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Frontline Gastroenterology

Alice Kington
No abstract text is available yet for this article.
April 2018: Frontline Gastroenterology
Stavroula Pelitari, Charlotte Hathaway, Dean Gritton, Andrea Smith, David Bush, Shyam Menon, Brian McKaig
Objective: The aim was to assess the financial and operational impact of our new gastroenterology referral pathway model on our services. Design: An electronic 'Clinical Assessment Service' (CAS) proforma and an information platform were developed, and all data were analysed retrospectively. Setting: Royal Wolverhampton NHS Trust. Patients: 14 245 general practitioner (GP) referrals were received during January 2014-December 2016 with 9773 of them being triaged via our CAS...
April 2018: Frontline Gastroenterology
Jonathan P Segal, Stephanie X Poo, Simon D McLaughlin, Omar D Faiz, Susan K Clark, Ailsa L Hart
Objective: Restorative proctolectomy is considered the procedure of choice in patients with ulcerative colitis who have failed medical therapy. Chronic pouchitis occurs in 10%-15% of patients, which often require long-term antibiotics to alleviate symptoms. Safety and efficacy of long-term maintenance antibiotics for chronic pouchitis has yet to be established. We aimed to assess the long-term safety and efficacy of maintenance antibiotic therapy for chronic pouchitis. Design: This was an observational study...
April 2018: Frontline Gastroenterology
Yugo Iwaya, Corwyn Rowsell, Teodor Grantcharov, Norman E Marcon
Introduction: A 52-year-old woman presented with iron deficiency anaemia and postprandial right lower quadrant pain. Abdominal examination was unremarkable and laboratory results showed mild anaemia (haemoglobin 11.3 g/dL). Upper and lower endoscopies did not reveal any source of bleeding. Video capsule endoscopy was performed which showed a large polypoid lesion in the mid-ileum (figure 1). Abdominal contrast enhanced CT demonstrated a heterogeneously enhancing pedunculated polyp measuring approximately 6 cm (figure 2)...
April 2018: Frontline Gastroenterology
Aamir Saifuddin, Adam Harris
Objective: To explore the 'real world' effectiveness of tacrolimus therapy for refractory ulcerative proctocolitis (UC). Design: Retrospective cohort study using prospectively collated clinical data. Setting: A single district general hospital in Kent, UK. Clinical decisions and regular monitoring were undertaken by a single expert in inflammatory bowel disease. Patients: All patients started on tacrolimus between January 2010 and August 2016 at Tunbridge Wells Hospital...
April 2018: Frontline Gastroenterology
Matthew James Armstrong, Tom Thomas, Tariq Iqbal, Ralph Boulton, Jason Goh
A 33-year-old man with ulcerative colitis presented with 5-day history of fever, night sweats, abdominal pain and increased stool frequency. He was on mesalazine M/R 1 g once daily, 6-mercaptopurine (6-MP) 75 mg once daily and prednisolone 40 mg once daily. Examination revealed fever and tachycardia. Blood examinations identified a persistent leucopenia, C reactive protein of 23 mg/L and an initial alanine transaminase of 855 IU/L. Flexible sigmoidoscopy revealed well-demarcated, punched-out ulcers in the proximal rectum and distal sigmoid, with histology pathognomonic of cytomegalovirus (CMV)...
April 2018: Frontline Gastroenterology
Akash J Maliampurakal, Donald C McMillan, John H Anderson, Paul G Horgan, David Mansouri
Objective: Flexible sigmoidoscopy reduces the incidence of colonic cancer through the detection and removal of premalignant adenomas. However, the efficacy of the procedure is variable. The aim of the present study was to examine factors associated with the efficacy of detecting polyps during flexible sigmoidoscopy. Design and patients: Retrospective observational cohort study of all individuals undergoing routine flexible sigmoidoscopy in NHS Greater Glasgow and Clyde from January 2013 to January 2016...
April 2018: Frontline Gastroenterology
Charlotte R Hitchins, Magdalena Metzner, Judy Edworthy, Catherine Ward
Background: Non-technical skills (NTS) have gained increasing recognition in recent years for their role in safe, effective team performance in healthcare. Gastrointestinal endoscopy is a procedure-based specialty with rapidly advancing technology, significant operational pressures and rapidly changing 'teams of experts'. However, to date there has been little focus on the effect of NTS in this field. Objectives: This review aims to examine the existing literature on NTS in gastrointestinal endoscopy and identify areas for further research...
April 2018: Frontline Gastroenterology
Vijay Pattni, David J Tate, Ana Terlevich, Peter Marden, Steve Hughes
Objective: Device-assisted enteroscopy (DAE) has developed rapidly, particularly with the advent of double-balloon enteroscopy (DBE). This study reports a case series from a UK tertiary centre for DAE across two modalities-DBE and spiral enteroscopy (SE)-under conscious sedation. Design: Retrospective observational study of 257 enteroscopy procedures from 2008 to 2014. Data were collected on demographics, indications, diagnosis, sedation requirements, duration, complications, tolerance, therapy performed and completion rate...
April 2018: Frontline Gastroenterology
Sampath De Silva, Wenhao Li, Polychronis Kemos, James H Brindley, Jibran Mecci, Salma Samsuddin, Joanne Chin-Aleong, Roger M Feakins, Graham R Foster, Wing-Kin Syn, William Alazawi
Objective: Liver biopsy is the most accurate method for determining stage and grade of injury in non-alcoholic fatty liver disease (NAFLD). Given risks and limitations of biopsy, non-invasive tests such as NAFLD fibrosis score, aspartate transaminase (AST) to platelet ratio index, Fib-4, AST/alanine transaminase ratio and BARD are used. Prevalence and severity of NAFLD and metabolic syndrome vary by ethnicity, yet tests have been developed in largely white populations. We tested our hypothesis that non-invasive tests that include metabolic parameters are less accurate in South Asian compared with white patients...
April 2018: Frontline Gastroenterology
Marinos Pericleous, Claire Kelly
Hereditary haemochromatosis is an autosomal recessive disorder with variable penetrance. Most patients are C282Y homozygotes while heterozygotes or patients who are homozygous with other mutations are uncommonly affected. The true genotype to phenotype expression remains unclear. Treatment with phlebotomy is highly effective and cost-efficient while liver transplantation confers a curative option.
April 2018: Frontline Gastroenterology
Adam McCulloch, Ovishek Roy, Dunecan Massey, Rachel Hedges, Serena Skerratt, Nicola Wilson, Jeremy Woodward
Objective: Percutaneous endoscopic gastrostomy (PEG) tube placement is associated with a high risk of cardiorespiratory complications in patients with significant respiratory compromise. This study reports a case series of high-risk patients undergoing PEG placement using a modified technique-nasal unsedated seated PEG (nuPEG) placement. Design: Retrospective review of 67 patients at high risk of complications undergoing PEG placement between September 2012 and December 2016...
April 2018: Frontline Gastroenterology
Michael McFarlane, Lauren O'Flynn, Rachel Ventre, Benjamin R Disney
Thalidomide was initially synthesised in 1954 and marketed as a sedative and antiemetic for morning sickness. It was withdrawn in 1961 due to the realisation that it was teratogenic with over 10 000 children born with congenital abnormalities. Since then it has been used for treatment of dermatological and oncological conditions, including myeloma. In 1994, it was found to have a potent antiangiogenic effect via downregulation of vascular endothelial growth factor (VEGF). This has led to its use in gastrointestinal bleeding, as vascular abnormalities such as angiodysplasia have been found to have elevated VEGF levels...
April 2018: Frontline Gastroenterology
Matthew Kurien, Elizabeth Thurgar, Ashley Davies, Ron Akehurst, Jervoise Andreyev
Background: In 2012, the National Institute for Health and Care Excellence (NICE) assessed guidance (DG7) on the use of tauroselcholic (75 selenium) acid (also known as SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM) in patients with IBS-D and in patients with Crohn's disease who have not had an ileal resection. NICE concluded that tauroselcholic (75 selenium) acid was recommended for use in research only. NICE will be reviewing the decision to update the guidance for tauroselcholic (75 selenium) acid, for these populations, in March 2017...
April 2018: Frontline Gastroenterology
Matthew J Brookes, Simon Whitehead, Daniel R Gaya, Antony Barney Hawthorne
Differentiation between inflammatory bowel disease (IBD) and functional gut disorders, and the determination of mucosal disease activity in established cases of IBD remain the cornerstones of disease diagnosis and management. Non-invasive, accurate biomarkers of gut inflammation are needed due to the variability of symptoms, the inaccuracies of currently available blood markers and the cost and invasive nature of endoscopy. Numerous biomarkers have been used and/or considered with some in current use. This article reviews the current evidence base around the indications for using biomarkers and their limitations, with a particular focus on faecal calprotectin...
April 2018: Frontline Gastroenterology
Anton V Emmanuel
No abstract text is available yet for this article.
April 2018: Frontline Gastroenterology
B Wang, K Agarwal, D Joshi
Chronic hepatitis B infection is a global public health problem associated with significant morbidity and mortality. Persistent infection may evolve to liver cirrhosis and hepatocellular carcinoma, and hepatitis B-related liver disease is a common indication for liver transplantation. Patients with advanced liver disease should be treated with antiviral therapy which may result in clinical improvement. The management of patients after liver transplant then focuses on preventing hepatitis B recurrence in the graft...
January 2018: Frontline Gastroenterology
Giovanna Sheiybani, Peter Brydon, Miriam Toolan, John Linehan, Mark Farrant, Benjamin Colleypriest
Introduction: There is controversy in the literature recently regarding the efficacy of rectal non-steroidal anti-inflammatory drugs (NSAID) to prevent post-ERCP pancreatitis (PEP). The aim of this study was to compare the incidence of PEP in three distinct groups of patients at the Royal United Hospital, Bath: no use of rectal diclofenac, selective use and blanket use without contraindication. Method: Readmission data, blood results, radiology reports and discharge summaries were used to identify patients with PEP from August 2010 to December 2015...
January 2018: Frontline Gastroenterology
Victoria Gibson, Stephanie Needham, Manu Nayer, Nick P Thompson
Objective: To determine whether development of localised protocol could reduce the number of non-targeted gastric biopsies taken at endoscopy, without risking harm from non-detection of malignant conditions. Design: Retrospective analysis of patient records over a 3-month period in 2013, repeated in 2015 following intervention. Setting: Two UK teaching hospitals. Patients: Patient record data on indication for endoscopy, endoscopy findings, histopathology results and patient outcome...
January 2018: Frontline Gastroenterology
Hey-Long Ching, Melissa F Hale, Reena Sidhu, Mark E McAlindon
Objective: To evaluate the diagnostic yield of investigating dyspepsia with oesophagogastroduodenoscopy (OGD) with or without mucosal biopsy. Design: Retrospective service evaluation study. Setting: Two teaching hospitals: The Royal Hallamshire Hospital and Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK. Patients: 500 patients, 55 years of age and over, who underwent OGD to investigate dyspepsia were included...
January 2018: Frontline Gastroenterology
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