ENDOSCOPY
A masterclass in endoscopy
The British Society of Gastroenterology’s (BSG) annual meeting took place at ACC Liverpool, by King’s Dock, and provided 50 symposia from a broad range of specialists. Showcasing the best of British gastroenterology, hepatology and endoscopy expertise, The Clinical Services Journal highlights some of the best 2018 BSG Annual Meeting talks.
Qasim Aziz, Professor of Neurogastroenterology at Barts and The London School of Medicine and Dentistry at Queen Mary, University of London, discussed the dos and don’ts of managing an IBS patient, when standard treatments may have failed. Prof Aziz stressed the importance of listening to patients and taking a good basic history. “It’s critically important to ask when the symptoms first started, how they started, and also about any other associated factors, in association with the symptoms,” he said. “In particular, ask about what relieves their
symptoms and what makes them worse – what are the co-morbidities? “Remember your basic physiology. You
often see patients at different points in their management and you may not really understand their entire problem if you only take a history, which is relevant just to that particular time. You have to go back to when the symptoms first started.” Once a communication has been developed with a patient, Prof Aziz highlighted the importance of framing the discussion in terms of brain-gut interaction –
such as asking how is it that the gut can be more sensitive and how is that when a patient is feeling stressed that they can actually feel more gastrointestinal symptoms. “There are some don’ts that you have to keep in mind,” he continued. “Don’t over- simplify the situation by saying: ‘It’s just IBS, it’s all in the mind and there’s nothing really wrong with you.’ This can be very distressing for the patients! “Don’t give lactulose antispasmodics to constipated patients with bloating and cramping pains, because it’s a fermentable carbohydrate and it’ll just make things worse. Avoid using opioids as much as possible because they often make the symptoms worse – and avoid prokinetics and osmotic laxatives in a patient with rectal evacuatory dysfunction – this also makes the symptoms worse. “Don’t miss simple diagnoses such
About 20% of patients with ulcerative colitis will experience an acute flair requiring admission to hospital – and furthermore, around 20% of first attacks in these patients are acute and severe in nature.
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as SIBO, AAWP, BAD, non-coeliac gluten sensitivity, and cyclical abdominal pain. Also, there are patients who develop cyclical symptoms – they’ll develop cyclical abdominal pain and vomiting and here they have the physiology very similar to cyclical vomiting. They often overlap with abdominal migraines as well. In my experience just treating them as cyclical vomiting with amitriptyline can often be quite helpful. “Overall, I think these patients can be managed sensibly but in a simple progressive way where you try and understand what the cause of their symptoms is and then apply a management strategy that is appropriate to that.”
Ulcerative colitis
Ulcerative colitis, and what to use after steroids fail in acute severe disease, was analysed by Professor Ailsa Hart, St Mark’s Hospital Harrow and Department of Surgery and Cancer, Imperial College, London. About 20% of patients with ulcerative colitis will experience an acute flair requiring
SEPTEMBER 2018
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