Consultant physicians working with patients - Royal College of ...

2 Specialties Gastroenterology and hepatologyGastroenterology and hepatologyDr Adam Harris BSc MBBS MD FRCP Consultant physician and gastroenterologist1 Description of the specialtyThe specialty of gastroenterology and hepatology caresfor patients with both benign and malignant disordersof the gastrointestinal (GI) tract and liver. The specialtyencompasses a wide range of conditions – fromcommon disorders, such as indigestion and irritablebowel syndrome, to highly complex problems, such asinflammatory bowel disease (IBD) and liver failure –and specialised procedures such as endoscopic resectionof cancers and liver transplantation.Gastroenterologists also see patients with a varietyof general medical problems, particularly anaemiaand weight loss. Much of the work, particularly toexclude organic disease in symptomatic patientsand to provide rapid diagnosis and treatment forpatients with suspected GI cancer, is based inoutpatients. The investigations required often includeendoscopy and imaging. An acute and emergencyinpatient service is needed for common problems suchas gastrointestinal haemorrhage, acute IBD anddecompensated liver disease (particularly due toalcohol).Gastroenterologists are involved in the National BowelCancer Screening Programme and provide a highquality,safe, diagnostic and therapeutic (removal ofpolyps) colonoscopy service.Gastroenterology departments have an essential role inthe implementation of urgent referral for patients withsuspected cancer (‘2-week referrals’) to improve thediagnosis and treatment of GI cancers. Severaldepartments have combined to form multidisciplinaryteams (MDTs) in order to provide the critical massof specialists needed to meet the standards forEngland of the Department of Health’s (DH’s) ClinicalOutcomes Group (COG) for the provision of specialistservices. 1 Tertiary referral units may receive patients withcomplex IBD or hepatobiliary disease or complexnutritional problems (who may require home totalparenteral nutrition) or who require advancedtherapeutic endoscopy. Patients who require transplantation of theliver and small intestine are referred to the smallnumber of units that undertake organtransplantation.Malnutrition is common in hospital patients(∼35%) and associated with increased morbidityand mortality. 2 Every healthcare facility should bescreening nutritional status using the MalnutritionUniversal Screening Tool (MUST), or equivalent.Patients found to be at risk should ideally bereferred to a multidisciplinary nutrition supportteam.2 Organisation of the service and patternsof referralMost symptomatic patients are looked after by their GP,and most problems are resolved by discussion, primarycare-initiated investigation, advice and medicaltreatment. Nonetheless, there has been a continuingsteady increase in outpatient and inpatient work forgastroenterologists, particularly in relation to alcoholicliver disease and the increasing numbers of cancers ofthe GI tract that occur in an ageing population. Theinpatient casemix usually comprises patients with GIbleeding, cancer, severe alcoholic liver disease and acutesevere IBD.Close liaison with colleagues in surgery, radiology,pathology and oncology facilitates the treatment ofdifferent forms of GI disease. Combined outpatientclinics (ie colorectal surgeon and gastroenterologist)undoubtedly improve management, and weekly cancermultidisciplinary team (MDT) meetings are a usefulforum for discussing all complex cases. Meetings withradiologists and pathologists should take place at leastonce a week and can be combined with formal trainingsessions for trainees.C○ Royal College of Physicians 2013 99