Login:
 

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]

Diagnosing and managing inflammatory bowel disease

25 Jul 2013Paid-up subscribers

Inflammatory bowel disease (IBD) has a prevalence of around 400 per 100,000 in the UK. The two major types of IBD are ulcerative colitis and Crohn’s disease. Both are characterised by a relapsing and remitting course.  Inflammatory markers in the blood are not always raised in ulcerative colitis. The diagnosis is confirmed by typical histological features on biopsy.

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]

Early diagnosis improves survival in colorectal cancer

26 Jul 2012Paid-up subscribers

Colorectal cancer is the second most common cause of death from cancer in the UK. The UK has one of the lowest survival rates for colorectal cancer in Europe. Collaborative work from cancer registries across Europe has indicated that early symptom recognition and early diagnosis are important factors in improving survival. GPs play an important role in recognising symptoms and supporting patients through the investigation and ongoing management of their disease.  [With external links to current evidence and summaries]

Diagnosing and managing acute diverticulitis

26 Jul 2012Paid-up subscribers

Acute diverticulitis is the most common complication of diverticulosis. Patients should be assessed according to their level of pain and associated systemic features of sepsis. In those in whom the pain is controlled and there are no signs of systemic sepsis and no high-risk features (immunocompromise, transplant patients, systemic immunosuppression) the patient may be treated in primary care but for those with systemic features of sepsis or high-risk features admission to hospital is required.

Upper GI bleeding requires prompt investigation

08 Aug 2011Paid-up subscribers

Upper GI bleeding is a common medical emergency with an incidence in the UK of 103 cases per 100,000 adults per year and is much more common in the elderly. A national audit on the management of upper GI bleeding in the UK, conducted between 1993 and 1994, showed 30-day mortality to be 14%. Several recommendations were made, including urgent endoscopy in high-risk patients and admission or early referral of patients with upper GI bleeding to gastroenterology teams. However, despite improvements in endoscopy, recognition of provoking factors and pharmacological interventions available when the audit was repeated in 2007 the mortality rate still remained significant at 10%.Rapid appropriate assessment and referral for early endoscopy can prevent morbidity and possibly reduce mortality. The use of reliable scoring systems has enabled early discharge and an evidence-based approach to subsequent secondary prevention can avoid recurrence.

Diagnosing and managing pancreatic cancer

07 Aug 2011Paid-up subscribers

Adenocarcinoma of the pancreas is one of the top ten leading causes of cancer deaths and in the UK approximately 8,000 people are diagnosed with the disease each year. The incidence is similar in men and women and rises with age. Rates increase significantly in people aged 45 years and over and around three-quarters of patients diagnosed with pancreatic cancer are over the age of 65. Treatment options include resectional surgery, which is the only chance of cure from the disease; and palliative stenting, chemotherapy and radiotherapy. Overall, the long-term prognosis of the disease is poor with a one-year survival rate of approximately 10-20%. For non-metastatic disease, median survival is six to ten months, although for those with metastatic disease at presentation median survival is only three to six months. Both one- and five-year survival rates for pancreatic cancer in the UK are lower than the European average. Despite improvements in imaging, surgical techniques and chemotherapy, overall survival has not improved appreciably in the past few decades.  [With external links to current evidence and summaries]

Be vigilant for patients with coeliac disease

01 Oct 2009Paid-up subscribers

Recent population studies show that coeliac disease is a common condition affecting around 1 in 100 people. The estimated ratio of diagnosed to undiagnosed individuals is 1:8, and the average delay in diagnosis is reported to be 11 years. The presentations are protean and patients are increasingly diagnosed later in life. The contemporary coeliac patient is diagnosed between the ages of 40 and 60, has a normal or even high BMI, and subtle symptoms.