Pub Date : 2024-08-24DOI: 10.1136/flgastro-2024-102650
Alan J Wigg, Sumudu Narayana, Michael Nugent, Arlene Ackland, Damian Riessen, Benjamin L Wigg, Kate R Muller, Jeyamani Ramachandran, Richard J Woodman
Objectives Remotely living Indigenous Australians have a disproportionate mortality from cirrhosis and hepatocellular cancer (HCC). However, there are no local population studies examining the prevalence of chronic liver disease (CLD) in remote communities. The main aims of this study were therefore to study a remote Indigenous population to determine the prevalence of CLD risk factors and the prevalence of significant fibrosis as defined by an Fibrosis-4 (FIB-4) score of ≥2.67. Methods The study design was a retrospective analysis of an electronic medical record database of a remote Aboriginal community-controlled health service. The setting was an Aboriginal community-controlled health service located in a remote South Australian town with a 15% Indigenous Australian population. Participants were all adult Indigenous Australians between the ages of 35 and 65 years. Results 83.9% of the study population had at least one CLD risk factor and 45% of the population had multiple CLD risk factors. The most prevalent risk factors were alcohol misuse, diabetes and obesity. 3.7% of the population had a high risk of significant fibrosis with an FIB-4 score≥2.67. Each additional CLD risk factor was associated with a 12.3% increase in FIB-4 mean (p=0.001). Conclusions CLD risk factors and significant liver fibrosis were highly prevalent in this population. Integrating simple liver screening tests into adult health checks has the potential to detect CLD at an early and treatable stage and to reduce the high morbidity and mortality from cirrhosis and HCC experienced by remotely living Indigenous Australians. Data are available upon reasonable request.
{"title":"Cross-sectional study of the prevalence of chronic liver disease risk factors and liver fibrosis in a remotely living Indigenous Australian population","authors":"Alan J Wigg, Sumudu Narayana, Michael Nugent, Arlene Ackland, Damian Riessen, Benjamin L Wigg, Kate R Muller, Jeyamani Ramachandran, Richard J Woodman","doi":"10.1136/flgastro-2024-102650","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102650","url":null,"abstract":"Objectives Remotely living Indigenous Australians have a disproportionate mortality from cirrhosis and hepatocellular cancer (HCC). However, there are no local population studies examining the prevalence of chronic liver disease (CLD) in remote communities. The main aims of this study were therefore to study a remote Indigenous population to determine the prevalence of CLD risk factors and the prevalence of significant fibrosis as defined by an Fibrosis-4 (FIB-4) score of ≥2.67. Methods The study design was a retrospective analysis of an electronic medical record database of a remote Aboriginal community-controlled health service. The setting was an Aboriginal community-controlled health service located in a remote South Australian town with a 15% Indigenous Australian population. Participants were all adult Indigenous Australians between the ages of 35 and 65 years. Results 83.9% of the study population had at least one CLD risk factor and 45% of the population had multiple CLD risk factors. The most prevalent risk factors were alcohol misuse, diabetes and obesity. 3.7% of the population had a high risk of significant fibrosis with an FIB-4 score≥2.67. Each additional CLD risk factor was associated with a 12.3% increase in FIB-4 mean (p=0.001). Conclusions CLD risk factors and significant liver fibrosis were highly prevalent in this population. Integrating simple liver screening tests into adult health checks has the potential to detect CLD at an early and treatable stage and to reduce the high morbidity and mortality from cirrhosis and HCC experienced by remotely living Indigenous Australians. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"15 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175683","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 : 2024-08-19DOI: 10.1136/flgastro-2024-102757
Alexander Thomas Elford, William Beattie, Andrew Downie, Varun Kaushik, Jeni Mitchell, Ralley Prentice, Aysha H Al-Ani, Jonathan Segal, Britt Christensen
Objective Sexual dysfunction is common in patients with inflammatory bowel disease (IBD). Data on IBD disease activity and IBD patients’ desire to seek specialist advice regarding sexual dysfunction are lacking. We aimed to identify sexual healthcare needs in patients with IBD. Design/method We conducted a cross-sectional survey of adult patients with IBD at a tertiary teaching hospital. Clinical disease activity was assessed using the Harvey-Bradshaw Index for patients with Crohn’s disease and the Patient-Simple Clinical Colitis Activity Index for patients with ulcerative colitis. Sexual health questions were derived from the validated IBD-Specific Female Sexual Dysfunction and IBD-Male Sexual Dysfunction Scales. Comparisons between those with inactive and active disease were made using Fisher’s exact test. Results 101 respondents completed the survey, of which 53 (52%) were female and 57 (56%) had Crohn’s disease. The median age was 38 (IQR 28–52). 34 respondents (34%) had active disease. Respondents with active Crohn’s disease trended towards having more significant sexual dysfunction than those in remission for all domains on the sexual dysfunction scale. 74% reported interest in accessing specialist advice regarding their sexual function while 20% have attempted to seek this advice. 36% would wish to be contacted by the IBD team if a sexual health service became available. Conclusions Negative impacts on sexual function were common in our cohort, particularly in the presence of active disease. Most patients with IBD are interested in obtaining advice regarding their sexual function. This is an unmet need among IBD services. Data are available on reasonable request.
{"title":"Sexual dysfunction is prevalent in IBD but underserved: a need to expand specialised IBD care","authors":"Alexander Thomas Elford, William Beattie, Andrew Downie, Varun Kaushik, Jeni Mitchell, Ralley Prentice, Aysha H Al-Ani, Jonathan Segal, Britt Christensen","doi":"10.1136/flgastro-2024-102757","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102757","url":null,"abstract":"Objective Sexual dysfunction is common in patients with inflammatory bowel disease (IBD). Data on IBD disease activity and IBD patients’ desire to seek specialist advice regarding sexual dysfunction are lacking. We aimed to identify sexual healthcare needs in patients with IBD. Design/method We conducted a cross-sectional survey of adult patients with IBD at a tertiary teaching hospital. Clinical disease activity was assessed using the Harvey-Bradshaw Index for patients with Crohn’s disease and the Patient-Simple Clinical Colitis Activity Index for patients with ulcerative colitis. Sexual health questions were derived from the validated IBD-Specific Female Sexual Dysfunction and IBD-Male Sexual Dysfunction Scales. Comparisons between those with inactive and active disease were made using Fisher’s exact test. Results 101 respondents completed the survey, of which 53 (52%) were female and 57 (56%) had Crohn’s disease. The median age was 38 (IQR 28–52). 34 respondents (34%) had active disease. Respondents with active Crohn’s disease trended towards having more significant sexual dysfunction than those in remission for all domains on the sexual dysfunction scale. 74% reported interest in accessing specialist advice regarding their sexual function while 20% have attempted to seek this advice. 36% would wish to be contacted by the IBD team if a sexual health service became available. Conclusions Negative impacts on sexual function were common in our cohort, particularly in the presence of active disease. Most patients with IBD are interested in obtaining advice regarding their sexual function. This is an unmet need among IBD services. Data are available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"9 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175682","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 : 2024-08-15DOI: 10.1136/flgastro-2024-102778
Daniel Maggs, Emma Saunsbury, Benjamin Masterman, Ben Hudson, SPRinG Network
We were delighted to see specific guidance on palliative care (PC) included in the recently published British Society of Gastroenterology (BSG) best practice guidance on the outpatient management of cirrhosis.1 Decompensated advanced chronic liver disease (dACLD) carries a significant, and seldom addressed, symptom burden.2 3 PC interventions demonstrably improve physical and psychological symptoms in dACLD and do not negatively impact survival.4 Severn and Peninsula Research in Gastroenterology is a trainee research network. We undertook a retrospective regional service evaluation to assess the quality of PC provided to patients within their last year of life (LYOL) who died of dACLD in the South West of England. Specific objectives were to determine the proportion of patients with documented discussions regarding prognosis and advance care planning (ACP), and/or referral to specialist PC (SPC) services. A pre-COVID-19 patient cohort was selected to avoid the confounder of reduced outpatient services during the pandemic. Data regarding adults who died of dACLD between 1 February 2019 and 31 January 2020 were collected from electronic records. Full inclusion and exclusion criteria and statistical analysis details are outlined in online supplemental material. Documented discussions with all members …
我们很高兴看到姑息治疗（PC）的具体指导被纳入最近出版的英国胃肠病学会（BSG）肝硬化门诊治疗最佳实践指南中1 。我们进行了一项回顾性地区服务评估，以评估为英格兰西南部死于 dACLD 的患者生命最后一年（LYOL）提供的 PC 的质量。具体目标是确定对预后和预先护理计划（ACP）进行有记录讨论和/或转诊至专科PC（SPC）服务的患者比例。为了避免大流行期间门诊服务减少带来的混杂因素，我们选择了 COVID-19 之前的患者队列。从电子记录中收集了2019年2月1日至2020年1月31日期间死于dACLD的成人数据。全部纳入和排除标准以及统计分析细节见在线补充材料。与所有成员的讨论记录...
{"title":"Palliative care provision for patients with decompensated advanced chronic liver disease: lessons from the South West","authors":"Daniel Maggs, Emma Saunsbury, Benjamin Masterman, Ben Hudson, SPRinG Network","doi":"10.1136/flgastro-2024-102778","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102778","url":null,"abstract":"We were delighted to see specific guidance on palliative care (PC) included in the recently published British Society of Gastroenterology (BSG) best practice guidance on the outpatient management of cirrhosis.1 Decompensated advanced chronic liver disease (dACLD) carries a significant, and seldom addressed, symptom burden.2 3 PC interventions demonstrably improve physical and psychological symptoms in dACLD and do not negatively impact survival.4 Severn and Peninsula Research in Gastroenterology is a trainee research network. We undertook a retrospective regional service evaluation to assess the quality of PC provided to patients within their last year of life (LYOL) who died of dACLD in the South West of England. Specific objectives were to determine the proportion of patients with documented discussions regarding prognosis and advance care planning (ACP), and/or referral to specialist PC (SPC) services. A pre-COVID-19 patient cohort was selected to avoid the confounder of reduced outpatient services during the pandemic. Data regarding adults who died of dACLD between 1 February 2019 and 31 January 2020 were collected from electronic records. Full inclusion and exclusion criteria and statistical analysis details are outlined in online supplemental material. Documented discussions with all members …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"7 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175684","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 : 2024-08-12DOI: 10.1136/flgastro-2024-102768
Anjan Dhar, Stephen Attwood, Kumar Basu, Jemma S Carter, Joseph Cooney, Jason Dunn, Hasan Haboubi, Amir Jehangir, Maxton Pitcher, Marion Sloan, Terry Wong, Jyotika Singh
Eosinophilic oesophagitis (EoE) is a chronic condition characterised by solid-food dysphagia and food bolus obstruction due to T-helper cell-driven eosinophilic infiltration of the oesophageal epithelium and submucosal fibrosis. Suboptimal management results in delayed diagnosis, repeated food bolus obstructions and hospital attendances, inappropriate referral and treatment, increased healthcare resource use, and impaired quality of life. A group of clinicians with an interest in EoE deliberated on the current care pathways and evidence of best practice to develop an integrated care pathway to optimise the diagnosis and management of EoE. Key recommendations include suspecting EoE in patients presenting with food bolus obstruction or dysphagia; referring to gastroenterology and for oesophago-gastro-duodenoscopy promptly; taking at least six biopsies from multiple sites (ideally three) to diagnose EoE based on >15 eosinophils/0.3 mm2 oesophageal epithelium; using budesonide orodispersible tablets, as the only UK-licensed therapy for EoE for induction of remission and maintenance; arranging regular oesophago-gastro-duodenoscopies, gastroenterology follow-up and maintenance therapy due to the high relapse rate; and involving primary care to manage follow-on prescribing.
嗜酸性粒细胞性食道炎（EoE）是一种慢性疾病，其特点是食道上皮细胞和粘膜下纤维化受到 T 辅助细胞驱动的嗜酸性粒细胞浸润，导致固体食物吞咽困难和食道梗阻。处理不当会导致诊断延误、反复食管梗阻和住院、转诊和治疗不当、医疗资源使用增加以及生活质量下降。一组对咽喉炎感兴趣的临床医生讨论了当前的护理路径和最佳实践证据，以制定综合护理路径，优化咽喉炎的诊断和管理。主要建议包括：对出现食栓阻塞或吞咽困难的患者怀疑患有食道水肿；及时转诊至消化内科并进行食道-胃-十二指肠镜检查；至少从多个部位进行六次活检（最好是三次），根据嗜酸性粒细胞大于 15 个/0.3 平方毫米的食道上皮细胞；使用布地奈德口服分散片，这是英国唯一获得许可的诱导缓解和维持治疗EoE 的疗法；由于复发率高，应安排定期的食道-胃-十二指肠镜检查、胃肠病学随访和维持治疗；让初级保健参与管理后续处方。
{"title":"Improving management of eosinophilic oesophagitis in adults in the UK: proposal for an integrated care pathway","authors":"Anjan Dhar, Stephen Attwood, Kumar Basu, Jemma S Carter, Joseph Cooney, Jason Dunn, Hasan Haboubi, Amir Jehangir, Maxton Pitcher, Marion Sloan, Terry Wong, Jyotika Singh","doi":"10.1136/flgastro-2024-102768","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102768","url":null,"abstract":"Eosinophilic oesophagitis (EoE) is a chronic condition characterised by solid-food dysphagia and food bolus obstruction due to T-helper cell-driven eosinophilic infiltration of the oesophageal epithelium and submucosal fibrosis. Suboptimal management results in delayed diagnosis, repeated food bolus obstructions and hospital attendances, inappropriate referral and treatment, increased healthcare resource use, and impaired quality of life. A group of clinicians with an interest in EoE deliberated on the current care pathways and evidence of best practice to develop an integrated care pathway to optimise the diagnosis and management of EoE. Key recommendations include suspecting EoE in patients presenting with food bolus obstruction or dysphagia; referring to gastroenterology and for oesophago-gastro-duodenoscopy promptly; taking at least six biopsies from multiple sites (ideally three) to diagnose EoE based on >15 eosinophils/0.3 mm2 oesophageal epithelium; using budesonide orodispersible tablets, as the only UK-licensed therapy for EoE for induction of remission and maintenance; arranging regular oesophago-gastro-duodenoscopies, gastroenterology follow-up and maintenance therapy due to the high relapse rate; and involving primary care to manage follow-on prescribing.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"34 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175685","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 : 2024-07-25DOI: 10.1136/flgastro-2024-102777
David Beaton, Linda Sharp, Nigel John Trudgill, Matt Rutter
Background and aims We aimed to analyse data from the UK National Endoscopy Database (NED) to investigate factors associated with endotherapy in patients with suspected upper gastrointestinal bleeding (UGIB) . Methods Analysis of oesophagogastroduodenoscopy (OGD) uploads to the NED from 1 March 2019 to 29 February 2020 was performed. UGIB was defined as procedures with indications of melaena and/or haematemesis. The proportion where endotherapy was performed was calculated. Mixed-effects logistic regression was performed with patient sex, patient age, type of admission (inpatient, outpatient, unclassified) and symptoms as fixed effects on the dependent variable (receipt of endotherapy). Results were presented as adjusted ORs (aORs) with 95% CIs. Results 47 481 OGDs were performed for UGIB; endotherapy was performed in 14.8%, increasing to 20.0% when only inpatient OGDs were analysed. Patients aged 18–39 years were half as likely to undergo endotherapy than those aged 50–59 years (aOR 0.5, 95% CI 0.5 to 0.6), with male patients at higher risk than females (aOR 1.3, 95% CI 1.2 to 1.4). Patients with both melaena and haematemesis were nearly three times more likely to receive endotherapy (aOR 2.8, 95% CI 2.6 to 3.0) compared with those with melaena alone. Conversely, patients with only haematemesis had a lower risk than those with melaena alone (aOR 0.9, 95% CI 0.8 to 0.9). Conclusions Younger and female patients were at lower risk of undergoing endotherapy, while patients with both melaena and haematemesis were at three times the risk as those with each symptom alone. Incorporating these findings into UGIB risk scores could improve patient triage. Data are available on reasonable request.
背景和目的 我们旨在分析英国国家内镜数据库（NED）中的数据，研究疑似上消化道出血（UGIB）患者接受内镜治疗的相关因素。方法 对2019年3月1日至2020年2月29日上传至NED的食管胃十二指肠镜检查（OGD）数据进行分析。UGIB 被定义为有黄疸和/或吐血指征的手术。计算了进行内科治疗的比例。将患者性别、患者年龄、入院类型（住院、门诊、未分类）和症状作为因变量（接受内科治疗）的固定效应，进行混合效应逻辑回归。结果以调整后的 ORs (aORs) 和 95% CIs 表示。结果 对47 481例UGIB进行了腹腔镜手术；14.8%的患者接受了内科治疗，仅对住院腹腔镜手术进行分析时，这一比例上升至20.0%。18-39岁患者接受内科治疗的几率是50-59岁患者的一半（aOR 0.5，95% CI 0.5-0.6），男性患者的风险高于女性（aOR 1.3，95% CI 1.2-1.4）。与仅有黄疽的患者相比，既有黄疽又有吐血的患者接受内科治疗的几率要高出近三倍（aOR 2.8，95% CI 2.6 至 3.0）。相反，仅有吐血的患者接受内科治疗的风险比仅有腹泻的患者低（aOR 0.9，95% CI 0.8 至 0.9）。结论 年轻患者和女性患者接受内科治疗的风险较低，而同时伴有腹水和吐血的患者接受内科治疗的风险是仅有两种症状的患者的三倍。将这些发现纳入 UGIB 风险评分可改善患者分流。如有合理要求，可提供相关数据。
{"title":"Improving triage in upper gastrointestinal bleeding: insights from the UK National Endoscopy Database (NED)","authors":"David Beaton, Linda Sharp, Nigel John Trudgill, Matt Rutter","doi":"10.1136/flgastro-2024-102777","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102777","url":null,"abstract":"Background and aims We aimed to analyse data from the UK National Endoscopy Database (NED) to investigate factors associated with endotherapy in patients with suspected upper gastrointestinal bleeding (UGIB) . Methods Analysis of oesophagogastroduodenoscopy (OGD) uploads to the NED from 1 March 2019 to 29 February 2020 was performed. UGIB was defined as procedures with indications of melaena and/or haematemesis. The proportion where endotherapy was performed was calculated. Mixed-effects logistic regression was performed with patient sex, patient age, type of admission (inpatient, outpatient, unclassified) and symptoms as fixed effects on the dependent variable (receipt of endotherapy). Results were presented as adjusted ORs (aORs) with 95% CIs. Results 47 481 OGDs were performed for UGIB; endotherapy was performed in 14.8%, increasing to 20.0% when only inpatient OGDs were analysed. Patients aged 18–39 years were half as likely to undergo endotherapy than those aged 50–59 years (aOR 0.5, 95% CI 0.5 to 0.6), with male patients at higher risk than females (aOR 1.3, 95% CI 1.2 to 1.4). Patients with both melaena and haematemesis were nearly three times more likely to receive endotherapy (aOR 2.8, 95% CI 2.6 to 3.0) compared with those with melaena alone. Conversely, patients with only haematemesis had a lower risk than those with melaena alone (aOR 0.9, 95% CI 0.8 to 0.9). Conclusions Younger and female patients were at lower risk of undergoing endotherapy, while patients with both melaena and haematemesis were at three times the risk as those with each symptom alone. Incorporating these findings into UGIB risk scores could improve patient triage. Data are available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"40 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141775037","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 : 2024-07-18DOI: 10.1136/flgastro-2024-102747
Nigel Grunshaw, Wendi Harrison, Hayley Owen, Philip J Smith
Background Intestinal ultrasound (IUS), although less widely practiced in the UK, offers several advantages in inflammatory bowel disease (IBD), particularly with regard to the accessibility of the test and immediate availability of reports. Aims To assess the use of point-of-care IUS in influencing management change in IBD. Methods A retrospective service evaluation review of 3 years of a rapid access IUS clinic performed in combination with IBD nurses in a District General Hospital setting. Results A total of 227 examinations were performed on 168 patients. All scans were performed by a consultant radiologist. 162 examinations (79%) were scanned and reported within 2 weeks of referral. 101/227 (44%) had evidence of significant active/obstructing disease, and in patients with known IBD, this rises to 101/185 (55%). Overall, 59.5% (135) of ultrasound examinations resulted in management changes. Conclusion Wider adoption of IUS in a point-of-care setting has the potential to significantly guide patient management in IBD. All data relevant to the study are included in the article or uploaded as supplementary information.
背景 肠道超声（IUS）虽然在英国应用较少，但它在炎症性肠病（IBD）中具有多项优势，尤其是在检测的可及性和报告的即时可用性方面。目的 评估床旁 IUS 在影响 IBD 管理变化方面的应用。方法 对一家地区综合医院与 IBD 护士联合开展的快速 IUS 诊所 3 年的服务进行回顾性评估。结果 共为 168 名患者进行了 227 次检查。所有扫描均由放射科顾问医师进行。162例检查（79%）在转诊后两周内完成扫描并出具报告。101/227（44%）例患者有明显的活动性/阻塞性疾病，在已知患有 IBD 的患者中，这一比例上升到 101/185（55%）例。总体而言，59.5%（135 例）的超声检查结果导致了治疗方案的改变。结论 在护理点环境中更广泛地采用 IUS 有可能极大地指导 IBD 患者的管理。与该研究相关的所有数据均包含在文章中或作为补充信息上传。
{"title":"Effect of combined rapid access point-of-care intestinal ultrasound clinic on the management of inflammatory bowel disease","authors":"Nigel Grunshaw, Wendi Harrison, Hayley Owen, Philip J Smith","doi":"10.1136/flgastro-2024-102747","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102747","url":null,"abstract":"Background Intestinal ultrasound (IUS), although less widely practiced in the UK, offers several advantages in inflammatory bowel disease (IBD), particularly with regard to the accessibility of the test and immediate availability of reports. Aims To assess the use of point-of-care IUS in influencing management change in IBD. Methods A retrospective service evaluation review of 3 years of a rapid access IUS clinic performed in combination with IBD nurses in a District General Hospital setting. Results A total of 227 examinations were performed on 168 patients. All scans were performed by a consultant radiologist. 162 examinations (79%) were scanned and reported within 2 weeks of referral. 101/227 (44%) had evidence of significant active/obstructing disease, and in patients with known IBD, this rises to 101/185 (55%). Overall, 59.5% (135) of ultrasound examinations resulted in management changes. Conclusion Wider adoption of IUS in a point-of-care setting has the potential to significantly guide patient management in IBD. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"36 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141737999","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 : 2024-07-18DOI: 10.1136/flgastro-2024-102676
Carly Lamb, Jennifer Tham, Tee Lin Goh, Stephen Barclay, Matthew Priest, Ewan H Forrest, Andrew Fraser, David Kay, Ram Kasthuri, Jeff Evans, Adrian J Stanley
Introduction Hepatocellular carcinoma (HCC) is increasing in incidence across the UK. Most patients have underlying cirrhosis, but a significant minority do not. Progression and outcomes of HCC in patients without cirrhosis remains unclear. This study aimed to establish the proportion and characteristics of patients with HCC occurring in those with and without cirrhosis in the West of Scotland. Methods Data were collected from our prospectively collected database on patient demographics, liver disease aetiology, stage at presentation and outcomes for patients with a diagnosis of HCC confirmed at the Regional West of Scotland multidisciplinary team from 2009 to 2015. Results 638 patients were included. 138 (21.6%) did not have cirrhosis and were older at diagnosis than those with cirrhosis (72 years vs 68 years, p=0.001). A higher proportion of those without cirrhosis presented with more advanced HCC (Barcelona clinic liver cancer (BCLC) score B or above; p=0.003). Patients with cirrhosis had median survival of 8 months, compared with those without cirrhosis (11.5 months) but survival was similar in both groups on Kaplan-Meier analysis (p=0.119). There was no difference in survival between these groups when adjusted for cancer stage. Survival was influenced by BCLC score in both cirrhotic and non-cirrhotic groups, as was survival by Child-Pugh score in patients with cirrhosis. Among the patients who underwent transarterial chemoembolisation (TACE), those with cirrhosis had worse survival (p=0.044). Conclusion 21.6% of patients with a new diagnosis of HCC in our region did not have underlying cirrhosis. Patients with non-cirrhotic HCC were diagnosed at an older age, with more advanced stage of HCC. There was no difference in overall survival between patients with HCC with and without cirrhosis, however, survival after TACE was higher in those without cirrhosis. Data are available on reasonable request. De-identified participant data available from CL (ORCID 0000-0003-0136-7835).
{"title":"Comparison between patient characteristics, aetiology and outcomes in patients with and without cirrhosis with hepatocellular carcinoma diagnosed in a regional centre","authors":"Carly Lamb, Jennifer Tham, Tee Lin Goh, Stephen Barclay, Matthew Priest, Ewan H Forrest, Andrew Fraser, David Kay, Ram Kasthuri, Jeff Evans, Adrian J Stanley","doi":"10.1136/flgastro-2024-102676","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102676","url":null,"abstract":"Introduction Hepatocellular carcinoma (HCC) is increasing in incidence across the UK. Most patients have underlying cirrhosis, but a significant minority do not. Progression and outcomes of HCC in patients without cirrhosis remains unclear. This study aimed to establish the proportion and characteristics of patients with HCC occurring in those with and without cirrhosis in the West of Scotland. Methods Data were collected from our prospectively collected database on patient demographics, liver disease aetiology, stage at presentation and outcomes for patients with a diagnosis of HCC confirmed at the Regional West of Scotland multidisciplinary team from 2009 to 2015. Results 638 patients were included. 138 (21.6%) did not have cirrhosis and were older at diagnosis than those with cirrhosis (72 years vs 68 years, p=0.001). A higher proportion of those without cirrhosis presented with more advanced HCC (Barcelona clinic liver cancer (BCLC) score B or above; p=0.003). Patients with cirrhosis had median survival of 8 months, compared with those without cirrhosis (11.5 months) but survival was similar in both groups on Kaplan-Meier analysis (p=0.119). There was no difference in survival between these groups when adjusted for cancer stage. Survival was influenced by BCLC score in both cirrhotic and non-cirrhotic groups, as was survival by Child-Pugh score in patients with cirrhosis. Among the patients who underwent transarterial chemoembolisation (TACE), those with cirrhosis had worse survival (p=0.044). Conclusion 21.6% of patients with a new diagnosis of HCC in our region did not have underlying cirrhosis. Patients with non-cirrhotic HCC were diagnosed at an older age, with more advanced stage of HCC. There was no difference in overall survival between patients with HCC with and without cirrhosis, however, survival after TACE was higher in those without cirrhosis. Data are available on reasonable request. De-identified participant data available from CL (ORCID 0000-0003-0136-7835).","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141738140","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 : 2024-07-17DOI: 10.1136/flgastro-2024-102797
Colin Fitzpatrick, Shaira Doherty, Sabina George, Daniel Richardson
Background The transmission dynamics of hepatitis E in men who have sex with men (MSM) are poorly understood. We aimed to explore any factors observed in MSM with hepatitis E by systematically reviewing the literature. Methods We searched five databases (PubMed, Embase, CINAHL Plus, MEDLINE and Web of Science Core Collections). The primary author performed an initial screen of citations and abstracts, and two authors independently reviewed full-text manuscripts for eligibility. We only included manuscripts in English that explored at least one risk factor for hepatitis E. The risk of bias was assessed using the Joanna Briggs Institute toolkits. Narrative data were synthesised and tabulated. This review was registered on PROSPERO (ID: CRD42023472303). Results 14 manuscripts were included in this review: two case reports, one case-control study, two cohort studies and nine cross-sectional studies from Italy (n=3), Japan (n=2), France (n=2), Argentina (n=1), Russia (n=1), the USA (n=1), the Netherlands (n=1), Belgium (n=1), Spain (n=1) and Greece (n=1). In total, there were 376 MSM with hepatitis E in this analysis. We have highlighted demographic (bimodal age (16–29 and >40), HIV pre-exposure prophylaxis use, living with HIV) and biological (previous syphilis, hepatitis C and hepatitis A) factors in MSM with previous/current hepatitis E. In five manuscripts, no association was found between MSM and hepatitis E. Conclusion Despite conflicting data, hepatitis E may be sexually transmissible in MSM, and MSM with unexplained jaundice, transaminitis, renal disease or neurological disease should be tested. HIV, hepatitis A (including vaccination), hepatitis C and syphilis testing are required in MSM with hepatitis E. This review provides some insight for future clinical guidelines, public health outbreak control strategies and research. Data sharing not applicable to this article as no datasets were generated or analysed during the current study. All data relevant to the study are included in the article
{"title":"Hepatitis E in men who have sex with men: a systematic review","authors":"Colin Fitzpatrick, Shaira Doherty, Sabina George, Daniel Richardson","doi":"10.1136/flgastro-2024-102797","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102797","url":null,"abstract":"Background The transmission dynamics of hepatitis E in men who have sex with men (MSM) are poorly understood. We aimed to explore any factors observed in MSM with hepatitis E by systematically reviewing the literature. Methods We searched five databases (PubMed, Embase, CINAHL Plus, MEDLINE and Web of Science Core Collections). The primary author performed an initial screen of citations and abstracts, and two authors independently reviewed full-text manuscripts for eligibility. We only included manuscripts in English that explored at least one risk factor for hepatitis E. The risk of bias was assessed using the Joanna Briggs Institute toolkits. Narrative data were synthesised and tabulated. This review was registered on PROSPERO (ID: CRD42023472303). Results 14 manuscripts were included in this review: two case reports, one case-control study, two cohort studies and nine cross-sectional studies from Italy (n=3), Japan (n=2), France (n=2), Argentina (n=1), Russia (n=1), the USA (n=1), the Netherlands (n=1), Belgium (n=1), Spain (n=1) and Greece (n=1). In total, there were 376 MSM with hepatitis E in this analysis. We have highlighted demographic (bimodal age (16–29 and >40), HIV pre-exposure prophylaxis use, living with HIV) and biological (previous syphilis, hepatitis C and hepatitis A) factors in MSM with previous/current hepatitis E. In five manuscripts, no association was found between MSM and hepatitis E. Conclusion Despite conflicting data, hepatitis E may be sexually transmissible in MSM, and MSM with unexplained jaundice, transaminitis, renal disease or neurological disease should be tested. HIV, hepatitis A (including vaccination), hepatitis C and syphilis testing are required in MSM with hepatitis E. This review provides some insight for future clinical guidelines, public health outbreak control strategies and research. Data sharing not applicable to this article as no datasets were generated or analysed during the current study. All data relevant to the study are included in the article","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745959","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 : 2024-07-17DOI: 10.1136/flgastro-2024-102780
Vaibhav Dubey, Vidhushan Sivachandran, Natasha Wahab, Carrie Llewellyn, Daniel Richardson
Objective Giardia duodenalis causes enteritis and malabsorption and can be sexually transmissible in men who have sex with men (MSM). The aim of this study was to explore factors associated with MSM with G. duodenalis . Methods MEDLINE, Embase, Emcare, PubMed, Global Health and Web of Science were searched for manuscripts published up to February 2024. The primary author screened manuscript titles and abstracts; two authors independently reviewed full-text manuscripts for eligibility and risk of bias. We only included manuscripts that included MSM with G. duodenalis and explored at least one risk factor or association. Narrative data were synthesised following the population of a predetermined table. Results Twelve manuscripts were included in this review, including cross-sectional studies (n=7), case series (n=3), cohort study (n=1), case-control study (n=1), from the USA (n=8), the UK (n=1), Cuba (n=1), Spain (n=1) and Canada (n=1) published between 1977 and 2024 and included 191 MSM with G. duodenalis . This review highlighted demographic (living with HIV and living with HIV with a CD4 count <400 cells/mL), biological (coinfection with Neisseria gonorrhoeae , Chlamydia trachomatis , Escherichia coli , Entamoeba histolytica , non-pathogenic enteric parasites, intestinal spirochaetosis, Enterobius vermicularis , previous Treponema pallidum , N. gonorrhoeae , Shigella spp, hepatitis A, E. histolytica and G. duodenalis ) and behavioural (lack of anal douching, oral-anal sex, oral sex, anal sex, group sex, use of sex toys, having more than one sexual partner per week, non-condom use, being part of a sexual network or having a sexual partner with G. duodenalis ) factors associated with MSM with G. duodenalis . Conclusion This review has highlighted some demographic, behavioural and biological factors associated with MSM with G. duodenalis , which provide insight for public health control strategies and future research. PROSPERO registration number CRD42023477691. No data are available.
目的 十二指肠贾第鞭毛虫会导致肠炎和吸收不良，并可通过性传播给男男性行为者（MSM）。本研究旨在探讨 MSM 感染十二指肠贾第虫的相关因素。方法 检索 MEDLINE、Embase、Emcare、PubMed、Global Health 和 Web of Science 上截至 2024 年 2 月发表的手稿。主要作者筛选了稿件标题和摘要；两位作者独立审阅了稿件全文，以确定是否符合要求和是否存在偏倚风险。我们只收录了包括患有十二指肠球菌的 MSM 并探讨了至少一种风险因素或关联的稿件。叙述性数据按照预先确定的表格进行综合。结果 本综述纳入了 12 篇手稿，包括横断面研究（n=7）、病例系列研究（n=3）、队列研究（n=1）、病例对照研究（n=1），分别来自美国（n=8）、英国（n=1）、古巴（n=1）、西班牙（n=1）和加拿大（n=1），发表于 1977 年至 2024 年之间，纳入了 191 名患有十二指肠球菌的 MSM。该综述强调了人口统计学（感染 HIV 和 CD4 细胞计数小于 400 cells/mL 的 HIV 感染者）、生物学（同时感染淋病奈瑟菌、沙眼衣原体、大肠杆菌、组织溶解恩塔米巴菌、非致病性肠道寄生虫、肠螺旋体病、蚯蚓肠杆菌、先前的苍白链球菌、N.淋病、志贺氏菌属、甲型肝炎、组织溶解性大肠杆菌和十二指肠球菌）和行为（缺乏肛门冲洗、口交-肛交、口交、肛交、群交、使用性玩具、每周有一个以上性伴侣、不使用安全套、属于性网络的一部分或性伴侣患有十二指肠球菌）因素与患有十二指肠球菌的 MSM 相关。结论 本综述强调了与感染十二指肠球菌的 MSM 相关的一些人口、行为和生物学因素，为公共卫生控制策略和未来研究提供了启示。PROSPERO 注册号为 CRD42023477691。无数据。
{"title":"Giardia duodenalis in men who have sex with men: a systematic review","authors":"Vaibhav Dubey, Vidhushan Sivachandran, Natasha Wahab, Carrie Llewellyn, Daniel Richardson","doi":"10.1136/flgastro-2024-102780","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102780","url":null,"abstract":"Objective Giardia duodenalis causes enteritis and malabsorption and can be sexually transmissible in men who have sex with men (MSM). The aim of this study was to explore factors associated with MSM with G. duodenalis . Methods MEDLINE, Embase, Emcare, PubMed, Global Health and Web of Science were searched for manuscripts published up to February 2024. The primary author screened manuscript titles and abstracts; two authors independently reviewed full-text manuscripts for eligibility and risk of bias. We only included manuscripts that included MSM with G. duodenalis and explored at least one risk factor or association. Narrative data were synthesised following the population of a predetermined table. Results Twelve manuscripts were included in this review, including cross-sectional studies (n=7), case series (n=3), cohort study (n=1), case-control study (n=1), from the USA (n=8), the UK (n=1), Cuba (n=1), Spain (n=1) and Canada (n=1) published between 1977 and 2024 and included 191 MSM with G. duodenalis . This review highlighted demographic (living with HIV and living with HIV with a CD4 count <400 cells/mL), biological (coinfection with Neisseria gonorrhoeae , Chlamydia trachomatis , Escherichia coli , Entamoeba histolytica , non-pathogenic enteric parasites, intestinal spirochaetosis, Enterobius vermicularis , previous Treponema pallidum , N. gonorrhoeae , Shigella spp, hepatitis A, E. histolytica and G. duodenalis ) and behavioural (lack of anal douching, oral-anal sex, oral sex, anal sex, group sex, use of sex toys, having more than one sexual partner per week, non-condom use, being part of a sexual network or having a sexual partner with G. duodenalis ) factors associated with MSM with G. duodenalis . Conclusion This review has highlighted some demographic, behavioural and biological factors associated with MSM with G. duodenalis , which provide insight for public health control strategies and future research. PROSPERO registration number CRD42023477691. No data are available.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"80 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141738136","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 : 2024-07-13DOI: 10.1136/flgastro-2023-102419
James Ashton, Kwang Yang Lee, Anthi Thangarajah, Astor Rodrigues, Jochen Kammermeier
There are ever-increasing therapeutic options for patients with ulcerative colitis (UC), but licensing and availability for children and young people are often years behind those aged >18 years. ‘Advanced therapies’, including biologics and small molecules, now target numerous different inflammatory pathways but continue to have a therapeutic ceiling with only 30–60% of patients responding to initial therapies, although with patients achieving mucosal healing having improved long-term outcomes. Within this review, we synthesise the paediatric evidence for the medicines, including anti-tumour necrosis factor, anti-integrin, anti-interleukin-12/23 monoclonal antibodies, alongside Janus kinase (JAK)-inhibitors and Sphingosine-1-phosphate inhibitors, used in moderate-to-severe UC, and extrapolate the adult literature where paediatric data are lacking. Finally, we look at the potential for optimal use and sequencing of these therapies when they are used in an empirical algorithm and consider some of the longer-term implications of loss of response.
{"title":"Therapeutic options for children and young people with moderate-to-severe ulcerative colitis","authors":"James Ashton, Kwang Yang Lee, Anthi Thangarajah, Astor Rodrigues, Jochen Kammermeier","doi":"10.1136/flgastro-2023-102419","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102419","url":null,"abstract":"There are ever-increasing therapeutic options for patients with ulcerative colitis (UC), but licensing and availability for children and young people are often years behind those aged >18 years. ‘Advanced therapies’, including biologics and small molecules, now target numerous different inflammatory pathways but continue to have a therapeutic ceiling with only 30–60% of patients responding to initial therapies, although with patients achieving mucosal healing having improved long-term outcomes. Within this review, we synthesise the paediatric evidence for the medicines, including anti-tumour necrosis factor, anti-integrin, anti-interleukin-12/23 monoclonal antibodies, alongside Janus kinase (JAK)-inhibitors and Sphingosine-1-phosphate inhibitors, used in moderate-to-severe UC, and extrapolate the adult literature where paediatric data are lacking. Finally, we look at the potential for optimal use and sequencing of these therapies when they are used in an empirical algorithm and consider some of the longer-term implications of loss of response.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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