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Sasegbon A, Hasan SS, Disney BR, Vasant DH. Rumination syndrome: pathophysiology, diagnosis and practical management. Frontline Gastroenterol 2022; 13:440-446. [PMID: 36046491 PMCID: PMC9380772 DOI: 10.1136/flgastro-2021-101856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/28/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK,Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Syed Shariq Hasan
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Benjamin R Disney
- Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Dipesh Harshvadan Vasant
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK,Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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McFarlane M, Disney BR. Editorial - out with the old and in with the new? Gastrointestinal bleeding risk of P2Y 12 inhibitors following acute coronary syndrome. Aliment Pharmacol Ther 2020; 52:887-888. [PMID: 32852831 DOI: 10.1111/apt.15912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/29/2022]
Affiliation(s)
- Michael McFarlane
- Department of Gastroenterology, University Hospital Coventry, Coventry, UK
| | - Benjamin R Disney
- Department of Gastroenterology, University Hospital Coventry, Coventry, UK
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Bannaga AS, Tabuso M, Farrugia A, Chandrapalan S, Somal K, Lim VK, Mohamed S, Nia GJ, Mannath J, Wong JL, Noufaily A, Disney BR, Arasaradnam RP. C-reactive protein and albumin association with mortality of hospitalised SARS-CoV-2 patients: A tertiary hospital experience. Clin Med (Lond) 2020; 20:463-467. [PMID: 32934038 PMCID: PMC7539728 DOI: 10.7861/clinmed.2020-0424] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective was to study hospitalised COVID-19 patients' mortality and intensive care unit (ICU) admission with covariates of interest (age, gender, ethnicity, clinical presentation, comorbidities and admission laboratory findings). METHODS Logistic regression analyses were performed for patients admitted to University Hospital, University Hospitals Coventry and Warwickshire NHS Trust, between 24 January 2020 - 13 April 2020. RESULTS There were 321 patients hospitalised. Median age was 73 years and 189 (59%) were male. Ethnicity was divided between Caucasian (77%), and black, Asian, and minority ethnic (BAME) groups (23%). Commonest symptoms were dyspnoea (62.9%), fever (59.1%) and cough (56%). Gastrointestinal symptoms amounted to 11.8%.Forty-four patients (13.7%) received ICU care. ICU male to female ratio was 3:1 (p=0.027; odds ratio (OR) 2.3; 95% confidence interval (CI) 1.1-4.9), BAME (p=0.008; OR 2.5; 95% CI 1.3-4.9), age >65 years (p=0.026; OR 0.28; 95% CI 0.09-0.93), heart disease (p=0.009; OR 0.2; 95% CI 0.1-0.6) and elevated C-reactive protein (CRP; p<0.001; OR 1.004; 95% CI 1.002-1.008) were associated with ICU admission.One-hundred and four patients (32.4%) died. Age >65 years (p=0.011; OR 5; 95% CI 1.6-21.9), neutrophils (p=0.047), neutrophil:lymphocyte ratio (NLR; p=0.028), CRP (p<0.001) and albumin (p=0.002) were associated with mortality. When analysis adjusted for age, CRP (p<0.001; OR 1.006; 95% CI 1.004-1.008) and albumin (p=0.005; OR 0.94; 95% CI 0.90-0.98) remained associated with mortality. CONCLUSIONS COVID-19 has high mortality. BAME and male patients were associated with ICU admission. High CRP and low albumin (after correcting for age) were associated with mortality.
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Affiliation(s)
- Ayman S Bannaga
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
| | - Maria Tabuso
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Alexia Farrugia
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
| | - Subashini Chandrapalan
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
| | - Karenjit Somal
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Voon Kune Lim
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Shahd Mohamed
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Gohar J Nia
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jayan Mannath
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - John Lh Wong
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Benjamin R Disney
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ramesh P Arasaradnam
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
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Verma AM, Bhala N, Chilton A, Disney BR. Concerns regarding the recommendations of the British Society of Gastroenterology's lower GI bleeding guidelines. Gut 2020; 69:792. [PMID: 30996044 DOI: 10.1136/gutjnl-2019-318582] [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: 02/24/2019] [Revised: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 12/08/2022]
Affiliation(s)
- Ajay M Verma
- Department of Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Neeraj Bhala
- Gastroenterology and Liver Units, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Chilton
- Department of Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Benjamin R Disney
- Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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McFarlane M, Bhala N, China L, Alrubaiy L, Chedgy F, Disney BR, Farmer AD, Fogden E, Sadler G, Hull MA, McLaughlin J, Ellison H, Solomon J, Brookes MJ. Attitudes to out-of-programme experiences, research and academic training of gastroenterology trainees between 2007 and 2016. Frontline Gastroenterol 2019; 10:57-66. [PMID: 30651959 PMCID: PMC6319145 DOI: 10.1136/flgastro-2018-100993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/30/2018] [Revised: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Academic medical training was overhauled in 2005 after the Walport report and Modernising Medical Careers to create a more attractive and transparent training pathway. In 2007 and 2016, national web-based surveys of gastroenterology trainees were undertaken to determine experiences, perceptions of and perceived barriers to out-of-programme research experience (OOP-R). DESIGN SETTING AND PATIENTS Prospective, national web-based surveys of UK gastroenterology trainees in 2007 and 2016. MAIN OUTCOME MEASURE Attitudes to OOP-R of two cohorts of gastroenterology trainees. RESULTS Response rates were lower in 2016 (25.8% vs 56.7%) (p<0.0001), although female trainees' response rates increased (from 28.8% to 37.6%) (p=0.17), along with higher numbers of academic trainees. Over 80% of trainees planned to undertake OOP-R in both surveys, with >50% having already undertaken it. Doctor of Philosophy/medical doctorate remained the most popular OOP-R in both cohorts. Successful fellowship applications increased in 2016, and evidence of gender inequality in 2007 was no longer evident in 2016. In the 2016 cohort, 91.1% (n=144) felt the development of trainee-led research networks was important, with 74.7% (n=118) keen to get involved. CONCLUSIONS The majority of gastroenterology trainees who responded expressed a desire to undertake OOP-R, and participation rates in OOP-R remain high. Despite smaller absolute numbers responding than in 2007, 2016 trainees achieved higher successful fellowship application rates. Reassuringly more trainees in 2016 felt that OOP-R would be important in the future. Efforts are needed to tackle potential barriers to OOP-R and support trainees to pursue research-active careers.
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Affiliation(s)
- Michael McFarlane
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospital Birmingham, Birmingham, UK
| | - Louise China
- Division of Medicine, University College London, London, UK
| | | | - Fergus Chedgy
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Benjamin R Disney
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Adam D Farmer
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Edward Fogden
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | - Gareth Sadler
- Department of Gastroenterology, St George’s University Hospitals NHS Trust, London, UK
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - John McLaughlin
- School of Medical Sciences, The University of Manchester, Manchester, UK
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McFarlane M, O’Flynn L, Ventre R, Disney BR. Emerging role of thalidomide in the treatment of gastrointestinal bleeding. Frontline Gastroenterol 2018; 9:98-104. [PMID: 29588836 PMCID: PMC5868454 DOI: 10.1136/flgastro-2017-100870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/08/2017] [Revised: 09/22/2017] [Accepted: 10/18/2017] [Indexed: 02/04/2023] Open
Abstract
Thalidomide was initially synthesised in 1954 and marketed as a sedative and antiemetic for morning sickness. It was withdrawn in 1961 due to the realisation that it was teratogenic with over 10 000 children born with congenital abnormalities. Since then it has been used for treatment of dermatological and oncological conditions, including myeloma. In 1994, it was found to have a potent antiangiogenic effect via downregulation of vascular endothelial growth factor (VEGF). This has led to its use in gastrointestinal bleeding, as vascular abnormalities such as angiodysplasia have been found to have elevated VEGF levels. This article will review the current evidence of the use of thalidomide in bleeding associated with gastrointestinal vascular malformations, including angiodysplasia, gastric cancer and radiation-induced proctitis.
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Affiliation(s)
- Michael McFarlane
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Lauren O’Flynn
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Rachel Ventre
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Benjamin R Disney
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Frost J, Sheldon F, Kurup A, Disney BR, Latif S, Ishaq S. An approach to acute lower gastrointestinal bleeding. Frontline Gastroenterol 2017; 8:174-182. [PMID: 28839906 PMCID: PMC5558275 DOI: 10.1136/flgastro-2015-100606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/26/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023] Open
Abstract
Lower gastrointestinal bleeding (LGIB) is a common problem that can be treated via a number of endoscopic, radiological and surgical approaches. Although traditionally managed by the colorectal surgeons, surgery should be considered a last resort given the variety of endoscopic and radiological approaches available. This article provides an overview on the common causes of acute LGIB and the various techniques at our disposal to control it.
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Affiliation(s)
- John Frost
- Gastroenterology Department, Russells Hall Hospital, Dudley, UK
| | - Faye Sheldon
- Gastroenterology Department, Russells Hall Hospital, Dudley, UK
| | - Arun Kurup
- Gastroenterology Department, Russells Hall Hospital, Dudley, UK
| | | | - Sherif Latif
- Radiology Department, Russells Hall Hospital, Dudley, UK
| | - Sauid Ishaq
- Gastroenterology Department, Russells Hall Hospital, Dudley, UK
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O'Flynn L, Disney BR, Menon V, Mannath J. Trichobezoar and Rapunzel syndrome : an unusual cause of abdominal mass. Acta Gastroenterol Belg 2017; 80:81-82. [PMID: 29364106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Affiliation(s)
- Benjamin R Disney
- Department of Gastroenterology, Russell's Hall Hospital, Dudley, United Kingdom
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Disney BR, Watson RDS, Blann AD, Lip GYH, Anderson MR. Review article: proton pump inhibitors with clopidogrel--evidence for and against a clinically-important interaction. Aliment Pharmacol Ther 2011; 33:758-67. [PMID: 21303400 DOI: 10.1111/j.1365-2036.2011.04585.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 12/20/2022]
Abstract
BACKGROUND The treatment of acute coronary syndromes involves a combination of antiplatelet therapies. Proton pump inhibitors are frequently recommended for patients receiving clopidogrel in addition to aspirin, to minimise the risk of bleeding. Several studies have shown that proton pump inhibitors can affect the platelet inhibitory effects of clopidogrel. However, the data on whether this has an effect on clinical outcomes are conflicting and a definitive answer is still awaited. AIM To provide an overview of the evidence for the pharmacological interaction between proton pump inhibitors and clopidogrel and to discuss whether this interaction translates into adverse clinical outcomes. Despite recent developments, clear consensus is lacking. METHODS A search of the published literature combined with the authors' knowledge of the field. RESULTS There is evidence to show that proton pump inhibitors can influence the pharmacodynamics of clopidogrel, but the data suggesting clinical effects are weak and conflicting. Supporting a clinically important interaction are four retrospective studies including over 11,000 patients prescribed both clopidogrel and a proton pump inhibitor. Evidence against a clinically important interaction is derived from over 18,000 patients from seven studies, including the only prospective trial to examine the potential interaction. Confounding variables are relevant and prospective clinical evidence is lacking. CONCLUSIONS Proton pump inhibitors offer clear protection and the concern over clinically relevant interactions with clopidogrel is biologically plausible, but not yet proven.
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Affiliation(s)
- B R Disney
- Department of Gastroenterology, City Hospital, SWBH NHS Trust, Dudley Road, Birmingham, UK
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