Charlie Andrews talks to Dr Anthony (Tony) Wisken, Consultant Paediatric Gastroenterologist in Bristol.

The Ingest podcast is hosted by Dr Charlie Andrews a GPwER in gastroenterology based near Bath. Charlie works as a GP partner at Somer Valley Medical Group, trained as an endoscopist and leads the national GPwER in gastroenterology training programme, launched in 2023 in the southwest of England. Charlie is a committee member of the PCSG (Primary Care Society of Gastroenterology). For more information visit pcsg.org.uk

With significant waiting lists and growing demand for secondary care services, Advice and Guidance is being increasingly explored as one potential solution to this problem.

In this episode, Charlie Andrews discusses an innovative and extremely successful use of advice and guidance in Northumbria with gastroenterologists Matthew Warren and Richard Thomson. Through the enhanced use of advice and guidance for all incoming referrals for secondary care input, they have demonstrated a significant reduction in waiting times for routine outpatient care.

They discuss their advice and guidance model, and what they have learned from developing this service and the impact it has been having on their waiting times, and how it has been received by primary care colleagues (3:30). We go on to discuss some common advice and guidance queries that Matt and Richard see (19:30) and I ask the question - what makes a good advice and guidance query? (43.30).

Key takeaways from the IBS Part 1 episode of the PCSG Ingest podcast:

Diagnosis of IBS

The episode is focused on making a diagnosis of Irritable Bowel Syndrome (IBS)and features Dr. Anton Emmanuel, a consultant gastroenterologist and Professor of neuro-gastroenterology at University College Hospital London.

Importance for Primary Care

• IBS is a common condition that primary care clinicians need to have a structured approach to diagnosing.

Topics Covered

• Causes of IBS
• Different subtypes of IBS
• Challenges in making a positive diagnosis

Clinical Pearls

Dr. Emmanuel shares several insights:

• Key questions to include in the patient history
• How to describe the condition to patients
• Practical tips for enhancing IBS diagnosis in primary care

Diagnostic Approach

The episode emphasises the importance of:

• Taking a structured approach to diagnosis
• Understanding the various presentations of IBS
• Recognizing the challenges in making a definitive diagnosis

Patient Communication

Guidance is provided on:

• Explaining IBS to patients effectively
• Addressing patient concerns and misconceptions

Additional Resources

The episode mentions useful guidance from the British Society of Gastroenterology, which listeners were encouraged to reference for more detailed information. Part 2 focusing on the management of IBS to be released soon.

bsg.org.uk/clinical-resource/british-society-of-gastroenterology-guidelines

The Ingest podcast is hosted by Dr Charlie Andrews a GPwER in gastroenterology based near Bath. Charlie works as a GP partner at Somer Valley Medical Group, trained as an endoscopist and leads the national GPwER in gastroenterology training programme, launched in 2023 in the southwest of England. Charlie is a committee member of the PCSG (Primary Care Society of Gastroenterology). For more information visit pcsg.org.uk

Dr Charlie Andrews speaks to Dr Jeremy Shearman about everything related to high iron levels (hyperferritinaemia). We discuss how iron is regulated within the body, causes of raised iron levels, and then we dive into hereditary haemochromatosis - when to suspect, how to test, who to refer (and to whom!), and how the condition is managed.

Useful links to accompany this episode include:

Welcome > Haemochromatosis: genetic iron overload disease (exeter.ac.uk)

Haemochromatosis - British Liver Trust

In this episode, Charlie Andrews speaks to Melanie Orchard, a consultant surgeon, about diverticular disease and diverticulitis. This is something that we encounter frequently in primary care, and understanding how to approach this condition is extremely important.

Melanie discusses a really pragmatic approach to patients with symptoms suggestive of diverticulitis. We discuss risk factors, presenting features, and how to assess the patient with suspected diverticulitis. We also discuss the difference between diverticulosis, diverticular disease and diverticulitis, and give you useful tips on what advice to give to patients who has just had a colonoscopy showing that they have diverticulosis.

For a useful visual summary of the management of patients with diverticulosis and diverticulitis, please follow this link: visual-summary-pdf-6968965213 (nice.org.uk)

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)

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.

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.