Pub Date : 2024-07-18DOI: 10.1136/flgastro-2024-102747
Nigel Grunshaw, Wendi Harrison, Hayley Owen, Philip J Smith
Background Intestinal ultrasound (IUS), although less widely practiced in the UK, offers several advantages in inflammatory bowel disease (IBD), particularly with regard to the accessibility of the test and immediate availability of reports. Aims To assess the use of point-of-care IUS in influencing management change in IBD. Methods A retrospective service evaluation review of 3 years of a rapid access IUS clinic performed in combination with IBD nurses in a District General Hospital setting. Results A total of 227 examinations were performed on 168 patients. All scans were performed by a consultant radiologist. 162 examinations (79%) were scanned and reported within 2 weeks of referral. 101/227 (44%) had evidence of significant active/obstructing disease, and in patients with known IBD, this rises to 101/185 (55%). Overall, 59.5% (135) of ultrasound examinations resulted in management changes. Conclusion Wider adoption of IUS in a point-of-care setting has the potential to significantly guide patient management in IBD. All data relevant to the study are included in the article or uploaded as supplementary information.
背景 肠道超声（IUS）虽然在英国应用较少，但它在炎症性肠病（IBD）中具有多项优势，尤其是在检测的可及性和报告的即时可用性方面。目的 评估床旁 IUS 在影响 IBD 管理变化方面的应用。方法 对一家地区综合医院与 IBD 护士联合开展的快速 IUS 诊所 3 年的服务进行回顾性评估。结果 共为 168 名患者进行了 227 次检查。所有扫描均由放射科顾问医师进行。162例检查（79%）在转诊后两周内完成扫描并出具报告。101/227（44%）例患者有明显的活动性/阻塞性疾病，在已知患有 IBD 的患者中，这一比例上升到 101/185（55%）例。总体而言，59.5%（135 例）的超声检查结果导致了治疗方案的改变。结论 在护理点环境中更广泛地采用 IUS 有可能极大地指导 IBD 患者的管理。与该研究相关的所有数据均包含在文章中或作为补充信息上传。
{"title":"Effect of combined rapid access point-of-care intestinal ultrasound clinic on the management of inflammatory bowel disease","authors":"Nigel Grunshaw, Wendi Harrison, Hayley Owen, Philip J Smith","doi":"10.1136/flgastro-2024-102747","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102747","url":null,"abstract":"Background Intestinal ultrasound (IUS), although less widely practiced in the UK, offers several advantages in inflammatory bowel disease (IBD), particularly with regard to the accessibility of the test and immediate availability of reports. Aims To assess the use of point-of-care IUS in influencing management change in IBD. Methods A retrospective service evaluation review of 3 years of a rapid access IUS clinic performed in combination with IBD nurses in a District General Hospital setting. Results A total of 227 examinations were performed on 168 patients. All scans were performed by a consultant radiologist. 162 examinations (79%) were scanned and reported within 2 weeks of referral. 101/227 (44%) had evidence of significant active/obstructing disease, and in patients with known IBD, this rises to 101/185 (55%). Overall, 59.5% (135) of ultrasound examinations resulted in management changes. Conclusion Wider adoption of IUS in a point-of-care setting has the potential to significantly guide patient management in IBD. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"36 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141737999","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 : 2024-07-18DOI: 10.1136/flgastro-2024-102676
Carly Lamb, Jennifer Tham, Tee Lin Goh, Stephen Barclay, Matthew Priest, Ewan H Forrest, Andrew Fraser, David Kay, Ram Kasthuri, Jeff Evans, Adrian J Stanley
Introduction Hepatocellular carcinoma (HCC) is increasing in incidence across the UK. Most patients have underlying cirrhosis, but a significant minority do not. Progression and outcomes of HCC in patients without cirrhosis remains unclear. This study aimed to establish the proportion and characteristics of patients with HCC occurring in those with and without cirrhosis in the West of Scotland. Methods Data were collected from our prospectively collected database on patient demographics, liver disease aetiology, stage at presentation and outcomes for patients with a diagnosis of HCC confirmed at the Regional West of Scotland multidisciplinary team from 2009 to 2015. Results 638 patients were included. 138 (21.6%) did not have cirrhosis and were older at diagnosis than those with cirrhosis (72 years vs 68 years, p=0.001). A higher proportion of those without cirrhosis presented with more advanced HCC (Barcelona clinic liver cancer (BCLC) score B or above; p=0.003). Patients with cirrhosis had median survival of 8 months, compared with those without cirrhosis (11.5 months) but survival was similar in both groups on Kaplan-Meier analysis (p=0.119). There was no difference in survival between these groups when adjusted for cancer stage. Survival was influenced by BCLC score in both cirrhotic and non-cirrhotic groups, as was survival by Child-Pugh score in patients with cirrhosis. Among the patients who underwent transarterial chemoembolisation (TACE), those with cirrhosis had worse survival (p=0.044). Conclusion 21.6% of patients with a new diagnosis of HCC in our region did not have underlying cirrhosis. Patients with non-cirrhotic HCC were diagnosed at an older age, with more advanced stage of HCC. There was no difference in overall survival between patients with HCC with and without cirrhosis, however, survival after TACE was higher in those without cirrhosis. Data are available on reasonable request. De-identified participant data available from CL (ORCID 0000-0003-0136-7835).
{"title":"Comparison between patient characteristics, aetiology and outcomes in patients with and without cirrhosis with hepatocellular carcinoma diagnosed in a regional centre","authors":"Carly Lamb, Jennifer Tham, Tee Lin Goh, Stephen Barclay, Matthew Priest, Ewan H Forrest, Andrew Fraser, David Kay, Ram Kasthuri, Jeff Evans, Adrian J Stanley","doi":"10.1136/flgastro-2024-102676","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102676","url":null,"abstract":"Introduction Hepatocellular carcinoma (HCC) is increasing in incidence across the UK. Most patients have underlying cirrhosis, but a significant minority do not. Progression and outcomes of HCC in patients without cirrhosis remains unclear. This study aimed to establish the proportion and characteristics of patients with HCC occurring in those with and without cirrhosis in the West of Scotland. Methods Data were collected from our prospectively collected database on patient demographics, liver disease aetiology, stage at presentation and outcomes for patients with a diagnosis of HCC confirmed at the Regional West of Scotland multidisciplinary team from 2009 to 2015. Results 638 patients were included. 138 (21.6%) did not have cirrhosis and were older at diagnosis than those with cirrhosis (72 years vs 68 years, p=0.001). A higher proportion of those without cirrhosis presented with more advanced HCC (Barcelona clinic liver cancer (BCLC) score B or above; p=0.003). Patients with cirrhosis had median survival of 8 months, compared with those without cirrhosis (11.5 months) but survival was similar in both groups on Kaplan-Meier analysis (p=0.119). There was no difference in survival between these groups when adjusted for cancer stage. Survival was influenced by BCLC score in both cirrhotic and non-cirrhotic groups, as was survival by Child-Pugh score in patients with cirrhosis. Among the patients who underwent transarterial chemoembolisation (TACE), those with cirrhosis had worse survival (p=0.044). Conclusion 21.6% of patients with a new diagnosis of HCC in our region did not have underlying cirrhosis. Patients with non-cirrhotic HCC were diagnosed at an older age, with more advanced stage of HCC. There was no difference in overall survival between patients with HCC with and without cirrhosis, however, survival after TACE was higher in those without cirrhosis. Data are available on reasonable request. De-identified participant data available from CL (ORCID 0000-0003-0136-7835).","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141738140","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 : 2024-07-17DOI: 10.1136/flgastro-2024-102797
Colin Fitzpatrick, Shaira Doherty, Sabina George, Daniel Richardson
Background The transmission dynamics of hepatitis E in men who have sex with men (MSM) are poorly understood. We aimed to explore any factors observed in MSM with hepatitis E by systematically reviewing the literature. Methods We searched five databases (PubMed, Embase, CINAHL Plus, MEDLINE and Web of Science Core Collections). The primary author performed an initial screen of citations and abstracts, and two authors independently reviewed full-text manuscripts for eligibility. We only included manuscripts in English that explored at least one risk factor for hepatitis E. The risk of bias was assessed using the Joanna Briggs Institute toolkits. Narrative data were synthesised and tabulated. This review was registered on PROSPERO (ID: CRD42023472303). Results 14 manuscripts were included in this review: two case reports, one case-control study, two cohort studies and nine cross-sectional studies from Italy (n=3), Japan (n=2), France (n=2), Argentina (n=1), Russia (n=1), the USA (n=1), the Netherlands (n=1), Belgium (n=1), Spain (n=1) and Greece (n=1). In total, there were 376 MSM with hepatitis E in this analysis. We have highlighted demographic (bimodal age (16–29 and >40), HIV pre-exposure prophylaxis use, living with HIV) and biological (previous syphilis, hepatitis C and hepatitis A) factors in MSM with previous/current hepatitis E. In five manuscripts, no association was found between MSM and hepatitis E. Conclusion Despite conflicting data, hepatitis E may be sexually transmissible in MSM, and MSM with unexplained jaundice, transaminitis, renal disease or neurological disease should be tested. HIV, hepatitis A (including vaccination), hepatitis C and syphilis testing are required in MSM with hepatitis E. This review provides some insight for future clinical guidelines, public health outbreak control strategies and research. Data sharing not applicable to this article as no datasets were generated or analysed during the current study. All data relevant to the study are included in the article
{"title":"Hepatitis E in men who have sex with men: a systematic review","authors":"Colin Fitzpatrick, Shaira Doherty, Sabina George, Daniel Richardson","doi":"10.1136/flgastro-2024-102797","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102797","url":null,"abstract":"Background The transmission dynamics of hepatitis E in men who have sex with men (MSM) are poorly understood. We aimed to explore any factors observed in MSM with hepatitis E by systematically reviewing the literature. Methods We searched five databases (PubMed, Embase, CINAHL Plus, MEDLINE and Web of Science Core Collections). The primary author performed an initial screen of citations and abstracts, and two authors independently reviewed full-text manuscripts for eligibility. We only included manuscripts in English that explored at least one risk factor for hepatitis E. The risk of bias was assessed using the Joanna Briggs Institute toolkits. Narrative data were synthesised and tabulated. This review was registered on PROSPERO (ID: CRD42023472303). Results 14 manuscripts were included in this review: two case reports, one case-control study, two cohort studies and nine cross-sectional studies from Italy (n=3), Japan (n=2), France (n=2), Argentina (n=1), Russia (n=1), the USA (n=1), the Netherlands (n=1), Belgium (n=1), Spain (n=1) and Greece (n=1). In total, there were 376 MSM with hepatitis E in this analysis. We have highlighted demographic (bimodal age (16–29 and >40), HIV pre-exposure prophylaxis use, living with HIV) and biological (previous syphilis, hepatitis C and hepatitis A) factors in MSM with previous/current hepatitis E. In five manuscripts, no association was found between MSM and hepatitis E. Conclusion Despite conflicting data, hepatitis E may be sexually transmissible in MSM, and MSM with unexplained jaundice, transaminitis, renal disease or neurological disease should be tested. HIV, hepatitis A (including vaccination), hepatitis C and syphilis testing are required in MSM with hepatitis E. This review provides some insight for future clinical guidelines, public health outbreak control strategies and research. Data sharing not applicable to this article as no datasets were generated or analysed during the current study. All data relevant to the study are included in the article","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745959","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 : 2024-07-17DOI: 10.1136/flgastro-2024-102780
Vaibhav Dubey, Vidhushan Sivachandran, Natasha Wahab, Carrie Llewellyn, Daniel Richardson
Objective Giardia duodenalis causes enteritis and malabsorption and can be sexually transmissible in men who have sex with men (MSM). The aim of this study was to explore factors associated with MSM with G. duodenalis . Methods MEDLINE, Embase, Emcare, PubMed, Global Health and Web of Science were searched for manuscripts published up to February 2024. The primary author screened manuscript titles and abstracts; two authors independently reviewed full-text manuscripts for eligibility and risk of bias. We only included manuscripts that included MSM with G. duodenalis and explored at least one risk factor or association. Narrative data were synthesised following the population of a predetermined table. Results Twelve manuscripts were included in this review, including cross-sectional studies (n=7), case series (n=3), cohort study (n=1), case-control study (n=1), from the USA (n=8), the UK (n=1), Cuba (n=1), Spain (n=1) and Canada (n=1) published between 1977 and 2024 and included 191 MSM with G. duodenalis . This review highlighted demographic (living with HIV and living with HIV with a CD4 count <400 cells/mL), biological (coinfection with Neisseria gonorrhoeae , Chlamydia trachomatis , Escherichia coli , Entamoeba histolytica , non-pathogenic enteric parasites, intestinal spirochaetosis, Enterobius vermicularis , previous Treponema pallidum , N. gonorrhoeae , Shigella spp, hepatitis A, E. histolytica and G. duodenalis ) and behavioural (lack of anal douching, oral-anal sex, oral sex, anal sex, group sex, use of sex toys, having more than one sexual partner per week, non-condom use, being part of a sexual network or having a sexual partner with G. duodenalis ) factors associated with MSM with G. duodenalis . Conclusion This review has highlighted some demographic, behavioural and biological factors associated with MSM with G. duodenalis , which provide insight for public health control strategies and future research. PROSPERO registration number CRD42023477691. No data are available.
目的 十二指肠贾第鞭毛虫会导致肠炎和吸收不良，并可通过性传播给男男性行为者（MSM）。本研究旨在探讨 MSM 感染十二指肠贾第虫的相关因素。方法 检索 MEDLINE、Embase、Emcare、PubMed、Global Health 和 Web of Science 上截至 2024 年 2 月发表的手稿。主要作者筛选了稿件标题和摘要；两位作者独立审阅了稿件全文，以确定是否符合要求和是否存在偏倚风险。我们只收录了包括患有十二指肠球菌的 MSM 并探讨了至少一种风险因素或关联的稿件。叙述性数据按照预先确定的表格进行综合。结果 本综述纳入了 12 篇手稿，包括横断面研究（n=7）、病例系列研究（n=3）、队列研究（n=1）、病例对照研究（n=1），分别来自美国（n=8）、英国（n=1）、古巴（n=1）、西班牙（n=1）和加拿大（n=1），发表于 1977 年至 2024 年之间，纳入了 191 名患有十二指肠球菌的 MSM。该综述强调了人口统计学（感染 HIV 和 CD4 细胞计数小于 400 cells/mL 的 HIV 感染者）、生物学（同时感染淋病奈瑟菌、沙眼衣原体、大肠杆菌、组织溶解恩塔米巴菌、非致病性肠道寄生虫、肠螺旋体病、蚯蚓肠杆菌、先前的苍白链球菌、N.淋病、志贺氏菌属、甲型肝炎、组织溶解性大肠杆菌和十二指肠球菌）和行为（缺乏肛门冲洗、口交-肛交、口交、肛交、群交、使用性玩具、每周有一个以上性伴侣、不使用安全套、属于性网络的一部分或性伴侣患有十二指肠球菌）因素与患有十二指肠球菌的 MSM 相关。结论 本综述强调了与感染十二指肠球菌的 MSM 相关的一些人口、行为和生物学因素，为公共卫生控制策略和未来研究提供了启示。PROSPERO 注册号为 CRD42023477691。无数据。
{"title":"Giardia duodenalis in men who have sex with men: a systematic review","authors":"Vaibhav Dubey, Vidhushan Sivachandran, Natasha Wahab, Carrie Llewellyn, Daniel Richardson","doi":"10.1136/flgastro-2024-102780","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102780","url":null,"abstract":"Objective Giardia duodenalis causes enteritis and malabsorption and can be sexually transmissible in men who have sex with men (MSM). The aim of this study was to explore factors associated with MSM with G. duodenalis . Methods MEDLINE, Embase, Emcare, PubMed, Global Health and Web of Science were searched for manuscripts published up to February 2024. The primary author screened manuscript titles and abstracts; two authors independently reviewed full-text manuscripts for eligibility and risk of bias. We only included manuscripts that included MSM with G. duodenalis and explored at least one risk factor or association. Narrative data were synthesised following the population of a predetermined table. Results Twelve manuscripts were included in this review, including cross-sectional studies (n=7), case series (n=3), cohort study (n=1), case-control study (n=1), from the USA (n=8), the UK (n=1), Cuba (n=1), Spain (n=1) and Canada (n=1) published between 1977 and 2024 and included 191 MSM with G. duodenalis . This review highlighted demographic (living with HIV and living with HIV with a CD4 count <400 cells/mL), biological (coinfection with Neisseria gonorrhoeae , Chlamydia trachomatis , Escherichia coli , Entamoeba histolytica , non-pathogenic enteric parasites, intestinal spirochaetosis, Enterobius vermicularis , previous Treponema pallidum , N. gonorrhoeae , Shigella spp, hepatitis A, E. histolytica and G. duodenalis ) and behavioural (lack of anal douching, oral-anal sex, oral sex, anal sex, group sex, use of sex toys, having more than one sexual partner per week, non-condom use, being part of a sexual network or having a sexual partner with G. duodenalis ) factors associated with MSM with G. duodenalis . Conclusion This review has highlighted some demographic, behavioural and biological factors associated with MSM with G. duodenalis , which provide insight for public health control strategies and future research. PROSPERO registration number CRD42023477691. No data are available.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"80 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141738136","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 : 2024-07-13DOI: 10.1136/flgastro-2023-102419
James Ashton, Kwang Yang Lee, Anthi Thangarajah, Astor Rodrigues, Jochen Kammermeier
There are ever-increasing therapeutic options for patients with ulcerative colitis (UC), but licensing and availability for children and young people are often years behind those aged >18 years. ‘Advanced therapies’, including biologics and small molecules, now target numerous different inflammatory pathways but continue to have a therapeutic ceiling with only 30–60% of patients responding to initial therapies, although with patients achieving mucosal healing having improved long-term outcomes. Within this review, we synthesise the paediatric evidence for the medicines, including anti-tumour necrosis factor, anti-integrin, anti-interleukin-12/23 monoclonal antibodies, alongside Janus kinase (JAK)-inhibitors and Sphingosine-1-phosphate inhibitors, used in moderate-to-severe UC, and extrapolate the adult literature where paediatric data are lacking. Finally, we look at the potential for optimal use and sequencing of these therapies when they are used in an empirical algorithm and consider some of the longer-term implications of loss of response.
{"title":"Therapeutic options for children and young people with moderate-to-severe ulcerative colitis","authors":"James Ashton, Kwang Yang Lee, Anthi Thangarajah, Astor Rodrigues, Jochen Kammermeier","doi":"10.1136/flgastro-2023-102419","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102419","url":null,"abstract":"There are ever-increasing therapeutic options for patients with ulcerative colitis (UC), but licensing and availability for children and young people are often years behind those aged >18 years. ‘Advanced therapies’, including biologics and small molecules, now target numerous different inflammatory pathways but continue to have a therapeutic ceiling with only 30–60% of patients responding to initial therapies, although with patients achieving mucosal healing having improved long-term outcomes. Within this review, we synthesise the paediatric evidence for the medicines, including anti-tumour necrosis factor, anti-integrin, anti-interleukin-12/23 monoclonal antibodies, alongside Janus kinase (JAK)-inhibitors and Sphingosine-1-phosphate inhibitors, used in moderate-to-severe UC, and extrapolate the adult literature where paediatric data are lacking. Finally, we look at the potential for optimal use and sequencing of these therapies when they are used in an empirical algorithm and consider some of the longer-term implications of loss of response.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608763","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 : 2024-07-13DOI: 10.1136/flgastro-2024-102703
Shivang Chaudhary, Hayden Rotramel, Anam Ahmad, Philip Vaidyan, Adam Kilian
The patient is admitted to the hospital for a 5-day history of diffuse myalgias, cough, diarrhoea and fever peaking at 100.8°F (38.2°C). Medical history is significant for systemic lupus erythematosus (SLE), managed with hydroxychloroquine 400 mg daily, mycophenolate mofetil 500 mg two times a day and prednisone 5 mg daily. Laboratory tests are provided in table 1. View this table: Table 1 Laboratory values Chest radiography identified interstitial opacities in the right upper lung field, indicative of pneumonia. Consequently, treatment with amoxicillin-clavulanic acid and doxycycline was initiated. During hospitalisation, the patient developed severe abdominal pain, was refractory to opioid analgesics and had exacerbated diarrhoea. A physical examination revealed generalised abdominal tenderness. To elucidate …
{"title":"Rare case of intractable abdominal pain","authors":"Shivang Chaudhary, Hayden Rotramel, Anam Ahmad, Philip Vaidyan, Adam Kilian","doi":"10.1136/flgastro-2024-102703","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102703","url":null,"abstract":"The patient is admitted to the hospital for a 5-day history of diffuse myalgias, cough, diarrhoea and fever peaking at 100.8°F (38.2°C). Medical history is significant for systemic lupus erythematosus (SLE), managed with hydroxychloroquine 400 mg daily, mycophenolate mofetil 500 mg two times a day and prednisone 5 mg daily. Laboratory tests are provided in table 1. View this table: Table 1 Laboratory values Chest radiography identified interstitial opacities in the right upper lung field, indicative of pneumonia. Consequently, treatment with amoxicillin-clavulanic acid and doxycycline was initiated. During hospitalisation, the patient developed severe abdominal pain, was refractory to opioid analgesics and had exacerbated diarrhoea. A physical examination revealed generalised abdominal tenderness. To elucidate …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"24 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608520","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 : 2024-07-13DOI: 10.1136/flgastro-2024-102710
Oliver D Tavabie, Yvanne Enever, Daniel Green, Helen Crisp, Emmanouil Tsochatzis, Amir Gander, Dina Mansour, Vanessa Hebditch, Julie Adams, Adam Ashbourn, Christopher Mysko, Richard Allen, Laura Kent, James B Maurice, Ankur Srivastava, Abhishek Chauhan, Tom Johnston, Janet Ruane, Rebecca Varni, Caroline Fletcher, Cyril Sieberhagen, Gordon Hay, Giovanna Bretland, Maggie Corrigan, Francesco Ferraro, Riley McMahon, Trudie Burge, Harry Ferguson, Louise Jennings, Brian Hogan, Andrew Cook, Rajiv Jalan, Gautam Mehta
Developing new treatments that improve outcomes for patients with decompensated cirrhosis remains an unmet area of clinical need. The UK has a rich history of being on the forefront of clinical trials for this patient group. However, there have been challenges in achieving this goal in the past decade, with several negative studies as well as trials struggling to achieve recruitment. This has been further exacerbated by the changed clinical landscape following the COVID-19 pandemic. In response to this, the O’Shaughnessy report was commissioned to identify potential opportunities to improve clinical trial performance in the UK. In this review article, we identify critical areas for the UK hepatology community to collaborate and develop sustainable partnerships for clinical trial delivery which will ensure that outcomes are representative, inclusive and patient-centred.
{"title":"From O’Shaughnessy to opportunity: innovating Hepatology Trials in the UK","authors":"Oliver D Tavabie, Yvanne Enever, Daniel Green, Helen Crisp, Emmanouil Tsochatzis, Amir Gander, Dina Mansour, Vanessa Hebditch, Julie Adams, Adam Ashbourn, Christopher Mysko, Richard Allen, Laura Kent, James B Maurice, Ankur Srivastava, Abhishek Chauhan, Tom Johnston, Janet Ruane, Rebecca Varni, Caroline Fletcher, Cyril Sieberhagen, Gordon Hay, Giovanna Bretland, Maggie Corrigan, Francesco Ferraro, Riley McMahon, Trudie Burge, Harry Ferguson, Louise Jennings, Brian Hogan, Andrew Cook, Rajiv Jalan, Gautam Mehta","doi":"10.1136/flgastro-2024-102710","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102710","url":null,"abstract":"Developing new treatments that improve outcomes for patients with decompensated cirrhosis remains an unmet area of clinical need. The UK has a rich history of being on the forefront of clinical trials for this patient group. However, there have been challenges in achieving this goal in the past decade, with several negative studies as well as trials struggling to achieve recruitment. This has been further exacerbated by the changed clinical landscape following the COVID-19 pandemic. In response to this, the O’Shaughnessy report was commissioned to identify potential opportunities to improve clinical trial performance in the UK. In this review article, we identify critical areas for the UK hepatology community to collaborate and develop sustainable partnerships for clinical trial delivery which will ensure that outcomes are representative, inclusive and patient-centred.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"43 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608587","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 : 2024-07-13DOI: 10.1136/flgastro-2024-102657
Alexander Johnson Parker, Greg Tokwabilula, Lakshmi Narsinganallore Venkatesh, Rana Bhattacharya, Jonathan Bannard-Smith, Daniel Haley, Abubaker Y M Ahmed, Anthony Wilson, Joe Geraghty
Objectives 1. Describe characteristics of patients with severe acute pancreatitis (SAP) requiring admission to Critical Care, including interventional management of pancreatic fluid collections. 2. Quantify whether patients requiring drainage of collections via a Lumen-Apposing Metal Stent (LAMS) have different patient experiences and demands on critical care and pancreatic services, compared with those without. 3. Identify possible standards of care to help guide management and to evaluate these standards in current practice. Design/Method Retrospective observational study of patients admitted to the adult Critical Care Unit at Manchester Royal Infirmary with SAP between 1st January 2019 and 16th June 2022 using Intensive Care National Audit &and Research Centre (ICNARC) data and electronic patient records. Results There were 96 admissions during 90 hospital episodes with a median admission Acute Physiology and Chronic Health Evaluation II (APACHE II) Score of 14. LAMS insertion was undertaken in 32%. Mean time to insertion was 49 days after initial presentation. Percutaneous drainage was undertaken in 30% and surgical management in 10%. Major bleeding was observed in 6% of LAMS patients and 5% of non-LAMS patients. 90% of LAMS patients were discussed in a specialist MDT, 84% underwent CT imaging within 7 days days prior to LAMS insertion and 26% underwent deep microbiological sampling via the LAMS. Median total hospital length of stay was 68 days and mortality at ultimate hospital discharge was 23%. Conclusion Critically ill patients with SAP have a long length of stay. Mortality rates are in keeping with predicted APACHE II scores. Technological advances have created a need for new optimizedoptimised treatment pathways, auditable by adherence to validated standards of care. Data are available on reasonable request.
{"title":"Severe acute pancreatitis in the era of endoscopically placed lumen-apposing metal stents (LAMS): critical care outcomes from a large UK pancreatobiliary centre","authors":"Alexander Johnson Parker, Greg Tokwabilula, Lakshmi Narsinganallore Venkatesh, Rana Bhattacharya, Jonathan Bannard-Smith, Daniel Haley, Abubaker Y M Ahmed, Anthony Wilson, Joe Geraghty","doi":"10.1136/flgastro-2024-102657","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102657","url":null,"abstract":"Objectives 1. Describe characteristics of patients with severe acute pancreatitis (SAP) requiring admission to Critical Care, including interventional management of pancreatic fluid collections. 2. Quantify whether patients requiring drainage of collections via a Lumen-Apposing Metal Stent (LAMS) have different patient experiences and demands on critical care and pancreatic services, compared with those without. 3. Identify possible standards of care to help guide management and to evaluate these standards in current practice. Design/Method Retrospective observational study of patients admitted to the adult Critical Care Unit at Manchester Royal Infirmary with SAP between 1st January 2019 and 16th June 2022 using Intensive Care National Audit &and Research Centre (ICNARC) data and electronic patient records. Results There were 96 admissions during 90 hospital episodes with a median admission Acute Physiology and Chronic Health Evaluation II (APACHE II) Score of 14. LAMS insertion was undertaken in 32%. Mean time to insertion was 49 days after initial presentation. Percutaneous drainage was undertaken in 30% and surgical management in 10%. Major bleeding was observed in 6% of LAMS patients and 5% of non-LAMS patients. 90% of LAMS patients were discussed in a specialist MDT, 84% underwent CT imaging within 7 days days prior to LAMS insertion and 26% underwent deep microbiological sampling via the LAMS. Median total hospital length of stay was 68 days and mortality at ultimate hospital discharge was 23%. Conclusion Critically ill patients with SAP have a long length of stay. Mortality rates are in keeping with predicted APACHE II scores. Technological advances have created a need for new optimizedoptimised treatment pathways, auditable by adherence to validated standards of care. Data are available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608586","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 : 2024-07-11DOI: 10.1136/flgastro-2024-102658
Michael Colwill, Richard Pollok, Leighton Seal, Andrew Poullis
There has been greater societal awareness of differences in gender identity and sexual orientation in recent years. The rates of identifying as transgender or gender non-conforming (TGNC) are increasing and are known to be higher in the younger population and will therefore be over-represented in the inflammatory bowel disease (IBD) subpopulation. However, despite this there is very little in the literature with regards to those who identify as TGNC and are diagnosed with IBD (TGNC-IBD). Many TGNC individuals have poor experiences when seeking healthcare and many physicians find it a challenging and daunting clinical situation to be faced with. We reviewed the available literature with regards to TGNC-IBD population demographics, physical, mental and sexual health considerations, medication interactions and implications for surgery in this heterogenous group. We have identified areas that need further research and suggested simple and practical steps that can be adopted in order to help healthcare providers improve the experience for TGNC individuals diagnosed with IBD and the quality of care they provide.
{"title":"Impact of gender identity in the inflammatory bowel disease population: an evidence review and practical steps for gastroenterologists","authors":"Michael Colwill, Richard Pollok, Leighton Seal, Andrew Poullis","doi":"10.1136/flgastro-2024-102658","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102658","url":null,"abstract":"There has been greater societal awareness of differences in gender identity and sexual orientation in recent years. The rates of identifying as transgender or gender non-conforming (TGNC) are increasing and are known to be higher in the younger population and will therefore be over-represented in the inflammatory bowel disease (IBD) subpopulation. However, despite this there is very little in the literature with regards to those who identify as TGNC and are diagnosed with IBD (TGNC-IBD). Many TGNC individuals have poor experiences when seeking healthcare and many physicians find it a challenging and daunting clinical situation to be faced with. We reviewed the available literature with regards to TGNC-IBD population demographics, physical, mental and sexual health considerations, medication interactions and implications for surgery in this heterogenous group. We have identified areas that need further research and suggested simple and practical steps that can be adopted in order to help healthcare providers improve the experience for TGNC individuals diagnosed with IBD and the quality of care they provide.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"64 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141585243","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 : 2024-06-26DOI: 10.1136/flgastro-2024-102644
Maria Bishara, Rebecca Smith, Christopher Roberts, Yousra Djouider, Claire Bewshea, Rachel Nice, Nicholas A Kennedy, James R Goodhand, Tariq Ahmad
Objective Why about a quarter of patients with inflammatory bowel disease (IBD) suffer symptoms for more than a year before their diagnosis made is unclear. Low public awareness, embarrassment and the apprehension of invasive tests are cited. The anonymity of direct-to-public calprotectin testing may overcome these barriers. We sought to characterise what calprotectin testing is available directly to the public in the UK. Design/method We conducted a cross-sectional evaluation of the calprotectin assays available online in the UK. Collection kits were procured from eligible providers, and surplus stool tested to receive follow-up advice for known positive (>50–100 μg/g) and negative (<50 μg/g) stool samples. Results Half (54.5% (6/11)) of the available tests were home lateral flow tests and the remainder were laboratory-based ELISAs. The lateral flow tests were considerably cheaper than the laboratory-based tests (median (range) cost £14.20 (£7.85–21.00) vs £75.85 (£59–151), p<0.0001). The median turnaround time for the laboratory tests was 14 (range: 1–23) days. All but one provider used a positivity threshold of 50 μg/g. All tests included written and pictorial instructions with the testing kit. Contact with a physician was recommended for similar proportions of positive and negative calprotectin results (54.5% (6/11) vs 54.5% (6/11), p=1). Conclusion In the UK, the public can choose between inexpensive home-based lateral flow tests or send stool samples for gold-standard laboratory testing of calprotectin. The low cost and rapid turnaround times suggest that direct-to-public calprotectin testing could be promoted to try to reduce the time to IBD diagnosis. Data are available upon reasonable request. The data will be made available to investigators whose proposed use of the data has been approved by an independent review committee. Analyses will be restricted to the aims in the approved proposal. Proposals should be directed to Tariq Ahmad (tariq.ahmad1@nhs.net). To gain full access data, requestors will need to sign a data access agreement.
{"title":"Cross-sectional evaluation of online direct-to-public calprotectin testing","authors":"Maria Bishara, Rebecca Smith, Christopher Roberts, Yousra Djouider, Claire Bewshea, Rachel Nice, Nicholas A Kennedy, James R Goodhand, Tariq Ahmad","doi":"10.1136/flgastro-2024-102644","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102644","url":null,"abstract":"Objective Why about a quarter of patients with inflammatory bowel disease (IBD) suffer symptoms for more than a year before their diagnosis made is unclear. Low public awareness, embarrassment and the apprehension of invasive tests are cited. The anonymity of direct-to-public calprotectin testing may overcome these barriers. We sought to characterise what calprotectin testing is available directly to the public in the UK. Design/method We conducted a cross-sectional evaluation of the calprotectin assays available online in the UK. Collection kits were procured from eligible providers, and surplus stool tested to receive follow-up advice for known positive (>50–100 μg/g) and negative (<50 μg/g) stool samples. Results Half (54.5% (6/11)) of the available tests were home lateral flow tests and the remainder were laboratory-based ELISAs. The lateral flow tests were considerably cheaper than the laboratory-based tests (median (range) cost £14.20 (£7.85–21.00) vs £75.85 (£59–151), p<0.0001). The median turnaround time for the laboratory tests was 14 (range: 1–23) days. All but one provider used a positivity threshold of 50 μg/g. All tests included written and pictorial instructions with the testing kit. Contact with a physician was recommended for similar proportions of positive and negative calprotectin results (54.5% (6/11) vs 54.5% (6/11), p=1). Conclusion In the UK, the public can choose between inexpensive home-based lateral flow tests or send stool samples for gold-standard laboratory testing of calprotectin. The low cost and rapid turnaround times suggest that direct-to-public calprotectin testing could be promoted to try to reduce the time to IBD diagnosis. Data are available upon reasonable request. The data will be made available to investigators whose proposed use of the data has been approved by an independent review committee. Analyses will be restricted to the aims in the approved proposal. Proposals should be directed to Tariq Ahmad (tariq.ahmad1@nhs.net). To gain full access data, requestors will need to sign a data access agreement.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509620","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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