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Join Charlie Andrews as he discusses Hepatitis C with hepatologist Dr Kosh Agarwal and GP and clinical champion for Hepatitis C Dr Rik Fijten. They discuss the prevalence and presentation of Hepatitis C, as well as how to test for the condition along with an overview of the treatment options available.
Hepatitis C is a chronic liver disease which carries significant morbidity and mortality if left untreated. Fortunately, it is both easy to test for and the treatments available offer a fantastic cure rate of in excess of 95% with simple and relatively short tablet regimens.
NHS England has set itself the target of eradicating the disease by 2025 through active case finding, simplifying the diagnostic process, and ensuring pathways are in place to provide rapid and effective treatments for the condition.
Resources:
For more information on Hepatitis C, the British Liver Trust offers useful patient-friendly leaflets and further information about the condition: Hepatitis C - British Liver Trust
The self-testing portal mentioned by Rik during the episode can be found here: Home - HepC (hepctest.nhs.uk)
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In this episode, Dr Charlie Andrews speaks to Professor Mark Pritchard about neuroendocrine tumours (NETs) of the gastrointestinal tract. You may be asking yourself: 'Do I really need to know about NETs in primary care, aren't they extremely rare?' The answer to that is a resounding yes, you do need to know about NETs and Mark will tell you why in this episode!
Neuroendocrine cancer is the 10th most prevalent cancer in England, and the second most prevalent cancer of the GI tract, with a rapidly rising incidence (371%) over the last 20 years. NETs are commonly diagnosed at a more advanced stage due to late diagnosis as the signs and symptoms can be vague, or mimic other more common conditions such as IBS. Mark provides lots of useful, practical advice about when to suspect this form of cancer in primary care, which patients may be a higher risk, and what to do if you are suspicious about this form of cancer in your patient.
Listen on to find out more.
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Dr Charlie Andrews, a committee member of the Primary Care Society for Gastroenterology (PCSG), introduces Ingest, the podcast for primary care that focuses on when to suspect, how to diagnose and how to manage common gastrointestinal presentations and conditions.
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In this episode Dr Charlie Andrews looks back at 2023 and highlights some key takeaways from Ingest in 2023.
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In this episode, Charlie Andrews speaks to Dr Andrew Moore about this condition, which affects up to 1.5% of the population, with a risk of progression to cancer of 3-13% over the patient's lifetime (Cancer Research UK). They discuss the typical presenting features, who needs an endoscopy to look for Barrett's, and how the condition is managed both in primary and secondary care. The BSG guidelines mentioned by Dr Moore in the episode can be found here: https://www.bsg.org.uk/clinical-resource/bsg-guidelines-on-the-diagnosis-and-management-of-barretts-oesophagus/
For more episodes about the oesophagus, you may find the following episodes of Ingest useful: Dyspepsia, Eosinophilic oesophagitis, Dysphagia and Achalasia.
BSG guidelines on the diagnosis and management of Barrett's oesophagus - The British Society of GastroenterologyFitzgerald RC, di Pietro M, Ragunath K et al. Abstract These guidelines provide a practical and evidence-based resource for the management of patients with Barrett’s oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) […]www.bsg.org.uk -
In this episode, Charlie Andrews speaks to Professor Julian Walters about bile acid malabsorption and diarrhoea. With up to a third of patients with diarrhoea-predominant IBS having underlying bile acid diarrhoea, and with diagnosis rates for this condition being low, this episode is an important one for anyone working in primary care. We explore the role and physiology of bile acids, the causes and symptoms of bile acid malabsorption, the diagnostic tests used to make the diagnosis and the treatment of this common but underdiagnosed condition. Should we use 'trial of treatment' in primary care to support the diagnosis? Are people who have had their gall bladder removed at greater risk of bile acid diarrhoea? Can bile acid sequestrants impact the absorption of other medications? These questions, and lots more, will be discussed in this episode!
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In this episode, Charlie Andrews speaks to Dr James Turvill about faecal calprotectin use in primary care. Dr Turvill is a gastroenterologist based in York, who was instrumental in developing the NICE-approved and widely adopted York Faecal Calprotectin Care Pathway. What is calprotectin? When should we use it in primary care? How should we interpret the result? Can any medications or conditions affect the result? Listen on to find the answers to these questions!
The care pathway can be found here: https://www.yorkhospitals.nhs.uk/seecmsfile/?id=941. It is recommended that you have a look at this either before, after or during this episode to enhance your learning. Enjoy!
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Marianne Williams is an extremely experienced dietician, innovator, digital technology advocate and winner of the NHS England Allied Health Professional of the Year prize for 2018.
In this episode, Marianne shares her wealth of knowledge around all things IBS to discuss initial dietary management, the low FODMAPs diet, the role of probiotics, and gives us some great advice about how we can maximise our (often short) patient consultations with newly diagnosed IBS patients. Marianne also discusses her innovative dietetic-led gastroenterology clinic for IBS patients with us.
There is so much food for thought here, and so many useful nuggets of information throughout this episode. Sit back and tuck into this feast of information!
Useful links/websites discussed in the episode:
Patient Webinars website: https://patientwebinars.co.uk/
Monash university IBS grand tour: https://www.youtube.com/watch?v=Z_1Hzl9o5ic
Monash university app: https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app/
IBS symptoms, the low FODMAP diet and the Monash app that can help See updated video for Irritable Bowel Syndrome (IBS) relief: Take the Monash University Low FODMAP grand tour down under! at https://www.youtube.com/watch?v=stdYoA4G9Dg
See more: IBS patient course: https://www.monashfodmap.com/online-training/patients-course/
Website: https://www.monashfodmap.com/
Monash FODMAP blog: https://www.monashfodmap ...www.youtube.com
BSG guidelines on the management of IBS: https://gut.bmj.com/content/gutjnl/early/2021/04/27/gutjnl-2021-324598.full.pdf
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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.
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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/
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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.
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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!
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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.
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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.
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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.
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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.
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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.
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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.
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Dyspepsia is a common presenting complaint in primary care, and encompasses a range of symptoms including GORD, nausea, and epigastric pain. Having an approach to these patients is vital given how commonly we see these symptoms, and Mike Burkitt joins me in this episode to provide a really useful overview of dyspepsia, and how we can approach this symptom in clinical practice. Mike also gives his thoughts on what to do when the endoscopy comes back normal in a symptomatic patient.
Useful resources for dyspepsia include:https://cks.nice.org.uk/topics/dyspepsia-unidentified-cause/https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#upper-gastrointestinal-tract-cancers
A great video recorded by Dr Sophie Nelson and Dr Mike Burkitt covering dyspepsia can be found here: https://mft.nhs.uk/mri/services/gastroenterology-and-hepatology/ -
Dr Charlie Andrews discusses coeliac disease. Following the last episode on iron deficiency anaemia this episode focuses on coeliac disease, what it is, NICE guidance, when to suspect, how to test and a non biopsy pathway to diagnosis. First though a history lesson ……
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