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Hoyle A, Gillett P, Gillett HR, Borg R, Nottley S, Farrow S, Elgoweini M, Elhassan M, Fletcher J, Whannel G, Gracie E, Morgan S, Jafferbhoy H, Dunbar L, Reid G, Metcalfe EL, Smith G, Harris S, Robertson C, Thomas M, Younger H, Furrie E. No-biopsy strategy for coeliac disease is applicable in adult patients: a 'real-world' Scottish experience. Frontline Gastroenterol 2022; 14:97-102. [PMID: 36818788 PMCID: PMC9933599 DOI: 10.1136/flgastro-2022-102254] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/29/2022] [Indexed: 02/24/2023] Open
Abstract
Objective Emergency interim guidance from the British Society for Gastroenterology (BSG) states that a no-biopsy strategy is possible to diagnose coeliac disease (CD) in adults with elevated transglutaminase IgA antibody (TGA-IgA) levels. We aimed to determine if the suggested TGA-IgA ≥10× ULN is safe and robust in making the diagnosis in adult patients in Scotland. We also aimed to establish if any important co-diagnoses would be missed if no biopsy was performed. Method All positive coeliac serology results for patients aged >15 years in Scotland in 2016 (Grampian 2019) were accessed. Data were collected on demographics, TGA-IgA titres, D1 sampling, histology and macroscopic findings at upper and lower gastrointestinal (GI) endoscopy. Results 1037/1429 patients with positive serology proceeded to biopsy, of which 796/1037 (76.8%) were diagnosed as CD. A total of 320/322 (99.37%) patients with TGA-IgA ≥10× ULN were diagnosed as CD giving the cut-off a positive predictive value of 99.38%. No significant co-pathology was found at endoscopy in these patients. Conclusion Our results show that a no-biopsy strategy using a cut-off of TGA-IgA ≥10× ULN is safe to diagnose CD and that no important pathology would be missed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition 2020 and BSG COVID-19 interim guidelines are applicable to adult patients in Scotland.
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Affiliation(s)
- Aoisha Hoyle
- Department of Pathology, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Peter Gillett
- Department of Paediatric Gastroenterology, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, UK
| | - Helen R Gillett
- Department of Gastroenterology, St John's Hospital, NHS Lothian, Edinburgh, UK
| | - Reuben Borg
- Department of Pathology, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Steven Nottley
- Department of Pathology, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Samantha Farrow
- Department of Gastroenterology, St John's Hospital, NHS Lothian, Edinburgh, UK
| | - Maha Elgoweini
- Department of Pathology, University Hospital Crosshouse, NHS Ayrshire and Arran, Ayr, UK
| | - Mohamed Elhassan
- Department of Pathology, University Hospital Crosshouse, NHS Ayrshire and Arran, Ayr, UK
| | - Jonathan Fletcher
- Department of Gastroenterology, Borders General Hospital, NHS Borders, Melrose, UK
| | - Gemma Whannel
- Department of Gastroenterology, Dumfries and Galloway Royal Infirmary, NHS Dumfries and Galloway, Dumfries, UK
| | - Edel Gracie
- Department of Gastroenterology, Dumfries and Galloway Royal Infirmary, NHS Dumfries and Galloway, Dumfries, UK
| | - Sarah Morgan
- Department of Gastroenterology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Hasnain Jafferbhoy
- Department of Gastroenterology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Laura Dunbar
- Department of Pathology, Forth Valley Royal Hospital, NHS Forth Valley, Stirling, UK
| | - Gordon Reid
- Department of Pathology, Forth Valley Royal Hospital, NHS Forth Valley, Stirling, UK
| | - Emma L Metcalfe
- Department of Digestive Disorders, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Graeme Smith
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sarah Harris
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Calum Robertson
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Moira Thomas
- Department of Immunology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Hazel Younger
- Department of Gastroenterology, Raigmore Hospital, NHS Highland, Inverness, UK
| | - Elizabeth Furrie
- Department of Immunology Laboratory Services, Ninewells Hospital, NHS Tayside, Dundee, UK
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Rashid M, Clyde D, Driscoll PJ, Jafferbhoy H. SP5.1.7 What did we miss? A 5 - year retrospective cohort study calculating the endoscopy miss rate for UGI cancers in a Scottish district general hospital. Br J Surg 2021. [DOI: 10.1093/bjs/znab361.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Despite the widespread use of endoscopy, upper gastrointestinal (UGI) cancers still present at an advanced stage. As survival is closely linked to stage and time of diagnosis, failure to detect subtle precancerous changes at endoscopy may compound poor prognoses. This study calculates the miss rate of UGI cancer over a 5-year period at a district general hospital.
Methods
All patients diagnosed with UGI cancer between January 2015 - December 2019 were identified from a prospectively collected cancer registry. Electronic health records and Unisoft GI reporting tool were used to identify patient demographics and previous UGI endoscopies. ‘Missed cancers’ were defined as patients who had a normal endoscopy within 3 years of their cancer diagnosis.
Results
The median age at diagnosis was 72.2 years (age range 24 - 98, n = 408) with a male predominance of 2:1 (66.6% male vs 33.4% female) in keeping with UK statistics.
Within this 5 year study period, there were 22 missed cancers (5.4%, n = 408).
A year by year break down shows miss rate in 2015 of 3% ( 3,n=100), 2016 of 4.2% (5,n=120), 2017 5.5% (5,n=91), 2018 6.4% (6,n=94) and most recently in 2019 3.2% (3,n=94).
Conclusions
In 2014, a meta-analysis by S.Menon et al recorded a miss rate of 11.3%. More recently published UK studies report miss rates between 6% - 7.3%, more in keeping with our local rate of 5.4%. Further assessment is required to assess whether the 2017 BSG and AUGIS UGI endoscopy quality standard statement will improve this rate.
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Affiliation(s)
- M Rashid
- NHS Fife, General Surgery
- East of Scotland Deanery, Singapore
| | - D Clyde
- NHS Fife, General Surgery
- IST in East of Scotland Deanery, Singapore
| | - P J Driscoll
- NHS Fife, Combined GI Unit, Victoria Hospital Kirkcaldy, Singapore
| | - H Jafferbhoy
- NHS Fife, Combined GI Unit, Victoria Hospital Kirkcaldy, Singapore
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Plevris N, Fulforth J, Siakavellas S, Robertson A, Hall R, Tyler A, Jenkinson PW, Campbell I, Chuah CS, Kane C, Veryan J, Lam WL, Saunders J, Kelly C, Gaya D, Jafferbhoy H, Macdonald JC, Seenan JP, Mowat C, Naismith G, Potts LF, Sutherland DI, Watts D, Arnott I, Bain G, Jones G, Lees CW. Real-world effectiveness and safety of ustekinumab for the treatment of Crohn's disease: the Scottish ustekinumab cohort. J Gastroenterol Hepatol 2021; 36:2067-2075. [PMID: 33381875 DOI: 10.1111/jgh.15390] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/06/2020] [Accepted: 12/20/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM Ustekinumab is a monoclonal antibody that targets interleukin-12/23. In Scotland, it was approved for the treatment of moderate to severe Crohn's disease in 2017. The objective of this study was to establish the real-world effectiveness and safety of ustekinumab in the treatment of Crohn's disease. METHODS We conducted a retrospective study of patients receiving ustekinumab across eight Scottish National Health Service health boards between 2017 and 2019. Inclusion criteria included a diagnosis of Crohn's disease with symptoms attributed to active disease plus objective signs of inflammation at baseline (C-reactive protein ≥ 5 mg/L or fecal calprotectin ≥ 250 μg/g or inflammation on endoscopy/magnetic resonance imaging) and completion of induction plus at least one clinical follow-up at 8 weeks. Kaplan-Meier survival analysis was used to establish 12-month cumulative rates of clinical remission, mucosal healing, deep remission, and perianal fistula response. Rates of serious adverse events were described quantitatively. RESULTS Our cohort consisted of 216 patients (female sex, 37.9%; median age, 39.0 years, interquartile range [IQR] 28.8-51.8 years; disease duration, 9.9 years, IQR 6.0-16.5 years; prior biologic, 98.6%) with a median follow-up of 35.0 weeks (IQR 17.4-52.0 weeks). Twelve-month cumulative rates of clinical remission, mucosal healing, and deep remission (clinical remission plus mucosal healing) were 32.0%, 32.7%, and 19.3%, respectively. In patients with active perianal disease (n = 37), the 12-month cumulative perianal response rate was 53.1%. The serious adverse event rate was 13.6 per 100 patient-years of follow-up. CONCLUSION Ustekinumab is a safe and effective treatment for the treatment of complex Crohn's disease.
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Affiliation(s)
- Nikolas Plevris
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - James Fulforth
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | | | - Andrew Robertson
- Department of Gastroenterology, University Hospital Hairmyres, East Kilbride, UK
| | - Rebecca Hall
- Department of Gastroenterology, Ninewells Hospital, Dundee, UK
| | - Amy Tyler
- Department of Gastroenterology, Raigmore Hospital, Inverness, UK
| | | | - Iona Campbell
- Department of Gastroenterology, Royal Alexandra Hospital, Paisley, UK
| | - Cher Shiong Chuah
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.,Department of Gastroenterology, Victoria Hospital, Kirkcaldy, UK
| | - Claire Kane
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Jennifer Veryan
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Wai Liam Lam
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Jayne Saunders
- Department of Gastroenterology, University Hospital Hairmyres, East Kilbride, UK
| | - Christopher Kelly
- Department of Gastroenterology, Forth Valley Royal Hospital, Larbert, UK
| | - Daniel Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Jonathan C Macdonald
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - John Paul Seenan
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital, Dundee, UK
| | - Graham Naismith
- Department of Gastroenterology, Royal Alexandra Hospital, Paisley, UK
| | - Lindsay F Potts
- Department of Gastroenterology, Raigmore Hospital, Inverness, UK
| | | | - David Watts
- Department of Gastroenterology, Forth Valley Royal Hospital, Larbert, UK
| | - Ian Arnott
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Gillian Bain
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Gareth Jones
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Charlie W Lees
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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Jafferbhoy H, Miller MH, Dunbar JK, Tait J, McLeod S, Dillon JF. Intravenous drug use: not a barrier to achieving a sustained virological response in HCV infection. J Viral Hepat 2012; 19:112-9. [PMID: 22239500 DOI: 10.1111/j.1365-2893.2011.01446.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) is commonly transmitted by intravenous drug use (IDU) but drug users are under represented in many treatment cohorts, this is because of the assumption of lowered treatment success. We assessed HCV treatment outcomes in active intravenous drug users and patients on opiate substitution therapy. The Tayside HCV treatment database was retrospectively analysed for consecutively treated patients based on risk factor for acquisition of HCV. Primary end point was sustained virological response (SVR). Two hundred and ninety-one consecutively treated patients were assessed. The overall SVR rate was 55.3%. The SVR rates by risk factor were; Non-IDU 61.4%, Ex-IDU 54.8% and Active IDU 47.1% (P = n/s). In the groups G1 patients SVR was; Non-IDU 52.7%, Ex-IDU 30.7% and active IDU 35.4% (P = n/s). In the non-G1 patients: non-IDU 65.1%, Ex-IDU 76.7% and active IDU 53.5%. Ex-IDU had a significantly better SVR than active IDU, other differences were not significant. Our results demonstrate that SVR rates in the active drug users and those on opiate substitution therapy can be achieved which are comparable with non-IDU infected individuals. Intravenous drug use in those engaged with treatment services should not be seen as a barrier to treatment of HCV.
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Affiliation(s)
- H Jafferbhoy
- Gut Group, Biomedical Research Institute, University of Dundee, Dundee, UK.
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Jafferbhoy H, Miller MH, El Wahed Z, Dillon JF. Pre-treatment prediction of response to pegylated-interferon plus ribavarin for chronic hepatitis C using RVR. J Hepatol 2011; 55:1162-4; author reply 1164-6. [PMID: 21740939 DOI: 10.1016/j.jhep.2011.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 04/04/2011] [Indexed: 12/04/2022]
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Jafferbhoy H, Gashau W, Dillon J. Cost effectiveness and quality of life considerations in the treatment of hepatitis C infection. Clinicoecon Outcomes Res 2010; 2:87-96. [PMID: 21935317 PMCID: PMC3169967 DOI: 10.2147/ceor.s7283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Indexed: 12/12/2022] Open
Abstract
Chronic hepatitis C1 is a common cause of liver disease worldwide. It is a slow and progressive condition which can lead to decompensated cirrhosis and hepatocellular carcinoma. Hepatitis C virus1 impairs quality of life (QOL) even in the absence of chronic liver disease, but its relative silent nature can lead to a delay in diagnosis. The current standard of care of treatment is pegylated interferon and ribavarin. This achieves a sustained virological response (SVR), which is a cure of infection, in up to 80% of patients depending on viral genotype. The attainment of SVR improves survival, avoids long-term complications, and improves QOL. But treatment is not only expensive; there are issues of tolerability and adverse effects. This has led to a multitude of cost effective analysis and health technology assessment on HCV treatment. This overview discusses the natural history of the virus infection and its effect on the patients’ QOL. It focuses on the treatment options available, their efficacy, and cost effectiveness. It reviews the evaluations that suggest combination therapy is cost effective and explores the assumptions and limitations of these studies in real world treatment arenas.
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Affiliation(s)
- H Jafferbhoy
- Gut Group, Biomedical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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