A systematic review of the literature related to the inclusion of oats in the gluten-free diet for patients with coeliac disease to assess whether oats can be recommended. A computerised literature review of multiple databases was carried out, identifying 17 primary studies, 6 of which met the criteria for inclusion in this review. None of the six studies found any significant difference in the serology between the oats and control groups. Two studies, however, identified a significant difference (p<0.001; p = 0.039) in intraepithelial lymphocyte counts between the oats and control groups. Oats can be symptomatically tolerated by most patients with coeliac disease; however, the long-term effects of a diet containing oats remain unknown. Patients with coeliac disease wishing to consume a diet containing oats should therefore receive regular follow-up, including small bowel biopsy at a specialist clinic for life.

Case historyA 53-year-old man presented with a 3-year history of chronic pancreatitis almost certainly of alcoholic aetiology. Computerized tomography revealed a large cyst in the region of the neck of the pancreas which proved resistant to treatment by aspiration. The patient was suffering from severe chronic pain typical of pancreatitis and after full discussion, surgery was undertaken.At laparotomy the cyst was located in the pancreatic neck and the gland showed signs of chronic inflammation: no other abnormality was detected. Because a communication between the cyst and the duct system could not be demonstrated, a partial pancreatectomy was carried out and the body and tail of the pancreas were removed. The cyst was drained into a Roux loop of jejunum. The patient made an excellent recovery and at his most recent review was asymptomatic.

IntroductionGood nutrition is pivotal for ensuring an individuals health and wellbeing. The Iraqi Healthcare system has suffered years of underinvestment, war and turmoil. In particular, services dealing with nutrition and dietetics are often overlooked or entirely non-existent in Iraqi hospitals leading to a significant adverse effect on overall health outcomes. We investigate the usefulness of an intensive nutritional course in improving knowledge and confidence amongst healthcare professionals in Iraq.MethodsA BSG-funded delegation visited the University of Kufa, Iraq in January 2016 to deliver an intensive four-day course on clinical nutrition based on the BSG, BDS, and BAPEN guidelines. Each day was dedicated to specific learning outcomes in general dietetic assessment, special situations (including GI nutrition & trauma), paediatric nutrition and obesity nutrition. This free for all course received 20 external CPD credits from the Royal College of Physicians. A detailed pre-course questionnaire was distributed to evaluate understanding of common nutritional problems and confidence in managing these. A subsequent questionnaire one-month following the course evaluated changes to confidence (using a standardised 5 point confidence Likert scale).Results147 delegates attended the course from 8 of the 19 Iraqi governates. Completed post-course questionnaires were available for 69 individuals (47% response rate). Whilst 88% of attendees did not feel confident diagnosing malnutrition before the course, this improved to 97% of respondents with >3/5 confidence in the post-course questionnaire (67% scoring >4/5). Other observed improvements included mean confidence scores for biochemical workup of patients with suspected malnutrition (2.9 pre-course compared to 4.3 post-course, p < 0.01). In fact, for the 40 sessions organised during the 4 day course, all showed a significant improvement in post-course confidence.ConclusionClinical nutrition is an often under taught component of medical education. It’s importance; particularly to war-torn developing countries that have no dietetic infrastructure should not be understated. A BSG-funded delegation was able to deliver an intensive 4 day conference to health leaders in Iraq and demonstrated improved knowledge and confidence at dealing with nutritional dilemmas. We welcome BSG-funding for such endeavours and thank them for their support.Disclosure of InterestNone Declared