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  • Kennedy, N. A.  (4)
  • Pharmacy  (4)
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  • Pharmacy  (4)
  • 1
    Online Resource
    Online Resource
    Faecal calprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: a prospective UK primary care cohort study
    Wiley ; 2018
    In:  Alimentary Pharmacology & Therapeutics Vol. 47, No. 8 ( 2018-04), p. 1103-1116
    Details
    In: Alimentary Pharmacology & Therapeutics, Wiley, Vol. 47, No. 8 ( 2018-04), p. 1103-1116
    Abstract: Primary care faecal calprotectin testing distinguishes inflammatory bowel disease ( IBD ) from functional gut disorder in young patients presenting with abdominal symptoms; however, previous evaluations have excluded patients with alarm symptoms. Aims We sought to evaluate the diagnostic accuracy of calprotectin to distinguish IBD from functional gut disorder in young adults in whom general practitioners ( GP s) suspected IBD ; including patients reporting gastrointestinal alarm symptoms. We hypothesised that calprotectin would reduce secondary care referrals and healthcare costs. Methods We undertook a prospective cohort study of 789 young adults (18‐46 years old) presenting with gastrointestinal symptoms to 49 local general practices that had undergone calprotectin testing (1053 tests: between Jan 2014 and May 2016) because of suspected IBD . We considered calprotectin levels of ≥100 μg/g positive. Primary and secondary care records over 12 months from the point of calprotectin testing were used as the reference standard. Results Overall, 39% (308/789) patients reported gastrointestinal alarm symptoms and 6% (50/789) tested patients were diagnosed with IBD . The positive and negative predictive values of calprotectin testing for distinguishing IBD from functional gut disorder in patients with gastrointestinal alarm symptoms were 50% (95% CI 36%‐64%) and 98% (96%‐100%): and in patients without gastrointestinal alarm symptoms were 27% (16%‐41%) and 99% (98%‐100%), respectively. We estimate savings of 279 referrals and £160 per patient. Conclusions Calprotectin testing of young adults with suspected IBD in primary care accurately distinguishes IBD from functional gut disorder, even in patients with gastrointestinal alarm symptoms and reduces secondary care referrals and diagnostic healthcare costs.
    Type of Medium: Online Resource
    ISSN: 0269-2813 , 1365-2036
    URL: Issue
    URL: Article
    DOI: 10.1111/apt.2018.47.issue-8
    DOI: 10.1111/apt.14563
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2003094-0
    SSG: 15,3
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  • 2
    Online Resource
    Online Resource
    Relapse after withdrawal from anti‐ TNF therapy for inflammatory bowel disease: an observational study, plus systematic review and meta‐analysis
    Wiley ; 2016
    In:  Alimentary Pharmacology & Therapeutics Vol. 43, No. 8 ( 2016-04), p. 910-923
    Details
    In: Alimentary Pharmacology & Therapeutics, Wiley, Vol. 43, No. 8 ( 2016-04), p. 910-923
    Abstract: Infliximab and adalimumab have established roles in inflammatory bowel disease ( IBD ) therapy. UK regulators mandate reassessment after 12 months' anti‐ TNF therapy for IBD , with consideration of treatment withdrawal. There is a need for more data to establish the relapse rates following treatment cessation. Aim To establish outcomes following anti‐ TNF withdrawal for sustained remission using new data from a large UK cohort, and assimilation of all available literature for systematic review and meta‐analysis. Methods A retrospective observational study was performed on 166 patients with IBD (146 with Crohn's disease ( CD ) and 20 with ulcerative colitis [ UC ) and IBD unclassified ( IBDU )] withdrawn from anti‐ TNF for sustained remission. Meta‐analysis was undertaken of all published studies incorporating 11 further cohorts totalling 746 patients (624 CD , 122 UC ). Results Relapse rates in the UK cohort were 36% by 1 year and 56% by 2 years for CD , and 42% by 1 year and 47% by 2 years for UC / IBDU . Increased relapse risk in CD was associated with age at diagnosis [hazard ratio ( HR ) 2.78 for age 〈 22 years], white cell count ( HR 3.22 for 〉 5.25 × 10 9 /L) and faecal calprotectin ( HR 2.95 for 〉 50 μg/g) at drug withdrawal. Neither continued immunomodulators nor endoscopic remission were predictors. In the meta‐analysis, estimated 1‐year relapse rates were 39% and 35% for CD and UC / IBDU respectively. Retreatment with anti‐ TNF was successful in 88% for CD and 76% UC / IBDU . Conclusions Assimilation of all available data reveals remarkable homogeneity. Approximately one‐third of patients with IBD flare within 12 months of withdrawal of anti‐ TNF therapy for sustained remission.
    Type of Medium: Online Resource
    ISSN: 0269-2813 , 1365-2036
    URL: Issue
    URL: Article
    DOI: 10.1111/apt.2016.43.issue-8
    DOI: 10.1111/apt.13547
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2003094-0
    SSG: 15,3
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  • 3
    Online Resource
    Online Resource
    Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn's disease
    Wiley ; 2017
    In:  Alimentary Pharmacology & Therapeutics Vol. 45, No. 5 ( 2017-03), p. 660-669
    Details
    In: Alimentary Pharmacology & Therapeutics, Wiley, Vol. 45, No. 5 ( 2017-03), p. 660-669
    Abstract: Few studies have reported the systematic use of exclusive enteral nutrition in the perioperative setting. Aim To test the hypothesis that exclusive enteral nutrition provides a safe and effective bridge to surgery and reduces post‐operative complications, in adult patients with Crohn's disease requiring urgent surgery for stricturing or penetrating complications. Methods Patients treated with exclusive enteral nutrition prior to surgery were each matched with two control patients for disease behaviour, type of surgery, age at diagnosis and disease duration. Data on disease phenotype, nutritional status, operative course and post‐operative complications were obtained. Results Twenty‐five per cent [13/51] patients treated with exclusive enteral nutrition avoided surgery. Exclusive enteral nutrition had no effect on pre‐operative weight, but it significantly reduced serum CRP [median at baseline 36 (interquartile range, IQR : 13–91] vs. pre‐operation 8 (4–31) mg/L, P  = 0.02]. The median ( IQR ) length of surgery was shorter in patients pre‐optimised with exclusive enteral nutrition than controls [3.0 (2.5–3.5) vs. 3.5 (3.0–4.0) hours respectively, P  〈  0.001]. Multivariable logistic regression analysis confirmed that going straight‐to‐surgery compared exclusive enteral nutrition pre‐optimisation was associated with a ninefold increase in the incidence of post‐operative abscess and/or anastomotic leak [ OR 9.1; 95% CI (1.2–71.2), P  = 0.04]. Conclusions Exclusive enteral nutrition frequently down‐stages the need for surgery in patients presenting with stricturing or penetrating complications of Crohn's disease; it is associated with a reduction in systemic inflammation, operative times and the incidence of post‐operative abscess or anastomotic leak. Further trials are needed to elucidate how exclusive enteral nutrition may improve operative outcomes.
    Type of Medium: Online Resource
    ISSN: 0269-2813 , 1365-2036
    URL: Issue
    URL: Article
    DOI: 10.1111/apt.2017.45.issue-5
    DOI: 10.1111/apt.13934
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2003094-0
    SSG: 15,3
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  • 4
    Online Resource
    Online Resource
    Thiopurine withdrawal during sustained clinical remission in inflammatory bowel disease: relapse and recapture rates, with predictive factors in 237 patients
    Wiley ; 2014
    In:  Alimentary Pharmacology & Therapeutics Vol. 40, No. 11-12 ( 2014-12), p. 1313-1323
    Details
    In: Alimentary Pharmacology & Therapeutics, Wiley, Vol. 40, No. 11-12 ( 2014-12), p. 1313-1323
    Abstract: Thiopurines (azathioprine and mercaptopurine) remain integral to most medical strategies for maintaining remission in Crohn's disease ( CD ) and ulcerative colitis ( UC ). Indefinite use of these drugs is tempered by long‐term risks. While clinical relapse is noted frequently following drug withdrawal, there are few published data on predictive factors. Aim To investigate the success of planned thiopurine withdrawal in patients in sustained clinical remission to identify rates and predictors of relapse. Methods This was a multicentre retrospective cohort study from 11 centres across the UK . Patients included had a definitive diagnosis of IBD , continuous thiopurine use ≥3 years and withdrawal when in sustained clinical remission. All patients had a minimum of 12 months follow‐up post drug withdrawal. Primary and secondary end points were relapse at 12 and 24 months respectively. Results 237 patients were included in the study (129 CD ; 108 UC ). Median duration of thiopurine use prior to withdrawal was 6.0 years (interquartile range 4.4–8.4). At follow‐up, moderate/severe relapse was observed in 23% CD and 12% UC patients at 12 months, 39% CD and 26% UC at 24 months. Relapse rate at 12 months was significantly higher in CD than UC ( P  = 0.035). Elevated CRP at withdrawal was associated with higher relapse rates at 12 months for CD ( P  = 0.005), while an elevated white cell count was predictive at 12 months for UC ( P  = 0.007). Conclusion Thiopurine withdrawal in the context of sustained remission is associated with a 1‐year moderate‐to‐severe relapse rate of 23% in Crohn's disease and 12% in ulcerative colitis.
    Type of Medium: Online Resource
    ISSN: 0269-2813 , 1365-2036
    URL: Issue
    URL: Article
    DOI: 10.1111/apt.2014.40.issue-11-12
    DOI: 10.1111/apt.12980
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 2003094-0
    SSG: 15,3
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