Gastroenterology

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  Gilbert's syndrome

A reminder of some physiology…

Bilirubin is a by-product of haemoglobin. To excrete bilirubin, it is usually conjugated by the glucuronyl transferase enzyme. Those with Gilbert's syndrome have a defect coding for the gene that makes glucuronyl transferase.
  Autoimmune liver disease
This clinical review was a good summary for non-specialists, and here I have extracted the information that I think is relevant to GPs.
  Nutritional supplements/SIP feeds
We are often asked to prescribe nutritional supplements (SIP feeds). Until recently, having little understanding of what I was doing, I diligently prescribed whatever was requested. However, our local prescribing team has been looking at the use of these products, and this has radically changed my approach to requests for such products.
  Travellers' diarrhoea
'Wash it, peel it, boil it, cook it or forget it!' This was the first of two pieces of excellent advice from the hospital treasurer when I arrived at the remote hospital in Uganda.
  Chronic constipation
This BMJ clinical review contained plenty of stuff you will be familiar with, so I have picked out the things that may be new to you. This applies to adults only.
  Cryptosporidium
In the UK cryptosporidium is only a notifiable disease if it is believed to be food- or water-borne. It is not a notifiable disease if caught by person–person transmission.
  Irritable Bowel Syndrome
Are you sure it isn't coeliac disease?
  Coeliac Disease
  Dyspepsia
The NHS spends £425 million/year on PPIs, but they are hardly a life-saving therapy.
  NSAIDs and coxibs: CV, GI and renal safety
  Management of faecal incontinence
This is a distressing and socially stigmatising condition which many sufferers feel unable to discuss with their doctor.
  Barrett's oesophagus
In Barrett's oesophagus, intestinal metaplasia occurs. Normal oesophageal tissue (multilayed squamous mucosa) becomes a single layer of premalignant mucin-secreting mucosa, with varying degrees of goblet differentiation.
  Hereditary haemochromatosis

Hereditary haemochromatosis leads to increased intestinal absorption of iron, which leads to accumulation of iron in tissues, especially the liver, which can lead to organ damage. Other organs commonly affected are the pancreas, joints, heart, skin and gonads.
  B12 deficiency
This BMJ '10-minute consultation' on B12 deficiency gives a helpful flow chart to assist us.