Gastroenterology

Useful links

• Cancer, FIT & Calprotectin
  • NICE guidance on when to use FIT
  • 2ww Upper GI
  • 2ww Lower GI
• 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
  • GORD on Sheffield CCG Portal
  • 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.

Top Ten hints: Gastroenterology

1. If sending a surgical request send direct and not through CASES gastro.

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

3. For iron deficiency anaemia, the critical test is ferritin.

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

5. Calprotectin:

– Unreliable if on aspirin, NSAIDS and some ACE inhibitors

– Invalidated in pr bleeding

– Not suitable for over 60s

6. Do not do CEA or AFP as a diagnostic test.

7. Reflux:  trial a ppi bd 1hour before food, plus ranitidine and gaviscon advance at night for 8 weeks.  Refer if no improvement.

8. NAFLD score: get the app on your phone & computer, info required:  Alter, ALT und AST, BMI, ?diabetic, platelets

If low risk:  give lifestyle advice

If intermediate or high risk: refer for opinion/FibroScan

9. Haemochromatosis family screening: request HFE genotyping (if kids under age 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 Haemaochromatosis if ferritin >1000 significant liver damage likely present.  test fbc:  ferritin: iron studies

10. Hep C now 95-98% curable with new drugs:  much less toxic than previous regimes.  Worth re-visiting if patients became disengaged. Screen risk groups: (Ex-)IVDA, haemophilia, migrants from high risk areas, “babyboomers”.

11. Bacterial overgrowth: look out for high folate and low B12

Videos:

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