712 results on '"Sanders, D.S."'
Search Results
2. Non-responsive and refractory coeliac disease : experience from the NHS England National Centre
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Penny, H.A., Rej, A., Baggus, E.M.R., Coleman, S.H., Ward, R., Wild, G., Bouma, G., Trott, N., Snowden, J.A., Wright, J., Cross, S.S., Hadjivassiliou, M., and Sanders, D.S.
- Abstract
We characterised the aetiology of non-responsive coeliac disease (NRCD) and provided contemporary mortality data in refractory coeliac disease (RCD) from our centre. We also measured urine gluten immunogenic peptides (GIPs) in patients with established RCD1 to evaluate gluten exposure in these individuals. Methods: This was a longitudinal cohort study conducted in Sheffield, UK. Between 1998 and 2019, we evaluated 285 adult (≥16 years) patients with NRCD or RCD. Patients with established RCD1 and persisting mucosal inflammation and/or ongoing symptoms provided three urine samples for GIP analysis. Results: The most common cause of NRCD across the cohort was gluten exposure (72/285; 25.3%). RCD accounted for 65/285 patients (22.8%), 54/65 patients (83.1%) had RCD1 and 11/65 patients (16.9%) had RCD2. The estimated 5-year survival was 90% for RCD1 and 58% for RCD2 (p = 0.016). A total of 36/54 (66.7%) patients with RCD1 underwent urinary GIP testing and 17/36 (47.2%) had at least one positive urinary GIP test. Conclusion: The contemporary mortality data in RCD2 remains poor; patients with suspected RCD2 should be referred to a recognised national centre for consideration of novel therapies. The high frequency of urinary GIP positivity suggests that gluten exposure may be common in RCD1; further studies with matched controls are warranted to assess this further.
- Published
- 2022
3. Functional gastrointestinal disorders and associated health impairment in individuals with celiac disease
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Parker, S., Palsson, O., Sanders, D.S., Simren, M., Sperber, A.D., Törnblom, H., Urwin, H., Whitehead, W., and Aziz, I.
- Abstract
Background & Aims\ud \ud Individuals with celiac disease (CD) can experience persisting gastrointestinal symptoms despite adhering to a gluten-free diet (GFD). This may be due to functional gastrointestinal disorders (FGIDs), although there is little data on its prevalence and associated factors.\ud \ud \ud \ud Methods\ud \ud An online health questionnaire was completed by adult members of Celiac UK in October 2018. The survey included validated questions on Rome IV FGIDs, non-gastrointestinal somatic symptoms, anxiety, depression, quality of life, healthcare use, GFD duration and its adherence using the celiac dietary adherence test score (with a value ≤ 13 indicating optimal adherence). The prevalence of FGIDs and associated health impairment in the celiac cohort was compared against an age- and sex- matched population-based control group.\ud \ud \ud \ud Results\ud \ud Of the 863 individuals with CD (73% female, mean-age 61 years) all were taking a GFD for at least 1 year, with 96% declaring that they have been on the diet for 2 or more years (2-4 years, 20%; ≥5 years, 76%). The adherence to a GFD was deemed optimal in 61% (n=523) with the remaining 39% (n=340) non-adherent. Those adhering to a GFD fulfilled criteria for a FGID in approximately a half of cases, although this was significantly lower than non-adherent subjects (51% vs. 75%, OR 2.0; p
- Published
- 2022
4. Sudomotor dysfunction in patients with gluten neuropathy
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Zis, P., Shafique, F., Sarrigiannis, P.G., Artemiadis, A., Rao, D.G., Sanders, D.S., and Hadjivassiliou, M.
- Abstract
Background and aim\ud \ud Gluten neuropathy (GN) is a common neurological manifestation of gluten sensitivity (GS), characterized by serological evidence of GS, while other risk factors for developing neuropathy are absent. The degree of small fiber dysfunction in GN has not been studied in depth to date. Small fiber involvement may lead to pain, thermal perception abnormalities, and sweat gland dysfunction. Sudomotor innervation refers to the cholinergic innervation of the sympathetic nervous system through small fibers in the sweat glands. The aim of our study was to assess the sudomotor function of GN patients.\ud \ud \ud \ud Methods\ud \ud Patients with GN were recruited. Clinical and neurophysiological data were obtained. HLA-DQ genotyping was performed. The skin electrochemical conductance (ESC) was measured with SUDOSCANTM.\ud \ud \ud \ud Results\ud \ud Thirty-two patients (25 males, mean age 69.5±10.2 years) were recruited. Thirteen patients (40.6%) had abnormal sudomotor function of the hands. Sixteen patients (50%) had abnormal sudomotor function of the feet. Twenty-one patients (65.6%) had abnormal sudomotor function of either the hands or feet.\ud \ud \ud \ud Sudomotor dysfunction did not correlate with the type of neuropathy (length-dependent neuropathy or sensory ganglionopathy), gluten-free diet adherence, severity of neuropathy, and duration of disease or HLA-DQ genotype. No differences in the ESC were found between patients with painful and patients with painless GN.\ud \ud \ud \ud Conclusion\ud \ud Sudomotor dysfunction affects two-thirds of patients with GN. The lack of correlation between pain and sudomotor dysfunction suggests different patterns of small fiber involvement in patients with GN.
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- 2022
5. TAKE A GLIMPSE TO THE SMALL BOWEL: ASSESSING MUCOSAL HEALING IN CELIAC PATIENTS WITH CAPSULE ENDOSCOPY
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Scaramella, L., additional, Marinoni, B., additional, Rimondi, A., additional, Tontini, G.E., additional, Penagini, R., additional, Sidhu, R., additional, Sanders, D.S., additional, Leffler, D., additional, Chetcuti Zammit, S., additional, Vecchi, M., additional, and Elli, L., additional
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- 2022
- Full Text
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6. Neurological evaluation of patients with newly diagnosed coeliac disease presenting to gastroenterologists : a 7-year follow-up study
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Hadjivassiliou, M., Croall, I.D., Grünewald, R.A., Trott, N., Sanders, D.S., and Hoggard, N.
- Abstract
We have previously shown that 67% of patients with newly diagnosed coeliac disease (CD) presenting to gastroenterologists have evidence of neurological dysfunction. This manifested with headache and loss of co-ordination. Furthermore 60% of these patients had abnormal brain imaging. In this follow-up study, we re-examined and re-scanned 30 patients from the original cohort of 100, seven years later. There was significant reduction in the prevalence of headaches (47% to 20%) but an increase in the prevalence of incoordination (27% to 47%). Although those patients with coordination problems at baseline reported improvement on the gluten free diet (GFD), there were 7 patients reporting incoordination not present at baseline. All 7 patients had positive serology for one or more gluten-sensitivity related antibodies at follow-up. In total, 50% of the whole follow-up cohort were positive for one or more gluten-related antibodies. A comparison between the baseline and follow-up brain imaging showed a greater rate of cerebellar grey matter atrophy in the antibody positive group compared to the antibody negative group. Patients with CD who do not adhere to a strict GFD and are serological positive are at risk of developing ataxia, and have a significantly higher rate of cerebellar atrophy when compared to patients with negative serology. This highlights the importance of regular review and close monitoring.
- Published
- 2021
7. Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study
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Taylor, M.A., Blanshard, R.J., Naylor, G., Penny, H.A., Mooney, P.D., and Sanders, D.S.
- Abstract
Objective: This study aimed to assess if there is secondary care medical inertia towards coeliac disease (CD).\ud \ud \ud \ud Design: Group (1): Time from primary care presentation to diagnostic endoscopy was quantified in 151 adult patients with a positive endomysial antibody test and compared with 92 adult patients with histologically proven inflammatory bowel disease (IBD). Group (2): Across four hospitals, duodenal biopsy reports for suspected CD were reviewed (n=1423). Group (3): Clinical complexity was compared between known CD (n=102) and IBD (n=99) patients at their respective follow-up clinic appointments. Group (4): 50 gastroenterologists were questioned about their perspective on CD and IBD.\ud \ud \ud \ud Results: Group (1): Suspected coeliac patients waited significantly longer for diagnostic endoscopy following referral (48.5 (28–89) days) than suspected patients with IBD (34.5 (18–70) days; p=0.003). Group (2): 1423 patients underwent diagnostic endoscopy for possible CD, with only 40.0% meeting guidelines to take four biopsies. Increased diagnosis of CD occurred if guidelines were followed (10.1% vs 4.6% p
- Published
- 2021
8. The use of small-bowel capsule endoscopy in cases of equivocal celiac disease
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Zammit, S.C., Schiepatti, A., Aziz, I., Kurien, M., Sanders, D.S., and Sidhu, R.
- Abstract
Background and Aims\ud Seronegative villous atrophy (SNVA), raised intraepithelial lymphocytes (IELs), and crypt hyperplasia on duodenal histology can be secondary to celiac disease (CD) or other causes such as medications or infections. Our aims were to assess the role of small-bowel capsule endoscopy (SBCE) in these patients and to ascertain whether findings on SBCE at diagnosis can predict disease outcome.\ud \ud Methods\ud Patients (n = 177) with SNVA, IELs, ± crypt hyperplasia on duodenal histology were studied. These patients all had an equivocal diagnosis of CD.\ud \ud Results\ud Overall, 56 patients (31.6%) had a positive SBCE. Thirty-three patients (58.9%) had disease affecting the proximal third of the small bowel (SB). The diagnostic yield of SBCE was 40.0% (22 patients), 51.4% (18 patients), 27.0% (10 patients), and 14.0% (7 patients) in patients with an unknown cause for SNVA (SNVA-UO), patients with SNVA who responded to a gluten-free diet (SNVA-CD), patients with a known cause for SNVA, and patients with railed IELs ± crypt hyperplasia, respectively. In SNVA-UO, SBCE at diagnosis was more likely to be positive in patients with persistent SNVA (10, 90.9%) and persistent SNVA with lymphoproliferative features (4, 80.4%) than patients with spontaneous resolution of SNVA (8, 20.5%) (P = .0001). All patients in the SNVA-CD group who eventually developed adverse events had a positive SBCE (P = .022). They also had more extensive SB disease than those without adverse events (50% vs 1% P = .002). More extensive SB disease on SBCE correlated with a higher SNVA-related mortality in patients with SNVA-UO and SNVA-CD (P = .019). Severity of histology did not correlate with mortality (P = .793).\ud \ud Conclusions\ud A positive SBCE at diagnosis predicts a worse outcome. More importantly, more extensive disease in these patients is associated with poor survival. Targeting patients with extensive disease at diagnosis with more aggressive therapy can help to improve prognosis.
- Published
- 2020
9. Non-responsive coeliac disease : a comprehensive review from the NHS England national centre for refractory coeliac disease
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Penny, H.A., Baggus, E.M.R., Rej, A., Snowden, J.A., and Sanders, D.S.
- Subjects
nutritional and metabolic diseases ,digestive system diseases - Abstract
Coeliac disease is a common small intestinal enteropathy which manifests following ingestion of gluten in genetically susceptible individuals. Since gluten was identified as the driving factor in coeliac disease, the gluten-free diet (GFD) has remained the mainstay of treatment. While most individuals will display improvement in symptoms and signs of coeliac disease following institution of the GFD, up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation. These individuals can be classified as having non-responsive coeliac disease (NRCD), which may be associated with dietary indiscretion, slow healing, refractory coeliac disease, and/or an alternative condition. The purpose of this review is to provide an overview of the causes of NRCD in adults, highlight a systematic approach to investigate these patients, and appraise the latest management aspects of this subset of coeliac disease.
- Published
- 2020
10. Neurologic deficits in patients with newly diagnosed celiac disease are frequent and linked with autoimmunity to TG6
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Hadjivassiliou, M., Croall, I.D., Zis, P., Sarrigiannis, P.G., Sanders, D.S., Aeschlimann, P., Grünewald, R.A., Armitage, P.A., Connolly, D., Aeschlimann, D., and Hoggard, N.
- Abstract
Background & Aims\ud Celiac disease is an autoimmune disorder induced by ingestion of gluten that affects 1% of the population and is characterized by gastrointestinal symptoms, weight loss, and anemia. We evaluated the presence of neurologic deficits and investigated whether the presence of antibodies to TG6 increases the risk of neurologic defects in patients with a new diagnosis of celiac disease.\ud \ud Methods\ud We performed a prospective cohort study at a secondary-care gastroenterology center of 100 consecutive patients who received a new diagnosis of celiac disease based on gastroscopy and duodenal biopsy. We collected data on neurologic history, and patients were evaluated in a clinical examination along with magnetic resonance imaging (MRI) of the brain, MR spectroscopy of the cerebellum, and measurements of antibodies against TG6 in serum samples. The first 52 patients recruited underwent repeat MR spectroscopy at 1 year after a gluten-free diet (GFD). The primary aim was to establish if detection of antibodies against TG6 can be used to identify patients with celiac disease and neurologic dysfunction.\ud \ud Results\ud Gait instability was reported in 24% of the patients, persisting sensory symptoms in 12%, and frequent headaches in 42%. Gait ataxia was found in 29% of patients, nystagmus in 11%, and distal sensory loss in 10%. Sixty percent of patients had abnormal results from the MRI, 47% had abnormal results from MR spectroscopy of the cerebellum, and 25% had brain white matter lesions beyond that expected for their age group. Antibodies against TG6 were detected in serum samples from 40% of patients–these patients had significant atrophy of subcortical brain regions compared to patients without TG6 autoantibodies. In patients with abnormal results from MR spectroscopy of the cerebellum, those on the GFD had improvements detected in the repeat MR spectroscopy 1 year later.\ud \ud Conclusions\ud In a prospective cohort study of patients with a new diagnosis of celiac disease at a gastroenterology clinic, neurological deficits were common and 40% had circulating antibodies against TG6. We observed a significant reduction in volume of specific brain regions in patients with TG6 autoantibodies, providing evidence for a link between autoimmunity to TG6 and brain atrophy in patients with celiac disease. There is a need for early diagnosis, increased awareness of the neurological manifestations amongst clinicians and reinforcement of adherence to a strict GFD by patients in order to avoid permanent neurological disability.
- Published
- 2019
11. What is the role of small bowel capsule endoscopy in established coeliac disease?
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Chetcuti Zammit, S., primary, Kurien, M., additional, Sanders, D.S., additional, and Sidhu, R., additional
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- 2020
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12. OC.06.2 PREVALENCE, CLINICAL FEATURES AND MORTALITY IN SERONEGATIVE COELIAC DISEASE: A COHORT STUDY FROM TWO INTERNATIONAL CENTRES OVER 19 YEARS
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Schiepatti, A., primary, Maimaris, S., additional, Porta, P., additional, Marks, L.J., additional, Kurien, M., additional, Key, T., additional, Goodwin, J., additional, Klersy, C., additional, Biagi, F., additional, and Sanders, D.S., additional
- Published
- 2020
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13. The growing global interest in the gluten free diet as reflected by Google searches
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Rej, A., primary, Tai, F.W.D., additional, Green, P.H.R., additional, Lebwohl, B., additional, and Sanders, D.S., additional
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- 2020
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14. Coeliac disease and noncoeliac wheat or gluten sensitivity
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Rej, A., primary, Aziz, I., additional, and Sanders, D.S., additional
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- 2020
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15. Sheffield Clinical Research Fellowship programme: A transferable model for UK gastroenterology
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Kurien, M., Hopper, A., Lobo, A.J., McAlindon, M.E., Sidhu, R., Gleeson, D.C., Hebden, J.M., Basu, K., Panter, S., Lockett, M., and Sanders, D.S.
- Abstract
Out of programme (OOP) opportunities are to be encouraged. This article gives an insightful view of the Sheffield Clinical Research Fellowship Programme. Unique trainee feedback is provided. The take home message is clear - trainees should grab OOP experiences with both hands! For consultants the logistics described are potentially transferrable to their own regions.
- Published
- 2018
16. Lower gastrointestinal symptoms are associated with worse glycemic control and quality of life in type 1 diabetes mellitus
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Leeds, J.S., Hadjivassiliou, M., Tesfaye, S., and Sanders, D.S.
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Objectives Lower gastrointestinal symptoms are not well characterized in people with type 1 diabetes, and the effects on quality of life and glycemic control are unknown. This study aimed to determine the prevalence of lower gastrointestinal symptoms and the effects on glycemic control and quality of life, and to investigate for underlying causes.\ud \ud \ud Research design and methods This is a prospective, cohort study in secondary care. Patients with type 1 diabetes completed a gastrointestinal symptom questionnaire and the Short Form 36 V.2 quality of life questionnaire and had their hemoglobin A1c measured. Patients with diarrhea were offered reassessment and investigation as per the national guidelines. Controls without diabetes were used to compare symptom prevalence and quality of life scores.\ud \ud \ud Results 706 with type 1 diabetes (mean age 41.9 years) and 604 controls (mean age 41.9 years) were enrolled. Gastrointestinal symptoms were significantly more frequent in type 1 diabetes compared with controls, in particular constipation (OR 2.4), diarrhea (OR 2.5), alternating bowel habit (OR 2.1), abdominal pain (OR 1.4), floating stools (OR 2.7), bloating (OR 1.4) and flatulence (OR 1.3) (all p
- Published
- 2018
17. Persistent mucosal damage and risk of epilepsy in people with celiac disease
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Kurien, M., Ludvigsson, J.F., Sanders, D.S., Zylberberg, H.M., Green, P.H., Sundelin, H.E.K., and Lebwohl, B.
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BACKGROUND: Celiac disease (CD) is associated with an increased risk of developing epilepsy, a risk that persists after CD diagnosis. A significant proportion of CD patients have persistent villous atrophy (VA) on follow-up biopsy. This study's objective was to determine whether persistent VA on follow-up biopsy affects long-term epilepsy risk and epilepsy-related hospital emergency admissions. METHODS: Nationwide Cohort Study. We identified all people in Sweden with histological evidence of CD who underwent a follow-up small intestinal biopsy (1969-2008). We compared those with persistent VA to those who showed histological improvement, assessing the development of epilepsy and related emergency hospital admissions (defined according to relevant ICD codes in the Swedish Patient Register). Cox regression analysis was used to assess outcome measures. RESULTS: Of 7590 people with CD who had a follow-up biopsy, VA was present in 43%. The presence of persistent VA was significantly associated with a reduced risk of developing newly-diagnosed epilepsy (hazard ratio [HR] 0.61; 95% confidence interval [CI] 0.38-0.98). On stratified analysis this effect was primarily amongst males (HR 0.35; 95 CI 0.15-0.80). Among the 58 CD patients with a prior diagnosis of epilepsy, those with persistent VA were less likely to visit an emergency department with epilepsy (HR 0.37; 95%CI 0.09-1.09). CONCLUSIONS: In a population-based study of CD individuals, persisting VA on follow up biopsy was associated with reduced future risk of developing epilepsy but did not influence emergency epilepsy-related hospital admissions. Mechanisms as to why persistent VA confers this benefit requires further exploration.
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- 2018
18. P.06.3 CLINICAL FEATURES, GENETIC BACKGROUND AND NATURAL HISTORY OF PATIENTS WITH SERONEGATIVE VILLOUS ATROPHY OF UNKNOWN ORIGIN
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Schiepatti, A., primary, Sanders, D.S., additional, Giuffrida, P., additional, Goodwin, J., additional, Key, T., additional, Quaye, L., additional, Da Silvestri, A., additional, Vanoli, A., additional, Betti, E., additional, Maiorano, G., additional, Di Sabatino, A., additional, Corazza, G.R., additional, and Biagi, F., additional
- Published
- 2019
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19. The Role of an IgA/IgG-Deamidated Gliadin Peptide Point-of-Care Test in Predicting Persistent Villous Atrophy in Patients With Celiac Disease on a Gluten-Free Diet
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Lau, M.S., Mooney, P.D., White, W.L., Rees, M.A., Wong, S.H., Kurien, M., Trott, N., Leffler, D.A., Hadjivassiliou, M., and Sanders, D.S.
- Abstract
OBJECTIVES: Mucosal healing is important in celiac disease (CD) for the prevention of complications. However, obtaining duodenal biopsies is invasive, and there is currently no reliable surrogate marker for histological remission in clinical practice. We aimed to assess the role of a point-of-care test (POCT) based on IgA/IgG-deamidated gliadin peptide, in detecting persistent villous atrophy (VA) in CD. \ud \ud METHODS: We prospectively recruited patients with CD attending endoscopy for the assessment of histological remission. All patients had IgA-endomysial (EMA) antibodies, IgA-tissue transglutaminase (TTG) antibodies, and the POCT performed, and completed a validated dietary adherence questionnaire. A gastroscopy was performed in all patients, with four biopsies taken from the second part of the duodenum and one from the duodenal bulb. We compared the diagnostic performance of the surrogate markers against duodenal histology as the reference standard. \ud \ud RESULTS: A total of 217 patients with CD (70% female, age range 16-83 years, median age 53 years) on a gluten-free diet (median duration 6 years) were recruited from 2013 to 2017. Eighty-five (39.2%) patients had persistent VA. The sensitivities of the POCT, TTG, EMA, and the adherence score in detecting VA were 67.1%, 44.7%, 37.7%, and 24.7% respectively (P=0.0005). The combination of the POCT and adherence score only marginally increased the sensitivity to 70.6% (59.7-80.0%). \ud \ud CONCLUSIONS: The sensitivity of the POCT was higher than the other surrogate markers in predicting VA. A POCT may provide the additional advantage of an immediate objective assessment of mucosal healing at the time of an office-based follow-up consultation.
- Published
- 2017
20. Gastrostomies Preserve but do not Increase Quality of Life for Patients and Caregivers
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Kurien, M., Andrews, R.E., Tattersall, R., McAlindon, M.E., Wong, E.F., Johnston, A.J., Hoeroldt, B., Dear, K.L., and Sanders, D.S.
- Abstract
BACKGROUND & AIMS: Gastrostomies are widely used to provide long-term enteral nutrition to patients with neurological conditions that affect swallowing (such as following a cerebrovascular accident or for patients with motor neuron disease) or with oropharyngeal malignancies. The benefits derived from this intervention are uncertain for patients and caregivers. We conducted a prospective, multicenter cohort study to determine how gastrostomies affect health-related quality of life (HRQoL) in recipients and caregivers. METHODS: We performed a study of 100 patients who received gastrostomies (55% percutaneous endoscopic gastrostomy, 45% radiologically inserted) at 5 centers in the United Kingdom, 100 caregivers, and 200 population controls. We used the EuroQol-5D (EQ-5D, comprising a questionnaire, index, visual analogue scale) to assess HRQoL for patients and caregivers before the gastrostomy insertion and then 3 months afterward; findings were compared with those from controls. Ten patients and 10 caregivers were also interviewed after the procedure to explore quantitative findings. Findings from the EQ-5D and semi-structured interviews were integrated using a mixed methods matrix. RESULTS: Six patients died before the 3-month HRQoL reassessments. We observed no significant longitudinal changes in mean EQ-5D index scores for patients (0.70 before vs 0.710 after; P=.83) or caregivers (0.95 before vs 0.95 after; P=.32) following gastrostomy insertion. The semi-structured interviews revealed problems in managing gastrostomy tubes, social isolation, and psychological and emotional consequences that reduced HRQoL. CONCLUSIONS: We performed a mixed methods prospective study of the effects of gastrostomy feeding on HRQoL. HRQoL did not significantly improve after gastrostomy insertion for patients or caregivers. The lack of significant decrease in HRQoL after the procedure indicates that gastrostomies may help maintain HRQoL. Findings have relevance to those involved in gastrostomy insertion decisions and indicate the importance of carefully selecting patients for this intervention, despite the relative ease of insertion.
- Published
- 2017
21. Should gluten-free foods be available on prescription?
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Kurien, M., Sleet, S., Sanders, D.S., and Cave, J.
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health care economics and organizations - Published
- 2017
22. Characterization of Paroxysmal Gluten-Sensitive Dyskinesia in Border Terriers Using Serological Markers
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Lowrie, M., primary, Garden, O.A., additional, Hadjivassiliou, M., additional, Sanders, D.S., additional, Powell, R., additional, and Garosi, L., additional
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- 2018
- Full Text
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23. Acceptability study on a new oral nutritional supplement in adult patients: Evaluation of gastrointestinal (GI) tolerance, palatability and compliance
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Trott, N., primary, Kurien, M., additional, and Sanders, D.S., additional
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- 2017
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24. Comparing dietitian-led group clinics to individual appointments for newly diagnosed patients with coeliac disease
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Trott, N., primary, Kurien, M., additional, Branchi, F., additional, and Sanders, D.S., additional
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- 2017
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25. Long-term care for patients with coeliac disease in the UK: a review of the literature and future directions
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Kurien, M., Trott, N., and Sanders, D.S.
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nutritional and metabolic diseases ,digestive system diseases - Abstract
Coeliac disease is a common digestive disorder that affects 1% of adults. It is characterised by mucosal damage of the small intestine caused by dietary gluten. The main treatment for coeliac disease is a lifelong gluten-free diet, which can reduce morbidity and mortality and also improve quality of life. Despite the benefits, adhering to this diet is often challenging, with patients often struggling to sustain dietary restriction. Structured follow-up for coeliac disease is recommended in international guidelines for improving adherence and for detecting complications;however, uncertainty exists concerning exactly who should be administering this follow-up care. Here, we undertake a review of the current approaches described in the literature to follow-up patients with coeliac disease, and assess the efficacy of these differing models. We also explore future directions for the care of these patients in the context of the UK National Health Service (a publicly funded healthcare system). Although the focus of this review pertains to follow-up within the UK healthcare system, these problems are recognised to be international, and so the findings of our review are likely to be of interest to all healthcare professionals seeing and managing patients with coeliac disease.
- Published
- 2016
26. The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000-2015)
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Aziz, I., Peerally, M.F., Barnes, J.H., Kandasamy, V., Whiteley, J.C., Partridge, D., Vergani, P., Cross, S.S., Green, P.H., and Sanders, D.S.
- Abstract
BACKGROUND: Seronegative villous atrophy (SNVA) is commonly attributed to coeliac disease (CD). However, there are other causes of SNVA. More recently angiotensin-2-receptor-blockers (A2RBs) have been reported as an association but data on SNVA have been limited to centres evaluating complex case referrals and not SNVA in general. OBJECTIVES: To provide clinical outcomes and associations in a large prospective study overseeing all newcomers with SNVA. DESIGN: Over a 15-year period (2000-2015) we evaluated 200 adult patients with SNVA at a UK centre. A diagnosis of either seronegative CD (SNCD) or seronegative non-CD (SN-non-CD) was reached. Baseline comparisons were made between the groups, with 343 seropositive CD subjects serving as controls. RESULTS: Of the 200 SNVA cases, SNCD represented 31% (n=62) and SN-non-CD 69% (n=138). The human leucocyte antigen (HLA)-DQ2 and/or DQ8 genotype was present in 61%, with a 51% positive predictive value for SNCD. The breakdown of identifiable causes in the SN-non-CD group comprised infections (27%, n=54), inflammatory/immune-mediated disorders (17.5%, n=35) and drugs (6.5%, n=13; two cases related to A2RBs). However, no cause was found in 18% (n=36) and of these 72% (n=26/36) spontaneously normalised duodenal histology while consuming a gluten-enriched diet. Following multivariable logistic regression analysis an independent factor associated with SN-non-CD was non-white ethnicity (OR 10.8, 95% CI 2.2 to 52.8); in fact, 66% of non-whites had GI infections. On immunohistochemistry all groups stained positive for CD8-T-cytotoxic intraepithelial lymphocytes. However, additional CD4-T helper intraepithelial lymphocytes were occasionally seen in SN-non-CD mimicking the changes associated with refractory CD. CONCLUSIONS: Most patients with SNVA do not have CD, in particular those who are not white. Furthermore, a subgroup with no obvious aetiology will show spontaneous histological resolution while consuming gluten. These findings suggest caution in empirically prescribing a gluten-free diet without investigation.
- Published
- 2016
27. Bulb Biopsy in Adult Celiac Disease: Pros Outweigh the Cons?
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Kurien, M., Mooney, P.D., Cross, S.S., and Sanders, D.S.
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ComputingMilieux_LEGALASPECTSOFCOMPUTING - Published
- 2016
28. Neurological Dysfunction in Coeliac Disease and Non-Coeliac Gluten Sensitivity
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Hadjivassiliou, M., Rao, D.G., Gruenewald, R.A., Aeschlimann, D.P., Sarrigiannis, P.G., Hoggard, N., Aeschlimann, P., Mooney, P.D., and Sanders, D.S.
- Abstract
OBJECTIVES: Non-coeliac gluten sensitivity (NCGS) refers to patients with primarily gastrointestinal symptoms\ud without enteropathy that symptomatically benefi t from gluten-free diet (GFD). Little is known about\ud its pathophysiology, propensity to neurological manifestations, and if these differ from patients with\ud coeliac disease (CD). We investigated the clinical and immunological characteristics of patients\ud presenting with neurological manifestations with CD and those with NCGS.\ud METHODS: We compared clinical, neurophysiological, and imaging data of patients with CD and NCGS\ud presenting with neurological dysfunction assessed and followed up regularly over a period of\ud 20 years.\ud RESULTS: Out of 700 patients, 562 were included. Exclusion criteria included no bowel biopsy to confi rm\ud CD, no HLA type available, and failure to adhere to GFD. All patients presented with neurological\ud dysfunction and had circulating anti-gliadin antibodies. Out of 562 patients, 228 (41%) had\ud evidence of enteropathy (Group 1, CD) and 334 (59%) did not (Group 2, NCGS). The most common\ud neurological manifestations were cerebellar ataxia, peripheral neuropathy, and encephalopathy. There\ud was a greater proportion of patients with encephalopathy in Group 1 and with a greater proportion\ud of neuropathy in Group 2. The severity of ataxia did not differ between the two groups. Patients in\ud Group 1 had more severe neuropathy. All patients from both groups responded to gluten-free diet.\ud Anti-tissue transglutaminase (TG2) antibodies were found in 91% of patients in Group 1 and in\ud 29% of patients in Group 2. Comparison between those patients in Group 2 with HLA-DQ2/DQ8 and\ud those without as well as those with positive TG2 compared with those with negative TG2 antibodies\ud identifi ed no differences within these subgroups. Serological positivity for TG6 antibodies was similar\ud in the two groups (67 and 60%).\ud CONCLUSIONS: The neurological manifestations of CD and NCGS are similar and equally responsive to a GFD\ud suggestive of common pathophysiological mechanisms.
- Published
- 2016
29. Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn's disease strictures
- Author
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Morar, P.S., Faiz, O., Warusavitarne, J., Brown, S., Cohen, R., Hind, D., Abercrombie, J., Ragunath, K., Sanders, D.S., Arnott, I., Wilson, G., Bloom, S., Arebi, N., and Crohn's Stricture Study (CroSS) Group
- Abstract
BACKGROUND: Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy can inform the design of future studies. \ud \ud AIM: To examine symptomatic (SR) and technical response (TR) and adverse events (AE) of EBD. Stricture characteristics were also explored. \ud \ud METHODS: A systematic search strategy of COCHRANE, MEDLINE and EMBASE was performed. All original studies reporting outcomes of EBD for Crohn's strictures were included. SR was defined as obstructive symptom-free outcome at the end of follow-up, TR as post-dilatation passage of the endoscope through a stricture, and adverse event as the presence of complication (perforation and/or bleeding). Pooled event rates across studies were expressed with summative statistics. \ud \ud RESULTS: Twenty-five studies included 1089 patients and 2664 dilatations. Pooled event rates for SR, TR, complications and perforations were 70.2% (95% CI: 60-78.8%), 90.6% (95% CI: 87.8-92.8%), 6.4% (95% CI: 5.0-8.2) and 3% (95% CI: 2.2-4.0%) respectively. Cumulative surgery rate at 5 year follow-up was 75%. Pooled unweighted TR, SR, complication, perforation and surgery rates were 84%, 45%, 15%, 9% and 21% for de novo and 84%, 58%, 22%, 5% and 32% for anastomotic strictures. Outcomes between two stricture types were no different on subgroup meta-analysis. \ud \ud CONCLUSIONS: Efficacy and complication rates for endoscopic balloon dilatation were higher than previously reported. From the few studies with 5 year follow-up the majority required surgery. Future studies are needed to determine whether endoscopic balloon dilatation has significant long-term benefits.
- Published
- 2015
30. The Clinical and Serological Effect of a Gluten‐Free Diet in Border Terriers with Epileptoid Cramping Syndrome
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Lowrie, M., primary, Garden, O.A., additional, Hadjivassiliou, M., additional, Harvey, R.J., additional, Sanders, D.S., additional, Powell, R., additional, and Garosi, L., additional
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- 2015
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31. Computational investigation of the aerodynamic performance of an optimised alternative fuselage shape.
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Odendaal, Diwan U., Smith, Lelanie, Craig, Kenneth J., and Sanders, Drewan S.
- Subjects
ASPECT ratio (Aerofoils) ,COMPUTATIONAL fluid dynamics ,BOUNDARY layer (Aerodynamics) ,AIRBUS A320 ,SURFACE area - Abstract
Purpose: The purpose of this study is to re-evaluation fuselage design when the main wing's has the ability to fulfill stability requirements without the need for a tailplane. The aerodynamic requirements of the fuselage usually involve a trade-off between reducing drag and providing enough length for positioning the empennage to ensure stability. However, if the main wing can fulfill the stability requirements without the need for a tailplane, then the fuselage design requirements can be re-evaluated. The optimisation of the fuselage can then include reducing drag and also providing a component of lift amongst other potential new requirements. Design/methodology/approach: A careful investigation of parameterisation and trade-off optimisation methods to create such fuselage shapes was performed. The A320 Neo aircraft is optimised using a parameterised 3D fuselage model constructed with a modified PARSEC method and the SHERPA optimisation strategy, which was validated through three case studies. The geometry adjustments in relation to the specific flow phenomena are considered for the three optimal designs to investigate the influencing factors that should be considered for further optimisation. Findings: The top three aerodynamic designs show a distinctive characteristic in the low aspect ratio thick wing-like aftbody that has pressure drag penalties, and the aftbody camber increased surface area notably improved the fuselage's lift characteristics. Originality/value: This work contributes to the development of a novel set of design requirements for a fuselage, free from the constraints imposed by stability requirements. By gaining insights into the flow phenomena that influence geometric designs when a lift requirement is introduced to the fuselage, we can understand how the fuselage configuration was optimised. This research lays the groundwork for identifying innovative design criteria that could extend into the integration of propulsion of the aftbody. [ABSTRACT FROM AUTHOR]
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- 2024
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32. Research on Large Hybrid Electric Aircraft Based on Battery and Turbine-Electric.
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Hui, Yannian, Li, Hongliang, Chai, Jianyun, and Kang, Yuanli
- Abstract
Hybrid electric aircraft use traditional engine and electric propulsion combinations to optimize aircraft architecture, improve propulsion efficiency, and reduce fuel consumption. As a new technology, the fuel and energy consumption calculation of hybrid electric aircraft is more complicated than traditional aircraft due to the usage of different energy forms. The purpose of this paper is to develop the analytical method for fuel and energy consumption for hybrid electric aircraft. This paper summarizes the working principle of hybrid electric aircraft, including the system architecture and power conversion mechanism. The calculation of fuel and energy consumption for hybrid electric aircraft is carried out in detail. In order to evaluate large hybrid electric aircraft, the architecture, based on energy flow, is established, and turbofan engine, electrical system, electric duct fan, and aerodynamic model characteristics are established. With a single-aisle aircraft as an example, the fuel and energy consumption under the 800 nautical mile range is performed. It shows that fuel consumption can be reduced by 10% and energy consumption by 4.7% compared with a traditional aircraft. The effects of different range and battery ratios are analyzed. The payload range for the hybrid electric aircraft is analyzed. The results show that even though the hybrid electric aircraft reduces the payload and range, it can significantly reduce fuel and energy consumption. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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33. Associations of Microbiota and Nutrition with Cognitive Impairment in Diseases.
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Młynarska, Ewelina, Jakubowska, Paulina, Frąk, Weronika, Gajewska, Agata, Sornowska, Joanna, Skwira, Sylwia, Wasiak, Jakub, Rysz, Jacek, and Franczyk, Beata
- Abstract
Background/Objectives: Recent research highlights the growing interest in the impact of nutrition on cognitive health and function in disease, as dietary habits are increasingly recognized as crucial factors in relation to brain function. This focus is especially important given the rising prevalence of neurodegenerative diseases and the cognitive decline associated with poor dietary choices. Links are now being sought between brain function and the microbiota and gut–brain axis. Mechanisms are proposed that include low-grade chronic neuroinflammation, the influence of short-chain fatty acids, or the disruption of glial cells and transmitters in the brain. Methods: We reviewed the articles on pubmed. This is not a systematic review, but of the narrative type. We wanted to outline the issue and summarise the latest information. Results: The axis in question has its foundation in nutrition. It has been reported that diet, particularly the components and the timing of food intake, has an impact on cognitive processes. The Mediterranean diet is most often cited in the literature as being beneficial to health. In order to obtain a more complete view, it is worth considering other dietary patterns, even those that impair our health. Conclusions: Determining what is beneficial and what is not will allow us to develop a speronized strategy for the prevention of, and fight against, cognitive impairment. Appropriately selected supplements, the functions of which we have also discussed, may prove supportive. [ABSTRACT FROM AUTHOR]
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- 2024
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34. Assessment of Gluten-Free Products' Availability and Satisfaction in a Polish Population of Coeliac Disease Patients and Their Caregivers.
- Author
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Głąbska, Dominika, Guzek, Dominika, Skolmowska, Dominika, and Vriesekoop, Frank
- Abstract
Background/Objectives: Among the most important challenges associated with the gluten-free diet are the high costs and limited availability of gluten-free products, accompanied by the lower nutritional value of gluten-free products. The aim of the presented study was to assess gluten-free products' availability and satisfaction in a Polish population of coeliac-disease patients and their caregivers. Methods: The study was conducted in a population of Polish female coeliac-disease patients and female family members/relatives of patients diagnosed with coeliac disease, being members of the Polish Coeliac Society and purchasing gluten-free products. A population of n = 819 was included in the studied group based on the inclusion and exclusion criteria (n = 547 of patients and n = 272 of family members/relatives of patients). The study was conducted as a part of an international project to assess the opinions of coeliac-disease patients about gluten-free products, as well as the availability and prices of gluten-free products in various countries, while an identical questionnaire was applied in all participating countries, with transcultural adaptation applied. Opinions concerning the availability of and satisfaction with gluten-free products were assessed based on a questionnaire of agreement with fixed statements about the accessibility, range and quality of gluten-free products in Poland, with a five-point Likert scale to declare the agreement. This was stratified by the following variables: age, place of residence, being diagnosed with coeliac disease, place of purchasing major grocery shopping, gluten-free products at least occasionally bought online, declared problem(s) with the availability and quality of gluten-free products. Results: While comparing the studied sub-groups, it may be stated that some of them were more satisfied than the other sub-groups with the gluten-free products, including their availability and quality; namely, older respondents were more satisfied than younger ones (p < 0.05), respondents living in small towns/villages were more satisfied than those living in big cities (p < 0.05), respondents undertaking major grocery shopping in hypermarkets were more satisfied than those not doing this (p < 0.05), and respondents not buying gluten-free products online were more satisfied than those undertaking this at least occasionally (p < 0.05). At the same time, respondents diagnosed with coeliac disease were more satisfied with the availability and less satisfied with the quality of gluten-free products, while respondents with diagnosed family members/relatives were less satisfied with the availability and more satisfied with the quality (p < 0.05). Conclusions: The group of female coeliac-disease patients and female family members/relatives of patients diagnosed with coeliac disease was highly diverse in terms of their satisfaction with gluten-free products' availability and quality, whilst older respondents, respondents living in small towns/villages, respondents doing major grocery shopping in hypermarkets, and respondents not buying gluten-free products online were more satisfied. Respondents with family members/relatives diagnosed with coeliac disease declared serious efforts and sacrifice to purchase gluten-free products, which was associated with their higher satisfaction with quality and lower satisfaction with availability, while respondents diagnosed with coeliac disease chose easier options, resulting in their higher satisfaction with availability and lower satisfaction with quality. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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35. Controversies in Venous Thromboembolism Risk Assessment in Inflammatory Bowel Disease: A Narrative Review.
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Sharma, Nikhil, Tewatia, Pavit, Harvey, Philip R., and Kumar, Aditi
- Subjects
INFLAMMATORY bowel diseases ,CROHN'S disease ,ULCERATIVE colitis ,THROMBOEMBOLISM ,GASTROINTESTINAL system - Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition affecting the gastrointestinal tract with increasing rates of incidence and prevalence across the world. Complex inflammatory and prothrombotic pathophysiology in IBD makes venous thromboembolism (VTE) a common complication with significant morbidity and mortality. This risk is increased in pregnancy. As we continue to understand the pathogenesis of IBD, this article highlights the continued risk of VTE following discharge, for which there is currently no clear guidance, yet the risk of VTE remains high. Furthermore, we discuss this increased VTE risk in the context of pregnant IBD patients and the relevant current guidelines. Alongside this, medications that are used to manage IBD carry their own thrombotic risk, which clinicians should be aware of. Assessing VTE risks in IBD populations using newer medications should be a focus of future research. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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36. A Narrative Review of the Evolution of Diagnostic Techniques and Treatment Strategies for Acral Lentiginous Melanoma.
- Author
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Choi, Myoung Eun, Choi, Eun Ji, Jung, Joon Min, Lee, Woo Jin, Jo, Yoon-Seo, and Won, Chong Hyun
- Subjects
REGULATORY T cells ,MOHS surgery ,SURGICAL excision ,MELANOMA ,IMMUNOSTAINING - Abstract
Acral melanoma (AM) is a subtype of cutaneous melanoma located on the palms, soles, and nails. The pathogenesis of AM involves mechanical stimulation and characteristic tumor-promoting mutations, such as those in the KIT proto-oncogene. Dermoscopy is useful for diagnosing AM, which is characterized by parallel ridge patterns and irregular diffuse pigmentation. Although histopathological confirmation is the gold standard for diagnosing AM, lesions showing minimal histopathological changes should be considered early-stage AM if they clinically resemble it. Recently, immunohistochemical staining of preferentially expressed antigen in melanoma has been recognized as a useful method to distinguish benign from malignant melanocytic tumors. Research reveals that AM is associated with an immunosuppressive microenvironment characterized by increased numbers of M2 macrophages and regulatory T cells, alongside a decreased number of tumor-infiltrating lymphocytes. Mohs micrographic surgery or digit-sparing wide local excision has been explored to improve quality of life and replace wide local excision or proximal amputation. AM has a worse prognosis than other subtypes, even in the early stages, indicating its inherent aggressiveness. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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37. Refractory Celiac Disease: What the Gastroenterologist Should Know.
- Author
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Verdelho Machado, Mariana
- Subjects
CELIAC disease ,THERAPEUTICS ,GASTROENTEROLOGISTS ,HOSPITAL laboratories ,PHYSICIANS - Abstract
Fewer than 1% of patients with celiac disease (CD) will develop refractory CD (RCD). As such, most gastroenterologists might never need to manage patients with RCD. However, all gastroenterologists must be familiarized with the basic concepts of RCD and non-responsive CD (NRCD), since it can present as a severe disease with high mortality, not only due to intestinal failure, but also due to progression to enteropathy-associated T cell lymphoma (EATL) and a higher susceptibility to life-threatening infections. The diagnostic workup and differential diagnosis with other causes of gastrointestinal symptoms and villous atrophy, as well as the differentiation between type I and II RCD, are complex, and may require specialized laboratories and reference hospitals. Immunosuppression is efficient in the milder RCDI; however, the treatment of RCDII falls short, with current options probably only providing transient clinical improvement and delaying EATL development. This review summarizes the current diagnostic and therapeutic approach for patients with RCD that all doctors that manage patients with CD should know. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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38. Optimizing the Landing Stability of Blended-Wing-Body Aircraft with Distributed Electric Boundary-Layer Ingestion Propulsors through a Novel Thrust Control Configuration.
- Author
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Yu, Mingxing, Tao, Zhi, Li, Haiwang, and Tang, Peng
- Subjects
ELECTRIC propulsion ,ENERGY conservation ,THRUST ,ENVIRONMENTAL protection ,SLEEVES - Abstract
The imperative for energy conservation and environmental protection has led to the development of innovative aircraft designs. This study explored a novel thrust control configuration for blended-wing-body (BWB) aircraft with distributed electric boundary-layer ingestion (BLI) propulsors, addressing the issues of sagging and altitude loss during landing. The research focused on a small-scale BWB demonstrator equipped with six BLI fans, each with a 90 mm diameter. Various thrust control configurations were evaluated to achieve significant thrust reduction while maintaining lift, including dual-layer sleeve, separate flap-type, single-stage linkage flap-type, and dual-stage linkage flap-type configurations. The separate flap-type configuration was tested through ground experiments. Control experiments were conducted under three different experimental conditions as follows: deflection of the upper cascades only, deflection of the lower cascades only, and symmetrical deflection of both cascades. For each condition, the deflection angles tested were 0°, 10°, 20°, 30°, 40°, 50°, and 60°. The thrust reductions observed for these three conditions were 0%, 37.5%, and 27.5% of the maximum thrust, respectively, without additional changes in the pitch moment. A combined thrust adjustment method maintaining a zero pitch moment demonstrated a linear thrust reduction to 20% of its initial value. The experiment concluded that the novel thrust control configuration effectively adjusted thrust without altering the BLI fans' rotation speed, solving the coupled lift–thrust problem and enhancing BWB landing stability. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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39. A New Strategy for Dietary Nutrition to Improve Intestinal Homeostasis in Diarrheal Irritable Bowel Syndrome: A Perspective on Intestinal Flora and Intestinal Epithelial Interaction.
- Author
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Wu, Xinyu, Cao, Yilong, Liu, Yixiang, and Zheng, Jie
- Abstract
Background and objectives: Although a reasonable diet is essential for promoting human health, precise nutritional regulation presents a challenge for different physiological conditions. Irritable Bowel Syndrome (IBS) is characterized by recurrent abdominal pain and abnormal bowel habits, and diarrheal IBS (IBS-D) is the most common, seriously affecting patients' quality of life. Therefore, the implementation of precise nutritional interventions for IBS-D has become an urgent challenge in the fields of nutrition and food science. IBS-D intestinal homeostatic imbalance involves intestinal flora disorganization and impaired intestinal epithelial barrier function. A familiar interaction is evident between intestinal flora and intestinal epithelial cells (IECs), which together maintain intestinal homeostasis and health. Dietary patterns, such as the Mediterranean diet, have been shown to regulate gut flora, which in turn improves the body's health by influencing the immune system, the hormonal system, and other metabolic pathways. Methods: This review summarized the relationship between intestinal flora, IECs, and IBS-D. It analyzed the mechanism behind IBS-D intestinal homeostatic imbalance by examining the interactions between intestinal flora and IECs, and proposed a precise dietary nutrient intervention strategy. Results and conclusion: This increases the understanding of the IBS-D-targeted regulation pathways and provides guidance for designing related nutritional intervention strategies. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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40. Exploring the Impact of Folic Acid Supplementation and Vitamin B12 Deficiency on Maternal and Fetal Outcomes in Pregnant Women with Celiac Disease.
- Author
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Lev, Lily, Petersen, Katherine, Roberts, Joseph L., Kupferer, Kevin, and Werder, Steven
- Abstract
Background: Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten, affecting approximately 1% of the global population and two million Americans. An increasing number of studies have identified a link between celiac disease and adverse maternal and fetal outcomes during pregnancy and after birth. Additionally, both celiac disease and pregnancy are associated with an increased risk for nutrient deficiencies, specifically vitamin B12 and folate. Methods: This review examines the current literature related to the folate trap and vitamin B12 deficiency in patients with celiac disease and pregnant women independently and provides rationale for future research to explore the relationship between the folate-to-12 ratio in pregnant women with celiac disease. Results: Deficiencies in vitamin B12 are linked with several negative maternal and fetal health outcomes including pre-eclampsia, gestational diabetes, spontaneous abortion/miscarriage, preterm birth, neural tube defects, intrauterine growth restriction, and low gestational age and birthweight. Conclusions: Folic acid supplementation is widely recommended during pregnancy, but complementary vitamin B12 supplementation is not standard. Physicians should consider celiac disease screening during pregnancy as well as vitamin B12 supplementation. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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41. Diet and Nutrients in Rare Neurological Disorders: Biological, Biochemical, and Pathophysiological Evidence.
- Author
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Briglia, Marilena, Allia, Fabio, Avola, Rosanna, Signorini, Cinzia, Cardile, Venera, Romano, Giovanni Luca, Giurdanella, Giovanni, Malaguarnera, Roberta, Bellomo, Maria, and Graziano, Adriana Carol Eleonora
- Abstract
Background/Objectives: Rare diseases are a wide and heterogeneous group of multisystem life-threatening or chronically debilitating clinical conditions with reduced life expectancy and a relevant mortality rate in childhood. Some of these disorders have typical neurological symptoms, presenting from birth to adulthood. Dietary patterns and nutritional compounds play key roles in the onset and progression of neurological disorders, and the impact of alimentary needs must be enlightened especially in rare neurological diseases. This work aims to collect the in vitro, in vivo, and clinical evidence on the effects of diet and of nutrient intake on some rare neurological disorders, including some genetic diseases, and rare brain tumors. Herein, those aspects are critically linked to the genetic, biological, biochemical, and pathophysiological hallmarks typical of each disorder. Methods: By searching the major web-based databases (PubMed, Web of Science Core Collection, DynaMed, and Clinicaltrials.gov), we try to sum up and improve our understanding of the emerging role of nutrition as both first-line therapy and risk factors in rare neurological diseases. Results: In line with the increasing number of consensus opinions suggesting that nutrients should receive the same attention as pharmacological treatments, the results of this work pointed out that a standard dietary recommendation in a specific rare disease is often limited by the heterogeneity of occurrent genetic mutations and by the variability of pathophysiological manifestation. Conclusions: In conclusion, we hope that the knowledge gaps identified here may inspire further research for a better evaluation of molecular mechanisms and long-term effects. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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42. Dietary Adherence to Recommendations among a Cohort of Adults and Teens with Celiac Disease Maintaining a Gluten-Free Diet Compared to a Nationally Representative Sample: A Cross-Sectional Study.
- Author
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Cadenhead, Jennifer W., Lee, Anne R., Nguyen, Thanh Thanh T., Lebwohl, Benjamin, Green, Peter H. R., and Wolf, Randi L.
- Abstract
Celiac disease (CeD) is a common autoimmune condition, with a prevalence of ~1%. Currently, a gluten-free diet (GFD) is the only treatment option. Due to fortification rules excluding gluten-free products in the United States of America (U.S.A.), understanding the nutritional adequacy of a GFD is important for promoting optimal health among those with CeD. Cross-sectional examination of multiple 24 h dietary recalls from a study sample of 50 adults and 30 teens with CeD was used to determine nutritional adequacy and excesses according to U.S.A. recommendations. The results were compared with those of 15,777 adults and 2296 teens from a nationally representative sample not reporting CeD, the National Health and Nutrition Examination Survey (NHANES) 2009–2014. Compared with NHANES, our study population was more at risk of low folate and carbohydrate (adults) consumption, and of excessive niacin and vitamin A (teens), as well as saturated and total fat consumption (adults). Overall, though, compared with NHANES, our study participants had similar nutrient concerns but fewer nutritional imbalances, with some notable exceptions. In addition to maintaining a GFD, individuals with CeD should be counseled to maintain a balanced diet and to pay attention to nutrient-dense foods. Special attention should be given to teens in providing dietary counseling to potentially mitigate the risk of future morbidity. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
43. Honey as a Sugar Substitute in Gluten-Free Bread Production.
- Author
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Cannas, Michela, Fadda, Costantino, Urgeghe, Pietro Paolo, Piga, Antonio, and Conte, Paola
- Subjects
GLYCEMIC index ,RHEOLOGY ,FOOD texture ,NUTRITIONAL value ,HONEYDEW ,HONEY ,BREAD ,EUCALYPTUS - Abstract
In recent years, there has been a significant focus on enhancing the overall quality of gluten-free breads by incorporating natural and healthy compounds to meet consumer expectations regarding texture, flavor, and nutritional value. Considering the high glycemic index associated with gluten-free products, the use of honey, renowned for its numerous health benefits, may serve as an optimal alternative to sucrose. This study investigates the impact of substituting sucrose, either partially (50%) or entirely (100%), with five Sardinian honeys (commercial multifloral honey, cardoon, eucalyptus, and strawberry tree unifloral honeys, and eucalyptus honeydew honey), on the rheological properties of the doughs and the physico-chemical and technological properties of the resulting gluten-free breads. The results demonstrated that an optimal balance was achieved between the leavening and viscoelastic properties of the doughs and the physical and textural attributes of the resulting breads in gluten-free samples prepared with a partial substitution of cardoon and multifloral honeys. Conversely, the least favorable outcomes were observed in samples prepared with strawberry tree honey and eucalyptus honeydew honey at both substitution levels. Therefore, the different behavior observed among all honey-enriched gluten-free breads was likely attributable to the distinct botanical origins of honey rather than to the substitution percentages employed. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
44. Longitudinal Analysis of Bone Metabolic Markers and Bone Mechanical Properties in STZ-Induced Diabetic Rats.
- Author
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Tomaszewska, Ewa, Dobrowolski, Piotr, Muszyński, Siemowit, Donaldson, Janine, Gołyński, Marcin, Zwolska, Jowita, Szadkowski, Mateusz, Osęka, Maciej, Mielnik-Błaszczak, Maria, and Balicki, Ireneusz
- Subjects
BONE mechanics ,TYPE 1 diabetes ,BONE health ,LABORATORY rats ,BLOOD sugar - Abstract
Background: This longitudinal study examined the early effects of type 1 diabetes on bone mechanical properties and metabolic markers in mature rats, focusing on the natural progression of diabetes-induced changes without external treatments. Methods: Forty-eight 8-month-old male Wistar rats were divided into two groups, with one group receiving a single dose of streptozotocin (STZ, 60 mg/kg). Assessments were performed 2, 4, and 8 weeks post-administration, including serum biochemical analyses, bone marker assessments, and mechanical bone tests. The data were analyzed using two-way ANOVA to evaluate the impact of time and treatment. Results: At 2 weeks, diabetic rats showed increased fasting blood glucose (p < 0.001), decreased insulin levels (p = 0.03), and changes in HOMA markers (p < 0.001), liver enzymes (p < 0.001), inflammatory markers (p < 0.001), and bone metabolism markers (osteocalcin (p < 0.001), OPG (p = 0.006), RANKL (p < 0.001), and OPG/RANKL ratio (p < 0.001)), with initial alterations in bone geometry. By week 4, decreased body weight in the diabetic group (p < 0.001) led to further changes in bone geometry and initial differences in mechanical properties. At 8 weeks, significant declines in body (p < 0.001) and bone (p < 0.001) weights were observed, along with further deterioration in bone geometry and mechanical properties. Conclusions: The study highlights the significant impact of STZ-induced diabetes on bone health as early as two weeks post-STZ administration, with marked temporal changes in biochemical markers and mechanical properties. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
45. Phenotype and Treatment Options for Mesenteric Lymph Node Cavitating Syndrome in Coeliac Disease: A Case Series and Literature Review.
- Author
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Marchetti, Federica, Raju, Suneil A., Nandi, Nicoletta, Shiha, Mohamed G., Cross, Simon S., Rea, Benjamin, Caio, Giacomo, and Sanders, David S.
- Subjects
LITERATURE reviews ,WEIGHT loss ,LYMPH nodes ,SURVIVAL rate ,CACHEXIA - Abstract
Background: There is a paucity of data on mesenteric lymph node cavitation syndrome (MLNCS), a rare condition associated with coeliac disease (CD), characterized by central necrosis within enlarged mesenteric lymph nodes. The largest case series of MLNCS was completed in 1984, (n = 6) and a poor prognosis was identified. Methods: A case series of all patients was conducted with MLNCS treated at the UK NHS England National Centre for Refractory Coeliac Disease between 2000 and 2023. A further literature review was conducted using PubMed and Google Scholar for patients with MLNCS and coeliac disease until 2023. Results: In total, there were 51 patients (6 from our case series and 45 from the literature review); 57% were female, and the mean age was 52.8 years (SD: 14.01 years). The most common presenting symptoms were weight loss (80%) and diarrhea (65%), and patients often had hyposplenism (80%). Persistent villous atrophy was present in 88% of the patients. Ten patients also had Refractory Coeliac Disease. Most of the patients (90%) were on a GFD, but the effect of this is unclear. Treatment with steroids and immunosuppressants resulted in a 40% survival rate. The overall mortality was 43%, associated with cachexia, sepsis, infectious complications, and lymphoma. Conclusions: MLNCS has a poor prognosis, and its diagnosis should prompt further intervention and careful follow-up. Patients commonly present with weight loss and hyposplenism should prompt further investigation. Current treatment options are inadequate and novel therapies are required. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
46. Expression of MicroRNAs in Adults with Celiac Disease: A Narrative Review.
- Author
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Rigo, Francielen Furieri, Oliveira, Ellen Cristina Souza de, Quaglio, Ana Elisa Valencise, Moutinho, Bruna Damásio, Di Stasi, Luiz Claudio, and Sassaki, Ligia Yukie
- Subjects
GENE expression ,RNA ,CELIAC disease ,LITERATURE reviews ,GLUTEN-free diet ,GLIADINS ,TRANSGLUTAMINASES ,FOCAL adhesions - Abstract
Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of proline- and glutamine-rich proteins, widely termed "gluten", in genetically susceptible individuals. CD induces an altered immune response that leads to chronic inflammation and duodenal mucosal damage. Currently, there are no specific tests for the accurate diagnosis of CD, and no drugs are available to treat this condition. The only available treatment strategy is lifelong adherence to a gluten-free diet. However, some studies have investigated the involvement of microRNAs (miRNAs) in CD pathogenesis. miRNAs are small noncoding ribonucleic acid molecules that regulate gene expression. Despite the growing number of studies on the role of miRNAs in autoimmune disorders, data on miRNAs and CD are scarce. Therefore, this study aimed to perform a literature review to summarize CD, miRNAs, and the potential interactions between miRNAs and CD in adults. This review shows that miRNA expression can suppress or stimulate pathways related to CD pathogenesis by regulating cell proliferation and differentiation, regulatory T-cell development, innate immune response, activation of the inflammatory cascade, focal adhesion, T-cell commitment, tissue transglutaminase synthesis, and cell cycle. Thus, identifying miRNAs and their related effects on CD could open new possibilities for diagnosis, prognosis, and follow-up of biomarkers. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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47. Intestinal Anti-Endomysium Antibodies Are a Useful Tool for Diagnosing Celiac Disease in Pediatric and Adult Patients.
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Zanchi, Chiara, Ziberna, Fabiana, Padoin, Alessia, Visintin, Alessia, Monica, Fabio, Simeth, Catrin, Cannizzaro, Renato, Pelizzo, Paola, Baragiotta, Anna Maria, Brosolo, Piero, Zamora, Josefina Panos, Zilli, Maurizio, Fontana, Giorgia, Di Leo, Grazia, Lega, Sara, Bramuzzo, Matteo, Ronfani, Luca, De Leo, Luigina, and Not, Tarcisio
- Abstract
Intestinal anti-endomysium antibodies are a specific marker of celiac disease. The diagnostic accuracy of this marker seems high in pediatric patients and has not yet been investigated in adults, so the aim of this prospective multicentric study was to evaluate the specificity and sensitivity of this marker in childhood and adulthood. Pediatric and adult patients undergoing intestinal endoscopy for any intestinal condition were enrolled. Serological celiac disease markers and HLA type were evaluated in all patients. Intestinal biopsies were analyzed for standard histology and for intestinal anti-endomysium antibodies with biopsy culture assay. In this study, 291 patients (145 adults and 146 children) were included. In the adult population, 34 were diagnosed with celiac disease, 105 were controls, and, in 6, celiac disease was not confirmed. In the pediatric population, 77 were diagnosed with celiac disease, 57 were controls, and, in 12, celiac disease was not confirmed. High diagnostic sensitivity and specificity of intestinal anti-endomysium antibodies were confirmed in children and additionally proven in adults. To conclude, we can affirm that intestinal anti-endomysium antibodies can be detected with high diagnostic accuracy in both children and adults. The implementation of this marker in the diagnostic work-up would help clinicians to correctly identify celiac disease. [ABSTRACT FROM AUTHOR]
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- 2024
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48. Monitoring the Quality of Life and the Relationship between Quality of Life, Dietary Intervention, and Dietary Adherence in Patients with Coeliac Disease.
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Dakó, Eszter, Dakó, Sarolta, Papp, Veronika, Juhász, Márk, Takács, Johanna, Csobod, Éva Csajbókné, and Pálfi, Erzsébet
- Abstract
Inadequate adherence to a gluten-free diet in coeliac disease triggers autoimmune reactions and can reduce the quality of life. The strict diet requires constant vigilance, which can cause psychological distress. Our research aimed to assess the quality of life in adult patients with coeliac disease and to find a correlation between quality of life, dietary intervention, and adherence. The study included 51 adult patients with coeliac disease who completed a quality-of-life questionnaire. Adherence was assessed using serological tests and a dietary adherence test. The patients were divided into two groups: those on a gluten-free diet for at least three months (Group I) and newly diagnosed patients (Group II). Group I showed a significant decrease in the dysphoria subscale of the quality-of-life test between the first and last surveys. Poor quality of life was associated with worse adherence in Group II. A higher "Health concerns" quality of life subscale score was also associated with worse adherence in Group II. Our results suggest that dietetic care may be beneficial for patients with coeliac disease by reducing dysphoria. We recommend regular and long-term dietary monitoring from diagnosis to ensure adherence to a gluten-free diet and to maintain quality of life. [ABSTRACT FROM AUTHOR]
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- 2024
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49. Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity.
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Orlandoni, Paolo and Jukic Peladic, Nikolina
- Abstract
Introduction: The main risk factors for major complications and early mortality after the positioning of percutaneous endoscopic gastrostomy (PEG) reported in the literature are old age, multimorbidity, and the use of inappropriate methods for PEG positioning. A proper PEG positioning technique and adequate post-positioning patient management and surveillance are the main protective factors, but the information on protective factors in the literature is much poorer. The aim of this study was to provide more information on PEG-related complications and mortality in geriatric patients treated with long-term enteral nutrition administered by PEG according to a specific home enteral nutrition (HEN) protocol. Methods: This was a retrospective study based on data from 136 elderly patients in whom PEG was positioned from 2017 to 2023 at the geriatric hospital IRCCS INRCA, Ancona (Italy), 88 of whom were treated with HEN. Data on PEG-related complications, duration of HEN, hospitalizations, and mortality were analyzed. Results: No complications were registered during or immediately after the PEG positioning. The prevalence of a major complication—buried bumper—was in the lower limit of the range reported in the literature (4.32%). The prevalence of minor complications such as peristomal leakage, inadvertent tube removal, and granulation tissue was higher than that reported in the literature (14.71%, 23.53%, 29.41%), while tube blockage and peristomal site infection were less frequent (8.82%, 38.23%). Three hospitalizations for PEG-related complications occurred. Both the all-cause 30-day mortality and within-two-months mortality were lower than those in the literature (1.92% and 3.84%). Conclusions: The impact of the risk factors recognized by the literature on complications and mortality could be probably mitigated by improving the PEG placement techniques and pre- and post-PEG placement patient management practices. Data on the prevalence of complications and mortality must be interpreted in correlation to this information. [ABSTRACT FROM AUTHOR]
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- 2024
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50. Gastrointestinal Manifestations of Sarcoidosis: A State-of-the-Art, Comprehensive Review of the Literature—Practical Clinical Insights and Many Unmet Needs on Diagnosis and Treatment.
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Nicolosi, Salvatore, Chernovsky, Maria, Angoni, Darina, Hughes, Michael, Bandini, Giulia, McMahan, Zsuzsanna, Maggisano, Marta, Salton, Francesco, Mondini, Lucrezia, Barbieri, Mariangela, Screm, Gianluca, Confalonieri, Marco, Baratella, Elisa, Confalonieri, Paola, and Ruaro, Barbara
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DELAYED diagnosis ,LITERATURE reviews ,SMALL intestine ,SYMPTOMS ,GASTROINTESTINAL diseases ,GASTROINTESTINAL system - Abstract
This comprehensive literature review explores the involvement of the gastrointestinal (GI) tract in sarcoidosis, a multisystem granulomatous disorder of unknown etiology. GI sarcoidosis presents a diagnostic and therapeutic challenge due to its rarity and nonspecific clinical manifestations, including overlap with other gastrointestinal diseases. We conducted a comprehensive screening of articles addressing the clinical features, diagnostic approaches, and treatment strategies for GI sarcoidosis. Our findings reveal that GI sarcoidosis can affect any part of the gastrointestinal tract, with the stomach and small intestine being the most involved. Clinical presentations range from asymptomatic cases to severe complications such as obstruction and perforation, with reflux being a common symptom. Diagnosis is often delayed due to the nonspecific nature of symptoms and the need for histopathological confirmation. Therapeutic approaches are poorly defined, typically involving corticosteroids as the mainstay of treatment. However, the long-term efficacy and safety of these treatments remain uncertain in this patient group, given the significant risks and complications associated with prolonged glucocorticoid therapy. There is a clear need to develop accurate diagnostic protocols to distinguish GI sarcoidosis from other conditions and to establish standardized therapeutic guidelines to optimize patient outcomes. Further research is essential to enhance our understanding and management of this complex condition. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
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