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Gastroenterology

Service Summary

The Gastroenterology service is well established in York Hospital. It provides for diagnosis and management of all gastroenterological conditions including; Hepatology, Inflammatory Bowel Disease (IBD) and functional GI (gastrointestinal) disorders.

The IBD Service is supported by 1.5 Clinical Nurse Specialists in Gastroenterology, who provide a nurse-led service, supported by the Consultant Physicians, for advice, support and management of patients with IBD and those receiving immuno-modulating therapy. Nurse-led clinics in IBD include; a telephone helpline, immunosuppressant monitoring and evaluation, and education health promotion and psycho-social support. They are available both for follow-up of stable patients and rapid access to patients with a 'flare'. A patient-held IBD record is being developed and the department participates in the National IBD Audit. Biological therapies are provided locally, in accord with NICE (National Institute for Clinical Excellence) Guidelines. Monthly joint clinics are held for patients with complex IBD with a Consultant Surgeon and Physician, and facilities for restorative Proctocolectomy (pouch) surgery are available locally and supported by a Pouch Nurse Specialist.

Patients with functional gut disorders, such as Irritable Bowel Syndrome (IBS), are supported by a Clinical Nurse Specialist in IBS, together with a Specialist Dietitian and Clinical Psychology services

Liver services are provided by the 4 Consultant Physicians and supported by an inpatient Substance Abuse Clinical Nurse Specialist for patients with alcoholic liver disease. The Gastroenterologists work closely with their colleagues on the Liver Unit in Leeds for patients requiring transplantation. A full range of diagnostic services for patients with Liver disease including biopsy (inpatient and outpatient) and imaging, including MRI (magnetic resonance imaging), is available at York. Patients requiring antiviral treatment for Hepatitis B and C are referred to the Regional Unit in Leeds at present, when treatment is initiated.

Dyspepsia services are provided by the Physician Gastroenterologists, but include access to ambulatory pH and manometry and open access upper GI endoscopy, which is provided in part by a Clinical Nurse Specialist in Endoscopy and 2 GPs undertaking weekly endoscopy lists.

The department liaises closely with local support groups, including those with IBD and Coeliac Disease. At present the Nurse Specialists are unable to take direct referrals from GPs, but many referrals, are triaged directly via the Clinical Assessment Service, run by the Consultant Physicians, to undergo investigations prior to their clinic appointment, usually endoscopy. This 'first to test' approach allows faster assessment and early treatment, often before a formal outpatient consultation. Patients referred for investigation of iron deficient anaemia are triaged directly to an iron deficiency service, including simultaneous upper and lower GI investigations.

Inpatient gastroenterology for patients with complex IBD and decompensated liver disease is provided largely on Ward 33 and supported by a nurse-led paracentesis service for patients with recurrent ascites. On the ward, the team is supported by Specialist Dietitian input.

Patients with colorectal disorders, requiring surgery, are managed jointly with the Colorectal Surgical Team, Dietitians and Stoma Care Nurses; and currently patients with upper GI malignancies undergo joint assessment between Physicians and Surgeons locally, with a Multi-Disciplinary Team (MDT) liaising with the Upper GI Cancer Team in St James's Hospital Leeds.

Palliative stenting for both oesophageal and rectal carcinomas is available in York and currently separate MDTs exist for upper GI cancer patients, pancreatico biliary cancer and colorectal cancer. These are supported by Clinical Nurse Specialists.

Patients with Coeliac Disease are jointly managed by Consultant Gastroenterologists and Dietitians, with a scheduled programme of annual review.

Endoscopy - a full range of diagnostic and therapeutic endoscopy service is available, including ERCP (Endoscopic Retrograde Cholangio-Pancreatography); and is accessed either by direct referral to Consultant Physicians, Consultant Surgeons or via the open access endoscopy scheme. Endoscopy is undertaken in a dedicated 3-room endoscopy suite and ERCP in the vascular imaging unit. The Endoscopy Unit is recognised by JAG (Joint Advisory Group on Gastrointestinal Endoscopy) for training purposes and participates in the global rating score (GRS).

Imaging facilities include, access to MRI and MRCP (magnetic resonance cholangio- pancreatography­), ERCP, ultrasound guided biopsy, CT colonography (virtual colonoscopy), small bowel imaging, radiologically guided biopsy and stent placement. Weekly meetings are held between Surgeons, Radiologists and Physicians

Who's Who

Clinical Director - Dr Donald Richardson
Lead Clinician for Gastroenterology - Dr Simon Smale
Directorate Manager - Sarah Lovell
Directorate Secretary - Pam Drake

Where to find us

Outpatient Services are provided in the main out-patient department on the Ground Floor at York Hospital. Inpatient services are provided on Ward 33. Endoscopy is undertaken in a dedicated 3-room endoscopy suite and ERCP in the Vascular Imaging Unit. For a map of the hospital, please click here.

Meet the Team

Useful Websites

British Society of Gastroenterology www.bsg.org.uk

Digestive Disorders Foundation www.digestivedisorders.org.uk

National Association for Colitis and Crohn's Disease www.nacc.org.uk

IBD Club www.ibdclub.org.uk/

IA (the Ileostomy and Internal Pouch Support Group) www.iasupport.org

Local IA group website: www.york-ia.org.uk

Tel 0800 0184724 or 02893344043.

British Liver Trust Foundation www.britishlivertrust.org.uk

Royal College of Nurses www.rcn.org.uk/

Coeliac UK www.coeliac.org.uk

Healthline (more information about Crohn's disease) www.healthline.com/health/crohns-disease