www.gastro-info.co.nz

It is probably surprising just how many clinicians, not only in New Zealand but also globally, have gone to the effort of establishing high quality patient-focused information resources in the form of a regularly updated disease or systems-specific website.

In the last two columns we have covered two local sites which dealt with hypertension and cardiovascular disease and a wide range of allergy-related conditions, and this month we review another local site - started back in 2005 by enthusiastic Auckland gastroenterologist Alan Fraser.

While it is clear a number of these similar sites - perhaps more notably from North America - are somewhat more self-promotional than educational, it must be said that "gastro-info" is very readable and informative and any commercialism is quite subtle if not actually hard to find.

Fraser was one of the early researchers involved with the Helicobacter saga some decades ago, having completed a research degree at the Royal Free Hospital in London on gastric acid secretion, protection of the gastric mucosa and Helicobacter pylori infection. In more recent times he has extended his field of interest towards inflammatory bowel disease and related topics.

The website is professionally produced and is very readable. In the home page synopsis he insists his resource is: "the place for easily readable 'info' on problems of the digestive system. We discuss gastro symptoms and conditions such as: anaemia, irritable bowel (IBS), coeliac, constipation, Crohn's disease, ulcerative colitis, polyps, bowel cancer, to name a few...all in a no-nonsense, plain simple way, avoiding the jargon where possible so you get the answers you need".

He has a shortened list of popular topics - coeliac, constipation, Crohn's, IBS, diet for IBS and also a full list of all 31 topics covered. While the list may not be clinically comprehensive, Fraser has clearly aimed to provide a resource for the majority of patients with the majority of gastroenterology problems, with some very useful information.

For example, there is an excellent section on fatty liver which clearly emphasises the importance of non-alcohol hepatic steatosis (NASH)and is certainly a sufficiently good and readable summary to be readily understood even by English as a second language (ESL) patients. The information is fluently telegraphic (using bullet points) and gives some very succinct reminders for clinician and patient alike, such as:

•    the underlying problem with NASH is considered to be "insulin resistance"
•    insulin resistance promotes increased rate of delivery of fat to the liver from the tissues
•    fatty liver is more common in some ethnic groups
•    about 10 per cent of people with excess fat in the liver will develop inflammatory changes in the liver
•    this inflammatory process, if sustained over a long period of time, can lead to significant liver fibrosis and eventually to cirrhosis (severe liver damage).
As expected, the section on Helicobacter is excellent and obviously extremely authoritative.

The section on B12 deficiency is succinct yet remarkably sensible and seems to reflect practice as conducted in the primary care sector for perhaps decades(gone are those days from the 70s to the 90s when we were advised by our senior clinical mentors that B12 was some form of rose-tinted placebo shot!).

The section on coeliac disease is also very good and emphasises the recalculated community incidence of gluten intolerance from the hitherto assumed 1:2000 to just 1:85. Alas, our advisors in Pharmac have yet to hear of this and still require proof of a small intestinal biopsy to approve subsidised low-gluten products for the condition. The subsection on gluten free diets is also excellent.

There are also excellent sections on lactose intolerance, hepatitis B, hepatitis C, colon cancer, IBS, rectal outlet problems and inflammatory bowel disease and a useful subsection on the place of alternative dietary treatments for IBS.

There are separate sections also covering latest news, popular topics and commonly asked questions. Some of the latest news items might include - the role of proton pump inhibitors in inducing osteoporosis, new probiotics for IBS and IBD, screening for colon cancer, and new treatments for chronic hepatitis B infection.

The site does appear to be up to date. In the coeliac disease section there is specific reference to the relevance of DQ2 and DQ8 genetic marker (HLA) testing of patients and family members. Interestingly, we can also discover here that Japanese and Chinese patients cannot develop coeliac disease as they do not possess the DQ2 HLA marker and yet the condition is common in the Indian subcontinent - and of course in Europe.

There are also tabs provided for frequently asked questions, some link sites, and there is also a participatory forum available.

In overview, the website is very simple - it provides all the covered 31 topics on the home page with access via a simple click. Within each topic there may be up to five tabs covering such items as the disease, diagnosis, the treatment, history and cause for each condition.

From my own perspective I will certainly look at using the site to give patients some skillfully condensed information (a single A4 page in many cases)and, apart from the succinct patient-based guidance, there is a wealth of information to keep many of us less-than-ageless clinicians up to speed with some newer developments.

In addition to working from his private practice at Mercy Specialist Centre, Alan Fraser also lectures at the Auckland University School of Medicine.