I have vetted ~https://abs.twimg.com/emoji/v2/... draggable="false" alt="3️⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">https://abs.twimg.com/emoji/v2/... draggable="false" alt="0️⃣" title="Tastenkappe Ziffer 0" aria-label="Emoji: Tastenkappe Ziffer 0">https://abs.twimg.com/emoji/v2/... draggable="false" alt="0️⃣" title="Tastenkappe Ziffer 0" aria-label="Emoji: Tastenkappe Ziffer 0"> referrals from primary care to Gastroenterology in last 2/52.

Pathways vary around the country - nevertheless I have observations / advice about managing common GI problems in primary care & when to refer in https://abs.twimg.com/emoji/v2/... draggable="false" alt="7️⃣" title="Tastenkappe Ziffer 7" aria-label="Emoji: Tastenkappe Ziffer 7"> tweets

#GastroTwearls 1/7

Simple GORD does not need an OGD. This is as per national guidance as OGDs aren’t pleasant & rarely changes management.

See #GastroTwearlhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏼" title="Rückhand Zeigefinger nach unten (mittelheller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (mittelheller Hautton)">

When giving a PPI, Omeprazole is better than Lansoprazole (fewer SEs) - give a decent dose of 40 mg / day

2/7 https://twitter.com/ukgastrodr/status/1273736516108537860">https://twitter.com/ukgastrod...

Constipation is really common & poorly recognised. Often a symptom of IBS.

Opioids are a major culprit and cause much misery - give concomitant laxatives.

See #GastroTwearl below for a https://abs.twimg.com/emoji/v2/... draggable="false" alt="4️⃣" title="Tastenkappe Ziffer 4" aria-label="Emoji: Tastenkappe Ziffer 4"> tweet guide.

3/7 https://twitter.com/ukgastrodr/status/1355967547548594176">https://twitter.com/ukgastrod...

Chronic diarrhoea

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">Look at medication as a cause.

Often a symptom of IBS

Consider IBD (check faecal calprotectin) & flag cases up https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚨" title="Polizeiautos mit drehendem Licht" aria-label="Emoji: Polizeiautos mit drehendem Licht">We don’t want to miss or see pts with IBD late

Consider BAM https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">

Don’t forget coeliac disease is common (1%) see #GastroTwearl https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏼" title="Rückhand Zeigefinger nach unten (mittelheller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (mittelheller Hautton)"> below

4/7 https://twitter.com/ukgastrodr/status/1370786142761717761">https://twitter.com/ukgastrod...

Liver disease causes much consternation. It is under-recognised & is common due to excessive alcohol consumption https://abs.twimg.com/emoji/v2/... draggable="false" alt="🍺" title="Bierkrug" aria-label="Emoji: Bierkrug">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🍷" title="Weinglas" aria-label="Emoji: Weinglas">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥃" title="Tumblerglas" aria-label="Emoji: Tumblerglas"> & metabolic conditions causing liver disease.

See #GastroTwearls below with links for abnormal LFTs & jaundice.

5/7 https://twitter.com/ukgastrodr/status/1388563767944941571">https://twitter.com/ukgastrod...

And how can we forget about iron deficiency anaemia? https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">

See #GastroTwearl below https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏼" title="Rückhand Zeigefinger nach unten (mittelheller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (mittelheller Hautton)">

Also remember that when given iron tablets - 𝗻𝗼 𝗺𝗼𝗿𝗲 𝘁𝗵𝗮𝗻 https://abs.twimg.com/emoji/v2/... draggable="false" alt="1️⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">𝗽𝗲𝗿 𝗱𝗮𝘆!

6/7 https://twitter.com/ukgastrodr/status/1322543496977403905">https://twitter.com/ukgastrod...

Finally...

Abdo pain - CT scan https://abs.twimg.com/emoji/v2/... draggable="false" alt="☢️" title="Symbol für Gefahr durch Radioaktivität" aria-label="Emoji: Symbol für Gefahr durch Radioaktivität"> is a good test so consider if cause not obvious.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warnsignal" aria-label="Emoji: Warnsignal">Weight loss is a serious complaint, see #GastroTwearlhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏼" title="Rückhand Zeigefinger nach unten (mittelheller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (mittelheller Hautton)">

Communication is https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔑" title="Schlüssel" aria-label="Emoji: Schlüssel"> so if concerned /unsure, discuss with your friendly Gastroenterology & Hepatology teams via A&G, https://abs.twimg.com/emoji/v2/... draggable="false" alt="☎️" title="Telefon" aria-label="Emoji: Telefon"> or email https://abs.twimg.com/emoji/v2/... draggable="false" alt="📧" title="E-Mail Symbol" aria-label="Emoji: E-Mail Symbol">

7/7 https://twitter.com/ukgastrodr/status/1334774418833367040">https://twitter.com/ukgastrod...

Thank you for reading!
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For more #GastroTwearls click the link https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏼" title="Rückhand Zeigefinger nach unten (mittelheller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (mittelheller Hautton)">
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Check">https://twitter.com/ukgastrod... out http://myEndoscopy.co.uk"> http://myEndoscopy.co.uk  for patient info on endoscopy procedures