Frontline Gastroenterology最新文献

{"title":"Unique cause of acute pancreatitis","authors":"Rory James McCluskey, Jessie Elliott, Jan Leyden, John Conneely, Gerry McEntee, Suzanne O'Mahony, Niall McInerney","doi":"10.1136/flgastro-2024-102673","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102673","url":null,"abstract":"A previously well 43-year-old men was admitted with right upper quadrant and epigastric pain, fever and vomiting. His medical history included asymptomatic cholestatic liver function tests for which serial ultrasound (US), magnetic resonance cholangiopancreatography, fibroscan and a US-guided liver biopsy had proved unremarkable several years prior to this presentation. Physical examination revealed diffuse abdominal tenderness worst in the right upper quadrant and epigastric region. Laboratory investigations demonstrated raised inflammatory markers and deranged liver function but were otherwise unremarkable. CT of the abdomen and pelvis showed extensive pancreatic stranding and fluid most prominent around the tail and body of the pancreas. The patient had no history of gallstones, alcohol misuse, new medications, family history or hypercholesterolemia. The patient was managed conservatively but subsequently deteriorated with features of abdominal sepsis. Serial …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"97 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141192019","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":"Climate change and gastroenterology: from the frontline","authors":"Mai Ling Perman","doi":"10.1136/flgastro-2023-102500","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102500","url":null,"abstract":"Despite contributing minimally to global greenhouse gas emissions,1 Pacific Island nations are at the frontline of climate change impacts.2 Their heightened vulnerability stems from their geographical dispersal across the expansive Pacific Ocean, which leaves them encircled by vast bodies of water. This unique geological position subjects these island communities to climate-related threats, including rising sea levels, coastline erosion, ocean acidification, loss of biodiversity, food and water insecurities and extreme weather events, jeopardising their existence and way of life. Oceania comprises Australia, New Zealand and the PICs and territories (see figure 1). The three ethnogeographic regions (Melanesia, Micronesia and Polynesia) form the PICs. Of these, 13 are sovereign nations, while others maintain unique political associations with France, New Zealand and the USA. Figure 1 Map of Oceania (Source: map-oceania-05.gif (720×410) (globalsecurity.org). The self-governing nations have almost 13 million people but only about 2.7 million live on the smaller islands.3 They are classified as low-income and middle-income countries.3 These include the Federated States of Micronesia, Fiji, Kiribati, the Republic of the Marshall Islands (RMI), Nauru, Papua New Guinea, Samoa, the Solomon Islands, Tonga, Tuvalu and Vanuatu. Each country boasts a unique blend of culture, tradition, history and political systems. As Earth becomes warmer due to climate change, sea levels rise via two main mechanisms: expanding heated seawater and melting ice sheets and glaciers.2 Because some PICs are low-lying atolls, they face the potential existential threat of vanishing underwater with rising sea levels. The countries with the most significant threat of ‘sinking’ first are Tuvalu, Kiribati and the Republic of the Marshall Islands. Their highest elevations vary from atoll to atoll, but, generally, they are mostly under 5 m above sea level. The only bridge, which is the highest peak (<10 m above sea level) in Majuro, Republic of the …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"68 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140930838","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":"Perforation of the fourth duodenal segment and peritonitis caused by a bezoar","authors":"Baptiste Massart, Chieh-Wen Lai, Kian-Hwee Chong, Jia-Hui Chen","doi":"10.1136/flgastro-2024-102739","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102739","url":null,"abstract":"A 43-year-old woman presented with 1 day of epigastric pain and a developing fever. She was tachycardic and febrile. Physical examination showed rebound tenderness on the left upper quadrant with decreased bowel sounds. CT of the abdomen revealed duodenal perforation surrounding a mass of unknown nature (figure 1). An oesophagogastroduodenoscopy showed a phytobezoar unusually located in the fourth duodenal segment (figure 2). A bezoar is a rare cause of small bowel perforation that most frequently occurs in …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140930839","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":"Unusual cause of recurrent vomiting in a patient with duodenal stenosis","authors":"Jian-Wei Liu, Ru-Yuan Li","doi":"10.1136/flgastro-2024-102643","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102643","url":null,"abstract":"A 44-year-old man was referred to our hospital with a 2-week history of abdominal distention, nausea and recurrent vomiting. The past medical history disclosed peptic ulcer-related duodenal stenosis at the bulb for 3 years and cholecystolithiasis for 20 years. On examination, the abdomen was distended and soft with no tenderness. Blood laboratory tests showed leucocytosis (12.10×109/L, reference 3.5–9.5), mild hypokalaemia (3.25 mmol/L, reference 3.5–5.3), normal C reactive protein, liver function, renal function and coagulation function. An abdominal CT showed a typical Rigler’s triad: pneumobilia, …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"98 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140931021","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":"Reflux riddle: an unforeseen element at the gastro-oesophageal junction","authors":"Swathi Prabhu, Anuradha Calicut Kini Rao, Vishwanath Basavaraj","doi":"10.1136/flgastro-2024-102654","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102654","url":null,"abstract":"A 70-year-old woman presented to the gastroenterology clinic with a 2-month history of acid reflux, heartburn and dysphagia. A clinical diagnosis of gastro-oesophageal reflux disease was made. Upper gastrointestinal (GI) endoscopy (figure 1) revealed a hiatus hernia with a red smooth surfaced lump at the gastro-oesophageal junction (GOJ), measuring 1 cm in diameter. The biopsy in our case threw up an unusual surprise of …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"42 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140930758","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":"Improving endoscopy unit efficacy and retention through the provision of role-specific admin and clerical training","authors":"Michael Dawson, Melissa Rankin, Grahame Smith","doi":"10.1136/flgastro-2024-102642","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102642","url":null,"abstract":"The North West Endoscopy Academy is committed to ensuring endoscopy training is of a standardised high quality that is multidisciplinary. It seeks to address the historic lack of admin training by providing a core admin and clerical (A&C) skills in endoscopy course for all A&C staff. The competency framework used for this training is the first developed specifically for A&C staff in endoscopy and the early indications are that it has significantly contributed to the efficacy of a unit’s performance, highlighting that greater focus should be placed on providing these opportunities to A&C staff in the future. This article will explore the aims and methodology of the course and present evaluation data to discuss the successes and future recommendations. We have used a combination of teaching methods, such as small group work, case study analysis and traditional classroom teaching to provide an education programme which seeks to underline existing best practice and introduce new themes and ways of working. Our two-tiered evaluation has shown this approach to be effective, in the future, we intend to implement a further evaluation to establish the long-term added value of the training. In combination, we will begin work on advanced skills modules aimed at supervisory and management staff.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"43 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835579","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-2024-102720","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102720","url":null,"abstract":"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 pandemic FIT testing was used to triage patients referred to the cancer pathway. FIT-negative patients were assessed and safety netted in a FIT negative clinic. In this issue Nigam and colleagues report a case note review of 622 patients referred to a FIT negative clinic – 2020/21, median age 71.5 years, median follow-up 2.5 years. Patients were referred with a change in bowel habit (61%), iron deficiency (24%), anaemia (11%), weight loss (9%), blood per rectum (5%). Further investigation by endoscopy/radiology was only indicated in around a third. Malignancy rate was low (1.5%) including rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. The authors rightly suggest that using FIT as a triage in patients referred to the 2 week wait cancer pathway can result in fewer patients requiring further investigation and so more effective and efficient use of healthcare resources. (See page 190) A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. In this issue Bashir and colleagues report the impact of the local implementation of a FIT diagnostic pathway (figure one) on cancer detection rate. The authors use National Endoscopic Data to compare local diagnostic rates in 2019 (before pathway implantation) and 2021. There was a significant increase …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"158 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140582640","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":"Randomised trial of ‘hybrid’ water-assisted colonoscopy (modified water immersion) versus water exchange colonoscopy: WAVE study","authors":"Ahmir Ahmad, Anna Buenaventura, Belma Motes, Ravi Misra, Ripple Man, Angad Dhillon, Paul Bassett, Kowshika Thiruvilangam, Brian P Saunders","doi":"10.1136/flgastro-2023-102606","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102606","url":null,"abstract":"Background and aims Colonoscopy practice has evolved with a trend towards water-assisted insertion. A recent national survey suggests a hybrid approach to colonic distension during insertion, with water used predominately to the splenic flexure and carbon dioxide (CO2) with water used thereafter to the caecum, is commonly used. This contrasts with the water exchange technique where no CO2 is used. This study aimed to evaluate whether a hybrid or water exchange technique allows more efficient colonoscopy. Methods This prospective, randomised controlled trial was conducted between March 2021 and June 2022. Participants were randomised 1:1 to hybrid or water exchange colonoscopy, performed by four experienced colonoscopists. The primary outcome was total procedure time with secondary outcomes of caecal intubation time, caecal intubation rate, polyp detection, loop formation, number of ancillary manoeuvres, sedation use and patient comfort. Results 256 patients were invited, and 246 were randomised to either hybrid or water exchange colonoscopy. 122 patients were included in each arm of the primary analysis. Total procedure time was greater in the water exchange group compared with hybrid (29 vs 25 min, p=0.009). Patient reposition episodes occurred more frequently in the water exchange group vs hybrid group (5.5 vs 5, p=0.003) and left colon Boston Bowel Preparation Scale (BBPS) score was improved. No difference was seen in all other outcomes. Conclusion A hybrid technique, compared with water exchange, enabled faster colonoscopy without adversely impacting sedation requirement, caecal intubation, overall bowel cleansing and patient comfort. This technique appears to maximise the advantages of both water and CO2 to enable more efficient colonoscopy. Trial registration number [NCT04710706][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04710706&atom=%2Fflgastro%2Fearly%2F2024%2F04%2F29%2Fflgastro-2023-102606.atom","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"60 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835610","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":"Climate change for gastroenterologists: understanding the basics","authors":"Judith Chantal Eling, Jennifer Barker, Stefi Barna","doi":"10.1136/flgastro-2023-102499","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102499","url":null,"abstract":"The healthcare sector is a significant producer of greenhouse gas emissions. Gases that contribute to climate change include carbon dioxide, methane, nitrous oxide and chlorofluorocarbons. Climate change will impact the types and prevalence of diseases seen in clinical practice. Practising preventive medicine in gastroenterology can protect population health and reduce the need for health services, thus reducing the carbon footprint of the health sector. Increasing patient empowerment, making care pathways leaner and minimising the environmental impact of treatments and interventions could also make healthcare more sustainable.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"94 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140803469","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":"Real-world effectiveness of upadacitinib in Crohn’s disease: a UK multicentre retrospective cohort study","authors":"Alexander Thomas Elford, Maria Bishara, Nikolas Plevris, Beatriz Gros, Nathan Constantine-Cooke, James Goodhand, Nicholas A Kennedy, Tariq Ahmad, Charlie W Lees","doi":"10.1136/flgastro-2024-102668","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102668","url":null,"abstract":"Background Upadacitinib is a Janus kinase inhibitor, which has recently been approved for treating Crohn’s disease. There are limited real-world studies on the outcomes of upadacitinib in Crohn’s disease. Objective Our aim was to evaluate the outcomes of upadacitinib in a real-world Crohn’s disease cohort. Methods We conducted a retrospective, multicentre, cohort study over a 2-year period across National Health Service (NHS) Lothian and Royal Devon University Healthcare NHS Foundation Trust. The primary outcome was treatment persistence at week 24. Secondary endpoints were corticosteroid-free clinical remission (Harvey-Bradshaw Index (HBI)<5) and biomarker remission (C-reactive protein (CRP)≤5 mg/L and faecal calprotectin (FCAL)<250 µg/g) at 12, 24 and 52 weeks. We recorded adverse events. Results 135 patients commenced upadacitinib as of the 1 January 2024, of which 93 patients with active Crohn’s disease were included with a minimum of 12 weeks follow-up. The median follow-up time was 25 weeks (IQR 15–42 weeks). 82% of the cohort had exposure to at least two classes of advanced therapies, and 52% had exposure to at least three classes of advanced therapies. Treatment persistence was 87.1% at week 12, 81.7% at week 24 and 62.8% at week 52. Rates of clinical remission were 64% (42/66), 48% (22/46) and 38% (8/21) at weeks 12, 24 and 52, respectively. Significant reductions in HBI, CRP and FCAL were observed during follow-up. 14% (13/91) had a hospitalisation due to Crohn’s disease. Adverse events occurred in 40% (37/93) of the cohort, of which 12% (11/93) were serious. Conclusion Upadacitinib was effective in a real-world, highly refractory, Crohn’s disease cohort with good persistence. Data are available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"15 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140582467","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}