Frontline Gastroenterology最新文献

{"title":"Rare case of intractable abdominal pain","authors":"Shivang Chaudhary, Hayden Rotramel, Anam Ahmad, Philip Vaidyan, Adam Kilian","doi":"10.1136/flgastro-2024-102703","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102703","url":null,"abstract":"The patient is admitted to the hospital for a 5-day history of diffuse myalgias, cough, diarrhoea and fever peaking at 100.8°F (38.2°C). Medical history is significant for systemic lupus erythematosus (SLE), managed with hydroxychloroquine 400 mg daily, mycophenolate mofetil 500 mg two times a day and prednisone 5 mg daily. Laboratory tests are provided in table 1. View this table: Table 1 Laboratory values Chest radiography identified interstitial opacities in the right upper lung field, indicative of pneumonia. Consequently, treatment with amoxicillin-clavulanic acid and doxycycline was initiated. During hospitalisation, the patient developed severe abdominal pain, was refractory to opioid analgesics and had exacerbated diarrhoea. A physical examination revealed generalised abdominal tenderness. To elucidate …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"24 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608520","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":"From O’Shaughnessy to opportunity: innovating Hepatology Trials in the UK","authors":"Oliver D Tavabie, Yvanne Enever, Daniel Green, Helen Crisp, Emmanouil Tsochatzis, Amir Gander, Dina Mansour, Vanessa Hebditch, Julie Adams, Adam Ashbourn, Christopher Mysko, Richard Allen, Laura Kent, James B Maurice, Ankur Srivastava, Abhishek Chauhan, Tom Johnston, Janet Ruane, Rebecca Varni, Caroline Fletcher, Cyril Sieberhagen, Gordon Hay, Giovanna Bretland, Maggie Corrigan, Francesco Ferraro, Riley McMahon, Trudie Burge, Harry Ferguson, Louise Jennings, Brian Hogan, Andrew Cook, Rajiv Jalan, Gautam Mehta","doi":"10.1136/flgastro-2024-102710","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102710","url":null,"abstract":"Developing new treatments that improve outcomes for patients with decompensated cirrhosis remains an unmet area of clinical need. The UK has a rich history of being on the forefront of clinical trials for this patient group. However, there have been challenges in achieving this goal in the past decade, with several negative studies as well as trials struggling to achieve recruitment. This has been further exacerbated by the changed clinical landscape following the COVID-19 pandemic. In response to this, the O’Shaughnessy report was commissioned to identify potential opportunities to improve clinical trial performance in the UK. In this review article, we identify critical areas for the UK hepatology community to collaborate and develop sustainable partnerships for clinical trial delivery which will ensure that outcomes are representative, inclusive and patient-centred.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"43 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608587","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":"Severe acute pancreatitis in the era of endoscopically placed lumen-apposing metal stents (LAMS): critical care outcomes from a large UK pancreatobiliary centre","authors":"Alexander Johnson Parker, Greg Tokwabilula, Lakshmi Narsinganallore Venkatesh, Rana Bhattacharya, Jonathan Bannard-Smith, Daniel Haley, Abubaker Y M Ahmed, Anthony Wilson, Joe Geraghty","doi":"10.1136/flgastro-2024-102657","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102657","url":null,"abstract":"Objectives 1. Describe characteristics of patients with severe acute pancreatitis (SAP) requiring admission to Critical Care, including interventional management of pancreatic fluid collections. 2. Quantify whether patients requiring drainage of collections via a Lumen-Apposing Metal Stent (LAMS) have different patient experiences and demands on critical care and pancreatic services, compared with those without. 3. Identify possible standards of care to help guide management and to evaluate these standards in current practice. Design/Method Retrospective observational study of patients admitted to the adult Critical Care Unit at Manchester Royal Infirmary with SAP between 1st January 2019 and 16th June 2022 using Intensive Care National Audit &and Research Centre (ICNARC) data and electronic patient records. Results There were 96 admissions during 90 hospital episodes with a median admission Acute Physiology and Chronic Health Evaluation II (APACHE II) Score of 14. LAMS insertion was undertaken in 32%. Mean time to insertion was 49 days after initial presentation. Percutaneous drainage was undertaken in 30% and surgical management in 10%. Major bleeding was observed in 6% of LAMS patients and 5% of non-LAMS patients. 90% of LAMS patients were discussed in a specialist MDT, 84% underwent CT imaging within 7 days days prior to LAMS insertion and 26% underwent deep microbiological sampling via the LAMS. Median total hospital length of stay was 68 days and mortality at ultimate hospital discharge was 23%. Conclusion Critically ill patients with SAP have a long length of stay. Mortality rates are in keeping with predicted APACHE II scores. Technological advances have created a need for new optimizedoptimised treatment pathways, auditable by adherence to validated standards of care. Data are available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608586","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":"Impact of gender identity in the inflammatory bowel disease population: an evidence review and practical steps for gastroenterologists","authors":"Michael Colwill, Richard Pollok, Leighton Seal, Andrew Poullis","doi":"10.1136/flgastro-2024-102658","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102658","url":null,"abstract":"There has been greater societal awareness of differences in gender identity and sexual orientation in recent years. The rates of identifying as transgender or gender non-conforming (TGNC) are increasing and are known to be higher in the younger population and will therefore be over-represented in the inflammatory bowel disease (IBD) subpopulation. However, despite this there is very little in the literature with regards to those who identify as TGNC and are diagnosed with IBD (TGNC-IBD). Many TGNC individuals have poor experiences when seeking healthcare and many physicians find it a challenging and daunting clinical situation to be faced with. We reviewed the available literature with regards to TGNC-IBD population demographics, physical, mental and sexual health considerations, medication interactions and implications for surgery in this heterogenous group. We have identified areas that need further research and suggested simple and practical steps that can be adopted in order to help healthcare providers improve the experience for TGNC individuals diagnosed with IBD and the quality of care they provide.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"64 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141585243","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":"Cross-sectional evaluation of online direct-to-public calprotectin testing","authors":"Maria Bishara, Rebecca Smith, Christopher Roberts, Yousra Djouider, Claire Bewshea, Rachel Nice, Nicholas A Kennedy, James R Goodhand, Tariq Ahmad","doi":"10.1136/flgastro-2024-102644","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102644","url":null,"abstract":"Objective Why about a quarter of patients with inflammatory bowel disease (IBD) suffer symptoms for more than a year before their diagnosis made is unclear. Low public awareness, embarrassment and the apprehension of invasive tests are cited. The anonymity of direct-to-public calprotectin testing may overcome these barriers. We sought to characterise what calprotectin testing is available directly to the public in the UK. Design/method We conducted a cross-sectional evaluation of the calprotectin assays available online in the UK. Collection kits were procured from eligible providers, and surplus stool tested to receive follow-up advice for known positive (>50–100 μg/g) and negative (<50 μg/g) stool samples. Results Half (54.5% (6/11)) of the available tests were home lateral flow tests and the remainder were laboratory-based ELISAs. The lateral flow tests were considerably cheaper than the laboratory-based tests (median (range) cost £14.20 (£7.85–21.00) vs £75.85 (£59–151), p<0.0001). The median turnaround time for the laboratory tests was 14 (range: 1–23) days. All but one provider used a positivity threshold of 50 μg/g. All tests included written and pictorial instructions with the testing kit. Contact with a physician was recommended for similar proportions of positive and negative calprotectin results (54.5% (6/11) vs 54.5% (6/11), p=1). Conclusion In the UK, the public can choose between inexpensive home-based lateral flow tests or send stool samples for gold-standard laboratory testing of calprotectin. The low cost and rapid turnaround times suggest that direct-to-public calprotectin testing could be promoted to try to reduce the time to IBD diagnosis. Data are available upon reasonable request. The data will be made available to investigators whose proposed use of the data has been approved by an independent review committee. Analyses will be restricted to the aims in the approved proposal. Proposals should be directed to Tariq Ahmad (tariq.ahmad1@nhs.net). To gain full access data, requestors will need to sign a data access agreement.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509620","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":"Delayed colonic perforation secondary to cold snare polypectomy","authors":"Jan Kubovy, Matthew Drake, Rajan N Patel","doi":"10.1136/flgastro-2024-102742","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102742","url":null,"abstract":"Cold snare polypectomy (CSP) is the treatment of choice for polyps less than 10 mm in size and sessile serrated lesions.1 We present a 66-year-old woman with Crohn’s colitis. Inflammatory bowel disease (IBD) was in complete clinico-endoscopic remission and colonoscopy was performed for dysplasia surveillance. …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141530114","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":"Uncommon cause of pancreatitis 20 years after cholecystectomy","authors":"Heng Chi, Michael Staessens, Wim J Lammers, Pieter Jan F de Jonge","doi":"10.1136/flgastro-2024-102764","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102764","url":null,"abstract":"A 65-year-old woman with a medical history of cholecystectomy 20 years ago was referred to our hospital for recurrent colic pain in the upper abdomen with intermittent cholestatic liver enzyme abnormalities. She also experienced an episode of acute pancreatitis 2 weeks before the presentation. CT showed a dilated common bile duct with a hyperdense object of 10×4 mm in the distal common bile duct, suspecting …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509521","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":"Rwandan man with a case of the blues","authors":"Benjamin Wipper, Hanna Blaney, Robert Giraneza, Prosper Ingabire, Vincent Dusabejambo, Udit Asija, Erik C von Rosenvinge","doi":"10.1136/flgastro-2024-102722","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102722","url":null,"abstract":"A Rwandan man in his 40s underwent an upper gastrointestinal endoscopy for evaluation of solid-food dysphagia. Of note, the patient also reported a long-standing history of anaemia, which was originally diagnosed in 2000. He had required four transfusions since and noted that he had previously been prescribed tot’hema syrup (a form of iron supplementation) but was no longer taking it. Laboratory tests around the time of endoscopy showed microcytic anaemia (haemoglobin 99.1 g/L, median corpuscular volume 61.84 fL) with an elevated reticulocyte count (91×109/L). Further labs showed low serum iron (28 mcg/dL) and ferritin (20.5 ng/mL). The patient denied ever experiencing melena or haematochezia. Endoscopic examination revealed a partially obstructing Schatzki’s ring as the explanation for his dysphagia and this was treated with balloon dilation. The endoscopy also revealed numerous blue-violet vascular-appearing …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509621","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":"Whitish colonic mucosa","authors":"Joaquin Fisac-Vazquez, Laura G-Pastrian, Marta de Uribe-Viloria, Maria Dolores Martin-Arranz","doi":"10.1136/flgastro-2024-102765","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102765","url":null,"abstract":"An asymptomatic 65-year-old woman was referred to our endoscopy unit after a screening positive faecal occult blood test. Colonoscopy revealed a pale, whitish colonic mucosa with yellowish specks (figure 1), congestive areas and foci of lymphoid follicular hyperplasia (figure 2). Sessile lesions (0-Is) with whitish speckling on their surface were also identified. Figure 1 Whitish colonic mucosa with yellowish specks. Figure 2 Congestive areas and foci of lymphoid follicular hyperplasia. On histology, a dense infiltrate of foamy macrophages was …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"18 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141509524","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":"Environmental impact assessment in healthcare: utility and limitations","authors":"Robin Baddeley, Nikolaos Voulvoulis, Siwan Thomas-Gibson, Bu'Hussain Hayee","doi":"10.1136/flgastro-2023-102473","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102473","url":null,"abstract":"Concern regarding the environmental impact of healthcare provision is now accompanied by a legal commitment for the NHS to align itself with national emissions targets. Meanwhile, the academic literature increasingly features environmental impact assessments focused on healthcare products, processes and systems. However, the current evidence base contains significant methodological heterogeneity, and the healthcare context demands that particular considerations are made when interpreting the findings from these studies. In this article, we consider the role environmental accounting methodologies can play in the effort to achieve environmental sustainability in healthcare; their utility and limitations.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"8 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141191774","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}