Publications
289 results found
Segal J, Askari A, Worley G, et al., 2018, THE NATURAL HISTORY OF TERMINAL ILEAL RESECTION IN CROHN'S DISEASE, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A161-A161, ISSN: 0017-5749
Segal J, Chan H, Collins B, et al., 2018, BIOFEEDBACK IN PATIENTS WITH ILEOANAL POUCH DYSFUNCTION: A SPECIALIST CENTRE EXPERIENCE, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A93-A94, ISSN: 0017-5749
Segal J, Leo C, Hodgkinson J, et al., 2018, EFFICACY AND ACCEPTABILITY OF A RENEW ANAL INSERT IN PATIENTS WHO HAVE UNDERGONE RESTORATIVE PROCTOCOLECTOMY, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A202-A202, ISSN: 0017-5749
Segal J, Rottoli M, Felwick R, et al., 2018, BIOLOGICAL THERAPY FOR THE TREATMENT OF PRE-POUCH ILEITIS: A RETROSPECTIVE EXPERIENCE FROM THREE CENTRES, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A93-A93, ISSN: 0017-5749
Segal J, Worley G, Warusavitarne J, et al., 2018, SYSTEMATIC REVIEW: THE MANAGEMENT OF EARLY POUCH-RELATED SEPTIC COMPLICATIONS IN ULCERATIVE COLITIS, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A202-A203, ISSN: 0017-5749
Segal JP, McLaughlin SD, Faiz OD, et al., 2018, Incidence and Long-term Implications of Prepouch Ileitis: An Observational Study, DISEASES OF THE COLON & RECTUM, Vol: 61, Pages: 472-475, ISSN: 0012-3706
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- Citations: 12
Segal JP, Chan H, Collins B, et al., 2018, Biofeedback in patients with ileoanal pouch dysfunction: a specialist centre experience, Scandinavian Journal of Gastroenterology, Vol: 53, Pages: 665-669, ISSN: 0036-5521
OBJECTIVES: To report outcomes following biofeedback for functional problems associated with an ileoanal pouch. Incontinence and evacuatory disorders associated with the ileoanal pouch can be particularly problematic and difficult to treat using conventional therapies. Biofeedback therapy is a behavioural treatment that offers a non-surgical approach as an alternative or adjunct for patients. MATERIALS AND METHODS: This was a retrospective single centre study. We reviewed the notes of all patients attending for biofeedback at our institution between January 2012 and October 2017 and identified all those that did so for ileoanal pouch related problems. We recorded patient reported subjective improvements following biofeedback. The validated International Consultation on Incontinence Questionnaire was used to assess improvement in incontinent symptoms and the evacuatory disorder questionnaire was used to assess improvement in evacuatory disorders. RESULTS: Twenty-six patients with ileoanal pouch related problems underwent biofeedback. Based on patients' feedback at next clinical encounter following biofeedback, nine reported much improvement, 11 reported some improvement and six reported no improvement. In the group treated for incontinence, quality of life improved significantly from a median pre-treatment score of 80 to a post-treatment score of 41 (p = .01). Biofeedback reduced pain, bloating straining and laxative use in patients with evacuatory disorders. CONCLUSIONS: Biofeedback may be associated with significant improvement in quality of life as well as possible improvements in symptoms related to both incontinence and evacuatory disorders. It is probably an underused service. Further larger prospective studies are required to properly assess the efficacy of biofeedback in ileoanal pouch related dysfunction.
Segal JP, Poo SX, McLaughlin SD, et al., 2018, Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis, Frontline Gastroenterology, Vol: 9, Pages: 154-158, ISSN: 2041-4137
Objective: Restorative proctolectomy is considered the procedure of choice in patients with ulcerative colitis who have failed medical therapy. Chronic pouchitis occurs in 10%-15% of patients, which often require long-term antibiotics to alleviate symptoms. Safety and efficacy of long-term maintenance antibiotics for chronic pouchitis has yet to be established. We aimed to assess the long-term safety and efficacy of maintenance antibiotic therapy for chronic pouchitis. Design: This was an observational study. We followed up patients who were diagnosed with chronic antibiotic-dependent pouchitis. Setting: Data were collected from our single specialist pouch centre. Patients: Patients with chronic antibiotic-dependent pouchitis who had been maintained on antibiotics continuously for at least 1 year with a least one follow-up visit. Main outcome measure: Development of pouch failure defined by the need for an ileostomy, patient-reported side effects of antibiotics and development of antibiotic resistance found on stool coliform testing. Results: Long-term use of antibiotics achieve remission in 21% of patients over a median follow-up of 102 (range 9-125). Pouch failure in association with chronic pouchitis after a median follow-up of 8.5 years occurred in 18%. Side effects of long-term antibiotic use occurred in 28% of patients, with resistance to antibiotics from at least one stool sample occurring in 78% patients. Conclusions: Although the use of antibiotics in chronic pouchitis may be justified, the use of long-term antibiotics must be weighed against potential complications associated with pouchitis and antibiotics.
Segal J, McLaughlin S, Penez L, et al., 2018, P141 Infliximab therapy for inflammatory pouch pathology: a multi-centre retrospective study, 13th Congress of ECCO – European Crohn’s and Colitis Organisation, Publisher: Oxford University Press (OUP), Pages: S167-S167, ISSN: 1873-9946
Kallenberg FGJ, Latchford A, Lips NC, et al., 2018, Duodenal Adenomas in Patients With Multiple Colorectal Adenomas Without Germline <i>APC</i> or <i>MUTYH</i> Mutations, DISEASES OF THE COLON & RECTUM, Vol: 61, Pages: 58-66, ISSN: 0012-3706
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- Citations: 9
Segal JP, Oke S, Hold GL, et al., 2017, Systematic review: ileoanal pouch microbiota in health and disease., Alimentary Pharmacology and Therapeutics, Vol: 47, Pages: 466-477, ISSN: 0269-2813
BACKGROUND: The resident gut microbiota is essential for physiological processes; the disturbance of its balance is linked to intestinal inflammation. The ileoanal pouch is a model for the study of intestinal inflammation, as inflammation of the pouch is common and mostly develops within 12 months following ileostomy closure. This allows the longitudinal study of the microbiota, giving insight into the microbiota changes during transition from a normal to an inflamed pouch. AIM: To explore the literature on the microbiota of the ileoanal pouch in health and disease. METHODS: A systematic computer search of the on-line bibliographic databases MEDLINE and EMBASE was performed between 1966 and February 2017. Randomised controlled trials, cohort studies and observational studies were included. Studies were included if they reported microbiota analysis on faecal samples or tissue from the ileoanal pouch. RESULTS: Twenty-six papers were eligible. Following ileostomy closure, anaerobic bacteria are the abundant species in the ileoanal pouch with presence of a diverse microbiota key to maintaining a healthy ileoanal pouch. Acute pouchitis is associated with an increase in Clostridia species, while chronic pouchitis is associated with an increase in Staphylococcus aureus. In the treatment of pouchitis, a decrease in Clostridia species appears to be associated with treatment response. CONCLUSION: The microbiota plays an important role in both the inflamed and the healthy ileoanal pouch. A direct causal relationship between individual microbiota changes and inflammation has not yet been established, but manipulation of the ileoanal pouch microbiota may be a novel therapeutic avenue to explore.
Segal JP, Worley G, Adegbola SO, et al., 2017, A systematic review: The management and outcomes of ileal pouch strictures, Journal of Crohns & Colitis, Vol: 12, Pages: 369-375, ISSN: 1873-9946
Background: Restorative proctocolectomy with ileal pouch-anal anastomosis removes the diseased tissue in ulcerative colitis but also allows gastrointestinal continuity and stoma-free living. Pouch strictures are a complication with a reported incidence of 5-38%. The three areas where pouch strictures occur are in the pouch inlet, mid-pouch and pouch-anal anastomosis. Aim: To undertake a systematic review of the literature and to identify management strategies available for pouch-anal, mid-pouch and pre-pouch ileal strictures and their outcomes. Methods: A computer assisted search of the on-line bibliographic databases MEDLINE and EMBASE limited to 1966 to February 2016 was performed. Randomised controlled trials, cohort studies, observational studies and case reports were considered. Those where data could not be extracted were excluded. Results: Twenty-two articles were considered eligible. Pouch-anal strictures have been initially managed using predominately dilators which include bougie and Hegar dilators with various surgical procedures advocated when initial dilatation fails. Mid-pouch strictures are relatively unstudied with both medical, endoscopic and surgical management reported as successful. Pouch inlet strictures can be safely managed using combined medical and endoscopic approach. Conclusion: The limited evidence available suggests that pouch-anal strictures are best treated in a stepwise fashion with initial treatment to include digital or instrumental dilatation followed by surgical revision or resection. Management of mid-pouch strictures requires a combination of medical, endoscopic and surgical management. Pouch inlet strictures are best managed using a combined medical and endoscopic approach. Future studies should compare different treatment modalities on separate stricture locations to enable an evidenced based treatment algorithm.
Thomas LE, Hurley JJ, Meuser E, et al., 2017, Burden and Profile of Somatic Mutation in Duodenal Adenomas from Patients with Familial Adenomatous- and <i>MUTYH</i>-associated Polyposis, CLINICAL CANCER RESEARCH, Vol: 23, Pages: 6721-6732, ISSN: 1078-0432
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- Citations: 17
Clark S, 2017, Universal testing of colorectal cancer for deficient mismatch repair - a new era has arrived., Colorectal Disease, Vol: 19, Pages: 801-802, ISSN: 1462-8910
O'Shea NR, Hodges NC, Man RF, et al., 2017, POUCH POLYPS IN FAP - A CLINICAL PROBLEM OR AN ENDOSCOPIC CURIOSITY?, Annual General Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A35-A35, ISSN: 0017-5749
Cunningham C, Leong K, Clark S, et al., 2017, Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Diagnosis, Investigations and Screening, COLORECTAL DISEASE, Vol: 19, Pages: 9-17, ISSN: 1462-8910
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- Citations: 21
Anele CC, Adegbola SO, Askari A, et al., 2017, Risk of metachronous colorectal cancer following colectomy in Lynch syndrome: a systematic review and meta-analysis, Colorectal Disease, Vol: 19, Pages: 528-536, ISSN: 1462-8910
imLynch syndrome (LS) accounts for 2–4% of all colorectal cancer (CRC) cases, and is associated with an increased risk of developing metachronous colorectal cancer (mCRC). The role of extended colectomy in LS CRC is controversial. There are limited studies comparing the risk of mCRC following segmental colectomy and extended colectomy. The objective of this systematic review is to evaluate the risk of developing mCRC following segmental and extended colectomy for LS CRC and endoscopic compliance.MethodA systematic review of major databases was performed using predefined terms. All original articles published in English comparing the risk of mCRC in LS patients after segmental and extended colectomy from 1950 to January 2016 were included.ResultsThe search retrieved 324 studies. Six studies involving 871 patients met the inclusion criteria. Of these, 705 (80.9%) underwent segmental colectomy and 166 (19.1%) extended colectomy. Average follow-up was 91.2 months. The mCRC rate was 22.8% and 6% in the segmental and extended colectomy groups, respectively. The segmental group were over four times more likely to develop mCRC (OR 4.02, 95% CI: 2.01–8.04, P < 0.0001). mCRC occurred in patients after segmental colectomy despite 1–2-yearly postoperative endoscopic surveillance.ConclusionThis result suggests that extended colectomy reduces the risk of mCRC by over four-fold compared with segmental colectomy. mCRC occurred in the segmental group despite postoperative endoscopic surveillance. This needs to be borne in mind when deciding on the appropriate surgical management of LS patients with CRC. We recommend that extended colectomy should be considered for patients with confirmed LS CRC.
East JE, Atkin WS, Bateman AC, et al., 2017, British Society of Gastroenterology position statement on serrated polyps in the colon and rectum, Gut, Vol: 66, Pages: 1181-1196, ISSN: 0017-5749
Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations—serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).
Monahan KJ, Alsina D, Bach S, et al., 2017, Urgent improvements needed to diagnose and manage Lynch syndrome, BMJ-BRITISH MEDICAL JOURNAL, Vol: 356, ISSN: 1756-1833
Walton SJ, Frayling IM, Clark SK, et al., 2017, Gastric tumours in FAP, Familial Cancer, Vol: 16, Pages: 363-369, ISSN: 1573-7292
Gastric cancer is not a recognised extra-colonic manifestation of FAP, except in countries with a high prevalence of gastric cancer. Data regarding gastric adenomas in FAP are sparse. The aim of this study was to review the clinical characteristics of gastric tumours occurring within an FAP population from the largest European polyposis registry. All patients that developed a gastric adenoma or carcinoma were identified from a prospectively maintained registry database. The primary outcome measure was the occurrence of gastric adenoma or adenocarcinoma. Secondary outcomes included APC mutation, tumour stage, management and survival. Eight patients developed gastric cancer and 21 an adenoma (median age 52 and 44 years, respectively). Regular oesophagogastroduodenoscopy surveillance was performed in 6/8 patients who developed cancer. Half were advanced T3/4 tumours and 6/8 had nodal or metastatic spread at diagnosis. All cancer cases died within a median of 13.5 months from diagnosis. Gastric adenomas were evenly distributed: 11/21 (52%) in the distal and 10/21 (48%) proximal stomach, whereas 5/8 (63%) cancers were located proximally. An association between gastric tumour and desmoid development was observed; 7/8 (88%) cancer and 11/21 (52%) adenoma cases had a personal or family history of desmoid. It would appear from this small, retrospective study that gastric cancer is not a prominent extra-colonic feature of FAP in the Western world. It seems to present at an advanced stage with a poor prognosis. There may be an association between gastric tumour and desmoid occurrence but a large multicentre cohort is necessary to investigate this further.
Brigic A, Sakuma S, Lovegrove RE, et al., 2016, A prospective case control study of functional outcomes and related quality of life after colectomy for neoplasia., International Journal of Colorectal Disease, Vol: 32, Pages: 777-787, ISSN: 1432-1262
AIM: Our aim was to assess bowel function and its effect on overall quality of life (QOL) when compared to healthy controls after colectomy. METHODS: Patients undergoing resection of colorectal neoplasia were recruited pre-operatively and followed up at 6 and 12 months, to assess 'early' bowel function. Patients who underwent surgery 2 to 4 years previously were recruited for assessment of 'intermediate' bowel function. Healthy relatives were recruited as controls. The Memorial Sloan-Kettering Cancer Centre and EQ-5D questionnaires were used to assess bowel function and QOL, respectively. Statistical assessment included regression analyses, parametric and non-parametric tests. The association between QOL and Memorial Sloan-Kettering Cancer Centre (MSKCC) scores was evaluated using Spearman's rank correlation. RESULTS: Ninety-one patients were recruited for assessment of 'early' and 85 for 'intermediate' bowel function. There were 85 controls. Patients had a significantly higher number of bowel movements at each follow-up (p < 0.001). At 12 months after surgery, patients reported difficulty with gas-stool discrimination. The 'intermediate' group were found to have lower scores for flatus control (<0.001) and total frequency score (p 0.03), indicating worse function. Patients with higher total MSKCC scores, no symptoms of urgency and those able to control flatus reported better QOL (p 0.006, 0.007 and 0.005, respectively) at 6 and 12 months. Gas-stool differentiation and complete evacuation correlated with better QOL in the 'intermediate' bowel function group (p 0.02 and 0.02, respectively). CONCLUSION: Colonic resection adversely affects elements of bowel function up to 4 years after surgery. Good colonic function, represented by higher MSKCC scores, correlates with better QOL.
Segal JP, Ding NS, Worley G, et al., 2016, Systematic review with meta-analysis: the management of chronic refractory pouchitis with an evidence-based treatment algorithm, Alimentary Pharmacology and Therapeutics, Vol: 45, Pages: 581-592, ISSN: 0269-2813
BACKGROUND: Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is considered the procedure of choice in patients with ulcerative colitis (UC) refractory to medical therapy. The incidence of pouchitis is 40% at 5 years. Ten to 15% of patients with pouchitis experience chronic pouchitis. AIM: To determine the efficacy of medical therapies for the treatment of chronic refractory pouchitis in patients undergoing IPAA for UC. METHODS: A systematic computer-assisted search of the on-line bibliographic database MEDLINE and EMBASE was performed between 1966 and February 2016. All original studies reporting remission rates following medical treatment for chronic pouchitis were included. All study designs were considered. Remission was defined according to the individual study. Remission endpoints ranged from 15 days to 10 weeks. Chronic pouchitis was defined by each study. RESULTS: Twenty-one papers were considered eligible. Results from all studies combined suggested that overall remission was obtained in 59% of patients (95% CI: 44-73%). Antibiotics significantly induced remission in patients with chronic pouchitis with 74% remission rate (95% CI:56-93%), (P < 0.001). Biologics significantly induced remission in patients with chronic pouchitis with 53% remission rate (95% CI:30-76%), (P < 0.001). Steroids, bismuth, elemental diet and tacrolimus all can induce remission but failed to achieve significance. Faecal microbiota transplantation in a single study was not found to achieve remission. CONCLUSIONS: Treatment of chronic refractory pouchitis remains difficult and is largely empirical. Larger randomised controlled trials will help aid the management of chronic pouchitis.
Ourô S, Shaikh I, Clark SK, 2016, Management of pouch dysfunction in a tertiary centre, Colorectal Disease, Vol: 18, Pages: 1167-1171, ISSN: 1463-1318
AIM: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis is the operation of choice for ulcerative colitis (UC) and some cases of familial adenomatous polyposis (FAP). Offering improvement in quality of life and high patient satisfaction, pouch surgery is also associated with significant morbidity. The aim of this study was to describe the management of patients referred to a tertiary centre with pouch dysfunction. METHOD: All patients referred with pouch dysfunction from other institutions, between October 2006 and November 2014, were included in this retrospective study. Information regarding initial diagnosis before RPC, type of procedure, symptoms leading to referral, relation of the appearance of symptom to the ileostomy closure, investigations, final diagnosis, treatment and follow-up was reviewed. RESULTS: One hundred and twenty one patients were included, having RPC mostly for UC (94%), and with diverting ileostomy (83%). The most frequent reasons for referral were high frequency of defaecation in 83 (69%) patients, abdominal pain and incontinence in 45 (37%) each and perianal pain in 44 (36%). The principal investigations performed were pouchoscopy in 97 (80%) patients, examination under anaesthesia (EUA) in 62 (51%), pelvic magnetic resonance imaging (MRI) in 56 (46%) and contrast radiology of the pouch (pouchogram) in 45 (35%). The commonest diagnoses were pouchitis (primary and secondary) in 24 (21%) patients and anastomotic leakage in 26 (22%). After full investigation a cause for the symptoms could not be found in 24 (20%) patients, resulting in the diagnosis of exclusion of 'irritable pouch syndrome' or functional disorder. Treatments given were long term antibiotic therapy in 29 (25%) patients, ileostomy in 19 (16%), use of a Medena catheter to promote anal evacuation in 17 (15%) and dilatation of a stenosis under anaesthetic in12 (10%). Six (5%) patients underwent major revision surgery of the pouch with a defunctioning ileostomy and
van der Ploeg VA, Maeda Y, Faiz OD, et al., 2016, The prevalence of chronic peri-pouch sepsis in patients treated for antibiotic-dependent or refractory primary idiopathic pouchitis, Colorectal Disease, Vol: 19, Pages: 827-831, ISSN: 1463-1318
AIM: Chronic peri-pouch sepsis (CPPS) may be mistaken for antibiotic-dependent or refractory primary idiopathic pouchitis (ADRP), but requires different treatment such as drainage. The study aimed to identify the prevalence of CPPS in patients thought to have ADRP. The secondary aims were to identify any specific features on pouchoscopy suggesting CPPS and to determine the results of treatment for CPPS. METHOD: The records of patients who had been treated for ADRP between March 2006 and June 2015 were reviewed retrospectively. Only those with endoscopic evidence of pouch inflammation who had also undergone magnetic resonance imaging (MRI) of the pelvis were included. The findings on pouchoscopy and the outcome of treatment were determined. RESULTS: Sixty-eight (43 (63%) male) patients were identified with apparent ADRP between March 2006 and June 2015. MRI of the pelvis showed CPPS in 26 (38%). In those with CPPS, the inflammation was more often located in the upper pouch alone (15%) compared with patients without CPPS (0%) (p = 0.0184). Examination under anaesthesia was performed in 13 of those with CPPS. In five a collection was identified and drained; symptoms improved in only one (4%). Eighteen patients (69%) remained on antibiotics and 7 (27%) had a defunctioning stoma or underwent pouch excision. CONCLUSION: In patients thought to have ADRP, 38% had CPPS on MRI. There was no clinically relevant specific feature on pouchoscopy suggestive of CPPS. The possibility of CPPS should be considered early in patients with apparent ADRP and pelvic MRI performed. This might lead to earlier detection of CPPS and appropriate treatment. This article is protected by copyright. All rights reserved.
Aziz O, Albeyati A, Derias M, et al., 2016, Anastomotic leaks can be detected within 5 days following ileorectal anastomosis: A case-controlled study in patients with familial adenomatous polyposis, Colorectal Disease, Vol: 19, Pages: 251-259, ISSN: 1463-1318
AIM: To determine the earliest time point at which anastomotic leaks can be detected in patients undergoing total colectomy (TC) with primary ileorectal anastomosis (IRA) for Familial Adenomatous Polyposis (FAP). METHOD: A case-controlled study of 10 anastomotic leak patients versus 20 controls following laparoscopic TC with IRA for FAP (from 96 consecutive patients between 2006-2013). Panel time-series data regression was performed using a double subscript structure to include both variables. A generalized least squares multi-variate approach was applied in a random effects setting to calculate correlations for observations, with anastomotic leak being the dependent variable. Univariate and multivariate regression calculations were then performed according to individual observations at each recorded time point. Time-series analysis was used to determine when a variable became significant in the leak group. RESULTS: Multivariate analysis identified a significant difference between leak and control groups in mean heart rate (p=<0.001), mean respiratory rate (p=0.017), and mean urine output (p=0.001). Time-point analysis showed that heart rate was significantly different between leak and control groups at post-operative day 4.25. Multivariate analysis identified a significant difference between groups in ALT (p=0.006), Bilirubin (p=0.008), Creatinine (p=0.001), Haemoglobin (p=<0.001), and Urea (p=0.007). There were no differences between groups with regards to markers of inflammation such as albumin, white blood cell count, neutrophil count, and CRP. CONCLUSION: Anastomotic leaks can be detected early (within 4.5 days of surgery) through changes in physiological, blood test, and observational parameters, providing an opportunity for early intervention in these patients to salvage the anastomosis. This article is protected by copyright. All rights reserved.
Walton S-J, Kallenberg FGJ, Clark SK, et al., 2016, Frequency and Features of Duodenal Adenomas in Patients With MUTYH-Associated Polyposis, CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, Vol: 14, Pages: 986-992, ISSN: 1542-3565
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- Citations: 28
Walton SJ, Lewis A, Jeffery R, et al., 2016, Familial adenomatous patients with desmoid tumours show increased expression of miR-34a in serum and high levels in tumours, Oncoscience, Vol: 3, Pages: 173-185, ISSN: 2331-4737
Familial adenomatous polyposis (FAP) is rare affecting 1 in 10,000 people and a subset (10%) are at risk of myofibroblastic desmoid tumours (DTs) after colectomy to prevent cancer. DTs are a major cause of morbidity and mortality. The absence of markers to monitor progression and a lack of treatment options are significant limitations to clinical management. We investigated microRNAs (miRNA) levels in DTs and serum using expression array analysis on two independent cohorts of FAP patients (total, n=24). Each comprised equal numbers of patients who had formed DTs (cases) and those who had not (controls). All controls had absence of DTs confirmed by clinical and radiological assessment over at least three years post- colectomy. Technical qPCR validation was performed using an expanded cohort (29 FAP patients; 16 cases and 13 controls). The most significant elevated serum miRNA marker of DTs was miR-34a-5p and in-situ hybridisation (ISH) showed most DTs analysed (5/6) expressed miRNA-34a-5p. Exome sequencing of tumour and matched germline DNA did not detect mutations within the miR-34a-5p transcript sites or 3'-UTR of target genes that would alter functional miRNA activity. In conclusion, miR-34a-5p is a potential circulatory marker and therapy target. A large prospective world-wide multi-centre study is now warranted.
Stellingwerf ME, Maeda Y, Patel U, et al., 2016, The role of the defaecating pouchogram in the assessment of evacuation difficulty after restorative proctocolectomy and pouch–anal anastomosis, Colorectal Disease, Vol: 18, Pages: O292-O300, ISSN: 1463-1318
AIM: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the most frequently performed operation for intractable ulcerative colitis (UC) and for many patients with familial adenomatous polyposis (FAP). It can be complicated by a functional evacuation difficulty, which is not well understood. We aimed to evaluate the role of defaecating pouchography in an attempt to assess the mechanism of evacuation difficulty in pouch patients. METHOD: All RPC patients who had had a defaecating pouchogram for evacuation difficulty at one hospital between 2006 and 2014 were retrospectively reviewed. The findings and features were correlated with the symptoms. Demographic, clinical and radiological variables were analysed. RESULTS: 87 (55 (63%) female (F)) patients of mean age of 47.6 ± 12.5 (standard deviation [SD]) years were identified. Thirty five had a mechanical outlet obstruction and 52 had no identified mechanical cause to explain the evacuation difficulty. The mean age of the 52 (33 [63%] F) patients was 48.2± 13 years. Of the 52 patients, significantly more used anti-diarrhoeal medication (p=0.029), complained of high frequency of defaecation (p=0.005), experienced a longer time to the initiation of defaecation (p=0.049) and underwent pouchoscopy (p=0.003). Biofeedback appeared to improve the symptoms in 7 of 16 patients with a non-mechanical defaecatory difficulty. The most common findings on defaecating pouchography included residual barium of more than 33% after an attempted evacuation (46%, n=24), slow evacuation (35%, n=18) and mucosal irregularity (33%, n=17). Correlation between radiological features and symptoms showed a statistically significant relationship between straining, anal pain, incontinence and urgency with patterns of anismus or pelvic floor descent or weakness seen on the defaecating pouchogram. Symptoms of incomplete evacuation, difficulty in the initiation of defaecation, high defaecatory frequency and abdominal
Landy J, Ronde E, English N, et al., 2016, Tight junctions in inflammatory bowel diseases and inflammatory bowel disease associated colorectal cancer, World Journal of Gastroenterology, Vol: 22, Pages: 3117-3126, ISSN: 1007-9327
van der ploeg VA, Maeda Y, faiz OD, et al., 2016, Prevalence of chronic peri-pouch sepsis in patients treated as primary idiopathic pouchitis, 11th Congress of European Crohn's and Colitis Organisation - ECCO, Publisher: Oxford University Press (OUP), Pages: S197-S197, ISSN: 1876-4479
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