GI Services at Luton and Dunstable Hospital

Services

Gastroenterology & Endoscopy service at Luton & Dunstable Hospital

The Gastroenterology Department provides an extensive range of services covering all areas of Gastroenterology and Hepatology, including Endoscopy and Clinical Nutrition.

Outpatient services include:

  • Investigation, diagnosis and advice on management of patients with
    • Dyspepsia and reflux symptoms
    • Dysphagia
    • Abdominal pain
    • Altered bowel habits (diarrhoea / constipation)
    • Rectal bleeding
    • Weight loss and nutritional problems
  • Management of chronic conditions including
    • Inflammatory Bowel Disease. This service is supported by 2 IBD specialist nurses and provides the full range of specialist care for IBD patients including:
      • Biologics and Immunomodulator service
      • IBD SSHAMP (Supported Self Help and Management Programme (the first of its kind in the UK)
      • Rapid access to specialist clinics
      • IBD telephone hotline
      • Transition clinic
      • Joint clinic with the colorectal surgeons
    • Coeliac disease
    • GI morbidity after treatment for cancer
    • Barrett's oesophagus
      • National Research projects include the BOSS (surveillance study) and CHOPIN (genetic study)
  • Clinical Nutrition. There is a strong Nutrition team currently led by Dr Rostami which provides support particularly for patients requiring enteral feeding, including PEG insertion, and inpatients requiring Parenteral Nutrition. The team works closely with colleagues at tertiary centres who provide Home Parenteral Nutrition to our patients. The team also works closely with the community dietitians to support Nutrition Screening and the treatment of patients at risk of malnutrition in hospital and in the community.
  • Specialist investigations available include:
    • Oesophageal pH studies, Impedance and High resolution oesophageal manometry
    • Faecal calprotectin
    • Hydrogen breath tests for lactose intolerance and bacterial overgrowth
    • Capsule endoscopy (small and large bowel assessments)

Endoscopy services include:

  • Diagnostic Upper GI Endoscopy (including an open access service)
  • Therapeutic Upper GI Endoscopy
    • Therapy of GI bleeds
    • Banding of varices and glue therapy for varices
    • Dilatation of oesophagus or pylorus
    • Oesophageal and pyloric stent insertion
    • Percutaneous Endoscopic Gastrostomy (PEG) insertion
  • Diagnostic Colonoscopy
  • Therapeutic Colonoscopy
    • Polypectomy, including endoscopic mucosal resection
    • Stricture dilatation
    • Ablation of vascular lesions
  • Flexible Sigmoidoscopy (including an open access service for patients with rectal bleeding)

The endoscopy unit also works jointly with Bedford Hospital to provide the Bowel Cancer Screening Programme for the eligible patients. (http://www.cancerscreening.nhs.uk/bowel/)

The Gastroenterology department has systems in place to ensure that patients requiring endoscopic follow-up (such as those with Barrett's oesophagus and colonic polyps) are contacted to arrange this in a timely fashion and vetting processes in place to ensure that further endoscopy is still appropriate in these patients.

Who to Refer

Urgent or suspected cancer referrals should be made for all patients with upper GI or colorectal cancer alarm symptoms http://guidance.nice.org.uk/CG27/QuickRefGuide/pdf/English

Upper GI Alarm Symptoms

  • Unintentional weight loss >3kg
  • Evidence of GI blood loss
  • True progressive dysphagia or odynophagia
  • Persistent continued vomiting
  • Epigastric mass
  • Unexplained iron deficiency anaemia
  • Previous gastric surgery
  • Suspicious imaging results
  • New persistent and unexplained dyspepsia>55yrs age

Colorectal Alarm Symptoms

  • Definite palpable R sided abdominal mass
  • Definite palpable mass on rectal examination
  • Unexplained iron deficiency anaemia
  • Persistent rectal bleeding and / or change in bowel habit
    • 40 - 60 yrs old with rectal bleeding and change of bowel habit
    • 60 yrs or over with rectal bleeding independent of change in bowel habit and in absence of anal symptoms
    • 60 yrs or over with change in bowel habit independent of rectal

Some patients with suspected Inflammatory Bowel Disease may also fit into the criteria above and also require urgent referral and investigation.

Routine referrals

  • Patients with troublesome dyspepsia or reflux symptoms that have not responded to first-line management (as detailed in the Luton dyspepsia pathway
  • Patients with troublesome lower GI symptoms (abdominal pain, diarrhoea, constipation) that have not responded to first-line management
  • Patients with a strong family history of GI cancer for consideration of screening
  • Patients with a known diagnosis of IBD requiring long term follow up
  • Patients with a known diagnosis of coeliac disease who have refractory symptoms or who have developed new symptoms
  • Patients with GI symptoms following treatment for cancer
  • Patients with nutritional problems and in particular those with diagnoses such as motor neurone disease who may need a PEG at some stage

Who not to Refer

Food allergy (allergy clinic at Addenbrookes)

Obesity (refer to Obesity clinic at L&D)

Anorexia (should be managed according to NICE Guidelines)

Gallstones (should be referred directly to the Upper GI or Hepatobiliary Surgeons)

Resources

Links for patients

https://www.ldh.nhs.uk/Gastroenterology_new.htm The Gastroenterology and Endoscopy section of the Luton and Dunstable hospital website contains information for patients on the common endoscopy procedures and common conditions with links to patient information. Luton & Dunstable Hospital are currently in the process of designing a new website - updated links will be provided if applicable.

www.theguttrust.org (extremely useful site full of advice & information for patients with irritable bowel syndrome)

www.nacc.org.uk Crohn's and Colitis UK (for patients with ulcerative colitis or Crohn's disease with downloadable information leaflets and factsheets)

www.coeliac.co.uk (for patients with coeliac disease)

http://www.patientsknowbest.com/ Patients know best is a website that allows clinicians to easily communicate and consult with their patients online through our secure website. It is being used as part of the IBD SSHAMP project.

www.corecharity.org.uk CORE is a charity that funds research into gastrointestinal diseases and provides a large range of patient information leaflets that can be downloaded from their website

www.iasupport.org Ileostomy Support Group

www.colostomyassociation.org.uk Colostomy Association

www.opa.org.uk The Oesophageal Patients Association - for patients affected by oesophageal cancer

www.beatingbowelcancer.org Beating Bowel Cancer - information on bowel cancer - a site working to improve public awareness and increase the rate of early diagnosis

http://www.barrettscampaign.org.uk/ Barrett's oesophagus campaign - information for patients and professionals on Barrett's including patient information leaflets for download

www.bapen.org.uk Information on malnutrition for patients and professionals including information on 'MUST' and information for patients on screening and treatment of malnutrition

http://www.pinnt.com/ A support group for patients  receiving artificial nutrition (both enteral and parenteral nutrition) with information on screening an treatment of malnutrition for patients



Last updated: 10/05/2013

Update due: 10/05/2014