ICGP Logo
user
ICGP Logo

Digestive Health (GI)

  • This chapter outlines the standards required of GPs working in Ireland to effectively diagnose, manage, and support patients with digestive issues. GPs must have a broad knowledge base, encompassing conditions involving any part of gastrointestinal tract well as associated liver and pancreatic diseases. 

     In daily practice, GPs encounter acute presentations requiring urgent referral for specialist input and chronic or subclinical conditions that need ongoing management. Early detection, appropriate investigation, and timely intervention is vital, especially in the case of serious diseases such as malignancy, inflammatory bowel disease and hepatitis.

    Preventive care plays a central role in digestive health. GPs are well placed to provide lifestyle advice and support relating to diet, alcohol, smoking and weight management.  

    Equally important is the GP’s ability to understand the broader psychosocial impact of gastrointestinal illness, to support affected patients and their families and to liaise effectively with community-based services and secondary care. 

    • GI1. Diagnose common gastrointestinal conditions in primary care through effective history-taking, targeted investigations, physical examination, and the formulation of a differential diagnosis.
    • GI2. Conduct appropriate gastrointestinal examinations, including digital rectal examination where appropriate, while ensuring patient comfort, respecting cultural factors, and utilising a chaperone where appropriate.
    • GI3. Understand the psychological, social, and cultural factors that influence gastrointestinal symptoms and patient interactions with healthcare and carefully address patient barriers such as embarrassment, to provide culturally sensitive and patient-centred care.
    • GI4. Provide patient-centred care for chronic gastrointestinal conditions, addressing physical, emotional, and social needs.
    • GI5. Demonstrate a holistic approach to the management of gastrointestinal conditions by integrating nutritional assessment and support, recognising and addressing bone health risks (e.g. in coeliac disease or malabsorption), empowering patients in self-management and lifestyle modification, and applying principles of palliative care where appropriate to optimise quality of life.
    • GI6. Demonstrate effective management of functional gastrointestinal symptoms by considering the complex interplay of psychological, social, and biological factors, and recognising the impact of personal biases on patient care.
    • GI7. Understand the role of psychological factors in gastrointestinal health and their influence on symptom presentation and management.
    • GI8. Manage the impact of alcohol and drug dependence on gastrointestinal health, maintaining a non-judgmental approach, and optimally utilising local referral pathways to gain input from relevant specialist and support services when necessary.
    • GI9. Demonstrate up to date knowledge of colorectal cancer screening, including understanding national screening programmes, family history assessment, and surveillance strategies.
    • GI10. Effectively coordinate care across the entire health system for patients with gastrointestinal conditions including utilisation of community-based services, appropriate specialist referral and ongoing collaboration with specialist multidisciplinary teams including gastroenterology, hepatology, surgical and other relevant secondary care teams.

    For each problem or disease, consider the following areas within the general context of primary care:  

    • the natural history of the condition, including whether acute or chronic
    • the incidence and prevalence, including in different demographic groups
    • typical and atypical presentations
    • recognition of normal variations throughout life
    • risk factors, including lifestyle, socio-economic and genetic factors
    • diagnostic features and differential diagnosis
    • recognition of ‘alarm’ or ‘red flag’ features
    • appropriate and relevant investigations
    • interpretation of test results
    • management, including initial and continuing care, chronic disease monitoring, emergency care and palliative care
    • patient and carer information and education
    • broad prognosis

    Signs, Symptoms & Presentations

    • Abdominal Masses
    • Abdominal Pain
    • Anorexia
    • Bloating
    • Chest Pain
    • Constipation
    • Diarrhoea
    • Dyspepsia
    • Dysphagia
    • Faecal Incontinence
    • Haematemesis
    • Hepatomegaly
    • Jaundice
    • Malena
    • Mouth Ulceration
    • Nausea and Vomiting
    • Pruritis
    • Rectal Bleeding
    • Regurgitation
    • Splenomegaly
    • Vomiting
    • Weight Gain
    • Weight Loss

    Common and Important Conditions

    • Acute Obstruction
    • Alcohol Related Liver Disease
    • Anal Fissure
    • Appendicitis
    • Barrett’s Oesophagus
    • Biliary Colic
    • Bowel Ischaemia
    • Cholecystitis
    • Coeliac Disease
    • Diverticular Disease
    • Diverticulitis
    • Drug Induced Hepatitis
    • Dyspepsia
    • Gastric and Duodenal Ulcer
    • GI Infection including E.coli, C.Diff, Rotavirus, Norovirus, Giardia, Salmonella, Campylobacter
    • GI Malignancy including Oesophageal Cancer, Colorectal Cancer, Carcinoid, Lymphoma, Liver Cancer, Pancreatic Cancer, Gallbladder Cancer
    • GORD
    • Haemorrhoids
    • Helicobacter Pylori
    • Hemochromatosis
    • Hernias – inguinal, femoral, diaphragmatic, hiatus, incisional
    • Infective Hepatitis
    • Inflammatory Bowel Disease
    • Intussusception
    • Irritable Bowel Syndrome
    • Meckel’s Diverticulum
    • Non-Alcoholic Fatty Liver Disease
    • Pancreatic Insufficiency
    • Pancreatitis
    • Perforation
    • Renal Colic
    • Upper GI Haemorrhage including Oesophageal Varices & Malory Weiss Syndrome
    • Volvulus

  • Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

    Self-Directed Learning

    Useful Websites

    Information on Bowel Screening Ireland

    British Society for Gastroenterology Guidelines

    Coeliac Society of Ireland Website

    RCGP Learning Resource IBD

    British Dieticians Association Website

    Workplace Based Learning

    The workplace provides a rich environment to develop practical skills and deepen clinical understanding in digestive health. During hospital or General Practice rotations, you’re your opportunity to spend time in specialist clinics. Ask questions and proactively seek out feedback on your performance. Participating in endoscopy sessions, hepatology clinics, or inflammatory bowel disease (IBD) clinics can offer valuable insights into the management of complex gastrointestinal conditions. Availability will vary by geographical location, but most Irish hospitals offer some access to these services - being proactive in seeking out these experiences is key. If a stoma nurse is available locally, attending their clinic can enhance your understanding of stoma care, patient education, and long-term support needs. Observing multidisciplinary teams in action will help you to appreciate the importance of continuity of care between primary and secondary settings and provide context to referral pathways, investigations, and follow-up care. These experiences not only reinforce theoretical knowledge but also strengthen communication, empathy, and clinical reasoning in the context of digestive health.

    Day Release

    Day release sessions provide an excellent platform to consolidate learning around digestive health through case-based discussions, peer learning, and topic-focused teaching. These sessions allow trainees to explore common and complex gastrointestinal presentations, from irritable bowel syndrome to coeliac disease and colorectal cancer. Reviewing referral pathways, interpreting test results (such as faecal calprotectin, liver function tests, or endoscopy reports), and discussing case outcomes as a group deepens understanding and builds diagnostic confidence. Day release also offers a space to share local experiences, including access to screening programmes, specialist clinics, and community resources such as dietitians or stoma care services. This collaborative approach fosters reflective practice and supports the development of practical strategies for managing digestive health effectively in primary care.

    Registrar Tutorials

    Registrar tutorials offer an ideal opportunity for personalised learning in digestive health. These one-to-one sessions can focus on real cases encountered in practice, allowing for detailed discussion on diagnostic reasoning, management decisions, and follow-up planning. Topics such as the investigation of abnormal liver function tests, the assessment of red flag symptoms, or the primary care role in bowel screening can be explored in depth with guidance from your trainer. Tutorials also provide space to review national guidelines, discuss recent developments in GI medicine, and reflect on communication challenges, such as delivering difficult news or supporting patients with chronic digestive conditions. These tailored sessions help to strengthen clinical confidence and ensure trainees are well-prepared to manage the wide range of gastrointestinal issues seen in general practice.

  • Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

    The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

    The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

    EPA 10: Manage the care of adults, including older people with chronic conditions and complex multimorbidity


    EPA 10 could be used to record the management of a patient with chronic irritable bowel syndrome. Reflection could cover use of nutritional assessment, psychological support, and self-management strategies, as well as awareness of personal biases.

    Core Knowledge Test (CKT)

    • Interpretation of Liver Function Tests.
    • Assessment of Painless Jaundice.
    • Management of Coeliac Disease.

    Clinical Competency Test (CCT)

    • A patient presents with intermittent abdominal pain.
    • A patient presenting with symptoms of reflux.
    • A patient with a new diagnosis of Coeliac Disease. 

    Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

    Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

    The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

    Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.