Society Of Gastroenterology Research Articles

DOP02 Developing explicit thresholds for outcomes to inform (GRADE) Evidence to Decision frameworks for Inflammatory Bowel Disease guidelines

Abstract Background Evidence to decision (EtD) frameworks are a key recent development in Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. They aim to ensure that decisions about healthcare interventions are based on a thorough, transparent and unbiased assessment of the available evidence. Core to this is to agree the importance of outcomes to be used, the specific measures for each outcome that have the most consensus and finally to develop explicit thresholds for interpretation of effect sizes of outcomes to inform (GRADE) evidence to decision frameworks. This ensures decisions are made in an unbiased fashion and allows stakeholders to focus on discussions based on their significant experience and expertise, rather than interpretation of evidence. Therefore, our study aims to develop these thresholds for the EtD framework to establish their use in several key IBD guidelines. Methods This online survey using Survey Monkey was conducted by inviting experts and stakeholders from the United Kingdom and British Society of Gastroenterology. Each expert was asked to select important clinically relevant outcomes and were asked about what magnitude of the effect they consider large, moderate, small, or trivial for each of the clinical, endoscopic, radiological, biochemical, histological outcomes and adverse events. Questions were framed as neutral statements without introducing a specific direction. Response options included sliding bars going from 1 to 100% for the desirable magnitude of effect for each outcome (Figure 1). The mean average of responses of experts were calculated. Results A total of 89 clinical experts/stakeholders participated in this online survey. Clinical remission, clinical response, endoscopic remission, withdrawal due to adverse events, and serious adverse events were considered critical outcomes. Trivial to small, small to moderate and moderate to large thresholds were as follows - clinical remission (10%, 20% and 31%), clinical response (13 %, 24% and 36%), endoscopic remission (9%, 17% and 28%), withdrawal due to AE (7 %, 14% and 23%), serious AE (6%, 11% and 17%) (Table 1). Conclusion This is the first study to develop thresholds for outcomes in IBD which can be used in EtD for the development of IBD guidelines. These thresholds have been used in the development of upcoming British Society of Gastroenterology guidelines for the management of IBD.

P490 Prevalence and clinical features of chronic nonbacterial osteomyelitis in a nationwide cohort of children with inflammatory bowel diseases

Abstract Background Among musculoskeletal extraintestinal manifestations (EIM), the association between IBD and a rare autoinflammatory condition, chronic nonbacterial osteomyelitis (CNO), has been reported. The primary objective of our study was to report the clinical characteristics and the disease course of a cohort of patient with concurrent diagnosis of CNO and IBD. The secondary outcome was to define the prevalence of CNO in a nationwide cohort of patients with IBD. Methods This is a retrospective, multicenter study based on the Italian Society of Gastroenterology, Hepatology, and Pediatric Nutrition (SIGENP) IBD National Registry. The diagnosis of CNO was defined as the presence of uni- or multifocal bone inflammatory lesions with suggestive radiological or histopathological characteristics, having excluded infectious, oncological, or other inflammatory conditions. All patients under 18 years of age with a combined diagnosis of IBD and CNO identified in the registry were included. Results 18 patients with a combined diagnosis of CNO and IBD out of 4229 patients with IBD were identified, with an overall prevalence of 0.4%. 15 (83.3%) patients were male. Median age at IBD diagnosis was 10.1 years (IQR: 6.16 years), whereas median age at CNO diagnosis was 11.7 years (IQR: 6.31 years). The most frequently reported IBD phenotype was CD (13 patients, 72.2%), followed by IBD-U (3 patients, 16.7%) and UC (2 patients, 11.1%). The diagnosis of concurrent CNO was more common in patients affected by CD than in those affected by either UC or IBD-U (13/1843, 0.7% vs 5/2886, 0.2%, p=0.01). Similarly, the occurrence of CNO was more frequent in male gender when compared to female one (15/2312, 0.6% vs 3/1917, 0.1%, p=0.01). All the patients had multifocal bone involvement; 2 (11.1%) developed subsequently dermatological manifestations consistent with SAPHO syndrome. In 8 patients (44.4%) IBD onset preceded CNO diagnosis, in 6 (33.3%) IBD onset followed CNO diagnosis, whereas in the remaining 4 patients (22.2%) the diagnosis of IBD and CNO was concomitant. Table 1. summarizes therapeutic approach to both conditions in each of the patient identified in our case series. At the end of follow-up, 14 (77.8%) patients had achieved IBD clinical and biochemical remission. Ten (55.6%) patients achieved clinical and radiological remission of bone lesions, 6 (32.3%) had achieved clinical remission but showed persistence of bone lesions at magnetic resonance imaging (MRI), 2 (11.1%) had persistence of both clinical and radiological activity. Conclusion Our findings support the hypothesis that CNO disease spectrum can be considered a rare extraintestinal manifestation of IBD, with a low but still non-negligible prevalence.

2010 The scope of CT in investigating iron deficiency anaemia in the context of frailty

Abstract Introduction Iron Deficiency Anaemia (IDA) is a highly prevalent co-morbidity in older patients with advanced frailty. It’s associated with adverse outcomes and heightened all-cause mortality. IDA is frequently multifactorial and can stem from various gastrointestinal causes. The British Society of Gastroenterology and National Institute for Health and Care Excellence advocate a combination of endoscopy and computerised tomography (CT) as the gold standard investigations for IDA. The aim of this review was to evaluate oesophagogastroduodenoscopy (OGD) findings and management outcomes of clinically frail patients with IDA. Methods We review notes for patients referred for OGD to investigate IDA without additional symptoms over a six-month period. The inclusion criteria were IDA, age of 65 years or greater and a clinical frailty score of 5 or greater. Results 53 patients met the inclusion criteria. A single case (1.8%) UGI malignancy using OGD was identified prior to CT. Thus, demonstrating low yield of OGD in malignancy. 35.6% of patients underwent CT scanning 3 months prior to OGD. Approximately 90% of OGD findings were benign. 23% of patients died within 90 days of OGD. No significant adverse events during OGD or significant complications were recorded in our cohort. It is therefore highly unlikely that the undergoing of an OGD had a direct impact on mortality. Conclusion This review shows there is a low yield of UGI malignancy on OGD following a negative CT. Benign upper GI condition is the most common finding. Thus, CT imaging alone may be an adequate investigation to rule out UGI malignancy in this group. Considering there is a high mortality rate in older patients with frailty, following an OGD, we suggest considering starting empirical treatment with PPI and iron replacement as a suitable and less invasive alternative to OGD after a negative CT in frail patients.

There is a long way from current clinical practice in Denmark compared to recent published English guideline on management of children with eosinophilic oesophagitis

BackgroundA low incidence of eosinophilic esophagitis (EoE) in children in the North Denmark Region (NDR) were measured in 2007–2017. Few of the children diagnosed before 2017 were treated to remission suggesting a lack of awareness. While there currently are no guidelines for treating EoE in Denmark, a new English guideline was published in 2022 renewing focus on the disease.ObjectiveThe aim of this study was to measure the difference of current Danish clinical practice for treatment and follow-up of EoE children in the NDR with the new English guideline from the British Society of Gastroenterology (BSG) and the British Society of Pediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN).MethodsThis retrospective, register-based DanEoE cohort study included 31 children diagnosed with EoE between 2007 and 2021 in NDR. Medical records were reviewed and information about treatment and follow-up were collected.ResultsIn 32% of the children with EoE in the NDR, first-line treatment corresponded with the new English guideline. One in 6 children were never started on any treatment even though treatment always is recommended. Histologic evaluation within 12 weeks as recommended was performed in 13% of the children.ConclusionsIn Denmark focus on improving EoE treatment and follow-up for children is needed, as there is a significant difference between current clinical practice and the recommendations in the new English guideline.

New concept in fatty liver diseases.

In 2023, the nonalcoholic fatty liver disease (NAFLD) Nomenclature Consensus group proposed a new name and concept for NAFLD/nonalcoholic steatohepatitis. The Japanese Society of Gastroenterology and the Japanese Society of Hepatology have accepted these new names and concepts. It was reported that the terms "nonalcoholic" and "fatty" are misleading and inappropriate, because NAFLD does not reflect the etiology. Thus, appropriate disease names are discussed, and new concepts are published. First, the concept of steatotic liver disease (SLD) was proposed to encompass fatty liver diseases of various etiologies, which are classified into five categories. The diagnostic criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) included fatty liver with at least one of the five cardiometabolic risk factors (body mass index or waist diameter, blood glucose or glycated hemoglobin, blood pressure, triglycerides, and high-density lipoprotein cholesterol) and the same restriction of alcohol consumption as NAFLD. A new fatty liver category was described, MetALD, to represent the intermediate drinker group (patients with MASLD with high weekly alcohol intake [140-350g/week in women and 210-420g/week in men]). The other five categories are alcohol-associated liver disease, fatty liver with an identifiable specific cause, and other fatty livers of unknown cause. Nonalcoholic steatohepatitis is an important pathological concept (metabolic dysfunction-associated steatohepatitis); however, its definition, including hepatocellular balloon-like degeneration, needs to be reassessed. In Japan, we should use these names and criteria to manage SLD, including hepatocellular carcinoma, which is markedly increasing.

Lynch Syndrome Screening and Surveillance Trends among Gastroenterologists in Japan: A Questionnaire Survey-based Analysis.

Objective Screening and surveillance methodologies for Lynch syndrome (LS) in Japan. This study assessed the changes in LS knowledge and practice trends. Methods In 2020 and 2022, 2 questionnaire surveys were administered to 3574 councilors of the Japanese Society of Gastroenterology to assess changes in LS-related knowledge and practices. Patients or Materials Each questionnaire item was analyzed by comparing responses between the first and second surveys to determine the proportion of doctors selecting each option relative to the total number of respondents. The responses from doctors who completed both surveys were analyzed to assess the temporal changes in their responses. Results The second survey showed a significant increase in the awareness of universal tumor screening (UTS), proportion of doctors selecting UTS for primary LS screening, use of BRAF V600E testing for chemotherapy selection, and number of newly diagnosed LS patients per doctor over the last three years. In addition, the number of patients currently under surveillance by doctors has also increased. Doctors who intensified primary screening for LS between surveys reported a greater increase in newly diagnosed cases. However, the rise in UTS suggests a potential bias from doctors with heightened interest in LS, which may have influenced the findings. Conclusion The number of newly diagnosed and currently monitored patients with LS in Japan has been increasing, likely due to expanded screening practices. However, the potential bias introduced by the increased adoption of UTS should be considered when interpreting these results.

The 65th Annual Meeting of the Japanese Society of Gastroenterology

The 65th Annual Meeting of the Japanese Society of Gastroenterology

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Attitudes, perceptions and barriers in implementing therapeutic drug monitoring for anti-TNFs in inflammatory bowel disease: a survey from the Middle East.

A growing body of evidence underscores the beneficial impact of therapeutic drug monitoring (TDM) on the efficacy and cost-effectiveness of anti-tumour necrosis factor (TNF) therapy in patients with inflammatory bowel disease (IBD). We surveyed clinician attitudes, perceptions and barriers related to TDM in IBD in the Middle East. A 15-question survey was distributed through national gastroenterological societies in five Middle Eastern countries (UAE, Saudi Arabia, Kuwait, Lebanon and Egypt). Data on clinician characteristics, demographics, utilization patterns and obstacles related to the adoption of TDM with anti-TNFs were gathered. Logistic regression analysis was used to predict factors influencing the utilization of TDM. Among 211 respondents (82% male), 82% were consultants, 8% were physicians with an interest in gastroenterology (GI), and 6% were GI trainees. Of these, 152 met inclusion criteria, treating >5 IBD patients per month and ⩾1 with an anti-TNF per month. TDM was used in clinical practice by 78% (95% CI: 71-85) of respondents. TDM was utilized following the loss of response (LOR) in 93%, for primary non-response (PNR) in 40% and before restarting anti-TNF therapy after a drug holiday in 33% of respondents, while 34% used TDM proactively. No specific factors were associated with the use of TDM. Barriers to TDM use included cost (85%), time lag to results (71%) and lack of insurance reimbursement (65%). Overall knowledge of TDM (70%), interpretation and actioning of results (76%) or awareness of clinical guidelines (57%) were not perceived as barriers. If barriers were removed, 95% would use TDM more frequently; 93% for LOR, 60% for PNR, 50% when restarting after a drug holiday, and 54% would use TDM proactively. Most gastroenterologists use TDM for LOR, with cost, time lag and insurance reimbursement being significant barriers. Addressing these barriers would increase the judicious use of reactive and proactive TDM to optimize anti-TNF therapy in IBD.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.

Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW) 2024, Adelaide Convention Centre, 14-16 September 2024.