Apr 25

Hypermobility Syndrome / Ehlers Danlos Syndrome

Within the field of gastroenterology I often see this condition typically associated with slow transit constipation, which in turn leads to gas trapping, uncomfortable bloating distension and lower abdominal cramps.

To make a simple assessment one can use the Beighton Score by clicking on the link provided by the Hypermobility Syndromes Association

In general a score of 0-3 is deemed normal

A score of 4-9 is suggestive of Hypermobility Syndrome (ligamentous laxity).

Further information can also be reviewed on the Ehlers Danlos Support UK site

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Apr 17

Please click on this link to find attached a patient advice sheet for Selective IgA Deficiency provided by Primary Immunodeficiency UK (PID UK) – www.piduk.org

They also offer free membership for and support. Joining is free and easy to do. You can do this via their website at www.piduk.org/register/

Members also get a monthly e‐bulletin and two newsletters per year.

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Apr 17

Recurrent isolated RUQ abdominal pain (e.g. often under the right ribs) is common and abdominal cutaneous nerve entrapment syndrome is said to account for 2% of all presentations to A+E with acute abdominal pain.

Click on this link to review a recent systematic review of the literature assessing outcomes from;-

a) Trigger point injection (TPI) alone – 86% short term successful response, 76% long-term response

b) Anterior neurectomy alone – 73% short term successful response, 61-69% long-term response

c) TPI followed by anterior neurectomy as stepwise regimen

d) Nerve stimulation and phenolization.

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Jun 01

Anal pain can have many potential causes

Click on this patient information link to be guided through some of the potential causes and their management

The Dr. Falk Foundation have kindly produced a full pdf leaflet with simple pictures that can be reviewed by clicking on the following link

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Jun 05

I have recently been chosen as a trainer for the new ACT (Advanced Training in Constipation) management courses in the East of England.

The aim of the course is to standardise the evidence-based understanding and treatment of constipation throughout Britain using the most up-to-date peer reviewed research.

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Sep 10


This new selective, high affinity 5-HT4 agonist appears to be one of the first new therapies to have really made a significant impact on the treatment of chronic constipation.
Presently in UK it is being offered in women only who have failed on standard laxatives.
Prucalopride 2mg od (or 1mg od for those over 65y)
If there has been no benefit after 1 month, it is unlikely that continuing any longer will be helpful .

In 3 seperate 12week trials it was shown to improve;-
a) regular bowel frequency to at least 1x/day in 67% (verses 39% on placebo)
b) abdominal pain and discomfort
c) bloating
d) straining
e) defaceation urgency
Benefits are seen with median time to spontaneous bowel movement within 3 hours.
Interestingly the improvement in quality of life was maintained for 2 years.
Side effects are mild (diarrhoea, nausease, headache, abdominal pain) and resolve swiftly (24 hrs).

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