A 4️⃣ tweet guide on investigating and managing:

🩸𝗜𝗿𝗼𝗻 𝗱𝗲𝗳𝗶𝗰𝗶𝗲𝗻𝗰𝘆 𝗮𝗻𝗮𝗲𝗺𝗶𝗮 (IDA)

for GPs & non-Gastroenterology colleagues.

Defined as:

⬇️🩸Haemoglobin levels
(based on your local laboratory reference range)
c̅ ⬇️ MCV / MCH

#GastroTwearls 1/ Check:
💉Haematinics
❗️Coeliac Ab (3-5% of IDA)
🔝treat ⬇️ B12/ folate
❌ no need for FIT

✅ Confirm IDA
⬇️ ferritin or
⬇️ transferrin sats or
⬆️ TIBC 𝘢𝘯𝘥 ⬇️ iron or
⬇️ CHr or
≥ 10 g/L ⬆️ Hb c̅ 2/52 iron

❌ ⬇️ iron 𝘢𝘭𝘰𝘯𝘦 (?anaemia of chronic disease)

#GastroTwearls 2/

I have vetted ~3️⃣0️⃣0️⃣ referrals from primary care to Gastroenterology in last 2/52.

Pathways vary around the country - nevertheless I have observations / advice about managing common GI problems in primary care & when to refer in 7️⃣ tweets

#GastroTwearls 1/7 Simple GORD does not need an OGD. This is as per national guidance as OGDs aren’t pleasant & rarely changes management.

See #GastroTwearl👇🏼

When giving a PPI, Omeprazole is better than Lansoprazole (fewer SEs) - give a decent dose of 40 mg / day

2/7

https://twitter.com/UKGastroDr/status/1273736516108537860

A 4️⃣ tweet guide on investigating and managing:

🩸𝗜𝗿𝗼𝗻 𝗱𝗲𝗳𝗶𝗰𝗶𝗲𝗻𝗰𝘆 𝗮𝗻𝗮𝗲𝗺𝗶𝗮 (IDA)

for GPs and non-Gastroenterology colleagues.

Defined as:

🩸Haemoglobin levels
🙎🏻‍♂️< 110 g/L
🙍🏼‍♀️< 100 g/L
with ⬇️ MCV / MCH

#GastroTwearls 1/ New anaemia case:

💉Check haematinics
❗️Don’t forget coeliac screen

Confirm IDA:
✅ ⬇️ ferritin or
✅ ⬇️ transferrin sats or
✅ ⬆️ TIBC & ⬇️ iron 𝘵𝘰𝘨𝘦𝘵𝘩𝘦𝘳

❌ 𝘯𝘰𝘵 ⬇️ serum iron alone (can be anaemia of chronic disease)

🔝Correct ⬇️ B12 / folate

#GastroTwearls 2/

Congratulations @RishiSunak on becoming Chancellor of the Exchequer. You, and your family must be exceptionally proud of your achievements. I can relate to you on some level, we are both of similar ages, and come from similar cultural backgrounds.
/1 The fact that your Dad was a GP & mum was a Pharmacist, means hopefully you can relate to me as a NHS Consultant on some level. Knowing that we are paid relatively well but work hard for this. And that Doctors often work additional hours (or sessions).
/2