Dr. Matt W Johnson BSc MBBS MRCP MD

Botox in Achalasia

admin — Wed, 18 Jan 2012 22:11:11 +0000

The most common method for delivering BT involves visual estimation of the location of LES and injection of 1 mL aliquots (20 to 25 units BT/mL) into each of four quadrants approximately 1 cm above the Z-line. The Z-line is the squamocolumnar junction, which corresponds to the gastroesophageal junction in the absence of Barrett’s esophagus.

Initial response rates 70-90%
One Treatment = 50% relapse at 6m
Better outcomes with Vigorous (Type 3) Achalasia + Multiple Rx (esp if repeated at 1m) = 60-85% success at 2 year review

New Small Bowel Capsule Enteroscopy Service at L&D

admin — Wed, 09 Nov 2011 23:16:14 +0000

Finally after 2 years, the equipment for our new small bowel capsule enteroscopy service has arrived.

We have a small waiting list of 26 patients to catch up on, but will then be able to offer it at the point of need to both inpatients and outpatients conforming to NICE guidance.

New Faecal Calprotectin Service at the L&D

admin — Wed, 09 Nov 2011 23:11:06 +0000

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 between its presence and quantity with the endoscopic and histological assessments of inflammation within the bowel. A significant number of trials have been performed to demonstrate its usefulness in differentiating between organic (eg. IBD) and functional (eg. IBS) bowel disease with a high degree of sensitivity and specificity.

We aim to use it as a marker to monitor our stable IBD patients on patient self management programmes, and hope to publish data shortly on its effective use in reducing unnecessary colonoscopy.

New Capsule Enteroscopy Service

admin — Mon, 24 Oct 2011 00:15:26 +0000

Finally, within the next few weeks we hope to open our new capsule enteroscopy service at the L&D.

New Treatment in Chronic Constipation

admin — Fri, 10 Sep 2010 15:43:49 +0000

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).

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.