RESUMEN
Objective: We aimed to establish the perception of foundation doctors (FDs) towards gastroenterology, focusing on identifying determinants which make the career desirable or undesirable between genders, and to recognise factors to increase diversity in recruitment. Method: An electronic survey was circulated to Northwest of England FDs, categorical variables and data were analysed using χ2 test including comparisons by gender and exposure to gastroenterology either as an undergraduate or FD. Results: 133 responses were received (males 55.6%, 37 foundation year 1 (FY1) doctors, 85 FY2 doctors and 11 FY3 doctors). Four (3.0%) FDs were considering a career in gastroenterology. Gastroenterology was perceived positively by 72 (54.1%) of FDs. Significant differences were found between genders in the importance of the following factors influencing specialty selection; patient-centred care (female 52.5% vs male 25.7%, p=0.01), good mentorship (female 67.8% vs male 45.9, p=0.012), income (female 33.9% vs male 59.5%, p=0.003) and length of training (female 27.1% vs male 52.7%, p=0.003). The male predominant existing workforce (female 27.1% vs male 6.8%, p=0.001), and requirement to be a medical registrar (female 74.6% vs male 56.8%, p=0.033) were negatively perceived aspects of gastroenterology among female FDs. Most FDs (female 80.5%, male 70.7%) indicated increased acceptability of less than full time training and greater flexibility may attract more females to gastroenterology. Conclusion: Increased flexibility in training and greater postfoundation exposure and mentorship may improve diversity within the specialty. The role of general medicine poses significant concern for FDs and may need further evaluation.
RESUMEN
Dysphagia is a common presentation in gastroenterology practice and the diagnosis and management requires a comprehensive knowledge of diverse range of aetiologies, with a systematic approach for assessment of symptoms, selection of investigations and appropriate treatment to relieve symptoms. In this curriculum review, the suggested diagnostic approach highlights the importance of thorough clinical assessment in order to guide the selection of investigations. This article discusses the utility of endoscopic, histopathology, fluoroscopic and motility investigations for dysphagia, and their interpretation, in order to guide targeted treatments ranging from dietary, pharmacological, endoscopic and surgical interventions.
RESUMEN
Widening of the exit site of a percutaneous gastrostomy tube is a rare but difficult to manage complication, which leads to significant morbidity as a result of caustic material leak and associated cutaneous injury. Such defects fail to close with conservative measures such that invasive (surgical or endoscopic) intervention is often required. The authors present a 49-year-old woman with neurological dysphagia, 2 years after gastrostomy tube insertion with several months' history of leakage and widening of the hole at the exit site. Following gastrostomy tube removal; the patient was left with a large, high-output gastrocutaneous fistula which was treated aggressively with measures to reduce gastric discharge including 'nil-by-mouth', bypassing the stomach with distal feeding, administration of a somatostatin analogue, high-dose proton pump inhibitor and prokinetics with the aim of preoperatively downsizing the wound. This novel approach led to complete closure of the large gastrocutaneous fistula, obviating the need for surgical intervention.