ABSTRACT
We aimed to assess the extent to which people with type 2 diabetes or pre-diabetes, obesity (BMI 30-45 kg/m2) and moderate obstructive sleep apnoea (OSA) requiring continuous positive airway pressure ventilation (CPAP) were able to discontinue CPAP following EndoBarrier-related weight loss. We assessed sleep and metabolic parameters before, during and after EndoBarrier in 12 participants with moderate OSA requiring CPAP (75% female, 8/12 [66%] type 2 diabetes, 4/12 [34%] prediabetes, mean ± SD age 52.6 ± 9.7 years, BMI 37.4 ± 3.5 kg/m2, median duration of OSA while on CPAP 9.0 [7.0-15.0] months). With EndoBarrier in-situ, mean ± SD Apnoea Hypopnoea Index (AHI) fell by 9.1 ± 5.0 events/h from 18.9 ± 3.8 to 9.7 ± 3.0 events/h (p < .001) with an associated reduction in symptoms of daytime sleepiness (mean Epworth Sleepiness Score) such that all the 12 participants no longer required CPAP according to National Institute for Health and Care Excellence criteria. After EndoBarrier removal, 10/12 (83%) patients attended follow-up and at 12 months after removal, AHI remained below 15 in 5/10 (50%) patients but in other five the AHI rose above 15 such that restarting CPAP was recommended as justified by their symptoms. Rather than restart CPAP, two patients lost the regained weight and their AHI dropped below 15 again. Thus, 7/10 (70%) of patients were able to remain off CPAP 12 or more months after EndoBarrier removal. These results demonstrate major benefit of EndoBarrier in moderate OSA, allowing all patients to discontinue CPAP during treatment, and with maintenance of improvement at follow-up in 70%. They confirm previously demonstrated metabolic improvements in diabetes and obesity.
Subject(s)
Bariatric Surgery , Diabetes Mellitus, Type 2 , Obesity, Morbid , Diabetes Mellitus, Type 2/surgery , Duodenum/surgery , Humans , Jejunum/surgery , Obesity/surgery , Obesity, Morbid/complications , Obesity, Morbid/epidemiology , Obesity, Morbid/surgery , State Medicine , Treatment OutcomeABSTRACT
Metabolic associated fatty liver disease, previously known as nonalcoholic fatty liver disease, is the most common cause of chronic liver disease across all ethnic groups; however, it remains enormously underestimated.1 , 2 Sepsis, hepatotoxic medications and malnutrition in the acute settings on top of unknown cirrhosis can lead to decompensation and various metabolic complications. Pyroglutamic acidosis is a rarely recognised cause for unexplained high anion gap metabolic acidosis that is felt to be frequently underdiagnosed. Particular patients at risk include women, the elderly, those on regular paracetamol and those suffering with malnourishment or sepsis. Other risk factors include alcohol abuse and chronic liver disease (3). We present the case of a patient with recurrent episodes of pyroglutamic acidosis and encephalopathy in the context of undiagnosed nonalcoholic fatty liver disease with cirrhosis.
ABSTRACT
BACKGROUND: The current epidemiology of inflammatory bowel disease (IBD) in the multi-ethnic United Kingdom is unknown. The last incidence study in the United Kingdom was carried out over 20 years ago. AIM: To describe the incidence and phenotype of IBD and distribution within ethnic groups. METHODS: Adult patients (> 16 years) with newly diagnosed IBD (fulfilling Copenhagen diagnostic criteria) were prospectively recruited over one year in 5 urban catchment areas with high South Asian population. Patient demographics, ethnic codes, disease phenotype (Montreal classification), disease activity and treatment within 3 months of diagnosis were recorded onto the Epicom database. RESULTS: Across a population of 2271406 adults, 339 adult patients were diagnosed with IBD over one year: 218 with ulcerative colitis (UC, 64.3%), 115 with Crohn's disease (CD, 33.9%) and 6 with IBD unclassified (1.8%). The crude incidence of IBD, UC and CD was 17.0/100000, 11.3/100000 and 5.3/100000 respectively. The age adjusted incidence of IBD and UC were significantly higher in the Indian group (25.2/100000 and 20.5/100000) compared to White European (14.9/100000, P = 0.009 and 8.2/100000, P < 0.001) and Pakistani groups (14.9/100000, P = 0.001 and 11.2/100000, P = 0.007). The Indian group were significantly more likely to have extensive disease than White Europeans (52.7% vs 41.7%, P = 0.031). There was no significant difference in time to diagnosis, disease activity and treatment. CONCLUSION: This is the only prospective study to report the incidence of IBD in an ethnically diverse United Kingdom population. The Indian ethnic group showed the highest age-adjusted incidence of UC (20.5/100000). Further studies on dietary, microbial and metabolic factors that might explain these findings in UC are underway.
Subject(s)
Colitis, Ulcerative/ethnology , Crohn Disease/ethnology , Adult , Asian People/statistics & numerical data , Catchment Area, Health/statistics & numerical data , Databases, Factual/statistics & numerical data , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , United Kingdom/epidemiology , White People/statistics & numerical dataABSTRACT
OBJECTIVE: Academic medical training was overhauled in 2005 after the Walport report and Modernising Medical Careers to create a more attractive and transparent training pathway. In 2007 and 2016, national web-based surveys of gastroenterology trainees were undertaken to determine experiences, perceptions of and perceived barriers to out-of-programme research experience (OOP-R). DESIGN SETTING AND PATIENTS: Prospective, national web-based surveys of UK gastroenterology trainees in 2007 and 2016. MAIN OUTCOME MEASURE: Attitudes to OOP-R of two cohorts of gastroenterology trainees. RESULTS: Response rates were lower in 2016 (25.8% vs 56.7%) (p<0.0001), although female trainees' response rates increased (from 28.8% to 37.6%) (p=0.17), along with higher numbers of academic trainees. Over 80% of trainees planned to undertake OOP-R in both surveys, with >50% having already undertaken it. Doctor of Philosophy/medical doctorate remained the most popular OOP-R in both cohorts. Successful fellowship applications increased in 2016, and evidence of gender inequality in 2007 was no longer evident in 2016. In the 2016 cohort, 91.1% (n=144) felt the development of trainee-led research networks was important, with 74.7% (n=118) keen to get involved. CONCLUSIONS: The majority of gastroenterology trainees who responded expressed a desire to undertake OOP-R, and participation rates in OOP-R remain high. Despite smaller absolute numbers responding than in 2007, 2016 trainees achieved higher successful fellowship application rates. Reassuringly more trainees in 2016 felt that OOP-R would be important in the future. Efforts are needed to tackle potential barriers to OOP-R and support trainees to pursue research-active careers.
ABSTRACT
BACKGROUND AND STUDY AIM: Although colonoscopy is reliable in identifying colorectal cancer (CRC), studies have demonstrated incorrect tumour localization in 21-34% of colonoscopies when compared with surgical localization. The aim of this study was to determine our accuracy in determining the position of CRCs detected at colonoscopy with the aid of the ScopeGuide endoscope positioning device. PATIENTS AND METHODS: Cancers identified within the English National Bowel Cancer Screening Programme were studied. Retrospective analysis was undertaken of all patients diagnosed with CRC during the first screening round in Wolverhampton Bowel Cancer Screening Centre, England. ScopeGuide was used in all cases. Data from colonoscopy reports, computed tomography reports and surgical resection specimens were analysed. RESULTS: A total of 82 cancers were identified within the surgical resection specimen in 80 patients. Two proximal cancers were not identified at colonoscopy due to obstruction by the distal cancers. Colonoscopy with the aid of the endoscopy positioning device correctly identified the tumour location in 93.75% of cases in which the tumour could be reached endoscopically. Abdominopelvic computed tomography localized 82.5% of CRC. CONCLUSION: The ScopeGuide endoscopy positioning device enables accurate localization of cancers at colonoscopy. Tattooing of suspected cancer remains to be a best practice for localization during laparoscopic resection. The use of the endoscopic-positioning device may, however, result in greater confidence for localization of polypectomy sites, which have not been tattooed, in cases when cancer was not suspected but found histologically.
Subject(s)
Colonic Neoplasms/pathology , Colonoscopes , Colonoscopy/instrumentation , Mass Screening/instrumentation , Aged , Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/surgery , Colonography, Computed Tomographic , England , Equipment Design , Humans , Mass Screening/methods , Middle Aged , Predictive Value of Tests , Reproducibility of Results , Retrospective StudiesSubject(s)
Biomedical Research/trends , Career Choice , Gastroenterology/education , Bibliometrics , Humans , United KingdomABSTRACT
OBJECTIVE: To evaluate whether there is any appreciable difference in imaging characteristics between high-resolution magnification white-light endoscopy (WLE-Z) and narrow-band imaging (NBI-Z) in Barrett's oesophagus (BE) and if this translates into superior prediction of histology. MATERIAL AND METHODS: This was a prospective single-centre study involving 21 patients (75 areas, corresponding NBI-Z and WLE-Z images) with BE. Mucosal patterns (pit pattern and microvascular morphology) were evaluated for their image quality on a visual analogue scale (VAS) of 1-10 by five expert endoscopists. The endoscopists then predicted mucosal morphology based on four subtypes which can be visualized in BE. Type A: round pits, regular microvasculature; type B: villous/ridge pits, regular microvasculature; type C: absent pits, regular microvasculature; type D: distorted pits, irregular microvasculature. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) were then compared with the final histopathological analysis and the interobserver variability calculated. RESULTS: The overall pit and microvasculature quality was significantly higher for NBI-Z, pit: NBI-Z=6, WLE-Z=4.5, p < 0.001; microvasculature: NBI-Z=7.3, WLE-Z=4.9, p < 0.001. This translated into a superior prediction of histology (Sn: NBI-Z: 88.9, WLE-Z: 71.9, p < 0.001). For the prediction of dysplasia, NBI-Z was superior to WLE-Z (chi(2)=10.3, p < 0.05). The overall kappa agreement among the five endoscopists for NBI-Z and WLE-Z, respectively, was 0.59 and 0.31 (p < 0.001). CONCLUSIONS: NBI-Z is superior to WLE-Z in the prediction of histology in BE, with good reproducibility. This novel imaging modality could be an important tool for surveillance of patients with BE.
Subject(s)
Barrett Esophagus/pathology , Esophagoscopy/methods , Esophagus/pathology , Image Enhancement , Adult , Aged , Aged, 80 and over , Barrett Esophagus/diagnosis , Esophagus/blood supply , Female , Humans , Image Enhancement/methods , Image Processing, Computer-Assisted , Light , Male , Middle Aged , Precancerous Conditions/diagnosis , Predictive Value of Tests , Prospective Studies , Sensitivity and SpecificityABSTRACT
Complementary and Alternative Medicine (CAM) is a heterogeneous group of theories and practices that are becoming increasingly popular in the West - between 20% and 65% of patients use CAM on a regular basis. In the UK, CAM is provided by over a third of general practitioners as well as by hospitals. The subject of much debate in both the lay and medical press, CAM is subject to increasing scrutiny from clinical research. In this review, we discuss the available evidence for herbal medicines, including that for silymarin, glycyrrhizin, Chinese herbal medicines and other herbal mixtures. We also review evidence regarding the safety of herbal medicines, both in terms of hepatotoxicity and drug interactions. We conclude that although CAM may be of benefit in the treatment of liver disease, the available evidence is insufficient to recommend any of the available therapies. CAM has not yet been well studied in liver disease and rigorous evaluation with well-designed double-blind randomised controlled trails is required. Doctors need to be aware of the widespread use of CAM, ask their patients specifically regarding their use of CAM and be aware of the potential for hepatotoxicity and interactions.