1
|
Patel PS, Fragkos K, Keane N, Wilkinson D, Johnson A, Chan D, Roberts B, Neild P, Yalcin M, Allan P, FitzPatrick MEB, Gomez M, Williams S, Kok K, Sharkey L, Swift C, Mehta S, Naghibi M, Mountford C, Forbes A, Rahman F, Di Caro S. Nutritional care pathways in cancer patients with malignant bowel obstruction: A retrospective multi-centre study. Clin Nutr ESPEN 2024; 59:118-125. [PMID: 38220364 DOI: 10.1016/j.clnesp.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Variation in access to parenteral nutrition (PN) in patients with intestinal failure secondary to malignant bowel obstruction (MBO) exists due to differing practice, beliefs and resource access. We aimed to examine differences in nutritional care pathways and outcomes, by referral to nutrition team for PN in patients with MBO. METHODS This is a retrospective cohort study of MBO adults admitted to eight UK hospitals within a year and 1 year follow-up. Demographic, nutritional and medical data were analysed by comparing patients referred (R) or not referred (NR) for PN. Differences between groups were tested by Kruskal-Wallis, Chi-Squared tests and multi-level regression and survival using Cox regression. RESULTS 232 patients with 347 MBO admissions [median 66yr, (IQR: 55-74yrs), 67 % female], 79/232 patients were referred for PN (R group). Underlying primary malignancies of gynaecological and gastrointestinal origin predominated (71 %) and 78 % with metastases. Those in the NR group were found to be older, weigh more on admission, and more likely to be treated conservatively compared to those in the R group. For 123 (35 %) admissions, patients were referred to a nutrition team, and for 204 (59 %) admissions, patients were reviewed by a dietician. Multi-disciplinary team discussion and dietetic contact were more likely to occur in the R group-123/347 admissions (R vs NR group: 27 % vs. 7 %, P = 0.001; 95 % vs 39 %, P < 0.0001). Median admission weight loss was 8 % (IQR: 0 to 14). 43/123 R group admissions received inpatient PN only, with 32 patients discharged or already established on home parenteral nutrition. Overall survival was 150 days (126-232) with no difference between R/NR groups. CONCLUSION In this multi-centre study evaluating nutritional care management of patients with malignant bowel obstruction, only 1 in 3 admissions resulted in a referral to the nutrition team for PN, and just over half were reviewed by a dietician. Further prospective research is required to evaluate possible consequences of these differential care pathways on clinical outcomes and quality of life.
Collapse
Affiliation(s)
- Pinal S Patel
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Konstantinos Fragkos
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - Niamh Keane
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - David Wilkinson
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Amy Johnson
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Derek Chan
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Bradley Roberts
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Penny Neild
- Department of Gastroenterology, St George's University Hospitals, London, United Kingdom
| | - Metin Yalcin
- Department of Gastroenterology, St George's University Hospitals, London, United Kingdom
| | - Philip Allan
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael E B FitzPatrick
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael Gomez
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarah Williams
- Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Klaartje Kok
- Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Lisa Sharkey
- Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Carla Swift
- Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Shameer Mehta
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Mani Naghibi
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Christopher Mountford
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Alastair Forbes
- Department of Gastroenterology, Norfolk & Norwich University Hospital, Norwich, United Kingdom; University of Tartu, Estonia
| | - Farooq Rahman
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - Simona Di Caro
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| |
Collapse
|
2
|
Jones D, Lal S, French C, Sowerbutts AM, Gittins M, Gabe S, Brundrett D, Culkin A, Calvert C, Thompson B, Cooper SC, Fletcher J, Donnellan C, Forbes A, Lam C, Radford S, Mountford CG, Rogers D, Muggridge R, Sharkey L, Neild P, Wheatley C, Stevens P, Burden S. Investigating the Relationship between Home Parenteral Support and Needs-Based Quality of Life in Patients with Chronic Intestinal Failure: A National Multi-Centre Longitudinal Cohort Study. Nutrients 2023; 15:nu15030622. [PMID: 36771328 PMCID: PMC9921538 DOI: 10.3390/nu15030622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Home parenteral support (HPS) is an essential but potentially burdensome treatment that can affect quality of life (QoL). The aims of this longitudinal study were to understand whether any changes in HPS over time were associated with QoL. The Parenteral Nutrition Impact Questionnaire (PNIQ) was used, and data were collected on HPS prescribed at three time points. Data were analysed using multi-level mixed regression models presented as effect size and were adjusted for confounders. Study recruited 572 participants from 15 sites. Of these, 201 and 145 completed surveys at second and third time-points, respectively. PNIQ score was out of 20 with a higher score indicating poorer QoL. Any reduction in HPS infusions per week was associated with an improved PNIQ score of -1.10 (95% CI -2.17, -0.02) unadjusted and -1.34 (95% CI -2.45, -0.24) adjusted. Per day change to the number of infusions per week was associated with a change in the PNIQ score of 0.32 (95% CI -0.15, 0.80) unadjusted and 0.34 (95% CI -0.17, 0.85) adjusted. This is the largest national study to demonstrate improvements in QoL associated with HPS reduction over time using an HPS-specific and patient-centric tool, adding unique data for use of therapies in intestinal failure.
Collapse
Affiliation(s)
- Debra Jones
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- Correspondence: (D.J.); (S.B.); Tel.: +44-(0)-161-306-1508 (D.J.)
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford M6 8HD, UK
| | - Chloe French
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Anne Marie Sowerbutts
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Matthew Gittins
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Simon Gabe
- St Mark’s Hospital, London North West University Healthcare NHS Trust, London HA1 3UJ, UK
| | - Diane Brundrett
- St Mark’s Hospital, London North West University Healthcare NHS Trust, London HA1 3UJ, UK
| | - Alison Culkin
- St Mark’s Hospital, London North West University Healthcare NHS Trust, London HA1 3UJ, UK
| | - Chris Calvert
- Intestinal Failure and Nutrition Team, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Beth Thompson
- Intestinal Failure and Nutrition Team, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Sheldon C. Cooper
- GI Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Jane Fletcher
- GI Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Clare Donnellan
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7JT, UK
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich NR4 7UQ, UK
- Institute of Clinical Medicine, University of Tartu, 50090 Tartu, Estonia
| | - Ching Lam
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | - Shellie Radford
- Nottingham University Hospitals NHS Trust, Queens Medical Centre Campus, Nottingham NG7 2UH, UK
| | | | - Daniel Rogers
- Leicester Intestinal Failure Team, Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Rebecca Muggridge
- Leicester Intestinal Failure Team, Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Lisa Sharkey
- Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Penny Neild
- Department of Gastroenterology, St. Georges University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Carolyn Wheatley
- Patients on Intravenous and Naso-gastric Nutrition Treatment, Christchurch, Dorset BH23 2XS, UK
| | | | - Sorrel Burden
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford M6 8HD, UK
- Correspondence: (D.J.); (S.B.); Tel.: +44-(0)-161-306-1508 (D.J.)
| |
Collapse
|
3
|
French C, Lal S, Jones D, Sowerbutts AM, Brundrett D, Burch N, Calvert C, Cooper SC, Donnellan C, Forbes A, Gabe S, Lam C, Major G, Mountford CG, Muggridge R, Natarajan B, Neild P, Rogers D, Sharkey L, Thompson B, Wheatley C, Burden S. Impact of home parenteral nutrition on family members: A national multi-centre cross-sectional study. Clin Nutr 2021; 41:500-507. [PMID: 35007818 DOI: 10.1016/j.clnu.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Home parenteral nutrition (HPN) is a necessary treatment for patients with chronic, type 3, intestinal failure (IF). HPN often requires lifestyle adaptations, which are likely to affect quality of life (QoL) in both patients and family members. The aim of this study was to identify the level of burden on family members who are involved with HPN care and to understand specific factors that contribute to any burden. METHODS Patients over the age of 18 and receiving HPN were identified in IF clinics from multiple centres across the U.K. Eligible patients were asked to complete the parenteral nutrition impact questionnaire (PNIQ) to assess their QoL, while family members were asked to complete the burden scale for family caregivers (BSFC). Logistical regression was undertaken giving adjusted odds ratios (aOR). RESULTS 678 participants completed the survey representing 339 patients with their appointed family member. Mean PNIQ score was 11.53 (S.D. 5.5), representing a moderate impact of HPN on patients' QoL. On the BSFC scale, 23% of family members reported a moderate to very severe subjective burden indicating an increased risk of psychosomatic symptoms. After adjusting for age and gender, predictors of BSFC included: family members self-reported health status using the EuroQol visual analogue scale (aOR 19.91, 95% CI 1.69, 233.99, p = 0.017) and support received by health services (aOR = 5.83, 95% CI = 1.93, 17.56, p = 0.002). Employment status, disease type, number of nights on HPN and length of time on HPN were not associated with BSFC. CONCLUSIONS Family members with a poor health status or lack of support by health service were more likely to have a moderate to very severe subjective burden. Tailored support from the multi-professional IF team may reduce the burden experienced by family members of people dependent on HPN.
Collapse
Affiliation(s)
- Chloe French
- School of Health Sciences, University of Manchester, UK
| | - Simon Lal
- Salford Royal Foundation Trust, Salford, UK
| | - Debra Jones
- School of Health Sciences, University of Manchester, UK
| | | | - Diane Brundrett
- London North West University Healthcare NHS Trust, London, UK
| | - Nicola Burch
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chris Calvert
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Clare Donnellan
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK; Institute of Clinical Medicine, University of Tartu, Estonia
| | - Simon Gabe
- London North West University Healthcare NHS Trust, London, UK
| | - Ching Lam
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Giles Major
- School of Medicine, University of Nottingham, Nottingham, UK; Nottingham NIHR Biomedical Research Centre, Nottingham, UK
| | | | - Rebecca Muggridge
- Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Brenavan Natarajan
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Penny Neild
- St. Georges University Hospitals NHS Foundation Trust, London, UK
| | - Dan Rogers
- Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Lisa Sharkey
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Beth Thompson
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Sorrel Burden
- School of Health Sciences, University of Manchester, UK; Salford Royal Foundation Trust, Salford, UK.
| |
Collapse
|
4
|
Patel P, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Yalcin M, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swfit C, Forbes A, Mehta S, Rahman F, Di Caro S. MON-PO399: Nutritional Care Pathways of Patients with Malignant Bowel Obstruction: Preliminary Findings from 8 UK Centres. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
5
|
Patel P, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Yalcin M, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swfit C, Forbes A, Mehta S, Rahman F, Di Caro S. MON-PO400: Parenteral Nutrition in Patients with Malignant Bowel Obstruction: Preliminary Findings from 8 UK Centres: Are all Patients Referred Appropriately? Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
6
|
Brown LAK, Ruis C, Clark I, Roy S, Brown JR, Albuquerque AS, Patel SY, Miller J, Karim MY, Dervisevic S, Moore J, Williams CA, Cudini J, Moreira F, Neild P, Seneviratne SL, Workman S, Toumpanakis C, Atkinson C, Burns SO, Breuer J, Lowe DM. A comprehensive characterization of chronic norovirus infection in immunodeficient hosts. J Allergy Clin Immunol 2019; 144:1450-1453. [PMID: 31415785 PMCID: PMC6843911 DOI: 10.1016/j.jaci.2019.07.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Li-An K Brown
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of Microbiology, Whittington Health NHS Trust, London, United Kingdom
| | - Christopher Ruis
- Division of Infection and Immunity, University College London, London, United Kingdom; Molecular Immunity Unit, Department of Medicine, University of Cambridge, Medical Research Council (MRC)-Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Ian Clark
- Department of Histopathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sunando Roy
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Julianne R Brown
- Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Adriana S Albuquerque
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, United Kingdom
| | - Smita Y Patel
- Oxford University Hospitals NHS Trust and NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Joanne Miller
- Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, United Kingdom
| | - Mohammed Yousuf Karim
- Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, United Kingdom; Pathology, Sidra Medicine, Doha, Qatar
| | - Samir Dervisevic
- Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom
| | - Jennifer Moore
- Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom
| | - Charlotte A Williams
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Juliana Cudini
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Fernando Moreira
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Penny Neild
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Suranjith L Seneviratne
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sarita Workman
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Christos Toumpanakis
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Claire Atkinson
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, United Kingdom
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, United Kingdom; Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - David M Lowe
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, United Kingdom; Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
7
|
Patel PS, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Metin Devrim Y, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swift C, Forbes A, Mehta S, Rahman F, Di Caro S. OWE-17 Nutritional care pathways of patients with malignant bowel obstruction: preliminary findings from 8 UK Centres. Nutrition 2019. [DOI: 10.1136/gutjnl-2019-bsgabstracts.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Long W, Neild P. Medical students perception of nutrition training at an undergraduate level and the role of the clinicians they shadow. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Inayet N, Neild P. Parenteral nutrition. J R Coll Physicians Edinb 2015; 45:45-8. [PMID: 25874831 DOI: 10.4997/jrcpe.2015.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Over the last 50 years, parenteral nutrition has been recognised as an invaluable and potentially lifesaving tool in the physician's arsenal in the management of patients with intestinal failure or inaccessibility; however, it may also be associated with a number of potentially life-threatening complications. A recent NCEPOD report (2010) identified a number of inadequacies in the overall provision and management of parenteral nutrition and recommendations were made with the aim of improving clinical practice in the future. This paper focuses on the practical aspects relating to parenteral nutrition for adults, including important concepts, such as patient selection, as well as general management. We also explore the various pitfalls and potential complications and how these may be minimised.
Collapse
Affiliation(s)
- N Inayet
- P Neild, Department of Gastroenterology, St George's Hospital, Blackshaw Rd, London SW17 0QT, UK. Email
| | | |
Collapse
|
10
|
Chatu S, Chhaya V, Holmes R, Neild P, Kang JY, Pollok RC, Poullis A. Factors associated with vitamin D deficiency in a multicultural inflammatory bowel disease cohort. Frontline Gastroenterol 2013; 4:51-56. [PMID: 28839700 PMCID: PMC5369785 DOI: 10.1136/flgastro-2012-100231] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 07/12/2012] [Revised: 09/05/2012] [Accepted: 09/06/2012] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of vitamin D deficiency in a multicultural inflammatory bowel disease (IBD) cohort and determine predictors of deficiency including ethnicity. DESIGN Patients with IBD were recruited into a dedicated database over a 6-month period and evaluated retrospectively. SETTING Department of Gastroenterology, St George's University Hospital, London, UK. OUTCOMES MEASURED Clinical data including demographics, ethnic group, disease phenotype by the Montreal classification, vitamin D level and season tested were recorded from clinical and electronic medical records. Vitamin D levels were classified as normal (≥50 nmol/l) and deficient (<50 nmol/l). RESULTS 168 patients had a vitamin D level measured subsequent to diagnosis. There was no significant difference in the median vitamin D level between patients with Crohn's disease (CD) and ulcerative colitis (UC) (39 nmol/l (IQR 23-56) vs 28 nmol/l (IQR 17-51), p=0.35). Overall the median vitamin D level was significantly lower in non-Caucasians (Asian and Black) versus Caucasians (28 nmol/l (IQR 17-41) vs 41 nmol/l (IQR 25-63), p<0.0001). Multiple regression analysis revealed IBD related surgery (OR 2.9) and ethnicity (OR 6.0 non-Caucasian vs Caucasian) in CD and ethnicity (OR 5.0 non-Caucasian vs Caucasian) in UC were independently associated with vitamin D deficiency. CONCLUSIONS Vitamin D deficiency is common in IBD patients; therefore, we suggest monitoring of vitamin D levels and correction with supplements especially in non-Caucasians and those with a history of IBD related surgery.
Collapse
Affiliation(s)
- Sukhdev Chatu
- Department of Gastroenterology, St George's University Hospital, London, UK
| | - Vivek Chhaya
- Department of Gastroenterology, St George's University Hospital, London, UK
| | - Rosamund Holmes
- Department of Gastroenterology, St George's University Hospital, London, UK
| | - Penny Neild
- Department of Gastroenterology, St George's University Hospital, London, UK
| | - Jin-Yong Kang
- Department of Gastroenterology, St George's University Hospital, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's University Hospital, London, UK
| | - Andrew Poullis
- Department of Gastroenterology, St George's University Hospital, London, UK
| |
Collapse
|
11
|
Adesokan A, Neild P. Attitudes and expectations of gastroenterology outpatients about the importance of diet and possible relationship to their symptoms. Frontline Gastroenterol 2012; 3:278-282. [PMID: 28839680 PMCID: PMC5369835 DOI: 10.1136/flgastro-2012-100177] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To evaluate gastroenterology outpatients' attitudes to the importance of diet and its relationship to their symptoms, as well as their expectations of dietary advice from health professionals. DESIGN Prospective clinical audit. SETTING Gastroenterology outpatient department of St George's Healthcare NHS Trust. PATIENTS Two hundred and twenty-five patients, aged between 18 and 70 years met the inclusion criteria. INTERVENTIONS None. MAIN OUTCOME MEASURES Participants' responses to a structured questionnaire. RESULTS Sixty-nine per cent of participants felt their diet played an important role in their condition. Factors significantly associated with a positive dietary attitude included younger age (40.6 years vs 46.0 years, p<0.01), regularity of dietary pattern (108 vs 35, p<0.01), number of symptoms (4.6 vs 2.5, p<0.01), severity of gastrointestinal symptoms (2.3 vs 1.5, p<0.01), history of weight loss (34% vs 20.3%, p<0.05) and history of dietary advice (71.1% vs 33.3%, p<0.01). Sixty-eight per cent (68%) of participants were interested in receiving dietary advice, though only 36% expected to receive it. No differences were found for any comparisons based on average body mass index. CONCLUSION The majority of gastroenterology outpatients view diet as playing an important role in their condition, particularly those who have more severe symptoms and those who have received dietary advice. Although a large proportion of patients are interested in receiving dietary advice, few expect to receive it in clinics. Further research is required to explore the reasons why, and to assess the confidence of health professionals in providing nutritional advice.
Collapse
Affiliation(s)
| | - Penny Neild
- Department of Gastroenterology, St George's Hospital, University of London, London, UK
| |
Collapse
|
12
|
Fiona Aldrich E, Neild P, Lavoi P, Murphy K. Abstract No. 114: Submarine-based technology for the detection of acute intracranial abnormalities and stroke: Validation in 40 patients. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
13
|
|
14
|
Affiliation(s)
- Muhammad Afzal
- Department of Gastroenterology, St George's Hospital, Blackshaw Road, London , UK.
| | | |
Collapse
|
15
|
Eze N, Jefford JM, Wolf D, Williamson P, Neild P. PEG and RIG tube feeding in Head and Neck patients: a retrospective review of complications and outcome. J Eval Clin Pract 2007; 13:817-9. [PMID: 17824878 DOI: 10.1111/j.1365-2753.2006.00741.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Abstract
BACKGROUND Gastro-oesophageal reflux disease affects approximately 20% of western populations. Barrett's oesophagus, associated with severe gastro-oesophageal reflux disease, is premalignant and regular endoscopic surveillance is generally performed. In contrast, mild gastro-oesophageal reflux disease is thought not to progress and is not generally subjected to endoscopic follow-up. Aim To investigate whether gastro-oesophageal reflux disease progresses endoscopically. METHODS Systematic review of the literature. RESULTS Well-designed prospective studies are few, diagnostic criteria were not always standardized, management strategies varied and various sources of bias could not be excluded. Whilst most patients do not progress to more severe forms of gastro-oesophageal reflux disease, and some cases actually regress, progression is seen in a small proportion of patients. Annual progression rates for non-erosive gastro-oesophageal reflux disease developing erosive oesophagitis ranged from 0% to 30%. About 1-22% of patients with mild erosive oesophagitis developed more severe inflammation annually, while 1-13% of patients with erosive oesophagitis developed Barrett's oesophagus each year. CONCLUSION Although most patients with gastro-oesophageal reflux disease do not progress, and some actually regress, progression does occur in a minority. Better data are required to determine whether patients with mild gastro-oesophageal reflux disease would benefit from increased surveillance with the aim of detecting more advanced disease.
Collapse
Affiliation(s)
- M Fullard
- Department of Gastroenterology, St George's Hospital, London, UK
| | | | | | | | | |
Collapse
|
17
|
|
18
|
Bull TJ, McMinn EJ, Sidi-Boumedine K, Skull A, Durkin D, Neild P, Rhodes G, Pickup R, Hermon-Taylor J. Detection and verification of Mycobacterium avium subsp. paratuberculosis in fresh ileocolonic mucosal biopsy specimens from individuals with and without Crohn's disease. J Clin Microbiol 2003; 41:2915-23. [PMID: 12843021 PMCID: PMC165291 DOI: 10.1128/jcm.41.7.2915-2923.2003] [Citation(s) in RCA: 284] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mycobacterium avium subsp. paratuberculosis is a robust and phenotypically versatile pathogen which causes chronic inflammation of the intestine in many species, including primates. M. avium subsp. paratuberculosis infection is widespread in domestic livestock and is present in retail pasteurized cows' milk in the United Kingdom and, potentially, elsewhere. Water supplies are also at risk. The involvement of M. avium subsp. paratuberculosis in Crohn's disease (CD) in humans has been uncertain because of the substantial difficulties in detecting this pathogen. In its Ziehl-Neelsen staining-negative form, M. avium subsp. paratuberculosis is highly resistant to chemical and enzymatic lysis. The present study describes the development of optimized sample processing and DNA extraction procedures with fresh human intestinal mucosal biopsy specimens which ensure access to M. avium subsp. paratuberculosis DNA and maximize detection of these low-abundance pathogens. Also described are two nested PCR methodologies targeted at IS900, designated IS900[L/AV] and IS900[TJ1-4], which are uniquely specific for IS900. Detection of M. avium subsp. paratuberculosis in mucosal biopsy specimens was also evaluated by using mycobacterial growth indicator tube (MGIT) cultures (Becton Dickinson). IS900[L/AV] PCR detected M. avium subsp. paratuberculosis in 34 of 37 (92%) patients with CD and in 9 of 34 (26%) controls without CD (noninflammatory bowel disease [nIBD] controls) (P = 0.0002; odds ratio = 3.47). M. avium subsp. paratuberculosis was detected by IS900[L/AV] PCR in MGIT cultures after 14 to 88 weeks of incubation in 14 of 33 (42%) CD patients and 3 of 33 (9%) nIBD controls (P = 0.0019; odds ratio = 4.66). Nine of 15 (60%) MGIT cultures of specimens from CD patients incubated for more than 38 weeks were positive for M. avium subsp. paratuberculosis. In each case the identity of IS900 from M. avium subsp. paratuberculosis was verified by amplicon sequencing. The rate of detection of M. avium subsp. paratuberculosis in individuals with CD is highly significant and implicates this chronic enteric pathogen in disease causation.
Collapse
Affiliation(s)
- Tim J Bull
- Department of Surgery, St. George's Hospital Medical School, London SW17 0RE, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Affiliation(s)
- J Y Kang
- Departments of Gastroenterology and Histopathology, St George’s Hospital, London, UK
| | - C Finlayson
- Departments of Gastroenterology and Histopathology, St George’s Hospital, London, UK
| | - J D Maxwell
- Departments of Gastroenterology and Histopathology, St George’s Hospital, London, UK
| | - P Neild
- Departments of Gastroenterology and Histopathology, St George’s Hospital, London, UK
| |
Collapse
|
20
|
Sharpstone D, Neild P, Crane R, Taylor C, Hodgson C, Sherwood R, Gazzard B, Bjarnason I. Small intestinal transit, absorption, and permeability in patients with AIDS with and without diarrhoea. Gut 1999; 45:70-6. [PMID: 10369707 PMCID: PMC1727572 DOI: 10.1136/gut.45.1.70] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diarrhoea in AIDS is associated with anorexia and weight loss. The importance of gastrointestinal transit in such symptoms has not been addressed. AIMS To assess jejunal to caecal transit times in subjects with AIDS related diarrhoea and weight loss and correlate these with measures of absorptive capacity and intestinal permeability. METHODS Jejunal to caecal transit times were assessed in 20 seronegative controls and 60 HIV seropositive subjects from serum analysis of 3-O-methyl-D-glucose and sulphapyridine after ingestion of the monosaccharide and sulphasalazine in aqueous solution. The method also allows an estimation of gastric emptying times for liquids. Intestinal absorptive capacity and permeability were assessed by a combined test using 3-O-methyl-D-glucose, D-xylose, L-rhamnose, and lactulose. RESULTS Gastric emptying was significantly delayed in all groups of patients with AIDS. Mean jejunal to caecal transit times were not significantly different between controls (246 (62) minutes) and patients without diarrhoea (AIDS, well: 278 (103) minutes; AIDS, wasting: 236 (68) minutes), cytomegalovirus colitis (289 (83) minutes), pathogen negative diarrhoea (192 (100) minutes), or microsporidiosis (190 (113) minutes), although 30% of patients had values below the control range. Patients with cryptosporidiosis differed significantly from controls (135 (35) minutes, p<0.0001), seven of 10 having rapid transit times. Absorptive capacity was reduced and intestinal permeability significantly increased in AIDS, but did not correlate significantly with transit times. CONCLUSION Small bowel transit is accelerated in many patients with AIDS, particularily in protozoal diarrhoea, but is not the sole explanation for malabsorption of monosaccharides.
Collapse
Affiliation(s)
- D Sharpstone
- Department of HIV/GUM, Chelsea and Westminster Hospital, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Fox JD, Brink NS, Zuckerman MA, Neild P, Gazzard BG, Tedder RS, Miller RF. Detection of herpesvirus DNA by nested polymerase chain reaction in cerebrospinal fluid of human immunodeficiency virus-infected persons with neurologic disease: a prospective evaluation. J Infect Dis 1995; 172:1087-90. [PMID: 7561185 DOI: 10.1093/infdis/172.4.1087] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A nested polymerase chain reaction-based method was used prospectively to detect herpesvirus DNA in cerebrospinal fluid (CSF) from 111 patients with AIDS, 39 of whom had a suspected diagnosis of cytomegalovirus (CMV)-associated neurologic disease (patients with encephalopathy, polyradiculopathy, or peripheral neuropathy) and 72 who had alternative diagnoses. CSF from 24 (62%) of the patients with suspected CMV-associated disease had detectable CMV DNA compared with only 8 (11%) of the patients with other diagnoses. Varicella-zoster virus DNA was detected in CSF from 3 patients (2 with myelitis and 1 with encephalitis), all of whom had recent cutaneous zoster. No CSF specimen contained detectable herpes simplex virus type 1 DNA, and none of the patients with myelitis had detectable herpes simplex virus type 2 DNA in CSF. This study demonstrates a significant association between detectable CMV DNA in CSF and suspected CMV-associated neurologic disease in patients with AIDS.
Collapse
Affiliation(s)
- J D Fox
- Department of Medical Microbiology, University College London Medical School and Hospitals, United Kingdom
| | | | | | | | | | | | | |
Collapse
|