70 research outputs found
The Role of the Human Gut Microbiome in Inflammatory Bowel Disease and Radiation Enteropathy
No full textThe human gut microbiome plays a key role in regulating host physiology. In a stable state, both the microbiota and the gut work synergistically. The overall homeostasis of the intestinal flora can be affected by multiple factors, including disease states and the treatments given for those diseases. In this review, we examine the relatively well-characterised abnormalities that develop in the microbiome in idiopathic inflammatory bowel disease, and compare and contrast them to those that are found in radiation enteropathy. We discuss how these changes may exert their effects at a molecular level, and the possible role of manipulating the microbiome through the use of a variety of therapies to reduce the severity of the underlying condition
P341 Systematic review and meta-analysis: prevalence of organic gastrointestinal conditions in patients with irritable bowel syndrome
No full textSupplementary Material for a Systematic Review and Meta-Analysis on the Prevalence of Alternative Non-Malignant, Organic GI Disorders in Patients with IBS-type Symptoms
No full textSupplementary Material for a Systematic Review and Meta-Analysis on the Prevalence of Alternative Non-Malignant, Organic GI Disorders in Patients with IBS-type Symptom
Kirsten ras mutation in colorectal adenocarcinoma: prognostic indicator & molecular target
No full text
Markers, Markers Everywhere . . . . . Prognosis in Colorectal Cancer—Time for a New Approach
No full textPWE-037 Diagnosis and management of bile acid diarrhoea: UK consensus survey of expert opinion and practice FREE
No full textIntroduction Bile acid diarrhoea (BAD), including bile acid malabsorption (BAM), causes a variety of digestive symptoms and is increasingly recognised, although diagnostic rates and management vary considerably. The UK Bile Acid Related Diarrhoea Network (UK-BARDN), established in 2017, conducted a survey of current practice to provide a review of expert opinion and guidance on diagnosis and management.
Methods An on-line survey was sent at the end of 2018 to 21 clinical members of UK-BARDN, who had all published research on BAD.
Results A response rate of 100% was obtained. 95% were NHS Consultants; 85% estimated they had diagnosed over 50 patients with the condition. BAD was the terminology preferred by 57%, with another 29% using BAD or BAM depending on the clinical circumstances. Primary and secondary were the preferred terms to classify the different causes.
A wide range of presenting symptoms and associated conditions were recognised. SeHCAT was the preferred diagnostic test, with a therapeutic trial the second choice. Access to SeHCAT by GPs was thought appropriate by 50%, with greater availability of specific blood tests in hospitals. SeHCAT would usually be requested (>70%) in patients who met the diagnostic criteria for functional diarrhoea, IBS-D, or post-cholecystectomy diarrhoea, and sometimes be requested (>30%) in other types of IBS, and in Crohn’s disease with ileal resection and negative inflammatory markers, where a therapeutic trial was also commonly used.
Treatment with a bile acid sequestrant (BAS) would always be given if SeHCAT was 70%, falling to 30% in these groups. Colestyramine was the usual first line BAS, with starting doses varying between 2 g od and 4 g bd. Colesevelam was also used. There was a slight preference to give the drug at bedtime. Warnings about drug interactions were usual. In patients who had an incomplete response, increasing the dose, changing to an alternative BAS, increasing use of drugs such as loperamide, and advice on a low fat (40 g/d) diet were commonly recommended. During follow-up, annual review by a specialist or GP, patient support groups, dietetic and pharmacist review, and monitoring of blood vitamins and lipids were given varying importance. To improve the overall patient experience, greater recognition by various professional groups and in the popular press, with improved diagnosis and drugs, were considered important.
Conclusions This expert consensus provides a basis for current best practice in the diagnosis and management of patients with BAD
Developing advanced clinical practice skills in gastrointestinal consequences of cancer treatment
No full text This article explores the transition from a clinical nurse specialist (CNS) towards developing advanced clinical practice skills within a gastrointestinal consequences of cancer clinic. It presents data on the first 50 patients assessed by the CNS from a prospective service evaluation, demonstrating how this informed the nurse's future learning. There is high demand for advanced clinical practice skills to address unmet health needs and improve the quality, efficiency, and sustainability of healthcare services. However, a literature review found no literature on developing advanced clinical practice skills in this setting. Emerging themes from the service evaluation focused on barriers and enablers, ongoing support, organisational commitment and working in a multidisciplinary team. Blended learning provided both structured and opportunistic learning, embedding both formal and tacit knowledge, as roles require increasing flexibility. Clinical supervision and reflective practice were key in maintaining professional and peer support. </jats:p
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