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Clinical Advice

We are happy to give clinical advice by telephone via our secretaries or for advice by email please contact us at ruh-tr.gastroadvice@nhs.net. The inbox will be checked on a daily basis by the departmental secretaries and enquiries distributed as appropriate. You may be able to find help with some queries in our FAQ section which will grow as time goes on.

Frequently Asked Questions

Q. Do patients with a positive TTG antibody need to have a small bowel biopsy to confirm the diagnosis of coeliac disease?

A. Yes. All patients should have histological confirmation of the diagnosis. It is best to refer initially for an endoscopy rather than to the outpatient clinic. The patient should be advised to be on a normal wheat containing diet for six weeks prior to the endoscopy. Shorter periods of including gluten in the diet are acceptable if this is all the patient can manage but may lead to less reliable results.

Q. How do I monitor my patient on IBD medications under shared care?

A. The BCAP guidance is summarised on the links below:

BCAP Shared Care Guidance

RUH Guidance for Monitoring of IBD Medications

Q. My patient with an enteral tube has a tube related concern?

A. RUH enteral tube information:

Enteral Tube Problems - Information for patients, nursing and medical staff

Q. Should this patient with a family history of colon cancer have colonoscopy screening?

A. The British Society of Gastroenterology's current recommendations for screening individuals with a family history of colon cancer are avialable via this link:

Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups

High risk
People who have a three or more first-degree relatives under 50 years old (mother, father, brother, sister, child) who have had colorectal cancer or a Lynch syndrome cancer (endometrium, small bowel, ureter or renal pelvis) in > 2 generations; at least one affected relative must be no more than 50 years old at diagnosis and one of the affected relatives must be a first degree relative of the other two, or a known family history of a genetic syndrome, should be referred to the clinical genetics team to determine colonoscopy surveillance interval alongside referral for colonoscopy.

High-moderate risk
People who have a three or more first-degree relatives over 50 years old (mother, father, brother, sister, child) who have had colorectal cancer, or two affected relatives less than 60 years old in a first degree kinship with each other, or two affected relatives with a mean age less than 60 years old in a first-degree kinship should be offered five yearly colonoscopy from age 50 until 75 years and be referred to the clinical genetics team.

Moderate risk
People with only one first-degree relative affected by colorectal cancer aged under 50 years or with only two first degree relatives who have had colorectal cancer over 60 have a moderate risk of developing colorectal cancer. These people should be offered a single colonoscopy at age 55 years. If the investigation is normal, then no further investigations (other than the normal bowel cancer screening by FOB) are recommended.

Low risk
People with family histories that are different to those listed above are classified as low risk, as their risk is similar to the population in general. These people do not need any further investigations (other than the normal bowel cancer screening by FOB).


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