Blogs

Three years since the personalised anti-TNF therapy in Crohn’s disease study (PANTS) was first published. This blog discusses the findings.

Iron deficiency anaemia (IDA) is a major disease burden all over the world, resulting in symptoms including extreme fatigue and breathlessness. The major contributors to iron deficiency are poor dietary intake, malabsorption, gastrointestinal (GI) disorders, and blood loss. It has been reported that almost a third of men and most postmenopausal women presenting with IDA have an underlying GI abnormality[1], and unexplained IDA in such at-risk individuals is an accepted indication for fast-track secondary care referral in the UK.

Graham Johnson, Managing Director at BIOHIT HealthCare, talks about the association between IDA and atrophic gastritis-induced achlorhydria. Along with sharing his experience and knowledge in this field, he also sheds light on the new guidelines by the British Society of Gastroenterology for the diagnosis and management of IDA in adults.

The risk of gastric cancer increases when a person suffers with atrophic gastritis – a pre-neoplastic condition of the gastric mucosa that is characterised by loss of normal antral or oxyntic glands. Recognised as a somewhat insidious condition, atrophic gastritis is associated with subtle or vague symptom presentation that’s difficult to distinguish, and therefore getting the right diagnosis early is very important.

In this blog we look a little closer at atrophic gastritis (AG) and gastric intestinal metaplasia (GIM), and show how an understanding of these conditions and their timely diagnosis can both streamline NHS resources and improve patient outcomes.

Faecal tests have been widely used by clinicians as informative, non-invasive tools that contribute to the differential diagnosis and monitoring of a wide range of gastrointestinal (GI) conditions. However, our growth in understanding of the GI tract – both normal and diseased – has created a need for new assays that take advantage of this convenient sample type, and potentially offer more analytes and quicker results.

Gastro-oesophageal reflux disease (GORD) occurs when excessive amounts of stomach contents – including acid, bile, pepsin and digested food and drink – enter the lower oesophagus, causing symptoms such as heartburn and indigestion. Medication for reflux, such as proton pump inhibitors (PPIs), suppress stomach acid and help to relieve these ‘classic’ reflux symptoms.

Dyspepsia affects between 20-40 % of the population, with GPs in the UK commonly seeing patients with various symptoms relating to the upper gastrointestinal (GI) tract. These patients are well managed at the primary care level, but there can be a gap in the patient pathway for refractory cases or those presenting with something potentially more sinister. This blog discusses the current limitations in managing patients with GI problems, and a potential solution to help streamline the screening process for gastric cancer.

The COVID-19 pandemic forced many hospitals to suspend or severely delay endoscopy services, resulting in a massive backlog of associated referrals after each wave. During these unprecedented times, patients still require investigation through endoscopy, but the heightened strain on the healthcare system has potentially delayed the diagnosis of gastrointestinal (GI) problems, resulting in poorer outcomes for these patients.

Helicobacter pylori is a gram-negative bacterium that commonly infects the stomach. For most people, infection doesn’t trigger any problems, however, it can cause gastric and duodenal ulcers or, more alarmingly, lead to mucosal damage resulting in gastric atrophy (GA) or gastric intestinal metaplasia (GIM), which are both pre-neoplastic conditions. H. pylori is therefore recognised as a group 1 (carcinogenic) pathogen, and must be carefully considered in the care of patients presenting with gastrointestinal problems.

Lactose intolerance (LI), or hypolactasia, is a common digestive problem whereby the body cannot digest lactose, the sugar found in milk and dairy products. It is caused by a shortage of the enzyme lactase in the small intestine, which breaks milk sugar into glucose and galactose to then be absorbed into the bloodstream. Prevalence of this condition is estimated to be at least 5%, however although lactase activity begins to decrease after weaning, roughly a third of the adult population worldwide retains the ability to digest lactose.

The word ‘microbiome’ is on everyone’s lips at the moment; there is growing awareness of what this actually means and a real emphasis on balancing your diet to achieve a healthy balance of gut bacteria. Our understanding of how the microbiota in the gut actually influence health and wellbeing is expanding at a rapid pace, and it’s now well recognised that every bacterial species naturally at home in the human gut has its own unique function.

One million people in the UK are affected by bile acid diarrhoea (BAD), but many sufferers are not aware of the term or understand what’s causing their symptoms. This common condition – also known as bile acid malabsorption – is a form of chronic diarrhoea, characterised by erratic and urgent loose bowel motions, with painful abdominal cramping.

According to Cancer Research UK statistics[1] there are 6,600 new cases of gastric cancer (GCa) per year in the UK, 70% of which are diagnosed at a late stage leading to poor prognosis and limited treatment options. The percentage of sufferers that survive for more than 5 years with the disease is just 21.6%, far fewer than our counterparts in Europe, and there are 4,400 deaths per year.

Dysbiosis is an imbalance of the microbiota in the gut compared to a normal and healthy reference microbiome. Identifying and quantifying the severity of dysbiosis is a very useful tool across a wide range of diseases, particularly for irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), and also to direct treatment or help weight loss.

Diagnostic testing for the detection and management of SARS-CoV-2, the respiratory virus responsible for the global COVID-19 pandemic, is evolving at pace. New tests that enable faster virus detection closer to the patient, or have less invasive sampling methods that facilitate the collection of good quality samples for testing, may produce significant benefits for society and the economy.

Therapeutic drug monitoring (TDM) measures specific drugs in a patient’s bloodstream over time, which is important for developing long term individualised care plans for patients with chronic inflammatory diseases such as inflammatory bowel disease (IBD) and rheumatoid arthritis.

Bile acid diarrhoea (BAD) – also known as bile acid malabsorption (BAM) – is a form of chronic diarrhoea, estimated to affect 1 % of people in the UK. The condition can be painful and debilitating, with sufferers experiencing numerous and daily episodes of watery and urgent bowel motions with faecal incontinence at times.

Reflux is an increasingly recognised term that many people associate with heartburn and indigestion. As many as 20 to 40 % of the UK population are affected by repeated episodes of gastric contents coming up from the stomach and into the oesophagus, causing immediate discomfort that sufferers are acutely aware of.

Reflux is a common condition that occurs when the contents of the stomach pass through the lower oesophageal sphincter (LOS) and up into the oesophagus. This can cause symptoms such as heartburn, difficulty in swallowing, nausea and inflammation of the oesophagus.