Type of publication:
Journal article
Author(s):
Little S.; Tawn J.; Khalil G.; Hardasani R.; Radford S.; Das D.; Peerally M.F.;
Citation:
Frontline Gastroenterology. (no pagination), 2025. Article Number: flgastro-2024-102952. Date of Publication: 2025 [epub ahead of print]
Abstract:
Link to full-text [NHS OpenAthens account required]
Type of publication:
Conference abstract
Author(s):
Kumar A.; Baxter J.; Rimmer P.; Noble B.; Makki M.; Chikhlia A.; Cheesbrough J.; Disney B.; *Muir J.; Karova M.; *Butterworth J.; Bower J.; Sagar N.; Al-Talib I.; Nahal J.; Hatta A.; Ali N.; Sagar V.; Varyani F.; Smith S.; Bourne S.; Hsu Y.K.; Eltahir A.; De silva S.; Harvey P.;
Citation:
Journal of Crohn's and Colitis. Conference: 20th Congress of ECCO. Berlin Germany. 19(Supplement 1) (pp i2143), 2025. Date of Publication: 01 Jan 2025.
Abstract:
Background: Tofacitinib, filgotinib and upadacitinib are JAK inhibitors (JAKi) that are licensed for treatment in moderate to severe ulcerative colitis (UC). Whilst these drugs have demonstrated efficacy against placebo, there is no head-to-head data. This study aims to compare the clinical efficacy between these drugs.
Method(s): This is a multi-centred, retrospective cohort study with data collected from January 2018 to June 2024. Patients with UC were recruited on their first JAKi, irrespective of previous advanced therapies. Clinical remission (faecal calprotectin (FCP) <250, Mayo 1, UCEIS 1, pMayo 2, SCCAI 2) and response (50% reduction in FCP from baseline, reduction in partial Mayo or UCEIS by 3 or more, or sustained <3) was measured at 3- and 6-months. If a patient stopped taking JAKi, they were considered to have failed both response and remission. Data was non-parametric and outcome measures were compared using Chi-squared tests.
Result(s): There was a total of 266 patients included in the final analysis. 70 (26%) were on upadacitinib, 47 (18%) on filgotinib and 149 (56%) on tofacitinib (Table 1). At least 87% (129/149) on tofacitinib had exposure to a previous biologic compared to 80% (56/70) for upadacitinib and 66% (31/47) for filgotinib. At 3-months, clinical response in upadacitinib, filgotinib and tofacitinib was demonstrated in 83%, 74% and 75% patients, respectively and clinical remission was seen in 69%, 64% and 52%, respectively. At 6-months, clinical response was demonstrated in 79%, 65% and 63%, respectively and remission was seen in 75%, 61% and 51%, respectively. Upadacitinib demonstrated significantly higher 3-months remission rate (p=0.019) and 6-months response (p=0.010) and remission rates (p= 0.001) compared to tofacitinib. In the bio-exposed cohorts, upadacitinib demonstrated greater 6-months remission rates (71%) compared to 64% on filgotinib (p=NS) and 52% tofacitinib (p= 0.022). In bio-naive cohorts (n=50), upadacitinib demonstrated greater 6-months remission rates (93%) compared to 56% on filgotinib (p=0.024) and 50% tofacitinib (p= 0.009). Combining the JAKi, 90% of patients were not on steroids at 3-months and 94% were not on steroids at 6-months. A total of 26 patients had a colectomy at the time of their JAKi, 17 on tofacitinib, 5 on filgotinib and 4 on upadacitinib.
Conclusion(s): This study demonstrates that upadacitinib is more likely to achieve 3- and 6-month remission compared to tofacitinib. In a small subgroup of bio-naive patients Upadacitinib was more likely to achieve 6-month remission compared to filgotinib and tofacitinib. JAKi were associated with minimal adverse events and importantly, the efficacy of JAKi does not appear diminished by prior biologic use.
Link to full-text [no password required]
Type of publication:
Conference abstract
Author(s):
Bodger K.; Booker C.; Kok K.; Lobo A.; Ahmad T.; Bloom S.; *Butterworth J.; Irving P.; Cummings F.
Citation:
Journal of Crohn's and Colitis. Conference: 19th Congress of the European Crohn's and Colitis Organisation, ECCO 2024. Stockholm Sweden. 18(Supplement 1) (pp i1775-i1777), 2024. Date of Publication: January 2024.
Abstract:
Background: The characteristics and outcomes of patients treated with vedolizumab in routine healthcare settings have not been widely evaluated in the UK. Method(s): Prospective, multicentre observational study of 364 patients started on vedolizumab in UK practice from January 2017 until February 2019 using the UK IBD Registry clinical web-based tool. For the present analysis, the primary outcome was drug survival (persistence) at 1-year, defined as attendance for infusion >=48 weeks after the first dose. Secondary outcomes were: Clinical remission (CR, based on partial Mayo score [<=1] or Harvey Bradshaw index [<=4]), physician global assessment (PGA), IBD-Control Questionnaire (IBD-Control-8, IBD-Control-VAS and individual item scores), laboratory parameters and adverse events. Result(s): Age (mean): 44 yrs; Males: 48%; IBD duration (mean): 6 yrs; Prev. resection: 18%; Steroids at baseline: 39%; Outcomes are summarized in Table 1. 37% of CD patients were assessed as being in clinical remission at baseline. Overall, 210 (58%) continued treatment beyond 48 weeks. At 1 year, 67.1% and 52.3% of CD and UC patients were in clinical remission with a clear improvement in QoL as assessed by IBD-Control -8. There were significant improvements across each IBD-Control-8 domain, including fatigue, with few patients considering switching treatment at that point (Figure 1). Conclusion(s): Vedolizumab was effective in clinical practice with 58% of patients remaining on treatment at one-year. Baseline status differed significantly from those recruited into RCTs. Patient reported outcomes demonstrated significant and meaningful improvements across physical, psychological, social and treatment domains.
Link to full-text [no password required]
Type of publication:
Journal article
Author(s):
Mohamedahmed, Ali Yasen; Hamid, Mohammed; Issa, Mohamed; Albendary, Mohamed; *Sultana, Emiko; Zaman, Shafquat; Bhandari, Santosh; Sarma, Diwakar; *Ball, William; Thomas, Pradeep; Husain, Najam.
Citation:
International Journal of Colorectal Disease. 39(1):184, 2024 Nov 18.
Abstract:
INTRODUCTION: Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management.
METHODS: A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a
12-month period (January – December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4.
RESULTS: A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM).
CONCLUSION: Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.
Link to full-text (open access - no password required)
Type of publication:
Journal article
Author(s):
Hughes M.; *Harrison E.; Herrick A.L.; Lal S.; McLaughlin J.T.
Citation:
Journal of Scleroderma and Related Disorders. (no pagination), 2024. Date of Publication: 2024.
Abstract:
Objective: Assessment of gastrointestinal and autonomic symptoms in patients with systemic sclerosis, and possible associations with gastric emptying rate. Method(s): Participant and patient disease-related characteristics were collected. Gastrointestinal and autonomic symptoms were assessed by the UCLA-SCTC GIT 2.0 and COMPASS-31 questionnaires, respectively. Potentially confounding gastrointestinal medications were discontinued where possible. Gastric emptying was assessed using a non-radioactive <sup>13</sup>C sodium acetate isotope, end-expiratory breath samples collected at baseline and then serial timepoints up to 120 min. Result(s): In total, 49 participants were studied: 17 with systemic sclerosis with variable gastrointestinal involvement, and healthy matched (n = 17) and non-matched controls (n = 15), the last to control for the impact of age rather than disease on gastric emptying and autonomic function. The total mean (range) UCLA GIT 2.0 questionnaire for patients with systemic sclerosis was 0.63 (0.0-1.5) and for both healthy matched and non-matched controls was 0.04 (0.0-0.2), and was higher in patients with systemic sclerosis across all domains. The total mean (range) COMPASS-31 score for patients with systemic sclerosis patients was 32.2 (0.0-54.9) and for healthy matched- and non-matched controls: 7.45 (0.0-24.9) and 4.25 (0.0-2.1), respectively, again higher for patients with systemic sclerosis across all domains. No association was observed between patients' UCLA GIT 2.0 total score (s = -0.039, p = 0.38), total COMPASS 31 score (s = -0.108, p = 0.68), or COMPASS-31 GI domain (s = -0.051, p = 0.85) and gastric emptying rates. Conclusion(s): Gastrointestinal and autonomic symptoms are overrepresented in patients with systemic sclerosis but did not associate with gastric emptying rates.
Link to full-text [open access - no password required]
Type of publication:
Conference abstract
Author(s):
Shah A.; Kelly S.; Powell S.; Henderson N.; Jackson T.; Richardson S.; *Ball A.; Livett H.; Murugananthan A.
Citation:
Gut. Conference: British Society of Gastroenterology Congress, BSG 2024. Birmingham United Kingdom. 73(Supplement 1) (pp A237-A238), 2024. Date of Publication: June 2024.
Abstract:
Introduction Non-technical skills impact clinical outcomes and team performance.1 Endoscopy team behaviours have been mapped to 5 categories, 16 elements and 47 behavioural descriptors via a national DELPHI process (Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills-TEAM-ENTS).1 Training in non-technical skills can improve team performance.2 A pilot simulation based TEAMENTS course was devised and piloted. Methods Faculty with prior training and experience in delivering ENTS focused simulation courses agreed objectives and designed scenarios. Faculty agreement extended the training offer to administrative and clerical teams. Participating teams from 3 Trusts provided teams of 4 participants (endoscopist, 2 workforce and 1 administration). Senior staff also attended from participating sites as observers. Pre and post course evaluation was via electronic questionnaires, analysed with Wilcoxon signed rank test. Results Teams members were endoscopists (band 7 Clinical Endoscopists), nurse workforce members [band 7 (1), band 5 (4) and band 2 (1)] and 3 admin team members. 5 observers also attended (2 Consultants and 3 band 6 nurses). Delegate and pooled course attendee data is displayed in table 1. All participants felt the scenarios were realistic and strongly agreed (87%) or agreed (13%) the course would change their practice. All delegates expressed they would have been comfortable working in different teams and they would recommend the course to others. Conclusions Delegates and observers expressed high background knowledge levels of all parameters of TEAM-ENTS categories resulting in little improvement with post course scores. Confidence in the ability to display categories of TEAM ENTS showed improvement in delegates as well as all attendees including observers. Further pilot courses will continue to shape this novel training offer.
Link to full-text [no password required]
Type of publication:
Service improvement case study
Author(s):
*Shriya Begum
Citation:
SaTH Improvement Hub, July 2024
Abstract:
To improve patient education post diagnosis of Barrett’s Oesophagus by June 2024 as evidenced by all new patients with an initial diagnosis of Barrett’s Oesophagus to be offered a follow-up clinic appointment within 6 weeks of their diagnosis, as per NICE guidelines (NG231)
Type of publication:
Service improvement case study
Author(s):
*Margaret Meredith
Citation:
SaTH Improvement Hub, August 2024
Abstract:
To identify patients that have had a previous diagnosis of Barrett’s Oesophagus and offer a service that is compliant with NICE guidelines (2023).
Type of publication:
Journal article
Author(s):
Kumar, Aditi; Quraishi, Mohammed Nabil; Al-Hassi, Hafid O; Elasrag, Mohammed; Segal, Jonathan P; Jain, Manushri; Steed, Helen; *Butterworth, Jeffrey; Farmer, Adam; Mclaughlin, John; Beggs, Andrew D; Brookes, Matthew J.
Citation:
Inflammatory Bowel Diseases. 31(2):539-551, 2025 Feb 10.
Abstract:
BACKGROUND: While surgery plays a pivotal role in the management of ileal Crohn's disease, the risk of endoscopic recurrence following an ileocaecal resection can be greater than 65% within 12 months of surgery. More than 90% of patients with Crohn's disease have a concomitant diagnosis of bile acid diarrhea following an ileal resection. This pilot study aimed to assess whether the use of bile acid sequestrants in patients with Crohn's disease who have undergone a primary terminal ileal resection with concomitant bile acid diarrhea can alter the microbiome and prevent disease recurrence. METHODS: Patients with Crohn's disease who underwent a primary terminal ileal resection and had symptoms of diarrhea within 1-3 months of surgery underwent 75SeHCAT testing for bile acid diarrhea. If positive (75SeHCAT <= 15%), patients were treated with colesevelam and stool samples were collected at 4 weeks, 8 weeks, and 6-12 months posttreatment. If negative (75SeHCAT > 15%), treatment was not given and were reviewed in the clinic as per local guidelines. All patients underwent a 6-12 month postoperative colonoscopy where further stool samples and mucosal biopsies were taken. Disease activity was established using the endoscopic Rutgeert's score, with disease remission defined as Rutgeert's score <i2 and disease recurrence >=i2. 16S ribosomal RNA gene analysis was undertaken for the collected fecal and mucosal samples to assess alpha/beta-diversity and microbial composition. RESULTS: A total of 14 patients who completed the study, 10 of whom had a 75SeHCAT positive diagnosis of bile acid diarrhea and were started on treatment with colesevelam. Four patients did not require treatment as 3 were asymptomatic and 1 had a negative 75SeHCAT scan. Three of the fourteen patients had disease recurrence at their 6-12 month postoperative colonoscopy assessment, of which 1 patient was taking colesevelam and 2 patients were not taking colesevelam. A total of 44 fecal samples and 44 mucosal biopsies underwent 16S ribosomal RNA gene analysis to assess alpha/beta-diversity and microbial composition. In the colesevelam treated patients there was no significant difference in alpha/beta-diversity pre- and posttreatment. Pretreatment, the 3 most abundant bacterial classes in all patients were Bacteroidia, Clostridia, and Gammaproteobacteria. Following 6-12 months of treatment, out of the 9 patients on colesevelam, 5/9 (55.6%) had a reduction in Bacteroidia, 9/9 (100%) had an increase in Clostridia, and 7/9 (77.8%) had a reduction in Gammaproteobacteria. Of the 2 patients not given colesevelam, one showed a reduction in Bacteroidia, increase in Clostridia and a reduction in Gammaproteobacteria. CONCLUSIONS: This small pilot study demonstrated that patients who were given colesevelam, were more likely to be in disease remission at their 6-12 months colonoscopy review compared with those not treated. Furthermore, treatment with colesevelam may have a role in altering the microbiome to help maintain remission states in postoperative Crohn's disease. Larger mechanistic studies are now needed to confirm these findings and demonstrate statistical significance as well as investigate whether this benefit may be present even in those patients with 75SeHCAT negative disease.
Altmetrics:
Type of publication:
Journal article
Author(s):
Gilani S.S.; *Shahzeb M.; Salman D.M.; Nadeem M.; Khan S.; Thomas J.J.; Almesri A.
Citation:
Journal of Population Therapeutics and Clinical Pharmacology. 31(8) (pp 853-858), 2024. Date of Publication: 01 Aug 2024.
Abstract:
Background and Aim: Gastrointestinal stomas main function is to divert the flow away from a difficult anastomoses or intestinal obstruction. There is now a trend toward avoiding permanent stomas, and temporary loop stomas often used to protect anastomotic or distal bowel segments in high-risk patients. The present study aimed to determine the morbidity-mortality after ileostomy or colostomy closure. Patients and Methods: This comparative observational study investigated 42 cases of ileostomy and colostomy closure in the Surgical Unit of Jinnah Hospital, Lahore from January 2020 to January 2024. Patients were divided into two groups; Group-I (Ileostomy closure) and Group-II (Colostomy closure). Demographic details such as age and gender, Clinical details such as indications, types of stoma technique used, and operative times, length of hospital stay, morbidity, and mortality recorded. SPSS version 26 was used for data analysis. Result(s): The overall mean age was 46.8+/-6.52 years (15-75 years). Out of 42 cases, 28 (66.7%) underwent ileostomy and 14 (33.3%) underwent colostomy closure. The most prevalent indication for closure was protection of anastomosis in both stoma groups. The interval between creation and closure of stoma was shorter (117.8 days) in Group-I than Group-II (162.4 days). The incidence of hand sewing sutures and stapled technique was 32 (76.2%) and 10 (23.8%), respectively. The Group-II patients took 107.9+/-5.24 minutes as operative time which was significantly higher than 82.96+/-8.84 minutes in Group-I. The prevalence of morbidity in Group-I and Group-II was 10.7% (n=3) and 14.3% (n=2), respectively. Prolong hospital stay was required in Group-II. No mortality case reported in both stoma groups. Conclusion(s): The present study observed that Stomatal closure well tolerated procedure, with low morbidity and mortality. The results suggest that ileostomy closure is a relatively simple procedure.
Link to full-text [open access - no password required]
Shrewsbury and Telford Hospital NHS Trust has an active Research and Innovation Department.
Find out more by visiting either the R&I Intranet pages (only available on a Trust PC) or the R&I pages on the SaTH website.
Shrewsbury and Telford Hospital NHS Trust has an active Improvement Hub.
Find out more by visiting either the Improvement Hub Intranet pages (only available on a Trust PC) or the Improvement Hub page on the SaTH website.