35 research outputs found
British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025
No full textIn response to recent advancements in inflammatory bowel disease (IBD) management, the British Society of Gastroenterology (BSG) Clinical Services and Standards Committee (CSSC) has commissioned the BSG IBD section to update its guidelines, last revised in 2019. These updated guidelines aim to complement the IBD standards and promote the use of the national primary care diagnostic pathway for lower gastrointestinal symptoms to enhance diagnostic accuracy and timeliness. Formulated through a systematic and transparent process, this document reflects a consensus of best practices based on current evidence. The guideline, while developed primarily for the UK, is structured to support IBD management internationally. It is endorsed by the BSG executive board and CSSC without external commercial funding, with involvement primarily supported through professional roles in public institutions and the National Health Service (NHS). Methodological revisions since the prior guidelines have enhanced rigor in technical review and development, with methodology details published independently following peer review. In developing the recommendations, 89 clinical experts and stakeholders participated in an online survey, identifying primary outcomes, such as clinical and endoscopic remission, as well as adverse event metrics, all stratified by clinically relevant effect sizes. These guidelines are intended to support clinical decision-making but are not prescriptive, recognizing that individual clinical scenarios may warrant tailored approaches. Further research may inform future revisions as new evidence emerges
Systematic review: The impact of inflammatory bowel disease-related fatigue on health-related quality of life
No full textBACKGROUND: Fatigue is frequently reported in inflammatory bowel disease (IBD) and impacts on health-related quality of life (HRQoL). HRQoL has not been systematically reviewed in IBD fatigue., AIM: To investigate what impact IBD fatigue has on HRQoL in adults with IBD., METHODS: Systematic searches (CINAHL, EMBASE, PsychINFO, Medline) were conducted on 25 September 2018, restricted to 'human', 'adult', 'primary research' and 'English language'. Search terms encompassed concepts of 'fatigue', 'IBD' and 'HRQoL'. A 5-year time limit (2013-2018) was set to include the most relevant publications. Publications were screened, data extracted and quality appraised by two authors. A narrative synthesis was conducted., RESULTS: Eleven studies were included, presenting data from 2823 participants. Fatigue experiences were significantly related to three HRQoL areas: symptom acceptance, psychosocial well-being and physical activity. Patients reporting high fatigue levels had low symptom acceptance. Psychosocial factors were strongly associated with both fatigue and HRQoL. Higher social support levels were associated with higher HRQoL. Physical activity was impaired by higher fatigue levels, lowering HRQoL, but it was also used as a means of reducing fatigue and improving HRQoL. Quality appraisal revealed methodological shortcomings in a number of studies. Notably, use of multiple measures, comparison without statistical adjustment and fatigue and HRQoL assessment using the same tool were some of the methodological shortcomings., CONCLUSION: Psychosocial factors, symptom management and acceptance and physical activity levels have significant impact on HRQoL. Results support application of psychosocial or exercise interventions for fatigue management. Further exploration of HRQoL factors in IBD fatigue is required, using validated fatigue and HRQoL measures., PROSPERO REGISTRATION NUMBER: CRD42018110005. Copyright © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.https://dx.doi.org/10.1136/flgastro-2019-10135
Opportunities for research in gastroenterology and hepatology nursing
No full textPatients have better outcomes through engaging in research and being treated in hospitals or NHS Trusts with active research programmes. The role of research nurses is diverse and multifactorial, calling on clinical expertise alongside research, project management, and communication skills. Nurse researchers undertake their own research, usually as part of their job or academic progression. Opportunities for research and research funding come from a range of sources, and social media may be the best way to monitor projects and calls for participants.https://www.bsg.org.uk/web-education-articles-list/nurse-articles/opportunities-for-research-in-gastroenterology-and-hepatology-nursing
Connect on campus
No full textNews and professional development from the committee of the British Society of Gastroenterology Nurses' Associationhttps://dx.doi.org/10.12968/gasn.2021.19.1.
Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies
No full textBACKGROUND: Fatigue is the inability to achieve or maintain an expected work output resulting from central or peripheral mechanisms. The prevalence of inflammatory bowel disease (IBD) fatigue can reach 86% in active disease, persisting in 50%-52% of patients with mild to inactive disease. Fatigue is the commonest reason for work absence in IBD, and patients often report fatigue burden to be greater than that of primary disease symptoms. Relatively few evidence-based treatment options exist, and the aetiology is poorly understood., AIM: To review the available data and suggest a possible aetiology of IBD fatigue and to consider the efficacy of existing management strategies and highlight potential future interventions., METHODS: We reviewed fatigue-related literature in IBD using PubMed database., RESULTS: Disease related factors such as inflammation and pharmacological treatments negatively impact skeletal muscle and brain physiology, likely contributing to fatigue symptoms. Secondary factors such as malnutrition, anaemia, sleep disturbance and psychological comorbidity are potential determinants. Immune profile, faecal microbiota composition and physical fitness differ significantly between fatigued and non-fatigued patients, suggesting these may be aetiological factors. Solution-focused therapy, high-dosage thiamine supplementation and biological therapy may reduce fatigue perception in IBD. The effect of physical activity interventions is inconclusive., CONCLUSIONS: A multimodal approach is likely required to treat IBD fatigue. Established reversible factors like anaemia, micronutrient deficiencies and active disease should initially be resolved. Psychosocial intervention shows potential efficacy in reducing fatigue perception in quiescent disease. Restoring physical deconditioning by exercise training intervention may further improve fatigue burden. Copyright © 2021 John Wiley & Sons Ltd.https://dx.doi.org/10.1111/apt.1646
Nurse and patient perspectives on participating in research: Experience of an inflammatory bowel disease fatigue study
No full textThe challenges, priorities and benefits of running and volunteering in clinical research studies, according to a specialist nurse and patient volunteer in a Nottingham-based study on fatigue in Crohn's diseasehttps://dx.doi.org/10.12968/gasn.2020.18.9.1
Clinical utility of small bowel ultrasound assessment of Crohn's disease in adults: A systematic scoping review
No full texthttps://dx.doi.org/10.1136/flgastro-2021-10189
Ultrasound use to assess Crohn’s disease in the UK: a survey of British Society of Gastroenterology Inflammatory Bowel Disease Group members
No full textBackground: Small bowel ultrasound has very good diagnostic accuracy for disease extent, presence and activity in Crohn's Disease, is well tolerated by patients and is cheaper when compared with MRI. However, uptake of ultrasound in the UK is limited. Methods: An online survey to assess the current usage of ultrasound throughout the UK was undertaken by BSG IBD group members between 9/06/2021-25/06/2021. Responses were anonymous. Results: 103 responses were included in the data analysis. Responses came from 66 different NHS trusts from 14 different regions of the UK. All respondents reported that they currently have an MRI service for Crohn's disease, whereas only 31 had an ultrasound service. Average time for results to be reported for MRI scans was reported as between 4-and 6 weeks, with a range of 2 days to 28 weeks. The average time for an ultrasound to be reported was stated as 1-4 weeks, with a range of 0-8 weeks. There was disparity between the reported confidence of clinicians making clinical decisions when using ultrasound compared to MRI. Of those respondents who did not have access to an ultrasound service, 72 stated that they would be interested in developing an ultrasound service. Conclusion: There is an appetite for the uptake of ultrasound in the UK for assessment of Crohn's disease, however, there remains a significant number of UK centres with little or no access to an ultrasound service. Further research is necessary to understand why this is the case
Ambulatory care management of 69 patients with acute severe ulcerative colitis in comparison to 695 inpatients: insights from a multicentre UK cohort study
No full textIntroduction Acute severe ulcerative colitis (ASUC) traditionally requires inpatient hospital management for intravenous therapies and/or colectomy. Ambulatory ASUC care has not yet been evaluated in large cohorts.Aims We used data from PROTECT, a UK multicentre observational COVID-19 inflammatory bowel disease study, to report the extent, safety and effectiveness of ASUC ambulatory pathways.Methods Adults (≥18 years old) meeting Truelove and Witts criteria between 1 January 2019–1 June 2019 and 1 March 2020–30 June 2020 were recruited to PROTECT. We used demographic, disease phenotype, treatment outcomes and 3-month follow-up data. Primary outcome was rate of colectomy during the index ASUC episode. Secondary outcomes included corticosteroid response, time to and rate of rescue or primary induction therapy, response to rescue or primary induction therapy, time to colectomy, mortality, duration of inpatient treatment and hospital readmission and colectomy within 3 months of index flare. We compared outcomes in three cohorts: (1) patients treated entirely in inpatient setting; ambulatory patients subdivided into; (2) patients managed as ambulatory from diagnosis and (3) patients hospitalised and subsequently discharged to ambulatory care for continued intravenous steroids.Results 37% (22/60) participating hospitals used ambulatory pathways. Of 764 eligible patients, 695 (91%) patients received entirely inpatient care, 15 (2%) patients were managed as ambulatory from diagnosis and 54 (7%) patients were discharged to ambulatory pathways. Aside from younger age in patients treated as ambulatory from diagnosis, no significant differences in disease or patient phenotype were observed. The rate of colectomy (15.0% (104/695) vs 13.3% (2/15) vs 13.0% (7/54), respectively, p=0.96) and secondary outcomes were similar among all three cohorts. Stool culture and flexible sigmoidoscopy were less frequently performed in ambulatory cohorts. Forty per cent of patients treated as ambulatory from diagnosis required subsequent hospital admission.Conclusions In a post hoc analysis of one of the largest ASUC cohorts collected to date, we report an emerging UK ambulatory practice which challenges treatment paradigms. However, our analysis remains underpowered to detect key outcome measures and further studies exploring clinical and cost-effectiveness as well as patient and physician acceptability are needed.Trial registration number NCT04411784
Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life
No full textBackground: Fatigue is frequently reported in inflammatory bowel disease (IBD) and impacts on Health-Related Quality of Life (HRQoL). HRQoL has not been systematically reviewed in IBD fatigue. Aim: To investigate what impact IBD fatigue has on HRQoL in adults with IBD.Methods: Systematic searches (CINAHL, EMBASE, PsychInfo, Medline) were conducted 25.09.2018, restricted to ‘human’, ‘adult’, ‘primary research’ and ‘English language’. Search terms encompassed concepts of ‘Fatigue’, ‘IBD’ and ‘HRQoL’. A 5 year time limit (2013-2018) was set to include the most relevant publications. Publications were screened, data extracted, and quality appraised by two authors. A narrative synthesis was conducted.Results: Eleven studies were included, presenting data from 2823 participants. Fatigue experiences were significantly related to three HRQoL areas: symptom acceptance, psychosocial wellbeing, and physical activity. Patients reporting high fatigue levels had low symptom acceptance. Psychosocial factors were strongly associated with both, fatigue and HRQoL. Higher social support levels were associated with higher HRQoL. Physical activity was impaired by higher fatigue levels, lowering HRQoL, but it was also used as a means of reducing fatigue and improving HRQoL. Quality appraisal revealed methodological shortcomings in a number of studies. Notably use of multiple measures, comparison without statistical adjustment and fatigue and HRQoL assessment using the same tool
