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Symposium articles on gastroenterology

Be vigilant for non-alcoholic fatty liver disease in primary care

28 Jul 2017Registered users

Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of chronic liver disease in the Western world. Between 10 and 30% of NAFLD patients will develop non-alcoholic steatohepatitis (NASH) with a risk of progression to cirrhosis. Of those with NASH and fibrosis at presentation, studies have suggested that approximately 21% of patients will have some regression of fibrosis while 38% of patients will progress over five years’ follow-up.

Chronic pancreatitis may be overlooked and undertreated

28 Jul 2017Registered users

The prevalence of chronic pancreatitis is variable, with estimates between 4 and 52.4 per 100,000. A mismatch exists between reported incidence and prevalence in many studies suggesting chronic pancreatitis is under recognised. One cause for this mismatch is that once diagnosed many patients are lost to secondary care follow-up. Therefore, although a GP may only see two new cases during their career they are likely to encounter patients requiring recurrent consultations.

Diagnosis and treatment of inflammatory bowel disease

01 Aug 2016Registered users

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.

Improving the detection of coeliac disease

01 Aug 2016Registered users

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 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.

 

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