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Clinical Education Articles

Our clinical education articles are part of a new venture from the BSG Education Committee designed to provide updates on hot topics in gastroenterology for consultants, trainees and nurses alike.

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Hot on Liver

Authors: Dr Paul Horn, Prof Philip N Newsome

Key learning points

  1. How to diagnose NAFLD and NASH
  2. How to risk-stratify patients with NAFLD and NASH
  3. Stage-dependent treatment of liver disease


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Authors: Dr Aditi Kumar and Professor Matthew Brookes

Inflammatory bowel disease (IBD) is a chronic and relapsing inflammatory disorder of the gastrointestinal tract. Diarrhoea is the presenting complaint in the majority of patients, with 85% reporting it as their initial symptom. It can become confusing whether persistent diarrhoea is due to active IBD or other co-existing diseases, often leading physicians to believe that a patient has refractory IBD when they do not respond to standard IBD treatment. In this instance, measuring faecal calprotectin levels and comparing them with previous measurements during active disease can be useful to confirm active inflammation. This article focuses on three common causes seen with stable IBD: bile acid malabsorption (BAM), small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS)

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Neurogastroenterology & Motility

Dr Peter Paine highlights a case study of chronic continuous abdominal pain.

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Highlights from the BSG Masterclass 2019

Learning points:

  • The risk of thiopurine-induced lymphomas can be limited by restricting the use of thiopurines in EBV-seronegative patients and older men
  • The carcinogenic role of anti-TNFs is still controversial (lymphomas) and there are no robust data for any other immunosuppressants
  • Sun protection and skin surveillance are recommended from diagnosis in all patients with IBD
  • In patients with previous cancer at substantial risk of recurrence: 1) try to respect a 2–5-year pause in the use of immunosuppressive drugs, except in patients with severely active disease without relevant therapeutic alternative; 2) prioritise the use of IBD drugs that are associated with the lowest carcinogenic effects


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