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Role of oesophageal balloon cryoablation in combination with personalised immunotherapy to achieve luminal control in metastatic oesophageal cancer: a case report Frontline Gastroenterol. Pub Date : 2024-03-15 Benjamin Charles Norton, Apostolis Papaefthymiou, Andrea Telese, Margaret Duku, Imran Chaudhry, Alberto Murino, Gavin Johnson, Charles Murray, Rehan Haidry
Metastatic oesophageal adenocarcinoma (OAC) is associated with a poor prognosis, but patients with a good performance status may be offered palliative oncological intervention. Oesophageal cryoablation is an emerging therapy for the palliation of malignant dysphagia that can be given over multiple sessions with relatively few side effects. Emerging evidence suggests that cryoablation may provide a
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Factors associated with Entamoeba histolytica proctocolitis in men who have sex with men: a systematic review Frontline Gastroenterol. Pub Date : 2024-03-14 Robbie Hughes, Daniel Richardson, Colin Fitzpatrick
Objective Entamoeba histolytica is parasitic infection that can cause a proctocolitis (amoebiasis) and extraintestinal sequelae (eg, liver abscess) and can be sexually transmitted in men who have sex with men (MSM). We aimed to identify factors associated with E. histolytica in MSM to provide insight for future control strategies. Design/methods We searched MEDLINE, Embase, CINAHL and Web of Science
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Sequential comparison of two intraductal biliary brush cytology devices for suspected malignant biliary strictures Frontline Gastroenterol. Pub Date : 2024-03-13 Manu Nayar, Kofi W Oppong, Pardeep Maheshwari, Sarah Johnson, Shiran Esmaily, Ruth Waller, John Leeds
Background The diagnostic performance of endoscopic retrograde cholangiopancreatography brush cytology for malignant strictures is modest. A novel larger more abrasive brush may have improved diagnostic performance. We compared the utility of the new biliary brush with a conventional brush. Methods The new brush was used in 51 consecutive patients (group 1) referred with a biliary stricture and matched
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Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study Frontline Gastroenterol. Pub Date : 2024-03-12 Peter Rimmer, Jonathan Cheesbrough, Jane Harris, Melanie Love, Samantha Tull, Asif Iqbal, Daniel Regan-Komito, Rachel Cooney, Karl Hazel, Naveen Sharma, Thomas Dietrich, Iain Chapple, Mohammad Nabil Quraishi, Tariq H Iqbal
Objective Diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation. Methods A rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were
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Liver outcomes following proctocolectomy in patients with primary sclerosing cholangitis and ulcerative colitis Frontline Gastroenterol. Pub Date : 2024-03-06 Thomas Ryan, Jonathan P Segal
Background The aims of this narrative review are to examine the impact of proctocolectomy on the liver in patients with primary sclerosing cholangitis and ulcerative colitis (PSC-UC), mainly focusing on graft loss, and to compare the different proctocolectomy techniques to help determine which is the best for PSC-UC patients. Methods A literature search was performed using the online databases MEDLINE
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How can we improve the carbon footprint of IBD clinical care? Frontline Gastroenterol. Pub Date : 2024-03-05 Isabel Carbery, Gauraang Bhatnagar, Rachel Cooney, Christian Selinger
The carbon footprint of the National Health Service (NHS) is estimated to be responsible for 5.9% of the total UK carbon footprint. The NHS has committed to reach carbon net zero by 2040, and therefore, all healthcare professionals have a role to play in identifying ways to help achieve this goal within their individual clinical areas. While specific research focusing on the carbon footprint of inflammatory
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Unmet research needs in sustainable luminal gastroenterology practice Frontline Gastroenterol. Pub Date : 2024-03-01 Anjan Dhar, Hasan Haboubi, Christian Selinger, Ramesh Arasaradnam
While it is now well recognised that gastroenterology, hepatology and endoscopy are major contributors to climate change on account of the amount of greenhouse gases (GHGs) that are generated in these specialties, systematic research that measures the exact amount of GHGs generated by different aspects of clinical care in the specialty is lacking. Similarly, while there are a number of publications
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Evaluation of the safety, efficacy and feasibility of ‘at-home’ capsule endoscopy Frontline Gastroenterol. Pub Date : 2024-02-26 Ioanna Parisi, Angelica Vania Hosea, Sandro Stoffel, Martin Nemec, Sohail Badat, Edward Seward, Aradhna Kaushal, Robert Kerrison, Christian Von Wagner
Objective The role of small bowel capsule endoscopy (SBCE) in diagnosing gastrointestinal diseases has long been established. Recently, colon CE (CCE) has been suggested as an alternative to colonoscopy. CE has been traditionally conducted at endoscopy units. However, during the COVID-19 pandemic, a switch was made to ‘at-home CE’ (ACE) which has continued to date. This study is an evaluation of ACE
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FIT for the future Frontline Gastroenterol. Pub Date : 2024-02-26 Robert Logan, Charles Andrews
Based on evidence from patients with both high-risk and low-risk symptoms of colorectal cancer (CRC), National Institute of Clinical Excellence (NICE) NG56 (quantitative faecal immunochemical testing (FIT) to guide CRC referral in primary care) places FIT at the heart of CRC diagnosis in primary care.1 When fully implemented, it should improve the diagnosis of CRC by identifying those at increased
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Chest pain in a patient with suicidal history Frontline Gastroenterol. Pub Date : 2024-02-26 Chien-Ming Chiang, Hsueh-Chien Chiang, Jui-Wen Kang
A 69-year-old man with diabetes mellitus (DM) visited the emergency department with chest pain for 4 days. He had suicidal history 6 months ago, using a knife to cut into his throat about 3 cm depth. An elevated body temperature (37.4°C) was detected. Electrocardiography showed sinus rhythm without ST or T wave changes, and chest computed tomography angiography (CTA) demonstrated no aortic dissection
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Should environmental sustainability be a priority for the gastroenterology community? Frontline Gastroenterol. Pub Date : 2024-02-23 Desmond Leddin
Sustainable practice means living within our means and not compromising the health of the planet for future generations. We are not meeting this goal at present as evidenced by the breaking of several indicators of planetary health and ever-increasing global mean temperatures. The arguments in favour of environmental sustainability include our ethical obligations as healthcare providers not to harm
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Green hepatology: moving forward – evidence base and practicalities Frontline Gastroenterol. Pub Date : 2024-02-19 James B Maurice, Mhairi Donnelly
Healthcare services have a significant environmental cost that is contributing to the current climate crisis. Patients with liver disease are vulnerable to the consequences of environmental change, but progress has been slow in making hepatology services more sustainable. This article explores how climate change may impact on liver disease, how we may make early steps to apply the principals of sustainable
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UpFront Frontline Gastroenterol. Pub Date : 2024-03-01 R Mark Beattie
We (mostly) think of abnormal serum amylase as being elevated. In this issue, Jalal and colleagues report a systematic review of the conditions associated with low serum amylase. The authors found 19 studies reporting 15 097 patients. The main conditions associated with low serum amylase were diabetes mellitus, metabolic syndrome, chronic pancreatitis (CP), non-alcoholic fatty liver disease and obesity
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Cost-benefits and environmental impact of the no-biopsy approach for the diagnosis of coeliac disease in adults Frontline Gastroenterol. Pub Date : 2024-03-01 Mohamed G Shiha, Nicoletta Nandi, Andrew J Hutchinson, Suneil A Raju, Foong Way David Tai, Luca Elli, Hugo A Penny, David Surendran Sanders
Objective Recent evidence suggests that adult patients with IgA tissue transglutaminase levels of ≥10× the upper limit of normal could be accurately diagnosed with coeliac disease without undergoing endoscopy and biopsy. We aimed to evaluate the cost-benefits and the environmental impact of implementing the no-biopsy approach for diagnosing coeliac disease in clinical practice. Design We calculated
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Outcome of long-term biliary stenting for stones in the 2010s: beware the cholecystectomised! Frontline Gastroenterol. Pub Date : 2024-03-01 Jamal Ahmed, Priyanka Prakash, Gney Mehta, Tessa Davies, Yin Yin Lim, Nicholas D Cross, Marek Alexander Czajkowski, Miles Clifford Allison
Objective Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for most patients with common bile duct stones (CBDS). Duct clearance at initial ERCP may not be achieved in a third of patients, many of whom may be elderly with multiple comorbidities rendering them at potentially high risk for further procedures. We aimed to quantify the rate of biliary sequelae and mortality
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Developing a generic business case for an advanced chronic liver disease support service Frontline Gastroenterol. Pub Date : 2024-03-01 Mark Wright, Sarah Willmore, Sumita Verma, Anita Omasta-Martin, Humraj Sahota, Wendy Prentice, Amelia Jane Stockley, Fiona Finlay, Julia Verne, Ben Hudson
Introduction Liver disease deaths are rising, but specialist palliative care services for hepatology are limited. Expansion across the NHS is required. Methods We surveyed clinicians, patients and carers to design an ‘ideal’ service. Using standard NHS tariffs, we calculated the cost of this service. In hospitals where specialist palliative care was available for liver disease, patient-level costs
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Quality improvement project demonstrating a sustained increase in the assessment and sampling of ascites for hospitalised patients with cirrhosis Frontline Gastroenterol. Pub Date : 2024-03-01 Elizabeth L Herrle, Monica Thim, Matthew S Buttarazzi, Jenna Ptaschinski, Victoria Molina, Natalie Channell, Lesley B Gordon
Objective Using quality improvement techniques, we aimed to improve the rate of assessment and sampling of ascitic fluid for the purpose of diagnosing spontaneous bacterial peritonitis in patients with cirrhosis admitted to the hospitalist service of our institution. Design/methods Based on stakeholder needs assessment, we implemented interventions targeting provider knowledge, procedure workflows
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Tailoring follow-up endoscopy in patients with severe oesophagitis Frontline Gastroenterol. Pub Date : 2024-03-01 Rebecca K Grant, William M Brindle, Caitlyn L Taylor, Edward J Rycroft, Oluwadara Oyewole, Sarah C Morgan, Eleanor F Watson, Atul Anand, Norma C McAvoy, Ian D Penman, Nicholas I Church, Kenneth C Trimble, Colin L Noble, John N Plevris, Gail S M Masterton, Rahul Kalla
Objective We aimed to investigate the clinical utility of follow-up oesophagogastroduodenoscopy (OGD2) in patients with severe oesophagitis (Los Angeles grades C or D) through evaluating the yield of Barrett’s oesophagus (BO), cancer, dysplasia and strictures. Second, we aimed to determine if the Clinical Frailty Scale (CFS) may be used to identify patients to undergo OGD2s. Design/method Patients
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Novel, nurse-led early postdischarge clinic is associated with fewer readmissions and lower mortality following hospitalisation with decompensated cirrhosis Frontline Gastroenterol. Pub Date : 2024-03-01 Benjamin Giles, Kirsty Fancey, Karen Gamble, Zeshan Riaz, Joanna K Dowman, Andrew J Fowell, Richard J Aspinall
Objective Patients hospitalised with decompensated cirrhosis have high rates of early unplanned readmission. Many readmissions are avoidable with secondary preventative strategies, but patients are often readmitted prior to outpatient review. To address this, we established a novel, nurse-led early postdischarge (EPD) clinic delivering goal-directed care for cirrhosis complications and evaluated the
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Inflammatory Bowel Disease Disability Index is a valid and reliable measure of disability in an English-speaking hospital practice and predicts long-term requirement for treatment escalation Frontline Gastroenterol. Pub Date : 2024-03-01 Darragh Storan, Edel McDermott, Jenny Moloney, Lisa Keenan, Roisin Stack, Juliette Sheridan, Glen Doherty, Garret Cullen, Louise McHugh, Hugh E Mulcahy
Objective The Inflammatory Bowel Disease Disability Index (IBD-DI) was developed according to WHO standards and has been validated in population-based cohorts. However, there are limited data on its relationship to various psychosocial and economic variables or its relevance to hospital clinical practice. The study aims were to determine the validity and reliability of the IBD-DI in an English-speaking
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Stepping into nursing research: an introduction for gastroenterology and hepatology nurses Frontline Gastroenterol. Pub Date : 2024-03-01 Stacey Munnelly, Shellie Jean Radford, Pooja Datt, Leigh Donnelly, Aileen Fraser, Elena Gil-Zaragozano, Kathryn Jack, Harriet Watson, Tariq H Iqbal, Shaji Sebastian, Karen Kemp
In this second part of an introduction to research for gastroenterology and hepatology nurses, we aim to build on the first article that introduced the significance and structure of the National Institute for Health and Care Research clinical research landscape in the UK and the importance of nurse engagement. This article introduces possible career pathways available in the profession and specialty
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Chronic abdominal pain in inflammatory bowel disease: a practical guide Frontline Gastroenterol. Pub Date : 2024-03-01 Samantha Baillie, Christine Norton, Sonia Saxena, Richard Pollok
Pain is common in inflammatory bowel disease (IBD), yet many patients feel their pain is not addressed by healthcare professionals. Listening to a patient’s concerns about pain, assessing symptoms and acknowledging the impact these have on daily life remain crucial steps in addressing pain in IBD. While acute pain may be effectively controlled by pain medication, chronic pain is more complex and often
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What is the clinical significance of low serum amylase? Systematic review of the conditions associated with low serum amylase Frontline Gastroenterol. Pub Date : 2024-03-01 Mustafa Jalal, Sebastine A Gbadegesin, Nadeem Tehami, Kei Nakajima
Objective Most studies have assessed the impact of elevated serum amylase levels in clinical practice, but only a few have investigated the significance of low serum amylase. We therefore, aimed to review the literature to understand the conditions associated with low serum amylase and its clinical relevance. Method This systematic review was performed in accordance with the criteria established in
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Nurse-led approach to standardising the management of iron-deficiency anaemia, achieving the 2-week cancer pathway targets and reducing hospital admissions: practicalities and learnings from a success story Frontline Gastroenterol. Pub Date : 2024-03-01 Pauline Reid, Kev Patterson, Emma McCulloch, Laura Walsh, Amal Murshid, William Kinsella, Andrew Moore, Thomas Skouras, Philip J Smith
The most significant and common cause of anaemia is iron deficiency, which occurs when iron absorption cannot meet the body’s demands due to growth, pregnancy, poor nutrition, malabsorption or blood loss. It is estimated that in the UK 11% of the adult population have iron-deficiency anaemia (IDA) and investigation is essential to exclude significant pathology as the underlying cause. It has been shown
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Significance and structure of clinical research in the UK: an introduction for gastroenterology and hepatology nurses Frontline Gastroenterol. Pub Date : 2024-03-01 Billye J Olsen, Karen Kemp, Rachel Campbell, Shaila Kumar, Laura Monje-Garcia, Shaji Sebastian, Tariq H Iqbal, Shellie Jean Radford
This is the first of two articles from the joint British Society of Gastroenterology Nurses association and Research Committee working group. The group is dedicated to signposting and improving access to research for specialist nurses working in gastroenterology and hepatology. This article is an introduction to the significance and structure of the National Institute for Health Research clinical research
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Symptomatic duodenal metastasis from a small cell lung cancer primary: a rare case Frontline Gastroenterol. Pub Date : 2024-03-01 Panagiotis Armonis, Jeffrey Leung, Charles Murray, Alberto Murino
An elderly man presented with chest pain and shortness of breath on a background of left lower lobe small cell lung cancer, previously treated with chemotherapy. Blood test showed iron deficiency anaemia requiring transfusion. An oesophagogastroduodenoscopy was performed, highlighting an external compression to the distal stomach and a 15 mm round lesion, with a central ulcerated depression and rolled
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Annular eruption with weight loss in a 47-year-old man Frontline Gastroenterol. Pub Date : 2024-03-01 Elissa Annabi, Sophie Lalevée, Thomas Bettuzzi, Juliette Demortier, Barbara Papouin, Louis De Mestier Du Bourg, Emilie Sbidian, Saskia Ingen-Housz-Oro
A 47-year-old man, with no medical history, presented with a 1-year history of a recurrent skin eruption made of erythematous, erosive, crusty and pruritic plaques involving the scrotum, inguinal and intergluteal skinfolds, trunk and legs (figure 1). Mucosal examination showed glossitis and perleche. He had received topical and systemic antifungal agents without improvement. General examination was
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Time to treat the climate and nature crisis as one indivisible global health emergency Frontline Gastroenterol. Pub Date : 2024-03-01 Chris Zielinski
Over 200 health journals call on the United Nations (UN), political leaders and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency. The world is currently responding to the climate crisis and
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UK endoscopy trainer survey: perspectives on current endoscopy training delivery, experience, barriers and opportunities Frontline Gastroenterol. Pub Date : 2024-02-01 Fraser Brown, Alice Weidner, Christopher Wells, Rumneet Ghumman, Susan McConnell, Wee Sing Ngu, Elizabeth Ratcliffe, Sharmila Subramaniam, Jamie Barbour
Objective UK endoscopy training is delivered by trainers possessing well developed endoscopy and teaching skills to help learners perform high-quality endoscopy. Train The Trainer (TTT) courses are effective, but additional trainer support is variable with little formal quality assurance. We performed a survey to map UK endoscopy training, assess trainer perspectives on training delivery and identify
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What can professional medical societies do to mitigate climate change? Frontline Gastroenterol. Pub Date : 2024-01-29 Andrew M Veitch
The climate emergency affects us all as individuals but also has major adverse effects on health and healthcare provision. Professional medical societies can advocate and educate, but can also lead by example. Medical societies can feel the same sense of helplessness, futility or a sense that it is not their responsibility which individuals face, but there are real and effective changes which can be
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European Crohn’s and Colitis Guidelines on sexuality, fertility, pregnancy and lactation: a guideline review Frontline Gastroenterol. Pub Date : 2024-01-23 Jennifer Phillips, Ann Jane Archer, Alice Lagnado, Morgan O’Flaherty, Aileen Fraser, Ruth Carr
The European Crohn’s and Colitis Organisation has recently published the third version of the European Consensus on reproduction in inflammatory bowel disease. Here, we summarise their key recommendations.
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Maintaining remission in Crohn’s disease post surgery: what can we learn from Cochrane? Frontline Gastroenterol. Pub Date : 2024-01-17 Morris Gordon
Surgery is a vital pillar in the management of Crohn’s disease and medical options for prevention of recurrence after surgery are a key consideration. The main classes of effective induction therapies have very different efficacy data for maintenance and this is more pronounced in the postsurgical setting. In this review article, the up-to-date Cochrane reviews on the topic are presented, including
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Gastroenterology trainee experience, confidence and satisfaction in nutrition training: a cross-sectional survey in the UK Frontline Gastroenterol. Pub Date : 2024-01-12 Stephanie Sartain, Charlotte Wong, Emma Murray, Suneil A Raju, Amy Woods, Daniel Ashmore, Lovesh Dyall, Flora Kokwaro, Eilidh McGowan, David Leiberman, Emma Routledge, Emily Clarke, Trevor R Smith
Introduction Nutrition is an essential part of gastroenterology specialist training. There is limited evidence of trainee experience in this area. The shorter training programme introduced in 2022 may lead to reduced exposure to this subspecialty. We aimed to explore and describe current nutrition training experiences, confidence and satisfaction to inform future improvements. Methods Gastroenterology
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Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units Frontline Gastroenterol. Pub Date : 2024-01-10 Christian Selinger, Alex Bottle, Christopher A Lamb, Rachel Ainley, Ruth Wakeman, Barney Hawthorne
Background Key performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI. Methods IBD emergency admissions for 2018–2019 from Hospital Episodes Statistics for England were compared per population and per IBD cases with patient-reported quality of care from the IBD Patient Survey 2019.
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Role of diet in prevention versus treatment of Crohn’s disease and ulcerative colitis Frontline Gastroenterol. Pub Date : 2024-01-09 Emma P Halmos, Lihi Godny, Julie Vanderstappen, Chen Sarbagili-Shabat, Vaios Svolos
Diet is a modifiable risk factor for disease course and data over the past decade have emerged to indicate its role in Crohn’s disease (CD) and ulcerative colitis (UC). However, literature is riddled with misinterpretation of data, often leading to unexpected or conflicting results. The key understanding is that causative factors in disease development do not always proceed to an opportunity to change
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Presentation, characteristics and management of obstructive intestinal conditions in cystic fibrosis Frontline Gastroenterol. Pub Date : 2024-01-06 Caitlin Miles, Natalie Ling, Eldho Paul, David Armstrong
Objective Constipation and distal intestinal obstruction syndrome (DIOS) are common gastrointestinal manifestations of cystic fibrosis (CF). The primary aim was to describe the characteristics of constipation and DIOS hospitalisations in a paediatric and adult CF service over a 12-year period. The secondary aims were to determine the proportion of constipation and DIOS presentations which met the European
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Creation of an institutional preoperative checklist to support clinical risk assessment in patients with ulcerative colitis (UC) considering ileoanal pouch surgery Frontline Gastroenterol. Pub Date : 2023-12-16 Bruno Augusto Alves Martins, Amira Shamsiddinova, Manal Mubarak Alquaimi, Guy Worley, Phil Tozer, Kapil Sahnan, Zarah Perry-Woodford, Ailsa Hart, Naila Arebi, Manmeet Matharoo, Janindra Warusavitarne, Omar Faiz
Background Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of life. As such, patient selection is crucial to its success. The main aim of this paper is to present an institutional preoperative checklist to support
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Guideline review: EASL clinical practice guidelines on the management of liver diseases in pregnancy Frontline Gastroenterol. Pub Date : 2023-12-12 Ann J Archer, Jennifer Phillips, Robbie Adamson, Francesca Neuberger, Christy Burden, Kushala WM Abeysekera, Andrew J Portal
The recently published European Association for the Study of the Liver (EASL) clinical practice guideline (CPG) on the management of liver diseases in pregnancy encompasses the management of gestational liver diseases as well as acute and chronic liver disease occurring coincidentally in pregnancy. This review will address the latter, given the broad scope of the CPG and the comprehensive Frontline
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Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose? Frontline Gastroenterol. Pub Date : 2023-12-09 Khalid Bashir, Iosif Beintaris, Linda Sharp, Julia Newton, Katherine Elliott, Jon Rees, Peter Rogers, Matt Rutter
Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure
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FIT negative clinic as a safety net for low-risk patients with colorectal cancer: impact on endoscopy and radiology utilisation–a retrospective cohort study Frontline Gastroenterol. Pub Date : 2023-12-09 Gaurav B Nigam, Laween Meran, Ishita Bhatnagar, Sarah Evans, Reem Malik, Nicole Cianci, Julia Pakpoor, Charis Manganis, Brian Shine, Tim James, Brian D Nicholson, James E East, Rebecca M Palmer
Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead
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UpFront Frontline Gastroenterol. Pub Date : 2024-01-01 R Mark Beattie
Diverticular disease is common, affecting 70% of the western population by the age of 80. In this issue Williams and colleagues provide a comprehensive overview discussing pathophysiology, classification and management. The incidence is rapidly increasing in younger age groups. Complications include acute diverticulitis, abscess, bleeding and perforation—most complications occur during the primary
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Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study Frontline Gastroenterol. Pub Date : 2024-01-01 The Trainee Collaborative for Research and Audit in Hepatology UK
Introduction Specialist centres have been developed to deliver high-quality Hepatology care. However, there is geographical inequity in accessing these centres in the United Kingdom (UK). We aimed to assess the impact of these centres on decompensated cirrhosis patient outcomes and understand which patients transfer to specialist centres. Methods A UK multicentred retrospective observational study
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Senior trainee as endoscopy teacher: impact on trainee learning and attending experience Frontline Gastroenterol. Pub Date : 2024-01-01 Colin Feuille, Justin L Sewell
Objective Training in how to effectively teach endoscopy is not included in most gastroenterology (GI) training programme curricula, yet many gastroenterologists are expected to teach endoscopy in their careers. Near-peer teaching could help senior GI trainees learn how to teach endoscopy and have benefits for junior trainees. We performed a qualitative study of a peer teaching initiative where senior
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Dedicated service for Barrett’s oesophagus surveillance endoscopy yields higher dysplasia detection and guideline adherence in a non-tertiary setting in the UK: a 5-year comparative cohort study Frontline Gastroenterol. Pub Date : 2024-01-01 Elizabeth Ratcliffe, James Britton, Harika Yalamanchili, Izabela Rostami, Syed Mujtaba Hasnain Nadir, Mohamed Korani, Ikedichukwu Eruchie, Muhammad Awais Wazirdin, Neeraj Prasad, Shaheen Hamdy, John McLaughlin, Yeng Ang
Objective Barrett’s oesophagus (BO) endoscopic surveillance is performed to varying quality, dedicated services may offer improved outcomes. This study compares a dedicated BO service to standard care, specifically dysplasia detection rate (DDR), guideline adherence and use of advanced imaging modalities in a non-tertiary setting. Design/method 5-year retrospective comparative cohort study comparing
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Patient experiences of Cytosponge: a qualitative study Frontline Gastroenterol. Pub Date : 2024-01-01 Laura Jane Neilson, Rebecca C Fitzgerald, Jennifer Deane, Irene Debiram-Beecham, Halime Gulle, Colin Rees, Linda Sharp
Objective Cytosponge is a novel technology for oesophageal pathology diagnosis. Uses include diagnosis of Barrett’s oesophagus and as a triage tool to prioritise upper gastrointestinal endoscopy. Patient experience is a key component of quality care. Previous work has developed endoscopy patient-reported experience measures. An appropriate tool to measure patient experience of Cytosponge is required
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UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come Frontline Gastroenterol. Pub Date : 2024-01-01 Emma Saunsbury, Yazan Haddadin, Radha Gadhok, Elizabeth Ratcliffe, Suneil A Raju, British Society of Gastroenterology Trainees Section
Objective Shape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views. Method The British Society of Gastroenterology Trainees Section collected
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Improving survival in alcohol-related hepatitis: what's new? Frontline Gastroenterol. Pub Date : 2024-01-01 Jessica Shearer, Amy Johnson, Steven Masson
Alcohol-related hepatitis (AH) is the most florid presentation of alcohol-related liver disease and carries a high short-term and long-term mortality rate. Specific treatment options remain inadequate. The current management approach for AH focuses on early identification, careful screening and treatment of infection, as well as identification of those patients who may benefit from corticosteroid therapy
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Diverticular disease: update on pathophysiology, classification and management Frontline Gastroenterol. Pub Date : 2024-01-01 Sophie Williams, Ingvar Bjarnason, Bu'Hussain Hayee, Amyn Haji
Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. Incidence is rapidly increasing in younger age groups. Between 10% and 25% of those with diverticular disease (DD) will experience acute diverticulitis. A further 15% will develop complications including abscess, bleeding and perforation. Such complications are associated with significant
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JAK inhibitors for inflammatory bowel disease: recent advances Frontline Gastroenterol. Pub Date : 2024-01-01 Sailish Honap, Alexandra Agorogianni, Michael J Colwill, Sonia Kalyanji Mehta, Fiona Donovan, Richard Pollok, Andrew Poullis, Kamal Patel
Inflammatory bowel disease (IBD) commonly requires immunosuppressive treatments to induce and maintain durable remission. Janus kinase inhibitors (JAKis) are a novel group of orally administered, small molecule drugs that work by attenuating multiple cytokine signalling pathways to mediate dysregulated immune responses involved in the pathogenesis of IBD. Tofacitinib, filgotinib and upadacitinib have
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British Society of Gastroenterology guidelines on the management of functional dyspepsia Frontline Gastroenterol. Pub Date : 2024-01-01 Ahthavan Narendren, Srikar Boddupalli, Jonathan P Segal
In 2022, the British Society of Gastroenterology released guidelines on the management of functional dyspepsia (FD), providing a long-anticipated evidence-based approach to the diagnosis, classification and management of patients with FD. This review summarises the key recommendations of the recent guidelines on the management of FD.
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Update on the optimisation of endoscopic retrograde cholangiography (ERC) in patients with primary sclerosing cholangitis Frontline Gastroenterol. Pub Date : 2024-01-01 Wafaa Ahmed, Deepak Joshi, Matthew T Huggett, Simon M Everett, Martin James, Shyam Menon, Kofi W Oppong, Wei On, Bharat Paranandi, Palak Trivedi, George Webster, Vinod S Hegade
Primary sclerosing cholangitis (PSC) is a rare cholestatic disorder with a prevalence of 16.2 per 100 000 population. It is characterised by progressive inflammation and destruction of the intrahepatic and extraheptic bile ducts culminating in progressive fibrosis and cirrhosis.1–3 The course of PSC is complicated by biliary strictures, recurrent cholangitis and a 400-1500 times higher risk of cholangiocarcinoma
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The language of consent: do we take or does the patient give? Frontline Gastroenterol. Pub Date : 2024-01-01 Simon M Everett
Let us start with some gentle debate. Informed consent is a time-consuming process that uses valuable resources. Do you agree? Probably, in private, you will think this way sometimes. Now let us change the words a little. Informed consent is a valuable process that can occasionally be time consuming. What are your thoughts about this? Nodding? Hopefully. The point is that the words we use and the order
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Cutaneous lesions in a patient with HIV: do not forget the GI tract! Frontline Gastroenterol. Pub Date : 2024-01-01 Sasha Shoba Devi Thrumurthy, Kok Pun Chen, Nicholas Wee Chong Koh, Alyssa Shin Yee Sim
A 42-year-old man presented to the emergency department with a 1-week history of fever, abdominal pain and diarrhoea with haematochezia. A medical history was significant for untreated AIDS, which he has had for the past 9 years. The only opportunistic infection that he has had in the past was pneumocystis pneumonia. Prior upper and lower endoscopic evaluation for weight loss in 2018 was unremarkable
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Abdominal pain in an adolescent boy Frontline Gastroenterol. Pub Date : 2024-01-01 Sinead Carlson, Simon Hew
A 16-year-old boy presented to our department with a 2-day history of abdominal pain and vomiting. The patient had a history of attention-deficit hyperactivity disorder on methylphenidate. He did not drink alcohol and was a non-smoker. Investigations revealed an alanine transaminase of 237 U/L (reference range: 5–40 U/L), gamma-glutamyl transferase of 212 U/L (5–50 U/L), bilirubin of 4 μmol/L (0–20
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Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II) Frontline Gastroenterol. Pub Date : 2024-01-01 BMJ Publishing Group Ltd
Aspinall RJ, Hudson M, Ryder SD, et al . Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II). …
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Infection control and environmental sustainability: focus on practice Frontline Gastroenterol. Pub Date : 2023-11-23 Helen Griffiths
Endoscopy is known to be a high generator of waste in healthcare. It also poses an infection risk to patients, both from their own endogenous flora and from exogenous micro-organisms. Increases in infection, as seen during the pandemic, result in increased use of single-use equipment, personal protective equipment, packaging and harmful chemicals. With the significant risk of a further pandemic within
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Nutritional assessment of patients with cirrhosis in the South West requires improvement: results of the Evaluation of NutRItion in CirrHosis (ENRICH) Study Frontline Gastroenterol. Pub Date : 2023-11-22 Keith Pohl, Ashwin Dhanda
Malnutrition is a concern for all inpatients; however, those with cirrhosis are particularly at risk. Current guidelines recommend standardised nutritional assessment of all inpatients with advanced chronic liver disease (eg, Malnutrition Universal Screening Tool (MUST)) followed by specialist dietician review within 24 hours to commence nutritional support.1 Such nutritional optimisation has been
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Challenges of developing a green gastroenterology evidence base and how trainee research networks can fill the gaps Frontline Gastroenterol. Pub Date : 2023-11-22 Oliver Tavabie, Jennifer Clough, Jonathan King, Victoria Nicholas, Aditi Kumar
Trainee research networks are a collaborative effort to enable high-quality multicentre audits or research that is more widely accessible to trainees. Such networks lead, design and deliver research at a far higher scale than could be achieved locally and are carried out solely by trainees. There is an increasing focus on delivering research that is not only environmentally sustainable but also focuses
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Unusual cause of a radiological subdiaphragmatic air-fluid level Frontline Gastroenterol. Pub Date : 2023-11-14 Rex Wan-Hin Hui, Arthur Ho-Cheung Tang, Lok-Ka Lam, Wai-Kay Seto, Siu-Yin Wong, Man-Fung Yuen
A middle-aged man with an unremarkable medical history presented with fever for 2 weeks. He had no recent travel history. He had epigastric tenderness but was haemodynamically stable. Chest X-ray (CXR) showed a right-sided subdiaphragmatic air-fluid level (figure 1). Blood tests showed neutrophilia (14.6×109/L) and a cholangiohepatitic picture (bilirubin 77 umol/L; alkaline phosphatase 917 U/L; ga
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Challenge of achieving truly individualised informed consent in therapeutic endoscopy Frontline Gastroenterol. Pub Date : 2023-11-08 Philip Berry, Sreelakshmi Kotha
Objective Guidance covering informed consent in endoscopy has been refined in the UK following the obstetric case of Nadine Montgomery, and in light of updated General Medical Council guidance. All risks likely to be material to the patient must be explored, as well as alternatives to the procedure. Despite this, departments and endoscopists still struggle to meet the current standards. In this article