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Parenteral Nutrition: A Mixed Bag (2010)

A Mixed Bag: An enquiry into the care of hospital patients receiving parenteral nutrition

This NCEPOD report highlights the process of care of patients who receive Parenteral Nutrition. These are patients with a compromised nutritional status, where oral or enteral feeding is not an option. The report takes a critical look at areas where the care of patients might have been improved. Remediable factors have been identified in the clinical and the organisational care of these patients.

The report may be downloaded from the NCEPOD website:

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.