Gastroenterology

Management of pancreatitis

This is a new guideline from NICE on pancreatitis from Sep 2018. Most of it is aimed at secondary care, but there are a few things that are useful for us which I've outlined below. Advice to give patients Recovery can take up to 3 x as long as the hospital stay (which can itself…
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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 review from earlier this year. When to test. In addition to the previous advice, they now suggest testing people with: Severe or…
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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 peripheral opioid receptors. It can be used IF the constipation has not responded adequately to at least one other class of laxative taken for…
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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 treatments, NICE advises that single item dietary exclusion could be tried. This includes the FODMAP diet (fermentable oligosaccharides,…
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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 variable. Remember that 15% of adults have gallstones, but only some of these will go on to have symptoms from them. Investigations LFT USS…
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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 increasing intestinal secretions and improving constipation. It has a different method of action to prucalopride, which NICE released guidance on in 2011. Lubiprostone is more cost-effective than…
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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 have colorectal cancer and it can be difficult to determine who needs investigation. Focusing on colorectal cancer, survival is significantly better if detected early, but…
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