Diagnostics


oesophagus or Oesophageal Cancer in the community. This simple 10-minute appointment means many more people can be screened in a shorter time frame


l Alleviating endoscopy backlogs: Capsule sponge also reduces reliance on endoscopy for cancer exclusion (where patients are referred only to receive normal results and re-enter the system months or years later)


l Breaking the “re-cycling” loop: Without a clear diagnosis, patients cycle between GP and secondary care, often managed symptomatically and re-referred when symptoms persist. There are many diagnostics which can be manged in community settings and are resource efficient, these can uncover misdiagnosed patients and set them onto the correct treatment pathways


Misdiagnosis is a hidden cost driver. Studies suggest that up to 30% of patients treated for GORD may not have acid reflux at all, but rather conditions like SIBO, functional dyspepsia or hiatus hernia.11


Without impedance testing,


manometry or microbiome profiling, these patients remain on PPIs; masking symptoms but not addressing root causes. A smarter pathway is one that stratifies risk early, confirms diagnosis of GORD once cancer is ruled out and redirects non-GORD patients to the correct pathway could save millions, reduce prescribing burden, and improve patient outcomes. The tools exist and the evidence is there: what is needed now is system-wide adoption.


Call to action It’s time for NHS leaders to rethink how we manage reflux; not just in hospitals, but in communities. The current model prioritises symptom suppression over diagnostic clarity, leading to overprescribing, missed pathology, and a costly cycle of repeat referrals. We need a diagnostic-first approach to GORD; one that aligns with NHS England’s 2025 mandate to shift from sickness to prevention, and from hospital to community care.3


Embedding reflux diagnostics


into primary and community pathways isn’t just clinically sound, it’s resource-efficient. Tools like impedance testing, manometry, capsule sponge and breath testing can be delivered by a single healthcare professional in a non-clinical room - without sedation, without endoscopy suite time and without delay. They stratify risk, clarify diagnosis, and redirect patients to the right care, whether that’s lifestyle support, microbiome restoration, or surgical input. The consequences of misdiagnosis are


real. A recent study led by the Functional Gut Clinic found that 60% of patients referred


It’s time for NHS leaders to rethink how we manage reflux; not just in hospitals, but in communities. The current model prioritises symptom suppression over diagnostic clarity, leading to overprescribing, missed pathology, and a costly cycle of repeat referrals.


for anti-reflux surgery actually had SIBO; a microbiome disorder treatable with antibiotics and dietary advice. Most of these patients didn’t need expensive surgery at all, they just needed early access to better diagnostics. SIBO can be detected with a simple at-home breath test (at a fraction of the cost of anti-reflux surgery).12 When it comes to reflux symptoms we don’t need more prescriptions — we need precision.


References 1. Jenkins D, Modolell I. Proton pump inhibitors. BMJ. 2023;383:e070752. doi:10.1136/bmj-2022- 070752.


2. Plehhova K, Wray J, Aluko P, Sutton S, McArdle J, Dawson A, Coyle C, Stevens RM. Prescribing practices for proton pump inhibitors among primary care physicians in England: an evaluation. BJGP Open. 2025;9(2):BJGPO.2024.0059. doi:10.3399/ BJGPO.2024.0059


3. Department of Health and Social Care. Road to recovery: the government’s 2025 mandate to NHS England. London: GOV.UK; 2025 [cited 2025 Sep 23].


4. Hicks S, Smith K. Safety of long term proton pump inhibitors (PPIs) [Internet]. PrescQIPP Bulletin 92. Ipswich: PrescQIPP CIC; 2015 May [cited 2025 Sep 23]. (https://www.prescqipp. info/media/1646/b92-safety-of-long-term- ppis-21.pdf)


5. All Wales Therapeutics and Toxicology Centre. National Prescribing Indicators 2022–2025: Supporting Information for Prescribers and Healthcare Professionals. NHS Wales; 2023 (National Prescribing Indicators 2022-2025 - All Wales Therapeutics and Toxicology Centre)


6. West Suffolk NHS Foundation Trust. Capsule sponge: Heartburn Health Check (for patients with persistent heartburn or Barrett’s oesophagus) [Internet]. Bury St Edmunds: West Suffolk NHS Foundation Trust; 2024 Jun 21 [cited 2025 Sep 23]. (https://www.wsh.nhs.uk/CMS- Documents/Patient-leaflets/Endoscopy/6915- 3-Capsule-sponge.pdf)


7. Ross-Innes CS, Kadri SR, Debiram-Beecham I, O’Donovan M, Petty E, Rogers S, et al. Evaluation of a non-endoscopic test for Barrett’s


34 www.clinicalservicesjournal.com I December 2025 About the author


Prof. Anthony Hobson (PhD) is an internationally renowned clinical GI scientist. He has wide- ranging experience across the NHS and the private healthcare sector. He founded The Functional Gut Clinic in 2014, one of the UK’s leading providers of diagnostics and physiology testing for gastrointestinal issues.


oesophagus in primary care: a multicentre pragmatic trial. Aliment Pharmacol Ther. 2023;58(3):314–24. doi:10.1111/apt.18472


8. Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014;349:g6154


CSJ


9. East of England Cancer Alliance. Project DELTA: Capsule sponge pilot for early detection of Barrett’s oesophagus and oesophageal cancer. Cancer Alliance UK. 2023. (https://www. canceralliance.co.uk/innovation/cytosponge)


10. Implantica AG. RefluxStop access expansion in UK NHS public hospital network. Implantica Press Release. 2024 Jun 19. (https://www. implantica.com/media/press-releases/2024/ implantica-announces-further-expansion- of-refluxstop-access-in-the-uk-nhs-public- hospital-network)


11. Boyle N. Reflux, the gut biome and SIBO. Reflux UK. 2025. (https://refluxuk.com/diagnosis/ sibo)


12. Haworth J. Is there a link between SIBO and symptoms of reflux? Functional Gut Clinic. 2025. (https://thefunctionalgutclinic.com/ post/is-there-a-link-between-sibo-and- symptoms-of-reflux)


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70