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Symposium articles on gastroenterology

Improving the detection of coeliac disease

01 Aug 2016Paid-up subscribers

The common presentation of coeliac disease has shifted from the historically classical symptoms of malabsorption in childhood to non-classical symptoms in adulthood such as irritable bowel syndrome-type symptoms, anaemia, chronic fatigue, change in bowel habit, abdominal pain and osteoporosis. A combination of coeliac serology and duodenal biopsy is required to diagnose coeliac disease in adults. A lifelong strict gluten-free diet is the only effective treatment currently available. All patients should be referred to a specialist dietitian for guidance and support.

 

Diagnosis and treatment of inflammatory bowel disease

01 Aug 2016Paid-up subscribers

Patients with inflammatory bowel disease (IBD) may previously have received a diagnosis of irritable bowel syndrome and there may be a delay in making the correct diagnosis. This is particularly the case in patients with ileal Crohn’s disease and those under 40. Diagnosis of IBD involves endoscopy and biopsy. Approximately 25% of people with IBD will have extra-intestinal manifestations of the disease, involving skin, eyes, joints or the liver. There is an increased risk of colorectal cancer in patients with ulcerative colitis.

Diagnosis and treatment of gallstone disease

22 Jun 2015Registered users

Gallstone disease increases with age. Women have a higher prevalence of gallstones than men, which is attributed to exposure to oestrogen and progesterone. Liver function tests and an abdominal ultrasound should be offered to patients with symptoms suggestive of gallstone disease (e.g. abdominal pain, jaundice, fever). They should also be considered in patients with less typical but chronic abdominal or gastrointestinal symptoms.

Managing irritable bowel syndrome in primary care

22 Jun 2015Registered users

The classic symptoms of irritable bowel syndrome (IBS) are abdominal pain, bloating and some form of bowel dysfunction. The abdomen feels flat in the morning and then gradually becomes more bloated as the day progresses reaching a peak by late afternoon or evening. Rectal bleeding, a family history of malignancy and a short history in IBS should always be treated with suspicion. Both pain and bowel dysfunction are often made worse by eating. It is recommended that a coeliac screening test is undertaken to rule out this condition.

Detecting patients with cirrhosis in primary care

25 Jul 2014Paid-up subscribers

Cirrhosis is a condition that arises as a result of chronic liver damage, typically over many years. It is characterised by fibrosis and nodularity of the liver parenchyma. Common causes of chronic liver disease include alcohol, non-alcoholic fatty liver disease and chronic viral hepatitis. Nearly half of patients with cirrhosis are asymptomatic. As a result the condition may only be discovered incidentally as a result of abnormalities in liver function tests or imaging of the abdomen performed for other reasons. Alternatively patients may present with signs and symptoms of the complications of cirrhosis e.g. jaundice, ascites, variceal bleeding, hepatic encephalopathy or hepatocellular carcinoma. The gold standard test for the diagnosis of cirrhosis remains a liver biopsy.

Early endoscopy improves survival in gastric cancer

25 Jul 2014Paid-up subscribers

Gastric cancer often presents late and the mortality ratio remains one of the highest compared with more common cancers. Early diagnosis improves survival in this potentially curable cancer. Dysphagia, weight loss and age over 55 are significant predictors of cancer. All patients presenting with dyspepsia and either alarm features or known conditions that increase the risk of gastric cancer should be referred for urgent endoscopy. Given that the majority of gastric cancer cases occur in people over 55, urgent endoscopy is also recommended in patients in this age group with new uncomplicated dyspepsia prior to treatment, even without alarm symptoms or if the symptoms respond to treatment. [With external links to current evidence base]

Improving the detection and treatment of liver cancer

25 Jul 2013Paid-up subscribers

Liver cancer is the sixth most common cancer worldwide. Over the past decade survival in liver cancer has been steadily improving as a result of developments in surgery, transplantation and the introduction of a number of novel local, ablative and molecular targeted therapies. [With external links to current evidence and summaries]

 

Children

Education key in tackling childhood constipation

20 Jul 2010Paid-up subscribers

Constipation is the most common childhood gastroenterological  problem, affecting 5-30% of children. Up to a third of these children will develop chronic constipation. The signs and symptoms of constipation in children are seldom clear and there is frequently a delay in seeking help in either a primary or secondary care setting. Patients and their parents often express concern that healthcare professionals do not take the problem seriously and the advice given is sometimes contradictory. Chronic constipation and soiling can have a massive impact on all aspects of a child's life, and that of their family, causing social, educational and psychological problems. [With external links to the evidence base]

Managing diarrhoea and vomiting in children

27 Aug 2009Paid-up subscribers

Diarrhoea and vomiting are common symptoms in children. In the majority of cases all that is required is some basic advice on management and appropriate reassurance. However, a few children will be at greater risk of complications or will deteriorate and require hospitalisation. GPs need to be able to differentiate between these groups and recognise the symptoms and signs requiring more active intervention. Guidance from NICE on the diagnosis, assessment and management of diarrhoea and vomiting in children under five provides a synthesis of evidence to aid GPs in the process.It also challenges some of the popular lay and professional myths that have developed around the management of gastroenteritis. [With external links to the evidence base]

 

Primary Care Society of Gastroenterology