Ingest

Ingest

By PCSGScienceMedicineEducation
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Ingest episodes

  • IBD Flare Management

    In this episode Charlie Andrews speaks to Dr Kevin Barrett about IBD flare management.  On average, 50% of patients will flare annually, and often the GP surgery is the first port of call.  We therefore need to know how to assess and manage patients presenting with symptomatic IBD.  Kevin Barrett, IBD clinical champion for IBD for the RCGP and Crohns and Colitis UK (2017-2021) shares his wealth of knowledge about IBD flare management.  We discuss how if can affect patient's quality of life, common symptoms of IBD flare, calprotectin testing and the management of IBD flare. 

    27 min
  • Updated guidance on FIT testing in primary care

    In this episode, Charlie Andrews speaks to Dr Kevin Monahan, lead author for the joint guidelines published by the BSG and ACPGBI in July 2022 outlining the role of FIT testing in patients with symptoms suggestive of colorectal cancer.  These guidelines have informed how we use FIT in primary care, and in this episode he asks Dr Monahan how this guideline has changed clinical practice, they discuss when it should be used and what to do if you have ongoing concerns about your patient's symptoms.  In addition, they discuss specific situations such as iron deficient anaemia, rectal bleeding, whether we can use it in younger age groups, and whether there is a role for repeat FIT testing.  

    A link to the full guideline can be found here: https://www.bsg.org.uk/clinical-resource/faecal-immunochemical-testing-fit-in-patients-with-signs-or-symptoms-of-suspected-colorectal-cancer-crc-a-joint-guideline-from-the-acpgbi-and-the-bsg/

    32 min
  • Abnormal LFTs and non-alcoholic liver disease

    Did you know that according to the British Liver Trust, up to 20% of the general population has non-alcoholic liver disease ('fatty liver disease') and the prevalence is predicted to rise over the coming years.  Morbidity associated with this can be significant, with a proportion of patients with fatty liver disease developing fibrosis of the liver as the disease progresses.  Diagnosing fatty liver disease and identifying those at risk of progression to fibrosis is therefore important.  In this episode I speak to Dr Helen Jarvis, a GP with a specialist interest in liver disease.  We discuss an approach to the patient with abnormal LFTs, and we look at the common causes of abnormal LFTs, with a particular focus on non-alcoholic fatty liver disease.  Helen demystifies the commonly used tests for assessing for fibrosis in fatty liver disease, and how we can empower our nursing teams to assess for fatty liver disease when abnormal LFTs are identified at chronic disease reviews.  

    41 min
  • Coeliac disease management and follow-up

    Join Charlie Andrews in this episode where he speaks to Cristian Costas about the management of people diagnosed with coeliac disease.  Cristian is a dynamic dietician who is based in Bradford.  He is passionate about coeliac disease and runs an innovative dietician-led service for those with coeliac disease in his area.  

    Cristian shares with us his top tips for supporting someone newly diagnosed with coeliac disease, including where to access support for those who are newly diagnosed, and how to avoid common dietary pitfalls.  We discuss how best to follow-up people with coeliac disease, and key interventions such as assessments for osteoporosis and vaccinations for coeliacs.  

    We know that education and the support of a dietician are key interventions that can help patients manage the gluten-free diet effectively, and in this episode, Cristian shares his passion for improving the care for those with coeliac disease.  An informative, enjoyable and inspiring listen!

    36 min
  • Background to FIT testing in primary care

    In primary care, we are increasingly using FIT (Faecal Immunochemical Testing) to assess the risk of bowel cancer in patients with lower gastrointestinal symptoms, whilst the latest PCN DES IIF (Impact and Investment Fund) has given FIT a prominent role in risk stratifying 2-week wait referrals to secondary care.  

    In this episode, Mo Thoufeeq, a gastroenterologist in Sheffield, talks to me about what FIT is, how it differs from previously used FOBT (and why it is a more effective test!), and how we are using FIT in both symptomatic and asymptomatic patients.  He shares his top tips about how to interpret, when to test and we discuss the tricky areas of patients with rectal bleeding and those with iron deficient anaemia.  

    Mo has a deep knowledge and understanding of FIT and provides a fantastic and relevant discussion of the topic for our primary care audience in this episode.  

    32 min
  • Bridging the gap between primary and secondary care in inflammatory bowel disease (IBD)

    In this episode, I am joined by Pearl Avery.  Pearl has a unique role - she spends part of her week as an IBD nurse specialist, and part of her week as an ANP (Advanced Nurse Practitioner) working in a GP practice.  Pearl has a fantastic understanding of both primary and secondary care and shares her experiences with me.  

    We discuss her unique and innovative role, common queries from GPs and patients from her IBD nurse specialist role (including common questions about flare management and biologic monitoring), and what she has learned about the care of people with IBD from her primary care role. 

    I felt extremely energised and enthusiastic after speaking to Pearl and took home some great top tips.  This episode really demonstrates the benefit of working collaboratives and 'bridging the gap' between primary and secondary care.  

    32 min
  • Inflammatory Bowel Disease (IBD)

    I speak to Chris Lamb about IBD.  Chris was lead author on the BSG IBD guidelines which were published in 2019.  The full guidance can be found here:  BSG-IBD-Guidelines-2019.pdf Chris is a fount of knowledge for all things related to IBD and I have a fascinating chat with him about the guidance and how these relate to primary care - we range over all aspects of IBD from diagnosis to management and everything in between.  

    35 min
  • Chronic diarrhoea

     In this episode, I speak to Professor Ramesh Arasaradnam.  Ramesh co-authored the BSG guidelines on chronic diarrhoea in 2018, and is a fount of knowledge in this area. 

    43 min
  • Functional Dyspepsia

    Affecting up to 20% of the UK population, dyspepsia is commonly seen in primary care.  Following investigations, the majority of people (up to 89%) are found to have functional dyspepsia. As with any functional problem of the gut, such as IBS, making a confident diagnosis is sometimes challenging but extremely important for the patient, and management encompasses a range of non-pharmacological interventions.

    Pali Hungin, an extremely experienced primary care clinician and a founding member of both the PCSG and it’s European counterpart, shares his vast experience and understanding of functional dyspepsia with us in this episode.  As chair of the ROME VI primary care committee, Pali is hugely knowledgeable about this complex yet common condition.   

    29 min
  • H. Pylori

    This edition of the podcast series Ingest published by the Primary Care Society for Gastroenterology (PCSG) features a very special guest from the world of gastroenterology. 

    Dr Charlie Andrews talks to Nobel Prize laureate Professor Barry Marshall, the Director of the Marshall Centre founded in 2007 in his honour, the Western Australian Ambassador for Life Sciences and University of WA Brand Ambassador, about his discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.

    Key Learnings from the Podcast

    What is Helicobacter pylori?

    • H. pylori is a microaerophilic bacterium that resides in the mucous layer of the stomach lining, not invading the bloodstream, which explains why even immunosuppressed patients do not develop sepsis from it.
    • It is classified as a Class 1 carcinogen by the WHO due to its established role in gastric cancer, and it is a primary cause of gastritis and peptic ulcer disease, alongside NSAID use[1].

      • Historical Context and Impact

      • The discovery of H. pylori by Marshall and Warren in the early 1980s overturned the previous belief that the stomach was sterile and that ulcers were caused mainly by stress or lifestyle factors.
      • Their work demonstrated that a common bacterial infection was the main cause of most gastritis and peptic ulcer disease, leading to a dramatic decline in ulcer surgeries and transforming ulcer management[1].
      • The link between H. pylori and gastric cancer was established epidemiologically: areas with high H. pylori prevalence have higher rates of stomach cancer[1].

        • Diagnosis in Primary Care

        Available Tests:

        Test TypeWhat it DetectsPros & ConsSerology (Blood)Antibodies to H. pyloriHighly sensitive; good for ruling out H. pylori if negative; can remain positive after eradication, so less useful for confirming active infection[1].Urea Breath TestActive infectionHighly specific for current infection; preferred in Australia for confirmation; fewer false positives[1].Stool Antigen TestActive infectionAlso highly specific; convenient for children; widely used in UK primary care[1].
        • Best Practice: Use stool antigen or breath test to confirm active infection, especially before starting eradication therapy. Serology is useful as a rule-out test-if negative, H. pylori infection is unlikely[1].
        • Caveat: Serology may remain positive for a year or more after eradication, so it should not be used to confirm cure or active infection[1].

          • Treatment Considerations

          • Once diagnosed, H. pylori infection is treatable with antibiotics, which is satisfying for both clinicians and patients as it offers a clear cure pathway[1].
          • There is ongoing debate about whom to treat: treat symptomatic patients (e.g., with ulcers or dyspepsia) rather than universally treating all who test positive, especially given increasing antibiotic resistance[1].
          • The advent of proton pump inhibitors (PPIs) combined with antibiotics in the 1990s significantly improved cure rates, making outpatient management by GPs routine[1].

            • Epidemiological Trends and Clinical Implications

            • The prevalence of H. pylori has declined in developed countries, but remains high in some regions and populations.
            • 57 min

            About Ingest

            From the publisher's feed

            Dr Charlie Andrews, a GP from Bath and PCSG Committee Member, explores a range of gastroenterology topics from a GPs perspective. The focus of the series covers when to suspect, how to diagnose, when…