Richard F. Harvey

Basiliximab (anti-CD25) in combination with steroids may be an effective new treatment for steroid-resistant ulcerative colitis

Background : Steroid resistance represents a major clinical problem in the treatment of ulcerative colitis. In vitro, interleukin‐2 renders lymphocytes steroid resistant.

Inverse relationship between alcohol consumption and active Helicobacter pylori infection: the Bristol Helicobacter project

OBJECTIVE:The aim of this study was to examine whether smoking or consumption of alcohol or coffee is associated with active Helicobacter pylori (H. pylori) infection.METHODS:This was a cross-sectional population study conducted as part of a randomized controlled trial of H. pylori infection eradication in southwest England. A total of 10,537 subjects, recruited from seven general practices, underwent 13C-urea breath testing for active infection with H. pylori and provided data on smoking, usual weekly consumption of alcohol, and daily intake of coffee.RESULTS:Smoking or coffee consumption were not related to active H. pylori infection. Total alcohol consumption was associated with a small, but not statistically significant, decrease in the odds of infection. After adjustment for age, sex, ethnic status, childhood and adult social class, smoking, coffee consumption, and intake of alcoholic beverages other than wine, subjects drinking 3–6 units of wine/wk had an 11% lower risk of H. pylori infection compared with those who took no wine: OR = 0.89, 95% CI = 0.80–0.99. Higher wine consumption was associated with a further 6% reduction in the risk of infection: OR = 0.83, 95% CI = 0.64–1.07. Intake of 3–6 units of beer (but no greater intake) was associated with a similar reduction in the risk of infection when compared to no beer intake (OR = 0.83, 95% CI = 0.75–0.91).CONCLUSIONS:This study indicates that modest consumption of wine and beer (approximately 7 units/wk) protects against H. pylori infection, presumably by facilitating eradication of the organism.

Randomised clinical trial: Helicobacter pylori eradication is associated with a significantly increased body mass index in a placebo-controlled study.

Aliment Pharmacol Ther 2011; 33: 922–929

Impact of Helicobacter pylori eradication on dyspepsia, health resource use, and quality of life in the Bristol helicobacter project: randomised controlled trial

Abstract Objective To determine the impact of a community based Helicobacter pylori screening and eradication programme on the incidence of dyspepsia, resource use, and quality of life, including a cost consequences analysis. Design H pylori screening programme followed by randomised placebo controlled trial of eradication. Setting Seven general practices in southwest England. Participants 10 537 unselected people aged 20-59 years were screened for H pylori infection (13C urea breath test); 1558 of the 1636 participants who tested positive were randomised to H pylori eradication treatment or placebo, and 1539 (99%) were followed up for two years. Intervention Ranitidine bismuth citrate 400 mg and clarithromycin 500 mg twice daily for two weeks or placebo. Main outcome measures Primary care consultation rates for dyspepsia (defined as epigastric pain) two years after randomisation, with secondary outcomes of dyspepsia symptoms, resource use, NHS costs, and quality of life. Results In the eradication group, 35% fewer participants consulted for dyspepsia over two years compared with the placebo group (55/787 v 78/771; odds ratio 0.65, 95% confidence interval 0.46 to 0.94; P = 0.021; number needed to treat 30) and 29% fewer participants had regular symptoms (odds ratio 0.71, 0.56 to 0.90; P = 0.05). NHS costs were £84.70 (£74.90 to £93.91) greater per participant in the eradication group over two years, of which £83.40 (

Improving the diagnosis of coeliac disease in anaemic women

146; €121) was the cost of eradication treatment. No difference in quality of life existed between the two groups. Conclusions Community screening and eradication of H pylori is feasible in the general population and led to significant reductions in the number of people who consulted for dyspepsia and had symptoms two years after treatment. These benefits have to be balanced against the costs of eradication treatment, so a targeted eradication strategy in dyspeptic patients may be preferable.

Clinical trial: prolonged beneficial effect of Helicobacter pylori eradication on dyspepsia consultations – the Bristol Helicobacter Project

The majority of patients with newly diagnosed coeliac disease have iron deficiency anaemia. Occult gluten enteropathy is common. We looked at blood donor volunteers, unable to donate because they were unexpectedly found to be anaemic, to determine the incidence of coeliac disease and whether this diagnosis is routinely considered. In a 4 month period, 110 973 blood donor volunteers were seen and 1% (1197 women and 183 men) were found to be anaemic. Of 483 anaemic samples selected for testing, 32 out of 483 were positive for IgA anti‐endomysial antibodies. Microcytic anaemia was found in all but three of the 32 seropositive cases. Twenty‐five out of 32 volunteers agreed to have endoscopic small bowel biopsies and 22 out of 25 (88%) had the typical histological appearances of coeliac disease. Twenty‐one out of 22 cases were women. In no case prior to our intervention had these women been investigated for the possibility of coeliac disease. By selecting anaemic subjects for screening, there was an improved detection rate (over 6%) compared with non‐anaemic volunteers (0%). There were far more anaemic women in the study population (ratio of anaemic women to anaemic men 5·5:1). We show that, especially in anaemic menstruating women, coeliac disease is unrecognized and under‐investigated.

A placebo-controlled randomized trial of eradication of Helicobacter pylori in the general population: study design and response rates of the Bristol Helicobacter Project

Aliment Pharmacol Ther 2010; 32: 394–400

Increased population prevalence of reflux and obesity in the United Kingdom compared with Sweden: a potential explanation for the difference in incidence of esophageal adenocarcinoma.

The Bristol Helicobacter Project is an ongoing, pragmatic, double-blind placebo-controlled trial of the effect of Helicobacter pylori eradication on symptoms of dyspepsia, health utilization and costs, and quality of life in the adult population. Commencing in 1996, 27,536 individuals ages 20-59 years who were registered with seven primary care centers in Bristol and the surrounding areas in southwest England were invited to undergo a 13C urea breath test. There was no selection on the basis of symptoms and 23.5% had dyspepsia on entry to the study. A total of 10,537 people were tested (38.3% of those invited), 1636 tested positive (15.5% of those tested), and 1558 (95.2% of those who tested positive) were randomized to H. pylori eradication therapy or placebo. The rate of participation in the screening phase increased with age (odds ratio [OR]: 1.42 per decade, 95% CI: 1.31 to 1.54) and female gender (OR: 1.35, 95% CI: 1.27 to 1.43) but decreased with lower socioeconomic status (OR: 0.70, 95% CI: 0.56 to 0.86 comparing lowest with highest category). H. pylori prevalence increased with age (OR: 1.69 per decade, 95% CI: 1.51 to 1.89) and lower socioeconomic status (OR: 1.33, 95% CI: 1.05 to 1.69) but was lower in women (OR: 0.87, 95% CI: 0.76 to 1.00). Population-based trials of H. pylori eradication are feasible but necessitate screening large numbers of people to identify those who are infected and who may benefit from eradication. In the Bristol Helicobacter Project the rate of participation varied inversely with both social deprivation and the prevalence of the infection.

Controlled prospective study of faecal occult blood screening for colorectal cancer in Bury, black pudding capital of the world

Objectives The incidence of esophageal adenocarcinoma is five times higher in the UK than in Sweden. We examined the prevalence of established risk factors for esophageal adenocarcinoma in both populations. Methods A population-based cross-sectional study comparing the prevalence of gastroesophageal reflux symptoms, obesity, and tobacco smoking between random samples of the English and Swedish populations aged 40–59 years. Data were collected through self-report questionnaires. Multivariable logistic regression yielded odds ratios with 95% confidence intervals, adjusting for potential confounding. Results The sample was composed of 3633 English and 1483 Swedish people (response rates 43 and 62%, respectively). The prevalence of reflux symptoms occurring at least weekly was twice as common in the English compared with the Swedish sample. Obesity (BMI ≥30) was also nearly two-fold more common in the English sample. The frequency of tobacco smoking was similar in both countries. The combination of reflux symptoms and a BMI of at least 25 was three-fold more common in the English than in the Swedish sample. Conclusion The substantially higher prevalence of reflux symptoms and obesity in samples of the English population compared with the Swedish population might contribute to the known higher incidence of esophageal adenocarcinoma in the UK.

Inverse association between gastroesophageal reflux and blood pressure: Results of a large community based study

Colorectal cancer is the second most common cause of death from cancer in the United Kingdom, claiming 20 000 lives each year. Most cancers originate from malignant transformation of adenomas, and screening the general population to detect asymptomatic adenomas and early cancers shows the greatest potential to reduce mortality. In the most evaluated screening protocol, small volumes of blood loss from such lesions are detected by a faecal occult blood test, and people testing positive then have a colonoscopy. This reduces mortality in two ways: detection and endoscopic removal of adenomas prevents later transformation and may reduce the incidence of cancer by 16%1; and early detection of carcinomas allows treatment of less advanced lesions, resulting in a better prognosis. A large trial of such screening showed that a 15% reduction in mortality from colorectal cancer can be achieved. …