Dr. Matt W Johnson BSc MBBS MRCP

Crohn’s Stricture Dilatation

admin — Sat, 20 Mar 2010 21:55:13 +0000

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 still required in 24%, however, 76% avoided surgery and its associated morbidity and mortality rates. Serious adverse events did occur with thenedoscopic dilatation in 5.1% of cases (6/237 perforations, 5/237 GI bleeds and 1/237 acute abdominal pain requiring hospitalisation).

The procedures were performed with Boston Scientific water filled Rigiflex balloons (8cm long, 18mm diameter). A multistep inflation protocol was used (2 minutes at 15 – 16.5 – 18mm) and repeated if neccessary. Patients were observed for 1 hour after. In general this proved to be a very safe technique and the efficacy of endoscopic dilatation was felt to outweigh the complication risk.

Capsule Enteroscopy Service

admin — Wed, 13 Jan 2010 11:29:53 +0000

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.

High Resolution Manometry

admin — Wed, 13 Jan 2010 11:25:42 +0000

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 we will auditing and publishing the results of our first year of service.
We are also starting additional research projects looking at oesophageal dysmotility and reflux as a major cause of;-
1) chronic cough, especially if this is predominantly troublesome during the night.
2) atypical chest pain

IBD + Immunisations

admin — Wed, 13 Jan 2010 10:29:11 +0000

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.

New Reflux Catagorisation

admin — Sun, 06 Sep 2009 19:56:05 +0000

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 differentiate these patients further by using assessments of their acid exposure time (AET) and symptom association probability (SAP).
Gut 2009;58:1185-1191

Of the 200 patients reviewed with presumed NERD, they found 3 main clinical catagories;
1) NERD pH+ive – 41%
   – +ive AET
2) Hypersensitive – 32%
   – Norm AET / +ive SAP
   – secondary to non/acid reflux
3) Functional – 27%
   - Norm AET / -ive SAP

The Rome III criteria for Functional Reflux also suggests that these patients should also have no response to anti acid / proton pump inhibitors (PPIs). Typically these patients also suffer from associated nausea, early satiety, bloating and postprandial fullness. It was felt that these patients have more in common with those suffering functional dyspepsia, than those with true NERD.

Achalasia: New HRM Classification

admin — Sun, 30 Aug 2009 23:47:14 +0000

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