Gastroenterology and Hepatology Services
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Item The effect of colesevelam on the microbiome in postoperative crohn's disease.(Oxford Academic., 2024-10-18) Brookes, Matthew J; Jain, Manushri; Kumar, Aditi; Steed, HelenBackground: While surgery plays a pivotal role in the management of ileal Crohn’s disease, the risk of endoscopic recurrence following an ileocaecal resection can be greater than 65% within 12 months of surgery. More than 90% of patients with Crohn’s disease have a concomitant diagnosis of bile acid diarrhea following an ileal resection. This pilot study aimed to assess whether the use of bile acid sequestrants in patients with Crohn’s disease who have undergone a primary terminal ileal resection with concomitant bile acid diarrhea can alter the microbiome and prevent disease recurrence. Methods: Patients with Crohn’s disease who underwent a primary terminal ileal resection and had symptoms of diarrhea within 1-3 months of surgery underwent 75SeHCAT testing for bile acid diarrhea. If positive (75SeHCAT ≤ 15%), patients were treated with colesevelam and stool samples were collected at 4 weeks, 8 weeks, and 6-12 months posttreatment. If negative (75SeHCAT > 15%), treatment was not given and were reviewed in the clinic as per local guidelines. All patients underwent a 6-12 month postoperative colonoscopy where further stool samples and mucosal biopsies were taken. Disease activity was established using the endoscopic Rutgeert’s score, with disease remission defined as Rutgeert’s scoreItem Controversies in venous thromboembolism risk assessment in inflammatory bowel disease: a narrative review.(MDPI Open Access Journals, 2024-09-24) Harvey, Philip R; Kumar , Aditi; Sharma, Nikhil; Tewatia, PavitInflammatory bowel disease (IBD) is a chronic inflammatory condition affecting the gastrointestinal tract with increasing rates of incidence and prevalence across the world. Complex inflammatory and prothrombotic pathophysiology in IBD makes venous thromboembolism (VTE) a common complication with significant morbidity and mortality. This risk is increased in pregnancy. As we continue to understand the pathogenesis of IBD, this article highlights the continued risk of VTE following discharge, for which there is currently no clear guidance, yet the risk of VTE remains high. Furthermore, we discuss this increased VTE risk in the context of pregnant IBD patients and the relevant current guidelines. Alongside this, medications that are used to manage IBD carry their own thrombotic risk, which clinicians should be aware of. Assessing VTE risks in IBD populations using newer medications should be a focus of future research.Item Is Clostridioides difficile diarrhoea associated with greater social deprivation in England?(Elsevier, 2024-08-27) Plant , Aiden JThe traditional risk factors for Clostridioides difficile infection (CDI) are well known and include advancing age, underlying comorbidities, antimicrobial exposure and recent hospitalisation. Since the COVID-19 pandemic, the incidence of CDI has increased, particularly for community-acquired disease, with little understanding of the drivers of this epidemic. We too have seen increasing cases of both community- and hospital-acquired CDI within the local population of our district general hospital (data not presented).Item Minimally invasive surgery for inflammatory bowel disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques.(Oxford Academic, 2024-09-03) Mohamedahmed, Ali Yasen YWe read with interest the letter recently published in the Journal of Crohn’s and Colitis by Cunha and Roseira,1 in response to our article ‘Minimally invasive surgery for inflammatory bowel disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques’.2 We appreciate their timely contribution and the important points raised. Our meta-analysis demonstrated comparable outcomes in the surgical management of inflammatory bowel disease [IBD] between conventional laparoscopic approaches and robotic-assisted minimally invasive surgery. Robotic platforms were associated with a significantly lower overall postoperative complication rate. The published studies included in our data synthesis were all non-randomised data, and we appreciate the potential inherent biases associated with observational studies. However, we recognise that conducting randomised controlled trials [RCTs] in IBD and adding new and emerging disciplines like robotic technologies might pose a challenge at present. Consequently, bringing together the best available evidence in the literature provides an important comparative outcome between the two surgical techniques and may help with the future planning of combined medical/surgical IBD trials.Item The variation in post-endoscopy upper gastrointestinal cancer rates among endoscopy providers in England and associated factors: a population-based study.(Thieme, 2024-08-29) Brookes , Matthew JBackground: Post-endoscopy upper gastrointestinal cancer (PEUGIC) is an important key performance indicator for endoscopy quality. We examined variation in PEUGIC rates among endoscopy providers in England and explored associated factors. Methods: The was a population-based, retrospective, case–control study, examining data from National Cancer Registration and Analysis Service and Hospital Episode Statistics databases for esophageal and gastric cancers diagnosed between 2009 and 2018 in England. PEUGIC were cancers diagnosed 6 to 36 months after an endoscopy that did not diagnose cancer. Associated factors were identified using multivariable logistic regression analyses. Results: The national PEUGIC rate was 8.5%, varying from 5% to 13% among endoscopy providers. Factors associated with PEUGIC included: female sex (odds ratio [OR] 1.29 [95%CI 1.23–1.36]); younger age (age >80 years, OR 0.52 [0.48–0.56], compared with ≤60 years); increasing comorbidity (Charlson score >4, OR 5.06 [4.45–5.76]); history of esophageal ulcer (OR 3.30 [3.11–3.50]), Barrett’s esophagus (OR 3.21 [3.02–3.42]), esophageal stricture (OR 1.28 [1.20–1.37]), or gastric ulcer (OR 1.55 [1.44–1.66]); squamous cell carcinoma (OR 1.50 [1.39–1.61]); and UK national endoscopy accreditation status – providers requiring improvement (OR 1.10 [1.01–1.20]), providers never assessed (OR 1.24 [1.04–1.47]). Conclusion: PEUGIC rates varied threefold among endoscopy providers, suggesting unwarranted differences in endoscopy quality. PEUGIC was associated with endoscopy findings known to be associated with upper gastrointestinal cancer and a lack of national endoscopy provider accreditation. PEUGIC variations suggest an opportunity to raise performance standards to detect upper gastrointestinal cancers earlier and improve outcomes.