Recent Submissions

  • Infliximab: a single-centre, prospective, observational evaluation of TDM data in patients with IBD

    Gadsby, Jessica; Hall, Karen; Shah, Fatima; Pattni, Sanjeev; Gethins, Sharon; Mulla, Hussain
    Objectives: Therapeutic drug monitoring of infliximab (IFX) is important to optimise treatment of inflammatory bowel disease (IBD). A recent IBD consensus statement recommends targeting trough serum concentrations of >3 μg/mL, higher than our local recommendation of >1 μg/mL. We therefore investigated the relationship between IFX trough concentrations and C reactive protein (CRP), faecal calprotectin (FCP), clinical outcomes and anti-IFX antibody (AB) development as well as the influence of concomitant thiopurine treatment. Methods: Observational data, prospectively collected in a cohort of adult patients with IBD newly initiated on IFX at a single centre. Results: IFX concentrations >3 μg/mL were associated with a greater reduction in CRP (% change from baseline) and lower FCP; mean (SD) 47 (33.8) % vs 102.3 (136.9) % and 233.9 (505.1) μg/g vs 416.3 (613.5) μg/g, respectively. Lower IFX concentrations were observed in patients who developed AB than those who did not, mean (range) 6.2 (1.1-10) μg/mL vs 0.9 (0.4-4.9) μg/mL, respectively, and also in patients who stopped/switched therapy compared with those who continued, 2.4 (2.9) μg/mL vs 6.5 (2.8) μg/mL; p=0.0002. Patients taking a concomitant thiopurine were found to have higher IFX concentrations; mean (range) 6.4 (0.7-10) μg/mL vs 3.9 (0.4-10) μg/mL. Conclusions: IFX concentrations are correlated with biomarkers, clinical response and AB development in patients with IBD. Concomitant thiopurine therapy appears to be associated with higher IFX concentrations and reduced likelihood of AB development.
  • A Multicenter Study of Patient Acceptability of the IBD Disk Tool and Patient-Reported Disabilities

    Pattni, Sanjeev (2022-02)
    Background: IBD, both Crohn's disease and ulcerative colitis, is associated with significant functional disability. Gastrointestinal symptoms alone are not the sole purpose of the interaction between patients and providers. In order to ascertain patients' disabilities, we utilized the recently developed IBD Disk to help determine their functional concerns and initiate relevant conversation. We aimed to ascertain patient acceptability and their major disabilities. Patients and methods: In this multicenter study, IBD patients at their outpatient visit were given the paper version of the IBD Disk. Patients were asked to score their level of disability for each item of the IBD Disk. The completed scores were then shared with their healthcare provider to act as a focus of discussion during the consultation. Patients and clinicians were also asked to provide informal qualitative feedback as to the benefits of the IBD Disk and areas for improvement. Results: A total of 377 (female 60%) patients completed the questionnaires over the study period. Patient acceptability scored on a 0-10 Likert scale was excellent. All patients scored all domains of disability. Sleep, energy, and joint pain were the highest scoring domains of the IBD Disk, scoring higher than digestive symptoms. Clinicians and patients agreed that the IBD Disk allowed for ease of communication about disability symptoms and relevance to their day-to-day functioning. Conclusion: The IBD Disk is a novel easy-to-use tool to assess the functional disability of patients. We next plan to utilize it in the form of an electronic app internationally and in relation to treatment commencement and escalation.
  • Unexplained peripheral blood eosinophilia with gastrointestinal symptoms

    Wardlaw, Andrew; Myers, Bethan; Rathbone, Barrie; Siddiqui, Salman; Wurm, Peter (2021)
    No abstract available.
  • Impact of home parenteral nutrition on family members: A national multi-centre cross-sectional study

    Rogers, Dan
    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.
  • Microbiomes in physiology: Insights into 21st century global medical challenges

    Suzuki, Toru (2022)
    New findings: What is the topic of this review? This review summarises the role of the gut microbiome in physiology and how it can be targeted as an effective strategy against two of the most important global medical challenges of our time namely, metabolic diseases and antibacterial resistance. What advances does it highlight? We outline the critical roles of the microbiome in regulating host physiology and discuss how microbiome analysis is useful for disease stratification to enable informed clinical decisions and develop interventions such as faecal microbiota transplantation (FMT), prebiotics, and probiotics. We also discuss the limitations of microbiome modulation, including the potential for probiotics to enhance antimicrobial resistance gene reservoirs, and that currently a "healthy microbiome" that can be used as a biobank for transplantation is yet to be defined. Abstract: The human gut microbiome plays a key factor in the development of metabolic diseases and antimicrobial resistance which are among the greatest global medical challenges of the 21st century. The symposium aimed to highlight state-of-the-art evidence for the role of the gut microbiome in physiology, from childhood to adulthood, and the impact this has on global disease outcomes, ageing and antimicrobial resistance. Although the gut microbiome is established early in life, over time the microbiome and their components including metabolites can become perturbed due to changes such as dietary habits, use of antibiotics and age. As gut microbial metabolites, including short chain fatty acids (SCFAs), secondary bile acids and trimethylamine-N-Oxide (TMAO), can interact with host receptors including G protein coupled receptors (GPCRs), and can alter host metabolic fluxes, they can significantly affect physiological homeostasis leading to metabolic diseases. These metabolites can be used to stratify disease phenotypes such as irritable bowel syndrome (IBS) and adverse events after heart failure and provide informed decisions on clinical management and treatment. While strategies such as probiotics, prebiotics, and faecal microbiota transplantation (FMT) have been proposed as interventions to treat and prevent metabolic diseases and antimicrobial resistance, caution must be exercised; first due to the potential of probiotics to enhance antimicrobial resistance gene reservoirs and second, a "healthy gut microbiome" that can be used as a biobank for transplantation is yet to be defined. We highlight that sampling other parts of the GI tract may produce more representative data than the faecal microbiome alone. This article is protected by copyright. All rights reserved.