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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Specialty Certificate Examination
The Exam: The BSG, in partnership with the Federation of Royal Colleges of Physicians of the UK organises and delivers the Specialty Certificate Examination in Gastroenterology. The first examination was held in 2008. The examination is currently held in April every year.
UK Trainees: The Specialty Certificate Examination (SCE) is a compulsory component of assessment for Certificate of Completion of Training (CCT) for all UK trainees. The examination compliments workplace-based assessments and ensures that trainees have sufficient knowledge to practice safely and competently as consultants.
Outside the UK: The SCE is open to all doctors who are in training or have completed their training from any part of the world. Applicants are no longer required to hold the MRCP (UK). The exam is a computer-based test and is held in several centres throughout the world.
Date of SCE Examination: The next Gastroenterology SCE Examination will take place on 20th April 2016. Registration opens in December 2015.
Dr Mounes Dakkak
Lead Specialist for Gastroenterology SCE
Duty of Candour – Advice for Gastroenterologists
Being open and honest with patients is something that all practising gastroenterologists in the UK have probably taken for granted throughout their career. However, in 2015 explicit guidance was published by the GMC along with the nursing and midwifery council highlighting the professional duty of candour for doctors (1) and furthermore there are now plans to implement a statutory duty of candour for healthcare providers in all four nations of the UK.
In essence the professional duty of candour can be summarised as: "Every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress. This means that healthcare professionals must:
- Tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong.
- Apologise to the patient (or, where appropriate, the patient’s advocate, carer or family).
- Offer an appropriate remedy or support to put matters right (if possible).
- Explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened."
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Cancer Genetics in Clinical Practice
A Guide to Cancer Genetics in Clinical Practice
BSG member Sue Clark has recently published a new textbook 'A GUIDE TO CANCER GENETICS IN CLINICAL PRACTICE' which has a significant gastroenterology content.
This book covers the basic concepts of cancer genetics. The common inherited cancer syndromes are each dealt with in greater depth, with the current management outlined. It is aimed at all clinicians who may encounter these conditions in their practice. The book sets out to facilitate identification of high-risk individuals and families, to inform interaction with geneticists and other sub-specialists, to provide a basis for patient management and to stimulate interest in these fascinating conditions.
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Publication date: June 2009
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.
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