Pub Date : 2023-10-20DOI: 10.1136/flgastro-2023-102531
Elizabeth L Herrle, Monica Thim, Matthew S Buttarazzi, Jenna Ptaschinski, Victoria Molina, Natalie Channell, Lesley B Gordon
Objective Using quality improvement techniques, we aimed to improve the rate of assessment and sampling of ascitic fluid for the purpose of diagnosing spontaneous bacterial peritonitis in patients with cirrhosis admitted to the hospitalist service of our institution. Design/methods Based on stakeholder needs assessment, we implemented interventions targeting provider knowledge, procedure workflows and clinical decision support. We analysed key metrics during preintervention (September–December 2020), intervention roll-out (January–April 2021), postintervention (May–September 2021) and sustainability (September–December 2022) periods for admissions of patients with cirrhosis to our hospitalist service at Maine Medical Center, a 700-bed tertiary-care academic hospital in Portland, Maine, USA. Results Among patients with cirrhosis admitted to our service, documentation of assessment for paracentesis increased from a preintervention baseline of 60.1% to 93.5% (p<0.005) postintervention. For patients with ascites potentially amenable to paracentesis, diagnostic paracentesis rate increased from 59.7% to 93% (p<0.005), with the rate of paracentesis within 24 hours increasing from 52.6% to 77.2% (p=0.01). These improvements persisted during our sustainability period. Complication rate was low (1.2%) across all study periods. Conclusion Our quality improvement project led to a sustained improvement in the identification of patients with cirrhosis needing diagnostic paracentesis and an increased procedure completion rate. This improvement strategy serves as a model for needed work toward closing a national performance gap for patients with cirrhosis.
{"title":"Quality improvement project demonstrating a sustained increase in the assessment and sampling of ascites for hospitalised patients with cirrhosis","authors":"Elizabeth L Herrle, Monica Thim, Matthew S Buttarazzi, Jenna Ptaschinski, Victoria Molina, Natalie Channell, Lesley B Gordon","doi":"10.1136/flgastro-2023-102531","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102531","url":null,"abstract":"Objective Using quality improvement techniques, we aimed to improve the rate of assessment and sampling of ascitic fluid for the purpose of diagnosing spontaneous bacterial peritonitis in patients with cirrhosis admitted to the hospitalist service of our institution. Design/methods Based on stakeholder needs assessment, we implemented interventions targeting provider knowledge, procedure workflows and clinical decision support. We analysed key metrics during preintervention (September–December 2020), intervention roll-out (January–April 2021), postintervention (May–September 2021) and sustainability (September–December 2022) periods for admissions of patients with cirrhosis to our hospitalist service at Maine Medical Center, a 700-bed tertiary-care academic hospital in Portland, Maine, USA. Results Among patients with cirrhosis admitted to our service, documentation of assessment for paracentesis increased from a preintervention baseline of 60.1% to 93.5% (p<0.005) postintervention. For patients with ascites potentially amenable to paracentesis, diagnostic paracentesis rate increased from 59.7% to 93% (p<0.005), with the rate of paracentesis within 24 hours increasing from 52.6% to 77.2% (p=0.01). These improvements persisted during our sustainability period. Complication rate was low (1.2%) across all study periods. Conclusion Our quality improvement project led to a sustained improvement in the identification of patients with cirrhosis needing diagnostic paracentesis and an increased procedure completion rate. This improvement strategy serves as a model for needed work toward closing a national performance gap for patients with cirrhosis.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135617902","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 : 2023-10-11DOI: 10.1136/flgastro-2023-102471
Samantha Baillie, Christine Norton, Sonia Saxena, Richard Pollok
Pain is common in inflammatory bowel disease (IBD), yet many patients feel their pain is not addressed by healthcare professionals. Listening to a patient’s concerns about pain, assessing symptoms and acknowledging the impact these have on daily life remain crucial steps in addressing pain in IBD. While acute pain may be effectively controlled by pain medication, chronic pain is more complex and often pharmacological therapies, particularly opioids, are ineffective. Low-dose tricyclic antidepressants and psychological approaches, including cognitive–behavioural therapy, have shown some promise in offering effective pain management while lifestyle changes such as a trial of low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet in those with overlapping irritable bowel syndrome may also reduce pain. Patients benefit from a long-term, trusting relationship with their healthcare professional to allow a holistic approach combining pharmacological, psychological, lifestyle and dietary approaches to chronic pain. We present a practical review to facilitate management of chronic abdominal pain in IBD.
{"title":"Chronic abdominal pain in inflammatory bowel disease: a practical guide","authors":"Samantha Baillie, Christine Norton, Sonia Saxena, Richard Pollok","doi":"10.1136/flgastro-2023-102471","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102471","url":null,"abstract":"Pain is common in inflammatory bowel disease (IBD), yet many patients feel their pain is not addressed by healthcare professionals. Listening to a patient’s concerns about pain, assessing symptoms and acknowledging the impact these have on daily life remain crucial steps in addressing pain in IBD. While acute pain may be effectively controlled by pain medication, chronic pain is more complex and often pharmacological therapies, particularly opioids, are ineffective. Low-dose tricyclic antidepressants and psychological approaches, including cognitive–behavioural therapy, have shown some promise in offering effective pain management while lifestyle changes such as a trial of low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet in those with overlapping irritable bowel syndrome may also reduce pain. Patients benefit from a long-term, trusting relationship with their healthcare professional to allow a holistic approach combining pharmacological, psychological, lifestyle and dietary approaches to chronic pain. We present a practical review to facilitate management of chronic abdominal pain in IBD.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136211464","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 : 2023-10-11DOI: 10.1136/flgastro-2023-102508
Ahthavan Narendren, Srikar Boddupalli, Jonathan P Segal
In 2022, the British Society of Gastroenterology released guidelines on the management of functional dyspepsia (FD), providing a long-anticipated evidence-based approach to the diagnosis, classification and management of patients with FD. This review summarises the key recommendations of the recent guidelines on the management of FD.
{"title":"British Society of Gastroenterology guidelines on the management of functional dyspepsia","authors":"Ahthavan Narendren, Srikar Boddupalli, Jonathan P Segal","doi":"10.1136/flgastro-2023-102508","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102508","url":null,"abstract":"In 2022, the British Society of Gastroenterology released guidelines on the management of functional dyspepsia (FD), providing a long-anticipated evidence-based approach to the diagnosis, classification and management of patients with FD. This review summarises the key recommendations of the recent guidelines on the management of FD.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136097725","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 : 2023-10-10eCollection Date: 2023-01-01DOI: 10.1136/flgastro-2023-102560
R Mark Beattie
{"title":"UpFront.","authors":"R Mark Beattie","doi":"10.1136/flgastro-2023-102560","DOIUrl":"10.1136/flgastro-2023-102560","url":null,"abstract":"","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-04DOI: 10.1136/flgastro-2023-102468
Emma Saunsbury, Yazan Haddadin, Radha Gadhok, Elizabeth Ratcliffe, Suneil A Raju
Objective Shape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views. Method The British Society of Gastroenterology Trainees Section collected anonymised survey responses from trainees between June and September 2022 via an online platform. Results 40.3% of trainees responded. Strikingly, only 10% of respondents felt they could achieve certificate of completion of training (CCT) within a 4-year programme. Furthermore, 31% were not confident they would attain the required expertise in their subspecialist interest during training. 70.8% reported spending a quarter or more of their training in general internal medicine (GIM) and 71.6% felt this negatively impacted on their gastroenterology training. Only 21.6% of respondents plan to pursue a consultant post with GIM commitments. Regarding endoscopy, only 36.1% of ST7s had provisional and 22.2% full accreditation in colonoscopy. Although 92.3% of respondents wanted exposure to a ‘bleed rota’, this was the case for only 16.2%. Teaching quality was judged to be insufficient by 45.9% of respondents. Conclusion Respondents had struggled to achieve the necessary competencies for CCT even prior to the newly reduced 4-year curriculum. While still maintaining service provision, we must safeguard gastroenterology training from encroaching GIM commitments. This will be critical in order to provide capable consultants of the future and prevent UK standards from falling behind internationally.
目的:Shape of Training将英国的胃肠病学课程从5年缩短为4年。目前有人担心，这将对培训和达到顾问一级预期的能力产生不利影响。我们在全英国范围内对胃肠病学学员进行了调查，以确定他们的观点。方法英国胃肠病学学会学员组通过在线平台收集了2022年6月至9月期间学员的匿名调查反馈。结果40.3%的学员有反馈。引人注目的是，只有10%的受访者认为他们可以在4年的课程中获得培训完成证书(CCT)。此外，31%的人不相信他们能在培训期间获得他们感兴趣的子专家所需的专业知识。70.8%的人表示，他们将四分之一或更多的时间用于普通内科(GIM)培训，71.6%的人认为这对他们的胃肠病学培训产生了负面影响。只有21.6%的受访者计划从事具有GIM承诺的顾问职位。在内窥镜方面，只有36.1%的st7获得结肠镜临时认证，22.2%的st7获得结肠镜完全认证。尽管92.3%的受访者希望接触到“流血轮班”，但只有16.2%的人这样做。45.9%的受访者认为教学质量不足。即使在新减少的4年课程之前，被调查者也努力达到CCT的必要能力。在继续提供服务的同时，我们必须保护胃肠病学培训不受GIM承诺的侵蚀。这将是至关重要的，以便为未来提供有能力的顾问，并防止英国标准落后于国际。
{"title":"UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come","authors":"Emma Saunsbury, Yazan Haddadin, Radha Gadhok, Elizabeth Ratcliffe, Suneil A Raju","doi":"10.1136/flgastro-2023-102468","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102468","url":null,"abstract":"Objective Shape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views. Method The British Society of Gastroenterology Trainees Section collected anonymised survey responses from trainees between June and September 2022 via an online platform. Results 40.3% of trainees responded. Strikingly, only 10% of respondents felt they could achieve certificate of completion of training (CCT) within a 4-year programme. Furthermore, 31% were not confident they would attain the required expertise in their subspecialist interest during training. 70.8% reported spending a quarter or more of their training in general internal medicine (GIM) and 71.6% felt this negatively impacted on their gastroenterology training. Only 21.6% of respondents plan to pursue a consultant post with GIM commitments. Regarding endoscopy, only 36.1% of ST7s had provisional and 22.2% full accreditation in colonoscopy. Although 92.3% of respondents wanted exposure to a ‘bleed rota’, this was the case for only 16.2%. Teaching quality was judged to be insufficient by 45.9% of respondents. Conclusion Respondents had struggled to achieve the necessary competencies for CCT even prior to the newly reduced 4-year curriculum. While still maintaining service provision, we must safeguard gastroenterology training from encroaching GIM commitments. This will be critical in order to provide capable consultants of the future and prevent UK standards from falling behind internationally.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135590768","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 : 2023-10-03DOI: 10.1136/flgastro-2023-102494
Mohamed G Shiha, Nicoletta Nandi, Andrew J Hutchinson, Suneil A Raju, Foong Way David Tai, Luca Elli, Hugo A Penny, David Surendran Sanders
Objective Recent evidence suggests that adult patients with IgA tissue transglutaminase levels of ≥10× the upper limit of normal could be accurately diagnosed with coeliac disease without undergoing endoscopy and biopsy. We aimed to evaluate the cost-benefits and the environmental impact of implementing the no-biopsy approach for diagnosing coeliac disease in clinical practice. Design We calculated the overall direct and indirect costs of the conventional serology-biopsy approach and the no-biopsy approach for the diagnosis of coeliac disease based on the national average unit costs and the Office of National Statistics data. We further estimated the environmental impact of avoiding endoscopy based on the estimated greenhouse gas emissions from endoscopy. Results Approximately 3000 endoscopies for suspected coeliac disease could be avoided each year in the UK. Implementing the no-biopsy approach for the diagnosis of coeliac disease in adults could save the National Health Service over £2.5 million in direct and indirect costs per annum and reduce endoscopy carbon footprint by 87 tonnes of CO 2 per year, equivalent to greenhouse gas emissions from driving 222 875 miles, carbon emissions from charging over 10 million smartphones and the carbon sequestrated by 1438 trees grown for 10 years. Conclusion The implementation of this non-invasive green approach could be an essential first step in the ‘Reduce’ strategy advocated by the British Society of Gastroenterology and other international endoscopy societies for sustainable endoscopy practice.
{"title":"Cost-benefits and environmental impact of the no-biopsy approach for the diagnosis of coeliac disease in adults","authors":"Mohamed G Shiha, Nicoletta Nandi, Andrew J Hutchinson, Suneil A Raju, Foong Way David Tai, Luca Elli, Hugo A Penny, David Surendran Sanders","doi":"10.1136/flgastro-2023-102494","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102494","url":null,"abstract":"Objective Recent evidence suggests that adult patients with IgA tissue transglutaminase levels of ≥10× the upper limit of normal could be accurately diagnosed with coeliac disease without undergoing endoscopy and biopsy. We aimed to evaluate the cost-benefits and the environmental impact of implementing the no-biopsy approach for diagnosing coeliac disease in clinical practice. Design We calculated the overall direct and indirect costs of the conventional serology-biopsy approach and the no-biopsy approach for the diagnosis of coeliac disease based on the national average unit costs and the Office of National Statistics data. We further estimated the environmental impact of avoiding endoscopy based on the estimated greenhouse gas emissions from endoscopy. Results Approximately 3000 endoscopies for suspected coeliac disease could be avoided each year in the UK. Implementing the no-biopsy approach for the diagnosis of coeliac disease in adults could save the National Health Service over £2.5 million in direct and indirect costs per annum and reduce endoscopy carbon footprint by 87 tonnes of CO 2 per year, equivalent to greenhouse gas emissions from driving 222 875 miles, carbon emissions from charging over 10 million smartphones and the carbon sequestrated by 1438 trees grown for 10 years. Conclusion The implementation of this non-invasive green approach could be an essential first step in the ‘Reduce’ strategy advocated by the British Society of Gastroenterology and other international endoscopy societies for sustainable endoscopy practice.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135695587","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 : 2023-10-03DOI: 10.1136/flgastro-2023-102541
Anjan Dhar
I read this paper with great interest and would like to congratulate Ratcliffe and coauthors for their welldesigned comparative cohort study carried out in a nontertiary centre. This paper emphasises the need for adequate time for assessment of Barrett’s oesophagus during surveillance, and confirms already published evidence recommending a Barrett’s inspection time of 1 min/cm length of the Barrett’s segment using highdefinition white light endoscopy. 3 There are a few important issues that need addressing when planning services for Barrett’s oesophagus surveillance in the UK. First, while it is ideal to have a full dedicated Barrett’s list, with adequate time and a trained Barrett’s endoscopist, to achieve the best outcomes for dysplasia detection, most secondary centres in the NHS will struggle to implement this practice in the present environment of endoscopy backlog and increased clinical pressures. Second, it is still unclear from the literature as to whether having a full list of Barrett’s surveillance cases or simply adequate time (30–45 min per case) in an upper GI endoscopy list carried out by a trained endoscopist will result in a statistically significant difference in dysplasia detection rate (DDR). In this paper, the authors have not clarified whether all lesions detected in the dedicated endoscopy group were using highdefinition white light endoscopy only and/or with the help of image enhanced endoscopy (such as narrow band imaging, near focus magnification or acetic acid chromoendoscopy) as compared with the surveillance carried out in the nondedicated list, which was predominantly carried out using white light endoscopy. This is an important aspect in the detection of early Barrett’s neoplasia, since the authors mention that narrow band imaging and acetic acid chromoendoscopy was used much more frequently in the dedicated surveillance group compared with the nondedicated group. Finally, the advent of new technologies such as sponge based cell collection techniques (Cytosponge, Medtronic Inc) and artificial intelligence (AI) and computer aided detection (CADe) and characterisation of Barrett’s related neoplasia may make DDRs in nontertiary centres as good as in expert tertiary centres as long as the Barrett’s mucosa is inspected with adequate time to allow the computer to analyse the mucosal surface and vascular characteristics to make a diagnosis. The use of sponge based cell analysis has been shown to improve the selection of patients for Barrett’s surveillance. Although adequate inspection time will still be needed for an accurate diagnosis, confirming the need for 30–40 min time for each patient on a Barrett’s surveillance programme, the use of AI tools in a Cytosponge positive patient may remove the expertise needed of an endoscopist to make an optical diagnosis. This is yet to be formally validated in a comparative study of the use of AIassisted CADe between tertiary and nontertiary centres. Overall, the authors of this study
{"title":"Re: ‘Dedicated service for Barrett’s oesophagus surveillance endoscopy yields higher dysplasia detection and guideline adherence in a non-tertiary setting in the UK: a 5-year comparative cohort study’ by Ratcliffe<i>et al</i>","authors":"Anjan Dhar","doi":"10.1136/flgastro-2023-102541","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102541","url":null,"abstract":"I read this paper with great interest and would like to congratulate Ratcliffe and coauthors for their welldesigned comparative cohort study carried out in a nontertiary centre. This paper emphasises the need for adequate time for assessment of Barrett’s oesophagus during surveillance, and confirms already published evidence recommending a Barrett’s inspection time of 1 min/cm length of the Barrett’s segment using highdefinition white light endoscopy. 3 There are a few important issues that need addressing when planning services for Barrett’s oesophagus surveillance in the UK. First, while it is ideal to have a full dedicated Barrett’s list, with adequate time and a trained Barrett’s endoscopist, to achieve the best outcomes for dysplasia detection, most secondary centres in the NHS will struggle to implement this practice in the present environment of endoscopy backlog and increased clinical pressures. Second, it is still unclear from the literature as to whether having a full list of Barrett’s surveillance cases or simply adequate time (30–45 min per case) in an upper GI endoscopy list carried out by a trained endoscopist will result in a statistically significant difference in dysplasia detection rate (DDR). In this paper, the authors have not clarified whether all lesions detected in the dedicated endoscopy group were using highdefinition white light endoscopy only and/or with the help of image enhanced endoscopy (such as narrow band imaging, near focus magnification or acetic acid chromoendoscopy) as compared with the surveillance carried out in the nondedicated list, which was predominantly carried out using white light endoscopy. This is an important aspect in the detection of early Barrett’s neoplasia, since the authors mention that narrow band imaging and acetic acid chromoendoscopy was used much more frequently in the dedicated surveillance group compared with the nondedicated group. Finally, the advent of new technologies such as sponge based cell collection techniques (Cytosponge, Medtronic Inc) and artificial intelligence (AI) and computer aided detection (CADe) and characterisation of Barrett’s related neoplasia may make DDRs in nontertiary centres as good as in expert tertiary centres as long as the Barrett’s mucosa is inspected with adequate time to allow the computer to analyse the mucosal surface and vascular characteristics to make a diagnosis. The use of sponge based cell analysis has been shown to improve the selection of patients for Barrett’s surveillance. Although adequate inspection time will still be needed for an accurate diagnosis, confirming the need for 30–40 min time for each patient on a Barrett’s surveillance programme, the use of AI tools in a Cytosponge positive patient may remove the expertise needed of an endoscopist to make an optical diagnosis. This is yet to be formally validated in a comparative study of the use of AIassisted CADe between tertiary and nontertiary centres. Overall, the authors of this study","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135695592","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 : 2023-09-22eCollection Date: 2023-01-01DOI: 10.1136/flgastro-2023-102462
Nkem Onyeador, Kumaran Thiruppathy
{"title":"Virtual consultations: navigating the future landscape of delivering gastroenterology outpatient care to young people.","authors":"Nkem Onyeador, Kumaran Thiruppathy","doi":"10.1136/flgastro-2023-102462","DOIUrl":"10.1136/flgastro-2023-102462","url":null,"abstract":"","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579549/pdf/flgastro-2023-102462.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-21DOI: 10.1136/flgastro-2023-102510
Rex Wan-Hin Hui, Nadir Abbas, Philip Dunne, Dhiraj Tripathi
PROGNOSTIC SCORES The debate kickedoff with a case presentation, followed by discussion on prognostic scores for estimating surgical risks. Among online participants, 53.2% chose the ChildTurcottePugh (CTP) or Model for Endstage Liver Disease (MELD) scores for risk prediction. Other scores chosen included the VOCALPenn Score (26.2%), Mayo Surgical Score (16.3%) and Hepatic Venous Pressure Gradient (HVPG) (4.3%). Most respondents chose CTP or MELD as these were familiar and triedandtested. However, neither CTP or MELD truly assesses the presence or severity of portal hypertension—the sequelae of liver disease most relevant in determining operative risks. The American Society of Anesthesiologists (ASA) classification was also proposed, given its long history in surgical risk stratification. The VOCALPenn and Mayo Surgical scores are designed for surgical risk assessment in cirrhosis. VOCALPenn is the only score to account for surgical factors, whereas the Mayo Surgical score incorporated the ASA classification. These scores were developed using retrospective data, and portal hypertension assessment may be more direct in predicting postoperative decompensation. Preoperative HVPG accurately assesses portal hypertension and has been studied for adverse outcome prediction. However, given the invasive and impractical nature of HVPG, alternatives such as liver/spleen stiffness and endoscopic ultrasoundguided portal pressure assessment were discussed. Participants agreed that these modalities have not been tested in preoperative settings and require validation. SERVICE PROVISION Discussions progressed to service provision and which clinicians should manage patients with cirrhosis undergoing nonhepatic surgery. Considering the potential role of HVPG, tertiary centres with interventional radiology expertise are required. The importance of multidisciplinary care was highlighted, as good communication between hepatologists, anaesthesiologists and surgeons would be critical. The role of allied health colleagues (ie, physiotherapists and dietitians) to provide personalised preoperative, perioperative and postoperative care was also raised.
{"title":"Predicting and optimising risks for non-hepatic surgery in patients with cirrhosis: insights from the #FGDebate","authors":"Rex Wan-Hin Hui, Nadir Abbas, Philip Dunne, Dhiraj Tripathi","doi":"10.1136/flgastro-2023-102510","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102510","url":null,"abstract":"PROGNOSTIC SCORES The debate kickedoff with a case presentation, followed by discussion on prognostic scores for estimating surgical risks. Among online participants, 53.2% chose the ChildTurcottePugh (CTP) or Model for Endstage Liver Disease (MELD) scores for risk prediction. Other scores chosen included the VOCALPenn Score (26.2%), Mayo Surgical Score (16.3%) and Hepatic Venous Pressure Gradient (HVPG) (4.3%). Most respondents chose CTP or MELD as these were familiar and triedandtested. However, neither CTP or MELD truly assesses the presence or severity of portal hypertension—the sequelae of liver disease most relevant in determining operative risks. The American Society of Anesthesiologists (ASA) classification was also proposed, given its long history in surgical risk stratification. The VOCALPenn and Mayo Surgical scores are designed for surgical risk assessment in cirrhosis. VOCALPenn is the only score to account for surgical factors, whereas the Mayo Surgical score incorporated the ASA classification. These scores were developed using retrospective data, and portal hypertension assessment may be more direct in predicting postoperative decompensation. Preoperative HVPG accurately assesses portal hypertension and has been studied for adverse outcome prediction. However, given the invasive and impractical nature of HVPG, alternatives such as liver/spleen stiffness and endoscopic ultrasoundguided portal pressure assessment were discussed. Participants agreed that these modalities have not been tested in preoperative settings and require validation. SERVICE PROVISION Discussions progressed to service provision and which clinicians should manage patients with cirrhosis undergoing nonhepatic surgery. Considering the potential role of HVPG, tertiary centres with interventional radiology expertise are required. The importance of multidisciplinary care was highlighted, as good communication between hepatologists, anaesthesiologists and surgeons would be critical. The role of allied health colleagues (ie, physiotherapists and dietitians) to provide personalised preoperative, perioperative and postoperative care was also raised.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136135883","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 : 2023-09-19DOI: 10.1136/flgastro-2023-102507
Elissa Annabi, Sophie Lalevée, Thomas Bettuzzi, Juliette Demortier, Barbara Papouin, Louis De Mestier Du Bourg, Emilie Sbidian, Saskia Ingen-Housz-Oro
INTRODUCTION A 47yearold man, with no medical history, presented with a 1year history of a recurrent skin eruption made of erythematous, erosive, crusty and pruritic plaques involving the scrotum, inguinal and intergluteal skinfolds, trunk and legs (figure 1). Mucosal examination showed glossitis and perleche. He had received topical and systemic antifungal agents without improvement. General examination was normal except a weight loss of 9 kg, without other digestive symptoms and despite a balanced diet. Blood routine tests were normal except a mild normocytic anaemia (11 g/dL) and a hypoalbuminaemia (31 g/L). Nutritional assessment revealed a zinc deficiency (7.37 μmol/L, normal value >12.5 μmol/L). Histological examination of a skin biopsy revealed a psoriasiform acanthosis with a keratinocyte vacuolation.
{"title":"Annular eruption with weight loss in a 47-year-old man","authors":"Elissa Annabi, Sophie Lalevée, Thomas Bettuzzi, Juliette Demortier, Barbara Papouin, Louis De Mestier Du Bourg, Emilie Sbidian, Saskia Ingen-Housz-Oro","doi":"10.1136/flgastro-2023-102507","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102507","url":null,"abstract":"INTRODUCTION A 47yearold man, with no medical history, presented with a 1year history of a recurrent skin eruption made of erythematous, erosive, crusty and pruritic plaques involving the scrotum, inguinal and intergluteal skinfolds, trunk and legs (figure 1). Mucosal examination showed glossitis and perleche. He had received topical and systemic antifungal agents without improvement. General examination was normal except a weight loss of 9 kg, without other digestive symptoms and despite a balanced diet. Blood routine tests were normal except a mild normocytic anaemia (11 g/dL) and a hypoalbuminaemia (31 g/L). Nutritional assessment revealed a zinc deficiency (7.37 μmol/L, normal value >12.5 μmol/L). Histological examination of a skin biopsy revealed a psoriasiform acanthosis with a keratinocyte vacuolation.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135059366","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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