Gastroenterology
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Research outputs from the Gastroenterology department at the RD&E.
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Item Management of intraoperatively identified small bile duct stones in patients undergoing cholecystectomy(Springer, 2024-02-01) Bunting, D.; Adesuyi, A.; Findlay, J.; Pawlak, M.; Sanders, D.INTRODUCTION: The management of CBDS (common bile duct stones) in patients with co-existing gallbladder stones has been debated. Guidelines recommend patients with CBDS identified on imaging should be offered duct clearance; however, this is based on low-quality evidence. This study aimed to investigate the natural history of small CBDS identified using IOUS (intraoperative ultrasound) in patients undergoing cholecystectomy. This may provide evidence to support a short-term expectant management approach in such patients. METHODS: Patients with CBDS diagnosed on IOUS during cholecystectomy were identified from a database of consecutive patients undergoing surgery. Patients with CBDS identified were divided into small stone (SS, =5 mm) and large stone (LS, >5 mm) groups. Intraoperative CBDS management, postoperative investigations, postoperative bile duct clearance, re-admissions, complications, length of stay (LOS) and follow-up are described. RESULTS: Fifty-nine of 427 patients had CBDS identified on IOUS. In the SS group (n=51), 46 patients underwent short-term expectant management rather than immediate/planned bile duct clearance. Following short-term expectant management, 41/46 patients (89.1%) did not require postoperative endoscopic retrograde cholangiopancreatography and at >3 year follow-up, none has since presented with residual CBDS. Median LOS was 0 days in the short-term expectant management group and 2 days in the immediate/planned bile duct clearance group, P=0.039. CONCLUSIONS: This study reports the natural history of small CBDS identified on IOUS in patients undergoing cholecystectomy. Such patients were safely treated with short-term expectant management associated with a reduced hospital LOS. This provides rationale for undertaking further research to establish this as a preferred management strategy.Item Opioid use and associated factors in 1676 patients with inflammatory bowel disease: a multicentre quality improvement project(BMJ, 2023-06-01) Baillie, S.; Limdi, J. K.; Bassi, A.; Fraser, A.; Parkes, G.; Scott, G.; Raine, T.; Lamb, C. A.; Kennedy, N. A.; Fumis, N.; Smith, M. A.; Nicolaou, A.; Emms, H.; Wye, J.; Lehmann, A.; Carbery, I.; Goodhand, J.; Lees, R.; Beshyah, W.; Luthra, P.; Pollok, R.; Selinger, C.OBJECTIVE: Despite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the associated factors and the use of mitigation techniques such as pain-service review and opioid weaning plans among individuals with IBD. METHODS: Data were collected from consecutive patients attending IBD outpatient appointments at 12 UK hospitals. A predefined questionnaire was used to collect data including patient demographics, IBD history, opioid use in the past year (>2 weeks) and opioid-use mitigation techniques. Additionally, consecutive IBD-related hospital stays leading up to July 2019 were reviewed with data collected regarding opioid use at admission, discharge and follow-up as well as details of the admission indication. RESULTS: In 1352 outpatients, 12% had used opioids within the past 12 months. Over half of these individuals were taking opioids for non-IBD pain and less than half had undergone an attempted opioid wean.In 324 hospitalised patients, 27% were prescribed opioids at discharge from hospital. At 12 months postdischarge, 11% were using opioids. Factors associated with opioid use in both cohorts included female sex, Crohn's disease and previous surgery. CONCLUSIONS: 1 in 10 patients with IBD attending outpatient appointments were opioid exposed in the past year while a quarter of inpatients were discharged with opioids, and 11% continued to use opioids 12 months after discharge. IBD services should aim to identify patients exposed to opioids, reduce exposure where possible and facilitate access to alternative pain management approaches.Item The importance of high-quality 'big data' in the application of artificial intelligence in inflammatory bowel disease(BMJ, 2023-11-01) Ashton, J. J.; Brooks-Warburton, J.; Allen, P. B.; Tham, T. C.; Hoque, S.; Kennedy, N. A.; Dhar, A.; Sebastian, S.Item What defines an incisional hernia as 'complex': results from a Delphi consensus endorsed by the European Hernia Society (EHS)(Wiley, 2023-10-28) Capoccia Giovannini, S.; Podda, M.; Ribas, S.; Montori, G.; Botteri, E.; Agresta, F.; Sartori, A.; Chàrvàtova, H.; Aiolfi, A.; Antoniou, S. A.; Arvieux, C.; Berrevoet, F.; Boermeester, M. A.; Campanelli, G.; Chintapatla, S.; Christoffersen, M. W.; Dahlstrand, U.; De la Croix, H.; Dietz, U. A.; Ferreira, A.; Fortenly, R. H.; Gaarder, C.; Garcia Urena, M. A.; Gok, H.; Hernández-Granados, P.; Jisova, B.; Laver, O.; Lerchuk, O.; Lopez-Cano, M.; Mega, M.; Mitura, K.; Muysoms, F.; Oliva, A.; Ortenzi, M.; Petersson, U.; Piccoli, M.; Radu, V. G.; Renard, Y.; Rogmark, P.; Rosin, D.; Senent-Boza, A.; Simons, M.; Slade, D.; Smart, N.; Smith, S. R.; Stabilini, C.; Theodorou, A.; Torkington, J.; Vironen, J.; Woeste, G.; De Beaux, A.; East, B.Item Antibody responses to Influenza vaccination are diminished in patients with inflammatory bowel disease on infliximab or tofacitinib(Oxford University Press, 2023-11-06) Liu, Z.; Alexander, J. L.; Eng, K. Y.; Ibraheim, H.; Anandabaskaran, S.; Saifuddin, A.; Constable, L.; Seoane, R. C.; Bewshea, C.; Nice, R.; D'Mello, A.; Jones, G. R.; Balarajah, S.; Fiorentino, F.; Sebastian, S.; Irving, P. M.; Hicks, L. C.; Williams, H. R. T.; Kent, A. J.; Linger, R.; Parkes, M.; Kok, K.; Patel, K. V.; Teare, J. P.; Altmann, D. M.; Boyton, R. J.; Hart, A. L.; Lees, C. W.; Goodhand, J. R.; Kennedy, N. A.; Pollock, K. M.; Ahmad, T.; Powell, N.BACKGROUND AND AIMS: We sought to determine whether six commonly used immunosuppressive regimens were associated with lower antibody responses after seasonal influenza vaccination in patients with IBD. METHODS: We conducted a prospective study including 213 IBD patients and 53 healthy controls; 165 who had received seasonal influenza vaccine and 101 who had not. IBD medications included infliximab, thiopurines, infliximab and thiopurine combination therapy, ustekinumab, vedolizumab or tofacitinib. The primary outcome was antibody responses against influenza/A H3N2 and A/H1N1, compared to controls, adjusting for age, prior vaccination and interval between vaccination and sampling. RESULTS: Lower antibody responses against influenza A/H3N2 were observed in patients on infliximab (Geometric Mean Ratio 0.35 [95% CI 0.20-0.60], p=0.0002), combination of infliximab and thiopurine therapy (0.46 [0.27-0.79], p=0.0050) and tofacitinib (0.28 [0.14-0.57], p=0.0005) compared to controls. Lower antibody responses against A/H1N1 were observed in patients on infliximab (0.29 [0.15-0.56], p=0.0003), combination of infliximab and thiopurine therapy (0.34 [0.17-0.66], p=0.0016), thiopurine monotherapy (0.46 [0.24-0.87], p=0.017) and tofacitinib (0.23 [0.10-0.56], p=0.0013). Ustekinumab and vedolizumab were not associated with reduced antibody responses against A/H3N2 or A/H1N1. Vaccination in the previous year was associated with higher antibody responses to A/H3N2. Vaccine-induced anti-SARS-CoV-2 antibody concentration weakly correlated with antibodies against H3N2 (r=0.27; p=0.0004) and H1N1 (r=0.33; p<0.0001). CONCLUSIONS: Vaccination in both the 2020-2021 and 2021-2022 seasons was associated with significantly higher antibody responses to influenza/A than no vaccination or vaccination in 2021-2022 alone. Infliximab and tofacitinib are associated with lower binding antibody responses to Influenza/A, similar to COVID-19 vaccine-induced antibody responses.