Pub Date : 2023-05-01DOI: 10.1136/bmjgast-2023-001136
Jasmijn Sijben, Yonne Peters, Sharell Bas, Peter Siersema, Linda Rainey, Mireille Broeders
Objective: Screening for early oesophageal adenocarcinoma (OAC), including its precursor Barrett's oesophagus (BO), can potentially reduce OAC-related morbidity and mortality. This study explores Dutch at-risk individuals' views of screening an at-risk population for BO/OAC.
Design: We invited 372 individuals with risk factors for OAC from primary care practices, 73 individuals with surveillance experience, and 221 participants of previous studies (BO/OAC screening trial or survey) to participate in focus groups. Transcripts were inductively and thematically analysed by two independent researchers.
Results: A total of 50 individuals (42% with gastro-oesophageal reflux symptoms) of 50-75 years participated. Themes that were raised included: theme 1 'screening intentions' describing participants' motivation to be screened (eg, early diagnosis, potential reassurance, physician recommendation, and knowing someone with cancer) or decline screening (eg, anticipated discomfort or suboptimal accuracy of the test); theme 2 'risk-based eligibility' describing the tension between effectiveness (eg, targeting high-risk individuals) and inclusivity (eg, making screening available for everyone); theme 3 'distributive justice', in which the pressure of a potential new screening programme on healthcare resources was discussed; and theme 4 'information needs' describing the perceived lack of information access and individuals' preference to discuss screening with their general practitioner.
Conclusion: Individuals not only expressed high willingness to be screened but also voiced the concern that a new screening programme may pressure limited healthcare resources. If implemented, it is crucial to develop educational materials that meet the public's information needs and explain the test procedures and eligibility criteria while avoiding stigmatising language.
{"title":"Dutch individuals' views of screening for oesophageal cancer: a focus group study.","authors":"Jasmijn Sijben, Yonne Peters, Sharell Bas, Peter Siersema, Linda Rainey, Mireille Broeders","doi":"10.1136/bmjgast-2023-001136","DOIUrl":"10.1136/bmjgast-2023-001136","url":null,"abstract":"<p><strong>Objective: </strong>Screening for early oesophageal adenocarcinoma (OAC), including its precursor Barrett's oesophagus (BO), can potentially reduce OAC-related morbidity and mortality. This study explores Dutch at-risk individuals' views of screening an at-risk population for BO/OAC.</p><p><strong>Design: </strong>We invited 372 individuals with risk factors for OAC from primary care practices, 73 individuals with surveillance experience, and 221 participants of previous studies (BO/OAC screening trial or survey) to participate in focus groups. Transcripts were inductively and thematically analysed by two independent researchers.</p><p><strong>Results: </strong>A total of 50 individuals (42% with gastro-oesophageal reflux symptoms) of 50-75 years participated. Themes that were raised included: theme 1 'screening intentions' describing participants' motivation to be screened (eg, early diagnosis, potential reassurance, physician recommendation, and knowing someone with cancer) or decline screening (eg, anticipated discomfort or suboptimal accuracy of the test); theme 2 'risk-based eligibility' describing the tension between effectiveness (eg, targeting high-risk individuals) and inclusivity (eg, making screening available for everyone); theme 3 'distributive justice', in which the pressure of a potential new screening programme on healthcare resources was discussed; and theme 4 'information needs' describing the perceived lack of information access and individuals' preference to discuss screening with their general practitioner.</p><p><strong>Conclusion: </strong>Individuals not only expressed high willingness to be screened but also voiced the concern that a new screening programme may pressure limited healthcare resources. If implemented, it is crucial to develop educational materials that meet the public's information needs and explain the test procedures and eligibility criteria while avoiding stigmatising language.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10254588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350905","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 : 2023-05-01DOI: 10.1136/bmjgast-2023-001113
Ulrik Deding, Morten Kobaek-Larsen, Henrik Bøggild, Lasse Kaalby, Marianne Kirstine Thygesen, Gunnar Baatrup
Objective: To estimate the risk of interval colorectal cancer (CRC) in faecal immunochemical test (FIT) negative screening participants according to socioeconomic status.
Design: In this register-based study, first round FIT negative (<20 µg hb/g faeces) screening participants (biennial FIT, citizens aged 50-74) were followed to estimate interval CRC risk. Multivariate Cox proportional hazard regression models estimated HRs based on socioeconomic status defined by educational level and income. Models were adjusted for age, sex and FIT concentration.
Results: We identified 829 (0.7‰) interval CRC in 1 160 902 individuals. Interval CRC was more common in lower socioeconomic strata with 0.7‰ for medium-long higher education compared with 1.0‰ for elementary school and 0.4‰ in the highest income quartile compared with 1.2‰ in the lowest. These differences did not translate into significant differences in HR in the multivariate analysis, as they were explained by FIT concentration and age. HR for interval CRC was 7.09 (95% CI) for FIT concentrations 11.9-19.8 µg hb/g faeces, and 3.37 (95% CI) for FIT between 7.2 and 11.8 compared with those <7.2. The HR rose with increasing age ranging from 2.06 (95% CI 1.45 to 2.93) to 7.60 (95% CI 5.63 to 10.25) compared with those under 55 years.
Conclusion: Interval CRC risk increased with decreasing income, heavily influenced by lower income individuals more often being older and having increased FIT concentrations. Individualising screening interval based on age and FIT result, may decrease interval CRC rates, reduce the social gradient and thereby increase the screening efficiency.
{"title":"Socioeconomic inequalities in interval colorectal cancer are explained by differences in faecal haemoglobin concentration and age: a register-based cohort study.","authors":"Ulrik Deding, Morten Kobaek-Larsen, Henrik Bøggild, Lasse Kaalby, Marianne Kirstine Thygesen, Gunnar Baatrup","doi":"10.1136/bmjgast-2023-001113","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001113","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the risk of interval colorectal cancer (CRC) in faecal immunochemical test (FIT) negative screening participants according to socioeconomic status.</p><p><strong>Design: </strong>In this register-based study, first round FIT negative (<20 µg hb/g faeces) screening participants (biennial FIT, citizens aged 50-74) were followed to estimate interval CRC risk. Multivariate Cox proportional hazard regression models estimated HRs based on socioeconomic status defined by educational level and income. Models were adjusted for age, sex and FIT concentration.</p><p><strong>Results: </strong>We identified 829 (0.7‰) interval CRC in 1 160 902 individuals. Interval CRC was more common in lower socioeconomic strata with 0.7‰ for medium-long higher education compared with 1.0‰ for elementary school and 0.4‰ in the highest income quartile compared with 1.2‰ in the lowest. These differences did not translate into significant differences in HR in the multivariate analysis, as they were explained by FIT concentration and age. HR for interval CRC was 7.09 (95% CI) for FIT concentrations 11.9-19.8 µg hb/g faeces, and 3.37 (95% CI) for FIT between 7.2 and 11.8 compared with those <7.2. The HR rose with increasing age ranging from 2.06 (95% CI 1.45 to 2.93) to 7.60 (95% CI 5.63 to 10.25) compared with those under 55 years.</p><p><strong>Conclusion: </strong>Interval CRC risk increased with decreasing income, heavily influenced by lower income individuals more often being older and having increased FIT concentrations. Individualising screening interval based on age and FIT result, may decrease interval CRC rates, reduce the social gradient and thereby increase the screening efficiency.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/18/19/bmjgast-2023-001113.PMC10230874.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9745080","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 : 2023-05-01DOI: 10.1136/bmjgast-2023-001139
Maro Kyriacou, Shellie Radford, Gordon W Moran
Background: Refractory ulcerative proctitis presents a huge clinical challenge not only for the patients living with this chronic, progressive condition but also for the professionals who care for them. Currently, there is limited research and evidence-based guidance, resulting in many patients living with the symptomatic burden of disease and reduced quality of life. The aim of this study was to establish a consensus on the thoughts and opinions related to refractory proctitis disease burden and best practice for management.
Methods: A three-round Delphi consensus survey was conducted among patients living with refractory proctitis and the healthcare experts with knowledge on this disease from the UK. A brainstorming stage involving a focus group where the participants came up with an initial list of statements was completed. Following this, there were three rounds of Delphi surveys in which the participants were asked to rank the importance of the statements and provide any additional comments or clarifications. Calculation of mean scores, analysis of comments and revisions were performed to produce a final list of statements.
Results: In total, 14 statements were suggested by the focus group at the initial brainstorming stage. Following completion of three Delphi survey rounds, all 14 statements reached consensus following appropriate revision.
Conclusions: We established consensus on the thoughts and opinions related to refractory proctitis from both the experts who manage this disease and the patients living with it. This represents the first step towards developing clinical research data and ultimately the evidence needed for best practice management guidance of this condition.
{"title":"Delphi consensus survey: the opinions of patients living with refractory ulcerative proctitis and the health care professionals who care for them.","authors":"Maro Kyriacou, Shellie Radford, Gordon W Moran","doi":"10.1136/bmjgast-2023-001139","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001139","url":null,"abstract":"<p><strong>Background: </strong>Refractory ulcerative proctitis presents a huge clinical challenge not only for the patients living with this chronic, progressive condition but also for the professionals who care for them. Currently, there is limited research and evidence-based guidance, resulting in many patients living with the symptomatic burden of disease and reduced quality of life. The aim of this study was to establish a consensus on the thoughts and opinions related to refractory proctitis disease burden and best practice for management.</p><p><strong>Methods: </strong>A three-round Delphi consensus survey was conducted among patients living with refractory proctitis and the healthcare experts with knowledge on this disease from the UK. A brainstorming stage involving a focus group where the participants came up with an initial list of statements was completed. Following this, there were three rounds of Delphi surveys in which the participants were asked to rank the importance of the statements and provide any additional comments or clarifications. Calculation of mean scores, analysis of comments and revisions were performed to produce a final list of statements.</p><p><strong>Results: </strong>In total, 14 statements were suggested by the focus group at the initial brainstorming stage. Following completion of three Delphi survey rounds, all 14 statements reached consensus following appropriate revision.</p><p><strong>Conclusions: </strong>We established consensus on the thoughts and opinions related to refractory proctitis from both the experts who manage this disease and the patients living with it. This represents the first step towards developing clinical research data and ultimately the evidence needed for best practice management guidance of this condition.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/30/bmjgast-2023-001139.PMC10230891.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9689220","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 : 2023-04-01DOI: 10.1136/bmjgast-2023-001144
Elaine Scallan Walter, Martyn D Kirk, Shannon E Majowicz
To the Editor, In their recent paper, Holland et al, compared foodborne illness rates in the UK, Australia, Canada, and the USA, asking whether such comparisons across countries can legitimately inform trade decisions based on food safety risks. The authors highlighted methodological differences as a major barrier to making accurate comparisons. While we agree that comparing estimates between countries should be done with caution, in our view, the major reason that foodborne burden estimates should not be used for trade purposes is that they do not reflect the food safety risks associated with exported foods, which must meet the standards of the importing country. Foodborne illness estimates reflect food safety risks associated with foods consumed within that country, which is why foodborne burden estimates are used for prioritising and directing food safety efforts within a country. Comparison between countries is feasible and can provide important insights. In analyses of the burden of foodborne disease in Australia, Canada, Ireland, and the USA that used similar methods and a common case definition, we were able to directly compare rates of acute gastroenteritis between countries, revealing consistencies in age and sex patterns and medical care seeking behaviours. After accounting for differences in healthcare delivery, we concluded that overall rates of Campylobacter infections were truly higher in Australia than in the USA. While cohort studies, such as the Infectious Intestinal Disease studies in the UK, have some methodological advantages, they are complex and costly. Thus, many countries rely on data from surveillance and other sources coupled with crosssectional surveys that assess underdiagnosis due to laboratory testing, medical care seeking, and stool sample submission. Crosssectional studies also provide data that we and others have found consistent and valid to estimate diarrheal disease incidence. Indeed, most of the uncertainty arising from foodborne gastroenteritis estimates comes from the expert elicitations used to derive the proportion of illness attributable to foodborne transmission, where data are mostly lacking. That said, there is more that we as a community of investigators should do to improve interpretability, comparability, and reproducibility. Comparative analyses would be greatly enhanced if all burden of foodborne illness studies published raw data and models, along with clear, detailed methods, an assessment of statistical and nonstatistical uncertainty and a clear rationale for how agents and data sources were selected. These efforts would not only benefit individual countries wanting to compare estimates over time, but they would also contribute to larger, international efforts to estimate the burden of foodborne disease, namely, the global estimates produced by the WHO’s Foodborne Disease Burden Epidemiology Reference Group (FERG), which are currently being updated. Whether for global estimation, better scienti
{"title":"Yes, they can! Comparing foodborne illness estimates, and the need for greater transparency.","authors":"Elaine Scallan Walter, Martyn D Kirk, Shannon E Majowicz","doi":"10.1136/bmjgast-2023-001144","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001144","url":null,"abstract":"To the Editor, In their recent paper, Holland et al, compared foodborne illness rates in the UK, Australia, Canada, and the USA, asking whether such comparisons across countries can legitimately inform trade decisions based on food safety risks. The authors highlighted methodological differences as a major barrier to making accurate comparisons. While we agree that comparing estimates between countries should be done with caution, in our view, the major reason that foodborne burden estimates should not be used for trade purposes is that they do not reflect the food safety risks associated with exported foods, which must meet the standards of the importing country. Foodborne illness estimates reflect food safety risks associated with foods consumed within that country, which is why foodborne burden estimates are used for prioritising and directing food safety efforts within a country. Comparison between countries is feasible and can provide important insights. In analyses of the burden of foodborne disease in Australia, Canada, Ireland, and the USA that used similar methods and a common case definition, we were able to directly compare rates of acute gastroenteritis between countries, revealing consistencies in age and sex patterns and medical care seeking behaviours. After accounting for differences in healthcare delivery, we concluded that overall rates of Campylobacter infections were truly higher in Australia than in the USA. While cohort studies, such as the Infectious Intestinal Disease studies in the UK, have some methodological advantages, they are complex and costly. Thus, many countries rely on data from surveillance and other sources coupled with crosssectional surveys that assess underdiagnosis due to laboratory testing, medical care seeking, and stool sample submission. Crosssectional studies also provide data that we and others have found consistent and valid to estimate diarrheal disease incidence. Indeed, most of the uncertainty arising from foodborne gastroenteritis estimates comes from the expert elicitations used to derive the proportion of illness attributable to foodborne transmission, where data are mostly lacking. That said, there is more that we as a community of investigators should do to improve interpretability, comparability, and reproducibility. Comparative analyses would be greatly enhanced if all burden of foodborne illness studies published raw data and models, along with clear, detailed methods, an assessment of statistical and nonstatistical uncertainty and a clear rationale for how agents and data sources were selected. These efforts would not only benefit individual countries wanting to compare estimates over time, but they would also contribute to larger, international efforts to estimate the burden of foodborne disease, namely, the global estimates produced by the WHO’s Foodborne Disease Burden Epidemiology Reference Group (FERG), which are currently being updated. Whether for global estimation, better scienti","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/87/bmjgast-2023-001144.PMC10124210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9478723","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 : 2023-04-01DOI: 10.1136/bmjgast-2023-001121
Omar AlOmair
Background Hepatic damage is one of the common forms of extra pulmonary organ destructions among patients with COVID-19 infections. Aim To evaluate the prognosis of liver damage among COVID-19 patients based on their liver enzymes profile. Methods A retrospective study was done to evaluate the records of the hospitably admitted patient due to COVID-19 infection. Retrieved data included clinical presentation and investigation either imaging or laboratory with special investing in liver function tests. Result We reviewed 442 patients who were diagnosed with COVID-19 infection. They were 64.5% of female patients and 35.5% of male patients. Their mean age was 54.5%, most of them were Saudi (76.7%) and the overall mortality reached up to (20.4%). Conclusion This large cohort of 442 patients has shown that liver damage may be an independent prognostic factor for morbidities and mortality among COVID-19 patients. It also showed the importance of liver function enzymes screening as a predictor for the outcome of those patients.
{"title":"Liver enzymes among COVID-19 patients in Al-Ahsa region of Saudi Arabia.","authors":"Omar AlOmair","doi":"10.1136/bmjgast-2023-001121","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001121","url":null,"abstract":"Background Hepatic damage is one of the common forms of extra pulmonary organ destructions among patients with COVID-19 infections. Aim To evaluate the prognosis of liver damage among COVID-19 patients based on their liver enzymes profile. Methods A retrospective study was done to evaluate the records of the hospitably admitted patient due to COVID-19 infection. Retrieved data included clinical presentation and investigation either imaging or laboratory with special investing in liver function tests. Result We reviewed 442 patients who were diagnosed with COVID-19 infection. They were 64.5% of female patients and 35.5% of male patients. Their mean age was 54.5%, most of them were Saudi (76.7%) and the overall mortality reached up to (20.4%). Conclusion This large cohort of 442 patients has shown that liver damage may be an independent prognostic factor for morbidities and mortality among COVID-19 patients. It also showed the importance of liver function enzymes screening as a predictor for the outcome of those patients.","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/de/bmjgast-2023-001121.PMC10151239.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10047449","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 : 2023-04-01DOI: 10.1136/bmjgast-2022-001091
Elizabeth Ratcliffe, James Britton, Calvin Heal, Richard Keld, Mark Murgatroyd, Robert Willert, John McLaughlin, Shaheen Hamdy, Yeng Ang
Objective: Barrett's oesophagus (BO) is a precursor lesion, via dysplastic phases, to oesophageal adenocarcinoma. Although overall risk from BO is low, it has been shown to adversely affect health-related quality of life (HRQOL). The aim was to compare dysplastic BO patients' HRQOL pre-endoscopic therapy (pre-ET) and post-ET. The pre-ET BO group was also compared with other cohorts: non-dysplastic BO (NDBO), those with colonic polyps, gastro-oesophageal reflux disease (GORD) and healthy volunteers.
Design: Participants in the pre-ET cohort were recruited prior to their endotherapy and HRQOL questionnaires provided pre-ET and post-ET. Wilcoxon rank test was used to compare the pre-ET and post-ET findings. The Pre-ET group was compared to the other cohorts' HRQOL results using multiple linear regression analysis.
Results: Pre-ET group of 69 participants returned the questionnaires prior to and 42 post-ET. Both the pre-ET and post-ET group showed similar levels of cancer worry, despite the treatment. No statistical significance was found for symptoms scores, anxiety and depression or general health measures with the Short Form-36 (SF-36) Score. Education for the BO patients was overall lacking with many of the pre-ET group still reporting unanswered questions about their disease.The Pre-ET group was compared with NDBO group (N=379), GORD (N=132), colonic polyp patients (N=152) and healthy volunteers (N=48). Cancer worry was similar between the NDBO group and the Pre-ET group, despite their lower risk of progression. GORD patients had worse symptom scores from a reflux and heartburn perspective. Only the healthy group has significantly better scores in the SF-36 and improved hospital anxiety and depression scores.
Conclusion: These findings suggest that there is a need to improve HRQOL for patients with BO. This should include improved education and devising-specific patient-reported outcome measures for BO to capture relevant areas of HRQOL in future studies.
{"title":"Quality of life measures in dysplastic Barrett's oesophagus are comparable to patients with non-dysplastic Barrett's oesophagus and do not improve after endoscopic therapy.","authors":"Elizabeth Ratcliffe, James Britton, Calvin Heal, Richard Keld, Mark Murgatroyd, Robert Willert, John McLaughlin, Shaheen Hamdy, Yeng Ang","doi":"10.1136/bmjgast-2022-001091","DOIUrl":"https://doi.org/10.1136/bmjgast-2022-001091","url":null,"abstract":"<p><strong>Objective: </strong>Barrett's oesophagus (BO) is a precursor lesion, via dysplastic phases, to oesophageal adenocarcinoma. Although overall risk from BO is low, it has been shown to adversely affect health-related quality of life (HRQOL). The aim was to compare dysplastic BO patients' HRQOL pre-endoscopic therapy (pre-ET) and post-ET. The pre-ET BO group was also compared with other cohorts: non-dysplastic BO (NDBO), those with colonic polyps, gastro-oesophageal reflux disease (GORD) and healthy volunteers.</p><p><strong>Design: </strong>Participants in the pre-ET cohort were recruited prior to their endotherapy and HRQOL questionnaires provided pre-ET and post-ET. Wilcoxon rank test was used to compare the pre-ET and post-ET findings. The Pre-ET group was compared to the other cohorts' HRQOL results using multiple linear regression analysis.</p><p><strong>Results: </strong>Pre-ET group of 69 participants returned the questionnaires prior to and 42 post-ET. Both the pre-ET and post-ET group showed similar levels of cancer worry, despite the treatment. No statistical significance was found for symptoms scores, anxiety and depression or general health measures with the Short Form-36 (SF-36) Score. Education for the BO patients was overall lacking with many of the pre-ET group still reporting unanswered questions about their disease.The Pre-ET group was compared with NDBO group (N=379), GORD (N=132), colonic polyp patients (N=152) and healthy volunteers (N=48). Cancer worry was similar between the NDBO group and the Pre-ET group, despite their lower risk of progression. GORD patients had worse symptom scores from a reflux and heartburn perspective. Only the healthy group has significantly better scores in the SF-36 and improved hospital anxiety and depression scores.</p><p><strong>Conclusion: </strong>These findings suggest that there is a need to improve HRQOL for patients with BO. This should include improved education and devising-specific patient-reported outcome measures for BO to capture relevant areas of HRQOL in future studies.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/64/bmjgast-2022-001091.PMC10105999.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9472882","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}
Objective: Ascites in patients with decompensated cirrhosis can lead to abdominal distention and decrease quality of life. Tolvaptan, a vasopressin V2 receptor antagonist, is an effective agent in the treatment of ascites, whereas some patients are refractory to tolvaptan. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for these patients is not known. In this study, we performed TIPS for tolvaptan-refractory cirrhotic patients and analysed its efficacy and safety in these patients.
Design: This retrospective analysis included patients with liver cirrhosis who received TIPS for ascites or hydrothorax refractory to tolvaptan therapy along with conventional diuretics between January 2015 and May 2018 at Tokai University Hospital. We evaluated the efficacy and safety of TIPS.
Results: This study included four patients. All patients presented with Child-Pugh class B liver cirrhosis and model for end-stage liver disease-sodium scores were 10/12/14/16. TIPS was generated successfully without any major complications in all patients. The body weight decreased by a mean of 4.7 (SD=1.0) kg and estimated glomerular filtration rate improved from a mean of 38.2 (SD=10.3) to 59.5 (SD=25.0) mL/min/1.73 m2 in a month after TIPS procedure.
Conclusion: TIPS is an effective potential treatment for ascites in patients with tolvaptan refractory condition. In appropriate patients who can tolerate TIPS, the treatment may lead towards renal function improvement.
{"title":"First reports of clinical effects of transjugular intrahepatic portosystemic shunt in four patients with cirrhotic ascites refractory to tolvaptan.","authors":"Kota Tsuruya, Jun Koizumi, Yuka Sekiguchi, Shun Ono, Tatsuya Sekiguchi, Takuya Hara, Yusuke Mishima, Yoshitaka Arase, Shunji Hirose, Koichi Shiraishi, Tatehiro Kagawa","doi":"10.1136/bmjgast-2023-001120","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001120","url":null,"abstract":"<p><strong>Objective: </strong>Ascites in patients with decompensated cirrhosis can lead to abdominal distention and decrease quality of life. Tolvaptan, a vasopressin V2 receptor antagonist, is an effective agent in the treatment of ascites, whereas some patients are refractory to tolvaptan. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for these patients is not known. In this study, we performed TIPS for tolvaptan-refractory cirrhotic patients and analysed its efficacy and safety in these patients.</p><p><strong>Design: </strong>This retrospective analysis included patients with liver cirrhosis who received TIPS for ascites or hydrothorax refractory to tolvaptan therapy along with conventional diuretics between January 2015 and May 2018 at Tokai University Hospital. We evaluated the efficacy and safety of TIPS.</p><p><strong>Results: </strong>This study included four patients. All patients presented with Child-Pugh class B liver cirrhosis and model for end-stage liver disease-sodium scores were 10/12/14/16. TIPS was generated successfully without any major complications in all patients. The body weight decreased by a mean of 4.7 (SD=1.0) kg and estimated glomerular filtration rate improved from a mean of 38.2 (SD=10.3) to 59.5 (SD=25.0) mL/min/1.73 m<sup>2</sup> in a month after TIPS procedure.</p><p><strong>Conclusion: </strong>TIPS is an effective potential treatment for ascites in patients with tolvaptan refractory condition. In appropriate patients who can tolerate TIPS, the treatment may lead towards renal function improvement.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10124206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9528399","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 : 2023-03-01DOI: 10.1136/bmjgast-2022-001070
Ahmir Ahmad, Sarah Marshall, Paul Bassett, Kowshika Thiruvilangam, Angad Dhillon, Brian P Saunders
Background: Poor bowel preparation is the leading cause of failed colonoscopies and increases costs significantly. Several, split preparation, 2 day regimens are available and recently, Plenvu, a low-volume preparation which can be given on 1 day has been introduced.
Aims: Assess efficacy and tolerability of commonly used purgative regimens including Plenvu.
Method: In this service evaluation, patients undergoing screening colonoscopy at St Mark's Hospital, London (February 2020-December 2021) were provided Plenvu (1 or 2 days), Moviprep (2 days) or Senna & Citramag (2 days).Boston Bowel Preparation Scale (BBPS) score, fluid volumes and procedure times were recorded. A patient experience questionnaire evaluated taste, volume acceptability, completion and side effects.
Results: 563 patients were invited to participate and 553 included: 218 Moviprep 2 days, 108 Senna & Citramag 2 days, 152 Plenvu 2 days and 75 Plenvu 1 day.BBPS scores were higher with Plenvu 1 and 2 days vs Senna & Citramag (p=0.003 and 0.002, respectively) and vs Moviprep (p=0.003 and 0.001, respectively). No other significant pairwise BBPS differences and no difference in preparation adequacy was seen between the groups.Patients rated taste as most pleasant with Senna & Citramag and this achieved significance versus Plenvu 1 day and 2 days (p=0.002 and p<0.001, respectively) and versus Moviprep (p=0.04).
Conclusion: BBPS score was higher for 1 day and 2 days Plenvu versus both Senna & Citramag and Moviprep. Taste was not highly rated for Plenvu but it appears to offer effective cleansing even when given as a same day preparation.
{"title":"Evaluation of bowel preparation regimens for colonoscopy including a novel low volume regimen (Plenvu): CLEANSE study.","authors":"Ahmir Ahmad, Sarah Marshall, Paul Bassett, Kowshika Thiruvilangam, Angad Dhillon, Brian P Saunders","doi":"10.1136/bmjgast-2022-001070","DOIUrl":"https://doi.org/10.1136/bmjgast-2022-001070","url":null,"abstract":"<p><strong>Background: </strong>Poor bowel preparation is the leading cause of failed colonoscopies and increases costs significantly. Several, split preparation, 2 day regimens are available and recently, Plenvu, a low-volume preparation which can be given on 1 day has been introduced.</p><p><strong>Aims: </strong>Assess efficacy and tolerability of commonly used purgative regimens including Plenvu.</p><p><strong>Method: </strong>In this service evaluation, patients undergoing screening colonoscopy at St Mark's Hospital, London (February 2020-December 2021) were provided Plenvu (1 or 2 days), Moviprep (2 days) or Senna & Citramag (2 days).Boston Bowel Preparation Scale (BBPS) score, fluid volumes and procedure times were recorded. A patient experience questionnaire evaluated taste, volume acceptability, completion and side effects.</p><p><strong>Results: </strong>563 patients were invited to participate and 553 included: 218 Moviprep 2 days, 108 Senna & Citramag 2 days, 152 Plenvu 2 days and 75 Plenvu 1 day.BBPS scores were higher with Plenvu 1 and 2 days vs Senna & Citramag (p=0.003 and 0.002, respectively) and vs Moviprep (p=0.003 and 0.001, respectively). No other significant pairwise BBPS differences and no difference in preparation adequacy was seen between the groups.Patients rated taste as most pleasant with Senna & Citramag and this achieved significance versus Plenvu 1 day and 2 days (p=0.002 and p<0.001, respectively) and versus Moviprep (p=0.04).</p><p><strong>Conclusion: </strong>BBPS score was higher for 1 day and 2 days Plenvu versus both Senna & Citramag and Moviprep. Taste was not highly rated for Plenvu but it appears to offer effective cleansing even when given as a same day preparation.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/50/bmjgast-2022-001070.PMC10032399.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9466510","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}
Background: Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency, which takes up considerable healthcare resources. However, only approximately 20%-30% of bleeds require urgent haemostatic intervention. Current standard of care is for all patients admitted to hospital to undergo endoscopy within 24 hours for risk stratification, but this is difficult to achieve in practice, invasive and costly.
Aim: To develop a novel non-endoscopic risk stratification tool for AUGIB to predict the need for haemostatic intervention by endoscopic, radiological or surgical treatments. We compared this with the Glasgow-Blatchford Score (GBS).
Design: Model development was carried out using a derivation (n=466) and prospectively collected validation cohort (n=404) of patients who were admitted with AUGIB to three large hospitals in London, UK (2015-2020). Univariable and multivariable logistic regression analysis was used to identify variables that were associated with increased or decreased chances of requiring haemostatic intervention. This model was converted into a risk scoring system, the London Haemostat Score (LHS).
Results: The LHS was more accurate at predicting need for haemostatic intervention than the GBS, in the derivation cohort (area under the receiver operating curve (AUROC) 0.82; 95% CI 0.78 to 0.86 vs 0.72; 95% CI 0.67 to 0.77; p<0.001) and validation cohort (AUROC 0.80; 95% CI 0.75 to 0.85 vs 0.72; 95% CI 0.67 to 0.78; p<0.001). At cut-off scores at which LHS and GBS identified patients who required haemostatic intervention with 98% sensitivity, the specificity of the LHS was 41% vs 18% with the GBS (p<0.001). This could translate to 32% of inpatient endoscopies for AUGIB being avoided at a cost of only a 0.5% false negative rate.
Conclusions: The LHS is accurate at predicting the need for haemostatic intervention in AUGIB and could be used to identify a proportion of low-risk patients who can undergo delayed or outpatient endoscopy. Validation in other geographical settings is required before routine clinical use.
背景:急性上消化道出血(AUGIB)是一种常见的急症,占用了大量的医疗资源。然而,只有大约20%-30%的出血需要紧急止血干预。目前的护理标准是所有入院患者在24小时内接受内镜检查以进行风险分层,但这在实践中难以实现,具有侵入性且费用昂贵。目的:为AUGIB开发一种新的非内镜风险分层工具,以预测通过内镜、放射或手术治疗进行止血干预的必要性。我们将其与格拉斯哥-布拉奇福德评分(GBS)进行了比较。设计:模型开发使用推导(n=466)和前瞻性收集的验证队列(n=404)进行,这些患者是2015-2020年在英国伦敦三家大医院接受AUGIB的患者。单变量和多变量logistic回归分析用于确定与需要止血干预的机会增加或减少相关的变量。该模型被转换成一个风险评分系统,即伦敦血肿评分(LHS)。结果:在衍生队列中,LHS在预测止血干预需求方面比GBS更准确(接受者工作曲线下面积(AUROC) 0.82;95% CI 0.78 ~ 0.86 vs 0.72;95% CI 0.67 ~ 0.77;结论:LHS在预测AUGIB患者是否需要止血干预方面是准确的,并可用于识别一定比例的低风险患者,这些患者可以接受延迟或门诊内镜检查。在常规临床使用之前,需要在其他地理环境中进行验证。
{"title":"Derivation and validation of a novel risk score to predict need for haemostatic intervention in acute upper gastrointestinal bleeding (London Haemostat Score).","authors":"Isobel Marks, Imran Karim Janmohamed, Sadek Malas, Athina Mavrou, Thomas Banister, Nisha Patel, Lakshmana Ayaru","doi":"10.1136/bmjgast-2022-001008","DOIUrl":"https://doi.org/10.1136/bmjgast-2022-001008","url":null,"abstract":"<p><strong>Background: </strong>Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency, which takes up considerable healthcare resources. However, only approximately 20%-30% of bleeds require urgent haemostatic intervention. Current standard of care is for all patients admitted to hospital to undergo endoscopy within 24 hours for risk stratification, but this is difficult to achieve in practice, invasive and costly.</p><p><strong>Aim: </strong>To develop a novel non-endoscopic risk stratification tool for AUGIB to predict the need for haemostatic intervention by endoscopic, radiological or surgical treatments. We compared this with the Glasgow-Blatchford Score (GBS).</p><p><strong>Design: </strong>Model development was carried out using a derivation (n=466) and prospectively collected validation cohort (n=404) of patients who were admitted with AUGIB to three large hospitals in London, UK (2015-2020). Univariable and multivariable logistic regression analysis was used to identify variables that were associated with increased or decreased chances of requiring haemostatic intervention. This model was converted into a risk scoring system, the London Haemostat Score (LHS).</p><p><strong>Results: </strong>The LHS was more accurate at predicting need for haemostatic intervention than the GBS, in the derivation cohort (area under the receiver operating curve (AUROC) 0.82; 95% CI 0.78 to 0.86 vs 0.72; 95% CI 0.67 to 0.77; p<0.001) and validation cohort (AUROC 0.80; 95% CI 0.75 to 0.85 vs 0.72; 95% CI 0.67 to 0.78; p<0.001). At cut-off scores at which LHS and GBS identified patients who required haemostatic intervention with 98% sensitivity, the specificity of the LHS was 41% vs 18% with the GBS (p<0.001). This could translate to 32% of inpatient endoscopies for AUGIB being avoided at a cost of only a 0.5% false negative rate.</p><p><strong>Conclusions: </strong>The LHS is accurate at predicting the need for haemostatic intervention in AUGIB and could be used to identify a proportion of low-risk patients who can undergo delayed or outpatient endoscopy. Validation in other geographical settings is required before routine clinical use.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dc/6b/bmjgast-2022-001008.PMC10069503.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9472382","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 : 2023-03-01DOI: 10.1136/bmjgast-2023-001118
Hassan Al-Balas, Zeyad Metwalli, Iftikhar Burney, David Sada
Objective: De novo percutaneous placement of radiologically inserted low-profile or 'button-type' gastrostomy catheters (LPG) is infrequently reported in adults. This study compares the safety and clinical outcomes of primary percutaneous placement of LPG catheters and traditional balloon-retention gastrostomy catheters (TG) using image guidance at a single institution.
Design: This was a retrospective, single-institution review comparing initial LPG and TG radiologically inserted catheter placements in a 36-month time period. The age, gender, indication, catheter type and method of anaesthesia of 139 consecutive initial gastrostomy placement procedures were recorded. Total catheter days without intervention, major and minor complications, reasons for reintervention, and procedure fluoroscopy times were compared.
Results: During the 36-month study period, 61 LPG and 78 TG catheters were placed. Mean total catheter days prior to intervention was 137 days in the LPG group and 128 days in the TG group (p=0.70). Minor complications including cellulitis, pericatheter leakage and early catheter occlusion occurred in 4.9% (3/61) in the LPG group and 9% (7/78) in the TG group (p=0.5). Major complications including early catheter dislodgement and bleeding requiring transfusion (in one patient) occurred in 4.9% (3/61) in the LPG group and 7.7% (6/78) in the TG group (p=0.4). Procedure fluoroscopy time was lower in the LPG group (2.56 min) compared with the TG group (4.21 min) (p<0.005).
Conclusion: Primary placement of low-profile or 'button-type' gastrostomy catheters is technically feasible with a low complication rate similar to that of traditional radiologically inserted gastrostomy catheters.
{"title":"Primary placement of low-profile or 'button' versus traditional balloon-retention radiologically inserted gastrostomy catheters in adults: a retrospective review.","authors":"Hassan Al-Balas, Zeyad Metwalli, Iftikhar Burney, David Sada","doi":"10.1136/bmjgast-2023-001118","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001118","url":null,"abstract":"<p><strong>Objective: </strong>De novo percutaneous placement of radiologically inserted low-profile or 'button-type' gastrostomy catheters (LPG) is infrequently reported in adults. This study compares the safety and clinical outcomes of primary percutaneous placement of LPG catheters and traditional balloon-retention gastrostomy catheters (TG) using image guidance at a single institution.</p><p><strong>Design: </strong>This was a retrospective, single-institution review comparing initial LPG and TG radiologically inserted catheter placements in a 36-month time period. The age, gender, indication, catheter type and method of anaesthesia of 139 consecutive initial gastrostomy placement procedures were recorded. Total catheter days without intervention, major and minor complications, reasons for reintervention, and procedure fluoroscopy times were compared.</p><p><strong>Results: </strong>During the 36-month study period, 61 LPG and 78 TG catheters were placed. Mean total catheter days prior to intervention was 137 days in the LPG group and 128 days in the TG group (p=0.70). Minor complications including cellulitis, pericatheter leakage and early catheter occlusion occurred in 4.9% (3/61) in the LPG group and 9% (7/78) in the TG group (p=0.5). Major complications including early catheter dislodgement and bleeding requiring transfusion (in one patient) occurred in 4.9% (3/61) in the LPG group and 7.7% (6/78) in the TG group (p=0.4). Procedure fluoroscopy time was lower in the LPG group (2.56 min) compared with the TG group (4.21 min) (p<0.005).</p><p><strong>Conclusion: </strong>Primary placement of low-profile or 'button-type' gastrostomy catheters is technically feasible with a low complication rate similar to that of traditional radiologically inserted gastrostomy catheters.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/73/bmjgast-2023-001118.PMC10030477.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9173550","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}