The following blog is a summary of key learning points from a talk given at Digestive Health and Wellbeing: The Patient Journey. Click here to learn more about the event or click here to visit the healthcare professional portal.

Meet the speaker

Dr Marion Sloan FRCGP is a Senior Partner in a busy 13,000 patient practice in the centre of Sheffield.  She holds a Hospital Practitioner post at Sheffield Teaching Hospitals, currently working there in Endoscopy services. She is an elected committee member of the Primary Care Society of Gastroenterology, a national organisation dedicated to the promotion of gastroenterology education for all primary healthcare professionals. Dr Sloan is an elected GP Board member of Sheffield Clinical Commissioning Group (CCG) and a GP Peer Reviewer for Sheffield Primary Care Gastroenterology referrals.

Dr Marion Sloan

Gastroenterology in Primary Care

An introduction to the digestive health patient journey, Marion’s presentation offers a primary care perspective on gastroenterology. The talk looks at various conditions that occur throughout the life span, including treatment and referral options. Marion’s presentation takes a look at how primary care professionals can support their populations to adopt a healthier lifestyle - over and above the old adage of “eat your greens”.

Summary points

The key role of primary care is to look after populations from birth to death. Marion discusses how bowel conditions are dealt with in primary care and gives her perspective on where primary care can support digestive health in the future. Fundamentally, a healthy lifestyle supports better health and longevity. GPs and healthcare professionals should take every opportunity to talk about lifestyle and the health advantages of making more beneficial lifestyle choice. Primary Care Networks, care delivered by teams rather than an individual, offer new employment opportunities for healthcare professionals. Today, primary care now includes Allied Health Professionals, teams of people who can support each other in looking after patients. This united approach, through a team, is important for the best care for patients.

Infanthood

When it comes to establishing the baby microbiome, ‘breast is best’ in terms of feeding. From the outset, the mother’s bowel bacteria begin to ‘seed’ the gut of the infant and colonise the baby microbiome. Human milk oligosaccharides (HMOs) from breast milk can feed the ‘good’ gut bacteria and help them to thrive.

Toddlers

A common problem in toddlers is diarrhoea, which sometimes stems from being fed a lot of fruit juice, alongside a low-fat diet with a lot of fruits and vegetables. This comes from well-meaning parents but in fact, toddlers need calorie dense diets with their main drinks being water and milk. Toddlers require a high-fat diet. Animal fats in meat or fish are fine, and as well as water, full fat milk is preferred over fruit juice. Food containing soluble fibre, such as porridge, is also valuable.

Children

Childhood is a time for primary care professionals to remain aware of coeliac disease and ensure that children are screened correctly for diagnosis if appropriate.

Teenagers

Healthcare professionals tend to find teenagers less open on matters of health and wellbeing, especially bowel habits. We must consider the role of the gut-brain axis - high stress is related to IBS prevalence in the teenage cohort, as well as lifestyles associated with this age group, such as alcohol, eating, experimenting with smoking and substances. These factors can contribute to Irritable Bowel Syndrome (IBS), with symptoms including wind, bloating, abdominal pain and diarrhoea.

It’s estimated that in the UK, 1 in 30 teenagers have IBS, 1 in 100 have coeliac disease and 1 in 250 have Inflammatory Bowel Disease (IBD), so formative teenage should be of particular interest to primary health care.

Adults

In young adults, we may see signs of Crohn’s disease or IBD onset. GPs tend to look out for blood, mucus and diarrhoea in stools as warning signs, and often periods of remission followed by relapse. Individualscan be affected from the mouth right through to anus, with inflammation sometimes leading to scarring and malabsorption. Anyone presenting with diarrhoea as a symptom requires a stool culture in the first instance, to rule out other possibilities such as infection, followed by a faecal calprotectin test.

Middle years

In confirmed bowel cancer cases, around 90% of cases are in those over the age of 50, usually beginning in a polyp. Bowel scopes have started to check over-55s to determine if a polyp is likely or not. This can be done with a one-off flexible sigmoidoscopy. If polyps are found, patients then go on to have a full colonoscopy. Screening for polyps complements the original bowel cancer screening programme for over-60s.

Older adults

As a result of changing lifestyle and more sedentary behaviours, cancer risk factors are of particular interest for older age groups. Known factors include increased risk of obesity, alcohol intake, relative lack of exercise and changes to dietary habits, including lower intake of red meat.

Conclusions

From a primary care perspective, lifestyle is absolutely crucial. From breast-feeding in early years, through to exercise, maintaining normal body weight and a varied diet should all be high on the agenda. It’s also important to remember the reference intake of fibre, which is 30g per day.

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