Gastroenterology

Gastroenterology is a heavily tested AKT topic covering a wide range of conditions from functional disorders to cancer recognition. Knowing when to test, when to treat, and when to refer is key.

Irritable bowel syndrome (IBS) is diagnosed clinically using NICE criteria: abdominal pain or bloating related to defecation, with altered bowel habit, for at least 6 months. Key investigations to exclude organic disease include FBC, ESR/CRP, coeliac serology, and calprotectin (to distinguish IBS from IBD). Management is stepwise: lifestyle and dietary advice (regular meals, adequate fluids, limit caffeine and alcohol), low FODMAP diet (with dietitian support), antispasmodics (mebeverine, hyoscine), laxatives for constipation-predominant IBS, loperamide for diarrhoea-predominant IBS, and low-dose tricyclic antidepressants if first-line measures fail.

Inflammatory bowel disease includes Crohn's disease (any part of GI tract, skip lesions, transmural inflammation) and ulcerative colitis (continuous inflammation starting at rectum, limited to mucosa). Calprotectin above 100 supports referral. Acute flares of UC may present with bloody diarrhoea, urgency, and systemic symptoms. First-line treatment for UC flares is mesalazine (topical and/or oral).

Coeliac disease affects approximately 1% of the UK population but is significantly underdiagnosed. Test with tissue transglutaminase (tTG) IgA antibodies and total IgA level (to exclude IgA deficiency which causes false negatives). The patient must be eating gluten for at least 6 weeks before testing. Positive serology requires duodenal biopsy for confirmation. Treatment is a strict lifelong gluten-free diet.

GORD management follows a stepwise approach. Lifestyle measures first, then PPI (omeprazole or lansoprazole) for 4-8 weeks. Refer for endoscopy if alarm symptoms are present (dysphagia, weight loss, persistent vomiting, GI bleeding, palpable mass) or if aged over 55 with unexplained new dyspepsia.

H. pylori testing uses urea breath test or stool antigen test (stop PPI 2 weeks before). Eradication therapy is triple therapy: PPI plus two antibiotics (amoxicillin and clarithromycin, or metronidazole if penicillin-allergic) for 7 days.

Liver disease presentations include non-alcoholic fatty liver disease (most common chronic liver disease in the UK, managed with lifestyle modification), alcohol-related liver disease, and hepatitis B and C. Know the enhanced liver fibrosis (ELF) test and FIB-4 score for fibrosis assessment.