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Background and Aim: Upper gastrointestinal bleeding from peptic ulcer disease is a common emergency presentation. It can be associated with significant morbidity and mortality, as well as being resource-intensive if there is a requirement for urgent endoscopy and inpatient monitoring. Several risk stratification models for upper gastrointestinal bleeding, including the Glasgow-Blatchford Score and Rockall score, have been established to assess risk of rebleeding and guide timing of endoscopic treatment. However, the decisions about length of monitoring, duration of intravenous proton pump inhibitor therapy, and timing of recommencement of antiplatelet and anticoagulant agents are largely clinician-dependent. Although the exact mechanism is not understood, previous studies have shown an association between blood group and rates of upper gastrointestinal bleeding, peptic ulcer, and gastric cancer. The aim of this study was to evaluate blood group distribution among patients with upper gastrointestinal bleeding due to peptic ulcer disease and their rates of complications. Method(s): Medical records of all patients who presented to three Melbourne metropolitan hospitals between 2007 and 2016 and underwent upper endoscopy for peptic ulcer bleeding were analyzed. Demographic, clinical, laboratory, and endoscopic data were assessed. Result(s): A total of 699 patients (62.3% male; mean age, 69.0 years) were included. The most common blood group was O (48.9%), followed by A (35.1%), B (12.4%), and AB (3.6%), equivalent to the distribution of the general Australian population (49%, 38%, 10%, and 3%, respectively; Australian Red Cross data). Sixty-two patients (8.9%) rebled; of these, only two patients (3.2%) were in blood group B, compared with 31 (50%) in blood group O, 26 (41.9%) in blood group A, and three (4.8%) in blood group AB. Blood group B was associated with a statistically significant protection against rebleeding, compared with other blood groups (odds ratio [OR]

Sertraline is widely prescribed to treat depression and anxiety disorders. However, hepatitis secondary to its use is a rare entity. We report the case of a 26-year-old woman in her 20th week of pregnancy presented with nausea, vomiting, malaise and dark urine. This occurred 6 months after sertraline 50 mg daily was started for the treatment of depression. Three weeks prior to her presentation, the dose of sertraline was increased to 100 mg daily. The patient's liver biochemical profile demonstrated increased transaminases. The biopsy of the liver showed lobular hepatitis, with a mild prominence of eosinophils, suggestive of a drug-induced or toxin-induced aetiology. Extensive biochemical work-up failed to show any other pathology to account for her hepatitis. Liver function tests normalised after cessation of sertraline, indicating a probable association between sertraline use and acute hepatocellular injury in our patient.

Background: Treating to target in inflammatory bowel disease is achieved through early immunosuppression with rapid escalation to combination therapy. Short-term studies support de-escalation to mono-therapy in certain contexts, however long-term outcomes of withdrawing immunosuppression are unknown.1,2 We aimed to assess clinician perspective on, and current barriers to, withdrawing immunosuppression in European practice. Method(s): 500 questionnaires were distributed to workshop participants at the 11th Congress of European Crohn's and Colitis Organisation (ECCO). Likelihood of withdrawing IBD therapies, as well as clinician and patient factors associated with cessation, and barriers to withdrawal were recorded. Result(s): Responses were obtained from 132 attendees. 108 clinicians [median age 37 (IQR33-46), 66.7% female] adequately completed surveys from 37 countries with varying levels of clinical experience [median years 6; IQR (3-15)]. Patient-clinician discussion around ceasing immunosuppressive therapy was infrequently raised by both clinicians and patients. The likelihood of ceasing mesalazine monotherapy was greater compared with any biologic agents (p < 0.05), in ulcerative colitis (UC) and Crohn's disease (CD). The likelihood of ceasing a thiopurine and anti-TNF was similar, however significantly different when compared with vedolizumab and ustekinumab (p < 0.05). The primary reason for ceasing mesalazine was to eliminate unnecessary medications, compared with malignancy and infection risk driving thiopurine and biologic agent cessation. For patients in long-term remission there was great variability in perceived barriers to stopping immunosuppression. Clinician's reported greater concern about relapse in patients being treated with anti-TNF, vedolizumab, or ustekinumab, compared with mesalazine or immunomodulators (p < 0.001). However, the majority of clinician's perceived high likelihood of 're-capture' above 50% for all medications. Conclusion(s): A re

Introduction: Despite its success, there appears to be practical issues with Faecal Calprotectin (FC) testing in Inflammatory Bowel Diseases (IBD), including sample collection, delivery and processing delays. Patients' perception and barriers to FC testing are yet to be explored in clinical practice. Method(s): A prospective patient survey was undertaken at IBD units in UK, Europe and Australia. A 9-point patient-based questionnaire was completed in clinic and included demographics, previous FC testing and FC sample difficulty rating score. Predictors of testing difficulty were derived using multivariable logistic regression analysis. Result(s): A total of 585 patients with IBD completed the survey; 306 males with a median age of 43 years (IQR: 31-54). There were 446 patients (76%) who had prior FC testing experience. Of these, 37% (n = 165) rated FC testing difficult; 'sample collection' (n = 106; 67%) being the most common reason reported. Multivariable regression analysis identified age <49 years (odds ratio (OR): 2.5, CI:1.6-4.0), disease duration <35 months (OR 1.4, CI:0.9-2.1) and testing location (UK centre: OR 1.9, CI:1.2-3.1) as predictors of a difficult FC rating score. Conclusion(s): A total of 37% of patients find FC testing challenging, in particular those aged <49 years, disease duration <35 months. Further studies understanding and addressing these practical issues may aid higher FC uptake in clinic.Copyright © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

Introduction Faecal Calprotectin is an established biomarker in the investigation and management of Inflammatory Bowel Disease (IBD). Despite its success, there appears to be practical issues with FC testing in clinical practice, including sample collection, sample delivery and processing delays. There are no studies exploring patients' perception of faecal testing in IBD. We investigate patients' perception of FC testing in clinical practice across centres in UK, Europe and Australia. Methods A prospective patient survey was undertaken in an IBD unit in England from 12/2016 to 2/2017 and extended to 3 centres (Spain, Australia and Norway) from 07/2017 until 11/2017. Patients were asked to complete a 9-point based questionnaire in clinic which included diagnosis, patient demographics, previous FC testing, FC sample collection difficulty rating score (0-4) and preference to alternative methods of disease monitoring including blood tests and endoscopy. Predictors of FC testing difficulty were derived using multivari-able logistic regression analysis. Continuous variables were categorised using integer cut points guided by the ROC curves and their relationship to the FC rating score. Results A total of 585 patients with IBD completed the survey. There were 306 males (52%) with a median age of 43 years (IQR: 31-54). A total of 299, 279, and 7 patients had a diagnosis of CD, UC, IBDU respectively Median disease duration of the entire cohort was 36 months (IQR 22-66 months). There were 446 patients (76%) who had prior FC testing experience. Of these, 37% (n = 165) rated FC testing either moderately difficult (score 2), difficult (score 3) or very difficult (score 4). The reasons included 'dropping FC sample' (n = 14; 9%), 'sample collection' (n = 106; 67%) or 'both' (n=39; 25%). In these patients, 80%(n = 130) patients would rather have a blood test over faecal testing. Categorical multi-variable regression analysis was performed to identify factors that predict a high FC

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this review is to assess the feasibility and safety of discontinuing immunosuppressant or biologic drugs, administered alone or in combination, in patients with quiescent CD.Copyright © 2017 The Cochrane Collaboration.

BODY: Background: Ileal bowel wall thickening (BWT) is frequently reported on Computed Tomography (CT) scanning. However, the predictive value and correlation with clinically significant disease is unclear. Ileocolonoscopy, laparoscopy and/or laparotomy are typically performed to further evaluate this imaging finding. Aim(s): To correlate abdominal CT scans revealing ileal BWT with underlying ileal pathology and identify the yields of ileo-colonoscopy and surgery in this setting. Method(s): Aretrospective analysis was conducted at a Melbourne tertiary hospital by searching a radiology database for all patients with ileal BWT found on CT reports in the period January 2009 to June 2012. Correlation was made with ileo-colonoscopy, surgical findings and ileal histology obtained within 3 months of the CT scan. Patients with known pre-existing bowel pathology or those with incomplete clinical records were excluded. Patients with no subsequent investigations for BWT within 3 months of the index CT scan were treated as without follow-up. Result(s): 280 patients with ileal BWT on CT were identified. Of these, 125 were excluded with pre-existing bowel pathology including 71 with Crohn's disease (CD). 55 patients had incomplete records. Of the remaining 100 patients (Mean age = 53.4 years; 61% M, 39% F) 30 underwent colonoscopy, 20 laparotomy, 10 laparoscopy and 40 were not followed-up. Of the 30 patients undergoing colonoscopy, 20 had views to the ileum. Of these, 11 patients were found to have terminal ileal pathology: CD (5), adenocarcinoma of the ileum/ileo-caecal valve (2), non-specific mild terminal ileitis (3) and infective ileitis (1). Of the 20 patients undergoing laparotomy, 11 had ileal pathology confirmed on histology: bowel perforation (6), CD (2), adenocarcinoma of the ileo-caecal valve (2) and small bowel obstruction (SBO) (1). Of the remaining 9 patients without ileal histology, diagnoses included: ischaemic bowel (3), SBO (2), bowel perforation (2), a

Sertraline is widely prescribed to treat depression and anxiety disorders. However, hepatitis secondary to its use is a rare entity. We report the case of a 26-year-old woman in her 20th week of pregnancy presented with nausea, vomiting, malaise and dark urine. This occurred 6 months after sertraline 50 mg daily was started for the treatment of depression. Three weeks prior to her presentation, the dose of sertraline was increased to 100 mg daily. The patient's liver biochemical profile demonstrated increased transaminases. The biopsy of the liver showed lobular hepatitis, with a mild prominence of eosinophils, suggestive of a drug-induced or toxininduced aetiology. Extensive biochemical work-up failed to show any other pathology to account for her hepatitis. Liver function tests normalised after cessation of sertraline, indicating a probable association between sertraline use and acute hepatocellular injury in our patient.

Background Dysphagia is a common symptom in patients presenting to a gastroenterologist. It can be a challenging symptom to investigate and manage particularly following a normal gastroscopy. It is unclear whether empirical dilatation at the time of the gastroscopy is beneficial in this group of patients some of whom may be suffering from cricopharyngeal dysfunction. Aims To investigate whether patients with dysphagia and a subsequent normal gastroscopy have an improvement in symptoms following empirical oesophageal dilatation. Methods We conducted a retrospective case note review of all patients referred to an open access private endoscopy centre in Melbourne, Victoria, for investigation of dysphagia who had a normal gastroscopy and empiric Savary dilation between November 2011 and March 2012. Data was collected for twenty-five patients meeting these criteria. Patients were contacted by phone following the endoscopic intervention to record any change in subjective symptoms. Patients were asked to choose from the categories 'significantly worse', 'slightly worse', 'no change', 'slight improvement' and 'significant improvement'. The study had no control group for comparison. Results Twenty-five patients over a six month period underwent empirical oesophageal dilatation after a normal gastroscopy. The mean age of patients was 71 (range 21-94) with 14 patients being male (56%). The mean diameter of the Savary dilator used was 15 mm (range 14-16 mm). There were no major complications however, one patient reported some mild self resolving chest pain for three days following the procedure. All patients had oesophageal biopsies taken and subsequent histology was positive in three patients for eosinophilic oesophagitis. 76% of patients had a 'significant improvement' in symptoms following the dilatation with the remainder of patients having slight or no improvement in symptoms. Patients were followed up for a mean of 129 days (range 53-195 days). Conclusion Empirical oesoph

We present a case of a 65-year-old man with an acute alteration in mental state that was initially diagnosed as a functional psychiatric condition. After extensive workup, herpes simplex virus type 1 (HSV-1) was detected in the patient's cerebrospinal fluid (CSF) by polymerase chain reaction (PCR), and he responded rapidly to treatment with acyclovir. The case illustrates the importance of actively excluding organic causes in such patients, the need to have a low threshold of suspicion for HSV encephalitis, and the central role of CSF PCR testing for the diagnosis of HSV encephalitis, even in the absence of CSF biochemical abnormalities.