<p><b>16</b></p><p><b>Early experience with endoscopic submucosal dissection at Austin Health</b></p><p><b>Sitong Chen</b><sup>1</sup>, Sujievvan Chandran<sup>1,2,3</sup>, Leonardo Zorron Cheng Tao Pu<sup>2,3</sup>, Nicholas Dalkie<sup>3</sup>, Rhys Vaughan<sup>1,2,3</sup> and Marios Efthymiou<sup>1,2,3</sup></p><p><sup>1</sup><i>Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia;</i> <sup>2</sup><i>Liver Transplant Unit, Austin Health, Heidelberg, Australia;</i> <sup>3</sup><i>Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia</i></p><p><b><i>Background and Aim:</i></b> Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic procedure which employs en-bloc dissection technique to remove premalignant or early malignant gastrointestinal lesions. In Japan, ESD is considered as first line treatment for early gastrointestinal neoplasms, yet the wide adoption of ESD in the West has been slow. Barriers include the technical difficulty of ESD, lower prevalence of early gastric cancer in the West, and the lack of training opportunities. We know that gastric location is the easiest location to start training in ESD whereas colorectal ESD is more challenging. The aim of this study was to assess the early experience with ESD at Austin Health.</p><p><b><i>Methods:</i></b> A retrospective analysis was conducted on 31 consecutive gastrointestinal lesions in 27 patients who underwent ESD from June 2020 to April 2023 at Austin Health, Melbourne Australia. Clinical and procedural data, complications, and the efficacy and efficiency of the ESD procedure were evaluated.</p><p><b><i>Results:</i></b> Twenty-seven patients (12 females and 15 males) were enrolled in the study, with a mean age of 72.0 years. Overall, thirty-one lesions were resected, including 16 gastric lesions, 6 oesophageal lesions and 9 colorectal lesions. The mean size of the lesions was 35.8mm and the mean resected base area was 12.0cm<sup>2</sup>. In the total cohort, en-bloc resection rate was 96.8%. Final ESD histology upstaged the initial diagnosis in four lesions based on pre-ESD pinch biopsies and imaging. Eleven malignant lesions were found in the final pathology. Six complications were reported in our study, including two cases of intraoperative perforation and four cases of delayed bleeding (all the complications were managed medically/endoscopically). The mean hospital stay was 1.6 days for all patients, and 19 patients were discharged after an overnight admission.</p><p><b><i>Conclusion:</i></b> ESD is an effective and safe treatment for gastrointestinal neoplasms in an Australian tertiary centre and our early treatment outcomes were comparable to recently published large study data. Outcomes are likely to progressively improve with further experience.</p><p><b>30</b></p><p><b>Intrathoracic cholecystitis managed with endoscopic gallbladder drainage</b></p><p><b>Andrea Huang</b><sup>1,4</sup>
腹腔镜胆囊切除术治疗严重急性胆囊炎。结果荟萃分析。外科内镜 2008; 22: 8-15 5. Dubecz, A, Langer, M, Stadlhuber, R et al. 非常年长者的胆囊切除术--90 岁是新的 70 岁吗？胃肠外科杂志》，2012 年；16: 282-285。 6. Teoh, AYB, Kitano, M, Itoi, T, et al. 急性胆囊炎高危手术患者的内超声引导胆囊引流术与经皮胆囊造口术：国际随机多中心对照优越性试验（DRAC 1） Gut 2020; 69: 1085-1091.226Can 光学评估区分 T1a 和 T1b 食管腺癌：Sunil Gupta1,2, Francesco V Mandarino1, Julia Gauci1, Anthony Whitfield1,2, Clarence Kerrison1, Prabha Selvanathan3, Puja Kumar1, Neal Shahidi1, Luke Hourigan3, Helmut Messmann4, Michael Wallace5, Alessandro Repici6, Mario Dinis-Ribeiro7, Gregory Haber8, Andrew Taylor9、Irving Waxman10、Peter Siersema11、Roos Pouw12、Arnaud Lemmers13、Raf Bisschops14、Jeffrey Mosko15、Christopher Teshima15、Krish Ragunath16、17、Thomas Rosch18、Oliver Pech19、Torsten Beyna20、Prateek Sharma21、Eric Y Lee1、Stephen Williams1、Nicholas Burgess1,2 和 Michael J Bourke1,21 澳大利亚悉尼韦斯特米德医院；2 澳大利亚悉尼，悉尼大学； 3 澳大利亚布里斯班，亚历山德拉公主医院；4 德国奥格斯堡大学医院；5 美国杰克逊维尔梅奥诊所；6 意大利米兰哈曼尼塔斯研究医院；7 葡萄牙波尔图综合癌症中心；8 美国纽约大学朗贡健康中心；9 澳大利亚墨尔本圣文森特医院；10 美国芝加哥拉什大学医学中心；11 荷兰奈梅亨拉德布德健康科学研究所；12Amsterdam University Medical Centers, Amsterdam, Netherlands; 13CUB Erasme Hospital, Belgium; 14University Hospitals Leuven, Belgium; 15St Michael's Hospital, Toronto, Canada; 16Royal Perth Hospital, Perth, Australia; 17Curtin Medical School, Perth, Australia; 18University Hospital Hamburg-Eppendorf, Hamburg, Germany; 19St.神约翰医院，德国雷根斯堡；20Evangelisches Krankenhaus，德国杜塞尔多夫；21堪萨斯城退伍军人医疗中心，美国堪萨斯城简介：T1a型食管腺癌可以接受零碎的EMR，而T1b型食管腺癌则主张R0切除术，因为它有可能治愈并减少复发。因此，在目前的治疗模式下，必须区分 T1a 和 T1b 疾病。我们试图确定巴雷特内镜专家是否能够根据光学评估进行区分：方法：我们从一家医疗机构的连续患者中收集了 60 组经组织学证实的高级别发育不良（HGD）、T1a 和 T1b 疾病的内窥镜图像（每组 20 张）。每组包含四张图像，并标准化为包括一张概览图像、一张高清白光特写图像、一张近焦放大图像和一张窄带图像。专家们受邀对每组图像的组织学进行预测：来自 8 个国家（澳大利亚、美国、意大利、荷兰、德国、加拿大、比利时和葡萄牙）的 19 位专家参加了此次活动。大多数专家的从业年限为20年，巴雷特EMR的年中位病例量为50例（IQR为18-75），巴雷特ESD的年中位病例量为25例（IQR为10-45）。食管腺癌（T1a/b）可与 HGD 区分开来，汇总灵敏度为 89.1%（95% CI：86.7-91.2）。在预测T1b腺癌病例的T分期时，汇总灵敏度为43.8%（95% CI：38.5-49.2）。Fleiss'kappa为0.421（95% CI：0.399-0.442，P<0.001），表明一致性尚可：结论：巴雷特内镜专家能可靠地区分 T1a/T1b 食管腺癌和 HGD。尽管在 T 型分期方面有相当到中等程度的一致性，但 T1b 型疾病与 T1a 型疾病不能可靠地区分开来。这可能会对临床决策和内镜治疗方法的选择产生影响242。内窥镜实时评估溃疡性结肠炎的组织学和内窥镜活动Thanaboon Chaemsupaphan1,2、Mohammad Shir Ali1、Sudarshan Paramsothy1,3、Rupert Leong1,31澳大利亚悉尼康科德遣返总医院消化内科和肝脏服务部；2 泰国曼谷玛希隆大学 Siriraj 医院医学系消化内科；3 澳大利亚悉尼悉尼大学医学与健康学院背景与目的：内窥镜（CF-H290ECI；日本奥林巴斯医疗系统公司；ARTG 121183）放大率为 500 倍，是一种新型的先进成像技术，能够对肠粘膜进行实时成像。溃疡性结肠炎（UC）的内镜-组织学缓解评估已成为治疗标准。然而，内镜医师并不参与组织学评估。
{"title":"Advanced Endoscopic Techniques","authors":"","doi":"10.1111/jgh.16696","DOIUrl":"https://doi.org/10.1111/jgh.16696","url":null,"abstract":"<p><b>16</b></p><p><b>Early experience with endoscopic submucosal dissection at Austin Health</b></p><p><b>Sitong Chen</b><sup>1</sup>, Sujievvan Chandran<sup>1,2,3</sup>, Leonardo Zorron Cheng Tao Pu<sup>2,3</sup>, Nicholas Dalkie<sup>3</sup>, Rhys Vaughan<sup>1,2,3</sup> and Marios Efthymiou<sup>1,2,3</sup></p><p><sup>1</sup><i>Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia;</i> <sup>2</sup><i>Liver Transplant Unit, Austin Health, Heidelberg, Australia;</i> <sup>3</sup><i>Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia</i></p><p><b><i>Background and Aim:</i></b> Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic procedure which employs en-bloc dissection technique to remove premalignant or early malignant gastrointestinal lesions. In Japan, ESD is considered as first line treatment for early gastrointestinal neoplasms, yet the wide adoption of ESD in the West has been slow. Barriers include the technical difficulty of ESD, lower prevalence of early gastric cancer in the West, and the lack of training opportunities. We know that gastric location is the easiest location to start training in ESD whereas colorectal ESD is more challenging. The aim of this study was to assess the early experience with ESD at Austin Health.</p><p><b><i>Methods:</i></b> A retrospective analysis was conducted on 31 consecutive gastrointestinal lesions in 27 patients who underwent ESD from June 2020 to April 2023 at Austin Health, Melbourne Australia. Clinical and procedural data, complications, and the efficacy and efficiency of the ESD procedure were evaluated.</p><p><b><i>Results:</i></b> Twenty-seven patients (12 females and 15 males) were enrolled in the study, with a mean age of 72.0 years. Overall, thirty-one lesions were resected, including 16 gastric lesions, 6 oesophageal lesions and 9 colorectal lesions. The mean size of the lesions was 35.8mm and the mean resected base area was 12.0cm<sup>2</sup>. In the total cohort, en-bloc resection rate was 96.8%. Final ESD histology upstaged the initial diagnosis in four lesions based on pre-ESD pinch biopsies and imaging. Eleven malignant lesions were found in the final pathology. Six complications were reported in our study, including two cases of intraoperative perforation and four cases of delayed bleeding (all the complications were managed medically/endoscopically). The mean hospital stay was 1.6 days for all patients, and 19 patients were discharged after an overnight admission.</p><p><b><i>Conclusion:</i></b> ESD is an effective and safe treatment for gastrointestinal neoplasms in an Australian tertiary centre and our early treatment outcomes were comparable to recently published large study data. Outcomes are likely to progressively improve with further experience.</p><p><b>30</b></p><p><b>Intrathoracic cholecystitis managed with endoscopic gallbladder drainage</b></p><p><b>Andrea Huang</b><sup>1,4</sup>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"3-24"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16696","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>92</b></p><p><b>Simethicone suppresses the growth of microbes cultured from the human duodenal mucosa</b></p><p>Thomas Fairlie<sup>1,2</sup>, Ayesha Shah<sup>1,2</sup>, Yenkai Lim<sup>2</sup>, Jing-Jie Teh<sup>2</sup>, Lauren Schooth<sup>2</sup>, Mark Morrison<sup>2</sup> and Gerald Holtmann<sup>1,2</sup></p><p><sup>1</sup><i>Princess Alexandria Hospital, Metro South Health, Woolloongabba, Australia;</i> <sup>2</sup><i>University of Queensland, Brisbane, Australia</i></p><p><b><i>Background and Aim:</i></b> Small intestinal dysbiosis (SID) is known to play an important role in the pathophysiology of various gastrointestinal and extraintestinal disorders, with recent studies linking select members of the duodenal microbiota with symptom severity in functional dyspepsia (FD). Simethicone is routinely used during endoscopy as an anti-foaming agent and at lower concentrations used to alleviate painful gut symptoms associated with excessive gas and/or bloating. Here, we assessed the effects from simethicone on the growth of a mixed culture of duodenal mucosa-associated microbiota (MAM).</p><p><b><i>Methods:</i></b> The consortia of duodenal MAM recovered from the biopsies of a non-FD asymptomatic control subject were anaerobically cultured using a duodenal habitat-simulating medium with no addition, or supplemented with a commercially available source of Simethicone to provide final concentrations of 0.2 mg/ml (lowest effective dose for antifoaming effects, 1 mg/mL, 2 mg/mL or 4 mg/mL. Three biological replicates with six technical replicates of the cultures (and uninoculated controls) were prepared using a 96-well microtitre plate format within an anaerobic chamber, then microbial growth (optical density change at 600 nm) at 37 °C was measured every 30 minutes for 18 hours using an automated microtiter plate also housed within the anaerobic chamber. The R package Growthcurver was applied to assess the growth kinetic profiles by calculating the area under the curve and statistical comparisons to control cultures calculated with a paired t-test.</p><p><b><i>Results:</i></b> Relative to control cultures, the growth kinetic profile (area under the curve) after 18 hours was unaffected by the addition of 0.2 mg/mL simethicone (<i>P</i> = 0.99), but progressively reduced by the addition of greater simethicone concentrations (Fig. 1). The reduction of growth kinetics with 2 mg/mL simethicone approached significance (<i>P</i> = 0.059) and were significantly reduced with 4 mg/mL simethicone (<i>P</i> = 0.023).</p><p><b>139</b></p><p><b>A whole blood interleukin-2 release assay offers a novel approach to detect and monitor pathogenic T cells to support epitope discovery and drug development in coeliac disease and beyond</b></p><p><b>Olivia Moscatelli</b><sup>1</sup>, Amy Russell<sup>1</sup>, Lee Henneken<sup>2</sup>, Linda Fothergill<sup>1</sup>, Hugh Reid<sup>3</sup>, Jamie Rossjohn<sup>3</sup>, Melinda Hardy<sup>1</sup>, Vanessa Bryant<sup>1</sup> and J
{"title":"Luminal Basic Science","authors":"","doi":"10.1111/jgh.16703","DOIUrl":"https://doi.org/10.1111/jgh.16703","url":null,"abstract":"<p><b>92</b></p><p><b>Simethicone suppresses the growth of microbes cultured from the human duodenal mucosa</b></p><p>Thomas Fairlie<sup>1,2</sup>, Ayesha Shah<sup>1,2</sup>, Yenkai Lim<sup>2</sup>, Jing-Jie Teh<sup>2</sup>, Lauren Schooth<sup>2</sup>, Mark Morrison<sup>2</sup> and Gerald Holtmann<sup>1,2</sup></p><p><sup>1</sup><i>Princess Alexandria Hospital, Metro South Health, Woolloongabba, Australia;</i> <sup>2</sup><i>University of Queensland, Brisbane, Australia</i></p><p><b><i>Background and Aim:</i></b> Small intestinal dysbiosis (SID) is known to play an important role in the pathophysiology of various gastrointestinal and extraintestinal disorders, with recent studies linking select members of the duodenal microbiota with symptom severity in functional dyspepsia (FD). Simethicone is routinely used during endoscopy as an anti-foaming agent and at lower concentrations used to alleviate painful gut symptoms associated with excessive gas and/or bloating. Here, we assessed the effects from simethicone on the growth of a mixed culture of duodenal mucosa-associated microbiota (MAM).</p><p><b><i>Methods:</i></b> The consortia of duodenal MAM recovered from the biopsies of a non-FD asymptomatic control subject were anaerobically cultured using a duodenal habitat-simulating medium with no addition, or supplemented with a commercially available source of Simethicone to provide final concentrations of 0.2 mg/ml (lowest effective dose for antifoaming effects, 1 mg/mL, 2 mg/mL or 4 mg/mL. Three biological replicates with six technical replicates of the cultures (and uninoculated controls) were prepared using a 96-well microtitre plate format within an anaerobic chamber, then microbial growth (optical density change at 600 nm) at 37 °C was measured every 30 minutes for 18 hours using an automated microtiter plate also housed within the anaerobic chamber. The R package Growthcurver was applied to assess the growth kinetic profiles by calculating the area under the curve and statistical comparisons to control cultures calculated with a paired t-test.</p><p><b><i>Results:</i></b> Relative to control cultures, the growth kinetic profile (area under the curve) after 18 hours was unaffected by the addition of 0.2 mg/mL simethicone (<i>P</i> = 0.99), but progressively reduced by the addition of greater simethicone concentrations (Fig. 1). The reduction of growth kinetics with 2 mg/mL simethicone approached significance (<i>P</i> = 0.059) and were significantly reduced with 4 mg/mL simethicone (<i>P</i> = 0.023).</p><p><b>139</b></p><p><b>A whole blood interleukin-2 release assay offers a novel approach to detect and monitor pathogenic T cells to support epitope discovery and drug development in coeliac disease and beyond</b></p><p><b>Olivia Moscatelli</b><sup>1</sup>, Amy Russell<sup>1</sup>, Lee Henneken<sup>2</sup>, Linda Fothergill<sup>1</sup>, Hugh Reid<sup>3</sup>, Jamie Rossjohn<sup>3</sup>, Melinda Hardy<sup>1</sup>, Vanessa Bryant<sup>1</sup> and J","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"262-265"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>181</b></p><p><b>A clinical nurse specialist comprehensive hepatology clinic: Streamlining service delivery</b></p><p>Marcelle Perrin, Crystal Connelly, Vanessa Sheehan and Ying Shen</p><p><i>Fiona Stanley Hospital, Murdoch, Australia</i></p><p><b><i>Background:</i></b> Advances in curative therapies for Hepatitis have seen the core role of the hepatology specialist nurses broaden significantly. In addition, hepatology service demand is increasing across both inpatient and outpatient settings. Transitioning to a new health service provided an opportunity to implement an alternative model to streamline access to hepatology services. A team of Hepatology Clinical Nurse Specialists deliver a clinic service to all hepatology patients aimed at managing extensive waitlists and ensuring appropriate services are provided in the timeliest manner. There is limited literature available on nurse-led hepatology clinics that are not condition specific. This clinic is the only one of its kind in Western Australia and, to our knowledge, nationally.</p><p><b><i>Service structure and implementation:</i></b> The clinic is autonomously led by a team of three Clinical Nurse Specialists and aims to divert from the Consultant waitlist where appropriate, provide baseline hepatology assessment including investigations and liver scan to facilitate early intervention and inform timely delivery of care, and improve the hepatology patient experience. A guideline and suite of standard operating procedures were developed and endorsed by the health service. Medical governance review is provided at weekly multidisciplinary team meetings. Patients are initially referred from Consultants or General Practitioners (GP) or identified through a virtual assessment triage of waitlisted patients. Hepatology screening and assessment is undertaken by a Hepatology Clinical Nurse Specialist and patients are either discharged from the service to the care of their GP, remain on the Consultant waitlist for review, or engage in ongoing monitoring and education within the clinic.</p><p><b><i>Service delivery outcomes:</i></b> Since implementation in 2022, the clinic has provided over 5,000 occasions of care. In the preceding year the clinic has had 195 referrals, with the primary sources of patient referrals being GPs (45%) and specialists (40%). The largest proportions of the cohort present due to deranged liver function tests (40%), followed by steatosis (29%). Seventy three percent of individuals referred engaged with the clinic service. Post assessment and clinic visit patients are most commonly identified to be suffering steatotic liver disease and are provided counselling and education. Half of presenting patients are discharged from the service to the care of their GP, resulting in a significant reduction to the waitlist for Consultant review. Ongoing surveillance is maintained for 40% of the presenting cohort. The service generates over $400,000 in activity-based funding per year to
181 临床专科护士综合肝病诊所：Marcelle Perrin、Crystal Connelly、Vanessa Sheehan 和 Ying Shen 澳大利亚默多克市菲奥娜斯坦利医院背景：肝炎治愈疗法的进步大大拓宽了肝病专科护士的核心作用。此外，住院病人和门诊病人对肝病服务的需求也在不断增加。向新医疗服务机构的过渡为我们提供了一个实施替代模式以简化肝病服务的机会。肝病科临床护士专家团队为所有肝病患者提供门诊服务，旨在管理广泛的候诊名单，确保以最及时的方式提供适当的服务。关于护士主导的非特定病症肝病诊所的文献资料十分有限。据我们所知，该诊所是西澳大利亚州乃至全国唯一一家此类诊所：该诊所由三名临床专科护士组成的团队自主领导，旨在酌情从顾问候诊名单中分流病人，提供包括检查和肝脏扫描在内的基线肝病评估，以促进早期干预和及时提供护理，并改善肝病患者的就医体验。医疗服务部门制定并批准了一份指南和一套标准操作程序。每周的多学科团队会议都会对医疗管理进行审查。患者最初由顾问或全科医生（GP）转诊，或通过对候诊患者进行虚拟评估分流确定。肝病临床专科护士负责对患者进行肝病筛查和评估，患者或从该服务机构出院，接受全科医生的护理，或继续留在顾问候诊名单上接受复查，或在诊所内接受持续监测和教育：服务成果：自 2022 年实施以来，诊所已提供了 5,000 多次护理服务。在过去的一年中，诊所共收到 195 份转诊病例，病人转诊的主要来源是全科医生（45%）和专科医生（40%）。因肝功能检测异常（40%）和脂肪变性（29%）而就诊的患者比例最高。73%的转诊患者接受了门诊服务。评估和门诊后，患者最常被确认为患有脂肪肝，并接受了咨询和教育。一半的就诊患者在出院后接受了全科医生的治疗，从而大大减少了等待医生复查的时间。对 40% 的就诊患者进行持续监测。这项服务每年产生 40 多万美元的活动资金，用于支持持续提供服务。针对 2 型糖尿病患者的社区 MASLD 护理路径：186 针对 2 型糖尿病患者的社区 MASLD 护理路径：障碍和考虑因素Melanie Aikebuse2、Lucy Gracen1、Babak Sarraf10、Steven McPhail5、Anthony Russell6、James O'Beirne7、Katharine Irvine8、Suzanne Williams9、Patricia Valery4 和 Elizabeth Powell2,3,41澳大利亚赫斯顿皇家布里斯班妇女医院胃肠病学和肝病学部；2Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; 3Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Woolloongabba, Brisbane, Australia; 4QIMR Berghofer Medical Research Institute, Brisbane, Australia；5Australian Centre for Health Services Innovation School of Public Health, Insitute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; 6Endocrinology and Diabetes, the Alfred Hospital, Melbourne, Australia；7 澳大利亚比尔廷亚阳光海岸大学胃肠病学和肝病学系；8 澳大利亚布里斯班转化研究所母校研究部；9 澳大利亚伊纳拉初级保健全科诊所；10 澳大利亚汤斯维尔汤斯维尔医院胃肠病学系背景和目的：人们越来越关注代谢功能障碍相关性脂肪性肝病（MASLD）对未来肝硬化造成的负担。这项研究的重点是 2 型糖尿病 (T2D)，这是 MASLD 的高发人群（40-70%）。现行指南建议使用纤维化-4评分（FIB-4）作为无创纤维化风险分层的第一步。然而，FIB-4对T2D患者低风险纤维化分层的准确性较低。我们旨在研究：(1)使用纤维化扫描为T2D患者提供 "肝脏健康检查 "的可行性，以此作为识别需要转诊接受专门治疗的高危患者的第一步；(2)全科医生（GP）对研究信函的回应，以及在初级医疗环境中的管理建议。
{"title":"Nursing","authors":"","doi":"10.1111/jgh.16705","DOIUrl":"https://doi.org/10.1111/jgh.16705","url":null,"abstract":"<p><b>181</b></p><p><b>A clinical nurse specialist comprehensive hepatology clinic: Streamlining service delivery</b></p><p>Marcelle Perrin, Crystal Connelly, Vanessa Sheehan and Ying Shen</p><p><i>Fiona Stanley Hospital, Murdoch, Australia</i></p><p><b><i>Background:</i></b> Advances in curative therapies for Hepatitis have seen the core role of the hepatology specialist nurses broaden significantly. In addition, hepatology service demand is increasing across both inpatient and outpatient settings. Transitioning to a new health service provided an opportunity to implement an alternative model to streamline access to hepatology services. A team of Hepatology Clinical Nurse Specialists deliver a clinic service to all hepatology patients aimed at managing extensive waitlists and ensuring appropriate services are provided in the timeliest manner. There is limited literature available on nurse-led hepatology clinics that are not condition specific. This clinic is the only one of its kind in Western Australia and, to our knowledge, nationally.</p><p><b><i>Service structure and implementation:</i></b> The clinic is autonomously led by a team of three Clinical Nurse Specialists and aims to divert from the Consultant waitlist where appropriate, provide baseline hepatology assessment including investigations and liver scan to facilitate early intervention and inform timely delivery of care, and improve the hepatology patient experience. A guideline and suite of standard operating procedures were developed and endorsed by the health service. Medical governance review is provided at weekly multidisciplinary team meetings. Patients are initially referred from Consultants or General Practitioners (GP) or identified through a virtual assessment triage of waitlisted patients. Hepatology screening and assessment is undertaken by a Hepatology Clinical Nurse Specialist and patients are either discharged from the service to the care of their GP, remain on the Consultant waitlist for review, or engage in ongoing monitoring and education within the clinic.</p><p><b><i>Service delivery outcomes:</i></b> Since implementation in 2022, the clinic has provided over 5,000 occasions of care. In the preceding year the clinic has had 195 referrals, with the primary sources of patient referrals being GPs (45%) and specialists (40%). The largest proportions of the cohort present due to deranged liver function tests (40%), followed by steatosis (29%). Seventy three percent of individuals referred engaged with the clinic service. Post assessment and clinic visit patients are most commonly identified to be suffering steatotic liver disease and are provided counselling and education. Half of presenting patients are discharged from the service to the care of their GP, resulting in a significant reduction to the waitlist for Consultant review. Ongoing surveillance is maintained for 40% of the presenting cohort. The service generates over $400,000 in activity-based funding per year to","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"306-308"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>10</b></p><p><b>Liver outcome score predicts long term clinical outcomes in primary biliary cholangitis: a multi-centre study</b></p><p><b>Dujinthan Jayabalan</b><sup>1,2</sup>, Leon A Adams<sup>1,2</sup>, Yi Huang<sup>1</sup>, Luis Calzadilla Bertot<sup>1,2</sup>, Wendy Cheng<sup>3</sup>, Simon Hazeldine<sup>4</sup>, Briohny Smith<sup>1</sup>, Gerry MacQuillan<sup>1,2</sup>, Michael Wallace<sup>1,2</sup>, George Garas<sup>1,2</sup> and Gary P Jeffrey<sup>1,2</sup></p><p><sup>1</sup><i>Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Australia;</i> <sup>2</sup><i>Medical School, University of Western Australia, Nedlands, Australia;</i> <sup>3</sup><i>Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia;</i> <sup>4</sup><i>Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Australia</i></p><p><b><i>Background and Aim:</i></b> Few predictive models of survival exist for primary biliary cholangitis (PBC) patients. This study investigated the natural history and assessed the accuracy of models for predicting liver-related outcomes in PBC patients.</p><p><b><i>Methods:</i></b> PBC patients were identified from the state-wide Hepascore and Clinical Outcome (HACO) cohort. Patients with PBC overlap syndromes were excluded. Overall death or transplant, liver-related mortality (liver-related death or transplant), and liver-related decompensation were determined using a population-based data linkage system. Accuracy of baseline Liver Outcome Score (LOS), composed of albumin, GGT, hyaluronic acid, age, sex, Hepascore and MELD were examined for predicting clinical outcomes.</p><p><b><i>Results:</i></b> 157 PBC patients (13% male, median age 60.5 years, median MELD 6, median Hepascore 0.22, 34% cirrhotic at enrolment) were followed for a median of 4.0 years (range, 0.01-9.5 years). Twelve patients died, 8 had liver-related deaths and 3 underwent liver transplant. Ten patients decompensated and two developed hepatocellular carcinoma. 5-year transplant-free survival was 92% (95% CI: 85-96%) overall, 71% (95% CI: 48-86%) in cirrhosis and 97% (95% CI: 91-99%) in non-cirrhotics (p<0.0001). 5-year liver-related mortality free rate was 95% (95% CI: 89-98%) in all, 76% (95% CI: 53-89%) in cirrhosis and 100% (95% CI: 100-100%) in non-cirrhotics (p<0.0001). Median time-to-decompensation was 3.3 years (range, 0.2-8.6). 5-year liver-related decompensation-free rate was 89% (95% CI: 78-95%) in all, 53% (95% CI: 22-76%) in cirrhosis, 98% (95% CI: 89-99.8%) in non-cirrhotics (p<0.0001). Multivariate analysis found LOS predicts overall death or transplant in all patients (HR 2.14; (95% CI: 1.26-3.62), p=0.005, C-statistic 0.89) and in cirrhotics (HR 2.24; (95% CI: 1.11-4.50), p=0.024, C-statistic 0.85). LOS predicted liver-related mortality in all (HR 2.40; (95% CI: 1.11-5.19), p=0.027, C-statistic 0.93) and in cirrhosis (HR 2.06; (95% CI: 0.98-4.31), p=0.056, C-statistic 0.93). LOS p
{"title":"Hepatology Clinical","authors":"","doi":"10.1111/jgh.16700","DOIUrl":"https://doi.org/10.1111/jgh.16700","url":null,"abstract":"<p><b>10</b></p><p><b>Liver outcome score predicts long term clinical outcomes in primary biliary cholangitis: a multi-centre study</b></p><p><b>Dujinthan Jayabalan</b><sup>1,2</sup>, Leon A Adams<sup>1,2</sup>, Yi Huang<sup>1</sup>, Luis Calzadilla Bertot<sup>1,2</sup>, Wendy Cheng<sup>3</sup>, Simon Hazeldine<sup>4</sup>, Briohny Smith<sup>1</sup>, Gerry MacQuillan<sup>1,2</sup>, Michael Wallace<sup>1,2</sup>, George Garas<sup>1,2</sup> and Gary P Jeffrey<sup>1,2</sup></p><p><sup>1</sup><i>Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Australia;</i> <sup>2</sup><i>Medical School, University of Western Australia, Nedlands, Australia;</i> <sup>3</sup><i>Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia;</i> <sup>4</sup><i>Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Australia</i></p><p><b><i>Background and Aim:</i></b> Few predictive models of survival exist for primary biliary cholangitis (PBC) patients. This study investigated the natural history and assessed the accuracy of models for predicting liver-related outcomes in PBC patients.</p><p><b><i>Methods:</i></b> PBC patients were identified from the state-wide Hepascore and Clinical Outcome (HACO) cohort. Patients with PBC overlap syndromes were excluded. Overall death or transplant, liver-related mortality (liver-related death or transplant), and liver-related decompensation were determined using a population-based data linkage system. Accuracy of baseline Liver Outcome Score (LOS), composed of albumin, GGT, hyaluronic acid, age, sex, Hepascore and MELD were examined for predicting clinical outcomes.</p><p><b><i>Results:</i></b> 157 PBC patients (13% male, median age 60.5 years, median MELD 6, median Hepascore 0.22, 34% cirrhotic at enrolment) were followed for a median of 4.0 years (range, 0.01-9.5 years). Twelve patients died, 8 had liver-related deaths and 3 underwent liver transplant. Ten patients decompensated and two developed hepatocellular carcinoma. 5-year transplant-free survival was 92% (95% CI: 85-96%) overall, 71% (95% CI: 48-86%) in cirrhosis and 97% (95% CI: 91-99%) in non-cirrhotics (p<0.0001). 5-year liver-related mortality free rate was 95% (95% CI: 89-98%) in all, 76% (95% CI: 53-89%) in cirrhosis and 100% (95% CI: 100-100%) in non-cirrhotics (p<0.0001). Median time-to-decompensation was 3.3 years (range, 0.2-8.6). 5-year liver-related decompensation-free rate was 89% (95% CI: 78-95%) in all, 53% (95% CI: 22-76%) in cirrhosis, 98% (95% CI: 89-99.8%) in non-cirrhotics (p<0.0001). Multivariate analysis found LOS predicts overall death or transplant in all patients (HR 2.14; (95% CI: 1.26-3.62), p=0.005, C-statistic 0.89) and in cirrhotics (HR 2.24; (95% CI: 1.11-4.50), p=0.024, C-statistic 0.85). LOS predicted liver-related mortality in all (HR 2.40; (95% CI: 1.11-5.19), p=0.027, C-statistic 0.93) and in cirrhosis (HR 2.06; (95% CI: 0.98-4.31), p=0.056, C-statistic 0.93). LOS p","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"59-145"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16700","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>20</b></p><p><b>Risk factors for central line-associated bloodstream infections in home parenteral nutrition patients: an observational cohort study</b></p><p>Paris Hoey<sup>1</sup>, Douglas Roche<sup>1</sup>, Paul Chapman<sup>2</sup>, Vishal Kaushik<sup>1</sup>, Stacey Llewellyn<sup>3</sup> and Niwansa Adris<sup>1</sup></p><p><sup>1</sup><i>Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia;</i> <sup>2</sup><i>Department of Infectious Disease, Royal Brisbane and Women's Hospital, Brisbane, Australia;</i> <sup>3</sup><i>QIMR Berghofer Medical Research Institute, Brisbane, Australia</i></p><p><b><i>Background and Aim:</i></b> A central line-associated bloodstream infection (CLABSI) is a common and potentially life-threatening complication for patients with intestinal failure (IF) receiving home parenteral nutrition (HPN). In uncomplicated infections, The European Society for Clinical Nutrition and Metabolism guidelines advocate for central venous access (CVC) salvage for venous access preservation. Existing knowledge regarding the risk factors of HPN-related CLABSIs have been extrapolated from European and North American studies, and the effects of tropical climates and its potentially higher support requirements on the incidence of infection has not yet been studied. We sought to analyse the risk factors of developing HPN-related CLABSI, and assess CLABSI management, in a large Australian state with a highly dispersed population.</p><p><b><i>Methods:</i></b> A retrospective observational cohort study was conducted on 34 adult patients receiving HPN via a CVC at a Queensland tertiary referral centre, between 2016 and 2023. Patient charts were reviewed, and a univariate cox regression analysis model was used to identify predictors of CLABSI in the first CVC. Kaplan-Meier analysis was employed to build survival curves of time to CLABSI, and log-rank tests analysed survival between characteristics.</p><p><b><i>Results:</i></b> Nineteen patients had ≥1 CLABSI(s), accounting for a total of 39 episodes. Patients with ≥1 CLABSI(s) used regular opioids more than those who did not develop CLABSI (p=0.016). Fourteen patients (41%, n=14/34) developed a CLABSI in their first CVC. No patient or line characteristics, including tropical climate, were found to be predictive of CLABSI in their first CVC. The overall infection rate was 1.02 per 1000 catheter days. Most CLABSIs were caused by <i>Enterobacterales</i> (22%, n=12/55), followed by coagulase-negative <i>Staphylococcus</i> (18%, n=10/55). Administration of empiric antimicrobials within the standardised 3-hour sepsis timeframe was inadequate (50%, n=14/28), with only 25% (n=7/28) providing adequate cover of causative pathogens. The median time to effective antibiotic therapy was 22.7 hours (IQR 4.8-29.8). There were 3 CVC salvages (8%, n=3/39), all of which were successful.</p><p><i><b>Conclusion:</b></i> In this cohort of patients, regular opioid
{"title":"Nutrition","authors":"","doi":"10.1111/jgh.16706","DOIUrl":"https://doi.org/10.1111/jgh.16706","url":null,"abstract":"<p><b>20</b></p><p><b>Risk factors for central line-associated bloodstream infections in home parenteral nutrition patients: an observational cohort study</b></p><p>Paris Hoey<sup>1</sup>, Douglas Roche<sup>1</sup>, Paul Chapman<sup>2</sup>, Vishal Kaushik<sup>1</sup>, Stacey Llewellyn<sup>3</sup> and Niwansa Adris<sup>1</sup></p><p><sup>1</sup><i>Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia;</i> <sup>2</sup><i>Department of Infectious Disease, Royal Brisbane and Women's Hospital, Brisbane, Australia;</i> <sup>3</sup><i>QIMR Berghofer Medical Research Institute, Brisbane, Australia</i></p><p><b><i>Background and Aim:</i></b> A central line-associated bloodstream infection (CLABSI) is a common and potentially life-threatening complication for patients with intestinal failure (IF) receiving home parenteral nutrition (HPN). In uncomplicated infections, The European Society for Clinical Nutrition and Metabolism guidelines advocate for central venous access (CVC) salvage for venous access preservation. Existing knowledge regarding the risk factors of HPN-related CLABSIs have been extrapolated from European and North American studies, and the effects of tropical climates and its potentially higher support requirements on the incidence of infection has not yet been studied. We sought to analyse the risk factors of developing HPN-related CLABSI, and assess CLABSI management, in a large Australian state with a highly dispersed population.</p><p><b><i>Methods:</i></b> A retrospective observational cohort study was conducted on 34 adult patients receiving HPN via a CVC at a Queensland tertiary referral centre, between 2016 and 2023. Patient charts were reviewed, and a univariate cox regression analysis model was used to identify predictors of CLABSI in the first CVC. Kaplan-Meier analysis was employed to build survival curves of time to CLABSI, and log-rank tests analysed survival between characteristics.</p><p><b><i>Results:</i></b> Nineteen patients had ≥1 CLABSI(s), accounting for a total of 39 episodes. Patients with ≥1 CLABSI(s) used regular opioids more than those who did not develop CLABSI (p=0.016). Fourteen patients (41%, n=14/34) developed a CLABSI in their first CVC. No patient or line characteristics, including tropical climate, were found to be predictive of CLABSI in their first CVC. The overall infection rate was 1.02 per 1000 catheter days. Most CLABSIs were caused by <i>Enterobacterales</i> (22%, n=12/55), followed by coagulase-negative <i>Staphylococcus</i> (18%, n=10/55). Administration of empiric antimicrobials within the standardised 3-hour sepsis timeframe was inadequate (50%, n=14/28), with only 25% (n=7/28) providing adequate cover of causative pathogens. The median time to effective antibiotic therapy was 22.7 hours (IQR 4.8-29.8). There were 3 CVC salvages (8%, n=3/39), all of which were successful.</p><p><i><b>Conclusion:</b></i> In this cohort of patients, regular opioid ","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"309-320"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16706","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>65</b></p><p><b>Using patient satisfaction scores to compare performance of nurse practitioner against doctors in direct access endoscopy clinic</b></p><p>David Huynh, Aathavan Shanmuga Anandan, Ruth Ayers and Peter Hendy</p><p><i>Mater Hospital Brisbane, Brisbane, Australia</i></p><p><i><b>Background and Aim</b>:</i> Physician shortages contribute to the growing presence of nurse practitioners (NP), driven by the expectation that NP can reduce outpatient wait times, leading to better patient outcomes. While Direct Assessment Endoscopy (DAE) aims to streamline access for simple cases, it still requires doctor involvement for consent and assessment. An NP-led care model presents an alternative, but concerns exist anecdotally about patient acceptance. We seek to assess patient expectations and acceptance of a newly introduced NP-led DAE clinic at Mater Health Brisbane (MHB).</p><p><b><i>Methods:</i></b> Patients attending DAE clinics at the MHB were surveyed across two months. Patients completed two survey sections: a pre- and post-consultation questionnaire using a 5-point Likert scale. The pre-consultation questions were set to determine if the patients had pre-conceived biases such as “expecting to see a doctor”. Post-consultation questions assessed ‘communication’, ‘experience’, ‘professionalism’, and ‘understanding’ of endoscopic procedures. Patients were blinded to whether they would see an NP or doctor for their endoscopic consultation. Scores were collated to compare NP against doctors.</p><p><i><b>Results</b>:</i> 92 patients offered to participate in the survey with 71 (77%) patients completing questionnaires. 33 (46%) patients saw a doctor, and 38 saw an NP (54%). NP ratings were significantly higher than doctors regarding ‘professionalism and friendliness’ (see table 1). NP scores were numerically greater than doctors in ‘overall experience’, ‘understanding’, and ‘communication’. Of the total 71 patients, 61 had anticipated seeing a doctor. Of these 61 patients, 51% encountered an NP instead (n = 31). Of these 31 patients, 28 expressed no reservations about seeing either an NP or a doctor following the consultation. The average scores for doctors (Group A) regarding overall experience, professionalism, understanding, and communication were 4.0 (95% CI [3.5–4.5]), 4.2 (95% CI [3.8–4.7]), 4.5 (95% CI [4.3–4.7], and 4.5 (95% CI [4.3–4.7]), respectively. Conversely, patients with preconceived biases determined by all the patients wanting to see a doctor (Group B) reported average scores of 4.3 (95% CI [3.9–4.7]), 4.7 (95% CI [4.5–4.9]), 4.5 (95% CI [4.5–4.6]), and 4.5 (95% CI [4.4–4.8]) for the same attributes, respectively.</p><p><b><i>Conclusion:</i></b> Overall, NP results proved non-significantly higher in all metrics than doctors except ‘professionalism and friendliness’. We also showed that pre-existing biases did not significantly influence patients' overall experiences with NPs. This suggests that the integration of an NP into
{"title":"Sustainability","authors":"","doi":"10.1111/jgh.16709","DOIUrl":"https://doi.org/10.1111/jgh.16709","url":null,"abstract":"<p><b>65</b></p><p><b>Using patient satisfaction scores to compare performance of nurse practitioner against doctors in direct access endoscopy clinic</b></p><p>David Huynh, Aathavan Shanmuga Anandan, Ruth Ayers and Peter Hendy</p><p><i>Mater Hospital Brisbane, Brisbane, Australia</i></p><p><i><b>Background and Aim</b>:</i> Physician shortages contribute to the growing presence of nurse practitioners (NP), driven by the expectation that NP can reduce outpatient wait times, leading to better patient outcomes. While Direct Assessment Endoscopy (DAE) aims to streamline access for simple cases, it still requires doctor involvement for consent and assessment. An NP-led care model presents an alternative, but concerns exist anecdotally about patient acceptance. We seek to assess patient expectations and acceptance of a newly introduced NP-led DAE clinic at Mater Health Brisbane (MHB).</p><p><b><i>Methods:</i></b> Patients attending DAE clinics at the MHB were surveyed across two months. Patients completed two survey sections: a pre- and post-consultation questionnaire using a 5-point Likert scale. The pre-consultation questions were set to determine if the patients had pre-conceived biases such as “expecting to see a doctor”. Post-consultation questions assessed ‘communication’, ‘experience’, ‘professionalism’, and ‘understanding’ of endoscopic procedures. Patients were blinded to whether they would see an NP or doctor for their endoscopic consultation. Scores were collated to compare NP against doctors.</p><p><i><b>Results</b>:</i> 92 patients offered to participate in the survey with 71 (77%) patients completing questionnaires. 33 (46%) patients saw a doctor, and 38 saw an NP (54%). NP ratings were significantly higher than doctors regarding ‘professionalism and friendliness’ (see table 1). NP scores were numerically greater than doctors in ‘overall experience’, ‘understanding’, and ‘communication’. Of the total 71 patients, 61 had anticipated seeing a doctor. Of these 61 patients, 51% encountered an NP instead (n = 31). Of these 31 patients, 28 expressed no reservations about seeing either an NP or a doctor following the consultation. The average scores for doctors (Group A) regarding overall experience, professionalism, understanding, and communication were 4.0 (95% CI [3.5–4.5]), 4.2 (95% CI [3.8–4.7]), 4.5 (95% CI [4.3–4.7], and 4.5 (95% CI [4.3–4.7]), respectively. Conversely, patients with preconceived biases determined by all the patients wanting to see a doctor (Group B) reported average scores of 4.3 (95% CI [3.9–4.7]), 4.7 (95% CI [4.5–4.9]), 4.5 (95% CI [4.5–4.6]), and 4.5 (95% CI [4.4–4.8]) for the same attributes, respectively.</p><p><b><i>Conclusion:</i></b> Overall, NP results proved non-significantly higher in all metrics than doctors except ‘professionalism and friendliness’. We also showed that pre-existing biases did not significantly influence patients' overall experiences with NPs. This suggests that the integration of an NP into","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"373-374"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16709","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>7</b></p><p><b>Safety, efficacy and tolerability of an ultra-low volume bowel preparation (NER1006) – a real world experience</b></p><p><b>Anthony Sakiris</b>, Arvinf Rajandran, Jane Lynch, Myles Rivlin and Sneha John</p><p><i>Gold Coast University Hospital, Gold Coast, Australia</i></p><p><b><i>Background and Aim:</i></b> Endoscopic assessment with colonoscopy allows for the detection of polyps and adenomas which are precursors to colorectal adenocarcinoma. The quality of bowel preparation is of significant importance to the outcome of a colonoscopy as poor bowel preparation results in prolonged procedure times, the need for repeat procedures and missed lesions. A split-dose regimen of 3-4L Polyethylene Glycol (PEG) has historically been the recommended form of bowel preparation. NER1006 is a 1L split-dose PEG bowel preparation that is comparatively novel to Australia and has been adopted within our service since 2020. NER1006 provides enhanced osmotic activity from the high-dose ascorbate that is present in the second dose. Given its ultra-low volume, the aim of this study was to assess the safety, efficacy and tolerability of NER1006 in a real-world setting within our hospital network.</p><p><i><b>Methods:</b></i> This study was a retrospective analysis of prospectively collected data for colonoscopy procedures at two centres within our hospital health service. Patients who underwent a colonoscopy between July 2020 and February 2024 and received NER1006 as bowel preparation with a split-dose regime were analysed. The study population consisted of patients who returned a positive faecal occult blood test from the Australian National Bowel Cancer Screening Program (NBCSP) as well as symptomatic patients referred through our nurse-led Direct Access Colonoscopy clinic. The quality of the bowel preparation was quantified through the Boston Bowel Preparation Scale (BBPS). The Polyp Detection Rate (PDR), Adenoma Detection Rate (ADR), Sessile Serrated Lesion Detection Rate (SSLDR) and Advanced Adenoma Rate (AADR) were also calculated as quality indicators of colonoscopy. Adverse events related to NER1006 were classified as either minor or major. Major adverse events were defined as those requiring hospitalisation or those that prevented the patient from adequately completing their bowel preparation.</p><p><b><i>Results:</i></b> A total of 2920 colonoscopies were performed on 2874 patients. There were 1571 males, 1301 females and 2 indeterminate with a mean age of 57 years. 2827/2920 (97%) of the colonoscopies performed produced a BPPS score equal to or greater than 6 (good or excellent), with an average score of 7.90. Analysis revealed a 72% PDR, 55% ADR, 16% SSLDR and 25% AADR. There were 2 cases (0.07%) of major adverse events. One patient was unable to complete their bowel preparation due to vomiting and one patient presented with an acute kidney injury. There 98 cases (3.36%) of minor adverse events. Tachycardia (>100 bpm) was the most co
138 基于血液的新型细胞因子释放测定显示，即使在严格遵守无麸质饮食的人群中，也能对乳糜泻的诊断显示出较高的灵敏度和特异性Olivia Moscatelli1、Amy Russell1、Lee Henneken2、Linda Fothergill1、Hugh Reid3、Jamie Rossjohn3、Melinda Hardy1、Vanessa Bryant1 和 Jason Tye-Din11Walter and Eliza Hall Institute，澳大利亚墨尔本；2 澳大利亚墨尔本皇家医院；3 澳大利亚墨尔本莫纳什大学背景与目的：临床实践中的 T 细胞诊断仅限于结核病，但如果 T 细胞诊断更灵敏的话，最终可用于替代组织学诊断抗原驱动的免疫性疾病，如乳糜泻（CD）。目前对 CD 的诊断并不理想。对于已经采用无麸质饮食（GFD）的患者来说，为确诊而进行的长时间麸质挑战往往耐受性很差。检测麸质特异性 CD4+ T 细胞对 CD 诊断很有吸引力，但像 HLA-DQ-麸质四聚体这样的复杂技术并不实用。我们最近发现血清白细胞介素（IL）-2 对麸质的释放是麸质特异性 T 细胞的标记。我们的目的是评估采用 "管内麸质挑战 "的 IL-2 全血测定（WBA）的诊断性能，并将其与口服麸质和四聚体分析后的血清 IL-2 水平进行比较：对 79 名 CD 成人（71 名服用 GFD 且 CD 血清学阴性，8 名食用麸质；75 名 HLA-DQ2.5）和 92 名非 CD 成人（34 名服用 GFD 且自我报告为非乳糜泻性麸质敏感，NCGS，58 名健康对照组食用麸质；35 名 HLA-DQ2.5）进行了 IL-2 WBA 评估。新鲜血液与麸质肽培养 24 小时，然后评估 IL-2（MesoScale Discovery）。在单次10克麸质挑战后0小时和4小时评估血清IL-2水平，并评估治疗CD和NCGS队列中的四聚体频率：IL-2 WBA检测CD的准确性很高：灵敏度为85%（67/79），特异性为97%（89/92），AUC=0.93。当排除非典型HLA-DQ8基因型的CD患者时，灵敏度增加到88%（67/76）（AUC=0.95）。IL-2 WBA反应与麸质诱导的血清IL-2（n=50，r=0.65，p <0.0001）和每百万CD4+ T细胞中麸质四聚体+肠道归巢T细胞的频率（n=10，r=0.9，p <0.0001）相关。当四聚体频率低至每百万 CD4+ T 细胞 1 个时，IL-2 WBA 呈阳性。较高的基线 IL-2 WBA 与麸质挑战后的呕吐有关：结论：IL-2 WBA 的灵敏度极高，相当于在 4 毫升血瓶中检测到一个麸质特异性 T 细胞。它是一种简单的管式检测方法，需要 10 毫升全血，可预测麸质诱发症状的严重程度。它对 CD 的诊断准确率很高，其重要优点是可以检测出转谷氨酶-IgA 阴性的 GFD 患者的 CD。正在进行的改进旨在提高诊断灵敏度。IL-2 WBA 有可能彻底改变 CD 诊断，并克服目前 CD 血清学和组织学的局限性：中性粒细胞减少性肠炎（NEC）是一种严重的危及生命的疾病，其特征是肠壁炎症性坏死，多见于中性粒细胞减少的患者。NEC 中的肠壁炎症会发展为溃疡和坏死，如果不及时处理，可能会导致肠穿孔。目前还没有因使用硫酰胺和甲状腺风暴患者继发 NEC 的病例报告：一名三十多岁的年轻女性最近被诊断患有巴塞杜氏病，并服用了甲巯咪唑，最近从泰国返回后因发烧、腹痛和腹泻到医院就诊。她发热达 38.8°C，心动过速达 140 bpm，血压为 105/56 mmHg。她的检查结果为眼球突出、可触及巨大甲状腺肿和扁桃体肿大。她的绝对中性粒细胞计数为 0.00x 10^9/L（2.5-7x 10^9/L），游离 T4 为 63.5 pmol/L（10-20 pmol/L），游离 T3 为 28.9 pmol/L（2.8-6.8 pmol/L），促甲状腺激素为 0.00 mU/L（0.50-4.00 mU/L）。她的表现与因使用硫酰胺治疗巴塞杜氏病而继发的粒细胞减少以及细菌性扁桃体炎引起的甲状腺风暴一致。由于她无法使用其他抗甲状腺药物来治疗甲状腺风暴，因此治疗过程非常复杂。因此，她接受了静脉输液、广谱抗生素和粒细胞集落刺激因子（G-CSF）治疗细菌性扁桃体炎和中性败血症。在等待甲状腺切除术期间，她使用了鲁戈尔碘、糖皮质激素和普萘洛尔来控制甲状腺风暴。入院第10天，她出现剧烈腹痛并伴有便血。经检查，她患有腹膜炎。
{"title":"Luminal Clinical","authors":"","doi":"10.1111/jgh.16704","DOIUrl":"https://doi.org/10.1111/jgh.16704","url":null,"abstract":"<p><b>7</b></p><p><b>Safety, efficacy and tolerability of an ultra-low volume bowel preparation (NER1006) – a real world experience</b></p><p><b>Anthony Sakiris</b>, Arvinf Rajandran, Jane Lynch, Myles Rivlin and Sneha John</p><p><i>Gold Coast University Hospital, Gold Coast, Australia</i></p><p><b><i>Background and Aim:</i></b> Endoscopic assessment with colonoscopy allows for the detection of polyps and adenomas which are precursors to colorectal adenocarcinoma. The quality of bowel preparation is of significant importance to the outcome of a colonoscopy as poor bowel preparation results in prolonged procedure times, the need for repeat procedures and missed lesions. A split-dose regimen of 3-4L Polyethylene Glycol (PEG) has historically been the recommended form of bowel preparation. NER1006 is a 1L split-dose PEG bowel preparation that is comparatively novel to Australia and has been adopted within our service since 2020. NER1006 provides enhanced osmotic activity from the high-dose ascorbate that is present in the second dose. Given its ultra-low volume, the aim of this study was to assess the safety, efficacy and tolerability of NER1006 in a real-world setting within our hospital network.</p><p><i><b>Methods:</b></i> This study was a retrospective analysis of prospectively collected data for colonoscopy procedures at two centres within our hospital health service. Patients who underwent a colonoscopy between July 2020 and February 2024 and received NER1006 as bowel preparation with a split-dose regime were analysed. The study population consisted of patients who returned a positive faecal occult blood test from the Australian National Bowel Cancer Screening Program (NBCSP) as well as symptomatic patients referred through our nurse-led Direct Access Colonoscopy clinic. The quality of the bowel preparation was quantified through the Boston Bowel Preparation Scale (BBPS). The Polyp Detection Rate (PDR), Adenoma Detection Rate (ADR), Sessile Serrated Lesion Detection Rate (SSLDR) and Advanced Adenoma Rate (AADR) were also calculated as quality indicators of colonoscopy. Adverse events related to NER1006 were classified as either minor or major. Major adverse events were defined as those requiring hospitalisation or those that prevented the patient from adequately completing their bowel preparation.</p><p><b><i>Results:</i></b> A total of 2920 colonoscopies were performed on 2874 patients. There were 1571 males, 1301 females and 2 indeterminate with a mean age of 57 years. 2827/2920 (97%) of the colonoscopies performed produced a BPPS score equal to or greater than 6 (good or excellent), with an average score of 7.90. Analysis revealed a 72% PDR, 55% ADR, 16% SSLDR and 25% AADR. There were 2 cases (0.07%) of major adverse events. One patient was unable to complete their bowel preparation due to vomiting and one patient presented with an acute kidney injury. There 98 cases (3.36%) of minor adverse events. Tachycardia (>100 bpm) was the most co","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"266-305"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16704","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>8</b></p><p><b>A rare lesion of the oesophagus: oesophageal submucosal gland duct adenoma</b></p><p><b>Gary Zhang</b><sup>1,2</sup>, Spiro Raftopoulos<sup>1,2,3</sup> and Priyanthi Kumarasinghe<sup>1,2,3</sup></p><p><sup>1</sup><i>Sir Charles Gairdner Osborne Park Health Care Group, Perth, Australia;</i> <sup>2</sup><i>The University of Western Australia, Perth, Australia;</i> <sup>3</sup><i>Curtin University, Bentley, Australia</i></p><p><b><i>Introduction:</i></b> Oesophageal submucosal gland duct adenomas (ESGDA) are a rare oesophageal lesion usually diagnosed in males 50-80 years of age presenting with abdominal pain or incidentally. Less than 20 cases of ESGDA have been reported in the literature, with two cases reporting incidental accompanying oesophageal squamous cell carcinoma and gastric adenocarcinoma, respectively.</p><p><b><i>Case report:</i></b> A 68-year-old Caucasian man without other significant medical history presented with mild reflux symptoms. There were no associated alarm symptoms. He was a non-smoker and consumed up to 2 standard drinks of alcohol a day. Initial upper gastrointestinal endoscopy demonstrated a 10mm subepithelial lesion (SEL) at the gastroesophageal junction with normal overlying squamous mucosa and no evidence of reflux changes (figure 1). Pinch biopsies were acquired and reported as an inflammatory polyp with no evidence of dysplasia. The patient was referred for consideration of endoscopic removal following 8 weeks of high dose twice daily proton pump inhibitor therapy. On subsequent endoscopy, the SEL remained despite high dose PPI and therefore a decision was made for endoscopic removal via local excision using a band and ligation technique (figure 1A-C). The lesion was completely resected, retrieved, pinned and sent for pathological assessment. Histopathological assessment of the SEL demonstrated a predominantly submucosal lesion featuring localised hyperplastic and proliferated oesophageal glands and ducts without malignancy (figure 1D). With histochemical stains, the glandular epithelial cells showed diffuse cytoplasmic positivity with epithelial membrane antigen and CK7. Some basal cells showed a positive reaction with p63 and p40. There was no aberrant p53 over-expression or heightened ki-67 proliferation index. The lesion was consistent with an ESGDA. Endoscopic appearances at follow-up demonstrated a smooth, contracted scar (figure 1E).</p><p><b>17</b></p><p><b>Colonoscopy in octogenarians and older patients with 1L polyethylene glycol plus ascorbic acid bowel preparation in the real-world setting</b></p><p>Elena Perez-Arellano<sup>1</sup>, Salvador Machlab<sup>2</sup>, Miguel A Pantaleón<sup>3</sup>, Ricardo Gorjão<sup>4</sup>, Cátia Arieira<sup>5</sup>, Jose Cotter<sup>5</sup>, Vicente Lorenzo-Zúñiga<sup>6</sup>, Sarbelio Rodriguez Muñoz<sup>7</sup>, David Carral-Martínez<sup>8</sup>, Carmen Turbi<sup>9</sup>, Fatma Akriche<sup>10</sup>, José M Esteban<sup>11</sup> and <b>Katherine Davies
{"title":"Routine GI Endoscopy","authors":"","doi":"10.1111/jgh.16708","DOIUrl":"https://doi.org/10.1111/jgh.16708","url":null,"abstract":"<p><b>8</b></p><p><b>A rare lesion of the oesophagus: oesophageal submucosal gland duct adenoma</b></p><p><b>Gary Zhang</b><sup>1,2</sup>, Spiro Raftopoulos<sup>1,2,3</sup> and Priyanthi Kumarasinghe<sup>1,2,3</sup></p><p><sup>1</sup><i>Sir Charles Gairdner Osborne Park Health Care Group, Perth, Australia;</i> <sup>2</sup><i>The University of Western Australia, Perth, Australia;</i> <sup>3</sup><i>Curtin University, Bentley, Australia</i></p><p><b><i>Introduction:</i></b> Oesophageal submucosal gland duct adenomas (ESGDA) are a rare oesophageal lesion usually diagnosed in males 50-80 years of age presenting with abdominal pain or incidentally. Less than 20 cases of ESGDA have been reported in the literature, with two cases reporting incidental accompanying oesophageal squamous cell carcinoma and gastric adenocarcinoma, respectively.</p><p><b><i>Case report:</i></b> A 68-year-old Caucasian man without other significant medical history presented with mild reflux symptoms. There were no associated alarm symptoms. He was a non-smoker and consumed up to 2 standard drinks of alcohol a day. Initial upper gastrointestinal endoscopy demonstrated a 10mm subepithelial lesion (SEL) at the gastroesophageal junction with normal overlying squamous mucosa and no evidence of reflux changes (figure 1). Pinch biopsies were acquired and reported as an inflammatory polyp with no evidence of dysplasia. The patient was referred for consideration of endoscopic removal following 8 weeks of high dose twice daily proton pump inhibitor therapy. On subsequent endoscopy, the SEL remained despite high dose PPI and therefore a decision was made for endoscopic removal via local excision using a band and ligation technique (figure 1A-C). The lesion was completely resected, retrieved, pinned and sent for pathological assessment. Histopathological assessment of the SEL demonstrated a predominantly submucosal lesion featuring localised hyperplastic and proliferated oesophageal glands and ducts without malignancy (figure 1D). With histochemical stains, the glandular epithelial cells showed diffuse cytoplasmic positivity with epithelial membrane antigen and CK7. Some basal cells showed a positive reaction with p63 and p40. There was no aberrant p53 over-expression or heightened ki-67 proliferation index. The lesion was consistent with an ESGDA. Endoscopic appearances at follow-up demonstrated a smooth, contracted scar (figure 1E).</p><p><b>17</b></p><p><b>Colonoscopy in octogenarians and older patients with 1L polyethylene glycol plus ascorbic acid bowel preparation in the real-world setting</b></p><p>Elena Perez-Arellano<sup>1</sup>, Salvador Machlab<sup>2</sup>, Miguel A Pantaleón<sup>3</sup>, Ricardo Gorjão<sup>4</sup>, Cátia Arieira<sup>5</sup>, Jose Cotter<sup>5</sup>, Vicente Lorenzo-Zúñiga<sup>6</sup>, Sarbelio Rodriguez Muñoz<sup>7</sup>, David Carral-Martínez<sup>8</sup>, Carmen Turbi<sup>9</sup>, Fatma Akriche<sup>10</sup>, José M Esteban<sup>11</sup> and <b>Katherine Davies","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"331-372"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16708","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>6</b></p><p><b>Comparing real-world utilisation of dietary and medical therapies in paediatric and adult inflammatory bowel disease patients using CCCare: A cross-sectional study</b></p><p><b>Joseph Pipicella</b><sup>1,2,3</sup>, Wai Kin Su<sup>1,3,4</sup>, William Wilson<sup>5,6</sup>, Jane Andrews<sup>1,7,8</sup> and Susan J Connor<sup>1,2,3,4</sup></p><p><sup>1</sup><i>Crohn's Colitis Cure, Sydney, Australia;</i> <sup>2</sup><i>South West Sydney Clinical Campus, University of New South Wales, Sydney, Australia;</i> <sup>3</sup><i>Ingham Institute for Applied Medical Research, Sydney, Australia;</i> <sup>4</sup><i>Department of Gastroenterology, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia;</i> <sup>5</sup><i>SA Health, Adelaide, Australia;</i> <sup>6</sup><i>Lyell McEwin Hospital, Adelaide, Australia;</i> <sup>7</sup><i>Central Adelaide Local Health Network, Adelaide, Australia;</i> <sup>8</sup><i>Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia</i></p><p><b><i>Background and Aim:</i></b> Approximately 10% of people with inflammatory bowel diseases (IBD) are diagnosed in childhood. Crohn’s Colitis Care (CCCare) is an IBD-specific electronic medical record (EMR) used across Australia and New Zealand, with a recent upgrade to incorporate paediatric functionality. Using CCCare, we explored the real-world use of dietary and medical therapies across the age spectrum in people with IBD under routine ambulatory care in ANZ.</p><p><b><i>Methods:</i></b> De-identified data from CCCare’s linked clinical quality registry were analysed in April 2024. All people with IBD under active care (clinical encounter within the prior 14 months) were included. Children were defined as being <18 years of age at time of extraction.</p><p><b><i>Results:</i></b> A total of 6,396 people with IBD were included. In the <18 years age group (n=172), 59.1% (n=101) were male with a median age of 15 years (IQR 12.8-16). The majority (93%, n=93) resided in Australia, and most had Crohn’s disease (66.5%, n=113), with 16.8% of them having ever had a perianal fistula. In the ≥18 years age group (n=6,224), 49.1% (n=3,055) were male with a median age of 42 years (IQR 32-57). The majority (76.5%, n=4,761) resided in Australia, and over half had Crohn’s disease (55.7%, n=113), with 15.9% having ever had a perianal fistula.Interestingly, 5-aminosalicylate use was more prevalent in adults than children (34% vs 27% respectively, P<0.05), whereas current immunomodulator use was less common in adults compared to children (29% vs 60% respectively, P<0.001). Current steroid use was ≤4% in both cohorts (P=0.26). Advanced therapy use by age group is shown below. Anti-TNF therapies (infliximab and adalimumab) were the predominant therapies in the paediatric cohort. Across the cohort, infliximab use decreased with age, whereas vedolizumab use increased with age. Dietary therapies were infrequently us
1），亚组分析显示，采用前瞻性方法的研究PPV更高（P=0.001）。敏感性分析表明，采用包含阳性 HLA 的 ESPGHAN 标准的研究与不含 HLA 的标准相比，PPV 更高（PPV 98.5 vs 96.7，P=0.014）。55儿童胶原性胃炎：对口服布地奈德的反应Jay Sharma、Ryan Joseph Anson 和 Ajay Sharma澳大利亚珀斯西澳大利亚大学背景和目的：胶原性胃炎（CG）是一种罕见的儿童疾病，其特征是胃固有层胶原带上皮下沉积和炎症浸润，迄今为止尚未发现有效的治疗方法。我们旨在描述 3 名患者口服布地奈德 3 个月疗程的结果，这将有助于改进这种罕见疾病的治疗方案：结果：病例 1：一名 15 岁的女性患者出现严重贫血，血红蛋白为 71 克/升（正常值为 125-175 克/升），铁蛋白为 5 微克/升（正常值为 20-200 微克/升）。食管胃十二指肠镜检查在组织学中发现了 CG。她开始服用布地奈德口服液 9 毫克、6 毫克和 3 毫克，疗程为 3 个月，复查血红蛋白和铁蛋白水平仍在正常范围。病例 3：一名 15 岁患者因疲劳（血红蛋白 57 g/dl）就诊，服用 PPI 和口服铁剂无效。病例 3：一名 15 岁的患者因疲劳（血红蛋白为 57 g/dl）而来就诊，服用 PPI 和口服铁剂均未见效：本系列病例表明，如果口服铁剂和 PPI 试验失败，可以考虑试用布地奈德 3 个月的断药疗程，这对 CG 患者来说可能是一种有效的治疗方案，但目前还不清楚这种治疗方案是否可被视为一种安全的长期方案。要了解病理生理学和治疗目标，还需要进一步的研究。分析儿科高分辨率结肠测压数据的自动化方法：使用贝叶斯功能混合效应模型分析赫氏胃肠病患儿进餐反应的特征Hannah Evans-Barns1,2,3、Lukasz Wiklendt6、John Hutson2,3,4、Warwick Teague1,2,3、Mark Safe5、Sebastian King1,2,3和Phil Dinning61澳大利亚墨尔本皇家儿童医院小儿外科；2澳大利亚墨尔本默多克儿童研究所外科研究小组；3 澳大利亚墨尔本墨尔本大学儿科系；4 澳大利亚墨尔本皇家儿童医院泌尿科；5 澳大利亚墨尔本皇家儿童医院胃肠病学和临床营养学系；6 澳大利亚贝德福德公园弗林德斯医疗中心胃肠病学系背景和目的：赫氏普隆病（Hirschsprung disease，HD）患儿普遍存在术后肠道功能障碍。本研究的目的是利用贝叶斯功能混合效应模型，通过高分辨率测压（HRCM）记录结肠进餐反应的特征，并将结果与健康对照组进行比较：方法： 将一根 HRCM 导管插入结肠，传感器横跨盲肠和直肠。在进行一小时的基线记录后，再进行一小时的进餐挑战和记录。对照组由 13 名健康成人组成。交叉小波分析用于计算所有传播压力波 (PPW) 的频率和方向。使用潜在高斯过程模型比较了患者和对照组内部以及患者和对照组之间进餐对 PPW 的影响。研究获得了伦理批准（HREC 64192）：13 名儿童（12 名男性；6.83±2.56 岁；9/13 名短段）进餐。在近端结肠中，虽然进餐会在不同频率（1/16 至 8 周/分 [cpm]）范围内引起前向和逆向 PPW 的显著增加，但在 HD 中这种效应显著降低（图）。在对照组的远端结肠中，膳食导致 1/16 - 8 cpm 之间的所有 PPW 都显著增加。而在 HD 患者中，餐点不会增加 2-10 cpm 的 PPW。Crossed wires: aligning clinical practice with family experiences in paediatric temporary tube feedingClaire Reilly1,2, Jeanne Marshall1,2, Rebecca Packer1, Jasmine Foley1 and Nikhil Thapar1,2,31The University Of Queensland, Brisbane, Australia; 2Children's Health Queensland, Brisbane, Australia; 3Queensland University of Technology, Brisbane, Australia背景和目的：临时插管喂养对于需要短期营养支持的儿童至关重要，但对其对家庭的影响研究不足。
{"title":"Paediatrics","authors":"","doi":"10.1111/jgh.16707","DOIUrl":"https://doi.org/10.1111/jgh.16707","url":null,"abstract":"<p><b>6</b></p><p><b>Comparing real-world utilisation of dietary and medical therapies in paediatric and adult inflammatory bowel disease patients using CCCare: A cross-sectional study</b></p><p><b>Joseph Pipicella</b><sup>1,2,3</sup>, Wai Kin Su<sup>1,3,4</sup>, William Wilson<sup>5,6</sup>, Jane Andrews<sup>1,7,8</sup> and Susan J Connor<sup>1,2,3,4</sup></p><p><sup>1</sup><i>Crohn's Colitis Cure, Sydney, Australia;</i> <sup>2</sup><i>South West Sydney Clinical Campus, University of New South Wales, Sydney, Australia;</i> <sup>3</sup><i>Ingham Institute for Applied Medical Research, Sydney, Australia;</i> <sup>4</sup><i>Department of Gastroenterology, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia;</i> <sup>5</sup><i>SA Health, Adelaide, Australia;</i> <sup>6</sup><i>Lyell McEwin Hospital, Adelaide, Australia;</i> <sup>7</sup><i>Central Adelaide Local Health Network, Adelaide, Australia;</i> <sup>8</sup><i>Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia</i></p><p><b><i>Background and Aim:</i></b> Approximately 10% of people with inflammatory bowel diseases (IBD) are diagnosed in childhood. Crohn’s Colitis Care (CCCare) is an IBD-specific electronic medical record (EMR) used across Australia and New Zealand, with a recent upgrade to incorporate paediatric functionality. Using CCCare, we explored the real-world use of dietary and medical therapies across the age spectrum in people with IBD under routine ambulatory care in ANZ.</p><p><b><i>Methods:</i></b> De-identified data from CCCare’s linked clinical quality registry were analysed in April 2024. All people with IBD under active care (clinical encounter within the prior 14 months) were included. Children were defined as being <18 years of age at time of extraction.</p><p><b><i>Results:</i></b> A total of 6,396 people with IBD were included. In the <18 years age group (n=172), 59.1% (n=101) were male with a median age of 15 years (IQR 12.8-16). The majority (93%, n=93) resided in Australia, and most had Crohn’s disease (66.5%, n=113), with 16.8% of them having ever had a perianal fistula. In the ≥18 years age group (n=6,224), 49.1% (n=3,055) were male with a median age of 42 years (IQR 32-57). The majority (76.5%, n=4,761) resided in Australia, and over half had Crohn’s disease (55.7%, n=113), with 15.9% having ever had a perianal fistula.Interestingly, 5-aminosalicylate use was more prevalent in adults than children (34% vs 27% respectively, P<0.05), whereas current immunomodulator use was less common in adults compared to children (29% vs 60% respectively, P<0.001). Current steroid use was ≤4% in both cohorts (P=0.26). Advanced therapy use by age group is shown below. Anti-TNF therapies (infliximab and adalimumab) were the predominant therapies in the paediatric cohort. Across the cohort, infliximab use decreased with age, whereas vedolizumab use increased with age. Dietary therapies were infrequently us","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"321-330"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haoxin Xu, Zhu He, Yulin Liu, Hong Xu, Pengfei Liu
Background and AimColonoscopy plays a crucial role in the early diagnosis and treatment of colorectal cancer. Adequate bowel preparation is essential for clear visualization of the colonic mucosa and lesion detection. However, inadequate bowel preparation is common in patients with constipation, and there is no standardized preparation protocol for these patients. This study aimed to explore the effectiveness and tolerability of a pre‐colonoscopy combination regimen of linaclotide and polyethylene glycol (PEG).MethodsIn this prospective, single‐center, randomized controlled trial, 322 participants were divided into two groups: a 3‐L PEG + 870‐μg linaclotide group (administered as a single dose for 3 days) and a 4‐L PEG group. The primary endpoints were the Boston Bowel Preparation Scale (BBPS) score and the rate of adequate and excellent bowel preparation. Secondary endpoints were the rates of detection of colonic adenomas and polyps, cecal intubation rates, colonoscopy time, adverse reactions, patient satisfaction, and physician satisfaction.ResultsThe study included 319 patients. The 3‐L PEG + linaclotide group showed significantly higher rates of adequate and excellent bowel preparation than the 4‐L PEG group (89.4% vs 73.6% and 37.5% vs 25.3%, respectively; P < 0.05). The mean BBPS score for the right colon in the 3‐L PEG + linaclotide group was significantly higher than that in the 4‐L PEG group. There were no significant between‐group differences regarding the detection rates of colonic polyps and adenomas (44.4% vs 37.7% and 23.1% vs 20.1%, respectively; P > 0.05). There were no significant between‐group differences regarding cecal intubation rates, colonoscopy operation, and withdrawal times. However, patient tolerance and sleep quality were better in the 3‐L PEG + linaclotide group.ConclusionThe combination of 3‐L PEG and 870‐μg linaclotide, because of its lower volume of intake, can be considered as an alternative bowel preparation regimen for constipated patients undergoing colonoscopy, especially for the elderly.
{"title":"Application of linaclotide in bowel preparation for colonoscopy in patients with constipation: A prospective randomized controlled study","authors":"Haoxin Xu, Zhu He, Yulin Liu, Hong Xu, Pengfei Liu","doi":"10.1111/jgh.16734","DOIUrl":"https://doi.org/10.1111/jgh.16734","url":null,"abstract":"Background and AimColonoscopy plays a crucial role in the early diagnosis and treatment of colorectal cancer. Adequate bowel preparation is essential for clear visualization of the colonic mucosa and lesion detection. However, inadequate bowel preparation is common in patients with constipation, and there is no standardized preparation protocol for these patients. This study aimed to explore the effectiveness and tolerability of a pre‐colonoscopy combination regimen of linaclotide and polyethylene glycol (PEG).MethodsIn this prospective, single‐center, randomized controlled trial, 322 participants were divided into two groups: a 3‐L PEG + 870‐μg linaclotide group (administered as a single dose for 3 days) and a 4‐L PEG group. The primary endpoints were the Boston Bowel Preparation Scale (BBPS) score and the rate of adequate and excellent bowel preparation. Secondary endpoints were the rates of detection of colonic adenomas and polyps, cecal intubation rates, colonoscopy time, adverse reactions, patient satisfaction, and physician satisfaction.ResultsThe study included 319 patients. The 3‐L PEG + linaclotide group showed significantly higher rates of adequate and excellent bowel preparation than the 4‐L PEG group (89.4% <jats:italic>vs</jats:italic> 73.6% and 37.5% <jats:italic>vs</jats:italic> 25.3%, respectively; <jats:italic>P</jats:italic> < 0.05). The mean BBPS score for the right colon in the 3‐L PEG + linaclotide group was significantly higher than that in the 4‐L PEG group. There were no significant between‐group differences regarding the detection rates of colonic polyps and adenomas (44.4% <jats:italic>vs</jats:italic> 37.7% and 23.1% <jats:italic>vs</jats:italic> 20.1%, respectively; <jats:italic>P</jats:italic> > 0.05). There were no significant between‐group differences regarding cecal intubation rates, colonoscopy operation, and withdrawal times. However, patient tolerance and sleep quality were better in the 3‐L PEG + linaclotide group.ConclusionThe combination of 3‐L PEG and 870‐μg linaclotide, because of its lower volume of intake, can be considered as an alternative bowel preparation regimen for constipated patients undergoing colonoscopy, especially for the elderly.","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"56 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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