Martyn J. Carter

Genetic determinants of ulcerative colitis include the ECM1 locus and five loci implicated in Crohn's disease

We report results of a nonsynonymous SNP scan for ulcerative colitis and identify a previously unknown susceptibility locus at ECM1. We also show that several risk loci are common to ulcerative colitis and Crohns disease (IL23R, IL12B, HLA, NKX2-3 and MST1), whereas autophagy genes ATG16L1 and IRGM, along with NOD2 (also known as CARD15), are specific for Crohns disease. These data provide the first detailed illustration of the genetic relationship between these common inflammatory bowel diseases.

Functional correlates of the interleukin-1 receptor antagonist gene polymorphism in the colonic mucosa in ulcerative colitis

Association studies have identified the interleukin-1 receptor antagonist gene allele 2(IL-1RN*2) as a marker of susceptibility in ulcerative colitis (UC). This study investigated the significance of the IL-1RN genotype with respect to protein and mRNA expression in the colonic mucosa. Homogenates of rectal biopsies from 99 UC and 54 controls were assayed for cytokines IL-1ra, IL-1a and IL-1b using ELISA. IL1RN, IL1A and IL1B genotypes were determined using restriction-enzyme analysis. The ability of the two IL1RN alleles to generate steady-state mRNA accumulation was assessed in the colonic mucosa of seven heterozygous patients. Stepwise linear regression demonstrated that IL-1RN genotype (P=0.001), diagnosis (P<0.0001) and treatment (P<0.03) were independent factors associated with the IL-1ra protein level whilst IL1RN genotype (P=0.005) and macroscopic inflammatory grade (P<0.0001) were associated with the IL-1ra/ total IL-1 ratio. The IL1RN*2 correlated with reduced IL-1ra and IL-1ra/IL-1 ratio with a gene dosage effect. In heterozygous UC patients the ratio of allele 1 mRNA / allele 2 steady state mRNA was always greater than 1 (range: 1.2–3.1) (P=0.018). The IL-1RN*2 is associated with reduced levels of IL-1ra protein and IL-1RN mRNA in the colonic mucosa, providing a biologically plausible explanation for the observed association of the allele with the disease.

Research outcomes in British gastroenterology: an audit of the subsequent full publication of abstracts presented at the British Society of Gastroenterology

Editor,—The presentation of abstracts at scientific meetings provides an opportunity to rapidly convey the results of novel research. It also allows the researcher a chance to receive informal peer review. This may help to clarify aspects of the work, particularly in the identification and correction of potential weaknesses prior to submission for full publication. Although abstracts submitted to conferences are peer reviewed, this process may not be as rigorous as that of an indexed journal considering publication of the full manuscript.1 Presentation of an abstract at a prestigious meeting may suggest that full publication is probable. Certainly, acceptance as opposed to rejection increases the likelihood of subsequent publication, but this is not absolute.2 Other medical specialities …

The setting up and running of a cross-county out-of-hours gastrointestinal bleed service: a possible blueprint for the future

Objective Acute upper gastrointestinal bleeding (AUGIB) results in 25 000 hospital admissions annually. Patients admitted at weekends with AUGIB have increased mortality, and guidelines advise out-of-hours endoscopy. We present retrospective data from our service involving the interhospital transfer of patients. Design We pooled resources of two neighbouring general hospitals, just north of London. Emergency endoscopy is performed at the start of the list followed by elective endoscopy in the endoscopy unit on Saturday and Sunday mornings. From Friday evening to Sunday morning, patients admitted to Queen Elizabeth II Hospital (QEII) are medically stabilised and transferred to Lister Hospital by ambulance. Results 240 endoscopies were performed out of hours from December 2007 to March 2011. Of these, 54 patients were transferred: nine had emergency endoscopy at QEII as they were medically unstable; eight of the patients transferred required therapeutic intervention for active bleeding. The mean pre-endoscopy Rockall score of those transferred was 2.5. We examined the records of 51 of the 54 patients transferred. There were three deaths within 30 days after endoscopy not associated with the transfer process. 19 (37%) patients had reduced hospitalisation after having their endoscopy at the weekend. Conclusions The introduction of the out-of-hours endoscopy service in our trust has had multiple benefits, including patients consistently receiving timely emergency endoscopy, significantly reduced disruption to emergency operating theatres, and participation of endoscopy nurses ensures a better and safer experience for patients, and better endoscopy decontamination. We suggest our model is safe and feasible for other small units wishing to set up their own out-of-hours endoscopy service to adopt.

M1078 Large Proportions of Patients With Renal Failure Have Significant Upper GI Findings at Endoscopy. Results From a Tertiary Referral Centre

tion rates and multiple choice question (MCQ) scores (r=0.24 and 0.27, p<0.01). Overall 27/30 candidates felt the DOPS assessment was fair/very fair, while 27/32 felt the MCQ was fair/very fair. Of the assessors, 12/16 felt the DOPS was valid/very valid, while 17/17 felt the overall process was fair/very fair. It is possible for candidates to fail the accreditation process repeatedly and yet be able to continue their routine National Health Service colonoscopy practice without sanctions. In countries that do not adopt the “driving test”, e.g. USA, Canada, there is no evidence that the quality of colonoscopy in these countries is inferior. Concerns about a two-tier service, and roll out of similar tests in other aspects of clinical practice have not been adequately addressed. CONCLUSION: For trained colonoscopists with proven satisfactory performance outcomes, it is not clear if the addition of a “driving test” is necessary to select screening colonoscopists.