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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.

For Trainees, BSG is collating articles of specific interest to you. You can access articles for Trainees here: career articles.

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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IBD

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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Endoscopy

  • Endoscopic therapy is required for peptic ulcers with spurting or oozing active bleeding (Forrest 1a or 1b lesions) or visible vessels (Forrest 2a)
  • Ulcers with adherent clots (Forrest 2b) should have the clot removed where possible and endoscopic therapy applied if active bleeding or a visible vessel is identified
  • Do not use adrenaline alone for endoscopic management of non-variceal bleeding
  • Clips are particularly useful for raised vessels in an accessible, non-fibrotic ulcer
  • Hemospray® is a useful rescue procedure, often as a temporising measure prior to definitive therapy
  • OTSC appears effective as rescue procedure for recurrent ulcer bleeding and other causes of non-variceal bleeding not controlled by standard endoscopic therapy
  • Variceal band ligation and injection of cyanoacrylate (or thrombin) are the endoscopic therapies of choice for oesophageal and gastric variceal bleeding, respectively
  • SX-ELLA Danis™ stent placement appears superior to traditional balloon tamponade as temporary rescue for refractory oesophageal variceal bleeding

 

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‘Genomics in Gastroenterology’ specialist resource

The Genomics Education Programme (GEP) has launched a new resource for those working in gastroenterology, endoscopy and others involved in the management and treatment of gastrointestinal diseases. This new resource has been developed in collaboration with Professor Kevin Monahan, consultant gastroenterologist at St Marks Hospital, Harrow. In the film, he explains how the use of genomics in gastroenterology can help in the diagnosis, treatment, and management of a whole range of rare and common conditions.

The ‘Genomics in Medical Specialties’ series looks at the impact of genomics across different disciplines within medicine, with a focus on the way in which new technology and rapidly increasing knowledge are changing the way we work and the ways in which patients are treated and cared for.

The full resource is available on the GEP website, and comprises of a short film and accompanying information covering key facts and uses.