Frontline Gastroenterology最新文献

{"title":"Symptomatic duodenal metastasis from a small cell lung cancer primary: a rare case","authors":"Panagiotis Armonis, Jeffrey Leung, Charles Murray, Alberto Murino","doi":"10.1136/flgastro-2023-102456","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102456","url":null,"abstract":"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 edges in D3, which was suspicious of malignancy (figure 1). Target biopsies (figure 2) confirmed the malignant nature of the lesion with features of small cell neuroendocrine carcinoma, in keeping with a lung metastasis. Gastrointestinal metastases from a lung cancer primary are rare, with a clinical prevalence of 0.19%. The small bowel is the most common gastrointestinal metastatic site and tumours are spread via the haematogenous and lymphatic routes. Patients with small bowel involvement usually present with bowel perforation or gastrointestinal bleeding. Diagnosis is made through oesophagogastroduodenoscopy or emergency laparotomy and the average time between discovery of gastrointestinal metastasis to death is 3–4 months. Panagiotis Armonis , Jeffrey Leung, Charles Murray, Alberto Murino General Internal Medicine, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK Division of Surgery and Interventional Science, UCL, London, UK Gastroenterology, Royal Free Hospital, London, UK Royal Free Unit for Endoscopy, Royal Free Hospital Liver Services, London, UK","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134911346","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}

{"title":"Stepping into nursing research: an introduction for gastroenterology and hepatology nurses","authors":"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","doi":"10.1136/flgastro-2023-102493","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102493","url":null,"abstract":"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. Practical information on how to start research is provided, including an overview of the education, training and support required for a career in research delivery and academic research. Some of the potential barriers to nursing research careers are highlighted, and solutions to navigate a successful career in nursing research are proposed.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134911351","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}

{"title":"JAK inhibitors for inflammatory bowel disease: recent advances","authors":"Sailish Honap, Alexandra Agorogianni, Michael J Colwill, Sonia Kalyanji Mehta, Fiona Donovan, Richard Pollok, Andrew Poullis, Kamal Patel","doi":"10.1136/flgastro-2023-102400","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102400","url":null,"abstract":"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 demonstrated efficacy against placebo and are licensed for the treatment of moderate to severe ulcerative colitis; upadacitinib is the only JAKi also currently approved for the treatment of Crohn’s disease. Safety concerns stratified by age have led to class-wide regulatory restrictions for JAKi use across all inflammatory diseases. It is important for gastroenterologists managing patients with IBD to be aware of the key pivotal trial outcomes, to identify appropriate patients in whom to commence a JAKi, and to understand the safety considerations and ways to mitigate these risks in the patients they treat. This review provides a contemporaneous overview of this emerging therapeutic class and provides a practical guide for healthcare practitioners for initiating and monitoring JAKi in IBD.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"213 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134911349","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}

{"title":"Update on the optimisation of endoscopic retrograde cholangiography (ERC) in patients with primary sclerosing cholangitis","authors":"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","doi":"10.1136/flgastro-2023-102491","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102491","url":null,"abstract":"© Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION 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. The course of PSC is complicated by biliary strictures, recurrent cholangitis and a 4001500 times higher risk of cholangiocarcinoma (CC) and other hepatopancreatobiliary malignancy than the general population. 4–9 Treatment of PSC revolves around managing symptoms and complications as they arise. Endoscopic retrograde cholangiography (ERC) is a valuable tool that allows therapeutic interventions to optimise biliary drainage and facilitate biliary sampling. Despite the utility, controversies remain as to when ERC should be performed. 12 This article aims to clarify some of the issues surrounding this and to provide practical guidance on the ERCbased assessment and management of biliary strictures in PSC. bile ducts culminating in progressive fibrosis and cirrhosis. The course of PSC is complicated by biliary strictures, recurrent cholangitis and a 4001500 times higher risk of cholangiocarcinoma (CC) and other hepatopancreatobiliary malignancy than the general population. 4–9 Treatment of PSC revolves around managing symptoms and complications as they arise. Endoscopic retrograde cholangiography (ERC) is a valuable tool that allows therapeutic interventions to optimise biliary drainage and facilitate biliary sampling. Despite the utility, controversies remain as to when ERC should be performed. 12 This article aims to clarify some of the issues surrounding this and to provide practical guidance on the ERCbased assessment and management of biliary strictures in PSC.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884509","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}

{"title":"Case of diarrhoea","authors":"Giorgio Bartalucci, David Parham, Richard Felwick","doi":"10.1136/flgastro-2023-102516","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102516","url":null,"abstract":"A 66year woman presented to our hospital with a 6week history of watery diarrhoea and central abdominal pain. She was taking naproxen occasionally with omeprazole for osteoarthritis but was not on any other regular medications. She had no significant medical history. On admission, physical examination was unremarkable. Laboratory evaluation showed an elevated C reactive protein of 95 mg/L and white cell count of 11.8×10/L. The remainder of her routine biochemistry was within normal ranges. On admission, faecal pathogen PCR panel for bacterial infection including Clostridioides difficile (C. difficile) was negative. Abdominal Xray showed mild thickening of the left colon. A recent faecal calprotectin that was elevated at 3620 μg/L (normal <50) was noted. A flexible sigmoidoscopy was performed and the appearance was as shown in (figure 1). Biopsies were taken (figure 2). Flexible sigmoidoscopy showed features of colitis with widespread pseudomembranes (a layer resembling a membrane over a mucosal surface) giving the endoscopic impression of C. difficile infection. However, repeated stool cultures were negative. Histology revealed a normal crypt architecture with pseudomembranes erupting from the surface of the mucosa. There was an excess of inflammatory cells in the lamina propria and a thickened subepithelial collagen band in keeping with a diagnosis of pseudomembranous collagenous colitis, a rare subtype of microscopic colitis (MC)/collagenous colitis (figure 2). Colonic pseudomembranes form from fibrinous exudate and acute inflammatory cells on the surface of the mucosa, most commonly driven by infection with C. difficile or ischaemia. However, rarer noninfectious causes have also been described including this variant of MC. Pseudomembranous collagenous colitis is uncommon. To date, there are only 15 case series/reports in the literature, with the largest case series having 10 patients. Typically, MC has a normal mucosal appearance, however, in 20% of patients inflammatory changes have been described. 4 A single case series of 10 patients reports inflammatory changes in all patients in addition to pseudomembranous collagenous colitis. Similar to classic MC, the use of nonsteroidal antiinflammatory drugs (NSAIDs) was also associated with statins, proton pump inhibitors and some antidepressants. This entity responds well to treatment with steroids as well as withdrawal of contributing medications. In our case, the patient was discharged with a 8week course of budesonide MMX 9 mg/day and advised to avoid NSAIDs. At followup 3 months later, her symptoms had resolved and a faecal calprotectin was undetectable (<3.8 μg/L). Giorgio Bartalucci, David Parham, Richard Felwick 1 Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK Histopathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981857","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}

{"title":"Patient experiences of Cytosponge: a qualitative study","authors":"Laura Jane Neilson, Rebecca C Fitzgerald, Jennifer Deane, Irene Debiram-Beecham, Halime Gulle, Colin Rees, Linda Sharp","doi":"10.1136/flgastro-2023-102484","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102484","url":null,"abstract":"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. The aim of this work was to describe the patient experience of Cytosponge. Design/Method Individuals aged 18 years or over, who had undergone Cytosponge from September 2020 to March 2021, were invited to participate in a semi-structured interview. Interviews were audio-recorded, transcribed verbatim and anonymised. Thematic analysis was undertaken. Themes were organised into two overarching areas relating to patient experiences and patient perceptions of the test. Results 19 patients underwent interview (aged 37–80 years, 13 male). In terms of patient experiences of Cytosponge, five themes were identified: emotional reaction; expectations; environment and physical process; sensory experience; communication and information. All themes were present across all procedural phases, aside from sensory experience which was only present during the test. With regard to perception of the test, two major themes were identified: test novelty (encompassing patient awareness of the test and reaction to the new test) and trusting the test results. Conclusion Patients must remain central to novel technologies such as Cytosponge. Measuring patient experience is essential to achieve that. This study demonstrates five major themes which describe the patient experience of this procedure. These have been used to adapt the Newcastle ENDOPREM for use in Cytosponge.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135982354","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}

{"title":"Outpatient management of cirrhosis: moving forward","authors":"Rebecca L. Jones","doi":"10.1136/flgastro-2023-102450","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102450","url":null,"abstract":"","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"14 1","pages":"447 - 448"},"PeriodicalIF":2.6,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44689205","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}

{"title":"UpFront.","authors":"R Mark Beattie","doi":"10.1136/flgastro-2023-102519","DOIUrl":"10.1136/flgastro-2023-102519","url":null,"abstract":"","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"14 5","pages":"357-358"},"PeriodicalIF":2.4,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10372900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 3: special circumstances.","authors":"Dina Mansour,&nbsp;Steven Masson,&nbsp;John Hammond,&nbsp;Joanna A Leithead,&nbsp;Jill Johnson,&nbsp;Mussarat Nazia Rahim,&nbsp;Andrew C Douds,&nbsp;Lynsey Corless,&nbsp;Debbie L Shawcross,&nbsp;Michael A Heneghan,&nbsp;Dhiraj Tripathi,&nbsp;Stuart McPherson,&nbsp;Emily Bonner,&nbsp;Gemma Botterill,&nbsp;Rebecca West,&nbsp;Mhairi Donnelly,&nbsp;Allison Grapes,&nbsp;Coral Hollywood,&nbsp;Valerie Ross","doi":"10.1136/flgastro-2023-102432","DOIUrl":"10.1136/flgastro-2023-102432","url":null,"abstract":"<p><p>The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Part 1 addresses outpatient management of compensated cirrhosis: screening for hepatocellular cancer, varices and osteoporosis, vaccination and lifestyle measures. Part 2 concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. In this, the third part of the guidance, we focus on special circumstances encountered in managing people with cirrhosis, namely surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis.</p>","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"14 1","pages":"474-482"},"PeriodicalIF":2.6,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/65/78/flgastro-2023-102432.PMC10579550.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46747002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 2: decompensated cirrhosis.","authors":"Dina Mansour, Steven Masson, Lynsey Corless, Andrew C Douds, Debbie L Shawcross, Jill Johnson, Joanna A Leithead, Michael A Heneghan, Mussarat Nazia Rahim, Dhiraj Tripathi, Valerie Ross, John Hammond, Allison Grapes, Coral Hollywood, Gemma Botterill, Emily Bonner, Mhairi Donnelly, Stuart McPherson, Rebecca West","doi":"10.1136/flgastro-2023-102431","DOIUrl":"10.1136/flgastro-2023-102431","url":null,"abstract":"<p><p>There are two distinct phases in the natural history of cirrhosis: compensated disease (corresponding to Child Pugh A and early Child Pugh B disease), where the patient may be largely asymptomatic, progressing with increasing portal hypertension and liver dysfunction to decompensated disease (corresponding to Child Pugh late B-C), characterised by the development of overt clinical signs, including jaundice, hepatic encephalopathy (HE), ascites, renal dysfunction and variceal bleeding. The transition from compensated cirrhosis to decompensated cirrhosis (DC) heralds a watershed in the nature and prognosis of the disease. DC is a systemic disease, characterised by multiorgan/system dysfunction, including haemodynamic and immune dysfunction. In this second part of our three-part series on the outpatient management of cirrhosis, we address outpatient management of DC, including management of varices, ascites, HE, nutrition, liver transplantation and palliative care. We also introduce an outpatient DC care bundle. For recommendations on screening for osteoporosis, hepatocellular carcinoma surveillance and vaccination see part one of the guidance. Part 3 of the guidance focusses on special circumstances encountered in patients with cirrhosis, including surgery, pregnancy, travel, management of bleeding risk for invasive procedures and portal vein thrombosis.</p>","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"14 1","pages":"462-473"},"PeriodicalIF":2.4,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/05/flgastro-2023-102431.PMC10579554.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45137924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}