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care referrals, unnecessary investigations, complications and associated conditions and medicatjons. ln addition, treating patients who have been given a diagnosis of IBS after red flag
investigation can also reduce the substantial 'revolving door' costs. This is a potential win-win scenario, with a proportion of the money saved being channelled to support the new community gastroenterology dietetic service.
Should this service include GI allergy? Allergy effects 1-2% ot the adult (r1)
UK population. Allergy as a whole costs the UK NHS over t1 billion pounds per annum (rr)
with a significant proportion of referrals to allergy clinics being related specifically to food
allergy. r- However. there is a UK-wide lack of specialist adult allergy servicesl,'and there is no adult allergy service in Somerset (with the nearest solution being expensive secondary or tertiary care referral to Bristol or Southampton). Despite the new 201 1 NICE guidelines on allergy,
which clearly state that allergy
Finally
diagnosis and treatment could predominantly take place in primary care (a), speclalist allergy
As the pressure increases
clinics within primary care remain almost non-existent. lnterestingly, all the patients in our audit were referred with IBS and yet almost B% improved when given dietary
intervention for Gl allergy and not lBS. A further 26%o were successfully treated using a combination of advice for food allergy and IBS (although follow-up needs to be done with this group to determine the true cause of their improvement).
Not only is there a need for specialist adult food allergy treatment within primary care, but there also appears to be a significant issue with the diagnosis of Gl symptoms. The Somerset audit results highlight that it is vital to run a clinic that covers both disciplines with a specialist dietitian who has the skills and competencies to be able to differentiate between the conditions.
throughout the NHS to reduce referrals to secondary care, dietetic community services are ideally placed to set up specialist
NHS'. (r3) Assuming that the specialist community dietitian has the necessary competencies and follows protocols stating when to refer a patient on for
are done", fitting perfectly with
further investigation. then in combination with new and effective evidence-based treatments they potentially
the 2010 White Paper, 'Equity and excellence: Liberating the
have an innovative recipe for significant NHS savings. dS
clinics to bridge the gap. We can "challenge the way things
References ) Beltlini M, Iosetfl C, Costa E B/agt S, Stasl C, Del Punta A, Monicelfi e Mumolo MG, Rlcchiuti A, Bwi n Marchi S (2005) 'The genetal pactlioneri appr@ch to iriable bowel sydrome: From intention to pectice , Jourrut of Dig5tive and Liver Disease: 37(7 A: 934-939 '2t Boyal College of Physicians Allergy: The unmet need'. London: Royal Colege of Physicians of London: (200q. Repoft No: /sBN 7 86076 783 9. NICE: ltritable Bowel Syndrcme: Costing repoft implementing NICE guidan@. February 2008. Londan 4) NICE: Food alergy in children and young p@ple: NICE clinical guideline 116; February2011, London 6) lnadomi JM etat. (2003). Systematic review: the economic impact ot iftitable bowel syndrcme. Alirent PmacolTher: 1 8; 671 -682 (6) Thompson WG, Hffiton KW Smylh GT Smyth C (2000)'hitable bowel stndrome in gensal pructice: prevalence, characteristics and referaf , Gut 46; 78-82 Greig E (201 1), Audit of gastroenterotogy outpatients clinic data fu May 201 1; Taunton & Someret NHS Irust (8) Gore S (201 1 ), Audit o! gastroenterology outpatients clinic data for May 201 ; Y&vil NHS Foundation Trust (1
&
A
1
(9) British Dietetic Association Gastroenterology Specialist Grou p 'Professional Guideline: UK evidencebased practice guidelines for the dietetic manaoement of iritable bowel syndrome (lBS) in adults': Birmingham. September 2O1O Q0) Skudacher H, Whehn K, lNing PM, Lomer M (201 1 ), Comparison of symptom
resporee following advice for a diet low in fementabte carbohydrules (FODM APs) ve6us standard dietary advice in patients with idtable bowel syndrcme. Journal of Human Nutritian & Dietetis:24: 487-4gs (l 1) Gupta R et al. e004. Review: Burden of allergic disase in the UK: secondary analyses of national databases. Clin Exp Ailergy: 34; 520-526 (12) Levy ML, Walker S, Woods A, Sheikh A (2009), Seruice evaluation of a l.JK primary cffi-based ailergy clinic: quality improvement repoft: Pimary Cae Bspiatory Journal: 1 8; Ahead of pint
- Micle in pres (13)
Depaftment of Heahh" NHS White Paper presented to parliament by the Secetary
of State for Health by Command of Her M4esty July 2010. 'EquW and exellence: Liberating the NHS'; The Stationery Office: Repotl No: Cm 7881; ISBN 97801017881
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