Paper III — Gastroenterology and nutrition

Appendix — Rapid Revision Grid

NIGHT-BEFORE REVISION

Numbers Worth Quoting

Topic Figure

GORD prevalence 6th commonest disorder in residential care; ~20% of general population have weekly reflux; hiatus hernia in ~60% of those over 60 GORD diagnosis Heartburn/regurgitation ~70% sensitive; double-dose PPI trial 2–8 weeks, sensitivity and specificity up to 80% Constipation Faecal impaction in 7% of institutionalised elderly; median 42% prevalence in long-term care; 90% of slow-transit responds to laxatives; biofeedback effective in ~70% Laxative doses Psyllium 3–6 g; PEG 17–34 g; lactulose 10–40 g; senna 15 mg; bisacodyl 5–10 mg; sodium picosulfate 5–10 mg; lubiprostone 8–24 µg BD IBS in elderly 10–15% of people over 70; placebo response in functional GI disorders 20–70% Achalasia Perforation risk ~1% for both pneumatic dilatation and myotomy; series of 51 patients aged ≥65 — no deaths, median stay 3 days Gastroparesis Up to 80% of diabetic gastroparesis has abnormal small-intestinal motility; scleroderma oesophageal dysmotility ~80% UGI bleeding Bleeding contributes to ~5% of elderly deaths; GBS 0–1 for outpatient care; transfuse at Hb 7 g/dL (8 g/dL with CVD), target 7–9 g/dL; erythromycin 250 mg IV 30–120 min pre-scope; endoscopy within 24 h; high-dose PPI ×3 days then BD oral ×2 weeks Malabsorption Faecal fat >7 g/day; faecal elastase-1 <200 µg/g suggests, <100 µg/g severe EPI; SIBO antibiotics 1–4 weeks MNA Screening max 14 points: 12–14 normal, 8–11 at risk, 0–7 malnourished; sensitivity 96%, specificity 60%; mortality risk 0.35 (0.18–0.66) with normal score GLIM Weight loss >5% in 6 months or >10% beyond 6 months; needs 1 phenotypic + 1 etiologic criterion TPN 25–30 kcal/kg/day (20–25 if acutely ill/elderly); protein 1.0–1.5 g/kg/day; refeeding start 10–20 kcal/kg or 100–150 g dextrose in first 24 h, advance ~33% of goal every 1–2 days; thiamine 100 mg before dextrose Refeeding severity Fall from pre-feeding phosphate, magnesium or potassium: ≥10% mild, ≥25% moderate, ≥50% severe (ASPEN)

Vitamin B12 Prevalence 5–40%; 10–30% malabsorb food-bound B12; pernicious anaemia 1–2%; nursing home 13.8% on admission, 4%/year new Folate <2 ng/mL deficient, 2–4 borderline, >4 normal; treat with folic acid 1 mg/day; red cell folate reflects 120 days Vitamin D Calcium 1000–1200 mg/day and vitamin D 800 IU/day after 50; ULs 2000 mg and 4000 IU; treat 25(OH)D below 25–30 nmol/L; SENECA — 40% below 30 nmol/L; skin synthesis reduced fourfold Named Guidelines and Evidence by Topic Topic Named source Malabsorption UEG malabsorption guideline 2025; ACG coeliac guideline update 2023; ESsCD 2025 (no-biopsy pathway restricted to under-45s)

Constipation Joint AGA–ACG CIC guideline 2023 (first joint guideline; PEG, sodium picosulfate, linaclotide, plecanatide, prucalopride strong); ASCRS 2024 GORD Lyon Consensus 2.0 (Gut 2024); ACG GERD guideline 2022; AGA Clinical Practice Update on P-CABs 2024; VISION 5-year safety study 2025; Seoul Consensus focused update 2025 Motility Chicago Classification v4.0; ACG gastroparesis guideline 2022 UGI bleeding ACG UGIB guideline 2021; ESGE non-variceal 2021 and variceal 2022; ACG LGIB update 2023; restrictive transfusion meta-analysis (Sci Rep 2023)

Nutrition assessment GLIM consensus 2019 and 5-year update 2025; ESPEN geriatric nutrition and hydration guideline; ESPEN–EASO sarcopenic obesity consensus 2022; EWGSOP2 Parenteral nutrition ASPEN refeeding consensus 2020; ESPEN ICU guideline revision 2023; ASPEN PN ordering/compounding and CVAD standards Vitamins Endocrine Society vitamin D guideline 2024; USPSTF fracture prevention; ICMR-NIN dietary guidelines (India)

Classifications and Criteria to Name

Name Use

Rome IV Constipation, IBS, functional dyspepsia

Bristol Stool Form Scale Stool consistency; target type 4–5 in faecal incontinence Los Angeles classification A–D Erosive oesophagitis; only B, C, D conclusive for GORD under Lyon 2.0 Chicago Classification v4.0 Oesophageal manometry; achalasia types I, II, III Forrest classification Ulcer stigmata; treat Ia, Ib, IIa endoscopically Glasgow–Blatchford / Rockall Pre-endoscopic and post-endoscopic UGIB risk GLIM criteria Diagnosis of malnutrition — 1 phenotypic + 1 etiologic MNA / MNA-SF / SNAQ / MUST / NRS- Nutritional screening and assessment tools 2002 / SGA ASPEN refeeding criteria Grading refeeding syndrome by electrolyte fall Indian Context — One Line per Topic Malabsorption: tropical sprue, intestinal tuberculosis, giardiasis, strongyloidiasis and HIV enteropathy must appear in every differential.

Constipation: ispaghula (isabgol) is the accessible bulking agent; PEG sachets are affordable and preferable to repeated enemas at home.

GORD: pantoprazole and rabeprazole are the cheapest available PPIs; vonoprazan is marketed but cost-limited. UGI bleeding: variceal bleeding from cirrhosis, non-cirrhotic portal fibrosis and EHPVO is a major cause; PCC availability is variable outside tertiary centres, so FFP may be the practical alternative. Nutrition: LASI Wave 1 data document high rates of undernutrition among older Indians; NPHCE provides the service framework.

Vitamins: widespread vitamin D deficiency despite sunlight; B12 deficiency common in lifelong vegetarians; ICMR-NIN RDAs and national food fortification are the population-level responses.