BackgroundIndividual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored.MethodAdmission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177).ResultsOne hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control.ConclusionsOverall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour may influence the response to inpatient care, as may improved social functioning and confidence to change.

The data indicate that professional and social support alleviates carer distress and may be of particular value for partners who are more isolated than parents. The data also suggest that time spent with practical support may be of more value than emotional support.

The cognitive interpersonal maintenance model of eating disorders (EDs) was confirmed in part and suggests that interventions targeting interpersonal maintaining factors such as carer distress might impact on patient outcomes.

Anorexia nervosa is a psychiatric disorder with potential life-threatening medical sequelae. This article reviews the principal medical complications associated with anorexia nervosa, highlights associated diagnostic pitfalls and emphasizes the importance of a multidisciplinary approach to management.

Objective: Caring for someone diagnosed with an eating disorder (ED) is associated with a high level of burden and psychological distress which can inadvertently contribute to the maintenance of the illness. The Eating Disorders Symptom Impact Scale (EDSIS) and Accommodation and Enabling Scale for Eating Disorders (AESED) are self-report scales to assess elements of caregiving theorised to contribute to the maintenance of an ED. Further validation and confirmation of the factor structures for these scales are necessary for rigorous evaluation of complex interventions which target these modifiable elements of caregiving. Method: EDSIS and AESED data from 268 carers of people with anorexia nervosa (AN), recruited from consecutive admissions to 15 UK inpatient or day patient hospital units, were subjected to confirmatory factor analysis to test model fit by applying the existing factor structures: (a) four-factor structure for the EDSIS and (b) five-factor structure for the AESED. Results: Confirmatory factor analytic results support the existing four-factor and five-factor structures for the EDSIS and the AESED, respectively. Discussion: The present findings provide further validation of the EDSIS and the AESED as tools to assess modifiable elements of caregiving for someone with an ED.

Patient demographics, clinical presentation, findings at DBE and subsequent follow up data were recorded. The majority of patients had a number of investigations, including radiology, prior to DBE without a firm diagnosis. 83.3% had CE prior to DBE. SPSS V18 was used to analyse the data. Results A total of 358 DBE procedures were carried out during the stated time period. Of these procedures, 18 (5.0%) were for the indication of suspected small bowel tumour. The majority (57.1%) of these patients were female and the average age at the time of diagnosis was 58 years (SD±12 y). Indications for performing DBE included iron deficiency anaemia 44.4%, overt bleeding 27.8%, abnormal radiology 22.2% and abdominal pain 5.6%. Of those who had prior CE, CE was positive in 93.3% (14/15) of patients with the presence of a mass lesion (50%), stricture or ulceration (35.7%) or the presence of blood alone (14.3%). Anterograde DBE was performed in 88.9% whilst the remaining number had DBE via the retrograde route. Tumour was successfully identified at DBE in 78% (n = 14) of patients, where tattoos were placed and histology obtained. Of the 4 patients where DBE failed to reach the lesion, the diagnosis was confirmed by laparotomy in 3 patients and intra-operative endoscopy in 1 patient. The final histological diagnosis of tumours identified is shown in Figure 1, UK. 61.1% tumours were located in the jejunum, 27.8% in the ileum and 11.1% in the distal duodenum. DBE influenced ongoing management in all patients that achieved a diagnosis from the procedure. Conclusion DBE plays a valuable role in the investigation pathway of patients with suspected small bowel tumours. The step wise approach of CE followed by DBE allows efficient use of small bowel resources. Disclosure of Interest None Declared. Introduction The clinical syndrome associated with infective diarrhoea is well known, however there are few studies which have rigorously analysed the characteristics in history, examination and investigation in a single cohort of patients. Methods This was a retrospective cohort study of patients admitted to the gastroenterology department of a single tertiary care teaching hospital with a culture positive episode of bacterial infective diarrhoea, excluding Clostridium difficile. Data was collected from clinical notes of patients presenting over an 8 year period (2004 -2012) with a follow up period of 12 months from the date of admission. Results 103 patients were included in the study; 59 (57%) males, mean age 43 (17-101). Organisms cultured were; Campylobacter 84, Salmonella 13, Shigella 2, E coli 4. Mean duration of symptoms was 5.7 days (1-14) while patient gave history of; abdominal pain 88% (91), per rectal (PR) bleeding 52% (53), vomiting 43% (44), weight loss 22% (23), food history 27% (28), and recent travel 8.5% (9). 13 patients (12%) had pre-existing inflammatory bowel disease (IBD) and 35 patients (34%) were on a PPI. Examination revealed; fever (>37.5) 35% (35), tachycardia 27% (28) and hypotension in 4% (5) patients. Blood...

No abstract