BMJ Open Gastroenterology最新文献

{"title":"Real-world analysis of acamprosate use in patients with cirrhosis and alcohol-associated hepatitis.","authors":"Christopher Oldroyd, Jonathan Wood, Michael Allison","doi":"10.1136/bmjgast-2024-001654","DOIUrl":"10.1136/bmjgast-2024-001654","url":null,"abstract":"<p><strong>Objective: </strong>Preventing return to alcohol is of critical importance for patients with alcohol-related cirrhosis and/or alcohol-associated hepatitis. Acamprosate is a widely used treatment for alcohol use disorder (AUD). We assessed the impact of acamprosate prescription in patients with advanced liver disease on abstinence rates and clinical outcomes.</p><p><strong>Methods: </strong>This was a retrospective case-control study. We reviewed data on all patients admitted to a large tertiary centre in the UK with alcohol-related cirrhosis and/or alcohol-associated hepatitis. We used propensity risk score matching to match patients prescribed acamprosate to controls. The primary outcome was repeat hospitalisation.</p><p><strong>Results: </strong>There were 451 patients who met the inclusion criteria of whom 55 patients were started on acamprosate during their admission. Before matching there were significant differences between the cohorts. Patients who received acamprosate were younger (median age 51 vs 57, p<0.005), more likely to have a purely alcohol-related admission (53% vs 24%, p<0.001), and more likely to suffer from a comorbid psychiatric diagnosis (42% vs 20%, p<0.001). On average patients who were started on acamprosate consumed more alcohol (median 155 units/week vs 80 units/week, p<0.001), were less likely to have a partner (35% vs 54%, p 0.006) and more likely to be unemployed (67% vs 44%, p<0.001). After matching for factors with significant differences between groups, we generated a cohort of 53 patients prescribed acamprosate and 53 matched controls. At 1 year there was a significantly higher rate of readmission (85% vs 57%, p<0.001) in the acamprosate group. There were no statistically significant differences in abstinence rates or mortality at 1 year.</p><p><strong>Conclusion: </strong>Acamprosate prescription was associated with higher rates of readmission in patients with cirrhosis and/or alcohol-associated hepatitis. This may reflect a greater severity of AUD in those patients or might indicate the limited ability of acamprosate to alter the disease course in this population.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963874","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":"<i>Helicobacter pylori</i> infection and staple-line leak in patients with class III obesity undergoing laparoscopic sleeve gastrectomy: a retrospective study.","authors":"Albaraa H Kazim, Fahad Y Bamehriz, Aldanah M Althwanay, Abdullah Aldohayan, Al-Bandari Zamil Abdullah, Bandar AlShehri, Rakan Masoud AlTuwayr, Habeeb I A Razack, Hani Tamim, Fahad Alsohaibani, Saleh A Alqahtani","doi":"10.1136/bmjgast-2024-001622","DOIUrl":"10.1136/bmjgast-2024-001622","url":null,"abstract":"<p><strong>Objective: </strong>Globally, over 50% of the population is affected by <i>Helicobacter pylori</i>, yet research on its prevalence and impact in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG) is inconclusive. This study aimed to assess the prevalence of <i>H. pylori</i> infection in individuals with obesity undergoing LSG, evaluate the percentage of postoperative staple-line leaks, and explore the potential link between <i>H. pylori</i> infection and staple-line leaks.</p><p><strong>Methods: </strong>This retrospective analysis assessed adult patients with class III obesity who underwent LSG between 2015 and 2020 at a tertiary care hospital in Riyadh, Saudi Arabia. Patient characteristics with and without postoperative staple-line leaks were compared, exploring the link between <i>H. pylori</i> infection and these leaks.</p><p><strong>Results: </strong>Of the 2099 patients (mean age, 34.7±12.2 years; female, 53.5%) included, 35% had <i>H. pylori</i> infection and 2% experienced post-LSG staple-line leaks. Patients with <i>H. pylori</i> were older (36.1±11.8 vs 34.0±12.3 years, p<0.0001). Patients with leaks were older, mostly male, and had higher body mass index (p<0.05). However, only 29% of those with leaks were <i>H. pylori</i>-positive. A non-significant association was found between <i>H. pylori</i> infection and staple-line leaks (adjusted OR 0.73, 95% CI 0.33 to 1.60, accounting for age, body mass index, and sex).</p><p><strong>Conclusions: </strong>Although over one-third of patients with class III obesity undergoing LSG had <i>H. pylori</i> infection, a non-significant association was observed with post-LSG staple-line leaks, suggesting routine preoperative <i>H. pylori</i> screening may not be necessary.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963847","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":"Economic evaluation of proton pump inhibitors in patients with gastro-oesophageal reflux disease: a systematic review.","authors":"Seidamir Pasha Tabaeian, Sajad Moeini, Aziz Rezapour, Somayeh Afshari, Aghdas Souresrafil, Mohammad Barzegar","doi":"10.1136/bmjgast-2024-001465","DOIUrl":"10.1136/bmjgast-2024-001465","url":null,"abstract":"<p><strong>Objectives: </strong>Our aim was to systematically review the cost-effectiveness of proton pump inhibitor (PPI) therapies and surgical interventions for gastro-oesophageal reflux disease (GORD).</p><p><strong>Design: </strong>The study design was a systematic review of economic evaluations.</p><p><strong>Data sources: </strong>We searched PubMed, Embase, Scopus, and Web of Science for publications from January 1990 to March 2023. Only articles published in English were eligible for inclusion.</p><p><strong>Eligibility criteria: </strong>Studies were included if they were full economic evaluations comparing PPIs with surgical or alternative therapies for GORD. Excluded were narrative reviews, non-peer-reviewed articles, and studies not reporting cost-effectiveness outcomes.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted data on study design, comparators, time horizon, and cost-effectiveness outcomes. The quality of studies was assessed using the Joanna Briggs Institute (JBI) checklist for economic evaluations.</p><p><strong>Results: </strong>A total of 25 studies met the inclusion criteria. Laparoscopic Nissen fundoplication (LNF) was found to be cost-effective in long-term horizons, while PPIs were preferred for short- to medium-term outcomes. Differences in healthcare settings and methodological approaches influenced the study findings.</p><p><strong>Conclusions: </strong>Strategic purchasing decisions for GORD treatment should consider the time horizon, healthcare setting, and cost structures. LNF may provide better long-term value, but PPIs remain effective for managing symptoms in the short term.</p><p><strong>Study registration: </strong>PROSPERO, CRD42023474181.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963859","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":"Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led management.","authors":"Imogen Stagg, Ailsa Hart, Fionn Cléirigh Büttner, Asma Fikree, John McLaughlin, Jean-Frederic LeBlanc, Sonia Bouri, Thomas Hamborg, Laura Miller, Christine Norton","doi":"10.1136/bmjgast-2024-001585","DOIUrl":"10.1136/bmjgast-2024-001585","url":null,"abstract":"<p><strong>Objective: </strong>Many people with inflammatory bowel disease (IBD) experience fatigue, pain and faecal incontinence that some feel are inadequately addressed. It is unknown how many have potentially reversible medical issues underlying these symptoms.</p><p><strong>Methods: </strong>We conducted a study testing the feasibility of a patient-reported symptom checklist and nurse-administered management algorithm ('Optimise') to manage common medical causes of IBD-related fatigue, pain and faecal incontinence. We conducted qualitative interviews with nurses implementing the algorithm.</p><p><strong>Results: </strong>515 individuals reporting IBD-related symptoms were invited to participate, of whom 201 (39%) consented. 194/201 (97%) returned the symptom checklist, of whom 157 (81%) returned a postal faecal calprotectin sample. Five (3%) participants reported 'red flags' and 31/157 (20%) participants had a faecal calprotectin result ≥200 µg/g, of whom 12 (8%) were judged to have likely active inflammation when clinical symptoms and disease history were reviewed. The algorithm suggested at least one clinical test or intervention for fatigue, pain or faecal incontinence in 67 (43%) participants, of whom 25 (37%) declined. Among 87 participants for whom clinical actions were indicated, 57 (66%) completed follow-up outcomes 3 months after algorithm implementation. Three nurses interviewed found the Optimise algorithm easy to administer.</p><p><strong>Conclusion: </strong>Implementing the Optimise checklist and algorithm appears feasible in UK clinical practice, with adjustments needed to minimise missing items. Not all patients accepted algorithm-indicated interventions, but a yield of 43% with symptoms having potentially reversible causes detected is clinically useful. Nurses endorsed ease and utility of the implementation process. Optimise now needs clinical effectiveness to be assessed.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963861","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":"Parallel randomised trial testing community fibrosis assessment for suspected non-alcoholic fatty liver disease: outcomes from LOCATE-NAFLD.","authors":"Ruth Tulleners, Adrian Barnett, James O'Beirne, Elizabeth Powell, Ingrid J Hickman, Patricia C Valery, Sanjeewa Kularatna, Katherine Stuart, Carolyn McIvor, Elen Witness, Melanie Aikebuse, David Brain","doi":"10.1136/bmjgast-2024-001418","DOIUrl":"10.1136/bmjgast-2024-001418","url":null,"abstract":"<p><strong>Objective: </strong>Non-alcoholic fatty liver disease (NAFLD) is estimated to affect a third of Australian adults, and its prevalence is predicted to rise, increasing the burden on the healthcare system. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) trialled a community-based fibrosis assessment service using FibroScan to reduce the time to diagnosis of high-risk NAFLD and improve patient outcomes.</p><p><strong>Methods: </strong>We conducted a 1:1 parallel randomised trial to compare two alternative models of care for NAFLD diagnosis and assessment. Participants had suspected NAFLD and were referred to a hepatology clinic in one of three major hospitals in South-East Queensland. Eligible consenting participants were randomised to receive usual care or the intervention (LOCATE). Participants in the intervention arm received a FibroScan outside of the hospital setting, with results provided to their primary care provider and the referring hepatologist. All participants were followed up 12 months after randomisation to measure their clinical and patient-reported outcomes.</p><p><strong>Results: </strong>97 participants were recruited from October 2020 to December 2022. Of the 50 participants randomised to the intervention arm, one failed to attend their appointment, and of the 48 (98%) who had a FibroScan 13 (27%) had a liver stiffness measurement of 8.0 kPa or greater. The HR for the time to diagnosis of high risk was 1.28 (95% CI 0.59 to 2.79), indicating a faster average time to diagnosis with the intervention, but failing to conclusively demonstrate a faster time. The intervention did greatly reduce the time to FibroScan by almost 1 year (median difference 0.92 years, 95% CI 0.56 to 1.45). Other clinical outcomes showed minimal changes.</p><p><strong>Conclusion: </strong>The LOCATE model shows potential for impact, particularly in reducing waiting times for patients at high risk of developing severe liver disease due to NAFLD. A larger sample and longer follow-ups are needed to measure additional clinical outcomes.</p><p><strong>Trial registration number: </strong>ACTRN12620000158965.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963864","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":"Costs of colorectal cancer screening in Sweden: an observational, longitudinal cost description.","authors":"Naimi Johansson, Camilla Nystrand, Johannes Blom","doi":"10.1136/bmjgast-2024-001574","DOIUrl":"10.1136/bmjgast-2024-001574","url":null,"abstract":"<p><strong>Objective: </strong>Colorectal cancer (CRC) screening programmes have been implemented worldwide, but the evidence of the economic consequences of screening programmes relies on data from short-term trials. The aim of this paper was to describe the costs of CRC screening in a population-based screening programme, using administrative real-world data. Specifically, we aimed to estimate the annual costs of the screening programme and the total costs of the full programme over five consecutive screening rounds.</p><p><strong>Methods: </strong>The CRC screening programme of Stockholm-Gotland, Sweden, targeted all resident men and women aged 60-69 years for biennial screening. The screening strategy was faecal occult blood testing (FOBT) sent to individuals' home addresses, with a positive test result leading to an invitation to diagnostic colonoscopy. The cost description was conducted with a retrospective, bottom-up costing design from a healthcare perspective using (1) a prevalence-based approach and (2) an incidence-based approach, with two different study samples.</p><p><strong>Results: </strong>Annual healthcare costs were estimated using a sample of 124 608 individuals who were affected by the screening programme in 2017. Annual healthcare costs of the screening programme summed up to €273 758 per 10 000 people, equivalent to €27.4 per eligible individual. The sum of costs for colonoscopy procedures was more than two times as high as the costs for FOBT. The costs of the full screening programme were estimated using a cohort of 92 689 individuals who were invited to five consecutive rounds of screening between 2009 and 2021. Total healthcare costs over five screening rounds were €960 654 per 10 000 people, equivalent to €96.1 per individual.</p><p><strong>Conclusion: </strong>The costs of diagnostic colonoscopies for a minority of participants were driving the costs of the CRC screening programme. The ongoing population-based screening programme and high-quality individual level data with long-term follow-up provide the opportunity to thoroughly describe the costs of CRC screening.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852831","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":"Epidemiology of chronic and acute pancreatitis in India (EPICAP-India): protocol for a multicentre study.","authors":"Anand Krishnan, Divya Pillai, Ritvik Amarchand, Ashish Agarwal, Vineet Ahuja, Vineeta Baloni, Subhra Samujjwal Basu, Pankaj Bhardwaj, Bikash Choudhury, Sudipta Dhar Chowdhury, Deepti Dabar, Soumi Das, Pradeep Deshmukh, Krishnadas Devadas, Gopal Krishna Dhali, Deepak Gunjan, Anmol Gupta, Saransh Jain, Saurabh Kedia, Rakesh Kumar, Sanjeev Kumar, Govind K Makharia, Nitika Monga, Sumit Rungta, Anoop Saraya, Rajib Sarkar, Shalimar, Brij Sharma, Shivendra Singh, Chintha Sujatha, Nitya Wadhwa, Pramod Kumar Garg","doi":"10.1136/bmjgast-2024-001562","DOIUrl":"10.1136/bmjgast-2024-001562","url":null,"abstract":"<p><strong>Introduction: </strong>Acute and chronic pancreatitis (CP) are inflammatory conditions of the pancreas that cause local and systemic complications. The epidemiology of these conditions are not well-known in India.</p><p><strong>Methods and analysis: </strong>We describe the protocol and procedures of a multicentre study for delineating the epidemiology of pancreatitis in India. We plan to cover 110 000 people across 10 geographically distributed sites in 10 states of India to estimate the burden and risk factors of CP. Trained investigators will make house visits and screen for abdominal pain requiring hospitalisation or pre-diagnosed CP. The screened positive participants will be reviewed by a gastroenterologist to confirm the diagnosis of CP based on radiological imaging. For each case, four controls will be selected and data on risk factors for CP (tobacco, alcohol, family history, metabolic causes) and blood for genetic markers will be collected. Information on the cost of treatment and quality of life will be collected from patients with CP. For estimating incidence of acute pancreatitis (AP), hospital-based sentinel surveillance will be conducted in 10 districts across these 10 states. All hospitals in the district will be contacted to provide a line list of admissions due to acute abdomen including AP for 2 years. The spread of acute abdomen cases will be used to define the catchment area and estimate the denominator population. The line-listed cases with AP living in the catchment area will form the numerator to calculate the incidence. The study will provide critical information for planning pancreatitis-related services in the country.</p><p><strong>Ethics and dissemination: </strong>The institutional ethics committee (IECs) at all the participating sites have given their approval for the study. All the participants whose data will be collected will be included after written informed consent. The results may be presented at national or international conferences and will be reported in peer-reviewed publications.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852794","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":"Medication use and risk of reflux oesophagitis.","authors":"Ren Ueta, Shiori Komori, Kumiko Umemoto, Masahiro Hata, Erika Masuda, Kana Seto, Yuriko Nishiie, Keigo Suzuki, Yuya Hisada, Yuka Yanai, Yuki Otake, Hidetaka Okubo, Kazuhiro Watanabe, Naoki Akazawa, Chizu Yokoi, Junichi Akiyama","doi":"10.1136/bmjgast-2024-001468","DOIUrl":"10.1136/bmjgast-2024-001468","url":null,"abstract":"<p><strong>Objective: </strong>Reflux oesophagitis (RO) is one of the most common diseases encountered by gastroenterologists and primary care physicians. However, few epidemiological studies have investigated the association of medication use and RO. This study aimed to investigate the prevalence of RO and its risk factors, particularly with respect to medication use.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study included consecutive patients who underwent oesophagogastroduodenoscopy (OGD) and were assessed using questionnaires at the National Center for Global Health and Medicine (Shinjuku, Tokyo, Japan) between October 2015 and December 2021. The questionnaire collected data on patient characteristics, medical history, smoking and alcohol consumption, and medications that patients were taking at the time of OGD.</p><p><strong>Results: </strong>Among the 13 993 eligible patients, the prevalence of RO was 11.8%. Multivariate logistic regression analysis indicated that male sex (OR=1.52 (95% CI 1.35 to 1.72), p<0.001); obesity (OR=1.57 (95% CI 1.40 to 1.77), p<0.001); smoking (OR=1.19 (95% CI 1.02 to 1.38), p=0.026); alcohol consumption (OR=1.20 (95% CI 1.07 to 1.35), p=0.002); diabetes (OR=1.19 (95% CI 1.02 to 1.39), p=0.029); hiatal hernia (OR=3.10 (95% CI 2.78 to 3.46), p<0.001); absence of severe gastric atrophy (OR=2.14 (95% CI 0.39 to 0.56), p<0.001); and the use of calcium channel blockers (CCBs) (OR=1.22 (95% CI 1.06 to 1.40), p=0.007), theophylline (OR=2.13 (95% CI 1.27 to 3.56), p=0.004), and non-steroidal anti-inflammatory drugs (NSAIDs) (OR=1.29 (95% CI 1.03 to 1.61), p=0.026) were independent predictors of RO.</p><p><strong>Conclusion: </strong>RO was present in 11.8% of patients. Use of CCBs, theophylline, and NSAIDs were independent predictors of RO.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845824","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":"Effectiveness of tofacitinib in patients with ulcerative colitis: an updated systematic review and meta-analysis of real-world studies.","authors":"Chien-Hung Lin, Wen-Sheng Liu, Chuan Wan, Hsin-Hui Wang","doi":"10.1136/bmjgast-2024-001347","DOIUrl":"10.1136/bmjgast-2024-001347","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the real-world effectiveness of tofacitinib for treating moderate-to-severe ulcerative colitis (UC).</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>PubMed, EMBASE and Cochrane CENTRAL databases were searched from inception up to 18 July 2023. Reference lists of included studies were manually searched to identify potentially relevant studies not found in the databases.</p><p><strong>Eligibility criteria: </strong>Eligible studies included real-world observational studies, reported in English, on patients with moderate-to-severe UC treated with tofacitinib, defined by the Partial Mayo Score. Excluded were clinical trials, reviews, letters, conference abstracts, case reports and studies involving patients with mixed Crohn's disease.</p><p><strong>Data extraction and synthesis: </strong>Two independent reviewers extracted data and recorded it in Excel. Quality assessment was performed using the Newcastle-Ottawa scale. Meta-analysis was performed using random-effects models due to high heterogeneity across studies.</p><p><strong>Results: </strong>19 studies containing a total of 2612 patients were included. Meta-analysis revealed that clinical response rates were 58% at week 8, 61% at weeks 12-16, 51% at weeks 24-26 and 51% at week 52. Clinical remission rates were 39% at week 8, 43% at weeks 12-16, 40% at weeks 24-26 and 43% at week 52. Corticosteroid-free clinical remission rates were 33% at week 8, 37% at weeks 12-16, 32% at weeks 24-26 and 40% at week 52.</p><p><strong>Conclusion: </strong>This meta-analysis of real-world studies indicates that treatment of UC with tofacitinib is associated with favourable clinical response and remission rates in the induction and maintenance phases.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817324","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 from 2010 (standard operating procedure): protocol for the 2024 British Society of Gastroenterology Guidelines on colorectal surveillance in inflammatory bowel disease.","authors":"Morris Gordon, Gaurav Bhaskar Nigam, Vassiliki Sinopoulou, Ibrahim Al Bakir, Adrian C Bateman, Shahida Din, Sunil Dolwani, Anjan Dhar, O D Faiz, Bu Hayee, Chris Healey, Christopher Andrew Lamb, Simon Leedham, Misha Kabir, Marietta Iacucci, Ailsa Hart, A John Morris, Marco Novelli, Tim Raine, Matt Rutter, Neil A Shepherd, Venkataraman Subramanian, Nigel J Trudgill, Maggie Vance, Ana Wilson, Lydia White, Ruth Wakeman, James E East","doi":"10.1136/bmjgast-2024-001541","DOIUrl":"10.1136/bmjgast-2024-001541","url":null,"abstract":"<p><strong>Introduction: </strong>The evolving landscape of inflammatory bowel disease (IBD) necessitates refining colonoscopic surveillance guidelines. This study outlines methodology adopted by the British Society of Gastroenterology (BSG) Guideline Development Group (GDG) for updating IBD colorectal surveillance guidelines.</p><p><strong>Methods and analysis: </strong>The 'Grading of Recommendations, Assessment, Development and Evaluation' (GRADE) approach, as outlined in the GRADE handbook, was employed. Thematic questions were formulated using either the 'patient, intervention, comparison and outcome' format or the 'current state of knowledge, area of interest, potential impact and suggestions from experts in the field' format. The evidence review process included systematic reviews assessed using appropriate appraisal tools. An extensive list of potential outcomes was compiled from literature and expert consultations and then ranked by GDG members. The top outcomes were identified for evidence synthesis in three key areas: utility of surveillance in IBD, quality of bowel preparation and use of advanced imaging techniques in colonoscopy for IBD. Risk thresholding exercises determined specific risk levels for different surveillance strategies and intervals. This approach enabled the GDG to establish precise thresholds for interventions based on relative and absolute risk assessments, directly informing the stratification of surveillance recommendations. Significance of effect sizes (small, moderate, large) will guide the final GRADE assessment of the evidence.</p><p><strong>Ethics and dissemination: </strong>Ethics approval is not applicable. By integrating clinical expertise, patient experiences and innovative methodologies like risk thresholding, we aim to deliver actionable recommendations for IBD colorectal surveillance. This protocol, complementing the main guidelines, offers GDGs, clinical trialists and practitioners a framework to inform future research and enhance patient care and outcomes.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766316","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}