SummaryBackgroundMagnetic resonance enterography (MRE) and ultrasound are used to image Crohn's disease, but their comparative accuracy for assessing disease extent and activity is not known with certainty. Therefore, we did a multicentre trial to address this issue.MethodsWe recruited patients from eight UK hospitals. Eligible patients were 16 years or older, with newly diagnosed Crohn's disease or with established disease and suspected relapse. Consecutive patients had MRE and ultrasound in addition to standard investigations. Discrepancy between MRE and ultrasound for the presence of small bowel disease triggered an additional investigation, if not already available. The primary outcome was difference in per-patient sensitivity for small bowel disease extent (correct identification and segmental localisation) against a construct reference standard (panel diagnosis). This trial is registered with the International Standard Randomised Controlled Trial, number ISRCTN03982913, and has been completed.Findings284 patients completed the trial (133 in the newly diagnosed group, 151 in the relapse group). Based on the reference standard, 233 (82%) patients had small bowel Crohn's disease. The sensitivity of MRE for small bowel disease extent (80% [95% CI 72–86]) and presence (97% [91–99]) were significantly greater than that of ultrasound (70% [62–78] for disease extent, 92% [84–96] for disease presence); a 10% (95% CI 1–18; p=0·027) difference for extent, and 5% (1–9; p=0·025) difference for presence. The specificity of MRE for small bowel disease extent (95% [85–98]) was significantly greater than that of ultrasound (81% [64–91]); a difference of 14% (1–27; p=0·039). The specificity for small bowel disease presence was 96% (95% CI 86–99) with MRE and 84% (65–94) with ultrasound (difference 12% [0–25]; p=0·054). There were no serious adverse events.InterpretationBoth MRE and ultrasound have high sensitivity for detecting small bowel disease presence and both are valid first-line investigations, and viable alternatives to ileocolonoscopy. However, in a national health service setting, MRE is generally the preferred radiological investigation when available because its sensitivity and specificity exceed ultrasound significantly.FundingNational Institute of Health and Research Health Technology Assessment.
Background: Proinflammatory cytokines, especially tumour necrosis factor a (TNF-a), play a prominent role in the pathogenesis of cancer cachexia. Thalidomide, which is an inhibitor of TNF-a synthesis, may represent a novel and rational approach to the treatment of cancer cachexia. Aims: To assess the safety and efficacy of thalidomide in attenuating weight loss in patients with cachexia secondary to advanced pancreatic cancer. Methods: Fifty patients with advanced pancreatic cancer who had lost at least 10% of their body weight were randomised to receive thalidomide 200 mg daily or placebo for 24 weeks in a single centre, double blind, randomised controlled trial. The primary outcome was change in weight and nutritional status. Results: Thirty three patients (16 control, 17 thalidomide) were evaluated at four weeks, and 20 patients (eight control, 12 thalidomide) at eight weeks. At four weeks, patients who received thalidomide had gained on average 0.37 kg in weight and 1.0 cm 3 in arm muscle mass (AMA) compared with a loss of 2.21 kg (absolute difference 22.59 kg (95% confidence interval (CI) 24.3 to 20.8); p = 0.005) and 4.46 cm 3 (absolute difference 25.6 cm 3 (95% CI 28.9 to 22.2); p = 0.002) in the placebo group. At eight weeks, patients in the thalidomide group had lost 0.06 kg in weight and 0.5 cm 3 in AMA compared with a loss of 3.62 kg (absolute difference 23.57 kg (95% CI 26.8 to 20.3); p = 0.034) and 8.4 cm
Up to 25 % colorectal adenomas are missed during colonoscopy. The aim of this study was to investigate whether the endocuff could improve polyp detection in an organized bowel cancer screening program (BCSP). This parallel group, single-blinded, randomized controlled trial included patients with positive fecal occult blood test (FOBT) who were attending for BCSP colonoscopy. The primary outcome was the number of polyps per patient. Secondary outcomes included the number of adenomas per patient, adenoma and polyp detection rates, and withdrawal times. A total of 534 BCSP patients were randomized to endocuff-assisted or standard colonoscopy. The mean age was 67 years and the male to female ratio was 1.8:1. We detected no significant difference in the number of polyps per patient (standard 1.8, endocuff 1.6; = 0.44), adenomas per patient (standard 1.4, endocuff 1.3; = 0.54), polyp detection rate (standard 69.8 %, endocuff 70.3 %; = 0.93), adenoma detection rate (standard 63.0 %, endocuff 60.9 %; = 0.85), advanced adenoma detection rate (standard 18.5 %, endocuff 16.9 %; = 0.81), and cancer detection rate (standard 5.7 %, endocuff 5.3 %; = 0.85). The mean withdrawal time was significantly shorter among patients in the endocuff group compared with the standard colonoscopy group (16.9 vs. 19.5 minutes; < 0.005). The endocuff had to be removed in 17/266 patients (6.4 %) because of inability to pass through the sigmoid colon. This study did not find improved polyp or adenoma detection with endocuff-assisted colonoscopy in the FOBT-positive BCSP population. A shorter withdrawal time with endocuff may reflect improved views and stability provided by the endocuff.Trial registered at ClinicalTrials.gov (NCT02529007).
INTRODUCTIONIron de®ciency anaemia is a common haematological problem but current treatment remains unsatisfactory. Intravenous iron supplementation has been withdrawn and intramuscular iron has signi®cant side-effects. Oral iron supplementation, typically with ferrous sulphate, is associated with a high incidence of gastrointestinal sideeffects, 1 and so compliance with treatment is often poor and treatment is ineffective. Although different ferrous preparations are available, there is no signi®cant difference in their side-effects or ef®cacy. 1±3 Ferrous iron preparations have more side-effects than ferric preparations, probably due to the initiation and propagation of potentially damaging hydroxyl free radicals 4, 5 at the gastrointestinal mucosa:However, iron is poorly absorbed from ferric preparations, because ferric salts are rapidly converted to poorly absorbed iron hydroxide polymers when passing from the acidic environment of the stomach to the more neutral pH of the duodenum. These polymers have high af®nity for intestinal mucus 6 and so absorption of the metal is further limited. Inhibition of this hydroxide polymer formation and a more rapid transit through the mucus layer and mucosa would facilitate ferric iron absorption.Maltol (3-hydroxy-2-methyl-4-pyrone) is a naturally occurring sugar derivative formed during caramelization SUMMARY Background: Oral iron supplements, which are usually in the form of ferrous (Fe 2+ ) salts, are toxic to the gastrointestinal mucosa, and so intolerance is common, resulting in poor compliance and failure of treatment. The sugar derivative maltol strongly chelates iron, rendering it available for absorption and stabilized in the less toxic ferric (Fe 3+ ) form. Aim: To test whether ferric trimaltol could correct iron de®ciency anaemia in patients intolerant of ferrous sulphate. Methods: Twenty-three patients were recruited from gastroenterology clinics, of whom 15 had in¯ammatory
Our adequately powered and carefully controlled dietary trial found no evidence that reducing microparticle intake aids remission in active Crohn's disease.
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