This week we finally opened our new faecal calprotectin service. Presently we are calibrating our system with samples donated from volunteers, but shortly we will be able to offer this routinely to our catchment patients. Faecal calprotectin is a neutophil degradation product which can be used as a non-invasive marker of inflammation. My own published research demonstrated a direct correlation…
Finally, within the next few weeks we hope to open our new capsule enteroscopy service at the L&D.
Prucalopride
This new selective, high affinity 5-HT4 agonist appears to be one of the first new therapies to have really made a significant impact on the treatment of chronic constipation.
Presently in UK it is being offered in women only who have failed on standard laxatives.
Prucalopride 2mg od (or 1mg od for those over 65y)
If there has been no benefit after 1 month, it is unlikely that continuing any longer will be helpful .
In 3 seperate 12week trials it was shown to improve;-
a) regular bowel frequency to at least 1x/day in 67% (verses 39% on placebo)
b) abdominal pain and discomfort
c) bloating
d) straining
e) defaceation urgency
Benefits are seen with median time to spontaneous bowel movement within 3 hours.
Interestingly the improvement in quality of life was maintained for 2 years.
Side effects are mild (diarrhoea, nausease, headache, abdominal pain) and resolve swiftly (24 hrs).
GUT 2010; 59: 320-324 P. Rutgeerts’ Leuven group have just released their outcome data from performing 237 stricture dilatations in 138 Crohn’s patients. This is the largest series to-date with the longest follow-up (5.8 years) Immediate success was seen in 97%, with 46% requiring a repeat dilatation after a mean time of 12.5 months. In the long term surgery was…
We have now had acceptance from the PCT to fund a capsule enteroscopy service and are now looking at raising the capital to buy in the equipement. We are optomistic that a SBCE (small bowel capsule enteroscopy) service up and running at the Luton & Dunstable Hospital some time during 2010.
We have been delighted with the results of our new high resolution manometry service. We have now investigated over 40 patients in the last few months. It has enabled us to diagnose a host of conditions that conventional manometry does not have the ability to define. As one of the first district general hospitals to embrace this cutting edge technology…
Following the new ECCO (European Crohn’s and Colitis Guidelines) we are due to be asking all IBD patients to under go immunisation screening and regular vaccinations. A formalised protocol is being drawn up and will be place on this web site and put into practice once we have the GPs and PCTs agreement.
Reflux Reflux symptoms can be experienced secondary to a range of problems that are not always acid related. Even in those related to acid reflux the OGD can be macroscopically normal in 85%. 15-30% of case are due to true gastro-oesophageal reflux disease, >70% is related to non erosive reflux disease (NERD) A recent trial by E. Savarino has helped…
Gastroenterology 2008;135:1528-1533 Type 1 – Classic achalasia with minimal oesophageal pressurization Type 2 – Achalasia with oesophageal compression Type 3 – Achalasia with spasm, functional obstruction, some peristalsis Response to therapy Type 1 – 56% overall Type 2 – 71% BoTox, 91% Balloon Dilatation, 100% Heller’s Myotomy Type 3 – 29% overall