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Dyspepsia and gastro-oesophageal reflux disease (GORD) are common conditions, affecting around 28% of the population.They cause significant impairment of quality of life (1)
Helicobacter pylori (H. pylori) testing:
Helicobacter pylori (formerly named Campylobacter pylori) is a gram negative S shaped or spiral bacillus, described as a Unipolar flagellate, 1 by 3 micrometres in size. It is a microaerophilic, and produces urease and other toxins. Infection with Helicobacter pylori is common in patients with peptic ulceration
Coeliac disease is clinically very variable and so is defined pathologically as a permanent gluten-sensitive enteropathy. The mucosal lesions seen on upper GI biopsy are the result of an abnormal, genetically determined, cell-mediated immune response to gliadin, a constituent of the gluten found in wheat. A similar response occurs to comparable proteins found in rye and barley. Gluten is not found in oats, rice and maize
In what age group does coeliac disease most commonly present?
There is an association between development of coeliac disease and insulin dependent diabetes. Can you think of any other associations?
How can coeliac disease present to the primary care clinicians in adults?
Dermatitis herpetiformis is a rash that is classically associated with coeliac disease. What are the clinical features of this condition?
Investigation for Coeliac Disease
Three different antibodies are often used in the diagnostic work-up for possible coeliac disease (antigliadin antibody, anti-endomysial, anti-transglutaminase antibody)
Treatment of this conditon includes dietary advice and a gluten-free diet. What factors should be considered if there was a failure to respond to the dietary changes?
Faecal occult blood testing
Liver Function Tests
Scenario: 35 year old man was seen by the health care assistant at his new patient medical and had some "routine blood tests" done. Of note in the results was a raised ALT at 90 IU/l (reference range 10-50 IU/l) with the rest of his liver function tests within the normal range. He had a fasting blood glucose of 5.8 mmol/l and a total cholesterol of 6.2 mmol/l and triglycerides of 3 mmol/l. His blood pressure was 135/80 mmHg. This gentleman had a BMI of 32.1. Abdominal examination revealed nil of note.
This gentleman had an alcohol consumption of 30 units per week. A repeat ALT and a GGT were requested after a period of reduction/abstinence from consumption of alcohol. The GGT was raised at 80 IU/l.
This gentleman's repeat ALT was 85 IU/l. How should this be managed?
After referral and further investigation, it was concluded that this gentleman had non-alcoholic fatty liver disease (NAFLD). What options are there for management of this condition?
Futher references on GPN: