Pub Date : 2024-09-09DOI: 10.1136/flgastro-2024-102804
Simon M Everett, Wafaa Ahmed, Christina Dobson, Emily Haworth, Mark Jarvis, Bettina Kluettgens, Beverly C Oates, Kofi W Oppong, Colin Rees, Lindsey Scarisbrick, Linda Sharp, Sharan Wadhwani, Ian D Penman
In 2014, the British Society of Gastroenterology (BSG) published a standards framework outlining key performance indicators for ERCP practitioners and services. In the last 10 years there have been numerous changes to clinical practice yet there remains considerable variation in service delivery in the UK. In 2021 the BSG commissioned an ERCP endoscopy quality improvement project (EQIP) comprising members from all relevant stakeholding groups. This document draws from the results of a national survey of ERCP practitioners and units performed in 2022/23 supported by detailed stakeholder interviews. These results informed a draft document and series of statements that were revised at 2 group meetings and through several iterations. Each statement was included only after achieving 100% consensus from all participants. This service specification has set out 70 consensus statements covering the patient journey from booking to discharge and follow up, the members of the ERCP team, requirements for continued professional development and clinical governance, equipment and facilities and network provision and MDT working. This document describes the key components of a high quality and safe ERCP Service, seen from the patient’s perspective. It provides a detailed template for service delivery that should now be implemented by ERCP practitioners and units through the UK and should be used by ERCP providers and commissioners to benchmark services and guide continuous quality improvement.
{"title":"British Society of Gastroenterology Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Improvement Programme: minimum service standards and good practice statements","authors":"Simon M Everett, Wafaa Ahmed, Christina Dobson, Emily Haworth, Mark Jarvis, Bettina Kluettgens, Beverly C Oates, Kofi W Oppong, Colin Rees, Lindsey Scarisbrick, Linda Sharp, Sharan Wadhwani, Ian D Penman","doi":"10.1136/flgastro-2024-102804","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102804","url":null,"abstract":"In 2014, the British Society of Gastroenterology (BSG) published a standards framework outlining key performance indicators for ERCP practitioners and services. In the last 10 years there have been numerous changes to clinical practice yet there remains considerable variation in service delivery in the UK. In 2021 the BSG commissioned an ERCP endoscopy quality improvement project (EQIP) comprising members from all relevant stakeholding groups. This document draws from the results of a national survey of ERCP practitioners and units performed in 2022/23 supported by detailed stakeholder interviews. These results informed a draft document and series of statements that were revised at 2 group meetings and through several iterations. Each statement was included only after achieving 100% consensus from all participants. This service specification has set out 70 consensus statements covering the patient journey from booking to discharge and follow up, the members of the ERCP team, requirements for continued professional development and clinical governance, equipment and facilities and network provision and MDT working. This document describes the key components of a high quality and safe ERCP Service, seen from the patient’s perspective. It provides a detailed template for service delivery that should now be implemented by ERCP practitioners and units through the UK and should be used by ERCP providers and commissioners to benchmark services and guide continuous quality improvement.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1136/flgastro-2024-102781
Jennifer Amy Scott, Christopher Mysko, Huw Purssell, Varinder S Athwal
Liver blood test (LBT) abnormalities are common in people with inflammatory bowel disease (IBD). The majority are self-limiting, with only 5% having clinically significant liver disease. Liver conditions most frequently associated with IBD include primary sclerosing cholangitis, metabolic dysfunction-associated steatotic liver disease and drug-induced liver injury (DILI). A combination of clinical assessment, blood tests and imaging can be used to help establish the causality and severity of abnormal LBTs in people with IBD. The use of immunomodulatory therapies for IBD has increased the incidence of abnormal LBTs. Most cases are self-limiting and clinically significant injury is rare, particularly with the newer therapeutic agents. Azathioprine and antitumour necrosis factor-α therapies have the greatest risk of liver injury. A clear timeline of drug initiation or dose escalation is essential when interpreting abnormal LBTs to identify DILI. Signs of serious liver dysfunction should prompt immediate cessation of the drug. Otherwise, a patient-centred approach is required when deciding on drug alteration, including the assessment of therapeutic efficacy and the availability of alternative treatment options.
{"title":"Investigation of abnormal liver blood tests in patients with inflammatory bowel disease","authors":"Jennifer Amy Scott, Christopher Mysko, Huw Purssell, Varinder S Athwal","doi":"10.1136/flgastro-2024-102781","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102781","url":null,"abstract":"Liver blood test (LBT) abnormalities are common in people with inflammatory bowel disease (IBD). The majority are self-limiting, with only 5% having clinically significant liver disease. Liver conditions most frequently associated with IBD include primary sclerosing cholangitis, metabolic dysfunction-associated steatotic liver disease and drug-induced liver injury (DILI). A combination of clinical assessment, blood tests and imaging can be used to help establish the causality and severity of abnormal LBTs in people with IBD. The use of immunomodulatory therapies for IBD has increased the incidence of abnormal LBTs. Most cases are self-limiting and clinically significant injury is rare, particularly with the newer therapeutic agents. Azathioprine and antitumour necrosis factor-α therapies have the greatest risk of liver injury. A clear timeline of drug initiation or dose escalation is essential when interpreting abnormal LBTs to identify DILI. Signs of serious liver dysfunction should prompt immediate cessation of the drug. Otherwise, a patient-centred approach is required when deciding on drug alteration, including the assessment of therapeutic efficacy and the availability of alternative treatment options.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1136/flgastro-2024-102815
Gemma Wells, Oliver D Tavabie, Stuart McPherson, Mohsan Subhani
Liver disease is now the second highest cause of years of working life lost in Europe, only surpassed by ischaemic heart disease.1 The April #FGDebate based on the recent paper entitled ‘Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study’2 aimed to facilitate discussion around this topic. It highlighted a number of important themes; possible strategies to reduce disparities in care across the UK, challenges in hepatology training and supporting care delivery for patients with decompensated cirrhosis. In this article, we will expand on some of the key themes and discussions from this debate. ### Defining the issue Regional disparities in the provision of hepatology services and outcomes have been well-described historically3 as well as in multiple recent audits.2 4–6 Undoubtedly, this is partially explained by regional variation in social deprivation as well as public health policy including minimum unit pricing.7 However, access to specialist care and intervention has been repeatedly identified as a potential risk factor for adverse outcome. In the primary biliary cholangitis (PBC) study, patients in specialist centres were significantly more likely to be managed with appropriate second-line therapies and be referred for transplant assessment than those in non-specialist centres.6 Patients with metabolic-dysfunction-associated steatotic liver disease (MASLD) were more likely to have fibrosis assessment and comprehensive cardiometabolic assessment and management if they were managed in a centre with a multidisciplinary MASLD service.5 In patients presenting with decompensated cirrhosis, significant variations in mortality were seen between non-specialist centres which were not present in specialist centres.2 Additionally, lower consultant numbers corresponded to higher inpatient mortality in non-specialist centres, which was more likely to be the case in areas of higher social deprivation.2 There is also evidence from the USA and UK that …
{"title":"#FGDebate: addressing regional variations in care and outcomes for patients with liver disease","authors":"Gemma Wells, Oliver D Tavabie, Stuart McPherson, Mohsan Subhani","doi":"10.1136/flgastro-2024-102815","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102815","url":null,"abstract":"Liver disease is now the second highest cause of years of working life lost in Europe, only surpassed by ischaemic heart disease.1 The April #FGDebate based on the recent paper entitled ‘Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study’2 aimed to facilitate discussion around this topic. It highlighted a number of important themes; possible strategies to reduce disparities in care across the UK, challenges in hepatology training and supporting care delivery for patients with decompensated cirrhosis. In this article, we will expand on some of the key themes and discussions from this debate. ### Defining the issue Regional disparities in the provision of hepatology services and outcomes have been well-described historically3 as well as in multiple recent audits.2 4–6 Undoubtedly, this is partially explained by regional variation in social deprivation as well as public health policy including minimum unit pricing.7 However, access to specialist care and intervention has been repeatedly identified as a potential risk factor for adverse outcome. In the primary biliary cholangitis (PBC) study, patients in specialist centres were significantly more likely to be managed with appropriate second-line therapies and be referred for transplant assessment than those in non-specialist centres.6 Patients with metabolic-dysfunction-associated steatotic liver disease (MASLD) were more likely to have fibrosis assessment and comprehensive cardiometabolic assessment and management if they were managed in a centre with a multidisciplinary MASLD service.5 In patients presenting with decompensated cirrhosis, significant variations in mortality were seen between non-specialist centres which were not present in specialist centres.2 Additionally, lower consultant numbers corresponded to higher inpatient mortality in non-specialist centres, which was more likely to be the case in areas of higher social deprivation.2 There is also evidence from the USA and UK that …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1136/flgastro-2024-102809
Benjamin Zare, Beatriz Gros, Natasha Lal, Patrick Dawson, Esha Sharma, Robin J Dart, Samuel Lim, Shuvra Ray, Simon H C Anderson, Joel Mawdsley, Peter M Irving, Charlie W Lees, Mark A Samaan
Objective Since approval in Crohn’s disease (CD) of risankizumab, there has been widespread use. Real-world data are, however, limited and our aim is to address that gap. Design/method We performed a retrospective, observational study of risankizumab use in patients with CD starting treatment between January 2021 and January 2023 at two UK centres. Clinical activity, biochemical and faecal biomarkers were measured at baseline, weeks 4, 12, 28 and 52. The primary outcome was clinical response at weeks 12, 28 and 52. Results 53 patients (51% women); median (range) age 40 years (20–70); median disease duration 15 years (6–52). Clinical response was observed in 33% (n=14/42), 45% (n=17/38) and 52% (n=13/25), and clinical remission in 31% (n=13/42), 40% (n=15/38) and 44% (n=11/25) at weeks 12, 28 and 52, respectively. Median C reactive protein decreased from 12 mg/L (IQR: 4–30; n=50) at baseline to 6 mg/L (IQR: 2–16; p=0.03 vs baseline; n=49) at week 12, 3 mg/L (IQR: 2–8, p=0.003; n=44) at week 28 and 3 mg/L (IQR 1–4, p=0.007; n=31) at week 52. Median faecal calprotectin concentration was 668 µg/g (IQR: 246–1098; n=32) at baseline, 298 µg/g (IQR: 176–546, p=NS; n=21) at week 12, 358 µg/g (IQR: 133–622, p=0.03; n=14) at week 28 and 63 µg/g (IQR: 38–120, p=0.007; n=12) at week 52. 12 out of 18 patients discontinued corticosteroids at week 12, 16 by week 28 and 18 by week 52. Four major adverse events—three elective and one emergency surgery—were recorded. Conclusion Risankizumab is effective in a refractory real-world population with CD. Data are available on reasonable request.
{"title":"Effectiveness of risankizumab induction and maintenance therapy for refractory Crohn’s disease: a real-world experience from a preapproval access programme and early access to medicines scheme","authors":"Benjamin Zare, Beatriz Gros, Natasha Lal, Patrick Dawson, Esha Sharma, Robin J Dart, Samuel Lim, Shuvra Ray, Simon H C Anderson, Joel Mawdsley, Peter M Irving, Charlie W Lees, Mark A Samaan","doi":"10.1136/flgastro-2024-102809","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102809","url":null,"abstract":"Objective Since approval in Crohn’s disease (CD) of risankizumab, there has been widespread use. Real-world data are, however, limited and our aim is to address that gap. Design/method We performed a retrospective, observational study of risankizumab use in patients with CD starting treatment between January 2021 and January 2023 at two UK centres. Clinical activity, biochemical and faecal biomarkers were measured at baseline, weeks 4, 12, 28 and 52. The primary outcome was clinical response at weeks 12, 28 and 52. Results 53 patients (51% women); median (range) age 40 years (20–70); median disease duration 15 years (6–52). Clinical response was observed in 33% (n=14/42), 45% (n=17/38) and 52% (n=13/25), and clinical remission in 31% (n=13/42), 40% (n=15/38) and 44% (n=11/25) at weeks 12, 28 and 52, respectively. Median C reactive protein decreased from 12 mg/L (IQR: 4–30; n=50) at baseline to 6 mg/L (IQR: 2–16; p=0.03 vs baseline; n=49) at week 12, 3 mg/L (IQR: 2–8, p=0.003; n=44) at week 28 and 3 mg/L (IQR 1–4, p=0.007; n=31) at week 52. Median faecal calprotectin concentration was 668 µg/g (IQR: 246–1098; n=32) at baseline, 298 µg/g (IQR: 176–546, p=NS; n=21) at week 12, 358 µg/g (IQR: 133–622, p=0.03; n=14) at week 28 and 63 µg/g (IQR: 38–120, p=0.007; n=12) at week 52. 12 out of 18 patients discontinued corticosteroids at week 12, 16 by week 28 and 18 by week 52. Four major adverse events—three elective and one emergency surgery—were recorded. Conclusion Risankizumab is effective in a refractory real-world population with CD. Data are available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-24DOI: 10.1136/flgastro-2024-102650
Alan J Wigg, Sumudu Narayana, Michael Nugent, Arlene Ackland, Damian Riessen, Benjamin L Wigg, Kate R Muller, Jeyamani Ramachandran, Richard J Woodman
Objectives Remotely living Indigenous Australians have a disproportionate mortality from cirrhosis and hepatocellular cancer (HCC). However, there are no local population studies examining the prevalence of chronic liver disease (CLD) in remote communities. The main aims of this study were therefore to study a remote Indigenous population to determine the prevalence of CLD risk factors and the prevalence of significant fibrosis as defined by an Fibrosis-4 (FIB-4) score of ≥2.67. Methods The study design was a retrospective analysis of an electronic medical record database of a remote Aboriginal community-controlled health service. The setting was an Aboriginal community-controlled health service located in a remote South Australian town with a 15% Indigenous Australian population. Participants were all adult Indigenous Australians between the ages of 35 and 65 years. Results 83.9% of the study population had at least one CLD risk factor and 45% of the population had multiple CLD risk factors. The most prevalent risk factors were alcohol misuse, diabetes and obesity. 3.7% of the population had a high risk of significant fibrosis with an FIB-4 score≥2.67. Each additional CLD risk factor was associated with a 12.3% increase in FIB-4 mean (p=0.001). Conclusions CLD risk factors and significant liver fibrosis were highly prevalent in this population. Integrating simple liver screening tests into adult health checks has the potential to detect CLD at an early and treatable stage and to reduce the high morbidity and mortality from cirrhosis and HCC experienced by remotely living Indigenous Australians. Data are available upon reasonable request.
{"title":"Cross-sectional study of the prevalence of chronic liver disease risk factors and liver fibrosis in a remotely living Indigenous Australian population","authors":"Alan J Wigg, Sumudu Narayana, Michael Nugent, Arlene Ackland, Damian Riessen, Benjamin L Wigg, Kate R Muller, Jeyamani Ramachandran, Richard J Woodman","doi":"10.1136/flgastro-2024-102650","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102650","url":null,"abstract":"Objectives Remotely living Indigenous Australians have a disproportionate mortality from cirrhosis and hepatocellular cancer (HCC). However, there are no local population studies examining the prevalence of chronic liver disease (CLD) in remote communities. The main aims of this study were therefore to study a remote Indigenous population to determine the prevalence of CLD risk factors and the prevalence of significant fibrosis as defined by an Fibrosis-4 (FIB-4) score of ≥2.67. Methods The study design was a retrospective analysis of an electronic medical record database of a remote Aboriginal community-controlled health service. The setting was an Aboriginal community-controlled health service located in a remote South Australian town with a 15% Indigenous Australian population. Participants were all adult Indigenous Australians between the ages of 35 and 65 years. Results 83.9% of the study population had at least one CLD risk factor and 45% of the population had multiple CLD risk factors. The most prevalent risk factors were alcohol misuse, diabetes and obesity. 3.7% of the population had a high risk of significant fibrosis with an FIB-4 score≥2.67. Each additional CLD risk factor was associated with a 12.3% increase in FIB-4 mean (p=0.001). Conclusions CLD risk factors and significant liver fibrosis were highly prevalent in this population. Integrating simple liver screening tests into adult health checks has the potential to detect CLD at an early and treatable stage and to reduce the high morbidity and mortality from cirrhosis and HCC experienced by remotely living Indigenous Australians. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1136/flgastro-2024-102757
Alexander Thomas Elford, William Beattie, Andrew Downie, Varun Kaushik, Jeni Mitchell, Ralley Prentice, Aysha H Al-Ani, Jonathan Segal, Britt Christensen
Objective Sexual dysfunction is common in patients with inflammatory bowel disease (IBD). Data on IBD disease activity and IBD patients’ desire to seek specialist advice regarding sexual dysfunction are lacking. We aimed to identify sexual healthcare needs in patients with IBD. Design/method We conducted a cross-sectional survey of adult patients with IBD at a tertiary teaching hospital. Clinical disease activity was assessed using the Harvey-Bradshaw Index for patients with Crohn’s disease and the Patient-Simple Clinical Colitis Activity Index for patients with ulcerative colitis. Sexual health questions were derived from the validated IBD-Specific Female Sexual Dysfunction and IBD-Male Sexual Dysfunction Scales. Comparisons between those with inactive and active disease were made using Fisher’s exact test. Results 101 respondents completed the survey, of which 53 (52%) were female and 57 (56%) had Crohn’s disease. The median age was 38 (IQR 28–52). 34 respondents (34%) had active disease. Respondents with active Crohn’s disease trended towards having more significant sexual dysfunction than those in remission for all domains on the sexual dysfunction scale. 74% reported interest in accessing specialist advice regarding their sexual function while 20% have attempted to seek this advice. 36% would wish to be contacted by the IBD team if a sexual health service became available. Conclusions Negative impacts on sexual function were common in our cohort, particularly in the presence of active disease. Most patients with IBD are interested in obtaining advice regarding their sexual function. This is an unmet need among IBD services. Data are available on reasonable request.
{"title":"Sexual dysfunction is prevalent in IBD but underserved: a need to expand specialised IBD care","authors":"Alexander Thomas Elford, William Beattie, Andrew Downie, Varun Kaushik, Jeni Mitchell, Ralley Prentice, Aysha H Al-Ani, Jonathan Segal, Britt Christensen","doi":"10.1136/flgastro-2024-102757","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102757","url":null,"abstract":"Objective Sexual dysfunction is common in patients with inflammatory bowel disease (IBD). Data on IBD disease activity and IBD patients’ desire to seek specialist advice regarding sexual dysfunction are lacking. We aimed to identify sexual healthcare needs in patients with IBD. Design/method We conducted a cross-sectional survey of adult patients with IBD at a tertiary teaching hospital. Clinical disease activity was assessed using the Harvey-Bradshaw Index for patients with Crohn’s disease and the Patient-Simple Clinical Colitis Activity Index for patients with ulcerative colitis. Sexual health questions were derived from the validated IBD-Specific Female Sexual Dysfunction and IBD-Male Sexual Dysfunction Scales. Comparisons between those with inactive and active disease were made using Fisher’s exact test. Results 101 respondents completed the survey, of which 53 (52%) were female and 57 (56%) had Crohn’s disease. The median age was 38 (IQR 28–52). 34 respondents (34%) had active disease. Respondents with active Crohn’s disease trended towards having more significant sexual dysfunction than those in remission for all domains on the sexual dysfunction scale. 74% reported interest in accessing specialist advice regarding their sexual function while 20% have attempted to seek this advice. 36% would wish to be contacted by the IBD team if a sexual health service became available. Conclusions Negative impacts on sexual function were common in our cohort, particularly in the presence of active disease. Most patients with IBD are interested in obtaining advice regarding their sexual function. This is an unmet need among IBD services. Data are available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-15DOI: 10.1136/flgastro-2024-102778
Daniel Maggs, Emma Saunsbury, Benjamin Masterman, Ben Hudson, SPRinG Network
We were delighted to see specific guidance on palliative care (PC) included in the recently published British Society of Gastroenterology (BSG) best practice guidance on the outpatient management of cirrhosis.1 Decompensated advanced chronic liver disease (dACLD) carries a significant, and seldom addressed, symptom burden.2 3 PC interventions demonstrably improve physical and psychological symptoms in dACLD and do not negatively impact survival.4 Severn and Peninsula Research in Gastroenterology is a trainee research network. We undertook a retrospective regional service evaluation to assess the quality of PC provided to patients within their last year of life (LYOL) who died of dACLD in the South West of England. Specific objectives were to determine the proportion of patients with documented discussions regarding prognosis and advance care planning (ACP), and/or referral to specialist PC (SPC) services. A pre-COVID-19 patient cohort was selected to avoid the confounder of reduced outpatient services during the pandemic. Data regarding adults who died of dACLD between 1 February 2019 and 31 January 2020 were collected from electronic records. Full inclusion and exclusion criteria and statistical analysis details are outlined in online supplemental material. Documented discussions with all members …
我们很高兴看到姑息治疗（PC）的具体指导被纳入最近出版的英国胃肠病学会（BSG）肝硬化门诊治疗最佳实践指南中1 。我们进行了一项回顾性地区服务评估，以评估为英格兰西南部死于 dACLD 的患者生命最后一年（LYOL）提供的 PC 的质量。具体目标是确定对预后和预先护理计划（ACP）进行有记录讨论和/或转诊至专科PC（SPC）服务的患者比例。为了避免大流行期间门诊服务减少带来的混杂因素，我们选择了 COVID-19 之前的患者队列。从电子记录中收集了2019年2月1日至2020年1月31日期间死于dACLD的成人数据。全部纳入和排除标准以及统计分析细节见在线补充材料。与所有成员的讨论记录...
{"title":"Palliative care provision for patients with decompensated advanced chronic liver disease: lessons from the South West","authors":"Daniel Maggs, Emma Saunsbury, Benjamin Masterman, Ben Hudson, SPRinG Network","doi":"10.1136/flgastro-2024-102778","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102778","url":null,"abstract":"We were delighted to see specific guidance on palliative care (PC) included in the recently published British Society of Gastroenterology (BSG) best practice guidance on the outpatient management of cirrhosis.1 Decompensated advanced chronic liver disease (dACLD) carries a significant, and seldom addressed, symptom burden.2 3 PC interventions demonstrably improve physical and psychological symptoms in dACLD and do not negatively impact survival.4 Severn and Peninsula Research in Gastroenterology is a trainee research network. We undertook a retrospective regional service evaluation to assess the quality of PC provided to patients within their last year of life (LYOL) who died of dACLD in the South West of England. Specific objectives were to determine the proportion of patients with documented discussions regarding prognosis and advance care planning (ACP), and/or referral to specialist PC (SPC) services. A pre-COVID-19 patient cohort was selected to avoid the confounder of reduced outpatient services during the pandemic. Data regarding adults who died of dACLD between 1 February 2019 and 31 January 2020 were collected from electronic records. Full inclusion and exclusion criteria and statistical analysis details are outlined in online supplemental material. Documented discussions with all members …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1136/flgastro-2024-102768
Anjan Dhar, Stephen Attwood, Kumar Basu, Jemma S Carter, Joseph Cooney, Jason Dunn, Hasan Haboubi, Amir Jehangir, Maxton Pitcher, Marion Sloan, Terry Wong, Jyotika Singh
Eosinophilic oesophagitis (EoE) is a chronic condition characterised by solid-food dysphagia and food bolus obstruction due to T-helper cell-driven eosinophilic infiltration of the oesophageal epithelium and submucosal fibrosis. Suboptimal management results in delayed diagnosis, repeated food bolus obstructions and hospital attendances, inappropriate referral and treatment, increased healthcare resource use, and impaired quality of life. A group of clinicians with an interest in EoE deliberated on the current care pathways and evidence of best practice to develop an integrated care pathway to optimise the diagnosis and management of EoE. Key recommendations include suspecting EoE in patients presenting with food bolus obstruction or dysphagia; referring to gastroenterology and for oesophago-gastro-duodenoscopy promptly; taking at least six biopsies from multiple sites (ideally three) to diagnose EoE based on >15 eosinophils/0.3 mm2 oesophageal epithelium; using budesonide orodispersible tablets, as the only UK-licensed therapy for EoE for induction of remission and maintenance; arranging regular oesophago-gastro-duodenoscopies, gastroenterology follow-up and maintenance therapy due to the high relapse rate; and involving primary care to manage follow-on prescribing.
嗜酸性粒细胞性食道炎（EoE）是一种慢性疾病，其特点是食道上皮细胞和粘膜下纤维化受到 T 辅助细胞驱动的嗜酸性粒细胞浸润，导致固体食物吞咽困难和食道梗阻。处理不当会导致诊断延误、反复食管梗阻和住院、转诊和治疗不当、医疗资源使用增加以及生活质量下降。一组对咽喉炎感兴趣的临床医生讨论了当前的护理路径和最佳实践证据，以制定综合护理路径，优化咽喉炎的诊断和管理。主要建议包括：对出现食栓阻塞或吞咽困难的患者怀疑患有食道水肿；及时转诊至消化内科并进行食道-胃-十二指肠镜检查；至少从多个部位进行六次活检（最好是三次），根据嗜酸性粒细胞大于 15 个/0.3 平方毫米的食道上皮细胞；使用布地奈德口服分散片，这是英国唯一获得许可的诱导缓解和维持治疗EoE 的疗法；由于复发率高，应安排定期的食道-胃-十二指肠镜检查、胃肠病学随访和维持治疗；让初级保健参与管理后续处方。
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Pub Date : 2024-08-08DOI: 10.1136/flgastro-2024-102646
Xiao Xu, Stephanie Y Chen, Ekaterina Maslova, D. Kielar, J. Kwiatek, H. Stirnadel-Farrant, Rohit Katial, Julia Langham, Sue Langham, Philip Woodland
Describe clinical characteristics, treatment patterns, time to diagnosis and development of strictures in patients diagnosed with eosinophilic oesophagitis (EoE) between January 2014 and October 2020 in England.Routinely collected data were sourced from three linked databases in England: Clinical Practice Research Datalink (CPRD) Aurum; Hospital Episode Statistics (HES); and Office for National Statistics mortality files. Eligible patients in the CPRD, who could be linked to HES data, had ≥1 diagnosis of EoE, recorded using a diagnostic code during the study period, and ≥12 months (baseline period) continuous registration with the practice before diagnosis, during which EoE-related symptoms and comorbidities were evaluated.Patients with EoE (n=2381) more frequently reported dysphagia (40.0% vs 0.2%), acid reflux/heartburn (21.6% vs 0.9%; including gastro-oesophageal reflux disease), abdominal pain (10.8% vs 2.9%) and food impaction (8.2% vs 0.0%) during baseline than age-matched and sex-matched controls (n=9365). The most common first-line and second-line therapies were proton pump inhibitor (PPI) monotherapy and PPI plus swallowed topical corticosteroids, respectively. Median (IQR) time from first recorded symptom to diagnosis was 4.5 (1.3 to 16.4) months. Patients with prolonged time to diagnosis (≥24 months) more frequently reported EoE-related comorbidities and were younger (<18 years) than those with shorter time to diagnosis (<24 months). Patients who developed strictures ≤3 years after diagnosis were more frequently men and more frequently reported food impaction or dysphagia at baseline.This study helps characterise patients with EoE who require closer monitoring, highlighting the need for earlier diagnosis and treatment.
描述英格兰2014年1月至2020年10月期间确诊的嗜酸性粒细胞食管炎（EoE）患者的临床特征、治疗模式、诊断时间和狭窄发展情况：常规收集的数据来自英格兰的三个链接数据库：临床实践研究数据链 (CPRD) Aurum、医院病例统计 (HES) 和国家统计局死亡率档案。在 CPRD 中，符合条件的患者可与 HES 数据链接，这些患者在研究期间使用诊断代码记录的咽喉炎诊断次数≥1 次，并且在诊断前连续在诊所登记≥12 个月（基线期），在此期间，对咽喉炎相关症状和合并症进行了评估。与年龄和性别匹配的对照组（人数=9365）相比，EoE 患者（人数=2381）在基线期更常报告吞咽困难（40.0% vs 0.2%）、反酸/烧心（21.6% vs 0.9%；包括胃食管反流病）、腹痛（10.8% vs 2.9%）和食物嵌塞（8.2% vs 0.0%）。最常见的一线和二线疗法分别是质子泵抑制剂（PPI）单药疗法和 PPI 加吞服局部皮质类固醇疗法。从首次出现症状到确诊的中位（IQR）时间为 4.5（1.3 至 16.4）个月。与确诊时间较短（<24个月）的患者相比，确诊时间较长（≥24个月）的患者更多地报告了与EoE相关的合并症，且年龄更小（<18岁）。诊断后≤3年出现狭窄的患者多为男性，基线时更常报告食物嵌塞或吞咽困难。
{"title":"Clinical symptoms, comorbidities, treatment patterns and time to diagnosis in patients with eosinophilic oesophagitis in England: a retrospective cohort study","authors":"Xiao Xu, Stephanie Y Chen, Ekaterina Maslova, D. Kielar, J. Kwiatek, H. Stirnadel-Farrant, Rohit Katial, Julia Langham, Sue Langham, Philip Woodland","doi":"10.1136/flgastro-2024-102646","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102646","url":null,"abstract":"Describe clinical characteristics, treatment patterns, time to diagnosis and development of strictures in patients diagnosed with eosinophilic oesophagitis (EoE) between January 2014 and October 2020 in England.Routinely collected data were sourced from three linked databases in England: Clinical Practice Research Datalink (CPRD) Aurum; Hospital Episode Statistics (HES); and Office for National Statistics mortality files. Eligible patients in the CPRD, who could be linked to HES data, had ≥1 diagnosis of EoE, recorded using a diagnostic code during the study period, and ≥12 months (baseline period) continuous registration with the practice before diagnosis, during which EoE-related symptoms and comorbidities were evaluated.Patients with EoE (n=2381) more frequently reported dysphagia (40.0% vs 0.2%), acid reflux/heartburn (21.6% vs 0.9%; including gastro-oesophageal reflux disease), abdominal pain (10.8% vs 2.9%) and food impaction (8.2% vs 0.0%) during baseline than age-matched and sex-matched controls (n=9365). The most common first-line and second-line therapies were proton pump inhibitor (PPI) monotherapy and PPI plus swallowed topical corticosteroids, respectively. Median (IQR) time from first recorded symptom to diagnosis was 4.5 (1.3 to 16.4) months. Patients with prolonged time to diagnosis (≥24 months) more frequently reported EoE-related comorbidities and were younger (<18 years) than those with shorter time to diagnosis (<24 months). Patients who developed strictures ≤3 years after diagnosis were more frequently men and more frequently reported food impaction or dysphagia at baseline.This study helps characterise patients with EoE who require closer monitoring, highlighting the need for earlier diagnosis and treatment.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141928999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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