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Objective: There are little data on the prevalence of reduced bone mineral density (BMD) in young adult patients with coeliac disease; guidelines do not support routine investigation of these patients. We assessed the prevalence of reduced BMD in our patients by age., Patients and Methods: Prospective observational study of 260 coeliac patients having DXA one year after commencing gluten-free diet. Nonparametric tests and regression were used., Results: Median age was 51years, BMI 24 and 85 (32.7%) were male. Reduced BMD was associated with increasing age (p < .001), female sex (p = .005), low BMI (p < .001) and previous fracture (p < .01); 49% of all patients and all patients under 20 years old had reduced BMD. The median age of patients with BMI <20 kgm 2 was 56 (27, 70) years with the majority of younger patients having normal BMI., Conclusions: Low BMD is a common finding in young patients with coeliac disease, yet routine assessment of BMD is not currently supported by national guidelines. Early identification may improve motivation to comply with GFD and allow adequate calcium and vitamin D supplementation to reduce risk of fracture later in life.

Background: Forty percent of patients with autoimmune hepatitis (AIH) present with acute jaundice/hepatitis. Such patients, when treated promptly, are thought to have a good prognosis., Objectives: The objective of this study was to describe the natural history of AIH in patients presenting with jaundice/hepatitis and to determine whether the diagnosis could have been made earlier, before presentation., Methods: This study is a retrospective review of 2249 consecutive patients who presented with jaundice to the Jaundice Hotline clinic, Truro, Cornwall, UK, over 15 years (1998-2013) and includes a review of the laboratory data over a 23-year period (1990-2013)., Results: Of the 955 patients with hepatocellular jaundice, 47 (5%) had criterion-referenced AIH: 35 female and 12 male, the median age was 65 years (range 15-91 years); the bilirubin concentration was 139 μmol/l (range 23-634 μmol/l) and the alanine transaminase level was 687 IU/l (range 22-2519 IU/l). Among the patients, 23/46 (50%) were cirrhotic on biopsy; 11/47 (23%) died: median time from diagnosis to death, 5 months (range 1-59); median age, 72 years (range 59-91 years). All 8/11 patients who died of liver-related causes were cirrhotic. Weight loss (P=0.04) and presence of cirrhosis (P=0.004) and varices (P=0.015) were more common among those who died. Among patients who died from liver-related causes, 6/8 (75%) died less than 6 months from diagnosis. Cirrhosis at presentation and oesophageal varices were associated with early liver-related deaths (P=0.011, 0.002 respectively). Liver function test results were available in 33/47 (70%) patients before presentation. Among these patients, 16 (49%) had abnormal alanine transaminase levels previously, and eight (50%) were cirrhotic at presentation., Conclusion: AIH presenting as jaundice/hepatitis was mainly observed in older women: 50% of the patients were cirrhotic, and liver-related mortality was high. Some of these deaths were potentially preventable by earlier diagnosis, as the patients had abnormal liver function test results previously, which had not been investigated.

Background: Acute upper gastrointestinal haemorrhage is a common medical emergency, initially managed with inpatient care. Bleeding stops spontaneously in over 80% of cases, indicating that patients with low-risk upper gastrointestinal haemorrhage may be more optimally managed in the community, without the need for admission to hospital., Aim: To assess the safety of managing patients with low-risk upper gastrointestinal haemorrhage without admission to hospital., Methods: Prospective/retrospective study of all patients presenting to a UK teaching hospital with low-risk upper gastrointestinal haemorrhage who were managed without admission to hospital over 5 years. Low risk was defined as Glasgow Blatchford Score of 2 or less, age below 70 years, no other active medical problems, not taking warfarin and suspected nonvariceal bleed. Outcome measures were the need for intervention (blood transfusion, endoscopic therapy or surgery) and death., Results: One hundred and forty-two patients fulfilled the inclusion criteria, and were managed without admission to hospital. No patients required endoscopic intervention, blood transfusion or surgery. The 28-day mortality was nil. Forty-one patients had normal endoscopic examination and 11 had significant endoscopic findings (peptic ulceration=10, oozing Mallory-Weiss tear=1) but did not require intervention., Conclusion: Patients presenting with a primary upper gastrointestinal haemorrhage aged below 70 years with a Glasgow Blatchford Score of 2 or less are at a low risk, and can be safely managed in the community.

Background: The Glasgow Blatchford Score (GBS) is a validated risk assessment tool in primary upper gastrointestinal haemorrhage, which accurately predicts the need for intervention (endoscopic therapy, blood transfusion or surgery) or death., Aims: To identify the GBS that predicts lack of intervention or death and to apply this to clinical practice by managing low-risk patients in the community., Methods: GBSs prospectively calculated on 232 patients with upper gastrointestinal haemorrhage to identify low-risk score. Patients with low-risk of requiring intervention (GBS

Objective: Barrett's oesophagus (BO) is associated with the development of oesophageal adenocarcinoma and endoscopic surveillance is commonly practised. In view of the clinical, psychological and economic implications of BO, we have studied patients' attitudes towards surveillance, their levels of anxiety and quality of life., Methods: Patients with BO undergoing endoscopic surveillance were asked to complete a questionnaire,including seven questions on their experience of surveillance, the Hospital Anxiety and Depression Scale,the Trust in Physician Scale (TIPS) and the Short Form-36 quality of life questionnaire., Results: Of the 250 patients invited, 178 responded (71%).One hundred and fifty-one (60%) completed the questionnaire sufficiently for analysis [median age 66 (range 41-79) years, 101 male]. Twenty-nine percent of patients had received too little information concerning surveillance of BO and 22% no information at all. Information was deemed difficult to understand by 24%. Hospital Anxiety and Depression Scale anxiety score: 14%abnormal, 25% borderline. Quality of life was lower than the general population in seven of eight Short Form-36 parameters. Increasing TIPS score correlated with having received (r= 0.33, P <0.001) and understood (r = 0.2, P= 0.037) BO information, and negatively with the belief that endoscopic surveillance reduced oesophageal adenocarcinoma risk (r= - 0.19, P =0.025). Increasing TIPS score was associated with less anxiety (P= 0.015) and depression (P =0.001), and better quality of life., Conclusion: Patients undergoing endoscopic surveillance for BO suffer anxiety and have impaired quality of life. As trust in their physicians is correlated with receiving sufficient BO information, we surmise that ensuring BO patients understand their condition is likely to improve quality of life, anxiety and depression.