Gastrointestinal infections presenting in general practice in Scotland.

OBJECTIVES: To determine the incidence of gastrointestinal infections (GII) presenting to general practitioners (GPs) in Scotland, To record the demographic and clinical characteristics of persons presenting with GII, To determine the proportion and characteristics of GII investigated in the laboratory, To report on the microbiological aetiology of the GII. DESIGN: Descriptive epidemiological study. SETTING: Twenty three general practices in Scotland serving a total practice population of 152,471. SUBJECTS: Patients consulting their GPs for a 'gastrointestinal infection' which met the study case definition. RESULTS: These are presented for the 3872 patient consultations for GII between April 1996 and December 31st 1997 which met the survey case definition. The crude annual rate of new consultations recorded was 1.7 per 100 person years. The crude monthly consultation rate for new cases ranged between 11 and 18 per 10,000 patients. GPs notified 9% of the cases as 'food poisoning'. A request for microbiological testing of samples at the local laboratory for clinical reasons was documented for 34% of cases with diarrhoea. The study laboratory received faecal samples by post from 66% of these cases. About one in five of the samples tested revealed evidence of infection with a common gastrointestinal pathogen. The pathogens most frequently reported were Campylobacter sp and Salmonella sp. CONCLUSION: The incidence of consultations for GII in Scotland is similar to that recorded in a recent survey in England. The very low notification rate by GPs means that statutory notification by telephone or post is a poor basis for early warning of outbreaks. It is recommended that a pilot study of electronic notification using the NHS net is set up.

A negative double-contrast barium meal--qualified reassurance.

Four hundred and forty-one consecutive patients referred for endoscopy after a negative double-contrast barium meal were studied to determine the reliability of good quality radiology in excluding significant upper gastrointestinal pathology. Endoscopic abnormalities were detected in 23 patients (5.2%), nine of which were reporting errors. Duodenal ulcer was the commonest lesion missed radiologically, 50% of these patients either having a history of overt upper gastrointestinal bleeding, a family history or impressive symptomatic relief with H2-receptor antagonists. The three patients with radiologically undetected gastric cancer presented with classical symptoms; the radiological demonstration of gastric mucosal atrophy in this clinical context should alert the referring clinician to initiate urgent endoscopy.

'The fat-encrusted colon'. A radiological abnormality of colonic mucosa occurring in patients with steatorrhoea.

The clinical and radiological features of six cases of fat-encrusted colon are described. In patients with steatorrhoea, despite standard colonic preparation, fat may adhere to colonic mucosa and produce a radiological appearance that simulates the changes of inflammatory bowel disease. Steatorrhoea was due to coeliac disease in five patients, the sixth being a case of primary sclerosing cholangitis. The initial radiological diagnosis at barium enema in all six patients was of inflammatory bowel disease. On the basis of this appearance surgery was advised in three patients, one of whom proceeded to laparotomy with a view to colectomy. The correct diagnosis can be established by familiarity with the radiological appearance and confirmed by repeating the barium enema examination after 5 days of a fat-free diet, when the colonic mucosal pattern returns to normal.

Endoscopic and radiological assessment of recurrent ulceration after peptic ulcer surgery.

One hundred and eighteen patients with dyspepsia after peptic ulcer surgery were assessed by a double contrast barium meal and fibre-optic endoscopy, for the possibility of recurrent ulceration. There was overall endoscopic-radiological agreement in 89%. It is concluded that the two techniques are complementary and that a double contrast barium meal performed and interpreted by an experienced radiologist can demonstrate the presence or absence of a recurrent peptic ulcer with an acceptable degree of accuracy.

Patient-orientated gastroenterology.

Analysis of the first year's working of a combined gastroenterology clinic in a district hospital has shown that the major benefit was improved patient management. Hospital attendances were reduced, the diagnostic process accelerated, and unnecessary radiological investigations and surgical operations avoided. There were no obvious major disadvantages.

Lymphatic cysts of the colon.

A patient with a lymphatic cyst of the descending colon is reported. He underwent segmental resection of the colon. The clinical features, pathology, radiology, and treatment of these lesions are reviewed. It is emphasized that these cysts are very rare and cannot be diagnosed radiologically, but must be included in the differential diagnosis of polypoid lesions of the colon.