Abstract
Gastrointestinal symptoms constitute about 10% of all presenting complaints reported in new primary care appointments. We have recently introduced a calprotectin-based referral pathway for young adults presenting to primary care with GI symptoms: general practitioners can refer individuals with normal coeliac serology and negative stool calprotectin test straight to our dietician-led community clinic, which was previously only accessible following secondary care referral. We sought to define the caseload referred to- and the effectiveness of, our primary care dietician service.MethodsWe conducted a prospective observational cohort service of patients referred to our new clinic between April 2018 and Jan 2019. Patients with coeliac disease and possible inflammatory bowel disease were excluded using serological tests and stool calprotectin, respectively. Symptoms were assessed using a symptom scale (SS) modified from the Gastrointestinal Symptom Rating Scale for irritable bowel syndrome. Patients also completed the Patient Health Questionnaire-12 Somatic Symptom (PHQ-12) scale. Personalised dietary treatments were instituted and patients were followed up after 8 weeks. Response was assessed using the symptom score and the dietitian assessment. Treatment failure was defined by a static symptom score and dieticians global assessment. Comparisons were made between referrals made to the service from primary compared with secondary care. ResultsDuring the 9-month inclusion period our dietician treated 152 patients: 43% (66/152) were referred from primary care, and 78% (119/152) female. Referred primary care patients were younger (median (IQR) 30 (2–9) years vs 46 (3–3) years, p<0.001) than patients referred from secondary care. Overall, the presenting symptoms were similar between groups. A low FODMAP diet was advised in 82% (122/148) people, with other dietary advice given to 18% (26/148). In 4 people dietary therapy was refused or felt to be inappropriate. Follow-up data was available in 94 patients: 65% (61/94) were deemed to have had a successful intervention. Rates of success were similar for primary (67%) and secondary care referrals (63%), p=0.83. None of age, sex, somatisation score and screening tests for anxiety and depression were associated with differences in proportions with successful intervention.ConclusionsOverall, dietary therapies were effective in the management of about two-thirds of patients referred with gastrointestinal disorders. Patients referred direct from primary care were typically younger than those referred from secondary care. We plan to develop the service further by signposting referred patients with high PHQ-12 scores to our integrated depression and anxiety and psychology services.