Gastroenterology

Dr Marion Sloan and Dietitian Gillian Goddard discuss IBS and its management in primary care:

Webinar session: Microbiome for Beginners

Webinar session: A fresh talk on Iron deficiency Anaemia in primary care

• If the patient is referred back to GP with advice and guidance, any you need to re-refer – send directly to the hospital. The referral does not need to come back through CASES a second time.

• For iron deficiency anaemia, the critical test is ferritin, iron profile is not needed.

• With any symptoms, if it is cancer, it gets worse. Other causes of diarrhoea for example, can get better. If symptoms are improving then sit tight, review, reconsider.

• Calprotectin
• Unreliable if drinking alcohol, on aspirin, ACEi, NSAIDs and PPIs
• Invalidated in PR bleeding.
• Not suitable for over 65s

• Do not do AFP or CEA as diagnostic tests.

• Reflux: trial a PPI BD 1 hour before food, plus acidex advance and famotidine for 8 weeks. Refer for open access gastroscopy if no improvement.

• NAFLD score: https://www.mdcalc.com/calc/3081/nafld-non-alcoholic-fatty-liver-disease-fibrosis-score

Info required: Age, ALT, AST, platelets, albumin, BMI diabetes status.

If low risk: give lifestyle advice

If indeterminate or high risk: refer hepatology for opinion/fibroscan

• Haemochromatosis family screening: request HFE genotyping (if kids underage and parent do not want testing – test spouse- if negative kids will be carriers, if carrier kids could have 50 % chance of being affected. Generally in Haemochromatosis if ferritin >1000 significant liver damage likely present.  Tests FBC, ferritin, iron studies. HFE genotyping (paper form to SCH genetics lab – yellow/gold top)

• Hepatitis C: now 95-98% curable with new drugs, much less toxic than previous regimes. Worth revisiting if patients became disengaged. Screen risk groups: (Ex-IVDU, haemophilia, migrants from high risk areas, babyboomers). Refer hepatology if liver damage otherwise infectious diseases

• Bacterial overgrowth: look out for high folate and low B12

• New onset watery diarrhoea and age > 60, check drugs – common causes – lansoprazole, sertraline

• Food bolus or obstruction/choking episode, refer for open access gastroscopy.

• Cancer, FIT & Calprotectin
  • NICE guidance on when to use FIT
  • Faecal calprotectin in primary care
• IBS
  • NICE Pathway
  • IBS Network : The IBS Network is a national charity; it provides information, advice and support for people with IBS and works alongside health care professionals to facilitate self care.
  • Local IBS-C guideline
  • Community Dietitian Service
• GORD
  • NICE Pathway
  • Balancing risks & benefits of PPIs
  • Gastro-oesophageal Reflux Disease (GORD)
  • Dr Kumar Basu’s helpful resources :
    • GP update article in Prescriber (March 2016)
• Abnormal LFTs
  • The CCG PRESS PORTAL has updated pathways on the following :
    • Isolated Hyperbilirubinaemia
    • Isolated raised Alk Phos
    • Isolated raised ALT
• Coeliac disease
  • NICE Pathway
  • Sheffield CCG Gluten-free prescribing guidelines
• PCSG
  • The PCSG (Primary Care Society for Gastroenterology) aims at promoting best practice in primary care gastroenterology. PCSG GP membership is open to all UK registered medical practitioners, nurses and those with an interest in primary care gastroenterology. You must be a member to access guidelines on its website.