Gastroenterology consultant at the John Radcliffe hospital, Oxford?

[jw44]

Has anyone ever been referred to gastroenterology at the John Radcliffe hosital in Oxford? If so, any advice on a good consultant who knows about B12 and PA?

I'm going to ask my GP for a referral to try and investigate the cause of my low B12. I had a bad experience with hematology though (the haematologist told me there was essentially no such thing as B12 def and the NICE guidelines were wrong) so I was hoping to get some advice first to avoid a similar experience!

Thanks.

[Gambit62 Administrator]

Sorry to hear about your experience - if the NICE guidelines are wrong then the haemo you saw must have been totally at odds with the updated BCSH guidelines.

I can't comment on gastros at JR but do know that professor Taylor works in the neurology department at JR - author of this article on treating a patient who showed signs of functional deficiency and needed to be treated with high levels of B12 to avoid the situation getting worse

ndcn.ox.ac.uk/publications/...

However, realise that is quite different from trying to get to the bottom of why you developed a B12 deficiency ... but it might give you a name to drop.

Given that absorption problems are related to the gut a gastro may be a better bet than a haemo for getting to the bottom of the cause anyway - it could be specific to B12 or it could be more general.

Hope it works out for you

[Songbird63 in reply to Gambit62]

Hi gambit

Prof Taylor at JR is a prof of rheumatology..is this whom you meant?

The paper listed is by Turner and Talbot.

Would be grateful for any clarity or info as my GP is trying to find someone at JR who knows about B12.

Thanks for all the info you post...very helpful.

[Gambit62 Administrator in reply to Songbird63]

Sorry - I get confused by the two - I think they are both holders of university chairs and hold posts at the JR which is a teaching hospital - if you google them both then you should be able to see what papers they've produced.  I'm not sure that either are experts but they obviously know something about B12.

I've not dealt with either - and in fact I was told that I was B12 deficient when I was in the JR ... but it was a very confusing conversation - possibly because it was in the orthopaedic section (broken ankle) ... and the impression I got from the consultant was that it involved diarrhoea and constipation ... possible that one of the students may have mentioned osteoarthritis and osteoporosis as potential consequences of a B12D but if someone had actually gone through a checklist of the full range of symptoms it would have been more useful and would have caught the fact that I also had neurological symptoms but ...

[jillc39]

Do let us all know how you get on.  my gp denies that there I any link between gastro problems and PA and B12 deficiency.  I know there is a link...,.

[wedgewood in reply to jillc39]

My gastroenterologist (Professor) told me that as a  P.A. Patient, I should assume that I have either Achlorhydria(no stomach acid) or Hypochlorhydria(low stomach acid) These conditions lead to many gut problems, for which the NHS has no treatment.  I treated my self first with Betaine hydrochloric acid with pepsin capsules, then with a water-based probiotic and latterly home-made organic raw unpasteurised sauerkraut. Has worked wonders. No more gut problems. 

[fbirder]

Hey! You must have had the same haematologist as me!

If you have low B12 and you're not - a vegan / had stomach surgery / a nitrous oxide abuser - then the most likely cause is poor absorption. And the most likely cause of that is gastric atrophy, caused either by H. pylori infection or an autoimmune attack. A gastroenterologist can test for those.

If you have PA then it's a good idea to have a gastroscopy anyhow. The achlorhydria mentioned by Wedgewood will cause hypergastrinaemia, which can cause the growth of Type 1 Gastric Carcinoids (aka Neuroendocrine Tumours or NETs).

These tend to be pretty indolent and sit around doing nothing. In fact the 5-year survival rate in people with these tumours is, for those in their late 50s, better than for people without them (I guess we have much more monitoring to catch other nasties). However, they can turn nasty in a very small fraction of cases. My 'treatment' is to have a gastroscopy once a year, just to make sure they're still dormant.

[jw44]

Thanks for all the comments. I guess I'm just a bit wary of getting another referral to someone who dismisses the whole B12 thing again, but I do feel that gastro is probably the way to go to try and get some answers (the only explanation is that it must be some sort of absorption issue). I find it really difficult to go to appointments with doctors and consultants when you clearly know much more than them and have to tell them how to do their job. It would just be nice to know that they have had some experience of this before, or at least are open minded enough to read the literature I can give them!

I've looked hard online to see if any of the Oxford gastro consultants mention anything about absorption issues / PA etc in their 'specialisms' but can't see anything useful, hence the original question.

Not that I would wish a bad experience on anyone, but conversely if there are no recommendations, has anyone seen a gastro consultant at the JR and not been impressed / listened to, so I can avoid those ones?!

Thanks again for all the advice. 

[Songbird63]

I was diagnosed with PA 3 years ago and last year I was referred to JR with gastro problems ...these had previously been diagnosed as IBS many years before. But after a bad bout of pain and diahhorea my GP decided to refer for more tests. Initially saw a lovely registra who decided to go right back to beginning and did loads of tests. Returned for results and saw different less helpful male registra. Upshot was diagnosis of severe bile salt malabsorption plus erosive and atrophic gastritis. However, neither registra seemed to know know very much about PA or B12, and the second one even disagreed with guidelines for regular endoscopies to check for gastric cancer in PA.

So basically I was impressed with the gastro side of things...scan for Bile salt malabsorption only been available for a while on NHS...but much less so re their PA and B12 knowledge.

My GP is trying to find someone at JR who does know about PA/B12 as I am having monthly injections but many symptoms still persist. Saw a neurologist last year too who gave me a thorough neurological examination and brain MRI but again knew very little about B12. 

Anyone have any advice re consultants in Oxford area?

[jillc39]

or the London area???

[jw44]

Thanks everyone. It's a shame its so hard to find out about the consultant's specialisms and experience! I guess I'll just have to take pot luck with whoever I end up seeing!