To read more click on this link.

I would like to thank all those that nominated Tracey, and especially for the kinds words written about her, as I know she has been considerably touched by them.

Further information can be found in the Luton Today press cutting –  http://www.lutontoday.co.uk/news/l_d_nurse_nominated_1_3524895

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

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.

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.

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).

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.

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