Frontline Gastroenterology最新文献

{"title":"Oral manifestations of inflammatory bowel disease: a guide to examination","authors":"Sandeep Joshi, Alice Moore, Joel Mawdsley, Barbara Carey","doi":"10.1136/flgastro-2023-102619","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102619","url":null,"abstract":"Orofacial symptoms are common in patients with inflammatory bowel disease (IBD). They may present as a primary manifestation of the disease in the oral cavity with oral Crohn’s disease, or as a secondary manifestation of the disease such as iron deficiency, or due to side effects to medications used in treatment. Orofacial manifestations of IBD may result in significant morbidity which can impact patients’ quality of life. Systematic examination and a timely diagnosis are fundamental in initiating appropriate management. This article provides a guide for gastroenterologists to systematically perform an extraoral and intraoral examination of the orofacial region. The extraoral examination includes evaluation of lymph nodes, lips and perioral skin. Common extraoral features of IBD include lip swelling, lip fissuring, angular cheilitis, perioral erythema and cervicofacial lymphadenopathy. The intraoral examination involves a systematic inspection of all areas of the oral cavity. Intraoral IBD features include ulceration, cobblestoning of the buccal mucosa, gingival erythema and mucosal tags. Examining the orofacial region is important in the complete assessment of patients with IBD, to diagnose orofacial conditions, to initiate tailored treatments and to identify those patients who would benefit from input from oral medicine specialists.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202336","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":"Carbon footprinting for the gastroenterologist","authors":"Sandeep Shivananda Siddhi, Mhairi Donnelly","doi":"10.1136/flgastro-2023-102612","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102612","url":null,"abstract":"We are in a climate emergency—this is anthropogenic, and we can do something about it. An awareness of carbon footprinting is essential to allow us to understand and address this issue, both in our personal and professional lives. The aim of this article is to demystify carbon footprinting and to make the concept relevant to the gastrointestinal healthcare professional.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202171","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":"Call for sustainable food systems including (medical) nutrition for hospitalised children and their families","authors":"Sascha C A T Verbruggen, Suzan Cochius den Otter, Johanna Bakker, George Briassoulis, Ilia Stavoula, Lynne Latten, Koen Joosten, Shancy Rooze, Eva van Zanten, R Mark Beattie, Luise V Marino","doi":"10.1136/flgastro-2023-102478","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102478","url":null,"abstract":"The climate emergency presents a profound threat to global health, adversely affecting the health and well-being of children who are projected to bear a substantial disease burden, as well as impacting children’s right to food, water, healthcare and education. The healthcare sector strives to prioritise preventative healthcare policies improving the health of individuals across the life course. However, current healthcare practices significantly contribute to greenhouse gas (GHG) emissions and waste generation, in which (medical) nutrition plays an important role. Plant-based proteins offer sustainability benefits, and potential health advantages, and have a lower climate footprint, although there may also be unintended consequences of land-use change and deforestation for certain crops. However, to develop suitable plant-based alternatives to medical nutrition, it will be necessary to address regulatory obstacles as well as ensure nutritional profiles are suitable, particularly protein (amino acid) and micronutrient composition. Additionally, the development of heat-tolerant and water-efficient plant genotypes could bolster adaptation to changing climatic conditions. Effective waste management, including wasted food and medical nutrition, emerges as a key strategy in mitigating the climate impact of medical nutrition. While research on food waste in healthcare settings is limited, minimising waste spillage in medical nutrition is a crucial area to explore. Healthcare professionals must acknowledge their roles in curbing the climate footprint of medical nutrition as well as recommendations for food-based approaches. This review aims to investigate the sustainability of medical nutrition for paediatric care, focusing on factors contributing to GHG emissions, plant-based alternatives, waste management and plastic packaging. Such an exploration is vital for healthcare professionals to fulfil their responsibilities in addressing the climate crisis while advocating for change.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202335","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":"Role of oesophageal balloon cryoablation in combination with personalised immunotherapy to achieve luminal control in metastatic oesophageal cancer: a case report","authors":"Benjamin Charles Norton, Apostolis Papaefthymiou, Andrea Telese, Margaret Duku, Imran Chaudhry, Alberto Murino, Gavin Johnson, Charles Murray, Rehan Haidry","doi":"10.1136/flgastro-2024-102666","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102666","url":null,"abstract":"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 synergistic effect with modern immunotherapies as cryonecrosis leads to the release of many tumour-specific autoantigens that induce a systemic antitumour response. We present the case of a 39-year-old man who presented with several months of non-specific upper abdominal pain and heartburn. He was subsequently diagnosed with metastatic OAC and proceeded to self-funded genomic tumour profiling. This enabled initiation of a personalised oncological treatment plan involving immunotherapy and a neoantigen cancer vaccination regimen. To facilitate continued oral intake and avoid the risk of endoscopic stenting, the patient underwent a concurrent programme of oesophageal balloon cryoablation over eight sessions. At 15 months following his diagnosis, he had complete histological remission of luminal disease and a preserved systemic treatment response. In summary, oesophageal cryoablation is an endoscopic option for luminal control among patients undergoing immunotherapy for metastatic OAC. This would provide a synergistic treatment effect and mitigate against the risk of endoscopic stenting.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"91 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140155277","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":"Factors associated with Entamoeba histolytica proctocolitis in men who have sex with men: a systematic review","authors":"Robbie Hughes, Daniel Richardson, Colin Fitzpatrick","doi":"10.1136/flgastro-2024-102641","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102641","url":null,"abstract":"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 Core Collections for manuscripts published up to November 2022. One author screened abstracts; two authors independently conducted a full-text review. We included manuscripts that contained primary data on factors associated with transmission in MSM. Quality and risk of bias were assessed independently by two authors using the Joanna Briggs Institute critical appraisal tools. We used the nine-point synthesis method to synthesise narrative data. Results Nine manuscripts consisting of 832 individuals with E. histolytica were included; six cross-sectional studies, two case-control studies and one cohort study. E. histolytica in MSM was associated with: increasing age, transmission in warm seasons, lower educational achievement, concurrent sexually transmitted infection (STI) ( Treponema pallidum , Neisseria gonorrhoeae , Chlamydia trachomatis ), hepatitis B core antibody positivity, hepatitis C antibody positivity, concurrent sexually transmitted enteric infection ( Shigella spp, Giardia duodenalis ), having a previous STI ( T. pallidum, N. gonorrhoeae ), oral-anal sex, exclusively/majority receptive anal sex and having an increased number of sexual partners. Conclusion This review has highlighted some important demographic, biological and behavioural factors associated with E. histolytica in MSM which can inform future clinical guidelines and public health control strategies. PROSPERO registration number CRD42022366168. Data sharing not applicable to this article as no data sets were generated or analysed during the current study.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"24 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140154922","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":"Sequential comparison of two intraductal biliary brush cytology devices for suspected malignant biliary strictures","authors":"Manu Nayar, Kofi W Oppong, Pardeep Maheshwari, Sarah Johnson, Shiran Esmaily, Ruth Waller, John Leeds","doi":"10.1136/flgastro-2023-102627","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102627","url":null,"abstract":"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 to 102 patients who underwent sampling with a conventional brush (group 2). Demographic data, stricture characteristics, sensitivity, specificity, negative predictive values and positive predictive values were analysed and compared with final diagnosis. Analysis was performed using strict criteria (definite for cancer) and relaxed criteria (suspicious for cancer). All patients had a minimum follow-up of 12 months. Results There was no statistically significant difference in the age and sex distribution between the two groups. Malignancy was diagnosed in 74% in both groups. There was no significant difference in sensitivity between the groups using either strict criteria (sensitivity group 1 47.4% vs group 2 52%, p=0.69) or relaxed criteria (sensitivity group 1 71.1% vs group 2 71.2%, p=1.0). Conclusions Our data suggest that the novel brush design does not confer improved diagnostic performance in malignant biliary strictures when compared in a robust manner. This highlights the difficulties of intraductal brush sampling and the need to develop newer diagnostic techniques. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"37 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140125934","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":"Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study","authors":"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","doi":"10.1136/flgastro-2023-102523","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102523","url":null,"abstract":"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 triaged using symptoms and FCP. A 13-point symptom history was taken prediagnosis and clinical indices, including repeat FCP, collected prospectively. Results Of 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements >100 µg/g (area under the curve (AUC) 0.800) and >200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947. Conclusion Serial FCP measurement prevents unnecessary colonoscopy. Two FCPs >200 µg/g could stream patients direct to colonoscopy, with two >100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"22 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140115140","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":"Liver outcomes following proctocolectomy in patients with primary sclerosing cholangitis and ulcerative colitis","authors":"Thomas Ryan, Jonathan P Segal","doi":"10.1136/flgastro-2023-102600","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102600","url":null,"abstract":"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 and Embase. Studies found via the search were evaluated against both inclusion and exclusion criteria by two independent reviewers (TR and JS). Relevant studies were included in the review. Results Seven studies were deemed relevant through the literature search and review process and another one was included via other sources, therefore, eight studies were included in the final review. Conclusions Proctocolectomy does not appear to have a negative impact on the liver and ileostomy appears to have better outcomes in terms of graft loss compared with ileal pouch-anal anastomosis. However, more high-quality studies on this topic are required as the existing literature is limited, and therefore, the findings should not be overinterpreted. Data is available upon request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"43 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140055336","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":"How can we improve the carbon footprint of IBD clinical care?","authors":"Isabel Carbery, Gauraang Bhatnagar, Rachel Cooney, Christian Selinger","doi":"10.1136/flgastro-2023-102564","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102564","url":null,"abstract":"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 bowel disease (IBD) care is limited, by combining principles of sustainable healthcare with work done in other healthcare areas, we can start to develop ideas to inspire our own sustainable IBD care. The aim of this review article is to examine each part of the IBD care pathway and consider where improvements in sustainability can be made or future research should be focused.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140044722","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-2024-102659","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102659","url":null,"abstract":"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. Low serum amylase showed a high specificity (94%) with low sensitivity (38.7%–59%) in diagnosing CP. The clinical implications are of interest. The authors suggest low amylase can be part of a metabolic process making it a useful metabolic marker in cases like obesity, metabolic syndrome and diabetes mellitus. It can be used as an exocrine marker and trigger investigation for pancreatic exocrine insufficiency. (See page 153) Chronic abdominal pain is common in inflammatory bowel disease (IBD) and not always straightforward to manage. In this issue, Baille and colleagues present a practical guide. The authors start by reviewing pain pathways (see figure 1). It is important to …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"5 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759616","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}