Gastrointestinal presentations rank within the top 15 presentations to general practice in Australia.1 With a vast array of clinical presentations that impact all age groups and genders, from acute and sub-acute to chronic presentations, general practice is often the first point of contact. The most common gastrointestinal conditions that are managed by general practitioners (GPs) include gastroesophageal reflux disease (GORD), constipation in children, irritable bowel syndrome (IBS), gastroenteritis (including traveller’s diarrhoea), inflammatory bowel disease (Crohn’s disease and ulcerative colitis), coeliac disease, non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH), hepatitis C and Helicobacter pylori infection.1
The GP’s role encompasses preventive health screening, diagnosis and management of acute and chronic conditions. Given the breadth of knowledge that is required for this area, one useful approach is to divide topics into organ-related systems and then further subdivide into acute and chronic presentations. GPs need to remain up to date with clinical guidelines, especially in chronic and terminal gastrointestinal conditions, to ensure management plans are supported by evidence-based practice.2 Allied health professionals (eg dieticians, psychologists, pharmacists) may also form part of a multidisciplinary team that assists in managing patients with gastrointestinal presentations. All members of this team should be included in patient clinical conferencing and participate in shared decision-making and advocacy for patient care.3
Gastrointestinal conditions impacting children can present as early as the first few weeks of life. GPs should be aware of age-specific disorders as well as the red flag signs and symptoms indicating the need for urgent referral or transfer to a tertiary centre. Another vital GP skill is the ability to differentiate between passing tummy trouble and a digestive disorder, given the impact these conditions can have on a child’s growth and development, in addition to the effect on parents and families.4
GPs also play a vital role in assisting with patient participation in the National Bowel Cancer Screening Program, and in understanding the difference between screening versus diagnostic tests.5 This is particularly important in under-screened populations such as Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse communities, individuals experiencing social disadvantage and very remote populations.6-8 GPs should be familiar with the risk factors for colorectal cancer and use resources to aid their decision-making.9 Socioeconomic status and health behaviours can contribute to gastrointestinal presentations and impact treatment. These are multifactorial and include poor nutrition, smoking, drug use, alcohol intake and obesity.10 The GP's role in identifying, counselling and supporting change in these areas is important in holistic care of the patient and in achieving positive treatment outcomes.
Screening for hepatitis B and C infection should also be offered to groups with increased prevalence, including Aboriginal and Torres Strait Islander peoples, patients within the justice system and migrants, refugees and asylum seekers from high-risk countries.11 GPs are now able to treat conditions such as hepatitis C in the community and need to be aware of opportunities to upskill as new regimens for disease management become available. Access to treatment can also be impacted by geographic region and will require ongoing advocacy and support from GPs.12
In rural and remote settings, GPs may encounter barriers to care such as access to further investigations including imaging and access to non-GP specialists for opinion and procedures such as gastroscopy and colonoscopy.13 Awareness of the services available within their network, including telehealth consultations with non-GP specialists, and connections with neighbouring medical services is vital for GPs and patients to ensure they are adequately supported.