take macrogol 3times a day and some other stuff ,manage it every 3rd day with hard stool , not very pleasant. We do not endorse non-Cleveland Clinic products or services. Thats why my leg went numb and i got anaemic due to it. Not sure if these are the withdrawal symptoms or related to an underlying problem Anyone with similar experience and how long could it last if its withdrawal symptoms. At present I take 40mg a day at the same time and almost without fail, my reflux starts half an hour or so before I take it. I have used SLIPPERY ELM BARK POWDER for many years - nourishing and good for lining the digestive tract. These drugs reduce the production of stomach acids. The first step to eliminating the globus sensation is to stop the reflux. Gaviscon is unlikely to cause any harmful side effects. Avoid raw fruits and vegetables, whole grains, and nuts and seeds. To make sure this medicine is safe for you, tell your doctor or pharmacist if you have: The day before test: An Endoscopy nurse will call you to tell you what time to arrive at the Endsocopy Unit. Gaviscon is available as a tablet or liquid. U.S. National Medicine. Will meet with your healthcare provider to discuss the results of the monitoring test. I guess it depends on what they are seeking in endoscope. I've had 3 endoscopies and have followed many, many more here on the forum and have never heard of having to go off PPIs for that procedure. Thanks again for your help, if there any other comments or advice, please add to this discussion. Taking Gaviscon on an empty stomach may make it less effective. Policy. Gaviscon may interact with vitamin D and thyroid hormones, decreasing their absorption in the gut. If side effects occur, they tend to be mild but may include: Some of the side effects are due to the taste of Gaviscon, which some people describe as off-putting. Reflux esophagitis. Use exactly as directed on the label, or as prescribed by your doctor. Randomised clinical trial: the effectiveness of Gaviscon Advance vs nonalginate antacid in suppression of acid pocket and postprandial reflux in obese individuals after latenight supper. Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked. Page last reviewed: 10 August 2021 A gastroscopy should not be painful. Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them. Before using Gaviscon, tell your healthcare provider if you have any of the following: Gaviscon is also high in sodium, so you may need to avoid it if you are on a low-salt diet. Same here. I have lost the natural urge to use the toilet and have to apply a bit of pressure to haven some bowel movement daily. There was no suggestion I should stop taking it prior to endoscope. I have a query that I would like some advice for, hoping someone may have gone through similar to me, and be able to give me some guidance. Welcome to Healing Well! and our Coming off PPIs for endoscopy. 7 users are following. Can resume your normal diet and medications. Like Gaviscon, you can buy Peptac or Acidex from pharmacies and supermarkets. Knowing if and when stomach acid backs up into your esophagus can help your provider treat your symptoms. Gaviscon is a very safe medicine. You need to do what the professionals say, they know best in their field. I wish you all the best, try not to stress, it makes it worse. You get what's called a rebound effect where all your symptoms come back with a vengeance and you are supposed to ween off slowly to avoid this but if this isn't possible then you are bombarded with massive acid heartburn as I did. Your provider will apply a local anesthetic (pain-relieving medication) at the back of your throat. They generally work as well as Gaviscon and have similar side effects. aluminum hydroxide and magnesium trisilicate, Gaviscon Regular Strength Tablets side effects, Gaviscon Regular Strength Tablets drug interactions. Ideally I would not want to start on omeprazole again after the endoscopy nick45Rick44 2 years ago Sometimes, stomach acid backs up into the esophagus (the tube that connects the throat to the stomach, or the food pipe) which can increase the acidity level within your esophagus. I found out due to my gut being badly damaged and my villi all flattened in my small intestine that i wasnt able to absorb anything. Has anyone had to stop omeprazole or similar medication before endoscopy? For example, it can help to: If this does not work, your doctor or midwife may recommend a medicine like Gaviscon. The process can be used both to examine your system and to treat certain conditions. Im taking Gaviscon after lunch and before bed. A thin, flexible tube with a camera (endoscope) is passed down your throat. Drug class: Antacids. Thanks for your input Margery, as soon as I find my symptoms starting to get too much to cope with, which I can guarantee they will, then I'll be on to my doctor and the hospital, there's no way I'm going to be in pain for near on 2 weeks. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. I will try a 20mg next two days in hopes I can rapidly wean myself off but fear without a long tapering off I will get rebound. I'm phoning the hospital tomorrow anyway - as I have a few queries of my own. But you can ask for the procedure to be stopped at any time. Stop eating 6 hours before your appointment. They said to ignore and keep taking (in my case, esomeprazole) until 6 hours before the procedure. This is not a complete list of side effects and others may occur. I was scheduled for an endoscopy today, mainly to rule out any other causes of my worsening dysphagia and reflux. How the Antacid Protects Against Acid Reflux. The provider will insert an endoscope into your mouth and into your esophagus (the "food pipe" leading from your mouth into your stomach). My GI doc actually just changed me to this so I would not be without while going through a bunch of tests and possibly procedures. Gaviscon comes as a chewable tablet or liquid. I definitey suffered with reflux during the two prior to my surgery, but thankfully, post-surgery I had no reflux pain at all. When to Take Gaviscon Gaviscon should be taken after meals and at bedtime. I had to stop for 2 weeks 1 time because the omeprazole can mask problems in my case to check whether h pylori infection had cleared. Ask your doctor or pharmacist which one is best for you. So - how do any of you with bad reflux cope if you have to come off PPIs for medical reasons even for short periods? Is it safe to take Gaviscon for a long time? Can anyone offer guidance on how to take these medications? Yeah my first endoscopy showed i had coeliac disease. You can also DGL but double check with your doc on that one, honestly its not enough for me on its own but with a significantly restricted and bland diet its better. By Sharon Gillson Follow up - Double dose (40 mg x 2) esomeprazole for 2 months and then back again for another endoscopy! 1 0 obj Gaviscon should be taken after meals and at bedtime. When reflux occurs on a regular basis, it can cause permanent damage to the esophagus. Youre probably wondering what your Bravo test experience will be like. The active ingredients aluminum hydroxide and magnesium carbonate help neutralize stomach acids. Drinking a glass of water after a dose may help reduce nausea, indigestion and, belching. Scan this QR code to download the app now. You could be having a serious allergic reaction and may need immediate treatment in hospital. He/she will then let you know after your diagnosis whether you . Vaezi MF. ever had an allergic reaction to Gaviscon or any other medicines, been advised to eat a low calcium or low salt (low sodium) diet, you get a skin rash that may include itchy, red, swollen, blistered or peeling skin, your mouth, face, lips, tongue or throat start swelling, antipsychotic medicines (for mental health problems like, do not eat foods that can make your symptoms worse, including rich, spicy and fatty foods, and acidic foods like tomatoes, citrus fruits, salad dressings and fizzy drinks, cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol and smoking, try not to eat for at least 3 hours before you go to bed. If you must need something use Zantac/Rantidine but I'm not sure if it's suitable if your having a endoscopy u must check! 2023 Dotdash Media, Inc. All rights reserved. I was taken off Omeprazole a couple of months ago, just to see how I'd react, and I lasted 3 days before my symptoms flared up and had to go back on them. i just couldn't eat or drink for a number of hours for obvious reasons. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you choose to have sedationplease arrange for someone to drive you home and stay with you overnight. If you dont have acid reflux, your healthcare team can then help you find out what is really causing your symptoms. Ask your doctor, as these remedies will help some. Gaviscon is a popular, over-the-counter antacid used to relieve heartburn in people with occasional acid reflux or GERD. You might be asked to change into a gown at the hospital or outpatient facility. Evaluation of Gastroesophageal Reflux Disease Using the Bravo Capsule pH System. Only treat them with Gaviscon if their doctor prescribes it. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. 6. _Iv_OvWg:H'AD@j? Jay Yepuri, MD, MS, is a board-certified gastroenterologist and a practicing partner at Digestive Health Associates of Texas (DHAT). Don't eat any solid food. Lansoprazole is not suitable for some people. Lawenko RM, Lee YY. Diagnose inflammatory bowel diseases, such as Crohn's disease. Outcome - Grade D oesophagitis (the worst), probably a combination of the previous failure of lansoprazole and the esomeprazole not having a long enough chance to cure it before the 2 week stoppage. However, it may reduce the effectiveness of one type of emergency contraception called Ellaone (ulipristal) if taken together. Available for Android and iOS devices. My pain was high up in the middle between ribcage. Version: 1.01. If your healthcare provider thinks you might have gastroesophageal reflux disease (GERD), they might ask you to have a Bravo pH test. You should not take Gaviscon on an empty stomach. I have been suffering from upper middle stomach tighness (just below ribcage) since early June. GAVISCON- aluminum hydroxide and magnesium carbonate liquid label. I am hoping to have endoscopy done next month. You may report side effects to FDA at 1-800-FDA-1088. You should start to feel better soon after taking a dose of Gaviscon. However, they may be given in different doses to Gaviscon. I was then told there was nothing they could do for me except keep taking the meds and managing it. I was allowed to take a peptac solution when ever the acid got too bad so was taking it daily and it helped. This happens in less than 1 in 10,000 people. they are examining your inner walls. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Your healthcare provider will again explain the procedure and what to expect. You dont need to take medication that is not indicated. Galmiche JP, Bourreille A, Scarpignato C. Drug therapy of gastro-oesophageal reflux. Specialist says I must stop omeprazole for 3-4 weeks before I can have my test otherwise it could hide issues. Try our Symptom Checker Got any other symptoms? Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Aliment Pharmacol Ther. I was in alot of pain couldnt eat, sleep or hardly move. Gastoenterology. I'm happy with the procedure, and the bowel cleansing prep that has to be done before the examination, my main worry is having to come off my PPI Omeprazole 2 weeks before the scopes. These instructions related to most routine procedures are sent out as a standard letter on behalf of the department but they often make exceptions to the rule if you speak to them. However, if you have indigestion, its best to try and treat it without taking a medicine. Gaviscon is a combination medicine that is used to treat heartburn, acid indigestion, sour stomach, or upset stomach. I had been on omeprazole 20mg one daily form 12 June to 5 September and then 10mg daily form 6 September to 5 October and then alternate days until 11 October. Peptic Ulcer Disease as a Cause of Chest Pain, GAVISCON- aluminum hydroxide and magnesium carbonate liquid label, Alginate-Antacid (Gaviscon Double Action) Chewable Tablets Reduce Esophageal Acid Exposure in Chinese Patients with Gastroesophageal Reflux Disease and Heartburn Symptoms, Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor, Drug therapy of gastro-oesophageal reflux, Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate-antacid (Gaviscon Double Action) - a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease, Randomised clinical trial: the effectiveness of Gaviscon Advance vs nonalginate antacid in suppression of acid pocket and postprandial reflux in obese individuals after latenight supper, Allergies to any of the ingredients in Gaviscon. You must have a responsible adult (family member or friend) take you home. These are not all the side effects of Gaviscon. To make sure it's safe for you, tell your doctor before taking lansoprazole if you: have ever had an allergic reaction to lansoprazole or any other medicines have liver problems are pregnant, trying to get pregnant or breastfeeding Notes on Combined Gastroscopy / Colonoscopy preperation advice needed, https://patient.info/forums/discuss/combined-gastroscopy-colonoscopy-preperation-advice-needed-404552. You should avoid drinking anything red or orange. Both are taken by mouth and have different prescribing information. We comply with the HONcode standard for trustworthy health information. endobj Registered in England and Wales. Gaviscon Regular Strength Tablets aluminum hydroxide 80 mg / magnesium trisilicate 20 mg (GAVISCON 1175). Advertising on our site helps support our mission. Gaviscon is probably safe to take long-term. Some types of Gaviscon may be more likely to make you feel sick or cause vomiting, constipation or diarrhoea because of their ingredients. What it did show is that I was/am riddled with pollops which predate the Omeprazole, first endoscope. unless instructed by your physician. i may be wrong, but i've had a few scopes and don't remember having to come off of anything. It's a blip and you can see the end, which is sooner rather than later.

Sims 4 Realistic Pregnancy Mod, Vanderbilt Offensive Coordinator Salary, Articles C