Constipation is a highly prevalent condition in Western populations and may be difficult to manage, significantly impairing quality of life and generating substantial healthcare costs. It is a common reason for seeking medical care, with Family Physicians (FPs) playing a central role.This study aimed to characterize FPs’ knowledge, beliefs, and attitudes regarding adult constipation, identify the treatments most frequently prescribed, and explore barriers and facilitators to its diagnosis and management.A cross-sectional study was conducted using an online survey administered to FPs addressing constipation management in the primary healthcare (PHC) setting. An original 18-item survey was developed through Delphi methodology by specialists in Gastroenterology and Family Medicine. A total of 100 responses were analyzed, including sociodemographic data, screening, treatment practices, perceived clinical importance and barriers to management.The median age of respondents was 31 years (28-37); 56% were female, 60% were residents, 12% were specialist with under 5 years of practice, and 28% were specialists with over 5 years of practice. Most respondents (64%) reported performing targeted anamnesis in some patients with risk factors, 32% in almost all patients with risk factors, and 4% in few or none. Sixty percent considered constipation extremely important, and 80% felt moderately informed about its treatment. Lactulose (52%), polyethylene glycol (20%) and bisacodyl (20%) were the most frequently prescribed medications. Major barriers included presence of multiple problems to manage and reliance on patients to initiate discussion. Suggested improvements included referral criteria (32%), diagnostic and treatment algorithms (24%), and patient educational leaflets (24%).This study reveals a gap between the perceived importance of constipation and its practical management in PHC. Constipation remains underdiagnosed and inconsistently addressed, often due to time constraints and reliance on patients to raise the issue. Although physicians report moderate knowledge, treatment choices are limited, favoring traditional laxatives and empyrical approaches over first-line medications. Practical tools, structured algorithms, and patient education may improve screening, treatment consistency, and patient engagement in PHC setting.Although FPs recognize constipation as a relevant condition, its diagnostic and therapeutic management appears insufficient. Structured educational strategies and practical tools may improve care in PHC.

Fecal incontinence (FI) is a debilitating condition with significant impact on quality of life, associated with reduced self-esteem, social isolation and depression. Most affected patients do not seek medical care, making recognition by Family Physicians (FPs) crucial to improving access to treatment. However, data on FI management in Portuguese primary healthcare (PHC) are limited.To assess FPs knowledge, beliefs, attitudes, perceived barriers and facilitators in the diagnosis and management of adult FI.A cross-sectional study was conducted using an online survey administered to FPs regarding their approach to FI in PHC. An original 12-item survey was developed using Delphi methodology by specialists in Gastroenterology and Family Medicine. Ninety-six responses were included. Sociodemographic data, screening and treatment practices, perceived clinical importance and barriers to FI management were analyzed.Median age of respondents was 30 years (28-37); 56.3% were female; 40.6% were residents, 18.75% were specialists with under 5 years of practice, while 25% were specialists with over 5 years. Only 6.2% reported performing targeted anamnesis for FI in almost all patients with risk factors, whereas 46.9% in some patients and 46.9% in few or none. Although 93.8% considered asking about FI to be of moderate or extreme importance, 84% self-reported being slightly to moderately informed and 12.5% not informed about diagnosis and treatment. The main barriers identified were limited consultation time (78.1%), perception of low prevalence (59.4%), lack of knowledge (54.2%) and reliance on patient-initiated discussion (51%). Suggested improvement strategies included referral criteria (80.2%), educational materials for FPs (78.1%) and diagnostic and treatment algorithms (72.9%).This study demonstrates a gap between FPs recognition of FI as clinically relevant and its assessment in PHC, resulting in underdiagnosis despite risk factors, high prevalence and impact on quality of life. Time constraints, perceived low prevalence, stigma and reliance on patient-initiated discussion were considered key barriers. Limited physician knowledge further hindered proactive screening. Respondents emphasized the need for practical tools and training. Limitations include self-reported data, cross-sectional design, potential selection bias and limited generalizability.Overall, while FPs recognize FI as relevant, enhanced training and practical tools are needed to improve diagnosis and management in PHC.

Acid suppressant drugs, mainly proton pump inhibitors (PPIs), histamine type-2 receptor antagonists (H2RAs), and antacids, are among the very frequently used medications in society for various indications. Although generally considered safe, the long-term use of PPIs, in particular, has been associated with various diseases and disorders.This study compared chronic disease prevalence, common side effects, and lifestyle factors between adult patients using acid suppressants and a control group, while also identifying side effects associated with specific medications.The data were collected from 175 patients using a face-to-face questionnaire method. The collected data were analyzed using the IBM SPSS Statistics 23 program. The Chi-square test was used for categorical variables. The level of statistical significance was set at p<0.05.Of the 28.6% using acid suppressants, pantoprazole (36%) and esomeprazole (24%) predominated. Common indications included NSAID use and dyspepsia (38% each). A cid supressant usage linked significantly to hypertension, cardiovascular disease, and osteoporosis (p values were 0.05 , 0.006 , and 0.021 respectively). Pantoprazole use was positively associated with complaints of constipation and dizziness compared to the group not using pantoprazole (p values were 0.025 and 0.002 respectively). Additionally, gas and bloating complaints were statistically significantly more frequent in pantoprazole users compared to esomeprazole users (p=0.024).The rate of acid supressant drug use in our study is consistent with previous studies. The indications for acid suppressant drug use (such as NSAID use) are consistent with the literature.Given that PPIs accounted for 88% of the acid suppressants in our cohort, our findings regarding comorbidities like hypertension are consistent with established literature on PPI-related risks. Most existing literature evaluates PPIs as a class rather than investigating molecule-specific effects. Consequently, data supporting our observed associations between pantoprazole and side effects like constipation, dizziness, gas and bloating remain sparse.Clinicians should consider switching from pantoprazole to alternative PPIs or H2RAs in patients with constipation, gas, bloating, and dizziness. We can try the safer H2RAs instead of PPIs for an appropriate indication in patients with osteoporosis, hypertension, and cardiovascular disease or those with multiple risk factors for developing these diseases.

H. pylori colonisation in children does not cause gastroesophageal reflux or functional abdominal pain. General Practitioners often finds it difficult to distinguish dyspeptic symptoms from peptic ulcer disease during consultation leading to stool antigen testing for H. pylori. In the last two decades, antibiotic resistant H. pylori have emerged resulting in decline in efficacy of standard treatment regimens. There is no specific guideline in UK about retesting after treatment for microbiological clearance. In the UK, NICE and BNF guidelines on testing and treatment recommend treatment of H. pylori to reduce risk of peptic ulcer bleeding. One-week triple therapy regimen is recommended. There is no recommendation for re-testing. ESPGHN/NASPGHN recommends against non-invasive testing in absence of peptic ulcer disease. Diagnosis should be based on histopathology using Sydney system or on the basis of culture. Test to confirm eradication should be done after 6-8 weeks of completion of therapy.To evaluate current practice of diagnosing and managing Helicobacter pylori infection in children at our practice and compare with ESPGHAN-NASPGHAN guidelines.Retrospective 12 months audit (May 2024 – April 2025) of our paediatric patients (under 18 years) who had Helicobacter pylori testing and reviewed reason for testing, documented clinical findings, testing method, treatment of test positive cases and re-testing to confirm eradication.10 children were tested in the 12 month period. Reasons for testing were documented in 100% of cases but only 40% had abdominal pain. Clinical findings were recorded in 80% and in 20% patients were not examined. Testing method was stool antigen test in all cases. 100% of test positive cases were treated with 1 week of triple therapy. Test of eradication was not performed at all.In this audit 60%, H. pylori tests were carried out without specific indication. In 20% cases no clinical examination was performed. Confirmation of eradication was 0%.H. pylori testing in children should be done only if history suggests peptic ulcer disease. Re-testing at least 4 weeks after antibiotic and 2 weeks after PPI treatment is required.

MASLD, previously known as non-alcoholic fatty liver disease (NAFLD), is increasingly prevalent worldwide, closely associated with obesity, type 2 diabetes, and metabolic syndrome. Primary care providers (PCPs) play a critical role in early detection, risk stratification, and management, yet clinical guidance in the primary care setting remains variable.To summarize current evidence-based strategies for the diagnosis, risk assessment, and management of MASLD in primary care and to provide a framework for practical implementation.A narrative review of recent literature, clinical guidelines, and expert consensus statements on MASLD management in primary care was conducted. Key sources included PubMed, guideline documents from the American Association for the Study of Liver Diseases (AASLD), European Association for the Study of the Liver (EASL), and primary care-focused reviews published in the last five years.Screening and Diagnosis: MASLD should be suspected in patients with obesity, diabetes, dyslipidemia, or metabolic syndrome. Initial evaluation includes liver function tests and non-invasive fibrosis assessment using scores such as FIB-4 or NAFLD fibrosis score. Lifestyle Interventions: Weight reduction of 7–10% through dietary modification, increased physical activity, and behavioral interventions remains the cornerstone of management. Pharmacologic Therapy: Pharmacological interventions specifically for MASLD; however, insulin sensitizers (e.g., pioglitazone) and GLP-1 receptor agonists may be considered in select patients with comorbid metabolic disease. Comorbidity Management: Optimizing glycemic control, blood pressure, and lipid profile is essential. Referral: Specialist referral is indicated for advanced fibrosis (F3–F4), cirrhosis, or diagnostic uncertainty.Primary care is pivotal for early MASLD identification and intervention. Non-invasive fibrosis screening enables risk stratification without overburdening hepatology services. Lifestyle interventions, though challenging to implement, provide the most consistent evidence for improved outcomes. Pharmacologic interventions should be individualized and integrated with metabolic comorbidity management. Education and patient engagement are critical to success.MASLD is a common yet under-recognized condition in primary care. PCPs can effectively manage MASLD through early detection, risk stratification, lifestyle interventions, and optimization of metabolic comorbidities. Structured protocols and use of non-invasive fibrosis tools can improve patient outcomes and reduce progression to advanced liver disease.

IBS is a prevalent GI disorder within the broader category of Disorders of Gut-Brain Interaction (DGBI), affecting over 40% of the global population. The low FODMAP diet is considered an effective intervention for alleviating IBS symptoms, but reintroducing FODMAPs can provoke fear in some patients.The restrictive nature of the low FODMAP diet may increase the risk of avoidant/restrictive eating patterns, making FODMAP reintroduction psychologically stressful for some individuals. This study aims to examine how dietary restriction, patient symptoms, and psychological factors contribute to fear during the reintroduction phase, offering insights that may help predict individual trepidation responses.This study included participants who attended FODMAP group education sessions at University XXXXX Hospital between 2015 and 2020. The study used various questionnaires to assess IBS-related gastrointestinal symptoms, psychological problems, and dietary behaviors. Participants completed a baseline questionnaire before starting the low FODMAP diet and a follow-up questionnaire after the restriction phase, focusing on their concerns and experiences regarding the reintroduction of FODMAPs.The study included 150 participants, with a female majority (77.3%). The mean age of all participants was 45.6 years old. Notably, 45.3% of participants reported trepidation prior to reintroducing FODMAPs into their diet. Over two-thirds found that the low FODMAP diet restricted their dietary variety and increased their sensitivity to FODMAPs when they eat them. Patients with trepidation toward reintroducing FODMAPs had a higher risk of eating disorders (17.1% vs. 8.9%, p = 0.003) and depression (17.0% vs. 4.3%, p = 0.027), as well as increased overall symptom severity and IBS severity scores (p < 0.05).The study reveals that fear of reintroducing FODMAPs is associated with more severe gastrointestinal symptoms, higher IBS severity scores, or an increased risk of eating disorders. Psychological factors—particularly depression and eating-disorder tendencies—played a major role in driving this trepidation, while dietary restriction alone did not predict fear of reintroduction.Comprehensive IBS management should consider both psychological and physiological factors to reduce fear and improve patient outcomes.

In 2022, Crohn's Disease concerns about 180.000 patients in France and its prevalence is expected to increase within the next five years, particularly in young adults. Beyond the digestive attempts, Crohn's Disease  affects quality of life in a multidimensionnal manner. Extradigestive symptoms are often invisible and hidden to the GP, because patients may feel ashamed discussion them during consultation.To identify the most frequent and impactant symptoms experienced by patients with Crohn's Disease and the most symptoms considered by patients as taboo to discuss with the GP.We conducted a quantitative translational descriptive study from 15 Septmber 2024 to September 2025 among adult consent patients with Crohn's Disease. The study received ethical approval in january 2025 and the link to the anonymious standardized questionnaire was distributed via Lime Survey software online among patient organization, as a flashcode in GP waiting rooms and offices. Data analysis was performed with BiostatTGV software.400 patients returned their questionnaire among which 146 were incomplete. Overall 254 questionnaires have been analysed. Most of the participants were women (81%, n = 206).Half of the population was employeed (50¨%, n=128) and declared a last disease push as less than 6 months (51%, n=129) declared a disease duration of over 20 years  (28% , n=70).While fatigue pain and diarrhea were the most frequent symptoms declared, the most difficult to adress with their GP were emotional difficulties,altered body image, and a reduced satisfaction of social life.  From the free commentaries, 153 sub-themes, 27 themes, 6 categories emerged concerning other invisibles symptoms and 343 sub-themes, 16 themes, 4 categories emerged concerninig the patients's expectation toward their GP.There is currently few litterature adressing the Crohn's disease burden in primary care.  We based our study on an american research protocol (varma et al 2017) which explored 17 symptoms, but not sexual well bein, which we have added to our questionnaire as well as the experience of communication with their GP regarding these 18  symptoms.We highlight the multidimensional burden of Crohn's Disease and the need to adress both visible and invisible digestive and extradigestive symptoms and needs with our patients.