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Bhatia M, Thomas B, Chatu S, El-Hasani S. A 53-Year-Old Man Presenting with Pancreatic Exocrine Insufficiency 7 Years After Gastric Bypass Bariatric Surgery. Am J Case Rep 2022; 23:e936880. [PMID: 35765219 PMCID: PMC9252308 DOI: 10.12659/ajcr.936880] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Patient: Male, 53-year-old
Final Diagnosis: Pancreatic diseases
Symptoms: Dairrhea
Medication:—
Clinical Procedure: —
Specialty: Endocrinology and Metabolic
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Affiliation(s)
- Mohit Bhatia
- Department of General & Laparoscopic Surgery, Princess Royal University Hospital, King’s College, Orpington, London, United Kingdom
| | - Bindhiya Thomas
- Department of General & Laparoscopic Surgery, Princess Royal University Hospital, King’s College London, Orpington, London, United Kingdom
| | - Sukhdev Chatu
- Department of General & Laparoscopic Surgery, Princess Royal University Hospital, King’s College London, Orpington, London, United Kingdom
| | - Shamsi El-Hasani
- Department of General & Laparoscopic Surgery, Princess Royal University Hospital, King’s College London, Orpington, London, United Kingdom
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Meade S, Arora A, Goderya R, Ypsilantis E, Chatu S. Unusual case of severe colitis. Frontline Gastroenterol 2019; 10:322-324. [PMID: 31281629 PMCID: PMC6583583 DOI: 10.1136/flgastro-2018-101099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/02/2018] [Accepted: 12/09/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Susanna Meade
- Department of Gastroenterology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Ajay Arora
- Department of Radiology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Rashida Goderya
- Department of Histopathology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Efthymios Ypsilantis
- Department of Colorectal Surgery, King’s College Hospital NHS Foundation Trust, London, UK
| | - Sukhdev Chatu
- Department of Gastroenterology, King’s College Hospital NHS Foundation Trust, London, UK
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Subramanian V, Chatu S, Echterdiek F, Banerjee A, Finlayson C, Pollok RCG. Patients with Endoscopically Visible Polypoid Adenomatous Lesions Within the Extent of Ulcerative Colitis Have an Increased Risk of Colorectal Cancer Despite Endoscopic Resection. Dig Dis Sci 2016; 61:3031-3036. [PMID: 27405991 DOI: 10.1007/s10620-016-4246-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/09/2015] [Accepted: 07/04/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer (CRC). Few studies have looked at long-term outcomes of endoscopically visible adenomatous lesions removed by endoscopic resection in these patients. We aimed to assess the risk of developing CRC in UC patients with adenomatous lesions that develop within the segment of colitis compared to the remainder of an ulcerative colitis cohort. METHODS We identified patients with a confirmed histological diagnosis of UC from 1991 to 2004 and noted outcomes till June 2011. The Kaplan-Meier method was used to estimate cumulative probability of subsequent CRC. Factors associated with risk of CRC were assessed in a Cox proportional hazards model. RESULTS Twenty-nine of 301 patients with UC had adenomatous lesions noted within the segment of colitis. The crude incidence rate of developing colon cancer in patients with UC was 2.45 (95 % CI 1.06-4.83) per 1000 PYD and in those with UC and polypoid adenomas within the extent of inflammation was 11.07 (95 % CI 3.59-25.83) per 1000 PYD. Adjusted hazards ratio of developing CRC on follow-up in UC patients with polypoid dysplastic adenomatous lesions within the extent of inflammation was 4.0 (95 % CI 1.3-12.4). CONCLUSIONS The risk of developing CRC is significantly higher in UC patients with polypoid adenomatous lesions, within the extent of inflammation, despite endoscopic resection. Patients and physicians should take the increased risk into consideration during follow-up of these patients.
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Affiliation(s)
- Venkataraman Subramanian
- Molecular Gastroenterology, Leeds Institute Biomedical and Clinical Sciences, St James University Hospital, University of Leeds, Leeds, UK.,Department of Gastroenterology, St George's Healthcare NHS Trust, Tooting, London, UK
| | - Sukhdev Chatu
- Department of Gastroenterology, St George's Healthcare NHS Trust, Tooting, London, UK
| | - Fabian Echterdiek
- Department of Gastroenterology, St George's Healthcare NHS Trust, Tooting, London, UK
| | - Ashwini Banerjee
- Department of Gastroenterology, St George's Healthcare NHS Trust, Tooting, London, UK
| | - Caroline Finlayson
- Department of Histopathology, St George's Healthcare NHS Trust, Tooting, London, UK
| | - Richard C G Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, Tooting, London, UK.
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Abstract
The case describes a 50-year-old woman presenting with a severe painful dysphagia to solids, impacting on her nutritional intake. She had a history of pemphigus vulgaris maintained in remission with azathioprine, with no evidence of active oral or cutaneous disease at the time of presentation. Endoscopy and histology from the distal oesophagus revealed oesophageal involvement of pemphigus vulgaris. This is a relatively rare clinical form of the disease, with only 58 cases reported worldwide. Patients with pemphigus vulgaris are also prone to infective or steroid-induced gastritis, which present in the same way. Early endoscopic evaluation is therefore essential to distinguish between oesophageal involvement of pemphigus vulgaris and other pathologies, which warrant significant differences in management.
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Chhaya V, Saxena S, Cecil E, Chatu S, Subramanian V, Curcin V, Majeed A, Pollok RC. The impact of timing and duration of thiopurine treatment on colectomy in ulcerative colitis: a national population-based study of incident cases between 1989-2009. Aliment Pharmacol Ther 2015; 41:87-98. [PMID: 25382737 DOI: 10.1111/apt.13017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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] [Received: 09/08/2014] [Revised: 10/02/2014] [Accepted: 10/19/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND The role of thiopurines in altering the risk of colectomy in ulcerative colitis (UC) remains unclear. AIMS To examine predictors of colectomy in UC and determine the impact of thiopurines on the risk of colectomy. METHODS We constructed a population-based cohort of incident cases of UC in the United Kingdom between 1989 and 2009. We determined trends in thiopurine usage and colectomy for three defined cohorts: era 1 (1989-1995), era 2 (1996-2002), era 3 (2003-2009). We used Cox regression to determine predictors of colectomy and quantified the impact of duration and timing of thiopurine use on the risk of colectomy. RESULTS We identified 8673 incident cases of UC. 5-year colectomy rates increased from 4.2%, 5.1% to 6.9% (P = 0.001) for era 1, era 2 and era 3, respectively, despite increasing thiopurine use. This was not significant after adjustment for predictors of colectomy (P = 0.06). There was a higher risk of colectomy in men (HR 1.44, 95% CI: 1.19-1.73), those diagnosed at an early age (HR 1.35, 95% CI: 1.04-1.75; 16-24 vs. 25-64) and early steroid users (HR 1.94, 95% CI: 1.59-2.37). 5-ASA users were less likely to require a colectomy (HR 0.35, 95% CI: 0.28-0.44). Amongst thiopurine users, those treated for greater than 12 months had a 71% reduction in risk of colectomy (HR 0.29, 95% CI: 0.21-0.40). Early thiopurines offered no additional benefit. CONCLUSIONS Thiopurine exposure for greater than 12 months reduces the likelihood of colectomy by 71%. Young men and those requiring steroids within 3 months of diagnosis are at greatest risk of colectomy, and most likely to benefit from sustained thiopurine use.
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Affiliation(s)
- V Chhaya
- Department of Gastroenterology, St George's University Hospital, London, UK
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Davis J, Yanny I, Chatu S, Dubois P, Hayee B, Moran N. Spontaneous cerebrospinal fluid leak following a pilates class: a case report. J Med Case Rep 2014; 8:456. [PMID: 25528347 PMCID: PMC4308014 DOI: 10.1186/1752-1947-8-456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/10/2014] [Indexed: 12/01/2022] Open
Abstract
Introduction A spinal cerebrospinal fluid leak is the most common cause of spontaneous intracranial hypotension which is an uncommon but increasingly recognized cause of headache. This article describes the first reported case of pilates being associated with a spontaneous spinal cerebrospinal fluid leak whilst also highlighting the key information about spontaneous cerebrospinal fluid leaks that will be useful to the general clinician. Case presentation We present the case of a 42-year-old Caucasian woman who developed a low-pressure headache following a pilates class. A computed tomography scan of her head demonstrated bilateral chronic subdural hematomas and cerebellar descent. Magnetic resonance imaging of her spine revealed the presence of extensive extradural cerebrospinal fluid collections. She responded to conservative management and repeat neuroimaging after symptom resolution revealed no abnormalities. Conclusions Awareness and early recognition of spontaneous intracranial hypotension is important to prevent unnecessary investigations and delay in treatment. Pilates may be a risk factor for the development of a spontaneous cerebrospinal fluid leak.
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Affiliation(s)
- James Davis
- Department of Gastroenterology, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
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Chatu S, Subramanian V, Saxena S, Pollok R. Response to Fujita. Am J Gastroenterol 2014; 109:1497-8. [PMID: 25196878 DOI: 10.1038/ajg.2014.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sukhdev Chatu
- Department of Gastroenterology, St George's University Hospital, London, UK
| | | | - Sonia Saxena
- Department of Gastroenterology, St George's University Hospital, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospital, London, UK
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O'Connell RL, Chatu S, Thomas PRS, Keane A. A rare cause of abdominal pain. Assoc Med J 2014. [DOI: 10.1136/bmj.g4920] [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]
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Chatu S, Poullis A, Holmes R, Greenhalgh R, Pollok RCG. Temporal trends in imaging and associated radiation exposure in inflammatory bowel disease. Int J Clin Pract 2013; 67:1057-65. [PMID: 24073979 DOI: 10.1111/ijcp.12187] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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] [Received: 07/14/2012] [Accepted: 04/10/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Increasing use of diagnostic imaging in inflammatory bowel disease (IBD) has led to concerns about the malignant potential of ionising radiation in a cohort that have an increased lifetime risk of gastrointestinal malignancy. The aim was to quantify radiation exposure in IBD patients referred from primary care, determine predictors of high exposure and evaluate temporal trends in diagnostic imaging over a 20-year period. METHODS This was a retrospective cohort study whereby IBD patients were recruited from the outpatient clinic and evaluated retrospectively. The total cumulative effective dose (CED) received from tests was calculated for each subject. Cox regression was performed to assess factors associated with potentially harmful levels of ionising radiation defined as total CED > 50 milli-sieverts (mSv; equivalent to five CT abdomen scans). RESULTS The cohort included 415 patients. Median total CED was 7.2 mSv (IQR: 3.0-22.7) in Crohn's disease and 2.8 mSv (IQR: 0.8-8.9) in ulcerative colitis patients, respectively. A total of 32 patients (8%) received a CED > 50 mSv. A history of IBD-related surgery was associated with high exposure (HR 7.7). During the study period, usage of abdominal CT increased by 310%. CONCLUSION Approximately 1 in 13 patients in the study cohort were exposed to potentially harmful levels of ionising radiation. Strategies to minimise exposure to diagnostic medical radiation in IBD patients are required.
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Affiliation(s)
- S Chatu
- Department of Gastroenterology, St George's Hospital NHS Trust, London, UK
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Chatu S, Kumar D, Du Parcq J, Vlahos I, Pollok R. A rare cause of rectal bleeding masquerading as proctitis. J Crohns Colitis 2013; 7:e99-102. [PMID: 22739216 DOI: 10.1016/j.crohns.2012.05.022] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 05/29/2012] [Accepted: 05/29/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Diffuse cavernous haemangioma of the rectum (DCHR) is a rare benign vascular neoplasm that affects mainly young adults and can present with rectal bleeding or massive haemorrhage. We report a case of DCHR masquerading as proctitis which was diagnosed many years ago following colonoscopy. This is the first case where the DCHR was resected with subsequent formation of a colonic J pouch versus conventional colo-anal anastomosis in order to maintain good bowel function. METHOD Clinical case report including a review of current literature regarding DCHR. RESULTS This is one of few cases of DCHR reported that was initially misdiagnosed as proctitis. CONCLUSIONS Awareness of this rare condition is important when investigating patients presenting with rectal bleeding to prevent unnecessary treatment and delay surgery. Prompt intervention is necessary to prevent severe rectal haemorrhage.
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Affiliation(s)
- Sukhdev Chatu
- Department of Gastroenterology, St. George's Hospital NHS Trust, London, UK.
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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.
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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
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Chatu S, Subramanian V, Pollok RCG. Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease. Aliment Pharmacol Ther 2012; 35:529-39. [PMID: 22239831 DOI: 10.1111/j.1365-2036.2011.04975.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [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] [Received: 11/09/2011] [Revised: 11/28/2011] [Accepted: 12/13/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diagnostic imaging plays a pivotal role in the diagnosis and management of inflammatory bowel disease (IBD); however, increasing use has led to concerns about the malignant potential of ionising radiation. Several studies have demonstrated that diagnostic imaging can result in exposure to potentially harmful levels of ionising radiation in IBD patients. AIM To determine the pooled prevalence of increased exposure and pooled odds ratio of risk factors associated with exposure to potentially harmful levels of diagnostic medical radiation. METHODS We searched Medline, EMBASE, CINHAL and reference lists of identified articles, without language restrictions in October 2011. RESULTS Six studies with 1704 participants provided data on the proportion of patients receiving potentially harmful levels of radiation defined as ≥50 milli-sieverts (mSv)-equivalent to 5 CT abdomen scans. The pooled prevalence was 8.8% (95% CI 4.4-16.8) for IBD patients and 11.1% (95% CI 5.7-20.5%) and 2% (95% CI 0.8-4.9%) for Crohn's disease and ulcerative colitis patients respectively. Five studies involving 2627 participants provided data for risk factors. IBD-related surgery and corticosteroid use were significant with pooled adjusted odds ratio of 5.4 (95% CI 2.6-11.2) and 2.4 (95% CI 1.7-3.4) respectively. CONCLUSIONS About 1 in 10 patients may be exposed to potentially harmful levels of diagnostic medical radiation. Corticosteroid use and IBD related surgery increased this risk. Strategies to reduce radiation exposure while assessing disease activity need to be considered.
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Affiliation(s)
- S Chatu
- Department of Gastroenterology, St George's Hospital NHS Trust, London, UK.
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