Pub Date : 2023-10-11DOI: 10.1136/flgastro-2023-102508
Ahthavan Narendren, Srikar Boddupalli, Jonathan P Segal
In 2022, the British Society of Gastroenterology released guidelines on the management of functional dyspepsia (FD), providing a long-anticipated evidence-based approach to the diagnosis, classification and management of patients with FD. This review summarises the key recommendations of the recent guidelines on the management of FD.
{"title":"British Society of Gastroenterology guidelines on the management of functional dyspepsia","authors":"Ahthavan Narendren, Srikar Boddupalli, Jonathan P Segal","doi":"10.1136/flgastro-2023-102508","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102508","url":null,"abstract":"In 2022, the British Society of Gastroenterology released guidelines on the management of functional dyspepsia (FD), providing a long-anticipated evidence-based approach to the diagnosis, classification and management of patients with FD. This review summarises the key recommendations of the recent guidelines on the management of FD.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136097725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-04DOI: 10.1136/flgastro-2023-102468
Emma Saunsbury, Yazan Haddadin, Radha Gadhok, Elizabeth Ratcliffe, Suneil A Raju
Objective Shape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views. Method The British Society of Gastroenterology Trainees Section collected anonymised survey responses from trainees between June and September 2022 via an online platform. Results 40.3% of trainees responded. Strikingly, only 10% of respondents felt they could achieve certificate of completion of training (CCT) within a 4-year programme. Furthermore, 31% were not confident they would attain the required expertise in their subspecialist interest during training. 70.8% reported spending a quarter or more of their training in general internal medicine (GIM) and 71.6% felt this negatively impacted on their gastroenterology training. Only 21.6% of respondents plan to pursue a consultant post with GIM commitments. Regarding endoscopy, only 36.1% of ST7s had provisional and 22.2% full accreditation in colonoscopy. Although 92.3% of respondents wanted exposure to a ‘bleed rota’, this was the case for only 16.2%. Teaching quality was judged to be insufficient by 45.9% of respondents. Conclusion Respondents had struggled to achieve the necessary competencies for CCT even prior to the newly reduced 4-year curriculum. While still maintaining service provision, we must safeguard gastroenterology training from encroaching GIM commitments. This will be critical in order to provide capable consultants of the future and prevent UK standards from falling behind internationally.
目的:Shape of Training将英国的胃肠病学课程从5年缩短为4年。目前有人担心，这将对培训和达到顾问一级预期的能力产生不利影响。我们在全英国范围内对胃肠病学学员进行了调查，以确定他们的观点。方法英国胃肠病学学会学员组通过在线平台收集了2022年6月至9月期间学员的匿名调查反馈。结果40.3%的学员有反馈。引人注目的是，只有10%的受访者认为他们可以在4年的课程中获得培训完成证书(CCT)。此外，31%的人不相信他们能在培训期间获得他们感兴趣的子专家所需的专业知识。70.8%的人表示，他们将四分之一或更多的时间用于普通内科(GIM)培训，71.6%的人认为这对他们的胃肠病学培训产生了负面影响。只有21.6%的受访者计划从事具有GIM承诺的顾问职位。在内窥镜方面，只有36.1%的st7获得结肠镜临时认证，22.2%的st7获得结肠镜完全认证。尽管92.3%的受访者希望接触到“流血轮班”，但只有16.2%的人这样做。45.9%的受访者认为教学质量不足。即使在新减少的4年课程之前，被调查者也努力达到CCT的必要能力。在继续提供服务的同时，我们必须保护胃肠病学培训不受GIM承诺的侵蚀。这将是至关重要的，以便为未来提供有能力的顾问，并防止英国标准落后于国际。
{"title":"UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come","authors":"Emma Saunsbury, Yazan Haddadin, Radha Gadhok, Elizabeth Ratcliffe, Suneil A Raju","doi":"10.1136/flgastro-2023-102468","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102468","url":null,"abstract":"Objective Shape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views. Method The British Society of Gastroenterology Trainees Section collected anonymised survey responses from trainees between June and September 2022 via an online platform. Results 40.3% of trainees responded. Strikingly, only 10% of respondents felt they could achieve certificate of completion of training (CCT) within a 4-year programme. Furthermore, 31% were not confident they would attain the required expertise in their subspecialist interest during training. 70.8% reported spending a quarter or more of their training in general internal medicine (GIM) and 71.6% felt this negatively impacted on their gastroenterology training. Only 21.6% of respondents plan to pursue a consultant post with GIM commitments. Regarding endoscopy, only 36.1% of ST7s had provisional and 22.2% full accreditation in colonoscopy. Although 92.3% of respondents wanted exposure to a ‘bleed rota’, this was the case for only 16.2%. Teaching quality was judged to be insufficient by 45.9% of respondents. Conclusion Respondents had struggled to achieve the necessary competencies for CCT even prior to the newly reduced 4-year curriculum. While still maintaining service provision, we must safeguard gastroenterology training from encroaching GIM commitments. This will be critical in order to provide capable consultants of the future and prevent UK standards from falling behind internationally.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135590768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-03DOI: 10.1136/flgastro-2023-102494
Mohamed G Shiha, Nicoletta Nandi, Andrew J Hutchinson, Suneil A Raju, Foong Way David Tai, Luca Elli, Hugo A Penny, David Surendran Sanders
Objective Recent evidence suggests that adult patients with IgA tissue transglutaminase levels of ≥10× the upper limit of normal could be accurately diagnosed with coeliac disease without undergoing endoscopy and biopsy. We aimed to evaluate the cost-benefits and the environmental impact of implementing the no-biopsy approach for diagnosing coeliac disease in clinical practice. Design We calculated the overall direct and indirect costs of the conventional serology-biopsy approach and the no-biopsy approach for the diagnosis of coeliac disease based on the national average unit costs and the Office of National Statistics data. We further estimated the environmental impact of avoiding endoscopy based on the estimated greenhouse gas emissions from endoscopy. Results Approximately 3000 endoscopies for suspected coeliac disease could be avoided each year in the UK. Implementing the no-biopsy approach for the diagnosis of coeliac disease in adults could save the National Health Service over £2.5 million in direct and indirect costs per annum and reduce endoscopy carbon footprint by 87 tonnes of CO 2 per year, equivalent to greenhouse gas emissions from driving 222 875 miles, carbon emissions from charging over 10 million smartphones and the carbon sequestrated by 1438 trees grown for 10 years. Conclusion The implementation of this non-invasive green approach could be an essential first step in the ‘Reduce’ strategy advocated by the British Society of Gastroenterology and other international endoscopy societies for sustainable endoscopy practice.
{"title":"Cost-benefits and environmental impact of the no-biopsy approach for the diagnosis of coeliac disease in adults","authors":"Mohamed G Shiha, Nicoletta Nandi, Andrew J Hutchinson, Suneil A Raju, Foong Way David Tai, Luca Elli, Hugo A Penny, David Surendran Sanders","doi":"10.1136/flgastro-2023-102494","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102494","url":null,"abstract":"Objective Recent evidence suggests that adult patients with IgA tissue transglutaminase levels of ≥10× the upper limit of normal could be accurately diagnosed with coeliac disease without undergoing endoscopy and biopsy. We aimed to evaluate the cost-benefits and the environmental impact of implementing the no-biopsy approach for diagnosing coeliac disease in clinical practice. Design We calculated the overall direct and indirect costs of the conventional serology-biopsy approach and the no-biopsy approach for the diagnosis of coeliac disease based on the national average unit costs and the Office of National Statistics data. We further estimated the environmental impact of avoiding endoscopy based on the estimated greenhouse gas emissions from endoscopy. Results Approximately 3000 endoscopies for suspected coeliac disease could be avoided each year in the UK. Implementing the no-biopsy approach for the diagnosis of coeliac disease in adults could save the National Health Service over £2.5 million in direct and indirect costs per annum and reduce endoscopy carbon footprint by 87 tonnes of CO 2 per year, equivalent to greenhouse gas emissions from driving 222 875 miles, carbon emissions from charging over 10 million smartphones and the carbon sequestrated by 1438 trees grown for 10 years. Conclusion The implementation of this non-invasive green approach could be an essential first step in the ‘Reduce’ strategy advocated by the British Society of Gastroenterology and other international endoscopy societies for sustainable endoscopy practice.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135695587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-03DOI: 10.1136/flgastro-2023-102541
Anjan Dhar
I read this paper with great interest and would like to congratulate Ratcliffe and coauthors for their welldesigned comparative cohort study carried out in a nontertiary centre. This paper emphasises the need for adequate time for assessment of Barrett’s oesophagus during surveillance, and confirms already published evidence recommending a Barrett’s inspection time of 1 min/cm length of the Barrett’s segment using highdefinition white light endoscopy. 3 There are a few important issues that need addressing when planning services for Barrett’s oesophagus surveillance in the UK. First, while it is ideal to have a full dedicated Barrett’s list, with adequate time and a trained Barrett’s endoscopist, to achieve the best outcomes for dysplasia detection, most secondary centres in the NHS will struggle to implement this practice in the present environment of endoscopy backlog and increased clinical pressures. Second, it is still unclear from the literature as to whether having a full list of Barrett’s surveillance cases or simply adequate time (30–45 min per case) in an upper GI endoscopy list carried out by a trained endoscopist will result in a statistically significant difference in dysplasia detection rate (DDR). In this paper, the authors have not clarified whether all lesions detected in the dedicated endoscopy group were using highdefinition white light endoscopy only and/or with the help of image enhanced endoscopy (such as narrow band imaging, near focus magnification or acetic acid chromoendoscopy) as compared with the surveillance carried out in the nondedicated list, which was predominantly carried out using white light endoscopy. This is an important aspect in the detection of early Barrett’s neoplasia, since the authors mention that narrow band imaging and acetic acid chromoendoscopy was used much more frequently in the dedicated surveillance group compared with the nondedicated group. Finally, the advent of new technologies such as sponge based cell collection techniques (Cytosponge, Medtronic Inc) and artificial intelligence (AI) and computer aided detection (CADe) and characterisation of Barrett’s related neoplasia may make DDRs in nontertiary centres as good as in expert tertiary centres as long as the Barrett’s mucosa is inspected with adequate time to allow the computer to analyse the mucosal surface and vascular characteristics to make a diagnosis. The use of sponge based cell analysis has been shown to improve the selection of patients for Barrett’s surveillance. Although adequate inspection time will still be needed for an accurate diagnosis, confirming the need for 30–40 min time for each patient on a Barrett’s surveillance programme, the use of AI tools in a Cytosponge positive patient may remove the expertise needed of an endoscopist to make an optical diagnosis. This is yet to be formally validated in a comparative study of the use of AIassisted CADe between tertiary and nontertiary centres. Overall, the authors of this study
{"title":"Re: ‘Dedicated service for Barrett’s oesophagus surveillance endoscopy yields higher dysplasia detection and guideline adherence in a non-tertiary setting in the UK: a 5-year comparative cohort study’ by Ratcliffe<i>et al</i>","authors":"Anjan Dhar","doi":"10.1136/flgastro-2023-102541","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102541","url":null,"abstract":"I read this paper with great interest and would like to congratulate Ratcliffe and coauthors for their welldesigned comparative cohort study carried out in a nontertiary centre. This paper emphasises the need for adequate time for assessment of Barrett’s oesophagus during surveillance, and confirms already published evidence recommending a Barrett’s inspection time of 1 min/cm length of the Barrett’s segment using highdefinition white light endoscopy. 3 There are a few important issues that need addressing when planning services for Barrett’s oesophagus surveillance in the UK. First, while it is ideal to have a full dedicated Barrett’s list, with adequate time and a trained Barrett’s endoscopist, to achieve the best outcomes for dysplasia detection, most secondary centres in the NHS will struggle to implement this practice in the present environment of endoscopy backlog and increased clinical pressures. Second, it is still unclear from the literature as to whether having a full list of Barrett’s surveillance cases or simply adequate time (30–45 min per case) in an upper GI endoscopy list carried out by a trained endoscopist will result in a statistically significant difference in dysplasia detection rate (DDR). In this paper, the authors have not clarified whether all lesions detected in the dedicated endoscopy group were using highdefinition white light endoscopy only and/or with the help of image enhanced endoscopy (such as narrow band imaging, near focus magnification or acetic acid chromoendoscopy) as compared with the surveillance carried out in the nondedicated list, which was predominantly carried out using white light endoscopy. This is an important aspect in the detection of early Barrett’s neoplasia, since the authors mention that narrow band imaging and acetic acid chromoendoscopy was used much more frequently in the dedicated surveillance group compared with the nondedicated group. Finally, the advent of new technologies such as sponge based cell collection techniques (Cytosponge, Medtronic Inc) and artificial intelligence (AI) and computer aided detection (CADe) and characterisation of Barrett’s related neoplasia may make DDRs in nontertiary centres as good as in expert tertiary centres as long as the Barrett’s mucosa is inspected with adequate time to allow the computer to analyse the mucosal surface and vascular characteristics to make a diagnosis. The use of sponge based cell analysis has been shown to improve the selection of patients for Barrett’s surveillance. Although adequate inspection time will still be needed for an accurate diagnosis, confirming the need for 30–40 min time for each patient on a Barrett’s surveillance programme, the use of AI tools in a Cytosponge positive patient may remove the expertise needed of an endoscopist to make an optical diagnosis. This is yet to be formally validated in a comparative study of the use of AIassisted CADe between tertiary and nontertiary centres. Overall, the authors of this study","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135695592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22eCollection Date: 2023-01-01DOI: 10.1136/flgastro-2023-102462
Nkem Onyeador, Kumaran Thiruppathy
{"title":"Virtual consultations: navigating the future landscape of delivering gastroenterology outpatient care to young people.","authors":"Nkem Onyeador, Kumaran Thiruppathy","doi":"10.1136/flgastro-2023-102462","DOIUrl":"10.1136/flgastro-2023-102462","url":null,"abstract":"","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"14 6","pages":"450-452"},"PeriodicalIF":2.4,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579549/pdf/flgastro-2023-102462.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-21DOI: 10.1136/flgastro-2023-102510
Rex Wan-Hin Hui, Nadir Abbas, Philip Dunne, Dhiraj Tripathi
PROGNOSTIC SCORES The debate kickedoff with a case presentation, followed by discussion on prognostic scores for estimating surgical risks. Among online participants, 53.2% chose the ChildTurcottePugh (CTP) or Model for Endstage Liver Disease (MELD) scores for risk prediction. Other scores chosen included the VOCALPenn Score (26.2%), Mayo Surgical Score (16.3%) and Hepatic Venous Pressure Gradient (HVPG) (4.3%). Most respondents chose CTP or MELD as these were familiar and triedandtested. However, neither CTP or MELD truly assesses the presence or severity of portal hypertension—the sequelae of liver disease most relevant in determining operative risks. The American Society of Anesthesiologists (ASA) classification was also proposed, given its long history in surgical risk stratification. The VOCALPenn and Mayo Surgical scores are designed for surgical risk assessment in cirrhosis. VOCALPenn is the only score to account for surgical factors, whereas the Mayo Surgical score incorporated the ASA classification. These scores were developed using retrospective data, and portal hypertension assessment may be more direct in predicting postoperative decompensation. Preoperative HVPG accurately assesses portal hypertension and has been studied for adverse outcome prediction. However, given the invasive and impractical nature of HVPG, alternatives such as liver/spleen stiffness and endoscopic ultrasoundguided portal pressure assessment were discussed. Participants agreed that these modalities have not been tested in preoperative settings and require validation. SERVICE PROVISION Discussions progressed to service provision and which clinicians should manage patients with cirrhosis undergoing nonhepatic surgery. Considering the potential role of HVPG, tertiary centres with interventional radiology expertise are required. The importance of multidisciplinary care was highlighted, as good communication between hepatologists, anaesthesiologists and surgeons would be critical. The role of allied health colleagues (ie, physiotherapists and dietitians) to provide personalised preoperative, perioperative and postoperative care was also raised.
{"title":"Predicting and optimising risks for non-hepatic surgery in patients with cirrhosis: insights from the #FGDebate","authors":"Rex Wan-Hin Hui, Nadir Abbas, Philip Dunne, Dhiraj Tripathi","doi":"10.1136/flgastro-2023-102510","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102510","url":null,"abstract":"PROGNOSTIC SCORES The debate kickedoff with a case presentation, followed by discussion on prognostic scores for estimating surgical risks. Among online participants, 53.2% chose the ChildTurcottePugh (CTP) or Model for Endstage Liver Disease (MELD) scores for risk prediction. Other scores chosen included the VOCALPenn Score (26.2%), Mayo Surgical Score (16.3%) and Hepatic Venous Pressure Gradient (HVPG) (4.3%). Most respondents chose CTP or MELD as these were familiar and triedandtested. However, neither CTP or MELD truly assesses the presence or severity of portal hypertension—the sequelae of liver disease most relevant in determining operative risks. The American Society of Anesthesiologists (ASA) classification was also proposed, given its long history in surgical risk stratification. The VOCALPenn and Mayo Surgical scores are designed for surgical risk assessment in cirrhosis. VOCALPenn is the only score to account for surgical factors, whereas the Mayo Surgical score incorporated the ASA classification. These scores were developed using retrospective data, and portal hypertension assessment may be more direct in predicting postoperative decompensation. Preoperative HVPG accurately assesses portal hypertension and has been studied for adverse outcome prediction. However, given the invasive and impractical nature of HVPG, alternatives such as liver/spleen stiffness and endoscopic ultrasoundguided portal pressure assessment were discussed. Participants agreed that these modalities have not been tested in preoperative settings and require validation. SERVICE PROVISION Discussions progressed to service provision and which clinicians should manage patients with cirrhosis undergoing nonhepatic surgery. Considering the potential role of HVPG, tertiary centres with interventional radiology expertise are required. The importance of multidisciplinary care was highlighted, as good communication between hepatologists, anaesthesiologists and surgeons would be critical. The role of allied health colleagues (ie, physiotherapists and dietitians) to provide personalised preoperative, perioperative and postoperative care was also raised.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136135883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19eCollection Date: 2023-01-01DOI: 10.1136/flgastro-2023-102470
Stuart McPherson, Jessica Shearer
{"title":"Moving forward with the detection of chronic liver disease.","authors":"Stuart McPherson, Jessica Shearer","doi":"10.1136/flgastro-2023-102470","DOIUrl":"10.1136/flgastro-2023-102470","url":null,"abstract":"","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"14 6","pages":"449-450"},"PeriodicalIF":2.4,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.1136/flgastro-2023-102507
Elissa Annabi, Sophie Lalevée, Thomas Bettuzzi, Juliette Demortier, Barbara Papouin, Louis De Mestier Du Bourg, Emilie Sbidian, Saskia Ingen-Housz-Oro
INTRODUCTION A 47yearold man, with no medical history, presented with a 1year history of a recurrent skin eruption made of erythematous, erosive, crusty and pruritic plaques involving the scrotum, inguinal and intergluteal skinfolds, trunk and legs (figure 1). Mucosal examination showed glossitis and perleche. He had received topical and systemic antifungal agents without improvement. General examination was normal except a weight loss of 9 kg, without other digestive symptoms and despite a balanced diet. Blood routine tests were normal except a mild normocytic anaemia (11 g/dL) and a hypoalbuminaemia (31 g/L). Nutritional assessment revealed a zinc deficiency (7.37 μmol/L, normal value >12.5 μmol/L). Histological examination of a skin biopsy revealed a psoriasiform acanthosis with a keratinocyte vacuolation.
{"title":"Annular eruption with weight loss in a 47-year-old man","authors":"Elissa Annabi, Sophie Lalevée, Thomas Bettuzzi, Juliette Demortier, Barbara Papouin, Louis De Mestier Du Bourg, Emilie Sbidian, Saskia Ingen-Housz-Oro","doi":"10.1136/flgastro-2023-102507","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102507","url":null,"abstract":"INTRODUCTION A 47yearold man, with no medical history, presented with a 1year history of a recurrent skin eruption made of erythematous, erosive, crusty and pruritic plaques involving the scrotum, inguinal and intergluteal skinfolds, trunk and legs (figure 1). Mucosal examination showed glossitis and perleche. He had received topical and systemic antifungal agents without improvement. General examination was normal except a weight loss of 9 kg, without other digestive symptoms and despite a balanced diet. Blood routine tests were normal except a mild normocytic anaemia (11 g/dL) and a hypoalbuminaemia (31 g/L). Nutritional assessment revealed a zinc deficiency (7.37 μmol/L, normal value >12.5 μmol/L). Histological examination of a skin biopsy revealed a psoriasiform acanthosis with a keratinocyte vacuolation.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135059366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.1136/flgastro-2023-102492
Billie J Olsen, Karen Kemp, Rachel Campbell, Shaila Kumar, Laura Monje-Garcia, Shaji Sebastian, Tariq H Iqbal, Shellie Jean Radford
This is the first of two articles from the joint British Society of Gastroenterology Nurses association and Research Committee working group. The group is dedicated to signposting and improving access to research for specialist nurses working in gastroenterology and hepatology. This article is an introduction to the significance and structure of the National Institute for Health Research clinical research landscape in the UK and the importance of encouraging nurse engagement in research. This paper describes and ‘demystifies’ the clinical trials infrastructure in the UK, which is one of the most organised in the world. Going forwards this working group will organise and conduct educational events encouraging specialist nurses to become more aware of and engage in clinical research in their area of practice.
{"title":"Significance and structure of clinical research in the UK: an introduction for gastroenterology and hepatology nurses","authors":"Billie J Olsen, Karen Kemp, Rachel Campbell, Shaila Kumar, Laura Monje-Garcia, Shaji Sebastian, Tariq H Iqbal, Shellie Jean Radford","doi":"10.1136/flgastro-2023-102492","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102492","url":null,"abstract":"This is the first of two articles from the joint British Society of Gastroenterology Nurses association and Research Committee working group. The group is dedicated to signposting and improving access to research for specialist nurses working in gastroenterology and hepatology. This article is an introduction to the significance and structure of the National Institute for Health Research clinical research landscape in the UK and the importance of encouraging nurse engagement in research. This paper describes and ‘demystifies’ the clinical trials infrastructure in the UK, which is one of the most organised in the world. Going forwards this working group will organise and conduct educational events encouraging specialist nurses to become more aware of and engage in clinical research in their area of practice.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135488329","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：