Ingest

Dr Charlie Andrews talks to Dr James Kinross, PhD, FRCS Dr. Kinross is a senior lecturer in surgery at Imperial College in London. He is also a practicing colorectal surgeon in the NHS with a clinical interest in the prevention and treatment of colon cancer. He leads a team of amazing researchers working to better define how the microbiome causes cancer and other chronic diseases of the gut. He is increasingly interested in how the gut microbiome develops in newborn babies and the implications on our long-term health. He is the author of the well know book DARK MATTER.Here are the key learnings for primary care on the microbiome from the attached transcript of the Ingest podcast with James Kinross:Key Learnings for Primary Care on the Microbiome1. What the Microbiome Is and Why It MattersDefinition: The microbiome is the collection of all microscopic organisms (bacteria, viruses, fungi, etc.) and the environment they inhabit within a specific niche in the body, such as the gut, skin, or lungs. Symbiosis: The microbiome has a symbiotic relationship with the host, evolved over millennia. It is not static but dynamic and changes throughout life. Personalization: Each person's microbiome is unique, impacting how individuals respond to treatments and develop diseases[1].2. Microbiome Development and Early LifeEarly Colonization: The microbiome starts developing in utero, influenced by the mother's microbiome, and is further shaped by birth route, breastfeeding, and early environmental exposures. Critical Window: Early life is a critical period for microbiome development. Disruption, especially through antibiotic use, can have long-term effects on immune system development and disease risk[1]. Antibiotics Impact: Repeated or broad-spectrum antibiotic use in early life can lead to persistent changes in the microbiome, increasing the risk of immune-mediated diseases (e.g., allergies, asthma, eczema), obesity, and other non-communicable diseases[1].3. Microbiome and the Immune SystemImmune Regulation: The microbiome plays a crucial role in shaping both the innate and adaptive immune systems. It influences how the body recognizes and responds to threats. Disease Risk: Early disruption of the microbiome can increase susceptibility to autoimmune diseases, allergies, and chronic conditions later in life. Gene-Environment-Microbiome Interaction: Disease risk is not just about genes and environment but also involves the microbiome (GEM interaction), which is highly personalized and dynamic[1].4. Probiotics, Prebiotics, and DietProbiotics: There is evidence supporting the use of probiotics, especially multi-strain, high-dose formulations, during and after antibiotic courses. However, probiotics must be taken consistently for weeks to have an effect. Prebiotics and Diet: Feeding the microbiome with a high-fiber, plant-based diet is crucial for maintaining a healthy gut ecosystem. Processed foods and sugary drinks should be minimized, especially during illness or antibiotic treatment[1]. Practical Advice: Clinicians should recommend probiotics and dietary changes as part of a holistic approach to gut health, but the evidence for specific strains is still evolving[1].5. Microbiome TestingDirect-to-Consumer Testing: Online microbiome tests are not currently recommended due to lack of stand... Chapters (00:00:00) - Ingest: The microbiome(00:01:06) - Dark Matter(00:03:45) - What exactly is the microbiome?(00:06:11) - What is the microbiome?(00:08:49) - The role of the microbiome in health(00:09:54) - Antimicrobial agents in the gut(00:13:20) - Probiotics and antibiotics(00:15:37) - How the microbiome affects the immune system(00:24:05) - The role of the microbiome in health(00:27:04) - Will we measure the microbiome 100%?(00:31:02) - Primary care: The microbiome challenge(00:32:22) - Probiotics and the future of gut health(00:36:02) - The microbiome of the human gut

The episode features Dr. David Bartlett, a retired GP and neuroendocrine cancer patient, offering a dual perspective as both clinician and patient.Key Learnings from this episode.Patient Experience and Diagnostic ChallengesDr. Bartlett's symptoms began with severe, intermittent abdominal pain, starting in 2001, but he did not seek medical help for several years due to a combination of stoicism, not wanting to trouble others, and a belief in the commonality of benign causes. Over 15 years, he experienced repeated misdiagnoses, primarily being labeled as having irritable bowel syndrome (IBS) despite atypical features (severe pain, minimal bowel habit change, and no systemic symptoms). Multiple opinions and investigations (including ultrasounds and CT scans) failed to identify the underlying cause, with a key scan being misread by local radiologists. The correct diagnosis of a small bowel neuroendocrine tumour was only made after a tertiary centre re-examined previous scans, highlighting the importance of specialist review and persistence in unexplained cases.Clinical Red Flags and SymptomatologyDr. Bartlett's case underscores that neuroendocrine tumors can present with isolated, severe abdominal pain without classic red flags (vomiting, weight loss, significant bowel changes)[1]. He retrospectively identified subtle signs of carcinoid syndrome (flushing, one episode of profound diarrhoea, and skin changes), which are present in only about 10% of small bowel neuroendocrine tumour cases. The lack of awareness about neuroendocrine tumors, even among experienced clinicians, contributed to the diagnostic delay[1].Lessons for Primary Care and CliniciansThe story illustrates the risk of anchoring on common diagnoses (like IBS) and the need to reconsider the diagnosis when symptoms are severe, persistent, or atypical. It highlights the value of listening to the patient's narrative, especially when symptoms do not fit classic patterns, and the importance of considering rare conditions in the differential diagnosis. The episode emphasises the need for ongoing education about neuroendocrine tumours and the importance of keeping rare but serious conditions on the diagnostic radar in primary care.Management InsightsStandard treatment for small bowel neuroendocrine tumours often includes monthly somatostatin analog injections (e.g., lanreotide). Surgical intervention may be considered, but it carries specific risks such as carcinoid crisis, requiring specialised perioperative management. The decision for surgery is individualised, weighing potential symptomatic improvement against procedural risks.Systemic and Human FactorsDr. Bartlett's experience reflects how personal traits (stoicism, reluctance to seek help) and systemic issues (misinterpretation of scans, diagnostic inertia) can delay diagnosis. The narrative also demonstrates the importance of patient advocacy, persistence, and the value of second (or third) opinions, especially in complex or unresolved cases.Educational ValueThe episode serves as a reminder for clinicians to maintain a broad differential, revisit diagnoses when the clinical picture changes, and to be aware of their own cognitive biases. It also advocates for the inclusion of patient voices in medical education to better understand the lived experience and challenges of rare diseases like neuroendocrine cancer.Summary Table: Key LearningsThemeKey PointsDiagnostic Delay15 years from symptom onset t... Chapters (00:00:10) - Ingest(00:02:07) - David Bartlett on neuroendocrine cancer(00:05:32) - Irritable bowel syndrome, 15 years after first bout(00:12:09) - Carcinoid syndrome in small bowel neuroendocrine tumors(00:16:10) - Neuroendocrine tumour, surgery and recovery(00:20:43) - Somaostatin analogues for neuroendocrine cancer(00:25:43) - The role of the multidisciplinary team in bowel cancer care(00:28:21) - The battle with depression in your 50s(00:30:00) - General Practice and the Art of Medicine(00:33:13) - General Practice: The challenge of slowing down(00:35:35) - Neuroendocrine Cancer UK support group(00:39:28) - David's story of cancer(00:40:38) - David's Neuroendocrine Cancer Episode 1

Dr Charlie Andrews talks to Dr John Leeds. John Leeds is a Consultant Pancreaticobiliary Physician and Endoscopist based at the Freeman Hospital in Newcastle and an Honorary Clinical Senior Lecturer based in the Population Health Sciences Institute at Newcastle University. He is involved in research in pancreaticobiliary disorders including benign and malignant conditions as well as outcomes from therapeutic/advanced endoscopy.John is a member of the British Society of Gastroenterology and Pancreatic Society of Great Britain and Ireland. He serves on the endoscopy and Pancreas committees for BSG and is the website lead for PSGBI.He is also a founder member of the BSG Pancreas Clinical Research Group which is coordinating research for the society.Key Learnings from this episode:Challenges in Early Detection of Pancreatic Cancer • Pancreatic cancer is often diagnosed at an advanced stage due to the deep location of the pancreas and the lack of early symptoms. • Tumors in the body and tail of the pancreas can grow significantly before causing symptoms, often invading major arteries or veins, making them inoperable. • Tumors in the head of the pancreas may present earlier due to bile duct obstruction, leading to jaundice, but even these are often detected late. Early Symptoms and Red Flags • Early symptoms are vague or absent, making early diagnosis difficult. • Possible early indicators include: • Weight loss (often a sign of advanced disease). • New-onset diabetes, particularly in individuals with a normal BMI or without typical risk factors for type 2 diabetes. • Jaundice, which is a significant red flag and often indicates a serious underlying condition. • Classic signs like painless jaundice and Courvoisier's sign (palpable gallbladder) are important but not always present. Limitations of Current Screening Methods • There is no reliable biomarker or screening test for pancreatic cancer: • CA19-9 is not suitable as a screening tool due to its lack of specificity (elevated in other conditions). • Imaging techniques like CT scans or MRIs are used but have limitations, including incidental findings that may lead to unnecessary anxiety (“scanxiety”) and over-investigation. • Screening is currently limited to high-risk groups, such as those with familial pancreatic cancer syndromes or hereditary pancreatitis. High-Risk Groups for Screening • Familial pancreatic cancer accounts for less than 10% of cases. Criteria for screening include: • Multiple family members with pancreatic cancer, especially diagnosed under age 50–60. • Genetic syndromes like BRCA mutations, familial adenomatous polyposis (FAP), and Peutz-Jeghers syndrome. • Hereditary pancreatitis patients have an increased risk but are harder to screen due to pre-existing pancreatic abnormalities. Emerging Research and Future Directions • Studies are exploring potential biomarkers, such as microbiome signatures in the pancreas, which might help identify high-risk individuals in the future. • Trials like the EuroPAC study focus on surveillance protocols for high-risk individuals using imaging techniques like MRI or endoscopic ultrasound. • Research into new-onset diabetes as a potential marker for pancreatic cancer is ongoing but currently has a low yield due to the high prevalence of type 2 diabetes unrelated to malignancy. Considerations for Screening and Surveillance • Screening should be carefully targeted to avoid over-diagnosis and unnecessary investigations. • The psychological impact of screening (e.g., anxiety from incidental findings) must be considered. • Smoking cessation is emphasized as smoking is a significant risk factor for pancreatic cancer. Advances in Treatment Approaches • PET-CT scans are increasingly used to detect systemic disease that might not be evident on standard CT scans. • Neoadjuvant treatments (therapy before surgery) are being... Chapters (00:00:00) - Ingest(00:00:53) - Pancreatic Cancer(00:04:03) - New diabetes and pancreatic cancer(00:08:01) - Pancreatic Cancer: Screening(00:15:42) - Determining breast cancer early is hard(00:16:03) - Pulmonary neuroendocrine tumors of the pancreas(00:22:26) - Pancreatic cancer 20, Management(00:29:00) - Pancreatic cancer, management principles(00:33:48) - Primary Care Take Home: Pancreas, pain(00:40:29) - Primary Care: Pancreas Cancer Episode 2

Dr Charlie Andrews talks to Dr John Leeds. John Leeds is a Consultant Pancreaticobiliary Physician and Endoscopist based at the Freeman Hospital in Newcastle and an Honorary Clinical Senior Lecturer based in the Population Health Sciences Institute at Newcastle University. He is involved in research in pancreaticobiliary disorders including benign and malignant conditions as well as outcomes from therapeutic/advanced endoscopy.John is a member of the British Society of Gastroenterology and Pancreatic Society of Great Britain and Ireland. He serves on the endoscopy and Pancreas committees for BSG and is the website lead for PSGBI.He is also a founder member of the BSG Pancreas Clinical Research Group which is coordinating research for the society. Chapters (00:00:01) - Ingest: pancreatic lesions(00:01:09) - Pancreas(00:05:39) - Chronic Pancreas disease, early signs and symptoms(00:11:54) - Pulmonary pancreatitis, diagnosis and management(00:17:52) - Diarrhea, weight loss(00:18:29) - Pancreatic disease, ultrasound and the best treatment(00:23:49) - Pancreatitis, chronic pancreatitis in primary care(00:26:19) - Pancreatitis 20, Surgery or drainage?(00:32:24) - Pancreatic Exocrine Insufficiency(00:38:05) - Pulmonary dysrhythmias, management tips(00:43:46) - PPI for cystic fibrosis patients 8,(00:46:16) - Pancreatic insufficiency 20, Detection and treatment(00:49:57) - Pancreatic cysts(00:55:32) - Choosing the right cyst for surgery(00:57:20) - autoimmune pancreatitis, presentation and treatment(01:03:34) - Pancreatic cancer: diagnosis and treatment(01:06:14) - Pancreatitis, part 1, unboxing

Charlie Andrews talks to Dr Chris Black about the management of IBS.This podcast provides key insights into managing Irritable Bowel Syndrome (IBS), emphasising a multidisciplinary and individualised approach to care. Here are the main takeaways:1. Multidisciplinary and Integrative CareIBS management requires a holistic, patient-centered approach involving dietitians, behavioral therapists, and gastroenterologists. This "team sport" approach expands treatment options and tailors care to individual patient needs1. Integrative care, which combines dietary, psychological, and medical interventions, has been shown to improve symptoms, psychological well-being, and quality of life for IBS patients1.2. Personalised TreatmentIBS is not a one-size-fits-all condition. There are different subtypes of IBS (e.g., IBS-D for diarrhea-predominant or IBS-C for constipation-predominant), and treatment must be customized based on the patient's symptoms and triggers4. Emerging research suggests the need to identify distinct subtypes of IBS to guide more effective treatments24.3. Dietary ManagementThe low FODMAP diet is a widely recommended dietary intervention for IBS. It helps identify food triggers and manage symptoms but should not be used long-term without personalization3. Probiotics may also play a role in symptom relief for some patients, though their effectiveness varies3.4. Behavioral InterventionsCognitive Behavioral Therapy (CBT) and gut-directed hypnotherapy are effective in managing IBS symptoms, particularly when patients are motivated to engage in these therapies1. Stress management is critical since stress and anxiety can exacerbate IBS symptoms15.5. Pharmacological TherapiesMedications are often used as complementary treatments when dietary or behavioral strategies alone are insufficient. These include antispasmodics, laxatives, or medications targeting gut-brain interaction Chapters (00:00:01) - Ingest on Irritable Bowel Syndrome(00:02:49) - In the Know: irritable bowel syndrome (IBs)(00:04:03) - Irritable bowel syndrome, management principles(00:08:07) - How to manage irritable bowel syndrome? ((00:16:15) - How much loperamide can one give for IBS?(00:17:36) - Non-steroidal anti-inflammation for IBS?(00:24:05) - Physical and psychological therapies for abdominal pain(00:26:17) - IBS, secondary care referrals(00:32:11) - First line diabetes: An integrated approach(00:32:40) - IBS, group-based care(00:40:27) - Management of IBS 11(00:42:28) - Primary Care: IBS Episode 4

Charlie Andrews talks to Dr Anthony (Tony) Wisken, Consultant Paediatric Gastroenterologist in Bristol.The Ingest podcast is hosted by Dr Charlie Andrews a GPwER in gastroenterology based near Bath. Charlie works as a GP partner at Somer Valley Medical Group, trained as an endoscopist and leads the national GPwER in gastroenterology training programme, launched in 2023 in the southwest of England. Charlie is a committee member of the PCSG (Primary Care Society of Gastroenterology). For more information visit pcsg.org.uk Chapters (00:00:05) - INGEST(00:01:02) - Chronic abdominal pain in children(00:07:47) - Pediatric gastroenterology, pain in the tummy(00:13:13) - Reflux in children, 6 years and older(00:15:26) - Headache and abdominal pain in children, age 6(00:21:34) - Idiopathic bowel syndrome in children(00:24:51) - Tummy pain 11, constipation(00:31:08) - Mesenteric adenitis 20, Cancer(00:35:06) - Functional GI disorders, the role of ultrasound(00:38:57) - Obstructive bowel disease in teenagers(00:45:41) - Gallstones in children, anaesthesia and surgery(00:47:01) - Celiac disease, tests and how to manage it(00:49:40) - Top 3 Take Homes for kids(00:51:51) - H. Pylori in children's tummy pain(00:55:37) - 3 take home points from the abdominal pain episode

Key takeaways from the IBS Part 1 episode of the PCSG Ingest podcast:Diagnosis of IBSThe episode is focused on making a diagnosis of Irritable Bowel Syndrome (IBS)and features Dr. Anton Emmanuel, a consultant gastroenterologist and Professor of neuro-gastroenterology at University College Hospital London.Importance for Primary CareIBS is a common condition that primary care clinicians need to have a structured approach to diagnosing.Topics CoveredCauses of IBS Different subtypes of IBS Challenges in making a positive diagnosisClinical PearlsDr. Emmanuel shares several insights:Key questions to include in the patient history How to describe the condition to patients Practical tips for enhancing IBS diagnosis in primary careDiagnostic ApproachThe episode emphasises the importance of:Taking a structured approach to diagnosis Understanding the various presentations of IBS Recognizing the challenges in making a definitive diagnosisPatient CommunicationGuidance is provided on:Explaining IBS to patients effectively Addressing patient concerns and misconceptionsAdditional ResourcesThe episode mentions useful guidance from the British Society of Gastroenterology, which listeners were encouraged to reference for more detailed information. Part 2 focusing on the management of IBS to be released soon.bsg.org.uk/clinical-resource/british-society-of-gastroenterology-guidelinesThe Ingest podcast is hosted by Dr Charlie Andrews a GPwER in gastroenterology based near Bath. Charlie works as a GP partner at Somer Valley Medical Group, trained as an endoscopist and leads the national GPwER in gastroenterology training programme, launched in 2023 in the southwest of England. Charlie is a committee member of the PCSG (Primary Care Society of Gastroenterology). For more information visit pcsg.org.uk Chapters (00:00:00) - Ingest(00:01:33) - Intense bowel dysrhythmia (IBs)(00:04:02) - How common is ibs?(00:06:17) - Obstructive bowel syndrome(00:10:06) - IBS: Classification and treatment tips(00:13:39) - Determining the diagnosis of IBS(00:14:44) - IBS(00:19:22) - IBS 12, Missing other comorbidities(00:22:21) - What to ask about IBS?(00:25:25) - IBS and secondary care,(00:29:33) - Confirmations about inflammatory bowel disease (IBs)(00:33:37) - Talking to the patient about ibs(00:35:09) - IBS, the diagnosis and treatment(00:38:11) - In the Know: Irritable bowel syndrome(00:40:22) - Irritable Bowel Syndrome(00:41:15) - The Primary Care Society for Gastroenterology Podcast

Dr Charlie Andrews speaks to Dr Jeremy Shearman about everything related to high iron levels (hyperferritinaemia).  We discuss how iron is regulated within the body, causes of raised iron levels, and then we dive into hereditary haemochromatosis - when to suspect, how to test, who to refer (and to whom!), and how the condition is managed.  Useful links to accompany this episode include:Welcome > Haemochromatosis: genetic iron overload disease (exeter.ac.uk)Haemochromatosis - British Liver TrustKey Learnings for Primary Care from the Ingest Podcast on HyperferritinaemiaKey LearningsUnderstanding Iron Regulation and FerritinFerritin is an acute-phase reactant and a marker of total body iron stores, but can be elevated in a range of conditions beyond iron overload, including inflammation, liver disease, and malignancy[2]. Understanding the physiological regulation of iron is crucial for interpreting ferritin results in context.Causes of HyperferritinaemiaRaised ferritin can result from: Hereditary haemochromatosis (genetic iron overload) Chronic inflammatory states (e.g., infection, autoimmune disease) Liver disease (e.g., alcoholic liver disease, hepatitis) Malignancy Metabolic syndrome It is important to consider these differential diagnoses when encountering an elevated ferritin[2].Hereditary Haemochromatosis: When to SuspectPrimary care clinicians should suspect hereditary haemochromatosis in patients with persistently raised ferritin and transferrin saturation, especially with suggestive symptoms (e.g., fatigue, arthralgia, diabetes, liver dysfunction) or family history[2]. Early recognition is key, as treatment can prevent complications.How to TestInitial investigations should include: Repeat ferritin measurement to confirm persistence Transferrin saturation (TSAT): TSAT >45% is suggestive of iron overload Liver function tests and assessment for other causes of raised ferritin[2] If hereditary haemochromatosis is suspected, genetic testing (HFE gene) should be considered.Who to Refer (and to Whom)Refer patients with confirmed iron overload (high ferritin and TSAT) or positive HFE mutation to hepatology or a relevant specialist for further assessment and management[2]. Referral is also warranted if there are signs of organ involvement (e.g., abnormal LFTs, diabetes, cardiac symptoms).Management PrinciplesFor hereditary haemochromatosis, mainstay of treatment is venesection (therapeutic phlebotomy) to reduce iron stores. Primary care plays a role in monitoring, supporting adherence, and managing comorbidities. For other causes, management is directed at the underlying condition.Practical Tips for Primary CareDo not ignore isolated raised ferritin-always interpret in clinical context. Exclude common secondary causes (infection, inflammation, liver disease) before pursuing rare diagnoses. Family screening may be appropriate in hereditary haemochromatosis cases[2]. Use local guidelines and specialist advice where available.Summary Table: Approach to Hyperferritinaemia in Primary CareStepAction/ConsiderationConfirm raised ferritinRepeat test... Chapters (00:00:00) - Ingesting: Iron overload and hereditary haemochromat(00:01:07) - Hemochromatosis 7, Regulation of iron stores(00:03:31) - What would you consider to be a high ferritin level?(00:04:57) - Ferritin and transfer and saturation(00:06:45) - High ferritin in liver, causes and treatment(00:09:05) - Hereditary Haemochromatosis in the UK(00:12:36) - Diagnosing hereditary haemochromatosis in primary care(00:15:58) - Hemochromatosis, C282Y homozygosity(00:19:26) - Cascade screening in haemochromatosis(00:23:07) - Hematology and hepatocellular cancer referral(00:25:30) - How to manage haemochromatosis in the UK?(00:32:27) - Hereditary haemochromatosis and iron overload(00:34:56) - Hemochromatosis(00:36:51) - Iron Overload

In this episode, Charlie Andrews speaks to Professor Julian Walters about bile acid malabsorption and diarrhoea. With up to a third of patients with diarrhoea-predominant IBS having underlying bile acid diarrhoea, and with diagnosis rates for this condition being low, this episode is an important one for anyone working in primary care. We explore the role and physiology of bile acids, the causes and symptoms of bile acid malabsorption, the diagnostic tests used to make the diagnosis and the treatment of this common but underdiagnosed condition. Should we use 'trial of treatment' in primary care to support the diagnosis? Are people who have had their gall bladder removed at greater risk of bile acid diarrhoea? Can bile acid sequestrants impact the absorption of other medications? These questions, and lots more, will be discussed in this episode.Key Learnings for Primary Care from this Ingest Podcast on Bile Acid DiarrhoeaOverview and PrevalenceBile acid diarrhoea (BAD), also known as bile acid malabsorption, is a significant but under-recognized cause of chronic diarrhoea in primary care. It is more common than Crohn's disease and ulcerative colitis combined, with a prevalence of about 1% in the general population-comparable to coeliac disease[1]. BAD is often misdiagnosed as IBS with diarrhoea (IBS-D); about one third of patients with IBS-D may actually have BAD[1].Causes and ClassificationBAD is classified into three types: Type 1: Secondary to ileal disease or resection (e.g., Crohn's disease, surgical removal of terminal ileum) Type 2: Primary or idiopathic (often confused with IBS-D; thought to be due to overproduction of bile acids) Type 3: Other causes affecting absorption, such as cholecystectomy, small intestinal bacterial overgrowth, or radiation[1]. Post-cholecystectomy BAD is relatively common, affecting about 1 in 10 patients after gallbladder removal[1].Clinical PresentationPatients typically present with chronic, watery diarrhoea (Bristol stool types 6–7), often frequent (4–12 times daily), sometimes nocturnal, and can be long-standing (sometimes decades)[1]. There is often a long delay in diagnosis; nearly half of patients wait over five years for a correct diagnosis[1]. BAD is frequently overlooked in differential diagnosis, with clinicians more likely to investigate for IBD, coeliac disease, or cancer[1].Diagnosis in Primary CareThe key is to think about BAD as a possible diagnosis, especially in patients with chronic diarrhoea where other causes have been excluded[1]. The gold standard diagnostic test is the SeHCAT (selenium homocholic acid taurine) scan, which is widely available in the UK but not in all countries[1]. A retention value below 15% at seven days is diagnostic; lower values indicate more severe disease[1]. There is no simple blood test for BAD, unlike coeliac disease[1]. Empirical trials of bile acid sequestrants may be considered if SeHCAT is unavailable or in specific cases (e.g., pregnancy), but a confirmed diagnosis is preferred to guide treatment and improve adherence[1]. Before considering BAD, it is essential to exclude other causes of diarrhoea (negative coeliac serology, faecal calprotectin, and, depending on age, appropriate cancer screening)[1].TreatmentFirst-line treatment is with bile acid sequestrants: Cholestyramine: A powder taken in 4g sachets, usually started at night on an empty stomach for best effect (contrary to original cholesterol-lowering indications)[1]. Chapters (00:00:06) - Ingest(00:01:24) - Bile Acid Diarrhea(00:02:35) - Bile acid malabsorption(00:03:43) - Bile Acid Diarrhea after cholecystectomy(00:06:44) - Bile acid diarrhea in the UK(00:12:00) - Bile acid diarrhea, empirical treatment in primary care(00:14:28) - Bile Acid Depiction 6, Treatment options(00:20:14) - Bile acid diarrhea 12, Long term prognosis(00:22:12) - Bile acid diarrhea(00:25:12) - Bile Acid Diarrhea

Join Charlie Andrews in this episode where he speaks to Cristian Costas about the management of people diagnosed with coeliac disease.  Cristian is a dynamic dietician who is based in Bradford.  He is passionate about coeliac disease and runs an innovative dietician-led service for those with coeliac disease in his area.   Cristian shares with us his top tips for supporting someone newly diagnosed with coeliac disease, including where to access support for those who are newly diagnosed, and how to avoid common dietary pitfalls.  We discuss how best to follow-up people with coeliac disease, and key interventions such as assessments for osteoporosis and vaccinations for coeliacs.   We know that education and the support of a dietician are key interventions that can help patients manage the gluten-free diet effectively, and in this episode, Cristian shares his passion for improving the care for those with coeliac disease. An informative, enjoyable and inspiring listen!

In primary care, we are increasingly using FIT (Faecal Immunochemical Testing) to assess the risk of bowel cancer in patients with lower gastrointestinal symptoms, whilst the latest PCN DES IIF (Impact and Investment Fund) has given FIT a prominent role in risk stratifying 2-week wait referrals to secondary care. In this episode, Mo Thoufeeq, a gastroenterologist in Sheffield, talks to me about what FIT is, how it differs from previously used FOBT (and why it is a more effective test!), and how we are using FIT in both symptomatic and asymptomatic patients. He shares his top tips about how to interpret, when to test and we discuss the tricky areas of patients with rectal bleeding and those with iron deficient anaemia. Mo has a deep knowledge and understanding of FIT and provides a fantastic and relevant discussion of the topic for our primary care audience in this episode.

In this episode, I am joined by Pearl Avery. Pearl has a unique role - she spends part of her week as an IBD nurse specialist, and part of her week as an ANP (Advanced Nurse Practitioner) working in a GP practice. Pearl has a fantastic understanding of both primary and secondary care and shares her experiences with me. We discuss her unique and innovative role, common queries from GPs and patients from her IBD nurse specialist role (including common questions about flare management and biologic monitoring), and what she has learned about the care of people with IBD from her primary care role. I felt extremely energised and enthusiastic after speaking to Pearl and took home some great top tips. This episode really demonstrates the benefit of working collaboratives and 'bridging the gap' between primary and secondary care.

I speak to Chris Lamb about IBD.  Chris was lead author on the BSG IBD guidelines which were published in 2019.  The full guidance can be found here:  BSG-IBD-Guidelines-2019.pdf Chris is a fount of knowledge for all things related to IBD and I have a fascinating chat with him about the guidance and how these relate to primary care - we range over all aspects of IBD from diagnosis to management and everything in between.  

In this episode, I speak to Professor Ramesh Arasaradnam. Ramesh co-authored the BSG guidelines on chronic diarrhoea in 2018, and is a fount of knowledge in this area.

Affecting up to 20% of the UK population, dyspepsia is commonly seen in primary care. Following investigations, the majority of people (up to 89%) are found to have functional dyspepsia. As with any functional problem of the gut, such as IBS, making a confident diagnosis is sometimes challenging but extremely important for the patient, and management encompasses a range of non-pharmacological interventions. Pali Hungin, an extremely experienced primary care clinician and a founding member of both the PCSG and it’s European counterpart, shares his vast experience and understanding of functional dyspepsia with us in this episode. As chair of the ROME VI primary care committee, Pali is hugely knowledgeable about this complex yet common condition.

This edition of the podcast series Ingest published by the Primary Care Society for Gastroenterology (PCSG) features a very special guest from the world of gastroenterology.  Dr Charlie Andrews talks to Nobel Prize laureate Professor Barry Marshall, the Director of the Marshall Centre founded in 2007 in his honour, the Western Australian Ambassador for Life Sciences and University of WA Brand Ambassador, about his discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.

Dyspepsia is a common presenting complaint in primary care, and encompasses a range of symptoms including GORD, nausea, and epigastric pain. Having an approach to these patients is vital given how commonly we see these symptoms, and Mike Burkitt joins me in this episode to provide a really useful overview of dyspepsia, and how we can approach this symptom in clinical practice. Mike also gives his thoughts on what to do when the endoscopy comes back normal in a symptomatic patient. Useful resources for dyspepsia include:https://cks.nice.org.uk/topics/dyspepsia-unidentified-cause/https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#upper-gastrointestinal-tract-cancersA great video recorded by Dr Sophie Nelson and Dr Mike Burkitt covering dyspepsia can be found here: https://mft.nhs.uk/mri/services/gastroenterology-and-hepatology/

Dr Charlie Andrews discusses coeliac disease. Following the last episode on iron deficiency anaemia this episode focuses on coeliac disease, what it is, NICE guidance, when to suspect, how to test and a non biopsy pathway to diagnosis. First though a history lesson ……

Dr Charlie Andrews discusses iron deficiency anaemia (IDA) with Dr Sophie Nelson, a GP from Manchester with a special interest in gastroenterology and a self proclaimed geek when it comes to IDA. Dr Sophie Nelson is a committee member of the PCSG This podcast was recorded soon after the publication of updated guidelines for the management of IDA in adults by the BSG.

Following on from the episode on dysphagia Dr Charlie Andrews talks to patients about their experience of being diagnosed and living with achalasia. Achalasia affects about one in every 100,000 people and can occur at any age. The key symptom is dysphagia.

In this episode of Ingest I speak to Dr Mark Follows, a GPwER in gastroenterology, about dysphagia. Mark bridges both primary and secondary care gastroenterology and provides an informative and authoritative overview of dysphagia. We look at the normal swallowing process, the differential diagnosis of dysphagia (including neurological, ENT and gastrointestinal causes), and how to investigate the patient with dysphagia. Mark talks about his approach to the patient with dysphagia, red flags and who to refer to and how urgently. If your automatic reaction to the patient with swallowing difficulties is to refer directly to gastroenterology, I would recommend you listen to this episode to develop a deeper understanding of this symptom.

I have a fascinating discussion with Professor Stephen Atwood, a surgeon and honorary professor at Durham university, about Eosinophilic oesophagitis (EoE), an important cause of dysphagia. Rarely do I get to speak to someone who has first identified a disease, however this is exactly what Professor Attwood did in the 1980s, and he discusses how this discovery came about, and brings us up to speed on the risk factors for the condition, the causes of the disease, how the patient may present and how to manage the patient with EoE, including the latest treatment orodispersible steroid treatment Jorveza.