Gastrointestinal Investigations Research Articles

Liraglutide in adolescents with simple obesity and gastrointestinal comorbidities: treatment experience

BACKGROUND: Liraglutide was approved for treatment of obesity in children and adolescents since 12 years. Due to gastrointestinal (GI) side effects not all patients reach maximal dose; this can affect the efficacy of obesity treatment.AIM: To study efficacy and tolerability of liraglutide in adolescents with obesity.MATERIALS AND METHODS: We analyzed medical data of adolescents with simple obesity and GI comorbidities before and in 3 months after start of liraglutide (BMI SDS; obesity complications; liraglutide side effects, and maximal doses), duration of therapy, reasons for discontinuation, and BMI SDS in 3–6 months after discontinuation.RESULTS: Liraglutide was administered for 10 adolescents (7 girls, 3 boys) 15.4 (13.5; 16.2) years with BMI SDS 3.3 (2.9; 3.7). Three months of treatment led to significant (p=0.001) decrease of BMI SDS till 2.8 (2.6; 3.5). Maximal dose of liraglutide was 3.0 mg (6 patients), 2.4 mg (2), 1.8 mg (1), and 1.2 mg (1). No correlation between maximal dose and BMI ΔSDS was detected. While dose titration patients complained of nausea (9), diarrhea (3), obstipation (1), and flatulence (1). In majority of cases complains were not dose-dependent. Only in 1 patient nausea and diarrhea that did not allow to increase liraglutide dose above 1.2 mg; additional investigation after discontinuation of therapy revealed GI infection.Therapy was discontinued in 3 months by 2 patients (1 — side effects, 1 — satisfactory result), in 4–5 months by 3 patients (1 — relapse of excessive weight gain, 2 — financial reasons), in 6 months by 1 patient (satisfactory result); 4 continued therapies. In 3–6 months after discontinuation of therapy BMI SDS increased and did not significantly differ from basal.CONCLUSION: Liraglutide is effective for treatment of obesity in adolescents and well tolerated by majority of patients. In case of pronounced adverse events additional GI investigation is recommended. Patients can discontinue treatment not only due to side effects, but also when they achieve their goal, and due to financial reasons.

The impact of posttraumatic stress disorder on upper gastrointestinal investigations in Australian Defence Force veterans: a retrospective review.

Veterans with posttraumatic stress disorder (PTSD) commonly exhibit associated gastrointestinal (GI) symptoms. We compared upper GI endoscopy and abdominal ultrasound rates in veterans with and without PTSD. Veterans with PTSD were 77-81% more likely to undergo these procedures than those without PTSD. PTSD symptomatology influences GI investigation rate and more emphasis on clinician and patient education is recommended regarding stress-related gut symptoms.

A103 DESIGNING QUALITATIVE RESEARCH FOR UNDERSTANDING THE EXPERIENCES OF TRANGENDER AND GENDER DIVERSE PERSONS WITH GASTROINTESTINAL DISEASE OR SEEKING GASTROINTESTINAL CARE

Abstract Background Transgender and gender diverse (TGD) people make up approximately 1% of the population, with 2.1% of Generation Z adults (born 1997-2003) identifying as TGD. As a marginalized population, TGD people have been shown to have poorer access to health care services and report worse health-related outcomes. While the health care disparities faced by TGD people need to be addressed by Medicine broadly, TGD people may face unique barriers in gastrointestinal (GI) care. To date, there has been no systematic assessment of the GI health care needs of TGD people. With the aging of Generation Z, GI care providers will increasingly be responsible for the care of TGD people, and it is important to understand their needs and experiences to ensure they receive appropriate and sensitive care. Purpose Recognizing the absence of literature on the issues faced by TGD people with GI disease or seeking care for GI issues, we plan to use qualitative research methodology to aggregate and analyze narrative experiences of TGD people of diverse backgrounds, identities and experiences. Our research will focus on TGD people’s interactions with GI care providers, and on the experience of being a TGD person with GI disease or having sought evaluation of GI symptoms. Method We will use a qualitative approach to gain a broad understanding of the experiences and perceptions of TGD people with: 1) established GI diseases, in particular IBD and DGBIs (disorders of gut-brain interaction), and 2) GI symptoms or concerns requiring GI investigations. We will use snowball sampling to reach out to TGD people in Canada and the US, with the aim of achieving diverse representation across gender identity, surgical status, age, race/ethnicity, and socioeconomic status. Participants will sit for semi-structured interviews to elicit narratives about their beliefs and experiences while living with GI disease and/or seeking care for GI issues. Interview transcripts will be subjected to objective and researcher-guided thematic analysis to identify commonalities and disparities in experiences and points-of-view. Result(s) Our proposed presentation will highlight our process in designing and initiating this project. We believe our methods and approach to this work is an important discussion and will help shape next steps in this field. We may also present some of the early results of our semi-structured interviews. Conclusion(s) This work will provide a foundation to guide further research into the process and outcomes of care for TGD people with GI disease and undergoing GI evaluations and will provide a framework to develop best practices for GI care providers pertaining to the care of TGD people. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Gastrointestinal problems and non‐Oral feeding in children evaluated for medical child abuse (fabricated and induced illness)

AbstractVictims of medical child abuse (MCA) often have gastrointestinal (GI) complaints and nutritional difficulties, leading to non‐oral feeding methods. We documented the frequency of GI complaints, non‐oral feeding methods, medical complaints leading to them and difficulties experienced. They were compared with children evaluated preoperatively by a G‐tube protocol.Children with possible MCA at Children's Hospital, 2011–2015, were retrospectively reviewed. They were compared with a 5 per cent random sample of G‐tube protocol children, 2013–2015.Sixty‐five of 143 (45.5%) children evaluated for MCA were determined to be MCA victims. Twenty‐four out of 65 children with MCA (39.6%) had GI complaints compared to nine out of 60 G‐tube protocol children (15.0%). Gastroesophageal reflux and oral‐motor dysfunction were the most frequent GI problems in both groups. Fewer MCA children had prior non‐oral feeding methods than G‐tube protocol children. However, MCA victims had more prior GI investigations, non‐oral feeding types and complications thereof. MCA children were less likely to have feeding tubes placed, but caretakers took 30 per cent who did not receive a tube elsewhere for tube insertion. Interventions in MCA children restored many to oral feeding and resolved nutritional and developmental complaints.MCA victims had frequent GI complaints, numerous investigations and frequent complications. They had more uncommon GI complaints. MCA interventions improved feeding and nutrition.Key Practitioner Messages Gastrointestinal (GI) problems and non‐oral feeding methods are common in medical child abuse (MCA). MCA victims undergo many investigations and tend to have multiple GI complaints. Non‐oral feeding methods are common and often fail or are fraught with complications. Consider MCA in children with unusual primary and/or GI diagnoses. Intervention can relieve feeding and developmental problems and failure to thrive.

Modelling the episodes of care for iron deficiency anemia patients in a secondary-care center using continuous-time multistate Markov chain.

Background:Despite the high prevalence of gastro-intestinal (GI) cancer in iron deficiency anemia (IDA), some IDA patients do not complete all the necessary GI investigations at the initial referral. As a result, existing cancers are diagnosed at a later referral with worse prognosis. The potential to detect GI cancer early depends on minimizing the delay time spent between the two consecutive referrals, where a patient did not complete investigations at the first referral, but at the second is diagnosed with positive GI cancer. This retrospective longitudinal study aims to highlight the proper methods to model these referrals.Methods:Using anonymized data of 168 episodes of care for IDA patients at an IDA clinic in a secondary care setting, continuous-time multi-state Markov chain is employed to determine the transition rates among three observed states for IDA patients at the IDA clinic, “incomplete investigations,” “negative GI cancer,” and “positive GI cancer” and to estimate the delay time.Results:Once in the state of incomplete investigations, an estimated mean delay time of 3.1 years (95% CI: 1.2, 5) is spent before being diagnosed with positive GI cancer. The probability that a “positive GI diagnosis” is next after the state of “incomplete investigation” is 17%, compared with 11% when it is followed in the state of negative GI cancer. Defining the survival as the event of not being in the state of “positive GI cancer,” the survival rate of IDA patients with negative GI cancer is always higher than those with incomplete investigations. Finally, being diagnosed with positive GI cancer is always preceded by the prediction of being considered “very high risk” at the earlier visit.Conclusion:A baseline model was proposed to represent episodes of care for IDA patients at a secondary care center. Preliminary results highlight the importance of completing the GI investigations, especially in IDA patients, who are at high risk of GI cancer and fit to go through the investigations.

Step-in Dosing in the Bosutinib Dose Optimization Study (BODO) Failed to Reduce Gastrointestinal (GI) Toxicity in Patients Failing Second Generation TKI (2G-TKI) in Chronic Phase Chronic Myeloid Leukemia (CML) but Suggests Promising Molecular Response

Step-in Dosing in the Bosutinib Dose Optimization Study (BODO) Failed to Reduce Gastrointestinal (GI) Toxicity in Patients Failing Second Generation TKI (2G-TKI) in Chronic Phase Chronic Myeloid Leukemia (CML) but Suggests Promising Molecular Response

Paradigm-Shifting Research in Gastroenterology, Hepatology, and Nutrition: A Top 20 List of Articles Published in 2020

Paradigm-Shifting Research in Gastroenterology, Hepatology, and Nutrition: A Top 20 List of Articles Published in 2020

Does Family History of Cancer Influence Undergoing Screening and Gastrointestinal Investigations?

Although a family history of cancer (FHC) can modify the lifestyle and attitudes towards participation in cancer screening programs, studies on this relationship show mixed results and vary across populations. The objectives of the study were to compare sociodemographic characteristics, history of gastrointestinal (GI) investigations and Helicobacter pylori eradication, and modifiable cancer risk factors between those with FHC and those with no FHC (NFHC), and to investigate the association between FHC and a history of GI investigations. A total of 3,455 questionnaires from the pilot study of the "Helicobacter pylori eradication and pepsinogen testing for prevention of gastric cancer mortality (GISTAR study)" in Latvia were analysed. We compared sociodemographic characteristics and history of GI investigations between participants with self- reported FHC and NFHC. Binary logistic regression models adjusted for socio-demographic characteristics and modifiable cancer risk factors were built for a FHC and each GI investigation. Participants with a FHC were more likely to be women, have a higher education and less likely to have harmful habits (smoking, alcohol consumption) than those with NFHC. Participants with a FHC were approximately twice as likely to report recent colorectal investigations specifically for screening, than those with NFHC. In fully adjusted logistic regression models, FHC was significantly associated with a recent history of faecal occult blood tests (FOBTs), colonoscopies, and colorectal investigations (FOBT or colonoscopy) specifically for screening as part of the national organized screening programme. Our results indicate that those with a FHC have different patterns of health-related behaviour than those with NFHC.

Integrated care in practise - across regions (Scotland and Denmark)

Background: SCOTCAP is a programme for an innovative point-of-care investigation of the lower gastrointestinal (GI) tract using minimally invasive colon capsule endoscopy (CCE). This project was established by working closely with partners in Region of Southern Denmark (RSD), where the model originated in population screening programmes. Working in partnership we have progressed the development, deployment and methodology in both regions. By using CCE, GI investigation can potentially become a primary care service, overseen by a remote GI consultant, allowing transformation into the community, a new integrated care model. The use of CCE has great potential to remove pressure that GI investigations impose on health care systems. Digital health and care innovation centre (DHI), Scotland’s national centre to accelerate digital health and care adoption, has brought together multi-stakeholders to demonstrate this service and digital innovation. The collaboration with RSD has demonstrated acceleration of the knowledge and lessons learned at transferring this to a scalable model. The projects have adopted a quadruple helix model by involving Industry, Academia, urban and rural health boards/regions, along with citizens to co-produce this integrated health and care innovation pathway. Objectives: The main objective is to reduce the bottleneck in diagnostic demand for GI disease assessment. This shall be achieved by creating an innovative integrated service based on CCE which can be delivered at point-of-care in the community, a GP practice or even the home of the person. Secondary care clinical nurse specialists (CNS) who are trained in CCE will deliver training to primary care practice nurses to support the patients that will receive CCE. Furthermore, it should reduce the total cost of GI diagnostics by eliminating unnecessary travel, minimize impact on daily life of patients, avoid complications, reduce specialist participation, optimise resource utilization and enable modern digital health technology in an integrated care setting. Secondly, it should improve innovation capabilities in health and life sciences and create local jobs in service delivery. Local regions have pioneered this work with feasibility studies conducted at primary care sites with a range of lessons learned. CCE is an innovative technology where a capsule containing a digital camera is swallowed, passes through the gastrointestinal tract and downloads 400,000 images which are then viewed and remotely analysed. It is highly accurate, cost effective and increases choice for patients. Patient participation has taken place, early feedback; “I think the pillcam procedure would be very helpful to patients in the future, enabling them to be diagnosed near home and not have to travel the long distance to Hospital” “Not having a round trip of 120 miles for the procedure” “Only took 2.5 hrs to complete so quicker recovery as no anaesthetic required”. Conclusion: By May 2018, DHI would present in partnership with RSD, early insight from functional framework for CCE delivery, we would welcome the opportunity to share this service, digital and business innovation, along with lessons learned and early indicators with delegates at the integrated care conference (ICIC) in the Netherlands – demonstrating how regions can work effectively together (Scotland/South Denmark).

Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer.

BackgroundPancreatic ductal adenocarcinomas are poor prognostic cancers accounting for 3% of all cancer cases in the UK. They often present late in the course of the disease process with non-specific symptoms, including gastro-intestinal(GI) symptoms. Delays in diagnosis occur when investigations are carried out in a primary care setting for GI symptoms. The aim of this study was to assess delays in pancreatic cancer diagnosis when patients were referred for GI investigations and evaluate its effect on survival.MethodsRetrospective cohort study of all patients diagnosed with pancreatic adenocarcinoma in a Scottish district general hospital over a seven year period from January 2010 to December 2016. Patients were divided into two groups, those who had a GI investigation 18 months prior to the pancreatic cancer diagnosis and those who did not have GI investigations. Data on demographics, symptoms on referral, stage of disease at diagnosis, treatment undergone and length of survival collected and analysed.ResultsOne hundred and fifty-three patients were diagnosed with pancreatic cancer in the study period. Forty (26%) of the 153 underwent gastrointestinal investigations in the 18 months prior to diagnosis. The remaining 113 (74%) had no gastro-intestinal investigations in the same time period. Demographic data were comparable. Significant delays occurred from referral to diagnosis in the GI investigated group compared to those who did not have GI investigations. (64.5days vs 9 days, p = 0.001). No difference was noted in disease stage or treatments undergone between the groups. There was no difference in the average survival after diagnosis between the two groups with median of 108 days for those who underwent GI investigations to 97 days for those who did not.(U = 2079.5, p = 0.454).ConclusionDelays caused by pre-diagnostic GI investigations do not appear to contribute to the poor prognosis of pancreatic cancer. Recently updated NICE Guidelines recommends early ultrasound or CT in patients with GI symptoms and weight loss which may reduce delays in diagnosis. Screening tests in future may become cost effective and diagnose this condition at a curable stage which in turn may improve survival rates.

Haemoglobin responses to transfusion in severe iron deficiency anaemia: potential impact of gastrointestinal disorders.

Red blood cell (RBC) transfusion may be justified in iron deficiency anaemia (IDA) when an increase in oxygen delivery is needed, as sometimes occurs in subjects with haemoglobin <8·0mg/dL, serious comorbidities or at risk of cardiovascular instability. Earlier investigations showed that some patients with severe IDA requiring transfusion had lower than expected post-transfusion haemoglobin levels with poorer clinical outcomes than other patients. After hypothesizing that haemoglobin responses to transfusion were different and that the underlying gastrointestinal (GI) disorders causing IDA could be a confounder explaining this association, these responses were analysed in a prospective cohort of IDA adults referred for outpatient GI investigation. Transfused patients with proven IDA, baseline haemoglobin at referral <9·0g/dL and no extraintestinal bleeding were eligible. To assess a homogeneous population, only GI disorders known to cause occult bleeding were considered. Haemoglobin increments per 100 mL of RBCs were investigated. In total, 2818 patients were enrolled over 10·5 years. On multivariable regression, diffuse angiodysplasias and GI cancer independently predicted for reduced increments in post-transfusion haemoglobin [adjusted regression coefficients: -0·082 (95% confidence interval, -0·093 to -0·072) and -0·073 (95% confidence interval, -0·081 to -0·066), respectively, P<0·001 in both]. Haemoglobin responses in the remaining bleeding disorders were adequate and agreed with the principle that one RBC unit increases the haemoglobin an average of 1g/dL. The potential differential impact of GI disorders on changes in haemoglobin levels after RBC transfusion could be useful for transfusing physicians, especially for diagnostic purposes.

A 5-Year Follow-Up of Study Patients With Asymptomatic Iron-Deficiency Anemia Using a Nurse-Led Pathway.

A protocol-driven, systematic pathway was developed to allow rapid and coordinated investigation of patients with iron-deficiency anemia (IDA) in a nurse-delivered outpatient setting. The study objective was to assess the safety and efficacy of the pathway by 5-year outcome data for the exclusion of gastrointestinal (GI) malignancy. This is a 5-year follow-up study of 122 patients entered onto the pathway with negative initial upper and lower GI investigations. The study was conducted at Hereford County Hospital NHS Trust (a district general hospital serving 220,00 people). Clinical outcomes of patients at 5 years and service efficiency at detecting relevant pathology were observed. A total of 272 patients were investigated through the pathway, and in 150 patients a GI cause for IDA was found. We established the outcome in 97% of the 122 patients with normal GI investigation at 5 years after their initial investigation. Of the 118 patients followed up, 92 patients were alive and well and 26 had died or developed malignancy. With the exception of diabetes (odds ratio 0.24; 95% confidence interval [0.1, 0.8]; p = .02), no features were found to be a significant risk factor for poor prognosis, including age, gender, hemoglobin level, anemia at 3 months, or other comorbidities. Three patients developed colonic malignancy; two patients had diverticular disease at barium enema and presented 4 years later with colorectal cancer. One patient declined lower GI investigation and presented with metastatic colon cancer on computed tomography scan at 1 year. No other GI cancers were diagnosed. Our nurse-delivered, protocol-driven pathway is a highly effective and safe system for the exclusion of GI cancer within 5 years of follow-up.

PTH-022 A Novel Experience of The Pillcam® ESO 3 Capsule Endoscope In Patients Unwilling To Undergo Conventional Upper GI Endoscopy

Introduction Gastroscopy (OGD) is the gold standard test for investigating dyspepsia, but is uncomfortable, incurs the risk of intubation and sedation and has a diagnostic yield in our practice in 16.4% (data submitted). Capsule endoscopy is safe, non-invasive and well-tolerated. Furthermore, capsules to image the oesophagus are now used in routine clinical practice. We test the feasibility and safety of a novel protocol using the ESO3 upper gastrointestinal (GI) capsule (Given Imaging Ltd) which boasts an improved field of view and battery life compared to earlier models. Methods All consecutive patients undergoing investigation with the ESO3, between December 2015 and February 2016, were prospectively recruited. All patients required upper GI investigation but had declined conventional OGD ± barium studies. Patients were asked to drink 1 L of water containing simethicone prior to the procedure. They were then asked to swallow the ESO3 and adopt lying positions in 3 different directions at 3 angles (30° head down/up and horizontal) for 3 minutes each. Data on patient demographics, procedural data and patient tolerance was reviewed. Results 10 patients (mean age 49±17.3 years, 50% male) were included. Indications for the ESO3 included investigation for dyspepsia (n = 2), iron deficiency anaemia (n = 2), variceal screening (n = 3), suspected gastric Crohn’s disease (n = 1), subjective dysphagia (n = 1) and assessment of oesophageal ulcer healing (n = 1). Pathologies detected at CE included oesophagitis (n = 2), hiatus hernias (n = 3), oesophageal ulcers and erosions (n = 3), oesophageal varices (n = 3) and gastric and Cameron ulcers (n = 1, each). The mean time of the ESO3 transit in the oesophagus, stomach and small bowel was 12±9 secs, 58±27 mins, 23±22 mins respectively. The mean reading time for the capsule video was faster with the accelerated reading mode (39±18.4 mins) than with standard mode (79±14.6 mins) using the RAPID® software (p Conclusion We report the first study of a novel protocol demonstrating the feasibility and safety of the ESO3. Further protocol amendments are necessary to improve reading time and visualisation while randomised control trials are needed to compare diagnostic yield to conventional OGD. However, the excellent patient tolerance affords an alternative upper GI investigative tool worth pursuing. Disclosure of Interest None Declared

OC-021 Should the Renal Tract be Routinely Investigated in Iron Deficiency Anaemia?

Introduction Iron deficiency anaemia (IDA) accounts for 4–13% of referrals to gastroenterology. The British Society of Gastronterology IDA guidelines recommend the investigation of the gastrointestinal (GI) tract, but not the renal tract. A single consultant led one stop IDA clinic was set up. As part of the evaluation of IDA, urine microscopy and an ultrasound or CT abdomen/pelvis (if used in lower GI tract examination) were performed to investigate for renal tract malignancies, alongside GI tract investigations. We aimed to demonstrate the yield of renal and GI tract malignancies in patients with IDA. Methods Patients with IDA or isolated hypoferritinaemia attending the clinic from 2013–2015 who underwent urine microscopy and an ultrasound or CT abdomen/pelvis alongside bidirectional GI investigations (Upper GI: gastroscopy/barium swallow/CT; lower GI: colonoscopy/barium enema/CT) were analysed. We described the yield of haematuria from urine microscopy and the yield of malignancy from renal and GI tract investigations. Results A total of 196 patients had renal tract investigations alongside bidirectional GI investigations (152 urinalysis/ultrasound, 44 urinalysis/CT). 6.1% (12/196) patients had microscopic haematuria. Four renal tract cancers were found: 2 from the haematuria group and 2 from the normal urine microscopy group. In the haematuria group, 2 bladder cancers were identified by CT and cystoscopy respectively. The latter patient was asymptomatic apart from gastroesophageal reflux and had no weight loss. He had a normal gastroscopy, colonoscopy and ultrasound abdomen. A cystoscopy was performed due to the persistent haematuria, which revealed a bladder cancer. In the normal urinalysis group, CT identified 1 prostate cancer and 1 renal cell carcinoma (RCC) where both patients presented with weight loss. The yield of renal tract malignancies in this cohort was 2.0% (4/196). The yield of GI malignancy was 3.1% (6/196) from bidirectional GI investigations in the same cohort of patients. All GI malignancies identified were colorectal cancers. Conclusion The ratio of renal: GI tract malignancies was 2:3 in this cohort. Urine microscopy identified 50% of renal tract cancers. Following the standard practice of bidirectional GI investigations for IDA, the 1 case of asymptomatic bladder cancer would have been missed had urine microscopy not been performed. Routine urine microscopy is easy and cheap to perform, and should be tested in all patients with IDA, and those with haematuria should have their renal tracts investigated. Routine renal tract ultrasound in the asymptomatic IDA patient is not indicated. Disclosure of Interest None Declared

PTU-014 Relationship between Ferritin/MCV and GI Pathology in Patients Referred from Primary Care with Iron Deficiency Anaemia: Abstract PTU-014 Table 1

Introduction Iron deficiency anaemia (IDA) is common with BSG guidance suggesting Gastrointestinal (GI) blood loss from colonic or gastric cancer, and malabsorption in coeliac disease are the most important causes. 1 Serum ferritin, microcytosis and hypochromia are the most sensitive markers for iron deficiency. 2 Our objective was to investigate the correlation between MCV/ferritin and GI pathology in patients with IDA by comparing GI pathology in patients with low ferritin versus normal ferritin; and in patients with microcytosis versus normocytosis. Methods Retrospective cohort study for consecutive patients who had undergone bi-directional endoscopy and/or GI imaging to investigate unexplained anaemia were included. Data was retrieved including Hb, MCV, folate, B12, co-morbidities and findings at endoscopy, histology and imaging were recorded. Patients with normal haemoglobin as per our laboratory’s cut off were excluded. Included patients were stratified according to serum ferritin and MCV into 2 groups (low/normal) for each marker. We used the cut-off concentration as per our local laboratory (10 µg/l for ferritin and 78 FL for MCV). The outcome assessed was any GI pathology found that may explain the IDA. Data was analysed including and excluding the diagnosis of gastritis/oesophagitis as possible GI causes of anaemia. Results 265 included patients (mean age: 68; range: 16–91 years old; 124 males and 141 females) had undergone GI investigations for IDA. Of these, 84 patients had low ferritin (31.6%) whereas 181 patients had normal ferritin. GI pathology excluding gastritis/oesophagitis occurred in 40 (47.6%) and 68 (37.5%) patients in low and normal ferritin group respectively. P = 0.12. Based on MCV, 96 patients had low MCV (36.2%) whereas 169 patients had normal MCV. GI pathology occurred in 38 patients in low MCV group (39.5%) and in 70 patients with normal MCV (41.4%), P = 0.76. No differences were noted upon including gastritis/oesophagitis. Conclusion There was no clinical or statistical difference in GI pathology in patients presenting with anaemia with or without evidence of iron deficiency. Although a significant number of patients had a GI workup despite no evidence of iron deficiency, the lesion pickup was similar in both groups. Therefore, our study demonstrates the MCV/ferritin might be sensitive markers for IDA but they don’t correlate with GI pathology. References 1 Gut 2011; 60 :1309e–1316. doi:10.1136/gut.2010.228874 2 Prevalence of hypochromia vs microcytosis in iron deficiency. Clin Lab Haematol 2000; 22 :79e80. Disclosure of Interest None Declared

Introduction to the “GRG Scholars Invited Reviews”

The editors of Digestive Diseases and Sciences (DDS) and the leadership of the Gastroenterology Research Group (GRG) wish to welcome the readership of our journal to a new section entitled “GRG Scholars Invited Reviews.” In 1955, the GRG was founded by Drs. Joseph B. Kirsner, Basil I. Hirschowitz, and E. Clinton Texter in order to provide a forum for young investigators to discuss basic research problems in gastroenterology, and to focus on exchanging information and generating new ideas. In the 58 years since its inception, the GRG has maintained these goals as its primary mission. Today’s GRG promotes GI research through its support of the annual GRG Spring Symposium held during Digestive Disease Week, which features forward-looking basic research on gastrointestinal (GI) diseases. Through the sponsorship of the American Gastroenterological Association (AGA), the GRG Young Investigator awards are presented to outstanding young investigators involved in clinical and basic science GI research. The goal for the new section of DDS is to provide our readership with up-to-date reviews on research topics of special interest to all GI investigators, but in particular to young investigators engaged in basic science investigation. The invited reviews will be authored by the GRG Spring Symposium invited speakers and by our AGA/GRG young investigator awardees, who will provide scholarly and current summaries of their fields of research. To kick off this new section, we have invited Jason R. Spence, PhD, Assistant Professor of Medicine at the University of Michigan, who will deliver one of our 2013 GRG Spring Symposium lectures entitled “Directed Differentiation of Human iPS Cells into Intestine.” This excellent review addresses the latest science in the field of stem cell engineering. To promote the GRG’s mission of fostering productive interactions between senior and young investigators, we are encouraging joint submission of up–to-date and learned research reviews. We are delighted that Dr. Spence has taken us up on that offer by co-authoring his review with his research fellow, Stacey R. Finkbeiner, PhD. We look forward to publishing more learned reviews authored by the GRG symposium speakers and young investigators, and hope that you, the reader, will benefit from their outstanding content.

Guidelines for the investigation and management of mantle cell lymphoma.

The guideline group was selected to be representative of UK-based medical experts and patients representatives. Ovid MEDLINE, EMBASE and NCBI Pubmed were searched systematically for publications in English from 1980 to 2011 using the MeSH subheading 'lymphoma, mantle cell' and 'lymphoma, mantle cell' as a keyword, as well as all subheadings. In addition, all references to mantle cell lymphoma in the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissue (Swerdlow et al, 2008) and the British Committee for Standards in Haematology (BCSH) Guideline: Best Practice in Lymphoma Diagnosis and Reporting (Parker et al, 2010) have been included. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemato-oncology Task Force of the BCSH. The guideline was then reviewed by a sounding board of approximately 50 UK haematologists, the BCSH and the British Society for Haematology Committee and comments incorporated where appropriate. The 'GRADE' system was used to quote levels and grades of evidence, details of which can be found in Appendix I. The objective of this guideline is to provide healthcare professionals with clear guidance on the investigation and management of patients with mantle cell lymphoma. The guidance may not be appropriate to patients with other lymphoma sub-types and in all cases individual patient circumstances may dictate an alternative approach.

PTU-147 Structured gastroenterological evaluation and improved outcomes for patients with chronic gastrointestinal symptoms following pelvic radiotherapy

Introduction17 000 patients are treated with radical pelvic radiotherapy per year in the UK. 50% will develop chronic gastrointestinal (GI) symptoms that adversely affect quality-of-life, which have been shown to...

PTU-148 Does investigating chronic gastrointestinal symptoms following pelvic radiotherapy identify treatable diagnoses?

Introduction17 000 patients are treated with radical pelvic radiotherapy per year in the UK. Although 50% develop significant chronic gastrointestinal (GI) symptoms, <20% are referred for gastroenterological evaluation. We aimed...

Capsule endoscopy in the assessment of iron deficiency anaemia and obscure gastrointestinal bleeding

Introduction: Capsule endoscopy (CE) was introduced in the year 2000 for visualizing the gastrointestinal (GI) tract and since then it has played an important role in the assessment of patients with obscure GI bleeding (OGIB) and unexplained iron deficiency anaemia (IDA). Methods: The aim of this study was to describe the usefulness of CE in the assessment of OGIB and IDA. We analysed the demographical and medical conditions of these patients and the diagnostic yield of CE and its impact on patient management. Results: Of the 22 patients, 12 were male. Mean age was 50.7 (SD=19.6 years, Range= 20-81) years. The majority (n=11) referred were being investigated for unexplained iron deficiency anaemia. Other indications were, OGIB (n=6), melaena (n=4), malabsorption and IDA (n=1) and massive GI bleed (n=1). CE showed no abnormalities in 7, polyps and helminthiasis were identified in 2 patients each. Multiple other pathologies were also identified in the remaining. In 91.3 % (n=21) it provided new information and in 83.3% (n=20) it provided the information sought by the doctor. In 79.2% (n=19) it changed the management. Conclusion: Though the cost of CE is significantly high compared to other GI investigations, the high diagnostic yield and its impact on patient management justified its use. Key words: Anaemia; Obscure gastro intestinal bleeding; Capsule endoscopy. DOI: http://dx.doi.org/10.4038/sljs.v29i1.3578 Sri Lanka Journal of Surgery 2011: 29(1) 23-27