Recent Submissions

  • The effect of education on the knowledge of patients with celiac disease

    Barzegar, Farnoush; Rostami-Nejad, Mohammad; Mohaghegh Shalmani, Hamid; Sadeghi, Amir; Allahverdi Khani, Maryam; Aldulaimi, David; Aldulaimi, David; Department of Gastroenterology; Medical and Dental; Shahid Beheshti University of Medical Sciences, Tehran, Iran; Islamic Azad University, Najafabad, Iran; South Warwickshire University NHS Foundation Trust (Shahid Beheshti University of Medical Sciences, 2017)
    Aim: 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.
  • Recent advances in nutrition

    King, Dominic; Aldulaimi, David; Aldulaimi, David; Department of Gastroenterology; Medical and Dental; Heart of England NHS Foundation Trust; South Warwickshire University NHS Foundation Trust (Shahid Beheshti University of Medical Sciences, 2017)
    This 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.
  • Challenging diagnostic issues in adenomatous polyps with epithelial misplacement in bowel cancer screening: 5 years' experience of the Bowel Cancer Screening Programme Expert Board

    Griggs, Rebecca K. L.; Novelli, Marco R.; Sanders, D. S. A.; Warren, Bryan F.; Williams, Geraint T.; Quirke, Philip; Shepherd, Neil A.; Sanders, D. S. A.; Department of Cellular Pathology; Medical and Dental; et al. (Wiley, 2016-11-15)
    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.
  • The national development programme for the management of significant colorectal polyps supports the implementation of higher standards of the bowel cancer screening programme

    Dattani, M.; Fabio, F. D.; Subramanian, T.; Tayyab, M.; Lambert, J.; Wild, J. B.; Ward, S.; Soliman, F.; Moran, B. J.; Wild, J. B.; et al. (Wiley, 2017-09-19)
    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.
  • Vitamin A deficiency: experience from a tertiary referral UK hospital; not just a low- and middle-income country issue.

    Marley, Alexandra; Smith, Samuel Cl; Ahmed, Ruhina; Nightingale, Peter; Cooper, Sheldon C; Cooper, Sheldon; GI Medicine; Medical and Dental (Cambridge University Press, 2021-08-12)
    Objective: 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.
  • Clinical outcomes at 12 months and risk of inflammatory bowel disease in patients with an intermediate raised fecal calprotectin : a 'real-world' view

    McFarlane, Michael; Chambers, Samantha; Malik, Ahmad; Lee, Bee; Sung, Edmond; Nwokolo, Chuka; Waugh, Norman; Arasaradnam, Ramesh; Sung, Edmond; Gastroenterology; et al. (BMJ Publishing Group, 2016-06-06)
    Objectives: 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.
  • Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

    Arasaradnam, Ramesh P; Brown, Steven; Forbes, Alastair; Fox, Mark R; Hungin, Pali; Kelman, Lawrence; Major, Giles; O'Connor, Michelle; Sanders, Dave S; Sinha, Rakesh; et al. (BMJ Publishing Group, 2018-04-13)
    Chronic 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.
  • A multi-centre analysis of AUGIB : urea-creatinine ratio is a useful predictor for bleeding, and endotherapy

    Serna, Solange; Segal, Jonathan P.; Abbasi, Abdullah; Aleem, Junaid; Alhamamy, Noor; Alkoury, Jad; Anjum, Raheel; Disney, Benjamin; Howard, Emma; Hundle, Aaron; et al. (BMJ Publishing Group, 2021-11-07)
    A 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.
  • Esomeprazole and aspirin in Barrett's oesophagus (AspECT): a randomised factorial trial

    Jankowski, Janusz A. Z.; de Caestecker, John; Love, Sharon B; Reilly, Gavin; Watson, Peter; Sanders, Scott; Ang, Yeng; Morris, Danielle; Bhandari, Pradeep; Brooks, Claire; et al. (Elsevier, 2018)
    Background: Oesophageal adenocarcinoma is the sixth most common cause of cancer death worldwide and Barrett's oesophagus is the biggest risk factor. We aimed to evaluate the efficacy of high-dose esomeprazole proton-pump inhibitor (PPI) and aspirin for improving outcomes in patients with Barrett's oesophagus. Methods: The Aspirin and Esomeprazole Chemoprevention in Barrett's metaplasia Trial had a 2 × 2 factorial design and was done at 84 centres in the UK and one in Canada. Patients with Barrett's oesophagus of 1 cm or more were randomised 1:1:1:1 using a computer-generated schedule held in a central trials unit to receive high-dose (40 mg twice-daily) or low-dose (20 mg once-daily) PPI, with or without aspirin (300 mg per day in the UK, 325 mg per day in Canada) for at least 8 years, in an unblinded manner. Reporting pathologists were masked to treatment allocation. The primary composite endpoint was time to all-cause mortality, oesophageal adenocarcinoma, or high-grade dysplasia, which was analysed with accelerated failure time modelling adjusted for minimisation factors (age, Barrett's oesophagus length, intestinal metaplasia) in all patients in the intention-to-treat population. This trial is registered with EudraCT, number 2004-003836-77. Findings: Between March 10, 2005, and March 1, 2009, 2557 patients were recruited. 705 patients were assigned to low-dose PPI and no aspirin, 704 to high-dose PPI and no aspirin, 571 to low-dose PPI and aspirin, and 577 to high-dose PPI and aspirin. Median follow-up and treatment duration was 8·9 years (IQR 8·2-9·8), and we collected 20 095 follow-up years and 99·9% of planned data. 313 primary events occurred. High-dose PPI (139 events in 1270 patients) was superior to low-dose PPI (174 events in 1265 patients; time ratio [TR] 1·27, 95% CI 1·01-1·58, p=0·038). Aspirin (127 events in 1138 patients) was not significantly better than no aspirin (154 events in 1142 patients; TR 1·24, 0·98-1·57, p=0·068). If patients using non-steroidal anti-inflammatory drugs were censored at the time of first use, aspirin was significantly better than no aspirin (TR 1·29, 1·01-1·66, p=0·043; n=2236). Combining high-dose PPI with aspirin had the strongest effect compared with low-dose PPI without aspirin (TR 1·59, 1·14-2·23, p=0·0068). The numbers needed to treat were 34 for PPI and 43 for aspirin. Only 28 (1%) participants reported study-treatment-related serious adverse events. Interpretation: High-dose PPI and aspirin chemoprevention therapy, especially in combination, significantly and safely improved outcomes in patients with Barrett's oesophagus.
  • An updated overview of spectrum of gluten-related disorders: clinical and diagnostic aspects

    Taraghikhah, Nazanin; Ashtari, Sara; Asri, Nastaran; Shahbazkhani, Bijan; Aldulaimi, David; Rostami-Nejad, Mohammad; Rezaei-Tavirani, Mostafa; Razzaghi, Mohammad Reza; Zali, Mohammad Reza; Al-Dulaimi, David; et al. (BMC, 2020-08)
    Abstract The incidence of gluten-related disorders (GRDs) continues to increase and its global prevalence is estimated at approximately 5% of the population. Celiac disease (CD), dermatitis herpetiformis (DH), gluten ataxia (GA), wheat allergy (WA), and non-celiac gluten sensitivity (NCGS) are the five major GRDs that present with a wide range of clinical manifestations. The diagnosis of GRDs can be challenging because the typical and atypical clinical manifestations of the GRDs overlap. In this review, the current definitions of gluten-related disorders, focusing on their clinical features, diagnostic and therapeutic approaches are presented. We concluded that GRDs are usually diagnosed using a combination of clinical features, serological tests, and histopathological findings. Treatment usually involves dietary modification. Keywords: Ataxia; Celiac disease; Diagnosis; Diet, gluten-free; Gluten; Hypersensitivity.
  • Anxiety Symptoms in Adult Celiac Patients and the Effect of a Gluten-Free Diet: An Iranian Nationwide Study

    Rostami-Nejad, Mohammad; Taraghikhah, Nazanin; Ciacci, Carolina; Pourhoseingholi, Mohamad Amin; Barzegar, Farnoush; Rezaei-Tavirani, Mostafa; Aldulaimi, David; Zali, Mohammad Reza; Aldulaimi, David; Gastroenterology; et al. (Karger Publishers, 2020-02)
    Introduction: Psychiatric disorders, especially anxiety, are considered extraintestinal manifestations of celiac disease (CD). Objective: This study aims to evaluate the level of anxiety in treated patients with CD in Iran. Methods: A total of 283 CD patients (190 female, 93 male) were enrolled in a study during 2016-2018 from 9 centers in Iran. The Zung Self-Rating Anxiety Scale questionnaire was completed. The anxiety index was calculated. Also, demographic data and the duration of treatment with a gluten-free diet (GFD) were recorded. Data were analyzed by SPSS version 20. Results: Anxiety symptoms were reported in 67.8% of patients. Female patients had a higher anxiety index than male patients. Duration of treatment with a GFD did not influence the anxiety index (17.3% were on a GFD for <1 year, 33.6% for 1-2 years, and 49.1% had GFD for >2 years; p = 0.86). Conclusions: These results suggest that anxiety symptoms are common among patients, especially females, with CD in Iran and GFD duration has no effect on their improvement. Keywords: Anxiety; Celiac disease; Gluten-free diet; Iran; Zung Self-Rating Anxiety Scale.
  • Hereditary haemochromatosis: Lifetime risks of primary hepatic carcinoma and mortality in the UK Biobank

    Atkins, Janice L.; Pilling, Luke C.; Masoli, Jane A. H.; Kuo, Chia-Ling; Shearman, Jeremy; Adams, Paul C.; Melzer, David; Shearman, J. D.; Gastroenterology; Medical and Dental; et al. (Springer Nature, 2020-12)
    Background:Hereditary haemochromatosis (HH) is predominantly caused by the HFE p.C282Y homozygous mutation. Hepatic carcinomas and mortality risks are raised in clinically diagnosed HH, especially with liver cirrhosis. However, outcomes are unclear in mutation carriers in the community setting without clinically diagnosed HH. Methods:UK Biobank European descent participants (n = 451,186, 40-70 years) including 2,890 p.C282Y homozygotes, followed via hospitalization records, national cancer registry, primary care records and death certificates. Cox regression models adjusted for age, assessment center, genotyping array and genetic principal components. Kaplan Meier lifetable probabilities of incident diagnoses were estimated from age 40 to 75. Results:Incidence of hepatic carcinomas was higher in male p.C282Y homozygotes compared to those without mutations (HR: 14.1, 95% CI: 7.6-26.1). However, no associations were observed in female p.C282Y homozygotes, p.C282Y heterozygotes or p.C282Y/p.H63D compound heterozygotes. Lifetables estimate project that by age 75, 7.2% (95% CI: 3.9-13.1) of male p.C282Y homozygotes develop hepatic carcinoma and 19.5% (95% CI 15.8-24.0) of homozygote men would die, compared to 15.1% (95% CI:14.7-15.5) in those without mutations. Female p.C282Y homozygotes also had an increased risk of death from hepatic carcinomas (HR: 3.36, 95% CI:1.06-10.67). Conclusions:In a large sample of community volunteers, p.C282Y homozygosity was associated with substantial risks of hepatic cancer and excess mortality in males. As haemochromatosis iron overload is preventable and treatable by phlebotomy, early case ascertainment is needed for hereditary haemochromatosis, including at the community level. Our findings support the case that p.C282Y homozygous individuals identified incidentally during DNA sequencing should be notified.
  • Association of hemochromatosis HFE p.C282Y homozygosity with hepatic malignancy

    Atkins, Janice L.; Pilling, Luke C.; Masoli, Jane A. H.; Kuo, Chia-Ling; Shearman, Jeremy; Adams, Paul C.; Melzer, David; Shearman, Jeremy D.; Gastroenterology; Medical and Dental; et al. (American Medical Association, 2020-11)
    Importance: Hereditary hemochromatosis is predominantly caused by the HFE p.C282Y homozygous pathogenic variant. Liver carcinoma and mortality risks are increased in individuals with clinically diagnosed hereditary hemochromatosis, but risks are unclear in mostly undiagnosed p.C282Y homozygotes identified in community genotyping. Objective: To estimate the incidence of primary hepatic carcinoma and death by HFE variant status. Design, setting, and participants: Cohort study of 451 186 UK Biobank participants of European ancestry (aged 40-70 years), followed up from baseline assessment (2006-2010) until January 2018. Exposures: Men and women with HFE p.C282Y and p.H63D genotypes compared with those with neither HFE variants. Main outcomes and measures: Two linked co-primary outcomes (incident primary liver carcinoma and death from any cause) were ascertained from follow-up via hospital inpatient records, national cancer registry, and death certificate records, and from primary care data among a subset of participants for whom data were available. Associations between genotype and outcomes were tested using Cox regression adjusted for age, assessment center, genotyping array, and population genetics substructure. Kaplan-Meier lifetable probabilities of incident diagnoses were estimated from age 40 to 75 years by HFE genotype and sex. Results: A total of 451 186 participants (mean [SD] age, 56.8 [8.0] years; 54.3% women) were followed up for a median (interquartile range) of 8.9 (8.3-9.5) years. Among the 1294 male p.C282Y homozygotes, there were 21 incident hepatic malignancies, 10 of which were in participants without a diagnosis of hemochromatosis at baseline. p.C282Y homozygous men had a higher risk of hepatic malignancies (hazard ratio [HR], 10.5 [95% CI, 6.6-16.7]; P < .001) and all-cause mortality (n = 88; HR, 1.2 [95% CI, 1.0-1.5]; P = .046) compared with men with neither HFE variant. In lifetables projections for male p.C282Y homozygotes to age 75 years, the risk of primary hepatic malignancy was 7.2% (95% CI, 3.9%-13.1%), compared with 0.6% (95% CI, 0.4%-0.7%) for men with neither variant, and the risk of death was 19.5% (95% CI, 15.8%-24.0%), compared with 15.1% (95% CI, 14.7%-15.5%) among men with neither variant. Among female p.C282Y homozygotes (n = 1596), there were 3 incident hepatic malignancies and 60 deaths, but the associations between homozygosity and hepatic malignancy (HR, 2.1 [95% CI, 0.7-6.5]; P = .22) and death (HR, 1.2 [95% CI, 0.9-1.5]; P = .20) were not statistically significant. Conclusions and relevance: Among men with HFE p.C282Y homozygosity, there was a significantly increased risk of incident primary hepatic malignancy and death compared with men without p.C282Y or p.H63D variants; there was not a significant association for women. Further research is needed to understand the effects of early diagnosis and treatment.
  • Effect of inflammatory bowel disease treatments on patients with diabetes mellitus

    Bower, Joshua; O'Flynn, Lauren; Kakad, Rakhi; Aldulaimi, David; Bower, Joshua; O'Flynn, Lauren; Kakad, Rakhi; Aldulaimi, David; Gastroenterology; Endocrinology; et al. (Baishideng Publishing Group, 2021-08)
    As medical care progresses and the number of patients with chronic conditions increases there is the inevitable challenge of managing patients with multiple co-morbidities. Inflammatory bowel disease (IBD) is an umbrella term for are inflammatory conditions affecting the gastrointestinal tract, the two most common forms being Ulcerative Colitis and Crohn's disease. These diseases, usually diagnosed in young adults, exhibit a relapsing and remitting course and usually require long-term treatment. IBD can be treated with a number of topical and systemic treatments. We conducted a review of the current published evidence for the effects these medications can have on diabetes mellitus (DM) and glycaemic control. Searches were conducted on medline and embase with a timeframe from 1947 (the date from which studies on embase are recorded) to November 2020. Suitable publications were selected and reviewed. Current evidence of the impact of aminosalicylates, corticosteroids, thiopurines, and biologic agents was reviewed. Though there was limited evidence for certain agents, IBD medications have been shown to have an effect of DM and these effects should be considered in managing patients with dual pathologies. The effects of steroids on blood sugar control is well documented, but consideration of other agents is also important. In patients requiring steroids for Ulcerative Colitis, locally acting steroid agents delivered rectally may be preferred to minimise side effects in those with distal bowel Ulcerative Colitis. A switch to other agents should be considered as soon as possible in people with diabetes to limit the impact on glycaemic control. 5-aminosalicylates appear to play a role in the reduction of hemoglobin A1c (HbA1c), although the literature suggests these may be falsely low readings. Consequently, monitoring of people with diabetes on these agents may require daily monitoring of capillary blood sugars rather than relying simply on HbA1c; for example fructosamine performed 3-6 monthly, although this risks missing the rise in readings. There is only limited evidence of the effects of thiopurines on diabetes and further investigation is needed into the possible relationship between them. However, given the current available evidence it may be preferable to commence patients with diabetes on thiopurines as soon as possible, whilst also monitoring for side effects such as pancreatitis. There appears to be more evidence supporting a link between tumor necrosis factor-α inhibitors and DM. Both infliximab and adalimumab have evidence suggesting that both can cause reduced blood sugar levels. Further studies on the effects of the various biological agents mentioned are required alongside any novel biologic therapy and the impact of dual biologic therapy in the future.
  • Gastrointestinal and liver adverse effects of anti-tumoral immune therapy: from recognition to treatment

    Weissman, Simcha; Saleem, Saad; Aldulaimi, David; Aldulaimi, David; Gastroenterology; Medical and Dental; Touro College of Osteopathic Medicine, Middletown, NY, USA; Mercy Saint Vincent Medical Center, Toledo, OH, USA; South Warwickshire University NHS Foundation Trust (Research Institute for Gastroenterology and Liver Diseases, 2021)
    Anti-tumoral immune therapy consists of monoclonal antibodies that target intra-cellular immune checkpoints-which under normal circumstances, act as regulators of T-cell immunity. By serving as inhibitors of cellular checkpoints, monoclonal antibodies stimulate the immune system thus augmenting the body's response against cancer. These immune-enhancers or stimulators have revolutionized the treatment of malignancy as they continue to show improvement in the overall survival of cancer patients. Currently, in the United States, six immune checkpoint inhibitors are approved for the treatment of a variety of solid tumors (1). As these checkpoint inhibitors are relatively new, only a scant amount of literature is available regarding both their adverse effects and management thereof. In addition, as newer antibodies are being developed, and expected to be enlisted among the armamentarium of cancer chemotherapeutic agents-the need to understand their toxicity and adverse effects is of paramount importance. Herein, we review some of the gastrointestinal and liver sequelea secondary to the usage of immunotherapeutic checkpoint inhibitor agents in cancer chemotherapy, as well as present the diagnosis and recommended treatment strategies for their adverse effects.
  • Publication output of National Health Service Bariatric centres in England

    Charalampakis, Vasileios; Giet, Leeying; Daskalakis, Markos; Richardson, Martin; Tahrani, Abd A; Mahawar, Kamal; Singhal, Rishi; Charalampakis, Vasileios; Daskalakis, Markos; Richardson, Martin; et al. (Elsevier, 2021-05)
    Obesity has been identified as an independent risk factor for a wide range of health conditions. Therefore, there is a clear need for high quality Bariatric research in order to improve patient selection, outcomes and safety for patients with obesity. We sought to identify and compare the quantitative and qualitative publication output from Bariatric centres in England. We identified 42 National Health Service (NHS) Trusts and 162 surgeons providing Bariatric services in England. A median of 4 (range 1-7) Bariatric surgeons were identified per centre. Eight NHS Trusts (19%) and 75 surgeons (46.3%) had no Bariatric publications during the study period, while 87 surgeons published a total of 432 Bariatric papers. Only 15 surgeons (9%) had ≥10 publications within the study period. However, these surgeons produced >50% of all Bariatric publications. Departments with more than 4 surgeons produced a significantly higher number of Bariatric publications (median 8.5 vs 2, p = 0.01). There is significant variation in research contribution amongst Bariatric centres in England. Academia should be encouraged and promoted across all bariatric services in order to broaden our understanding on Bariatric outcomes by expanding the service and proportional increase in funding. Given that a number of health conditions can afflict individuals living with obesity, bariatric surgery research becomes all the more important.
  • N16 ‘Same storm, different boat’… Exploring the impact of the COVID-19 pandemic on patients with Inflammatory Bowel Disease, with or without shielding: a qualitative study

    Kemp, K.; Avery, P.; Bryant, R.; Cross, A.; Danter, K.; Kneebone, A.; Morris, D.; Walker, A.; Whitley, L.; Dibley, L.; et al. (Oxford University Press, 2022-01)
    Background During the Covid-19 pandemic, patients with Inflammatory Bowel Disese (IBD) were advised about shielding based on clinical risk assessment. We explored experiences of IBD patients who did or did not shield during three UK lockdowns. Methods Participants aged 18 years+ with a confirmed diagnosis of Crohn’s disease, Ulcerative Colitis or IBD-Unclassified, who had shielded or not during any lockdown period were recruited from Crohn’s and Colitis UK. Semi-structured online or phone interviews (captured February-May 2021) were audio-recorded, transcribed professionally, and analysed using thematic analysis. Results Of 43 participants, 24 shielded; median age 38 years (19–63 years); 27 (62.7%) females; diagnosed with Crohn’s Colitis (n=2), Crohn’s disease (n=21), Ulcerative colitis (n=18) and IBD-Unclassified (n=2). Median disease duration 13 years (0.6–36 years). Participants were assessed as high (n-=10), moderate (n=23) and low (n=10) risk. Four main themes emerged: Vulnerability and Risk; IBD Preparedness; The Two Faces of Janus and Transitions. Vulnerability and Risk The ‘Clinically Extremely Vulnerable’ label caused alarm, despite bringing benefits. Conflicting information caused confusion; some made their own decision about risk which did not always match official advice. Participants felt vulnerable to higher risk caused by others’ behaviour. Some feared catching Covid. IBD Preparedness Living with IBD prepared participants for shielding/social distancing. Many felt others now appreciated their usual world of periods of isolation and missing out on social events. Some realised the need to take their IBD more seriously. The Two Faces of Janus The pandemic brought benefits and challenges to most participants. Working/studying from home often impacted positively on symptoms such as urgency and fatigue, as work and travel-related stresses eased. Loss of physical social contact with others was very distressing; many adopted new wellbeing activities to overcome social isolation. Few found the pandemic experience wholly positive. Transitions the experience of lockdown changed over time, as did shielding patterns. The easing of restrictions (March-June 2021) left shielding and non-shielding participants feeling confused, since they felt the risk remained. Some participants continued to shield or be socially distant, often mistrusting others to behave responsibly. Conclusion The pandemic had positive and negative effects for shielding and non-shielding participants alike. Adherence to Government shielding and/or social distancing guidelines was threatened by rising concerns about mental health and wellbeing. Any patient, regardless of official risk status, may need support to re-integrate socially.
  • N13 Clinical service delivery implications of the Covid-19 pandemic on people with inflammatory bowel disease: a qualitative study

    Kemp, K.; Avery, P.; Bryant, R.; Cross, A.; Danter, K.; Kneebone, A.; Morris, D.; Walker, A.; Whitley, L.; Dibley, L.; et al. (Oxford University Press, 2022-01)
    Background As part of a qualitative study exploring the experiences of IBD patients during three UK lockdowns, we identified specific clinical service implications of the pandemic on IBD care. Methods Participants aged 18 years+ with a confirmed diagnosis of Crohn’s disease, Ulcerative Colitis or IBD-Unclassified, who had shielded or not during any lockdown period were recruited from Crohn’s and Colitis UK. Semi-structured online or phone interviews (captured February-May 2021) were audio-recorded, transcribed professionally, and analysed using thematic analysis. Results Forty-three people took part; median age 38 years (19–63 years); 27 (62.7%) females; diagnosed with Crohn’s Colitis (n=2), Crohn’s disease (n=21), Ulcerative colitis (n=18) and IBD-Unclassified (n=2). Median disease duration 13 years (0.6–36 years). Four clinically focussed themes emerged: The Risk of Attending Hospital; Missing Routine Monitoring; Accessing Care as Needed and Remote Access and The Future. The Risk of Attending Hospital Against the prevailing media messages to avoid going to hospital, staying at home to avoid burdening the healthcare system and the rising numbers of Covid patients in hospitals, participants felt anxious about the dilemma of needing treatment for their IBD but putting themselves at risk to receive it. Missing Routine Monitoring Routine appointments and monitoring, which participants relied on for ‘keeping on top of’ their condition, stopped for some. Many could not access their IBD team or GP services at all, so routine blood tests for therapeutic levels were missed; in some cases, disease activity increased. Accessing Care as Needed Many were able to get clinical help as needed, even if the method of contact, and source of help, was different to usual. For others, the pandemic had caused considerable delay in getting diagnosed, and they felt overwhelmed and unsupported. Most understood the disruption to services due to staff redeployment, but some coped with the changes better than others. Remote Access and The Future the shifting focus away from face to face and towards remote appointments received mixed opinions. Many were happy with remote (phone, email) contact during the pandemic, out of necessity, but there were concerns from others that this would become normal in the future. It was suggested that first appointments should always be face to face. Conclusion Maintenance of IBD services in some form is essential throughout crisis periods; newly diagnosed patients needed additional support; dependence on IBD services could be reduced in the future through use of treatment/self-management plans. Mode of appointment needs to suit the patient.