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}
Pub Date : 2024-06-26DOI: 10.1136/flgastro-2024-102742
Jan Kubovy, Matthew Drake, Rajan N Patel
Cold snare polypectomy (CSP) is the treatment of choice for polyps less than 10 mm in size and sessile serrated lesions.1 We present a 66-year-old woman with Crohn’s colitis. Inflammatory bowel disease (IBD) was in complete clinico-endoscopic remission and colonoscopy was performed for dysplasia surveillance. …
{"title":"Delayed colonic perforation secondary to cold snare polypectomy","authors":"Jan Kubovy, Matthew Drake, Rajan N Patel","doi":"10.1136/flgastro-2024-102742","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102742","url":null,"abstract":"Cold snare polypectomy (CSP) is the treatment of choice for polyps less than 10 mm in size and sessile serrated lesions.1 We present a 66-year-old woman with Crohn’s colitis. Inflammatory bowel disease (IBD) was in complete clinico-endoscopic remission and colonoscopy was performed for dysplasia surveillance. …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141530114","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 : 2024-06-20DOI: 10.1136/flgastro-2024-102764
Heng Chi, Michael Staessens, Wim J Lammers, Pieter Jan F de Jonge
A 65-year-old woman with a medical history of cholecystectomy 20 years ago was referred to our hospital for recurrent colic pain in the upper abdomen with intermittent cholestatic liver enzyme abnormalities. She also experienced an episode of acute pancreatitis 2 weeks before the presentation. CT showed a dilated common bile duct with a hyperdense object of 10×4 mm in the distal common bile duct, suspecting …
{"title":"Uncommon cause of pancreatitis 20 years after cholecystectomy","authors":"Heng Chi, Michael Staessens, Wim J Lammers, Pieter Jan F de Jonge","doi":"10.1136/flgastro-2024-102764","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102764","url":null,"abstract":"A 65-year-old woman with a medical history of cholecystectomy 20 years ago was referred to our hospital for recurrent colic pain in the upper abdomen with intermittent cholestatic liver enzyme abnormalities. She also experienced an episode of acute pancreatitis 2 weeks before the presentation. CT showed a dilated common bile duct with a hyperdense object of 10×4 mm in the distal common bile duct, suspecting …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509521","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 : 2024-06-20DOI: 10.1136/flgastro-2024-102722
Benjamin Wipper, Hanna Blaney, Robert Giraneza, Prosper Ingabire, Vincent Dusabejambo, Udit Asija, Erik C von Rosenvinge
A Rwandan man in his 40s underwent an upper gastrointestinal endoscopy for evaluation of solid-food dysphagia. Of note, the patient also reported a long-standing history of anaemia, which was originally diagnosed in 2000. He had required four transfusions since and noted that he had previously been prescribed tot’hema syrup (a form of iron supplementation) but was no longer taking it. Laboratory tests around the time of endoscopy showed microcytic anaemia (haemoglobin 99.1 g/L, median corpuscular volume 61.84 fL) with an elevated reticulocyte count (91×109/L). Further labs showed low serum iron (28 mcg/dL) and ferritin (20.5 ng/mL). The patient denied ever experiencing melena or haematochezia. Endoscopic examination revealed a partially obstructing Schatzki’s ring as the explanation for his dysphagia and this was treated with balloon dilation. The endoscopy also revealed numerous blue-violet vascular-appearing …
{"title":"Rwandan man with a case of the blues","authors":"Benjamin Wipper, Hanna Blaney, Robert Giraneza, Prosper Ingabire, Vincent Dusabejambo, Udit Asija, Erik C von Rosenvinge","doi":"10.1136/flgastro-2024-102722","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102722","url":null,"abstract":"A Rwandan man in his 40s underwent an upper gastrointestinal endoscopy for evaluation of solid-food dysphagia. Of note, the patient also reported a long-standing history of anaemia, which was originally diagnosed in 2000. He had required four transfusions since and noted that he had previously been prescribed tot’hema syrup (a form of iron supplementation) but was no longer taking it. Laboratory tests around the time of endoscopy showed microcytic anaemia (haemoglobin 99.1 g/L, median corpuscular volume 61.84 fL) with an elevated reticulocyte count (91×109/L). Further labs showed low serum iron (28 mcg/dL) and ferritin (20.5 ng/mL). The patient denied ever experiencing melena or haematochezia. Endoscopic examination revealed a partially obstructing Schatzki’s ring as the explanation for his dysphagia and this was treated with balloon dilation. The endoscopy also revealed numerous blue-violet vascular-appearing …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509621","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 : 2024-06-18DOI: 10.1136/flgastro-2024-102765
Joaquin Fisac-Vazquez, Laura G-Pastrian, Marta de Uribe-Viloria, Maria Dolores Martin-Arranz
An asymptomatic 65-year-old woman was referred to our endoscopy unit after a screening positive faecal occult blood test. Colonoscopy revealed a pale, whitish colonic mucosa with yellowish specks (figure 1), congestive areas and foci of lymphoid follicular hyperplasia (figure 2). Sessile lesions (0-Is) with whitish speckling on their surface were also identified. Figure 1 Whitish colonic mucosa with yellowish specks. Figure 2 Congestive areas and foci of lymphoid follicular hyperplasia. On histology, a dense infiltrate of foamy macrophages was …
{"title":"Whitish colonic mucosa","authors":"Joaquin Fisac-Vazquez, Laura G-Pastrian, Marta de Uribe-Viloria, Maria Dolores Martin-Arranz","doi":"10.1136/flgastro-2024-102765","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102765","url":null,"abstract":"An asymptomatic 65-year-old woman was referred to our endoscopy unit after a screening positive faecal occult blood test. Colonoscopy revealed a pale, whitish colonic mucosa with yellowish specks (figure 1), congestive areas and foci of lymphoid follicular hyperplasia (figure 2). Sessile lesions (0-Is) with whitish speckling on their surface were also identified. Figure 1 Whitish colonic mucosa with yellowish specks. Figure 2 Congestive areas and foci of lymphoid follicular hyperplasia. On histology, a dense infiltrate of foamy macrophages was …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"18 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509524","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 : 2024-05-31DOI: 10.1136/flgastro-2023-102473
Robin Baddeley, Nikolaos Voulvoulis, Siwan Thomas-Gibson, Bu'Hussain Hayee
Concern regarding the environmental impact of healthcare provision is now accompanied by a legal commitment for the NHS to align itself with national emissions targets. Meanwhile, the academic literature increasingly features environmental impact assessments focused on healthcare products, processes and systems. However, the current evidence base contains significant methodological heterogeneity, and the healthcare context demands that particular considerations are made when interpreting the findings from these studies. In this article, we consider the role environmental accounting methodologies can play in the effort to achieve environmental sustainability in healthcare; their utility and limitations.
{"title":"Environmental impact assessment in healthcare: utility and limitations","authors":"Robin Baddeley, Nikolaos Voulvoulis, Siwan Thomas-Gibson, Bu'Hussain Hayee","doi":"10.1136/flgastro-2023-102473","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102473","url":null,"abstract":"Concern regarding the environmental impact of healthcare provision is now accompanied by a legal commitment for the NHS to align itself with national emissions targets. Meanwhile, the academic literature increasingly features environmental impact assessments focused on healthcare products, processes and systems. However, the current evidence base contains significant methodological heterogeneity, and the healthcare context demands that particular considerations are made when interpreting the findings from these studies. In this article, we consider the role environmental accounting methodologies can play in the effort to achieve environmental sustainability in healthcare; their utility and limitations.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"8 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141191774","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 : 2024-05-29DOI: 10.1136/flgastro-2024-102673
Rory James McCluskey, Jessie Elliott, Jan Leyden, John Conneely, Gerry McEntee, Suzanne O'Mahony, Niall McInerney
A previously well 43-year-old men was admitted with right upper quadrant and epigastric pain, fever and vomiting. His medical history included asymptomatic cholestatic liver function tests for which serial ultrasound (US), magnetic resonance cholangiopancreatography, fibroscan and a US-guided liver biopsy had proved unremarkable several years prior to this presentation. Physical examination revealed diffuse abdominal tenderness worst in the right upper quadrant and epigastric region. Laboratory investigations demonstrated raised inflammatory markers and deranged liver function but were otherwise unremarkable. CT of the abdomen and pelvis showed extensive pancreatic stranding and fluid most prominent around the tail and body of the pancreas. The patient had no history of gallstones, alcohol misuse, new medications, family history or hypercholesterolemia. The patient was managed conservatively but subsequently deteriorated with features of abdominal sepsis. Serial …
一名 43 岁的男性因右上腹和上腹痛、发烧和呕吐入院。他的病史包括无症状性胆汁淤积性肝功能检查，在这次就诊前的几年里，连续的超声波（US）、磁共振胆胰造影、纤维扫描和 US 引导下的肝活检均未发现异常。体格检查显示，右上腹和上腹部弥漫性压痛最严重。实验室检查显示炎症标志物升高，肝功能异常，但其他方面无异常。腹部和盆腔CT显示，胰腺尾部和胰体周围有广泛的胰腺绞窄和积液。患者没有胆结石史、酗酒史、新服药史、家族史或高胆固醇血症史。患者接受了保守治疗，但随后病情恶化，出现腹腔败血症特征。连续...
{"title":"Unique cause of acute pancreatitis","authors":"Rory James McCluskey, Jessie Elliott, Jan Leyden, John Conneely, Gerry McEntee, Suzanne O'Mahony, Niall McInerney","doi":"10.1136/flgastro-2024-102673","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102673","url":null,"abstract":"A previously well 43-year-old men was admitted with right upper quadrant and epigastric pain, fever and vomiting. His medical history included asymptomatic cholestatic liver function tests for which serial ultrasound (US), magnetic resonance cholangiopancreatography, fibroscan and a US-guided liver biopsy had proved unremarkable several years prior to this presentation. Physical examination revealed diffuse abdominal tenderness worst in the right upper quadrant and epigastric region. Laboratory investigations demonstrated raised inflammatory markers and deranged liver function but were otherwise unremarkable. CT of the abdomen and pelvis showed extensive pancreatic stranding and fluid most prominent around the tail and body of the pancreas. The patient had no history of gallstones, alcohol misuse, new medications, family history or hypercholesterolemia. The patient was managed conservatively but subsequently deteriorated with features of abdominal sepsis. Serial …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"97 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141192019","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 : 2024-05-13DOI: 10.1136/flgastro-2023-102500
Mai Ling Perman
Despite contributing minimally to global greenhouse gas emissions,1 Pacific Island nations are at the frontline of climate change impacts.2 Their heightened vulnerability stems from their geographical dispersal across the expansive Pacific Ocean, which leaves them encircled by vast bodies of water. This unique geological position subjects these island communities to climate-related threats, including rising sea levels, coastline erosion, ocean acidification, loss of biodiversity, food and water insecurities and extreme weather events, jeopardising their existence and way of life. Oceania comprises Australia, New Zealand and the PICs and territories (see figure 1). The three ethnogeographic regions (Melanesia, Micronesia and Polynesia) form the PICs. Of these, 13 are sovereign nations, while others maintain unique political associations with France, New Zealand and the USA. Figure 1 Map of Oceania (Source: map-oceania-05.gif (720×410) (globalsecurity.org). The self-governing nations have almost 13 million people but only about 2.7 million live on the smaller islands.3 They are classified as low-income and middle-income countries.3 These include the Federated States of Micronesia, Fiji, Kiribati, the Republic of the Marshall Islands (RMI), Nauru, Papua New Guinea, Samoa, the Solomon Islands, Tonga, Tuvalu and Vanuatu. Each country boasts a unique blend of culture, tradition, history and political systems. As Earth becomes warmer due to climate change, sea levels rise via two main mechanisms: expanding heated seawater and melting ice sheets and glaciers.2 Because some PICs are low-lying atolls, they face the potential existential threat of vanishing underwater with rising sea levels. The countries with the most significant threat of ‘sinking’ first are Tuvalu, Kiribati and the Republic of the Marshall Islands. Their highest elevations vary from atoll to atoll, but, generally, they are mostly under 5 m above sea level. The only bridge, which is the highest peak (<10 m above sea level) in Majuro, Republic of the …
{"title":"Climate change and gastroenterology: from the frontline","authors":"Mai Ling Perman","doi":"10.1136/flgastro-2023-102500","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102500","url":null,"abstract":"Despite contributing minimally to global greenhouse gas emissions,1 Pacific Island nations are at the frontline of climate change impacts.2 Their heightened vulnerability stems from their geographical dispersal across the expansive Pacific Ocean, which leaves them encircled by vast bodies of water. This unique geological position subjects these island communities to climate-related threats, including rising sea levels, coastline erosion, ocean acidification, loss of biodiversity, food and water insecurities and extreme weather events, jeopardising their existence and way of life. Oceania comprises Australia, New Zealand and the PICs and territories (see figure 1). The three ethnogeographic regions (Melanesia, Micronesia and Polynesia) form the PICs. Of these, 13 are sovereign nations, while others maintain unique political associations with France, New Zealand and the USA. Figure 1 Map of Oceania (Source: map-oceania-05.gif (720×410) (globalsecurity.org). The self-governing nations have almost 13 million people but only about 2.7 million live on the smaller islands.3 They are classified as low-income and middle-income countries.3 These include the Federated States of Micronesia, Fiji, Kiribati, the Republic of the Marshall Islands (RMI), Nauru, Papua New Guinea, Samoa, the Solomon Islands, Tonga, Tuvalu and Vanuatu. Each country boasts a unique blend of culture, tradition, history and political systems. As Earth becomes warmer due to climate change, sea levels rise via two main mechanisms: expanding heated seawater and melting ice sheets and glaciers.2 Because some PICs are low-lying atolls, they face the potential existential threat of vanishing underwater with rising sea levels. The countries with the most significant threat of ‘sinking’ first are Tuvalu, Kiribati and the Republic of the Marshall Islands. Their highest elevations vary from atoll to atoll, but, generally, they are mostly under 5 m above sea level. The only bridge, which is the highest peak (<10 m above sea level) in Majuro, Republic of the …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"68 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140930838","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}
A 43-year-old woman presented with 1 day of epigastric pain and a developing fever. She was tachycardic and febrile. Physical examination showed rebound tenderness on the left upper quadrant with decreased bowel sounds. CT of the abdomen revealed duodenal perforation surrounding a mass of unknown nature (figure 1). An oesophagogastroduodenoscopy showed a phytobezoar unusually located in the fourth duodenal segment (figure 2). A bezoar is a rare cause of small bowel perforation that most frequently occurs in …
{"title":"Perforation of the fourth duodenal segment and peritonitis caused by a bezoar","authors":"Baptiste Massart, Chieh-Wen Lai, Kian-Hwee Chong, Jia-Hui Chen","doi":"10.1136/flgastro-2024-102739","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102739","url":null,"abstract":"A 43-year-old woman presented with 1 day of epigastric pain and a developing fever. She was tachycardic and febrile. Physical examination showed rebound tenderness on the left upper quadrant with decreased bowel sounds. CT of the abdomen revealed duodenal perforation surrounding a mass of unknown nature (figure 1). An oesophagogastroduodenoscopy showed a phytobezoar unusually located in the fourth duodenal segment (figure 2). A bezoar is a rare cause of small bowel perforation that most frequently occurs in …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140930839","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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