Gastroenterology

Nice | Who should we be testing for cirrhosis?

This is a new guideline from NICE on cirrhosis. The most important bit for us is knowing who should be tested as we may need to be referring these patients on. Higher risk patients Hepatitis B Hepati...

Nice | Coeliac disease

This is an updated guideline on coeliac disease from NICE. They have added a few extra presentations where people should be tested, but otherwise there is little that is new. See my coeliac disease re...

Nice | Naloxegol to treat opioid induced constipation

This is a new guideline from Nice advising that naloxegol can be used for treating opioid induced constipation. Naloxegol is a form of naloxol which has been pegalated and selectively antagonises peri...

Nice | Gatroesophageal Reflux Disease (GORD) in Children

This is a new guideline from Nice on the management of GORD in infants and children. The main differences from common practice is that they advice that PPI or H2 antagonists are only used if other spe...

Nice | Irritable Bowel Syndrome (IBS)

This is an update to the 2008 guideline on IBS from NICE. Most of it is same; I have listed the changes. Diet Most advice is the same. However, for people with symptoms not responding to other treatme...

BGS | Diagnosis and management of adult coeliac disease

This new guideline from the British Society for Gastroenterology (BSG) gives advice on the diagnosis and management of coeliac disease (CD). The diagnosis bits are useful for us as they widen the advi...

Nice | Gallstone disease

This is a new guideline from NICE on gallstone disease. It doesn't say anything very surprising and doesn't change our current management, but does try to unify practice, which can currently be quite ...

Nice | Lubiprostone for treating chronic idiopathic constipation

This is guideline from NICE on a newly recommended treatment for chronic idiopathic constipation. The medication is Lubiprostone, which works by activating chloride channels in the GI tract, thus incr...

Colorectal cancer

Aimee Lettis from the GP Update team gives us short, sharp nuggets of clinical information for sessional GPs. Diagnosing colorectal cancer can be hugely challenging. Many patients come worried they ha...

GP Update | Risk of cancer diagnosis after herpes zoster

We know that shingles occurs more commonly in cancer patients. It has been postulated that the risk of a cancer diagnosis after zoster may also be increased. This large UK-based primary care study has...

BCSH | Vitamin B12 and folate deficiency

This is a new guideline from the BCSH. It is quite a chunky guideline and it covers a lot of detail. I will give a few 'top learning points' then a more detailed summary beneath. At the end I have att...

Pain in the bum

Aimee Lettis from the GP Update team gives us short, sharp nuggets of clinical information for sessional GPs. I’ll cover something you will be familiar with as GPs: anal fissures, as well the new test...

Nice | Dyspepsia and GORD

This is an updated guideline from Nice on dyspepsia and GORD. It updates the guideline from 2004 and I must say I found it quite non-specific and a little confusing about certain aspects, e.g. when en...

Nice | Faecal calprotectin in inflammatory bowel disease IBD

At the moment, we're pretty 'sensitive' at spotting IBD (i.e. we pick up nearly all cases), but we also refer a lot of patients who don't have IBD (i.e. we're not very 'specific'). This is expensive a...

Nice | Ulcerative colitis

This is new guidance from Nice on ulcerative colitis. It really doesn't change anything for us. Treatment remains the same (see my PLOG on the British Gastroenterological Society guideline from 2011)....

Crohn’s Disease

This guideline is mainly relevant for secondary care and doesn’t really change our practice. There are a few useful bits for us. General Information: Stop Smoking – encourage this as has a huge impac...

Oral bowel preparation agents

You may have seen the recent letter from QA asking that we prescribe bowel prep for patients going to endoscopy. This guideline gives advice on how you can safely do this. Portsmouth prefers Picolax (...

Upper gastro-intestinal bleeding

This guideline is aimed at secondary care and bleeding from peptic-ulcers or varices. Bear in mind, that this doesn’t really look at management of other causes of bleeding, like Mallory-Weiss tears an...

Sign | Colorectal cancer

Most of this guideline won’t change our management. The following points are helpful: Prevention of colorectal cancer Patients should be advised to lower their risk by following a healthy lifestyle (...

Colonoscopy for cancer surveillance in Crohn’s/ulcerative Colitis

The main thing for us in this guideline is to refer on for colonoscopy anyone with the following diseases for over 10 yrs: Anyone with ulcerative colitis (other than just proctitis) Anyone with Crohn...