Acute upper gastrointestinal (GI) bleeding is a common medical emergency and associated with significant morbidly and mortality. The risk of bleeding from peptic ulceration and oesophagogastric varices can be reduced by appropriate primary and secondary preventative strategies. Helicobacter pylori eradication and risk stratification with appropriate gastroprotection strategies when used with antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in preventing peptic ulcer bleeding, whilst endoscopic screening and either nonselective beta blockade or endoscopic variceal ligation are effective at reducing the risk of variceal haemorrhage. For secondary prevention of variceal haemorrhage, the combination of beta blockade and endoscopic variceal ligation is more effective. Recent data on the possible interactions of aspirin and NSAIDs, clopidogrel and proton pump inhibitors (PPIs), and the increased risk of cardiovascular adverse events associated with all nonaspirin cyclo-oxygenase (COX) inhibitors have increased the complexity of choices for preventing peptic ulcer bleeding. Such choices should consider both the GI and cardiovascular risk profiles. In patients with a moderately increased risk of GI bleeding, a NSAID plus a PPI or a COX-2 selective agent alone appear equivalent but for those at highest risk of bleeding (especially those with previous ulcer or haemorrhage) the COX-2 inhibitor plus PPI combination is superior. However naproxen seems the safest NSAID for those at increased cardiovascular risk. Clopidogrel is associated with a significant risk of GI haemorrhage and the most recent data concerning the potential clinical interaction of clopidogrel and PPIs are reassuring. In clopidogrel-treated patients at highest risk of GI bleeding, some form of GI prevention is indicated.

Reduced endothelium-dependent vasodilator responses with increased synthesis of ET-1 (endothelin-1) are characteristics of endothelial dysfunction in heart failure and are predictive of mortality. Identification of treatments that correct these abnormalities may have particular benefit for patients who become refractory to current regimens. Hawthorn preparations have a long history in the treatment of heart failure. Therefore we tested their inhibitory effects on ET-1 synthesis by cultured endothelial cells. These actions were compared with that of GSE (grape seed extract), as the vasoactive components of both these herbal remedies are mainly oligomeric flavan-3-ols called procyanidins. This showed extracts of hawthorn and grape seed were equipotent as inhibitors of ET-1 synthesis. GSE also produced a potent endothelium-dependent vasodilator response on preparations of isolated aorta. Suppression of ET-1 synthesis at the same time as induction of endothelium-dependent vasodilation is a similar response to that triggered by laminar shear stress. Based on these results and previous findings, we hypothesize that through their pharmacological properties procyanidins stimulate a pseudo laminar shear stress response in endothelial cells, which helps restore endothelial function and underlies the benefit from treatment with hawthorn extract in heart failure.

No abstract

No abstract

Introduction Virtually all published data on colonic endoscopic mucosal resection (EMR) comes from expert centres and yet it is likely that the majority of these procedures are performed outside these hospitals. At our centre, like many others, a single endoscopist (JMS) provides an EMR service that the other eight colonoscopists have referred to over the last 5+ years. We evaluated its use, effi cacy and safety. Methods Sessile and fl at colonic polyps >10 mm assessed for resection were identifi ed prospectively and follow-up data collection started. These would include referrals to the EMR service as well as lesions resected by JMS at the index endoscopy. Multi-session resections were done within 3 months. Standard endoscopic follow-up was at 3 months for piecemeal resections. For en-bloc resections follow-up was at a minimum as per BSG guidelines but additional surveillance procedures may

No abstract

to reduce future risk of colorectal cancer. High definition colonoscopy allows better visualisation of the colonic mucosa and may improve detection of polyps. Previous studies have shown variable results when comparing polyp and adenoma detection between standard definition (SD) and high definition (HD) colonoscopy. The UK bowel cancer screening programme offers colonoscopy to all citizens aged 60e75 years who test positive for faecal occult blood (FOB). We aimed to compare polyp and adenoma detection rates between those patients undergoing SD Colonoscopy and HD colonoscopy in the screening population. Methods Endoscopy, histopathology and screening database reports were analysed for all BCSP in our institution for the period September 2009 to October 2011. 1020 colonoscopies were performed of which 68 were excluded from further analysis (Incomplete procedure/polyposis syndrome/colitis/unknown definition of endoscope/previous colonic resection). Procedures were divided according to the definition of endoscope used: SD (500 000 pixels) n¼421, HD (>500 000 pixels) n¼531. Reports were analysed for demographic data, bowel preparation, withdrawal time, and the number, size, morphology, site and histology of all lesions removed. Results There were no significant differences between the SD and HD groups respectively in percentage male subjects (57% vs 60.0%, p¼0.229), mean age (66.47 vs 66.54, p¼0.24), percentage with good or adequate bowel preparation (96.1% vs 96.2%, p>0.5), mean withdrawal time (10.9 min vs 10.6 min, p¼0.06). In total 1553 lesions were detected: 49 cancers, 1149 adenomas and 335 nonneoplastic polyps. There was no significant difference between the SD and HD in overall polyp detection rate (SD 0.63 vs HD 0.65, p¼0.401) and adenoma detection rate (SD 0.59 vs HD 0.59, p¼0.516). However a significantly greater number of adenomas per patient (APP) were detected in the HD group (SD 1.20 vs HD 1.34, p¼0.016). HD endoscopy detected significantly more diminutive adenomas (1e5 mm) than SD endoscopy (0.87 per pt vs 0.72 per pt, p¼0.02), but there was no difference in the rate of detection adenomas >5 mm. More adenomas were detected in the proximal colon in the HD group (0.59 vs 0.44, p¼0.03) but there was no significant difference in the distal colon (HD 0.79 vs SD 0.77). Conclusion Overall adenoma detection rate in this study population was excellent with 59% of patients having one or more adenomas detected. HD endoscopy appears to improve the total number of adenomas detected in the screening population. The main gain of HD endoscopy is in detection of diminutive polyps in the proximal colon.Competing interests None declared. Introduction The endoscopy literature 1 2 has raised concerns regarding variations in polyp detection rates during the day. One mechanism for this is thought to be operator fatigue which increases as the day progresses. However, published data so far has been conflicting. PWE-102 IS THERE3 4 This is worrying as one purpose of colonoscopy is to detect and remove polyps in order to preven...

No abstract