The Conference

THE GASTROCAREUK CONFERENCE REPORT
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:. The Speakers Professor David Rampton Consultant Gastroenterologist and Professor of Medicine at the Royal London Hospital, London Dr Ashley Brown Consultant Hepatologist and Hon Senior Lecturer at St Mary’s Hospital, London Dr Andrew Millar Consultant Gastroenterologist at the North Middlesex University Hospital and Hon Senior Lecturer in Medicine at the UCLH and RFH Medical School, London

Dr Paul Maxwell Consultant Gastroenterologist at the North Middlesex University Hospital Dr Niall van Someren Consultant Gastroenterologist at Chase Farm and Barnet Hospital, London

The first GastroCareUK conference was held in the noble surroundings of the Royal Society of Medicine on the 16th March 2007, attracting an audience of General Practitioners and Practice Nurses. Delegates came from areas as far away as Scotland. The conference theme was to provide a forum for greater communication between Primary Care and Consultant Gastroenterologists to promote evidence-based advice on management of common gastroenterological conditions with the emphasis on managing these problems without referral to specialists where possible.

The organisers (all NHS Consultant Gastroenterologists) particularly wished to emphasise the role that General Practitioners could play in limiting hospital referrals, and that where referral was indicated, the process of referral could be refined to meet specific end points. Topics covered in the presentations included abnormal liver function tests, dyspepsia, irritable bowel, anaemia, pr bleeding and management of inflammatory bowel disease in primary care.

Dr Ashley Brown, senior lecturer in Hepatology at St Mary’s Hospital, Paddington, spoke eloquently about the difficulties in the investigation of abnormal liver function tests. Many patients with raised enzymes are likely to have NAFLD (non-alcoholic fatty liver disease), which encompasses mild fatty liver disease, through to severe steatohepatitis complicated by liver failure and primary hepatocellular carcinoma. He described how this condition was intimately related to the metabolic syndrome; and how addressing hypertension, obesity, diabetes and hypercholesterolaemia was the main aim in this condition and referral for investigation of liver disease was not usually required. On the other hand the diagnosis and management of viral hepatitis, a rapidly moving field, with ever improving therapies, often needed to be referred to Specialists with perhaps greater emphasis needed to identify patients in primary care who were carriers of hepatitis B and C.

Professor David Rampton (St Bartholomew’s & The Royal London Hospitals), a world-renowned expert in inflammatory bowel disease (IBD), manages a large number of patients in the east end of London. He is one of the architects of shared care of IBD with Primary Care and also promotes self-care by patients, where appropriate. Most GP’s have only a few patients with this condition, and provision of simple guidance was needed to ensure that patients continued to receive specialist input when needed.

Dr Paul Maxwell (North Middlesex University Hospital) gave a clear account of the history of the irritable bowel syndrome, and emphasised that it was both necessary and possible to make a positive diagnosis. This could often be achieved by careful clinical history and examination and simple investigations where needed with few patients needing referral to Specialists. He outlined the available treatments and finished with an excellent animated algorithm. In another session he discussed modern use of proton pump inhibitors (PPIs) as gastroprotection, particularly against non-steroidal anti-inflammatory drugs (NSAIDs). He outlines how many patients admitted with gastrointestinal bleeding were suffering a complication of NSAID use. He outlined which patients were at the greatest risk and showed a simple algorithm to help decide which patients needed PPI gastroprotection therapy. He showed how the potential cost implications of using PPI therapy for this indication could be reduced by choosing an appropriate duration, dose and type.

Dr Andrew Millar (North Middlesex University Hospital) expanded on the topic of the of PPI use in the management of dyspepsia. As clinical lead for the North Central London Strategic Health Authority PPI Rationalisation Project he had been the architect of a set of protocols for PPI use, to take NICE guidance forward with clear pragmatic treatment algorithms. He outlined how these plans covered PPI use during investigation and management of dyspepsia, and particularly whether or not endoscopy was required.

Dr Niall van Someren (Chase Farm Hospital, Enfield) spoke on the related subjects of iron deficiency anaemia and rectal bleeding. Although each GP has only a few patients with these conditions, the spectre of underlying cancer tips the balance towards referral. However, the risk of underlying serious disease tends to be inversely related to age. By carefully stratifying the risk profile of patients the numbers referred could be limited and there was potential for increased use of relevant investigations in Primary Care.

Dr Andrew Millar concluded the conference with a short presentation indicating the importance of Specialists working more closely with Primary Care in the future. He explained the aim of GastroCareUK as being a forum for this dialogue and plans were continuing for the provision of further education materials and events to promote this relationship. Speakers and delegates then gathered at a champagne reception at the end of the meeting.

Feedback from both delegates and speakers was very positive. Dr Andrew Millar, Consultant Gastroenterologist said “We intended to make the day interesting for our GP colleagues. The level of audience participation was high, and the feedback was highly encouraging”. Oxfordshire GP Sarah Morris agreed, saying “ There is nothing else like this course around, which addresses the grey area between primary and secondary care”.

GastroCareUK would like to thank Wyeth Pharmaceuticals and Schering Plough for their support and sponsorship of this meeting.