Luminal Gastroenterology Research Articles

Tofacitinib in Steroid-Refractory Acute Severe Ulcerative Colitis: A Retrospective Analysis.

Steroid-refractory acute severe ulcerative colitis (ASUC) patients are at the highest risk of colectomy. Among the available options, cyclosporine and infliximab have similar efficacy but infliximab is a costly drug and cyclosporine has multiple side effects like kidney injury, neurotoxicity, and dyselectrolytemia.Surgical management is often associated with higher morbidity. Newer oral small molecules like Janus kinase inhibitors are the ideal molecules to bridge the gap. Tofacitinib has already been extensively evaluated in patients with moderate to severe UC; however, data on ASUC treated by tofacitinib are limited. We retrospectively analyzed the data of patients with ASUC who were admitted to our hospital's luminal gastroenterology unit between January 2021 and July 2023. Patients with ASUC who were managed with tofacitinib were included in the study. Eight patients with ASUC were identified who did not respond to intravenous hydrocortisone and were treated with tofacitinib.The mean age was 39 ± 15 years and 87.5% were female. The median duration of illness was 24 months (interquartile range (IQR): 12-120 months).Seven of eight patients (87.5%) responded to oral tofacitinib 10 mg twice a day by the fifth day of treatment. The median follow-up period was six months (IQR: 1-12 months). One patient required colectomy and one patient had varicella zoster reactivation requiring treatment discontinuation. Tofacitinib is an attractive alternative to the currently available salvage therapy for steroid-refractory ASUC;however, long-term efficacy and risk remain to be explored.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Social Media and Research Publication Activity During Early Stages of the COVID-19 Pandemic: Longitudinal Trend Analysis.

BackgroundThe COVID-19 pandemic has highlighted the importance of rapid dissemination of scientific and medical discoveries. Current platforms available for the distribution of scientific and clinical research data and information include preprint repositories and traditional peer-reviewed journals. In recent times, social media has emerged as a helpful platform to share scientific and medical discoveries.ObjectiveThis study aimed to comparatively analyze activity on social media (specifically, Twitter) and that related to publications in the form of preprint and peer-reviewed journal articles in the context of COVID-19 and gastroenterology during the early stages of the COVID-19 pandemic.MethodsCOVID-19–related data from Twitter (tweets and user data) and articles published in preprint servers (bioRxiv and medRxiv) as well as in the PubMed database were collected and analyzed during the first 6 months of the pandemic, from December 2019 through May 2020. Global and regional geographic and gastrointestinal organ–specific social media trends were compared to preprint and publication activity. Any relationship between Twitter activity and preprint articles published and that between Twitter activity and PubMed articles published overall, by organ system, and by geographic location were identified using Spearman’s rank-order correlation.ResultsOver the 6-month period, 73,079 tweets from 44,609 users, 7164 journal publications, and 4702 preprint publications were retrieved. Twitter activity (ie, number of tweets) peaked in March 2020, whereas preprint and publication activity (ie, number of articles published) peaked in April 2020. Overall, strong correlations were identified between trends in Twitter activity and preprint and publication activity (P<.001 for both). COVID-19 data across the three platforms mainly concentrated on pulmonology or critical care, but when analyzing the field of gastroenterology specifically, most tweets pertained to pancreatology, most publications focused on hepatology, and most preprints covered hepatology and luminal gastroenterology. Furthermore, there were significant positive associations between trends in Twitter and publication activity for all gastroenterology topics (luminal gastroenterology: P=.009; hepatology and inflammatory bowel disease: P=.006; gastrointestinal endoscopy: P=.007), except pancreatology (P=.20), suggesting that Twitter activity did not correlate with publication activity for this topic. Finally, Twitter activity was the highest in the United States (7331 tweets), whereas PubMed activity was the highest in China (1768 publications).ConclusionsThe COVID-19 pandemic has highlighted the potential of social media as a vehicle for disseminating scientific information during a public health crisis. Sharing and spreading information on COVID-19 in a timely manner during the pandemic has been paramount; this was achieved at a much faster pace on social media, particularly on Twitter. Future investigation could demonstrate how social media can be used to augment and promote scholarly activity, especially as the world begins to increasingly rely on digital or virtual platforms. Scientists and clinicians should consider the use of social media in augmenting public awareness regarding their scholarly pursuits.

A prospective single centre pilot evaluation of a serum calprotectin assay in unselected GI patients

BackgroundWhilst C-reactive protein (CRP) is an established serum marker of inflammation, its use in gastroenterology has been limited by its poor sensitivity and specificity for GI disease. Faecal calprotectin (FC) has been adopted into mainstream GI practice as a sensitive but non-specific marker of intestinal inflammation. However, stool samples collection for FC can be challenging and the possibility of utilising a sensitive and specific serum biomarker of intestinal inflammation in luminal gastroenterology is an attractive prospect. This work investigates the performance of serum calprotectin (SC) compared to current biomarkers, FC and CRP, in an unselected cohort of patients attending our GI unit. MethodsPatients attending in and outpatients within an adult GI service who submitted a stool sample for FC analysis were identified. A total of 109 who had a serum sample obtained within one day of stool sample collection had the serum analysed for CRP and SC and the correlation between these biomarkers was investigated. ResultsThe intraclass correlation coefficient (ICC) between SC, FC and CRP was 0.10, 95% CI −0.09–0.28 and 0.18, 95% CI −0.01–0.35, respectively. The ICC between FC and CRP was 0.18, 95% CI −0.01–0.35. ConclusionsOur data reveals that there is no significant correlation between SC and FC, nor between SC and CRP in a large unselected cohort of GI patients. Therefore, as a serum biomarker for intestinal inflammation, SC is unlikely to be of clinical utility and the search for an appropriate serum GI biomarker continues.

PTU-128 Prevalence and Management of Irritable Bowel Syndrome Seen in Colorectal Surgery and Gastroenterology Clinics

Introduction Irritable bowel syndrome (IBS) in the UK accounts for a large proportion of patients seen in secondary care. Pathways to the diagnosis of IBS are not standardised, and patients are often reviewed outside a luminal Gastroenterology service. We examined the burden of IBS in both Colorectal Surgery and Gastroenterology clinics. Methods All patients seen with IBS in either Gastroenterology (GE) or Colorectal Surgery (CS) clinics over a 1 month period January to February 2014 at Leeds Teaching Hospitals NHS Trust were identified. The following data were retrospectively recorded: age/sex of the patient, investigations prior to diagnosis, number of visits to that speciality clinic, number and type of medications prescribed, and final placement of the patient. We compared management of patients in both settings using a Chi-squared test. Results There were a total of 76 patients with IBS seen in CS clinics (mean age 49.6 years, 39 (51.3%) female) and 57 patients in GE clinics (mean age 39.1 years, 39 (68.4%) female). The number and type of investigations requested prior to diagnosis are detailed in Table 1. In CS clinics, colonic imaging (colonoscopy, sigmoidoscopy or barium enema) was requested in 70 (92.1%) patients, compared with 39 (68.4%) patients in GE clinics (P = 0.001). Cross-sectional imaging was utilised in 36 (47.4%) patients in CS clinics, compared with 19 (33.3%) patients in GE clinics (P = 0.15). Serological testing for coeliac disease was not performed in 22 (29.9%) patients in CS clinics, and 5 (8.8%) patients in GE clinics (P = 0.008). For the CS clinic patients the mean number of visits was 2.7 (range 1–14) with 22 (28.95%) patients offered prescribed therapy. In the GE clinic patients the mean number of visits was 2.5 (range 1–5), with 43 (75.4%) patients offered prescribed therapy (P Conclusion These data highlight the need for a more consistent referral process, and a more specialised approach to the management of this patient group. This should be based on current guidelines for the management of IBS using evidence-based treatments and with easy access to dietetic, psychological, and specialist nurse support. Disclosure of Interest None Declared

The Morbidity and Mortality Conference in Gastroenterology and Hepatology: An Important Cornerstone of Patient Safety and Optimal Care

The morbidity and mortality (M&M) conference has evolved considerably in recent years. M&M was originally developed by surgeons and anesthesiologists to investigate negative “end results.” M&Ms were intended to be an open discussion promote and enhance patient safety, and to be engaged in projects to improve systems of care, decrease health care disparities and improve patient outcomes. Incorporation of these varied objectives and principles has led to a variety of innovations in M&M conferences that have been reported widely in general and emergency medicine, oncology, surgery, pediatrics, and obstetrics. The result is an evolution of the traditional M&M into a comprehensive and dynamic Quality and Patient Outcomes (QPO) conference, which fosters QI, patient safety, and medical education. The combination of high-volume diverse procedures, inpatient and outpatient clinical practice, and integration of hepatology and luminal gastroenterology each

Mike Stroud: exploring nutrition at the limits of endurance

Mike Stroud: exploring nutrition at the limits of endurance

Prevalence of functional gastrointestinal disorders among consecutive new patient referrals to a gastroenterology clinic

ObjectiveFunctional gastrointestinal disorders (FGIDs) are common in the community. Many patients will consult a physician in primary care, but the burden that these diseases represent to secondary care has not...

Practice-Owned Pathology Services: Controversies and Pitfalls—The Use of Special Stains

The US Government Accountability Office (GAO) released a study on June 24, 2013, calling for “action” to address higher use of anatomic pathology services by providers who “self-refer” (ie, those that have ownership positions in pathology labs). The report suggested that profit and not science drove utilization, including that of special stains. The relationship between luminal gastroenterology and pathology has been close since the beginning of flexible endoscopy and is inherent to excellent patient care and management.

Probiotics in luminal gastroenterology: the current state of play

In recent years, there has been a growing interest in the use of probiotics in various areas of gastrointestinal (GI) health. Probiotics are defined as live microorganisms that provide beneficial health effects on the host when administered in adequate amounts. Various probiotics have been shown to suppress bacterial growth, modulate the immune system and improve intestinal barrier function. However, despite several studies with promising results, most trials are small and many have substantial methodological limitations. However, with better targeting and appropriate randomised controlled trials, this area may soon yield important therapeutic strategies to optimise GI health. Here, we review the current knowledge of probiotics of relevance to luminal GI health.

The Indian Journal of Gastroenterology: looking ahead at the next five years

The Indian Journal of Gastroenterology was launched 30 years ago, in 1982, as the official publication of the Indian Society of Gastroenterology and with Dr Bhupendra J Vakil as the Editor. Over the years, there have been different Editors at the helm including Dr F P Antia, Dr S R Naik and Dr Philip Abraham. The last 5 years, under the Chief Editorship of Dr Shobna Bhatia, has witnessed a major change in the nature and content of the Journal. The tie-upwith Springer has been a landmark for the Journal making it more visible internationally. While the Journal continues to aim at its primary readership, i.e. the members of the Indian Society of Gastroenterology, medicine and science do not know any boundaries and the Journal will need to provide the evidence base and the review articles that will serve gastroenterologists in practice in India and internationally. There has been a proliferation of Journals in the last decade and specialty journals such as the Indian Journal of Gastroenterology now have an increasing number of competitors. Journals will survive only so long as they reinvent themselves. In doing so, it is important to retain our core values while taking advantage of new technology to keep upwith the times. The Journal belongs to the Indian Society of Gastroenterology and we wish to reach out to the members of the Society and hear their views on how we may improve the Journal. The space in the Journal is limited and thus we will need to be selective in our acceptance of manuscripts. In 2011, a total of 328 manuscripts were submitted, of which 210 originated from India. Our acceptance rate in that year was 32 %. As expected, manuscript rejection decisions were made fairly rapidly and the average time to a final decision of rejection was 44 days. On the other hand, acceptance decisions were often made after one to three revisions and hence the time to final acceptance was 217 days. As the new Editor-in-Chief, it is my major priority to ensure that there is rapid review and decision on submitted manuscripts. Alongside this, the Editorial board and the publishers are committed to providing a more transparent review process and we are in continuous dialog with the publishers to provide tracking of the process on the website. Accepted manuscripts are usually published via Springer’s Online Firstservice. They have a Digital Object Identifier (DOI) number and are citable in a few weeks after acceptance. The online publication date is accepted as the official date of publication. Being online makes these articles visible to the professional readership around the world, and the articles are downloadable for those who are interested in accessing them. In 2011, there were a total of 8,902 full-text downloads from the Journal’s collection with Springer. Of the top ten downloads from the Journal, five were articles published in 2011, four in 2012 and one in 2009. Fifty-one percent of the download requests originated from the Asia Pacific, 26 % from Europe and 19 % from North America. About a half of the full-text article requests were from abstracting and indexing services. Table of Content alerts are sent out by email to interested readers. It has been a pleasure and privilege to serve as Editor (Luminal Gastroenterology) for the last 5 years along with Dr Rakesh Aggarwal the Editor (Hepatology) and Dr Shobna Bhatia as the Editor-in-Chief. I would like to use this opportunity to acknowledge the many changes that were brought about in the Journal during Dr Bhatia’s editorship. Mr Marian D’Souza has done a sterling job at the Journal’s office in Mumbai and will continue to manage this office and remain involved from the time of manuscript submission through proof reading and uploading on to the online edition of the Journal. As the Journal moves forward we need to utilize to our best advantage the new paradigms continuously being invented to further communication in science and medicine. We hope that members of the Society and the readership of this Journal will be with us and constantly guide us along this journey. Indian J Gastroenterol (May–June 2012) 31(3):102 DOI 10.1007/s12664-012-0232-y

PMO-019 Evaluation of evidence-based recommendations in current British society of gastroenterology guidelines

IntroductionClinical practice guidelines aim to improve patient care. They are based on best available evidence and are frequently viewed as “gold-standard” care for the disease or intervention that they address....

* Is there a role for faecal elastase-1 in patients referred to a luminal gastroenterology service?

IntroductionPancreatic disease can be subtle particularly in the early stages and therefore may be missed. Symptoms of pancreatic disease are not specific and therefore patients may present to gastrointestinal (GI)...

Who is at risk of coeliac disease? Prospective case finding in a luminal gastroenterology service

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I wish to become a hepatologist. Is there training in the United Kingdom for this alone or must I also study luminal gastroenterology and internal medicine?

I wish to become a hepatologist. Is there training in the United Kingdom for this alone or must I also study luminal gastroenterology and internal medicine?

Advances in nutrition and gastroenterology: summary of the 1997 A.S.P.E.N. Research Workshop.

The 1997 A.S.P.E.N. Research Workshop was held at the annual meeting in San Francisco, on January 26, 1997. The workshop focused on advances in clinical and basic research involving the interface between nutrient and luminal gastroenterology. Presentations on the genetic regulation of gastrointestinal development, the molecular biology of small intestinal adaptation, the effect of nutrition support on intestinal mucosal mass, the relationship between nutrition and gastrointestinal motility, nutrient absorption, and gastrointestinal tract substrate metabolism were made by the preeminent leaders in the field. The investigators presented an insightful analysis of each topic by reviewing data from their own laboratories and the published literature. This workshop underscored the important interactions between nutrition and luminal gastroenterology at the basic science, metabolic/physiologic, and clinical levels. The integration of presentations from the different disciplines provided a unique interaction of information and ideas to advance our understanding of nutrition and gastrointestinal tract.