Gastroenterology

Introduction

Welcome to the Gastroenterology CASES webpage. We hope you will find the links and videos educationally useful and relevant.
The Pie chart below represents the breakdown of gastroenterology referrals received into CASES from the Pilot launch until 31 January 2017. Around 20% of the referrals were sent back to practices with advice on management that can be carried out in primary care. A further 3% were sent back to practices asking for more information to be included in the referral letter before sending on to secondary care.

Dr Marion Sloan, Dr Scot Darling, Dr Jim Lee and Dr Qumer Younis are our peer reviewing GPs for gastroenterology. They are mentored by Dr Basu, Consultant Gastroenterologist at Sheffield Teaching Hospitals NHS Foundation Trust.

Educational materials and advice

Please contact PCS if you feel you would benefit from receiving CASES information based on individual GP or Practice referrals for reflective learning (please note this can support CPD training and appraisal). You may wish to use the below template:

Record of learning template

Videos:

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

Useful links

IBS (irritable bowel syndrome) Network The IBS Network is the national charity supporting people living with Irritable Bowel Syndrome. It provides information, advice and support for people with IBS and works alongside health care professionals to facilitate self care
NICE guidelineson IBS:
Link to Dietetic referral form on PRESS PORTAL
Recently updated CCG guidelines on gastroscopy and Gastroesophageal reflux disorder (GORD)
Gastroscopy Referral Form Open Access Gastroscopy
The CCG PRESS PORTAL has updated pathways on the following

Dr Kumar Basu’s article in Prescriber March 2016 for a GP update (ref: CCG PRESS PORTAL)
Video and Podcast By Dr Basu on GORD and its management: This is also available on the PRESS PORTAL.
PPI Paper On the PRESS PORTAL
Primary care society for Gastroenterology (PCSG): The PCSG 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

Meet the review team

Dr Scot Darling

Dr Darling qualified from Sheffield University in 1989. He worked in partnership in the city for 15 years and obtained Membership of the Royal College of General Practitioners in 2004. Since then he has been a sessional GP. He is a medical student tutor and GP appraiser. Dr Darling has a special interest in medico-legal work.

Dr Marion Sloan

Dr Sloan is a GP Partner at the Sloan Medical Centre and has been a GP for 38 years. She has a career-long interest in gastroenterology and is a committee member of the Primary Care Society for Gastroenterology. Dr Sloan has worked as a Hospital Practitioner at STH since 1983, undertaking upper / lower GI endoscopy and out patient clinics and she developed and ran a Community Gastroenterology Service.

Dr Jim Lee

Dr Lee completed his undergraduate and VTS training in Sheffield and is a partner at Nethergreen Surgery. He has recently returned from sabbatical in Australia and is looking forward to helping improve patient care in an ever-changing NHS. A member of the Primary Care Gastroenterology Society, he looks forward to being involved with the educational and service improvement opportunities that CASES provides.

Dr Qumer Younis

Dr Younis qualified from the University of Sheffield in 2008. He is truly a local GP having been born and bred in Sheffield. He undertook all his undergraduate and postgraduate training in South Yorkshire. Dr Younis worked in gastroenterology as a Junior Doctor and has always maintained an interest since. He has worked as a GP at Heeley Green Surgery since 2012. Dr Younis also works at the Sheffield GP Collaborative. He is a medical student tutor and examiner for the University of Sheffield Medical School. Dr Younis sits on the Continuing Healthcare Eligibility and Retrospective panels for NHS Sheffield CCG. He is keen to enhance the patient experience and improve the communication between primary and secondary care.