Naila Arebi

Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial

BACKGROUND Colonoscopy has a miss rate for adenomas that may partly relate to poor visualization of the colonic surface. Dynamic position changes during colonoscope withdrawal can improve luminal distension. OBJECTIVE To assess whether position changes also improve adenoma and polyp detection. DESIGN Randomized crossover clinical trial. SETTING Academic endoscopy unit. PATIENTS This study involved 130 patients who presented for routine colonoscopy. INTERVENTION Examination either entirely in the left lateral position followed by position changes (cecum to hepatic flexure, left lateral; transverse colon, supine; splenic flexure and descending colon, right lateral) or vice versa. After both examinations, polyps were removed for histopathology. MAIN OUTCOME MEASUREMENTS Proportion of patients with ≥1 polyp or adenoma detected between the hepatic flexure and the sigmoid-descending colon junction. Luminal distension was measured on a scale of 1 to 5: 1, total collapse; 5, fully distended. RESULTS At least 1 adenoma was detected in 34% of patients in colon areas in which the patient position differed from left lateral (transverse colon, splenic flexure, descending colon) compared with 23% examined with the patient in the left lateral position alone (P = .01). At least 1 polyp was detected in 52% of patients with position changes versus 34% of patients examined in the left lateral position alone (P < .001). Adenoma and polyp detection were positively correlated with an improved distension score (correlation coefficient, 0.12; P < .001). Adenomas were detected in 16% of colon areas with adequate distension scores (4 and 5) compared with 7% of those with borderline or nondiagnostic scores (1-3; P < .001). LIMITATIONS Single-operator study. CONCLUSION Dynamic position changes during colonoscope withdrawal significantly improved polyp and adenoma detection. ( CLINICAL TRIAL REGISTRATION NUMBER NCT00234650).

Helicobacter felis infection is associated with lymphoid follicular hyperplasia and mild gastritis but normal gastric secretory function in cats.

ABSTRACT The relationship of Helicobacter felis, a bacterium observed in the stomachs of cats, to gastric disease is unclear. The objective of this study was to determine if H. felisinfection alters gastric histopathology, proinflammatory cytokine expression, and secretory function and evokes a humoral immune response in cats. Five specific-pathogen-free (SPF)Helicobacter-free cats were studied before and for 1 year after oral inoculation with H. felis (ATCC 49179). Four SPFH. felis-uninfected cats served as controls. The stomachs of all five H. felis-inoculated cats became colonized, as determined by urease activity, histopathology, PCR, culture, and transmission electron microscopy of serial gastric biopsies at 0, 3, 5, 8, and 12 months. Uninoculated cats remained Helicobacterfree. Lymphoid follicular hyperplasia, atrophy, and fibrosis were observed primarily in the pylorus of infected cats. Mild mononuclear inflammation was detected in both infected and uninfected cats, but was more extensive in infected cats, with pangastric inflammation, eosinophilic infiltrates, and cardia gastritis observed only in infected cats. No upregulation of antral mucosal interleukin 1α (IL-1α), IL-1β, or tumor necrosis factor alpha was detected by reverse transcription-PCR in any cat. The gastric secretory axes, assessed by fasting plasma gastrin, antral mucosal gastrin and somatostatin immunoreactivity, and pentagastrin-stimulated gastric acid secretion, were similar in both infected and uninfected cats. Gradual seroconversion (immunoglobulin G) was observed in four of five infected cats, with enzyme-linked immunosorbent assay values reaching 4× to 12× baseline 12 months postinfection. These findings indicate thatH. felis infection in cats induces lymphoid follicular hyperplasia, mild gastritis, and seroconversion, but is associated with normal gastric secretory function.

Helicobacter pylori infection in the cat: evaluation of gastric colonization, inflammation and function.

Further elucidation of the consequences of Helicobacter pylori infection on gastric mucosal inflammation and gastric secretory function would be facilitated by an animal model that is susceptible to infection with H. pylori, is broadly similar in gastric physiology and pathology to people, and is amenable to repeated non‐invasive evaluation. The goal of this study was to examine the interrelationship of bacterial colonization, mucosal inflammation and gastric secretory function in cats with naturally acquired H. pylori infection.

Colectomy Rates for Ulcerative Colitis Differ between Ethnic Groups: Results from a 15-Year Nationwide Cohort Study

Introduction. Previous epidemiological studies suggest a higher rate of pancolonic disease in South Asians (SA) compared with White Europeans (WE). The aim of the study was to compare colectomy rates for ulcerative colitis (UC) in SA to those of WE. Methods. Patients with UC were identified from a national administrative dataset (Hospital Episode Statistics, HES) between 1997 and 2012 according to ICD-10 diagnosis code K51 for UC. The colectomy rate for each ethnic group was calculated as the proportion of patients who underwent colectomy from the total UC cases for that group. Results. Of 212,430 UC cases, 73,318 (35.3%) were coded for ethnicity. There was no significant difference in the colectomy rate between SA and WE (6.93% versus 6.90%). Indians had a significantly higher colectomy rate than WE (9.8% versus 6.9%, p < 0.001). Indian patients were 21% more likely to require colectomy for UC compared with WE group (OR: 1.21, 95% CI: 1.04–1.42, and p = 0.001). Conclusions. Given the limitations in coding, the colectomy rate in this cohort was higher in Indians compared to WE. A prospectively recruited ethnic cohort study will decipher whether this reflects a more aggressive phenotype or is due to other confounding factors.

Mo1004 Is There an East-West Gradient in the Incidence of IBD in Europe? and Further Far East in China? First Results From the Epicom Study

Is there an east-west gradient in the incidence of IBD in Europe? : and further far east in China? First results from the epicom study

A review of endoscopic balloon dilatation techniques for treating Crohn's strictures: time to standardise therapy.

ABSTRACT Introduction: Endoscopic balloon dilatation (EBD) is a recognised treatment for symptomatic Crohn’s disease strictures. Over 3000 procedure are reported in the literature and yet the long term benefits are unclear. This is largely because of different populations, study designs, techniques, types of strictures, the outcome measures used and follow-up periods. Areas covered: We summarised the techniques reported in the literature based on a systematic review and key factors that may influence outcome: pre-intervention imaging, stricture length and type, balloon size in relation to intestinal lumen diameter, duration of dilatation, frequency of repeat dilatation and instructions on follow-up. Expert commentary: We noted that shorter, non-ulcerated and anastomotic strictures fare better and 2 mins dilatation duration was the commonest technique used without an increased risk of complications. The findings were translated into a standardised protocol and a management pathway to guide clinicians on the therapeutic strategy for Crohn’s strictures. To resolve the uncertainty about long-term benefits, future studies should adopt a replicable standardised EBD technique, define degree of fibrosis to decide therapy accordingly, compare it to alternative interventions (strictureplasty or stents) within a randomised controlled trial and apply a validated outcome measure to include intestinal damage and quality of life.

The Pharmacological Management of Chronic Constipation and Faecal Incontinence

This two part chapter describes the use of pharmacotherapy in the management of bowel dysfunction. It examines current evidence and practice and provides the reader with an insight into possible treatment options.

Su1316 Unchanged Surgery and Hospitalization Rates in an East-West European Inception Cohort Despite Differences in Use of Biologicals - 3-Year Follow-Up of the ECCO-EpiCom Cohort

Unchanged surgery and hospitalization rates in an East-West European inception cohort despite differences in use of biologicals-3-year follow-up of the ECCO-EpiCom cohort

P464 Dysbiosis in mucosally adherent microbiota at surgery and in post-endoscopic recurrence at 6 and 12 months a longitudinal prospective evaluation in Crohn's disease

P464 Dysbiosis in mucosally adherent microbiota at surgery and in post-endoscopic recurrence at 6 and 12 months a longitudinal prospective evaluation in Crohn’s disease A. Murugananthan1 *, P. Tozer1, D. Bernardo1, A. Hart2, S. Knight1, K. Whelan3, H.O. Al-Hassi1, N. Arebi2. 1Antigen Presentation Research Group, Imperial College, London, United Kingdom, 2St Mark’s Hospital, Department of Gastroenterology, London, United Kingdom, 3King’s College Hospital, London, United Kingdom

Mo1763 Clinical Risk Factors for Crohn's Disease Postoperative Recurrence are Reflected in Alterations in Mucosally Adherent Microbiota at Surgical Resection

Introduction Clinical risk factors for Crohn9s disease (CD) recurrence after ileo-caecal resection (ICR) include smoking status, perforating disease and >1 surgical resection. The underlying mechanisms contributing to clinical risk are unknown. We aimed to study the relationship between risk factors and gut microbiota. Methods Samples of macroscopically inflamed and non-inflamed small bowel from patients undergoing surgical resection for CD were analysed. Samples were snap frozen in liquid nitrogen. Cryosections were cut and the frozen sections were hybridised with oligonucleotide probes targeting the microbial 16S rRNA of total bacteria, Escherichia coli , Bacteroides-Prevotella, Faecalibacterium prausnitzii , Clostrium coccoides - Eubacterium rectale and bifidobacteria. The hybridised mucosa associated microbiota (MAM) were identified and quantified. Patients with ≥1 risk factor were classified as high risk for disease recurrence. Results Fifteen patients underwent ICR (10 female); 9 were high risk (6 smokers, 4 fistulating disease and 2 recurrent resection- 3 patients had multiple risk factors). Faecalibacterium prausnitzii numbers in inflamed operative samples were lower in smokers compared with non-smokers (p=0.036). High-risk patients had lower numbers of bifidobacteria in both inflamed (p=0.006) and non-inflamed (p=0.01) operative samples compared with low risk patients. Conclusion The risk of post-operative CD recurrence may be predetermined at a pre-operative stage due to dysbiosis. The role of MAM as a tool to stratify risk requires further study. Drugs that modulate MAM may, in future, play a role in reducing post-operative recurrence. Competing interests None declared.