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Publication Venesection treatment in haemochromatosis – current best practice from the BSG/BASL Special Interest Group(BMJ Publishing Group, 2025-06-20) Singh, Prabhsimran; Mortimore, Gerri; Hicks, Kim; McDonald, Natasha; Cash, Johnny; Lowry, Lisa; Griffiths, William; Shearman, Jeremy; York and Scarborough Teaching Hospitals NHS Foundation Trust; Hull York Medical School; University of Derby; Royal Cornwall Hospitals NHS Trust; NHS Lanarkshire; Belfast Health and Social Care Trust; Somerset NHS Foundation Trust; Cambridge University Hospitals NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; Warwick Medical School; Gastroenterology; Medical and Dental; Shearman, JeremyHaemochromatosis is the most common single gene disorder affecting the population of the UK, resulting in iron overload and organ damage. Venesection (therapeutic phlebotomy) has been the primary treatment offered to patients for more than half a century. Despite the prevalence of the condition in the UK, there has been little progress in new treatments being offered over this time. Moreover, there is a lack of robust research to guide the optimal frequency, timing and treatment targets for venesection treatment in haemochromatosis. Retrospective cohort studies established a clear mortality benefit when treatment is commenced before the development of liver cirrhosis—assumed to be due to limiting the progression of liver disease and development of hepatocellular carcinoma. However, the benefit of venesection on symptoms of haemochromatosis lacks quality evidence. In this best practice description, we review the currently available literature on the benefits and limitations of venesection treatment. We describe current practice as reflected by the experiences of a multidisciplinary team of professional members of the British Society of Gastroenterology/British Association for the Study of the Liver haemochromatosis Special Interest Group. We describe a framework and recommendations for treatment in addition to describing the management of treatment side effects and complications. Through this work and the establishment of consistency in treatment, patients will benefit from better evidence-based care and the profession will be better able to identify the potential value of future treatments.Publication HFE genotypes, haemochromatosis diagnosis and clinical outcomes at age 80 years : a prospective cohort study in the UK Biobank(BMJ Publishing Group, 2024-03-13) Lucas, Mitchell R.; Atkins, Janice L.; Pilling, Luke C.; Shearman, Jeremy; Melzer, David; University of Exeter; South Warwickshire University NHS Foundation Trust; Gastroenterology; Medical and Dental; Shearman, Jeremy D.Objectives: HFE haemochromatosis genetic variants have an uncertain clinical penetrance, especially to older ages and in undiagnosed groups. We estimated p.C282Y and p.H63D variant cumulative incidence of multiple clinical outcomes in a large community cohort. Design: Prospective cohort study. Setting: 22 assessment centres across England, Scotland, and Wales in the UK Biobank (2006-2010). Participants: 451 270 participants genetically similar to the 1000 Genomes European reference population, with a mean of 13.3-year follow-up through hospital inpatient, cancer registries and death certificate data. Main outcome measures: Cox proportional HRs of incident clinical outcomes and mortality in those with HFE p.C282Y/p.H63D mutations compared with those with no variants, stratified by sex and adjusted for age, assessment centre and genetic stratification. Cumulative incidences were estimated from age 40 years to 80 years. Results: 12.1% of p.C282Y+/+ males had baseline (mean age 57 years) haemochromatosis diagnoses, with a cumulative incidence of 56.4% at age 80 years. 33.1% died vs 25.4% without HFE variants (HR 1.29, 95% CI: 1.12 to 1.48, p=4.7×10-4); 27.9% vs 17.1% had joint replacements, 20.3% vs 8.3% had liver disease, and there were excess delirium, dementia, and Parkinson's disease but not depression. Associations, including excess mortality, were similar in the group undiagnosed with haemochromatosis. 3.4% of women with p.C282Y+/+ had baseline haemochromatosis diagnoses, with a cumulative incidence of 40.5% at age 80 years. There were excess incident liver disease (8.9% vs 6.8%; HR 1.62, 95% CI: 1.27 to 2.05, p=7.8×10-5), joint replacements and delirium, with similar results in the undiagnosed. p.C282Y/p.H63D and p.H63D+/+ men or women had no statistically significant excess fatigue or depression at baseline and no excess incident outcomes. Conclusions: Male and female p.C282Y homozygotes experienced greater excess morbidity than previously documented, including those undiagnosed with haemochromatosis in the community. As haemochromatosis diagnosis rates were low at baseline despite treatment being considered effective, trials of screening to identify people with p.C282Y homozygosity early appear justified. Keywords: GENETICS; Hepatology; Mortality; Other metabolic, e.g. iron, porphyria.Publication Clinical service delivery implications of the COVID-19 pandemic on people with inflammatory bowel disease : a qualitative study(BioMed Central, 2023-11-02) Kemp, Karen; Avery, Pearl; Bryant, Ruby; Cross, Amanda; Danter, Kayleigh; Kneebone, Andrew; Morris, Deborah; Walker, Amy; Whitley, Lisa; Dibley, Lesley; Manchester Royal Infirmary; University of Manchester; St Mark's Hospital, Harrow; Patient and Public Involvement Group, Swansea; Gloucestershire Hospitals NHS Foundation Trust; Royal Bolton Hospital Foundation Trust; East and North Hertfordshire NHS Trust; South Warwickshire University NHS Foundation Trust; University College London Hospitals NHS Foundation Trust; University of Greenwich; Gastroenterology; Nursing and Midwifery Registered; Walker, AmyBackground: During the COVID-19 pandemic, clinical services were severely disrupted, restricted, or withdrawn across the country. People living with Inflammatory Bowel Disease (IBD) - an auto-immune disorder for which medical treatment often results in immunosuppression, thus requiring regular monitoring-may have struggled to access clinical support. As part of a larger qualitative study, we investigated experiences of access to clinical services during the pandemic, and patient concerns about and preferences for services in the future. Methods: This exploratory qualitative study used semi-structured interviews to explore participants' experiences of clinical services across the UK during the pandemic. All data were collected remotely (March - May 2021) using online video-calling platforms or by telephone. Audio files were transcribed professionally and anonymised for analysis. Data were analysed using thematic analysis. Results: Of the eight themes found across all data, four related specifically to accessing GP, local (district) hospital, and specialist (tertiary) referral services for IBD: 1) The Risk of Attending Hospital; 2) Missing Routine Monitoring or Treatment; 3) Accessing Care as Needed, and 4) Remote Access and The Future. Conclusions: Our findings support other studies reporting changes in use of health services, and concerns about future remote access methods. Maintenance of IBD services in some form is essential throughout crisis periods; newly diagnosed patients need additional support; future dependence on IBD services could be reduced through use of treatment / self-management plans. As the NHS digitalises it's future services, the mode of appointment-remote (telephone, video call), or in-person - needs to be flexible and suit the patient. Keywords: Clinical Services; Inflammatory Bowel Disease; Remote Access.Publication Managing raised ferritin in primary care(BMJ Publishing Group, 2023-07-26) Stewart, Stuart; Evans, William; Turnbull, Iain; Bradbury, Charlotte; Hayward, Judith; Shearman, Jeremy; University of Manchester; Northern Care Alliance, Greater Manchester; University of Nottingham; Yorkshire Regional Genetic Service; University of Oxford; University Hospitals Bristol and Weston; St George's University London; South Warwickshire University NHS Foundation Trust; University of Warwick; Gastroenterology and Hepatology; Medical and Dental; Shearman, JeremyWhat you need to know Raised levels of ferritin can be associated with several serious underlying conditions and should be investigated appropriately Determine whether raised ferritin reflects iron overload or another disease process Initial tests for investigating raised ferritin in primary care are fasting transferrin saturation, full blood count, liver blood tests, and C reactive protein Assess patients for organ damage associated with iron overload to determine further investigations, management, and whether the patient needs to be referred to secondary care Haemochromatosis is a common genetic condition that can cause iron overload, and primary care clinicians can order HFE gene mutation analysis to diagnose the conditionPublication Emerging role of dual biologic therapy for the treatment of inflammatory bowel disease(Baishideng Publishing Group, 2023-04-26) McCormack, Matthew D.; Wahedna, Natasha A.; Aldulaimi, David; Hawker, Peter; South Warwickshire University NHS Foundation Trust; Gastroenterology; Medical and Dental; McCormack, David; Wahedna, Natasha A.; Aldulaimi, David; Hawker, PeterBiologic agents have now been used in the management of inflammatory bowel disease (IBD) for many years where experience, expertise and confidence in their use has developed over time. In the United Kingdom, there are well established guidelines and recommendations for both single agent biologic treatments, and with combination therapy of a biologic agent with a small molecule agent in maintenance therapy. In recent times, there has been increasing interest and experience using dual biologic therapy (DBT) in IBD, primarily in difficult to treat and refractory cases with high disease burden. However, published data on use, experience and safety profiles is limited and large-scale studies remain low in number in this developing area. We therefore aim to present a summary and review of the available published data in this area to help us better understand the emerging role of DBT in IBD. Keywords: Biologic safety; Combination therapy; Crohn’s disease; Dual biologic therapy; Inflammatory bowel disease; Ulcerative colitis.Publication The UK nationwide observational study of colon capsule: CAP ACCESS study.(Elsevier, 2025-05-13) Lei, Ian Io; Ibrahim, Hussain; Jardine, Ruari; Koulaouzidis, Anastasios; Beshyah, Waleed; Mcgreevy, Conor; Arefin, Aamerrashad; Jarocki, Matthew; Ambler, Tracey; Kiladze, Giorgi; Hunt, Catherine; Pillay, Lushen; Patel, Sachin; Nair, Sujith Sasidharan; Nizar, Zanil Yoonus; Fisher, Ian; Arasaradnam, Ramesh P; University Hospitals Coventry and Warwickshire NHS Trust; University of Warwick; NHS Highland, Inverness; South Warwickshire University NHS Foundation Trust; et al.; Lee, Thomas; Parisi, Ioanna; Bhandare, Anirudh; Shekhar, Chander; Dear, Keith; Jennings, Jason; Aly, Mohamed; McStay, Mary; Anderson, Simon; Selvaraj, Emmanuel; Watson, Angus; Parsons, Nicholas; Medical and DentalBackground: Colon capsule endoscopy (CCE) is increasingly used as an alternative to optical endoscopy (OE), particularly in Europe. However, challenges like low completion rates, inadequate bowel preparation, high conversion to OE, and discrepancies in findings remain. Accurate polyp size measurement in CCE is essential to avoid unnecessary procedures due to size overestimation. Objective(s): This retrospective study analysed real-world data to compare polyp size measurements between CCE, OE, and histopathology (HP) and assess the impact on the need for further procedures. Methods: Data from 2508 participants across 12 UK centres were analysed, with 4898 polyps identified via CCE. Polyps were matched with OE and HP reports based on size, location, morphology, sequence, and count, including those meeting ≥3 criteria. Regional data from Scotland and England were compared. Results: Half of the CCE patients required follow-up OE, with 29 % undergoing colonoscopy. Among these, 32 % required OE for polypectomy, and 18 % due to incomplete CCE. In these cases, CCE overestimated polyp size by an average of 2.5 mm compared to HP and 2.7 mm compared to OE, leading to 17.3 % of potentially deferrable procedures. Conclusion: one in six participants had a further procedure reflecting the overestimation of polyp size. AI advancement could enhance polyp measurement accuracy and reduce unnecessary procedures whilst improving the cost-effectiveness of CCE. Keywords: Bowel preparation; Capsule endoscopy; Colon capsule endoscopy; Colonoscopy; Completion rate; Histopathology; Panenteric capsule endoscopy.Publication The Bowel Cancer Screening Programme (BCSP) pathology Expert Board: five years’ experience of an extraordinary pathological diagnostic conundrum(BMJ Publishing Group, 2015-06-22) Griggs, R.; Noormohamed, S.; Vella, J.; Foy, C.; Sanders, S.; Novelli, M. R.; Shepherd, N. A.; Gloucestershire Hospitals NHS Foundation Trust; Birmingham Women's and Children's NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; University College London Hospitals NHS Foundation Trust; Histopathology; Medical and Dental; Sanders, S.Conference abstract PWE-366 in the section 'Colon and Anorectum – Cancer Including Diagnosis, Prevention and Screen' of the 2nd Digestive Disorders Federation Conference, 22–25 June 2015, London, UK.Publication Recent advances in endoscopy(Research Institute for Gastroenterology and Liver Diseases, 2019-09-01) Weissman, Simcha; Sciarra, Michael; Aldulaimi, David; Hackensack University-Palisades Medical Center, North Bergen, NJ, USA; South Warwickshire University NHS Foundation Trust; Gastroenterology; Medical and Dental; Aldulaimi, DavidNo abstract available.Publication Landmark studies and emerging strategies for the management of acute severe ulcerative colitis(Research Institute for Gastroenterology and Liver Diseases, 2019-06-11) Weissman, Simcha; Saleem, Saad; Aldulaimi, David; Touro College of Osteopathic Medicine, Middletown, New York, USA; Mercy Saint Vincent Medical Center, Toledo, Ohio, USA; South Warwickshire University NHS Foundation Trust; Gastroenterology; Medical and Dental; Aldulaimi, DavidNo abstract available.Publication Portal hypertension in non-alcoholic fatty liver disease(MA Healthcare, 2019-10-16) Rose, Joanne M.; Aldulaimi, David; University of Warwick; South Warwickshire University NHS Foundation Trust; Gastroenterology; Medical and Dental; Aldulaimi, DavidNo abstract available.Publication Is NICE too optimistic about savings from faecal calprotectin testing?(Elsevier, 2015-11) McFarlane, M.; Chambers, S.; Dhaliwal, A.; Lee, B.; Sung, E.; Nwokolo, C.; Waugh, N.; Arasaradnam, R.; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; George Eliot Hospital NHS Trust, Nuneaton; University of Warwick; Gastroenterology; Medical and Dental; Sung, E.Research Podium Presentation abstract PGI8 of the ISPOR 18th Annual European Congress, 7-11 November 2015, Milan, Italy.Publication Is NICE too optimistic about savings from normal faecal calprotectin results?(ACT Publishing Group, 2016-02-21) McFarlane, Michael; Chambers, Samantha; Malik, Ahmad; Lee, Bee; Sung, Edmond; Nwokolo, Chuka; Waugh, Norman; Arasaradnam, Ramesh; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; George Eliot Hospital NHS Trust, Nuneaton; University of Warwick; Gastroenterology; Medical and Dental; Sung, EdmondBackground: A recent systematic review confirmed the utility of faecal calprotectin (FC) in distinguishing organic (inflammatory bowel disease) from non-organic gastrointestinal disease (irritable bowel syndrome). FC levels <50 mcg/g have a negative predictive value >92% to exclude organic GI disease. Levels >250mcg/g correlate with endoscopic IBD disease activity; sensitivity 90%. This study aimed to determine clinical outcomes in those with a normal FC result. Method: Adults (>16 years old) with FC results between July 2012 - October 2013 were reviewed. Clinical data was collected from hospital databases and General Practitioners (GPs). GPs were provided with a referral pathway prior introduction of FC in 2012. Clinical data at 12 months post index FC test was available in 275 patients; 208 normal, 41 intermediate and 26 raised results. Results: A new IBD diagnosis was made in only 1% of patients with a normal FC result. Conversely, a new IBS diagnosis was made in a further 40% of normal FC results referred to secondary care. Despite a normal FC and referral guidance, 40% of patients were still referred to secondary care. Conclusions: Normal FC testing remains a useful test in excluding organic GI conditions, although 40% were still referred to secondary care despite a normal FC. Despite a normal FC, 6% still remained in secondary care at 12 months without a new diagnosis.Publication The effect of education on the knowledge of patients with celiac disease(Shahid Beheshti University of Medical Sciences, 2017) Barzegar, Farnoush; Rostami-Nejad, Mohammad; Mohaghegh Shalmani, Hamid; Sadeghi, Amir; Allahverdi Khani, Maryam; Aldulaimi, David; Shahid Beheshti University of Medical Sciences, Tehran, Iran; Islamic Azad University, Najafabad, Iran; South Warwickshire University NHS Foundation Trust; Department of Gastroenterology; Medical and Dental; Aldulaimi, DavidAim: The aim of this study was to investigate the effects of education on patients' knowledge of celiac disease, in an Iranian population. Background: Education can increase patients' knowledge regarding their disease, leading to improvements in their health. Methods: This cross-sectional study was conducted on patients who had been diagnosed with celiac disease. The patients attended an educational meeting in September, 2016. During the educational meeting information regarding the epidemiology, diagnosis and treatment of celiac disease was provided to the study subjects. Each patient completed a questionnaire regarding celiac disease before and after the educational meeting. The questionnaires were scored. Study data was analyzed using SPSS version 20. Results: 90 patients were recruited (69 [77%] were women). Analysis of questionnaire responses showed that except for awareness of cross contamination with gluten, the education meeting significantly increased the knowledge of patients with celiac disease regarding epidemiology, diagnosis and treatment (p=0.001). Conclusion: The result of this study shows that an educational meeting can increase the knowledge of CD patients in treatment. Increasing patients' knowledge may lead to improvements in patients' health.Publication Recent advances in nutrition(Shahid Beheshti University of Medical Sciences, 2017) King, Dominic; Aldulaimi, David; Heart of England NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; Department of Gastroenterology; Medical and Dental; Aldulaimi, DavidThis Hungarian based single center prospective study investigated the effect of infliximab (IFX) and adalimumab (ADA) on the nutritional status of patients with IBD, when administered according to national guidelines over a 12-week period.Publication Challenging diagnostic issues in adenomatous polyps with epithelial misplacement in bowel cancer screening: 5 years' experience of the Bowel Cancer Screening Programme Expert Board(Wiley, 2016-11-15) Griggs, Rebecca K. L.; Novelli, Marco R.; Sanders, D. S. A.; Warren, Bryan F.; Williams, Geraint T.; Quirke, Philip; Shepherd, Neil A.; Cheltenham General Hospital; University College Hospital, London; Warwick Hospital; John Radcliffe Hospital, Oxford; Cardiff University School of Medicine; St James's University Hospital, Leeds; Department of Cellular Pathology; Medical and Dental; Sanders, D. S. A.The diagnostic difficulties of differentiating epithelial misplacement from invasive cancer in colorectal adenomatous polyps have been recognised for many years. Nevertheless, the introduction of population screening in the UK has resulted in extraordinary diagnostic problems. Larger sigmoid colonic adenomatous polyps, which are those most likely to show epithelial misplacement, are specifically selected into such screening programmes, because these polyps are likely to bleed and screening is based on the detection of occult blood. The diagnostic challenges associated with this particular phenomenon have necessitated the institution of an 'Expert Board': this is a review of the first five years of its practice, during which time 256 polyps from 249 patients have been assessed. Indeed, the Expert Board contains three pathologists, because those pathologists do not necessarily agree, and a consensus diagnosis is required to drive appropriate patient management. However, this study has shown substantial levels of agreement between the three Expert Board pathologists, whereby the ultimate diagnosis has been changed, from that of the original referral diagnosis, by the Expert Board for half of all the polyps, in the substantial majority from malignant to benign. In 3% of polyp cases, the Expert Board consensus has been the dual diagnosis of both epithelial misplacement and adenocarcinoma, further illustrating the diagnostic difficulties. The Expert Board of the Bowel Cancer Screening Programme in the UK represents a unique and successful development in response to an extraordinary diagnostic conundrum created by the particular characteristics of bowel cancer screening.Publication The national development programme for the management of significant colorectal polyps supports the implementation of higher standards of the bowel cancer screening programme(Wiley, 2017-09-19) Dattani, M.; Fabio, F. D.; Subramanian, T.; Tayyab, M.; Lambert, J.; Wild, J. B.; Ward, S.; Soliman, F.; Moran, B. J.; Pelican Cancer Foundation, Basingstoke; Hampshire Hospitals NHS Foundation Trust; Heart of England NHS Foundation Trust, Birmingham; The Royal Wolverhampton NHS Trust; The Pennine Acute Hospitals NHS Trust, Manchester; South Warwickshire University NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust; Glan Clwyd Hospital, Rhyl; Medical and Dental; Wild, J. B.Aim Introduction of the Bowel Cancer Screening Programme (BCSP) led to increased detection of significant colorectal polyps [SCP]. Management of SCP is a clinical dilemma and surgical resection [SR] is often regarded as overtreatment for a largely benign condition, amenable to less invasive endoscopic resection [ER] Method We reviewed all SCP, defined as sessile/flat polyps of >20 mm size, diagnosed in 2014 at 9 hospitals in the U.K. Polyps were considered morphologically benign on endoscopy, or had a biopsy with benign histology. Results 383 patients were treated by primary ER (84%) or SR (12%). The mean size of SCP was 31 mm; 108 (28%) were diagnosed in the BCSP. Whilst there was no difference in the size (29 mm vs. 31 mm, P = 0.15) or the anatomical location (45% vs. 38% right-sided, P = 0.23) of SCP between BCSP and non-screening cohorts, BCSP patients had lower rates of SR (7% vs. 15%, P = 0.02), pre-treatment biopsies (58% vs. 74%, P < 0.01). Non-screening status was an independent risk factor for SR on multivariate analysis [OR: 2.52 (1.08–5.82), P = 0.03]. Conclusion This disparity may be explained by the robust quality assurance of endoscopy within the BCSP. Standardization and education may improve outcomes, and to this effect, a national multi-disciplinary programme titled ‘Significant Polyps and Early Colorectal Cancer (SPECC)’ has been developed.Publication Vitamin A deficiency: experience from a tertiary referral UK hospital; not just a low- and middle-income country issue.(Cambridge University Press, 2021-08-12) Marley, Alexandra; Smith, Samuel Cl; Ahmed, Ruhina; Nightingale, Peter; Cooper, Sheldon C; GI Medicine; Medical and Dental; Cooper, SheldonObjective: Vitamin A (VA) deficiency, more common in low- and middle-income countries (LMIC) secondary to malnutrition, is associated with increased morbidity and mortality. The prevalence and impact of VA deficiency in high-income countries (HIC) where chronic conditions may predispose is less well understood. Design: Interpretation of serum retinol may be affected by inflammation, so C-reactive protein (CRP) levels were sought. Binary logistic regression and generalised estimating equations were performed to review the relationship between CRP and VA. Setting: We examined the scale of low and deficient VA status in our tertiary University Teaching Hospital (HIC). Participants: Patients undergoing serum retinol concentrations 2012-2016 were identified from laboratory records, and records examined. Results: Totally, 628 assays were requested, with eighty-two patients VA low (0·7-0·99 Umol/l) or deficient (<0·7 Umol/l). Sixteen patients were symptomatic (fifteen deficient), predominantly visual. Only one symptomatic patient's VA deficiency was secondary to poor intake. Other symptomatic patients had chronic illnesses resulting in malabsorption. The incidence of a low VA level increases significantly with a raised CRP. Conclusion: The majority of patients tested either were replete or likely to have abnormal VA levels due to concomitant inflammation. A minority of patients had signs and symptoms of VA deficiency and was a cause of significant morbidity, but aetiology differs from LMIC, overwhelmingly malabsorption, most commonly secondary to surgery or hepatobiliary disease. A correlation between inflammation and low VA levels exists, which raises the possibility that requesting a VA level in an asymptomatic patient with active inflammation may be of questionable benefit.Publication Clinical outcomes at 12 months and risk of inflammatory bowel disease in patients with an intermediate raised fecal calprotectin : a 'real-world' view(BMJ Publishing Group, 2016-06-06) McFarlane, Michael; Chambers, Samantha; Malik, Ahmad; Lee, Bee; Sung, Edmond; Nwokolo, Chuka; Waugh, Norman; Arasaradnam, Ramesh; University Hospital Coventry & Warwickshire; South Warwickshire University NHS Foundation Trust; George Eliot Hospital, Nuneaton; University of Warwick; Gastroenterology; Medical and Dental; Sung, EdmondObjectives: A recent systematic review confirmed the usefulness of fecal calprotectin (FC) in distinguishing organic (inflammatory bowel disease (IBD)) from non-organic gastrointestinal disease (irritable bowel syndrome (IBS)). FC levels <50 μg/g have a negative predictive value >92% to exclude organic gastrointestinal (GI) disease. Levels >250 μg/g correlate with endoscopic IBD disease activity; sensitivity 90%. We aimed to determine clinical outcomes in intermediate raised FC results (50-250 μg/g). Setting: Primary care general practices in Coventry and Warwickshire, and 3 secondary care hospitals. Participants: 443 FC results in adults (>16 years old) were reviewed from July 2012 to October 2013. Clinical data was collected from hospital databases and general practitioners. Long-term clinical data was available in 41 patients (out of 48). Primary and secondary outcome measures: The number of new diagnoses of IBD, IBS and other diagnoses for the intermediate group. The number referred and discharged from secondary care. Results: A new IBD diagnosis was made in 19% (n=8) of intermediate results (1% of normal and 38% of raised results). 5% (n=2) of intermediate results had known IBD in remission. A new IBS diagnosis was made in 27% (n=11) of intermediate results, while 34% (n=14) remained undiagnosed, although 8 of these were not referred to secondary care. Conclusions: FC testing remains useful in aiding diagnosis of organic GI conditions. However, unlike negative and strongly positive FC results, intermediate FC results lead to a mixture of diagnoses. The OR of a new diagnosis of IBD for an intermediate result compared to normal FC result was 26.6, while an intermediate FC result gave an OR of 0.54 for a new IBS diagnosis compared to normal FC. For intermediate FC results, 1 in 3 patients remained in secondary care after 12 months with an OR of 3.6 compared to a normal FC result.Publication Guidelines for the investigation of chronic diarrhoea in adults : British Society of Gastroenterology, 3rd edition(BMJ Publishing Group, 2018-04-13) Arasaradnam, Ramesh P; Brown, Steven; Forbes, Alastair; Fox, Mark R; Hungin, Pali; Kelman, Lawrence; Major, Giles; O'Connor, Michelle; Sanders, Dave S; Sinha, Rakesh; Smith, Stephen Charles; Thomas, Paul; Walters, Julian R F; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; Radiology; Medical and Dental; Sinha, RakeshChronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.Publication A multi-centre analysis of AUGIB : urea-creatinine ratio is a useful predictor for bleeding, and endotherapy(BMJ Publishing Group, 2021-11-07) Serna, Solange; Segal, Jonathan P.; Abbasi, Abdullah; Aleem, Junaid; Alhamamy, Noor; Alkoury, Jad; Anjum, Raheel; Disney, Benjamin; Howard, Emma; Hundle, Aaron; Hussain, Nasir; Ismail, Asem; McFarlane, Michael; Mozdiak, Ella; Port, Saskia; Rattehalli, Deepa; Schembri, John; Silva, Geeth; Thoufeeq, Mo; Verma, Ajay M; Kettering General Hospital NHS Foundation Trust; Imperial College Healthcare NHS trust, London; The Shrewsbury and Telford Hospital NHS Trust; University Hospitals Birmingham NHS Foundation Trust; The Royal Wolverhampton NHS Trust; University Hospitals Coventry and Warwickshire NHS Trust; Sheffield Teaching Hospitals NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; The Dudley Group NHS Foundation Trust; McFarlane, MichaelA poster presentation reporting a multicentre analysis of acute upper GI bleed (AUGIB) investigating the usefulness of urea-creatinine ratio (UCR) as a predictor for bleeding when considering the need for endoscopic therapy.