Risultati per: Gastroenterology

Global health (GH) is a diverse field of study that promotes interdisciplinary collaborations focused on population-based prevention and individual-level clinical care across borders.1,2 The field extends beyond medicine to include economics, history, engineering, public policy, and biomedical and environmental sciences.2 GH in gastroenterology and hepatology (GI) applies GH concepts to clinical and research aspects of digestive health and diseases, which account for 18.2% of incidence, 38.4% of prevalence, and 14.2% of deaths globally.

Objective
This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation.

Design
A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett’s oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated.

Results
382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged

Deaths from the majority of cancers are falling globally, but the incidence and mortality from hepatocellular carcinoma (HCC) is increasing in the United Kingdom and in other Western countries. HCC is a highly fatal cancer, often diagnosed late, with an incidence to mortality ratio that approaches 1. Despite there being a number of treatment options, including those associated with good medium to long-term survival, 5-year survival from HCC in the UK remains below 20%. Sex, ethnicity and deprivation are important demographics for the incidence of, and/or survival from, HCC. These clinical practice guidelines will provide evidence-based advice for the assessment and management of patients with HCC. The clinical and scientific data underpinning the recommendations we make are summarised in detail. Much of the content will have broad relevance, but the treatment algorithms are based on therapies that are available in the UK and have regulatory approval for use in the National Health Service.

It is an honor to write this piece celebrating Dr Hashem El-Serag as recipient of the American Gastroenterological Association (AGA) William Beaumont Prize in Gastroenterology (Photo 1). Established in 1976, this prize honors a senior investigator who has made a major contribution that has significantly advanced the care of patients with digestive diseases through clinical or translational research. This year, Hashem joins a cadre of 21 highly accomplished scientists who have received this award since its inception.

The first British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS)-endorsed faecal microbiota transplant (FMT) guidelines were published in 2018. Over the past 5 years, there has been considerable growth in the evidence base (including publication of outcomes from large national FMT registries), necessitating an updated critical review of the literature and a second edition of the BSG/HIS FMT guidelines. These have been produced in accordance with National Institute for Health and Care Excellence-accredited methodology, thus have particular relevance for UK-based clinicians, but are intended to be of pertinence internationally. This second edition of the guidelines have been divided into recommendations, good practice points and recommendations against certain practices. With respect to FMT for Clostridioides difficile infection (CDI), key focus areas centred around timing of administration, increasing clinical experience of encapsulated FMT preparations and optimising donor screening. The latter topic is of particular relevance given the COVID-19 pandemic, and cases of patient morbidity and mortality resulting from FMT-related pathogen transmission. The guidelines also considered emergent literature on the use of FMT in non-CDI settings (including both gastrointestinal and non-gastrointestinal indications), reviewing relevant randomised controlled trials. Recommendations are provided regarding special areas (including compassionate FMT use), and considerations regarding the evolving landscape of FMT and microbiome therapeutics.

Medicine owes as much to technology as it does to basic science. Endoscopy, for good and for bad, changed gastroenterology more than any other technology. In 1985, the eminent English gastroenterologist, Sir Christopher Booth, wrote a long essay1 for Gut, asking “What has technology done to gastroenterology?” This article was based on a lecture he had given in Berlin the year before. Booth (1924–2012) was one of the great beasts of British academic medicine during its glory years in the decades after World War II.