I have vetted ~3️⃣0️⃣0️⃣ 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 7️⃣ 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 #GastroTwearl👇🏼

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
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 4️⃣ tweet guide.

3/7 https://twitter.com/ukgastrodr/status/1355967547548594176
Chronic diarrhoea

💊Look at medication as a cause.

Often a symptom of IBS

Consider IBD (check faecal calprotectin) & flag cases up 🚨We don’t want to miss or see pts with IBD late

Consider BAM 🤔

Don’t forget coeliac disease is common (1%) see #GastroTwearl 👇🏼 below

4/7 https://twitter.com/ukgastrodr/status/1370786142761717761
Liver disease causes much consternation. It is under-recognised & is common due to excessive alcohol consumption 🍺🍷🥃 & metabolic conditions causing liver disease.

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

5/7 https://twitter.com/ukgastrodr/status/1388563767944941571
And how can we forget about iron deficiency anaemia? 🩸

See #GastroTwearl below 👇🏼

Also remember that when given iron tablets - 𝗻𝗼 𝗺𝗼𝗿𝗲 𝘁𝗵𝗮𝗻 1️⃣💊𝗽𝗲𝗿 𝗱𝗮𝘆!

6/7 https://twitter.com/ukgastrodr/status/1322543496977403905
Finally...

Abdo pain - CT scan ☢️ is a good test so consider if cause not obvious.

⚠️Weight loss is a serious complaint, see #GastroTwearl👇🏼

Communication is 🔑 so if concerned /unsure, discuss with your friendly Gastroenterology & Hepatology teams via A&G, ☎️ or email 📧

7/7 https://twitter.com/ukgastrodr/status/1334774418833367040
Thank you for reading!
Please share.

Please ask questions & discuss.
Let me know your views

For more #GastroTwearls click the link 👇🏼
https://twitter.com/ukgastrodr/status/1336411189052575751?s=21

Check out http://myEndoscopy.co.uk  for patient info on endoscopy procedures
You can follow @UKGastroDr.
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