Andrew D. Hopper
Royal Hallamshire Hospital
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Featured researches published by Andrew D. Hopper.
Clinical Gastroenterology and Hepatology | 2008
Andrew D. Hopper; Marios Hadjivassiliou; David P. Hurlstone; Alan J. Lobo; Mark E. McAlindon; William Egner; Graeme Wild; David S. Sanders
BACKGROUND & AIMS The optimal serologic tests for the detection of celiac disease and follow-up assessment remains controversial. Our aim was to evaluate all current immunologic assays for diagnosing celiac disease using the gold standard of duodenal biopsy. We also assessed whether tissue transglutaminase (tTG) antibody is a quantitative marker for histologic severity. METHODS Consecutive adult patients referred for gastroscopy without a previous known diagnosis of celiac disease were recruited (group 1). Concurrently, patients with a known diagnosis of celiac disease on a gluten-free diet for more than 1 year undergoing repeat duodenal biopsy were identified (group 2). All patients had duodenal biopsies and serologic analysis performed for immunoglobulin(Ig) A and antibodies to human immunoglobulin (Ig)A-tTG, IgA-gliadin, IgG-gliadin, and IgA-endomysial antibody. RESULTS Two thousand patients were recruited in the first group. Seventy-seven (3.9%) patients were diagnosed with new celiac disease. The sensitivity, specificity, positive predictive value, and negative predictive value for IgA tTG were 90.9%, 90.9%, 28.6%, and 99.6%. When adopting a 2-step approach using tTG first and then EMA the sensitivity, specificity, positive predictive value, and negative predictive value was 85.7%, 98.6%, 71.7%, and 99.7%, respectively. The use of nondeamidated IgA/IgG gliadin antibodies conferred no additional diagnostic benefit when considering the detection of adult celiac disease. In the second group 48 patients with celiac disease on a gluten-free diet were identified. Sixteen of 48 of these patients had persisting villous atrophy, but 7 of 16 (44%) had a normal tTG level. CONCLUSIONS IgA tTG alone is a sensitive marker for celiac disease. A normal tTG level does not predict recovery of villous atrophy in patients with celiac disease on a gluten-free diet.
BMJ | 2007
Andrew D. Hopper; Marios Hadjivassiliou; Sohail Butt; David S. Sanders
#### Summary points The prevalence of coeliac disease is 0.5-1% in international population studies. The delay in diagnosis is reported to range from 4.5 years to 9.0 years.1 2 Patients may present on numerous occasions to both primary and secondary care without coeliac disease being considered.3 Currently, for every adult patient in whom the disease is diagnosed, eight cases are estimated to go undetected.4 Coeliac disease (or gluten sensitive enteropathy) is defined as a state of heightened immunological responsiveness to ingested gluten (from wheat, barley, or rye) in genetically susceptible individuals. Coeliac disease has historically been considered to be an uncommon gastrointestinal condition. In addition, most clinicians expect to recognise infant or childhood presentations with overt symptoms of malabsorption (or failure to thrive). A paradigm shift has occurred, however, in our conceptual understanding of coeliac disease. Recent international studies assessing the prevalence of coeliac disease in the general population have consistently reported that coeliac disease affects 0.5-1% of all adults.w1 Adult presentations are now more frequent than paediatric (a ratio of 9:1, according to the 2005 membership data of the Coeliac UK charity). Patients most commonly present during their 40s.w2 Patients with adult coeliac disease rarely present with symptoms suggestive of malabsorption (low body mass index accounts for 5% of all cases diagnosed, with most having either a normal or overweight body mass indexw3). Far more commonly they describe non-specific or subtle gastrointestinal symptoms (for example, non-specific abdominal pain, symptoms similar …
Diabetes Care | 2011
John S. Leeds; Andrew D. Hopper; Marios Hadjivassiliou; Solomon Tesfaye; David S. Sanders
OBJECTIVE The implications of celiac disease (CD) in adult patients with type 1 diabetes are unknown, with respect to diabetes-related outcomes including glycemic control, lipids, microvascular complications, quality of life, and the effect of a gluten-free diet (GFD). We identified CD in adults with type 1 diabetes and investigated the effect of a GFD on diabetes-related complications. RESEARCH DESIGN AND METHODS This was a case-control study conducted at a U.K. teaching hospital. Patients with type 1 diabetes aged >16 years (n = 1,000) were assessed for CD. HbA1c, lipid profile, quality of life, retinopathy stage, nephropathy stage, and degree of neuropathy before and after 1 year on a GFD were assessed. RESULTS The prevalence of CD was 33 per 1,000 subjects (3.3% [95% CI 2.3–4.6]). At diagnosis of CD, adult type 1 diabetic patients had worse glycemic control (8.2 vs. 7.5%, P = 0.05), lower total cholesterol (4.1 vs. 4.9, P = 0.014), lower HDL cholesterol (1.1 vs. 1.6, P = 0.017), and a higher prevalence of retinopathy (58.3 vs. 25%, P = 0.02), nephropathy (41.6 vs. 4.2%, P = 0.009), and peripheral neuropathy (41.6 vs. 16.6%, P = 0.11). There was no difference in quality of life (P > 0.1). After 1 year on a GFD, only the lipid profile improved overall, but in adherent individuals HbA1c and markers for nephropathy improved. CONCLUSIONS Adults with undetected CD and type 1 diabetes have worse glycemic control and a higher prevalence of retinopathy and nephropathy. Treatment with a GFD for 1 year is safe in adults with type 1 diabetes and does not have a negative impact on the quality of life.
Scandinavian Journal of Gastroenterology | 2007
John S. Leeds; Barbara S. Höroldt; Reena Sidhu; Andrew D. Hopper; K Robinson; Bonnie Toulson; Lynn Dixon; Alan J. Lobo; Mark E. McAlindon; David P. Hurlstone; David S. Sanders
Objective. The relationship between coeliac disease and inflammatory bowel disease (IBD) is controversial. The aim of this study was to determine the prevalence of coeliac disease in IBD and the prevalence of IBD in coeliac disease. Material and methods. Patients were enrolled from specialist IBD and coeliac clinics. Antigliadins, endomysial, tissue transglutaminase antibody and total IgA levels were measured in IBD patients. Patients with positive antibodies were offered a duodenal biopsy. The notes on coeliac patients were reviewed for colonoscopic and biopsy findings. Controls were recruited from the local population. Results. The study included 305 patients with coeliac disease, 354 with IBD and 601 healthy controls. The IBD group comprised 154 ulcerative colitis (UC) cases, 173 Crohns disease, 18 indeterminate colitis and 9 cases of microscopic colitis. Forty-seven patients had positive antibodies and 3 had villous atrophy on biopsy. All three patients had positive anti-tissue transglutaminase antibodies but only two were endomysial antibody (EMA) positive. Ten coeliac patients had IBD (5 UC and 5 lymphocytic colitis). Five controls had coeliac disease and 2 had IBD (1 Crohns disease and 1 UC). Stepwise multiple logistic regression showed only antibody positivity as being significant (p<0.0001). Conclusions. The prevalence of IBD in coeliac disease was increased 10-fold compared with that in controls (odds ratio 9.98, 95% CI 2.8–45.9, p=0.0006), while the prevalence of coeliac disease in IBD was comparable with that in controls (odds ratio 1.02, 95% CI, 0.24–4.29, p=1.0).
Alimentary Pharmacology & Therapeutics | 2010
Imran Aziz; K E Evans; Andrew D. Hopper; David M Smillie; David S. Sanders
Aliment Pharmacol Ther 2010; 32: 1392–1397
Alimentary Pharmacology & Therapeutics | 2006
J S Leeds; Andrew D. Hopper; D. P. Hurlstone; S. J. Edwards; M. E. Mcalindon; Alan J. Lobo; M. T. Donnelly; Stephen Morley; David S. Sanders
Patients with coeliac disease may have diarrhoea despite being on a gluten‐free diet.
Scandinavian Journal of Gastroenterology | 2011
Matthew Kurien; K E Evans; John S. Leeds; Andrew D. Hopper; Andrew Harris; David S. Sanders
Abstract Objective. Bile acid malabsorption (BAM) has been reported as a possible cause of diarrhea predominant irritable bowel syndrome (D-IBS) type symptoms. We aimed to determine how commonly patients with D-IBS type symptoms had a diagnosis of BAM as demonstrated by a positive SeHCAT (75 Selenium-homocholic acid taurine) test (retention <10% at seven days). Materials and methods. A retrospective analysis was undertaken of patients records for all patients who underwent a SeHCAT test between 2001 and 2009 in a tertiary hospital (Group A). Concurrently, a cohort of patients with Rome II D-IBS type symptoms was examined to determine the potential utility of SeHCAT test (Group B). Results. In Group A 39.2% (n = 107/273) of patients had a positive SeHCAT result. The median time from first hospital visit to SeHCAT result was 30 weeks. Predictive factors for BAM: terminal ileal Crohns disease (p < 0.01), terminal ileal resection (p < 0.01), and previous cholecystectomy (p < 0.01). 33.6% of patients who had a positive SeHCAT also had Rome II D-IBS. In Group B the D-IBS control cohort only 1.9% of patients had undergone a SeHCAT scan (p < 0.001 compared to Group A). Conclusion. BAM is common and should be considered earlier when investigating unselected patients with D-IBS type symptoms.
Gastrointestinal Endoscopy | 2010
Alan C. Moss; Michael J. Bourke; Vu Kwan; Kayla Tran; Craig Godfrey; Gary McKay; Andrew D. Hopper
BACKGROUND Succinylated gelatin (SG) is an inexpensive colloid that may combine ease of use with the advantages of a colloid to potentially increase EMR specimen size, leading to a higher rate of en bloc resection. OBJECTIVE To evaluate the safety, efficacy, and impact on EMR specimen size of SG as a submucosal (s.m.) injectant in comparison with normal saline solution (NS). DESIGN Randomized, blinded, controlled trial conducted with Animal Ethics Committee approval. SETTING Academic hospital. SUBJECTS Ten swine. INTERVENTIONS Sixty EMRs (30 using SG vs 30 using NS as 3 paired experiments per animal) of the largest possible en bloc snare resection of normal colonic mucosa after s.m. injection of a fixed volume of either SG or NS. MAIN OUTCOME MEASUREMENTS EMR specimen size, duration of s.m. cushion, duration of procedure, ratio of vertical elevation to lateral spread of injectant, ease of resection, adverse effects, perforation, histopathology of EMR sites in colectomy specimens at necropsy (for inflammatory cell content, depth of ulceration, and vascular or ischemic changes). RESULTS The mean subject weight was 53 kg. The mean EMR specimen dimensions and surface area were significantly larger with SG (length 37 vs 31 mm, P = .031; width 32 vs 26 mm, P = .022; surface area 9.5 cm(2) vs 6.7 cm(2), P = .044, respectively). The median s.m. cushion duration was 60 minutes with SG versus 15 minutes with NS (P = .005). The median procedure duration with SG was 2.6 minutes vs 2.5 minutes with NS (P = .515). The ratio of vertical elevation to lateral spread of injectant (mean score on a 3-point scale) was 3 with SG versus 2 with NS (P = .228). Ease of resection score (mean score on a 10-point scale) was 8 with SG versus 7 with NS (P = .216). There were no systemic adverse effects, hypersensitivity reactions, or bleeding episodes. There were 2 perforations (treated with clips) with SG and 1 with NS (P = 1.0). Blinded histopathologist assessment of necropsy colectomy specimens did not identify any significant differences between SG and NS EMR sites. LIMITATIONS Animal study. CONCLUSIONS SG is safe and results in a 42% increased surface area for en bloc EMR. Given its other favorable properties, it represents a significant step toward defining the ideal EMR solution.
Annals of Surgery | 2005
David S. Sanders; Andrew D. Hopper; Iman Azmy; Nahida Rahman; David P. Hurlstone; John S. Leeds; Rina R. George; Neeraj Bhala
Background:Acute abdominal pain is the most common indication for surgical admission. Nonspecific abdominal pain (NSAP) may account for up to 40% of cases. There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease. Aims:We aimed to assess the association of celiac disease with surgical abdominal pain. Patients and Methods:A case-control study was undertaken involving 300 consecutive new unselected patients presenting with acute abdominal pain (in a university hospital) and healthy controls (age and sex matched) without abdominal pain (n = 300). Initial investigations for celiac disease were immunoglobulins, IgA/IgG anti-gliadin (AGA), and endomysial antibodies (EMA). Any patient with a positive IgA AGA, EMA, or only IgG AGA in the presence of IgA deficiency was offered a small bowel biopsy to confirm the diagnosis. Results:There were 33 patients with abdominal pain who had positive antibodies, of whom 9 had histologically confirmed celiac disease (6 EMA positive; 3 EMA negative). One antibody positive patient (EMA in isolation) declined duodenal biopsy and the remaining 23 had normal duodenal mucosa. Within the control group, there were 2 cases of celiac disease. Compared with matched controls the association of acute abdominal pain with celiac disease gave an odds ratio 4.6. (P = 0.068, 95% confidence interval, 1.11–19.05). When only considering NSAP the prevalence of celiac disease was highly significant at 10.5% (9 of 86, P = 0.006). Patients’ symptoms improved on a gluten-free diet at 12- to 18-month follow-up. Conclusion:Celiac disease was diagnosed in 3% of patients who presented with unselected acute abdominal pain to secondary care. Targeting patients who have NSAP or celiac associated symptoms/diseases may improve the diagnostic yield.
Digestive and Liver Disease | 2008
Reena Sidhu; P. Sakellariou; Mark E. McAlindon; John S. Leeds; K. Shafiq; B.S. Hoeroldt; Andrew D. Hopper; M. Karmo; C. Salmon; D. Elphick; A. Ali; David S. Sanders
BACKGROUND Little is known about the infrastructure to train gastroenterologists in capsule endoscopy. The level of capsule endoscopy exposure among trainees in the United Kingdom or Europe has also not been quantified. AIMS AND METHODS To assess the ability of 10 gastroenterology trainees with endoscopy experience to interpret 10 capsule endoscopy videos against five medical students, with an expert in capsule endoscopy as the gold standard. Parameters assessed included gastric emptying time, small bowel transit and the diagnosis made. A questionnaire survey assessed the level of capsule endoscopy exposure among United Kingdom trainees. RESULTS Trainees were better at determining the gastric emptying time (p=0.013) and more likely to record true positives compared to the students (p=0.037). They were also less likely to record false positives (p=0.005) and more likely to reach the correct diagnosis (p=0.001, OR 3.6, CI 1.8-7.4). Our survey found that, 65% of trainees had prior exposure to capsule endoscopy but only 13% had done capsule endoscopy reporting. Sixty seven percent felt capsule endoscopy should be incorporated into their training. CONCLUSION This study has shown that prior endoscopic experience enables trainees to interpret capsule endoscopy more accurately than medical students. However, there is a demand for focussed training which would enable trainees to reliably interpret pathology on capsule endoscopy.