BSG Guidance on Coeliac Disease 2010
The Management of Adults with Coeliac Disease
There is clear evidence that coeliac disease is a common gastrointestinal disease affecting up to 1% of the adult population. Individuals may go undetected for many years. This is despite multiple presentations to both primary and secondary care. This may reflect that fact that affected individuals have subtle gastrointestinal symptoms or no gastrointestinal symptoms.
An active case finding strategy will increase the number of patients detected with coeliac disease. Testing for coeliac disease should incorporate an IgA level, Tissue Transglutaminase antibody and/or Endomysial antibody (depending on what is locally available). In patients with a positive antibody a duodenal biopsy should be undertaken to confirm the presence of villous atrophy. In patients who are antibody negative but the clinician is suspicious then a duodenal biopsy should still be undertaken having ensured that the patient is not on a self-imposed gluten-free diet (GFD).
The cornerstone of treatment is a GFD. Patients require regular dietetic support with the opportunity or access to a gastroenterologist should further problems arise. Follow-up may be in primary or secondary care as long as the support is adequate (as noted previously).
In patients with persisting symptoms they should be investigated carefully with particular reference to ensuring that refractory coeliac disease is excluded.
The provision of a percutaneously placed enteral tube feeding service
David Westaby, Alison Young, Paul O'Toole, Geoff Smith, David S Sanders
This guideline, relating to the provision of a percutaneously placed enteral tube feeding service, is focused upon a specific area of nutrition provision that has not been previously targeted. It should be read in the context of other recent guidelines, which have covered the wider field of nutrition provision. The present guideline includes a summary of the ethical issues associated with enteral tube feeding, but these issues are dealt with in detail by the Royal College of Physicians working party report on oral feeding. Furthermore there is no reference to the provision and make-up of the enteral feeds themselves (an area well covered in the reports referred to). The aim of the guideline is to identify the role of percutaneously placed enteral feeding tubes within the wider context of nutrition provision. Guidance is provided for patient selection, the technical aspects of tube placement as well as the prevention and management of associated complications, with an emphasis on endoscopic tube placement (rather than radiological or surgical techniques). The target audience is wide, and includes consultants and specialist registrars in gastroenterology, surgery and radiology, nurse endoscopists and endoscopy nurses, dietitians and nutrition nurse specialists (both hospital and community based). This guideline also provides a basis upon which a primary care trust can purchase enteral nutrition services.
- Download full guideline [ 363 kb ]
BSG Response to White Paper: 'Healthy Lives, Healthy People'
Responses to Public Health White Paper: 'Healthy Lives, Healthy People: Our Strategy for Public Health in England'
Submitted 31st March 2011
- BSG Response [ 270 kb ]
The organisations that contributed to the joint response are:
- The British Association for the Study of the Liver
- The British Society of Gastroenterology
- The British Liver Trust
- The Hepatitis C Trust
- Alcohol Concern
- Joint Response [ 528 kb ]
Chicago Classification Criteria of Esophageal Motility Disorders (EPT)
Chicago Classification Criteria of Esophageal Motility Disorders Defined in High Resolution Esophageal Pressure Topography (EPT)
High resolution esophageal pressure topography (EPT) is an evolutionary technology incorporating the combination of high resolution manometry (HRM) and pressure topography plotting in the form of Clouse plots introduced in 2000 for the clinical evaluation of esophageal motility. Prior to that, EPT had been developed and utilized as a highly innovative research modality. The HRM Working Group first met in San Diego during DDW 2007 with the objective of adapting EPT to the clinical evaluation of esophageal motility. Since then, a series of HRM Working Group meetings have ensued on a more-or-less annual basis to review, critique, and plan the iterative process of developing a practical classification for esophageal motility disorders based on EPT-specific metrics and criteria. The classification scheme was initially branded 'The Chicago Classification' in 2007 following a series of seminal publications defining key EPT metrics and interpretation criteria optimized for clinical EPT studies emanating from a group of investigators at Northwestern University in Chicago. Since then, two iterations of the Chicago Classification have been published summarizing the incremental development of the classification scheme. The most recent meeting of the HRM Working Group was in Ascona, Switzerland in conjunction an international congress focused on the clinical evaluation of esophageal disease. This paper summarizes the Chicago Classification of esophageal motility disorders emanating from the meeting at the Ascona congress.
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Consensus statements for management of Barrett's dysplasia and early-stage oesophageal adenocarcinoma
NICE has accredited the process used by the BAD CAT (BArrett's Dysplasia and CAncer Taskforce) consensus group to produce its guidelines using consensus statements for management of Barrett's dysplasia and early-stage oesophageal adenocarcinoma. Accreditation is valid for 5 years from September 2012 and is retrospectively applicable to guidance produced using the processes described in the International consensus of the management of dysplastic Barrett's and cancer (2010).
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