Center for Gastroenterology

London, United Kingdom

Center for Gastroenterology

London, United Kingdom
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Laskaratos F.-M.,Center for Gastroenterology | Laskaratos F.-M.,University College London | Wallace D.,University College London | Gkotsi D.,University College London | And 2 more authors.
Medical Education Online | Year: 2015

The ward round (WR) is a complex task and medical teachers are often faced with the challenge of finding a balance between service provision and clinical development of learners. The educational value of WRs is an under-researched area. This short communication aims to evaluate the educational role of WRs for junior trainees and provides insight into current practices. It also identifies obstacles to effective teaching/training in this setting and provides suggestions for improving the quality of WR teaching. © 2015 Faidon-Marios Laskaratos et al.

PubMed | Sheila Sherlock Education Center, Center for Gastroenterology and University College London
Type: | Journal: Medical education online | Year: 2015

The ward round (WR) is a complex task and medical teachers are often faced with the challenge of finding a balance between service provision and clinical development of learners. The educational value of WRs is an under-researched area. This short communication aims to evaluate the educational role of WRs for junior trainees and provides insight into current practices. It also identifies obstacles to effective teaching/training in this setting and provides suggestions for improving the quality of WR teaching.

Barone F.,King's College London | Vossenkamper A.,Blizard Institute of Cell and Molecular Science | Boursier L.,King's College London | Su W.,King's College London | And 7 more authors.
Gastroenterology | Year: 2011

Background & Aims: IgA contributes to homeostatic balance between host and intestinal microbiota. Mechanisms that initiate the IgA response are unclear and likely to differ between humans and animal models. We used multiple experimental approaches to investigate the origin of human intestinal plasma cells that produce IgA in the gastrointestinal tract. Methods: Complexity of IgA-producing plasma cell populations in human gastrointestinal mucosa and bone marrow and the specific response to oral cholera vaccine were compared by analysis of immunoglobulin genes. Flow cytometry, gene expression analysis, and immunohistochemistry were used to analyze signaling pathways induced by B-cell receptor engagement in human gut-associated lymphoid tissue (GALT) and involvement of innate immunity in B-cell activation in GALT compared with nonintestinal sites. Results: Human intestinal IgA-producing plasma cells appeared to be of germinal center origin; there was no evidence for the population complexity that accompanies multiple pathways of derivation observed in bone marrow. In germinal center B cells of human GALT, Btk and Erk are phosphorylated, CD22 is down-regulated, Lyn is translocated to the cell membrane, and Fos and Jun are up-regulated; these features indicate B-cell receptor ligation during germinal center evolution. No differences in innate activation of B cells were observed in GALT, compared with peripheral immune compartments. Conclusions: IgA-producing plasma cells appear to be derived from GALT germinal centers in humans. B-cell receptor engagement promotes formation of germinal centers of GALT, with no more evidence for innate immune receptor activation in the mucosa than nonintestinal immune compartments. Germinal centers in GALT should be targets of mucosal vaccinations because they are the source of human intestinal IgA response. © 2011 AGA Institute.

Mauss S.,Center for and Hepatogastroenterology | Hueppe D.,Center for Gastroenterology | Alshuth U.,Hoffmann-La Roche
Hepatology | Year: 2014

In clinical trials with telaprevir (TLV) and boceprevir (BOC) renal impairment was not reported as a relevant adverse event. The PAN study is a noninterventional study enrolling patients treated with peginterferon alfa-2a/ribavirin (PEG/RBV) with or without TVL or BOC. Here we restrict the analysis to hepatitis C virus genotype 1 patients having completed 12 (n=895) or 24 weeks (n=591) of treatment. For estimation of glomerular filtration rate (eGFR) the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was chosen. Patients on TLV 38/575 (6.6%) and BOC 10/211 (4.7%) more frequently experienced a decrease in eGFR to <60 mL/min compared to patients on PEG/RBV 1/109 (0.9%) (P<0.05). Risk factors associated with eGFR <60 mL/min in multiple logistic regression analysis were age (P<0.001), arterial hypertension (P<0.05), higher serum creatinine at baseline (P<0.001), and being on triple therapy with TLV or BOC (P<0.01). Patients with an eGFR of <60 mL/min had a lower absolute mean hemoglobin at week 12 compared to patients with an eGFR >60 mL/min (9.7 g/dL±1.4 g/dL versus 11.0 g/dL±1.7 g/dL) (P<0.001). Most patients on TLV with a decrease of eGFR <60 mL/min showed a marked improvement in renal function after discontinuation of TLV. Conclusion: Renal impairment has not been reported as a safety signal in clinical trials with TVL or BOC. However, in this large cohort including patients with risk factors for renal impairment a marked decline in renal function was observed in about 5% of patients on triple therapy. In addition to being a safety concern, substantial ribavirin dose reductions have to be considered in these patients, as anemia was more pronounced in patients with impaired renal function. © 2013 by the American Association for the Study of Liver Diseases.

Mauss S.,Center for and Hepatogastroenterology | Berger F.,Center for and Hepatogastroenterology | Schober A.,Center for Gastroenterology | Moog G.,Center for Gastroenterology | And 6 more authors.
Journal of Viral Hepatitis | Year: 2013

Autoantibodies in hepatitis C virus-infected patients may indicate autoimmune hepatitis or other immune-mediated diseases. This may impact safety and efficacy of interferon-based therapy of chronic hepatitis C. We investigated the association between a positive test result for a variety of autoantibodies and the initiation and efficacy of therapy for chronic hepatitis C. We analysed an observational cohort of 24 306 patients for an association between autoantibodies and treatment outcome. 8241 patients were tested simultaneously for antinuclear antibodies (ANA), liver kidney microsomal antibodies (LKM), smooth muscle antibodies (SMA) and antimitochondrial antibodies (AMA). Matched-pair analysis was performed matching one autoantibody-positive patient to three controls. Control patients had negative tests for all four antibodies. Analyses were performed for patients with a single positive autoantibody test and for patients with multiple positive autoantibody tests. A positive test result for ANA, LKM, SMA or AMA did not affect the physician's decision to initiate therapy with pegylated interferon and ribavirin. In addition, a positive test for one or multiple autoantibodies did not adversely affect sustained virologic response. There was no difference in fibrosis stage or alanine transaminase at baseline or during therapy irrespective of antibody status. Thyroid dysfunction was more frequent in patients with positive LKM antibodies (P = 0.004). Initiation of therapy for chronic hepatitis C and outcome were not affected by the presence of ANA, LKM, SMA or AMA. Routine testing of these autoantibodies seems not warranted. Determination of autoantibodies should be guided by individualized clinical decisions. © 2012 Blackwell Publishing Ltd.

PubMed | Teine Keijinkai Medical Center, Center for Gastroenterology and Hokkaido University
Type: | Journal: BMC neurology | Year: 2015

Extraintestinal manifestations in Crohns disease (CD) are frequent and well recognized. However, neurological involvement secondary to CD is rare, and there have been few histologically confirmed cases of cerebral vasculitis secondary to CD.A 58-year-old left-handed man with a history of refractory CD who had fever of over 38 C, progression of CD symptoms, and Gerstmanns syndrome consulted our hospital. Laboratory data showed elevation of C-reactive protein (CRP) and hypoproteinemia. T2-weighted magnetic resonance imaging (MRI) revealed a right parietal high-intensity lesion. Catheter angiography showed segmental multiple narrowing and occlusion in the distal part of the middle cerebral artery and anterior cerebral artery. Angiography also revealed multiple venous occlusions in the affected parietal area. To confirm the diagnosis, the patient underwent open biopsy, and histological examination revealed cerebral vasculitis. The patient was then started on high-dose prednisolone (60 mg/day) in addition to his previous therapy, which included mesalazine, adalimumab, and azathioprine. CRP elevation, hypoproteinemia, and gastrointestinal symptoms immediately improved after starting this treatment. Neurological status improved simultaneously with CD symptom improvement, and follow-up brain MRI revealed a reduction in the size of the right parietal lobe lesion. He returned to normal status and was discharged from our hospital 5 weeks after admission.This is an important case of histologically confirmed cerebral vasculitis associated with CD. The clinical course of our case clearly illustrates the relevance of the occurrence of cerebral vasculitis and the exacerbation of CD.

Gomes M.,London School of Hygiene and Tropical Medicine | Aldridge R.W.,University College London | Wylie P.,Center for Gastrointestinal Radiology | Bell J.,Center for Gastrointestinal Radiology | Epstein O.,Center for Gastroenterology
Applied Health Economics and Health Policy | Year: 2013

Background: When symptomatic gastroenterology patients have an indication for colonic imaging, clinicians have a choice between optical colonoscopy (OC) and computerized tomography colonography with three-dimensional reconstruction (3-D CTC). 3-D CTC provides a minimally invasive and rapid evaluation of the entire colon, and it can be an efficient modality for diagnosing symptoms. It allows for a more targeted use of OC, which is associated with a higher risk of major adverse events and higher procedural costs. A case can be made for 3-D CTC as a primary test for colonic imaging followed if necessary by targeted therapeutic OC; however, the relative long-term costs and benefits of introducing 3-D CTC as a first-line investigation are unknown. Aim: The aim of this study was to assess the cost effectiveness of 3-D CTC versus OC for colonic imaging of symptomatic gastroenterology patients in the UK NHS. Methods: We used a Markov model to follow a cohort of 100,000 symptomatic gastroenterology patients, aged 50 years or older, and estimate the expected lifetime outcomes, life years (LYs) and quality-adjusted life years (QALYs), and costs (£, 2010-2011) associated with 3-D CTC and OC. Sensitivity analyses were performed to assess the robustness of the base-case cost-effectiveness results to variation in input parameters and methodological assumptions. Results: 3D-CTC provided a similar number of LYs (7.737 vs 7.739) and QALYs (7.013 vs 7.018) per individual compared with OC, and it was associated with substantially lower mean costs per patient (£467 vs £583), leading to a positive incremental net benefit. After accounting for the overall uncertainty, the probability of 3-D CTC being cost effective was around 60 %, at typical willingness-to-pay values of £20,000-£30,000 per QALY gained. Conclusion: 3-D CTC is a cost-saving and cost-effective option for colonic imaging of symptomatic gastroenterology patients compared with OC. © 2013 Springer International Publishing Switzerland.

PubMed | Center for Gastroenterology and University College London
Type: Case Reports | Journal: Clinical and experimental rheumatology | Year: 2015

Gastrointestinal (GI) disease is one of the major causes of morbidity in patients with systemic sclerosis (SSc). The most common manifestation of GI disease is oesophageal involvement affecting 70-90% of patients. Severe GI disease is uncommon, but results in symptoms such as early satiety, pseudo-obstruction, weight loss and malnutrition. The pathogenesis is relatively poorly understood, and management focuses on symptomatic control rather than immunomodulation.We describe two cases of patients with SSc myositis overlap syndrome with severe GI involvement who demonstrated improvements in swallowing, early satiety and diarrhoea following the administration of intravenous immunoglobulin (IVIg).Clinical data related to the two cases were collected by review of medical records.GI complications range from mild symptoms to debilitating and life threatening. We propose that IVIg may have an immunomodulatory effect in a subset of patients with SSc myositis overlap syndrome.

Previous studies indicate significant variations in the rates of colorectal cancer between countries in the world as well as between individual regions within the same country. Differences in the incidence of colorectal cancer may be due to known risk factors and active measures of a country through screening programs. The goal of this study was to show the difference in the incidence of colorectal cancer among different districts in Serbia. In this paper we used the most recent data on the incidence and mortality of colorectal cancer in the world that were available to the International Agency for Research on Cancer (IARC) as well as the latest published data of the Institute of Public Health of Serbia "Milan Jovanovic Batut". This paper presents the agestandardized incidence rates of colorectal cancer in the districts in Serbia in 2010. It is shown that Serbia has one of the highest incidences of colorectal cancer worldwide for men. The highest rates of incidence of colorectal carcinoma in Serbia are found in districts that are more economically developed than others. The difference in the incidence of colorectal cancer may be due to the known risk factors that go with the so-called "westernization", such as the diet rich in high-calorie foods, obesity, physical inactivity and smoking. The data indicate that in Serbia, especially in the districts with a high incidence rate of colorectal cancer, some of the screening programs for early detection should be applied, as well as a public health measures to change the habits that are associated with the appearance of colorectal cancer.

News Article | October 28, 2016

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