Mainstreaming of genomic medicine in gastroenterology, present and future: a nationwide survey of UK gastroenterology trainees

Objective: Genomics and personalised medicine are increasingly relevant for patients with gastroenterological conditions. We aim to capture the current state of genomics training in gastroenterology to review current understanding, clinical experience and long-term educational needs of UK trainees. // Design and setting: A web-based nationwide survey of all UK gastroenterology specialty trainees was conducted in 2017. // Results: 100 trainees (14% of UK gastroenterology trainees) completed this survey. Only 9% and 16% of respondents believe that their local training programme adequately prepares them for the future clinical practice using genomic medicine and personalised medicine, respectively. Barriers identified include the need for greater trainee education (95%), inadequate clinical guidance to base interventions on the results of genomic testing (53%), concerns over misinterpretation by patients (43%) and overuse/misuse of testing by clinicians (34%). Survey respondents felt prepared to perform HFE genotyping (98%), assess TPMT status (97%) and interpret HLA subtyping for suspected coeliac disease (85%). However, only a minority felt prepared to perform the following investigations: polyposis screening (34%), hereditary pancreatitis screening (30%), testing for Lynch yndrome (33%) and KRAS testing for colorectal cancer (20%). Most respondents would support holding dedicated training days on genomic medicine (83%), formal training provisions for the mainstreaming of genomic testing (64%), an update to the UK gastroenterology specialty training curriculum and examinations (57%) and better-defined referral pathways for local genomic services (91%). // Conclusion: Most gastroenterology trainees in this survey feel ill equipped to practise genomic and personalised medicine as consultants. We propose specific revisions to the UK gastroenterology specialty curriculum that addresses trainees needs

Hypophosphataemia after intravenous iron therapy with ferric carboxymaltose—Real world experience from a tertiary centre in the UK

Background: Iron deficiency is the most common global cause of anaemia. Intravenous (IV) iron is used to correct iron deficiency anaemia (IDA) where oral iron cannot be used. Despite being effective, certain IV iron formulations cause significant hypophosphataemia. However, current knowledge on the clinical consequences of IV iron‐induced hypophosphataemia is broadly anecdotal or limited to isolated case reports. / Aims: To retrospectively examine the incidence and potential clinical consequences of hypophosphataemia post‐IV ferric carboxymaltose (FCM) in hospitalised patients with IDA (mixed aetiology). / Methods: Data were collected for 162 patients, who received a total of 169 FCM courses during a 2‐year audit period. Outcomes included incidence of moderate/severe hypophosphataemia (serum phosphate <0.65 mmol/L) ≤90 days post‐FCM, changes in alkaline phosphatase, need for phosphate replacement, and length of hospital stay. / Results: The incidence of moderate/severe hypophosphataemia post‐FCM was 33.7%; within this group the rate of severe hypophosphataemia (serum phosphate ≤0.32 mmol/L) was 8.8%. Moderate/severe hypophosphataemia persisted, with 35% of patients having a serum phosphate of <0.65 mmol/L for ≤90 days at the last measurement after IV FCM. Intervention with IV phosphate—an average of 4.4 infusions per person—was required in 29.8% of cases with moderate/severe hypophosphataemia. FCM‐induced moderate/severe hypophosphataemia was associated with a significantly longer hospital stay (P < 0.0035). / Conclusions: Moderate/severe hypophosphataemia is a frequent adverse drug reaction with FCM. In our study, FCM‐induced moderate/severe hypophosphataemia was also persistent, often required treatment, and was associated with longer hospital stay