Pub Date : 2024-02-23DOI: 10.1136/flgastro-2023-102567
Desmond Leddin
Sustainable practice means living within our means and not compromising the health of the planet for future generations. We are not meeting this goal at present as evidenced by the breaking of several indicators of planetary health and ever-increasing global mean temperatures. The arguments in favour of environmental sustainability include our ethical obligations as healthcare providers not to harm patients. We know that the emissions from healthcare are damaging health, so it follows that we have an obligation to minimise them. There is also the issue of intergenerational justice, that is not living beyond our means and leaving the problems for the next generation to deal with. We have professional obligations of leadership and advocacy on this issue, and it makes good economic and management sense to reduce environmental damage. Finally, there is the question of self-interest. If we do not change the trajectory of global warming, we face an existential threat in the not-too-distant future. We currently lack data on how to most effectively reduce the environmental impact of digestive health practice and we even lack a clear vision of what sustainable care might look like. However, that is being remedied and in the meantime it should not stop us beginning to take action, which is urgently needed as the climate crisis continues to gather momentum.
{"title":"Should environmental sustainability be a priority for the gastroenterology community?","authors":"Desmond Leddin","doi":"10.1136/flgastro-2023-102567","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102567","url":null,"abstract":"Sustainable practice means living within our means and not compromising the health of the planet for future generations. We are not meeting this goal at present as evidenced by the breaking of several indicators of planetary health and ever-increasing global mean temperatures. The arguments in favour of environmental sustainability include our ethical obligations as healthcare providers not to harm patients. We know that the emissions from healthcare are damaging health, so it follows that we have an obligation to minimise them. There is also the issue of intergenerational justice, that is not living beyond our means and leaving the problems for the next generation to deal with. We have professional obligations of leadership and advocacy on this issue, and it makes good economic and management sense to reduce environmental damage. Finally, there is the question of self-interest. If we do not change the trajectory of global warming, we face an existential threat in the not-too-distant future. We currently lack data on how to most effectively reduce the environmental impact of digestive health practice and we even lack a clear vision of what sustainable care might look like. However, that is being remedied and in the meantime it should not stop us beginning to take action, which is urgently needed as the climate crisis continues to gather momentum.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139945540","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 : 2024-02-19DOI: 10.1136/flgastro-2023-102472
James B Maurice, Mhairi Donnelly
Healthcare services have a significant environmental cost that is contributing to the current climate crisis. Patients with liver disease are vulnerable to the consequences of environmental change, but progress has been slow in making hepatology services more sustainable. This article explores how climate change may impact on liver disease, how we may make early steps to apply the principals of sustainable healthcare into our daily practice and identifies areas for future research priorities.
{"title":"Green hepatology: moving forward – evidence base and practicalities","authors":"James B Maurice, Mhairi Donnelly","doi":"10.1136/flgastro-2023-102472","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102472","url":null,"abstract":"Healthcare services have a significant environmental cost that is contributing to the current climate crisis. Patients with liver disease are vulnerable to the consequences of environmental change, but progress has been slow in making hepatology services more sustainable. This article explores how climate change may impact on liver disease, how we may make early steps to apply the principals of sustainable healthcare into our daily practice and identifies areas for future research priorities.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139911028","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 : 2024-02-01DOI: 10.1136/flgastro-2023-102557
Fraser Brown, Alice Weidner, Christopher Wells, Rumneet Ghumman, Susan McConnell, Wee Sing Ngu, Elizabeth Ratcliffe, Sharmila Subramaniam, Jamie Barbour
Objective UK endoscopy training is delivered by trainers possessing well developed endoscopy and teaching skills to help learners perform high-quality endoscopy. Train The Trainer (TTT) courses are effective, but additional trainer support is variable with little formal quality assurance. We performed a survey to map UK endoscopy training, assess trainer perspectives on training delivery and identify factors that would enhance training. Design/Method An online survey was designed by trainer representatives, in collaboration with the JAG training committee, and collected responses from trainers registered on JAG endoscopy training system e-portfolio from April to June 2022. Results There were 1024 responses from all trainer disciplines, with 813 (79%) completing TTT courses and 584 (57%) having job planned dedicated training lists (DTLs). Clinical endoscopists most frequently had job-planned DTLs (71%), and DTLs occurring at least weekly (58%). 293 (29%) respondents participated as course faculty. Trainers reported high levels of pre-procedure preparation, effective dialogue and frequent feedback. The DOPS forms were ‘always/often’ completed by 81% of clinical endoscopists, 73% of gastroenterologist and 58% of surgeons. 435 (42%) trainers never had peer feedback. Responses suggested training could improve by protecting training time, attending courses, participating as faculty and receiving feedback from experienced trainers. Conclusion This survey demonstrates substantial proportions of highly motivated UK trainers who value time spent teaching and learning how to teach. Skills taught on the TTT courses are often actively used in everyday training. Improved trainer course access, protected training time and formal use of existing feedback tools by peers were highlighted as measures that could support trainers’ development. Data are available upon reasonable request. The anonymous dataset generated from the survey can be made available on reasonable request.
{"title":"UK endoscopy trainer survey: perspectives on current endoscopy training delivery, experience, barriers and opportunities","authors":"Fraser Brown, Alice Weidner, Christopher Wells, Rumneet Ghumman, Susan McConnell, Wee Sing Ngu, Elizabeth Ratcliffe, Sharmila Subramaniam, Jamie Barbour","doi":"10.1136/flgastro-2023-102557","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102557","url":null,"abstract":"Objective UK endoscopy training is delivered by trainers possessing well developed endoscopy and teaching skills to help learners perform high-quality endoscopy. Train The Trainer (TTT) courses are effective, but additional trainer support is variable with little formal quality assurance. We performed a survey to map UK endoscopy training, assess trainer perspectives on training delivery and identify factors that would enhance training. Design/Method An online survey was designed by trainer representatives, in collaboration with the JAG training committee, and collected responses from trainers registered on JAG endoscopy training system e-portfolio from April to June 2022. Results There were 1024 responses from all trainer disciplines, with 813 (79%) completing TTT courses and 584 (57%) having job planned dedicated training lists (DTLs). Clinical endoscopists most frequently had job-planned DTLs (71%), and DTLs occurring at least weekly (58%). 293 (29%) respondents participated as course faculty. Trainers reported high levels of pre-procedure preparation, effective dialogue and frequent feedback. The DOPS forms were ‘always/often’ completed by 81% of clinical endoscopists, 73% of gastroenterologist and 58% of surgeons. 435 (42%) trainers never had peer feedback. Responses suggested training could improve by protecting training time, attending courses, participating as faculty and receiving feedback from experienced trainers. Conclusion This survey demonstrates substantial proportions of highly motivated UK trainers who value time spent teaching and learning how to teach. Skills taught on the TTT courses are often actively used in everyday training. Improved trainer course access, protected training time and formal use of existing feedback tools by peers were highlighted as measures that could support trainers’ development. Data are available upon reasonable request. The anonymous dataset generated from the survey can be made available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139662719","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 : 2024-01-22DOI: 10.1136/flgastro-2023-102481
Andrew M Veitch
The climate emergency affects us all as individuals but also has major adverse effects on health and healthcare provision. Professional medical societies can advocate and educate, but can also lead by example. Medical societies can feel the same sense of helplessness, futility or a sense that it is not their responsibility which individuals face, but there are real and effective changes which can be implemented at organisational level. These positive changes will be multiplied as more societies engage and can be amplified with collaborative efforts. Often it can be difficult to know where or how to start, but there are examples from around the world, and some guidance, which can help with this process. As awareness and concern grows, there is a greater scientific exploration of environmental sustainability on healthcare, and this works in parallel with practical guidance on how to mitigate the adverse effects. Professional medical societies can promote and support research in this area but can also undertake practical measures within their organisations and associated activities. The World Gastroenterology Organisation (WGO) surveyed the leaders of its 117 member societies (49% response).1 While the majority agreed that there was a climate crisis, and that this was caused by human activity, 80% felt that their society had more pressing issues and only 16% had an education programme related to it. 49% of respondents had reduced their personal carbon emissions, but this applied to their medical society in only 26%. On a positive note, 46% were planning to form a climate change working group, although there is clearly an opportunity for others to engage in this process. The first step for an organisation might be to acknowledge that there is a climate emergency, and that it is a threat to health. The next step would be to declare an intention …
{"title":"What can professional medical societies do to mitigate climate change?","authors":"Andrew M Veitch","doi":"10.1136/flgastro-2023-102481","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102481","url":null,"abstract":"The climate emergency affects us all as individuals but also has major adverse effects on health and healthcare provision. Professional medical societies can advocate and educate, but can also lead by example. Medical societies can feel the same sense of helplessness, futility or a sense that it is not their responsibility which individuals face, but there are real and effective changes which can be implemented at organisational level. These positive changes will be multiplied as more societies engage and can be amplified with collaborative efforts. Often it can be difficult to know where or how to start, but there are examples from around the world, and some guidance, which can help with this process. As awareness and concern grows, there is a greater scientific exploration of environmental sustainability on healthcare, and this works in parallel with practical guidance on how to mitigate the adverse effects. Professional medical societies can promote and support research in this area but can also undertake practical measures within their organisations and associated activities. The World Gastroenterology Organisation (WGO) surveyed the leaders of its 117 member societies (49% response).1 While the majority agreed that there was a climate crisis, and that this was caused by human activity, 80% felt that their society had more pressing issues and only 16% had an education programme related to it. 49% of respondents had reduced their personal carbon emissions, but this applied to their medical society in only 26%. On a positive note, 46% were planning to form a climate change working group, although there is clearly an opportunity for others to engage in this process. The first step for an organisation might be to acknowledge that there is a climate emergency, and that it is a threat to health. The next step would be to declare an intention …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139561331","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 : 2024-01-17DOI: 10.1136/flgastro-2023-102559
Morris Gordon
Surgery is a vital pillar in the management of Crohn’s disease and medical options for prevention of recurrence after surgery are a key consideration. The main classes of effective induction therapies have very different efficacy data for maintenance and this is more pronounced in the postsurgical setting. In this review article, the up-to-date Cochrane reviews on the topic are presented, including a network meta-analysis. The Cochrane evidence shows a high relapse rate in the first 5 years after surgery with placebo or no treatment. The reviews demonstrate that 5-aminosalicylic acid (5-ASA) agents are probably more effective than placebo on pairwise and network meta-analysis, with moderate certainty evidence of a number needed to treat (NNT) of 13. The Cochrane evidence demonstrates that adalimumab may be more effective than placebo on pairwise and network meta-analysis, with low certainty evidence of an NNT of 2. Thiopurine analogues may be effective on pairwise analysis, but may not be effective on network meta-analysis. There was no evidence to support the use of any other agent but these findings are of low and very low certainty. It is proposed that clinicians should consider adalimumab, 5-ASA and thiopurine analogue agents based on the findings of the Cochrane synthesis. The use of the evidence, including the Grading of Recomendations, Assessment, Development, and Evaluations (GRADE) certainty and magnitude of effect data, can support discussions with patients. Future research is needed to consider other therapies that are effective in medically induced maintenance given the low certainty of evidence limiting conclusions, either supporting or refuting their use.
{"title":"Maintaining remission in Crohn’s disease post surgery: what can we learn from Cochrane?","authors":"Morris Gordon","doi":"10.1136/flgastro-2023-102559","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102559","url":null,"abstract":"Surgery is a vital pillar in the management of Crohn’s disease and medical options for prevention of recurrence after surgery are a key consideration. The main classes of effective induction therapies have very different efficacy data for maintenance and this is more pronounced in the postsurgical setting. In this review article, the up-to-date Cochrane reviews on the topic are presented, including a network meta-analysis. The Cochrane evidence shows a high relapse rate in the first 5 years after surgery with placebo or no treatment. The reviews demonstrate that 5-aminosalicylic acid (5-ASA) agents are probably more effective than placebo on pairwise and network meta-analysis, with moderate certainty evidence of a number needed to treat (NNT) of 13. The Cochrane evidence demonstrates that adalimumab may be more effective than placebo on pairwise and network meta-analysis, with low certainty evidence of an NNT of 2. Thiopurine analogues may be effective on pairwise analysis, but may not be effective on network meta-analysis. There was no evidence to support the use of any other agent but these findings are of low and very low certainty. It is proposed that clinicians should consider adalimumab, 5-ASA and thiopurine analogue agents based on the findings of the Cochrane synthesis. The use of the evidence, including the Grading of Recomendations, Assessment, Development, and Evaluations (GRADE) certainty and magnitude of effect data, can support discussions with patients. Future research is needed to consider other therapies that are effective in medically induced maintenance given the low certainty of evidence limiting conclusions, either supporting or refuting their use.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139496157","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 : 2024-01-12DOI: 10.1136/flgastro-2023-102563
Stephanie Sartain, Charlotte Wong, Emma Murray, Suneil A Raju, Amy Woods, Daniel Ashmore, Lovesh Dyall, Flora Kokwaro, Eilidh McGowan, David Leiberman, Emma Routledge, Emily Clarke, Trevor R Smith
Introduction Nutrition is an essential part of gastroenterology specialist training. There is limited evidence of trainee experience in this area. The shorter training programme introduced in 2022 may lead to reduced exposure to this subspecialty. We aimed to explore and describe current nutrition training experiences, confidence and satisfaction to inform future improvements. Methods Gastroenterology trainees were invited to participate in an online survey from 20 May 2022 to 18 July 2022. The questionnaire consisted of 27 questions with a range of free-text and Likert scale responses. Results 86 responses were received. 39.5% had undertaken an advanced training programme or core placement in nutrition. 52.9% of these felt ‘fairly confident’ or ‘very confident’ in managing intestinal failure vs 5.8% of those who had not completed a nutrition placement. Obesity and eating disorders management received the lowest ratings. Nutrition training was described as ‘fairly important’ or ‘very important’ by 98.8% and 47.0% included nutrition as part of their preferred future practice. 53.1% of ST6/7 trainees were ‘fairly confident’ or ‘very confident’ their training offered adequate experience in nutrition. Participants reported barriers including a lack of education and training opportunities, and limited early rotations offering nutrition training. Conclusion Gastroenterology trainees believe nutrition training to be important. Nutrition placements increase trainee confidence, knowledge and experiences overall, but there is variability in this. Improved structuring of placements, increased educational opportunities and exposure to this subspecialty at an earlier stage are required to ensure competency in nutrition is reliably achieved during gastroenterology training. Data are available on reasonable request. Data available on request, including data not published within the article.
{"title":"Gastroenterology trainee experience, confidence and satisfaction in nutrition training: a cross-sectional survey in the UK","authors":"Stephanie Sartain, Charlotte Wong, Emma Murray, Suneil A Raju, Amy Woods, Daniel Ashmore, Lovesh Dyall, Flora Kokwaro, Eilidh McGowan, David Leiberman, Emma Routledge, Emily Clarke, Trevor R Smith","doi":"10.1136/flgastro-2023-102563","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102563","url":null,"abstract":"Introduction Nutrition is an essential part of gastroenterology specialist training. There is limited evidence of trainee experience in this area. The shorter training programme introduced in 2022 may lead to reduced exposure to this subspecialty. We aimed to explore and describe current nutrition training experiences, confidence and satisfaction to inform future improvements. Methods Gastroenterology trainees were invited to participate in an online survey from 20 May 2022 to 18 July 2022. The questionnaire consisted of 27 questions with a range of free-text and Likert scale responses. Results 86 responses were received. 39.5% had undertaken an advanced training programme or core placement in nutrition. 52.9% of these felt ‘fairly confident’ or ‘very confident’ in managing intestinal failure vs 5.8% of those who had not completed a nutrition placement. Obesity and eating disorders management received the lowest ratings. Nutrition training was described as ‘fairly important’ or ‘very important’ by 98.8% and 47.0% included nutrition as part of their preferred future practice. 53.1% of ST6/7 trainees were ‘fairly confident’ or ‘very confident’ their training offered adequate experience in nutrition. Participants reported barriers including a lack of education and training opportunities, and limited early rotations offering nutrition training. Conclusion Gastroenterology trainees believe nutrition training to be important. Nutrition placements increase trainee confidence, knowledge and experiences overall, but there is variability in this. Improved structuring of placements, increased educational opportunities and exposure to this subspecialty at an earlier stage are required to ensure competency in nutrition is reliably achieved during gastroenterology training. Data are available on reasonable request. Data available on request, including data not published within the article.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139458748","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 : 2024-01-10DOI: 10.1136/flgastro-2023-102577
Christian Selinger, Alex Bottle, Christopher A Lamb, Rachel Ainley, Ruth Wakeman, Barney Hawthorne
Background Key performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI. Methods IBD emergency admissions for 2018–2019 from Hospital Episodes Statistics for England were compared per population and per IBD cases with patient-reported quality of care from the IBD Patient Survey 2019. Patient-reported accident and emergency (A&E) attendances and hospital admissions for IBD were also compared with patient-reported quality of care. Results For 124 IBD services within England we found only a weak and not statistically significant correlation between IBD admissions per 100 000 population and patient-rated quality of care (Spearman’s rho=0.171; p=0.057). Similarly, there was no significant correlation between IBD admissions per case and patient-rated quality of care (Spearman’s rho=0.164; p=0.113). Patients with ≥2 A&E attendances (OR: 0.72, 95% CI: 0.57 to 0.91; p<0.001) were less likely to report quality of IBD care as good or very good compared with those without A&E attendances. Patients with ≥2 admissions were less likely to rate their care as good or very good (OR: 0.75, 95% CI: 0.65 to 0.88; p<0.0001) compared with those without hospital admissions. Conclusions There is a clear association for individual patients with ≥2 admissions or A&E attendances with a lower perceived quality of care. In contrast we found no correlation on a per-unit basis for IBD admissions derived from Hospital Episode Statistics with patient-assessed quality of care. Further work is required to determine whether hospital admissions could be a useful KPI for IBD. No data are available.
{"title":"Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units","authors":"Christian Selinger, Alex Bottle, Christopher A Lamb, Rachel Ainley, Ruth Wakeman, Barney Hawthorne","doi":"10.1136/flgastro-2023-102577","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102577","url":null,"abstract":"Background Key performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI. Methods IBD emergency admissions for 2018–2019 from Hospital Episodes Statistics for England were compared per population and per IBD cases with patient-reported quality of care from the IBD Patient Survey 2019. Patient-reported accident and emergency (A&E) attendances and hospital admissions for IBD were also compared with patient-reported quality of care. Results For 124 IBD services within England we found only a weak and not statistically significant correlation between IBD admissions per 100 000 population and patient-rated quality of care (Spearman’s rho=0.171; p=0.057). Similarly, there was no significant correlation between IBD admissions per case and patient-rated quality of care (Spearman’s rho=0.164; p=0.113). Patients with ≥2 A&E attendances (OR: 0.72, 95% CI: 0.57 to 0.91; p<0.001) were less likely to report quality of IBD care as good or very good compared with those without A&E attendances. Patients with ≥2 admissions were less likely to rate their care as good or very good (OR: 0.75, 95% CI: 0.65 to 0.88; p<0.0001) compared with those without hospital admissions. Conclusions There is a clear association for individual patients with ≥2 admissions or A&E attendances with a lower perceived quality of care. In contrast we found no correlation on a per-unit basis for IBD admissions derived from Hospital Episode Statistics with patient-assessed quality of care. Further work is required to determine whether hospital admissions could be a useful KPI for IBD. No data are available.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139423046","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 : 2024-01-09DOI: 10.1136/flgastro-2023-102417
Emma P Halmos, Lihi Godny, Julie Vanderstappen, Chen Sarbagili-Shabat, Vaios Svolos
Diet is a modifiable risk factor for disease course and data over the past decade have emerged to indicate its role in Crohn’s disease (CD) and ulcerative colitis (UC). However, literature is riddled with misinterpretation of data, often leading to unexpected or conflicting results. The key understanding is that causative factors in disease development do not always proceed to an opportunity to change disease course, once established. Here, we discuss the data on dietary influences in three distinct disease states for CD and UC—predisease, active disease and quiescent disease. We appraise the literature for how our dietary recommendations should be shaped to prevent disease development and if or how that differs for CD and UC induction therapy and maintenance therapy. In UC, principles of healthy eating are likely to play a role in all states of disease. Conversely, data linking dietary factors to CD prevention and treatment are paradoxical with the highest quality evidence for CD treatment being exclusive enteral nutrition, a lactose, gluten and fibre-free diet comprising solely of ultraprocessed food—all dietary factors that are not associated or inversely associated with CD prevention. High-quality evidence from dietary trials is much awaited to expand our understanding and ultimately lead our dietary recommendations for targeted patient populations.
饮食是影响病程的一个可改变的危险因素，过去十年中出现的数据表明饮食在克罗恩病（CD）和溃疡性结肠炎（UC）中的作用。然而，文献中充斥着对数据的误读，往往导致意想不到或相互矛盾的结果。关键的认识是，疾病发展的致病因素一旦确定，并不总是有机会改变病程。在此，我们讨论了 CD 和 UC 在三种不同疾病状态下的饮食影响数据--疾病前期、疾病活动期和疾病静止期。我们对文献进行了评估，以了解我们的饮食建议应如何预防疾病的发展，以及 CD 和 UC 的诱导治疗和维持治疗是否存在差异或差异如何。在 UC 中，健康饮食原则可能在疾病的所有状态中都会发挥作用。相反，将饮食因素与 CD 预防和治疗联系起来的数据却自相矛盾，CD 治疗的最高质量证据是纯肠内营养，不含乳糖、麸质和纤维素的饮食，只包含超加工食品--所有这些饮食因素都与 CD 预防无关或成反比。我们亟需来自膳食试验的高质量证据来扩大我们的认识，并最终引导我们为目标患者群体提供膳食建议。
{"title":"Role of diet in prevention versus treatment of Crohn’s disease and ulcerative colitis","authors":"Emma P Halmos, Lihi Godny, Julie Vanderstappen, Chen Sarbagili-Shabat, Vaios Svolos","doi":"10.1136/flgastro-2023-102417","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102417","url":null,"abstract":"Diet is a modifiable risk factor for disease course and data over the past decade have emerged to indicate its role in Crohn’s disease (CD) and ulcerative colitis (UC). However, literature is riddled with misinterpretation of data, often leading to unexpected or conflicting results. The key understanding is that causative factors in disease development do not always proceed to an opportunity to change disease course, once established. Here, we discuss the data on dietary influences in three distinct disease states for CD and UC—predisease, active disease and quiescent disease. We appraise the literature for how our dietary recommendations should be shaped to prevent disease development and if or how that differs for CD and UC induction therapy and maintenance therapy. In UC, principles of healthy eating are likely to play a role in all states of disease. Conversely, data linking dietary factors to CD prevention and treatment are paradoxical with the highest quality evidence for CD treatment being exclusive enteral nutrition, a lactose, gluten and fibre-free diet comprising solely of ultraprocessed food—all dietary factors that are not associated or inversely associated with CD prevention. High-quality evidence from dietary trials is much awaited to expand our understanding and ultimately lead our dietary recommendations for targeted patient populations.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139412880","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 : 2024-01-06DOI: 10.1136/flgastro-2023-102533
Caitlin Miles, Natalie Ling, Eldho Paul, David Armstrong
Objective Constipation and distal intestinal obstruction syndrome (DIOS) are common gastrointestinal manifestations of cystic fibrosis (CF). The primary aim was to describe the characteristics of constipation and DIOS hospitalisations in a paediatric and adult CF service over a 12-year period. The secondary aims were to determine the proportion of constipation and DIOS presentations which met the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) CF Working Group definitions and to describe management strategies of both conditions. Method A retrospective study of children and adults with CF who were admitted with a primary diagnosis of constipation or DIOS between 1 January 2011 and 31 December 2022. ESPGHAN definitions for constipation and DIOS were retrospectively applied to all admissions to determine if the primary medical diagnosis met ESPGHAN criteria. Results During the 12-year study period, 42 hospitalisations for constipation were recorded in 19 patients, and 33 hospitalisations for DIOS were recorded in 23 patients. 88.10% of constipation episodes met ESPGHAN definitions, compared with 3.0% of DIOS episodes. Constipation and DIOS were primarily treated with polyethylene glycol (PEG). The use of sodium amidotrizoate meglumine enemas was significantly higher in the DIOS group (p=0.045). Those admitted with DIOS were significantly less likely to be recommended a weaning dose of PEG (p=0.018). Conclusion Children and adults with CF are more commonly admitted for the management of constipation than DIOS. There is considerable variation in diagnostic and therapeutic practice, and this study highlights the need to enhance the translation and adoption of existing best-practice guidelines. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Presentation, characteristics and management of obstructive intestinal conditions in cystic fibrosis","authors":"Caitlin Miles, Natalie Ling, Eldho Paul, David Armstrong","doi":"10.1136/flgastro-2023-102533","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102533","url":null,"abstract":"Objective Constipation and distal intestinal obstruction syndrome (DIOS) are common gastrointestinal manifestations of cystic fibrosis (CF). The primary aim was to describe the characteristics of constipation and DIOS hospitalisations in a paediatric and adult CF service over a 12-year period. The secondary aims were to determine the proportion of constipation and DIOS presentations which met the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) CF Working Group definitions and to describe management strategies of both conditions. Method A retrospective study of children and adults with CF who were admitted with a primary diagnosis of constipation or DIOS between 1 January 2011 and 31 December 2022. ESPGHAN definitions for constipation and DIOS were retrospectively applied to all admissions to determine if the primary medical diagnosis met ESPGHAN criteria. Results During the 12-year study period, 42 hospitalisations for constipation were recorded in 19 patients, and 33 hospitalisations for DIOS were recorded in 23 patients. 88.10% of constipation episodes met ESPGHAN definitions, compared with 3.0% of DIOS episodes. Constipation and DIOS were primarily treated with polyethylene glycol (PEG). The use of sodium amidotrizoate meglumine enemas was significantly higher in the DIOS group (p=0.045). Those admitted with DIOS were significantly less likely to be recommended a weaning dose of PEG (p=0.018). Conclusion Children and adults with CF are more commonly admitted for the management of constipation than DIOS. There is considerable variation in diagnostic and therapeutic practice, and this study highlights the need to enhance the translation and adoption of existing best-practice guidelines. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139374199","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 : 2024-01-01DOI: 10.1136/flgastro-2022-102221corr1
BMJ Publishing Group Ltd
Aspinall RJ, Hudson M, Ryder SD, et al . Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II). …
Aspinall RJ, Hudson M, Ryder SD, et al .接受利福昔明-α治疗的肝性脑病患者长期生存和医疗资源使用的现实证据：一项长期随访的回顾性观察性扩展研究（IMPRESS II）。...
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