BSG

BSG Guidance on Coeliac Disease 2010

The Management of Adults with Coeliac Disease

Summary

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.

 

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

Joint Response

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
 

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.

   

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).

 

The Role of Faecal Calprotectin in Primary Care

A joint position statement by the Neurogastroenterology & Motility and IBD sections of the BSG:

Faecal calprotectin is recommended for use in primary care to aid in the differential diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) in adults with recent onset lower gastrointestinal symptoms for whom specialist assessment is being considered1. This should be in patients aged less than 60 with inflammatory bowel type symptoms in whom cancer is not suspected. Appropriate quality assurance processes and locally agreed care pathways should also be in place for the testing. A normal cut off value of 50µg/g is recommended2. It is anticipated that this strategy would lead to a reduction in secondary care referrals and colonoscopies with associated reduced cost and morbidity1,2,3.

Faecal calprotectin is additionally recommended for use in follow-up of patients with inflammatory bowel disease for detection of relapse or treatment failure in secondary care. A normal cut off value of 250µg/g is recommended3. A lower cut off of 50µg/g could be considered in secondary care to differentiate inflammatory from non-inflammatory lower gastrointestinal symptoms2.

References:

  1. NICE guidance DG11 Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel: guidance
  2. Faecal calprotectin for differentiating between irritable bowel syndrome and inflammatory bowel disease: a useful screen in daily gastroenterology practice. Banerjee A et al. Frontline Gastroenterology in Press
  3. Utility of Faecal Calprotectin in Inflammatory Bowel Disease (IBD) – what cut offs should we apply? Dhaliwal A et al. Frontline Gastroenterology in Press
   

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