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Gut
Journal Prestige (SJR): 7.44
Citation Impact (citeScore): 10
Number of Followers: 254  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0017-5749 - ISSN (Online) 1468-3288
Published by BMJ Publishing Group Homepage  [64 journals]
  • Correction: Risk factors for SARS-CoV-2 infection and course of COVID-19
           disease in patients with IBD in the Veterans Affair Healthcare System

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      Abstract: Khan N, Mahmud, N, Trivedi C, et al. Risk factors for SARS-CoV-2 infection and course of COVID-19 disease in patients with IBD in the Veterans Affair Healthcare System. Gut 2021;70:1657–64. doi: 10.1136/gutjnl-2021-324356The title should read:Risk factors for SARS-CoV-2 infection and course of COVID-19 disease in patients with IBD in the Veterans Affairs Healthcare System
      Keywords: Open access, Gut, COVID-19
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-324356corr1
      Issue No: Vol. 70, No. 11 (2021)
       
  • Metabolic signature might be an option to identify patients with early CP

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      Authors: Eross, B; Szentesi, A, Hegyi, P.
      Pages: 2023 - 2024
      Abstract: Metabolites are biomarkers measured in blood, urine, stool and tissue samples, determined by several factors, most importantly by the gut microbiota and changes in the metabolism from underlying diseases. Theoretically, specific diseases lead to changes in both factors that result in specific metabolomic profiles characterising these disorders. In recent years, metabolomic profiling for the diagnosis and the prognostic assessment of GI diseases has been an emerging and new tool; there are examples of metabolomics in diagnosing and assessing chronic GI disorders such as cancers, IBD and cirrhosis.1–6 The recent studies on metabolomics have assessed its potential roles in gastroenterology patients' care, but it is not yet part of the daily routine. In Gut, Adam et al report a very important study, which aimed to assess metabolomics' diagnostic potential in chronic pancreatitis (CP).7 Patients with unequivocally...
      Keywords: Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-324206
      Issue No: Vol. 70, No. 11 (2021)
       
  • Uniting the global gastroenterology community to meet the challenge of
           climate change and non-recyclable waste

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      Authors: Leddin, D; Omary, M. B, Veitch, A, Metz, G, Amrani, N, Aabakken, L, Raja Ali, R. A, Alvares-Da-Silva, M. R, Armstrong, D, Boyacioglu, S, Chen, Y, Elwakil, R, Fock, K.-M, Hamid, S. S, Makharia, G, Macrae, F, Malekzadeh, R, Mulder, C. J, Piscoya, A, Perman, M. l, Sadeghi, A, Saenz, R, Saurin, J.-C, Butt, A. S, Wu, K, Yeh Lee, Y.
      Pages: 2025 - 2029
      Abstract: Climate change has been described as the biggest global health threat of the 21st century1 and has significant implications for gastrointestinal (GI) health and disease,2 which is the focus of this consensus commentary provided by the World Gastroenterology Organisation (WGO) Climate Change Working Group (CCWG). The CCWG has members from 18 countries representing high-income, medium-income and low-income populations. The WGO includes gastroenterology societies from 108 countries, which represent more than 60 000 medical practitioner members. The CCWG members, who have coauthored this consensus commentary, aim to review the scientific literature on climate and GI health, to encourage education and the undertaking of actionable measures including advocacy, and to further research and collaborations within the global GI community. The CCWG’s objective is to assist GI health providers worldwide to adapt to, and mitigate, the effects of climate change on health. The CCWG has partnered with three major...
      Keywords: Press releases, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-325789
      Issue No: Vol. 70, No. 11 (2021)
       
  • British Society of Gastroenterology guidelines for the management of iron
           deficiency anaemia in adults

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      Authors: Snook, J; Bhala, N, Beales, I. L. P, Cannings, D, Kightley, C, Logan, R. P, Pritchard, D. M, Sidhu, R, Surgenor, S, Thomas, W, Verma, A. M, Goddard, A. F.
      Pages: 2030 - 2051
      Abstract: Iron deficiency anaemia (IDA) is a major cause of morbidity and burden of disease worldwide. It can generally be diagnosed by blood testing and remedied by iron replacement therapy (IRT) using the oral or intravenous route. The many causes of iron deficiency include poor dietary intake and malabsorption of dietary iron, as well as a number of significant gastrointestinal (GI) pathologies. Because blood is iron-rich it can result from chronic blood loss, and this is a common mechanism underlying the development of IDA—for example, as a consequence of menstrual or GI blood loss.Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract. Therefore optimal management of IDA requires IRT in combination with appropriate investigation to establish the underlying cause. Unexplained IDA in all at-risk individuals is an accepted indication for fast-track secondary care referral in the UK because GI malignancies can present in this way, often in the absence of specific symptoms. Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel. In recurrent or refractory IDA, wireless capsule endoscopy plays an important role in assessment of the small bowel.IDA may present in primary care or across a range of specialties in secondary care, and because of this and the insidious nature of the condition it has not always been optimally managed despite the considerable burden of disease— with investigation sometimes being inappropriate, incorrectly timed or incomplete, and the role of IRT for symptom relief neglected. It is therefore important that contemporary guidelines for the management of IDA are available to all clinicians. This document is a revision of previous British Society of Gastroenterology guidelines, updated in the light of subsequent evidence and developments.
      Keywords: Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-325210
      Issue No: Vol. 70, No. 11 (2021)
       
  • Endoscopic transmural route for dissection of gastric submucosal tumors
           with extraluminal growth: experience in two cases

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      Authors: Liu, X; Chen, T, Cheng, J, Gao, P, Li, Q, Chen, W, Zhang, Y, Zhou, P, Hu, J.
      Pages: 2052 - 2054
      Abstract: Messages The spectrum of endoscopic resection methods, including full thickness techniques, has enabled removal of most smaller gastric submucosal tumours (SMTs). We developed an extended transmural endoscopic dissection technique for lesions with predominately extraluminal growth arising from the muscularis propria. It consists of transmural intraperitoneal access with the endoscope besides the lesion followed by subserosal dissection from the outside. The technique was successful in two patients with smaller (2–3 cm) gastric stromal tumours; lesions were resected completely and short-term follow-up was normal. Further studies are warranted to confirm the safety and feasibility of this this new approach. In more detail With the popularisation of endoscopy and the development of endoscopic ultrasonography (EUS), the detection rate of gastrointestinal (GI) SMT has increased significantly.1 Complete surgical resection is still recognised as the primary and the most important way to treat gastric SMT and to get clear pathological...
      Keywords: Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-324027
      Issue No: Vol. 70, No. 11 (2021)
       
  • Integrated genomic profiling and modelling for risk stratification in
           patients with advanced oesophagogastric adenocarcinoma

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      Authors: Hao, D; He, S, Harada, K, Pizzi, M. P, Lu, Y, Guan, P, Chen, L, Wang, R, Zhang, S, Sewastjanow-Silva, M, Abdelhakeem, A, Shanbhag, N, Bhutani, M, Han, G, Lee, J. H, Zhao, S, Weston, B, Blum Murphy, M, Waters, R, Estrella, J. S, Roy-Chowdhuri, S, Gan, Q, Lee, J.-S, Peng, G, Hanash, S. M, Calin, G. A, Song, X, Zhang, J, Song, S, Wang, L, Ajani, J. A.
      Pages: 2055 - 2065
      Abstract: ObjectivePrognosis of patients with advanced oesophagogastric adenocarcinoma (mEGAC) is poor and molecular determinants of shorter or longer overall survivors are lacking. Our objective was to identify molecular features and develop a prognostic model by profiling the genomic features of patients with mEGAC with widely varying outcomes.DesignWe profiled 40 untreated mEGACs (20 shorter survivors 36 months) with whole-exome sequencing (WES) and RNA sequencing and performed an integrated analysis of exome, transcriptome, immune profile and pathological phenotypes to identify the molecular determinants, developing an integrated model for prognosis and comparison with The Cancer Genome Atlas (TCGA) cohorts.Results KMT2C alterations were exclusively observed in shorter survivors together with high level of intratumour heterogeneity and complex clonal architectures, whereas the APOBEC mutational signatures were significantly enriched in longer survivors. Notably, the loss of heterozygosity in chromosome 4 (Chr4) was associated with shorter survival and ‘cold’ immune phenotype characterised by decreased B, CD8, natural killer cells and interferon-gamma responses. Unsupervised transcriptomic clustering revealed a shorter survivor subtype with distinct expression features (eg, upregulated druggable targets JAK2, MAP3K13 and MECOM). An integrated model was then built based on clinical variables and the identified molecular determinants, which significantly segregated shorter and longer survivors. All the above features and the integrated model have been validated independently in multiple TCGA cohorts.ConclusionThis study discovered novel molecular features prognosticating overall survival in patients with mEGAC and identified potential novel targets in shorter survivors.
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-322707
      Issue No: Vol. 70, No. 11 (2021)
       
  • Focal pancreatic lesions in autoimmune pancreatitis and weight loss

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      Authors: Aghdassi, A; Tran, Q. T, Bulla, T, Bülow, R, Ribback, S, Lerch, M. M, Pickartz, T.
      Pages: 2065 - 2195
      Abstract: Clinical presentation A 67-year-old male patient was admitted to hospital with upper abdominal pain, jaundice and pale stool for 2 weeks. Laboratory investigation showed highly elevated cholestatic parameters and transaminases but no increase of serum IgG4. MRI (figure 1) and endoscopic ultrasound (EUS) demonstrated a diffuse enlargement of the pancreas. Parenchymal biopsy taken by EUS-guided fine needle aspiration (FNA) contained storiform fibrosis with increased plasma cells expressing IgG4 (>30 cells/HPF) compatible with autoimmune pancreatitis type I. A steroid pulse therapy was initiated followed by maintenance therapy (prednisolone 5 mg/kg p.o.) and the patient recovered. One year later, the patient presented again with weight loss. This time cholestatic enzymes were only slightly elevated. CT identified an ill-defined lesion in the pancreatic head (figure 2). In a subsequent EUS examination, a hypoechoic lesion was detected in the pancreatic head corresponding to the CT findings while the surrounding tissue...
      Keywords: GUT Snapshot, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-321987
      Issue No: Vol. 70, No. 11 (2021)
       
  • Association between proton pump inhibitor use and gastric cancer: a
           population-based cohort study using two different types of nationwide
           databases in Korea

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      Authors: Seo, S. I; Park, C. H, You, S. C, Kim, J. Y, Lee, K. J, Kim, J, Kim, Y, Yoo, J. J, Seo, W.-W, Lee, H. S, Shin, W. G.
      Pages: 2066 - 2075
      Abstract: ObjectiveThe association between proton pump inhibitor (PPI) use and gastric cancer related to Helicobacter pylori eradication has not been fully investigated in geographical regions with high risk of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea.DesignThis study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after 1-year drug exposure, between new users of PPIs and other drugs excluding PPIs, by Cox proportional hazards model. We also analysed the incidence of gastric cancer among PPI users after H. pylori eradication.ResultsThe analysis included 11 741 patients in matched PPI and non-PPI cohorts after large-scale propensity score matching. During a median follow-up of 4.3 years, PPI use was associated with a 2.37-fold increased incidence of gastric cancer (PPI≥30 days vs non-PPI; 118/51 813 person-years vs 40/49 729 person-years; HR 2.37, 95% CI 1.56 to 3.68, p=0.001). The incidence rates of gastric cancer showed an increasing trend parallel to the duration of PPI use. In H. pylori-eradicated subjects, the incidence of gastric cancer was significantly associated with PPI use over 180 days compared with the non-PPI group (PPI≥180 days vs non-PPI; 30/12 470 person-years vs 9/7814 person-years; HR 2.22, 95% CI 1.05 to 4.67, p=0.036).ConclusionPPI use was associated with gastric cancer, regardless of H. pylori eradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323845
      Issue No: Vol. 70, No. 11 (2021)
       
  • The influence of proton pump inhibitor therapy on the outcome of
           infliximab therapy in inflammatory bowel disease: a patient-level
           meta-analysis of randomised controlled studies

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      Authors: Lu, T. X; Dapas, M, Lin, E, Peters, T, Sakuraba, A.
      Pages: 2076 - 2084
      Abstract: ObjectiveIn treating patients with inflammatory bowel disease (IBD), how concomitant medications influence the response to infliximab is largely unexplored. We aim to evaluate whether proton pump inhibitors (PPIs) affect the response to infliximab therapy in patients with IBD.DesignPatient-level data of adult patients with moderate-to-severe IBD treated with infliximab were obtained from the Yale Open Data Access Framework. Multivariable analysis and propensity score-matched analysis were performed to assess week 30 remission rates, week 54 remission rates and hospitalisation rates in patients on infliximab therapy with and without PPI exposure.ResultsAmong the five randomised controlled studies, there were 147 and 889 patients on infliximab with and without PPI therapy, respectively. Patients on PPI were older, more likely to be Caucasian and were less likely to be on immunomodulator therapy. Patients on PPI were significantly less likely to achieve week 30 remission on multivariable analysis (OR 0.45, p
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-321609
      Issue No: Vol. 70, No. 11 (2021)
       
  • Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS
           randomised controlled trial

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      Authors: Yaskolka Meir, A; Rinott, E, Tsaban, G, Zelicha, H, Kaplan, A, Rosen, P, Shelef, I, Youngster, I, Shalev, A, Blüher, M, Ceglarek, U, Stumvoll, M, Tuohy, K, Diotallevi, C, Vrhovsek, U, Hu, F, Stampfer, M, Shai, I.
      Pages: 2085 - 2095
      Abstract: ObjectiveTo examine the effectiveness of green-Mediterranean (MED) diet, further restricted in red/processed meat, and enriched with green plants and polyphenols on non-alcoholic fatty liver disease (NAFLD), reflected by intrahepatic fat (IHF) loss.DesignFor the DIRECT-PLUS 18-month randomized clinical trial, we assigned 294 participants with abdominal obesity/dyslipidaemia into healthy dietary guidelines (HDG), MED and green-MED weight-loss diet groups, all accompanied by physical activity. Both isocaloric MED groups consumed 28 g/day walnuts (+440 mg/day polyphenols provided). The green-MED group further consumed green tea (3–4 cups/day) and Mankai (a Wolffia globosa aquatic plant strain; 100 g/day frozen cubes) green shake (+1240 mg/day total polyphenols provided). IHF% 18-month changes were quantified continuously by proton magnetic resonance spectroscopy (MRS).ResultsParticipants (age=51 years; 88% men; body mass index=31.3 kg/m2; median IHF%=6.6%; mean=10.2%; 62% with NAFLD) had 89.8% 18-month retention-rate, and 78% had eligible follow-up MRS. Overall, NAFLD prevalence declined to: 54.8% (HDG), 47.9% (MED) and 31.5% (green-MED), p=0.012 between groups. Despite similar moderate weight-loss in both MED groups, green-MED group achieved almost double IHF% loss (–38.9% proportionally), as compared with MED (–19.6% proportionally; p=0.035 weight loss adjusted) and HDG (–12.2% proportionally; p
      Keywords: Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323106
      Issue No: Vol. 70, No. 11 (2021)
       
  • Diet quality and risk and severity of COVID-19: a prospective cohort study

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      Authors: Merino, J; Joshi, A. D, Nguyen, L. H, Leeming, E. R, Mazidi, M, Drew, D. A, Gibson, R, Graham, M. S, Lo, C.-H, Capdevila, J, Murray, B, Hu, C, Selvachandran, S, Hammers, A, Bhupathiraju, S. N, Sharma, S. V, Sudre, C, Astley, C. M, Chavarro, J. E, Kwon, S, Ma, W, Menni, C, Willett, W. C, Ourselin, S, Steves, C. J, Wolf, J, Franks, P. W, Spector, T. D, Berry, S, Chan, A. T.
      Pages: 2096 - 2104
      Abstract: ObjectivePoor metabolic health and unhealthy lifestyle factors have been associated with risk and severity of COVID-19, but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its interaction with socioeconomic deprivation.DesignWe used data from 592 571 participants of the smartphone-based COVID-19 Symptom Study. Diet information was collected for the prepandemic period using a short food frequency questionnaire, and diet quality was assessed using a healthful Plant-Based Diet Score, which emphasises healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate HRs and 95% CIs for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalisation with oxygen support, respectively.ResultsOver 3 886 274 person-months of follow-up, 31 815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR 0.91; 95% CI 0.88 to 0.94) and severe COVID-19 (HR 0.59; 95% CI 0.47 to 0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate per 10 000 person/months for lowest vs highest quartile of diet score was 22.5 (95% CI 18.8 to 26.3) among persons living in areas with low deprivation and 40.8 (95% CI 31.7 to 49.8) among persons living in areas with high deprivation.ConclusionsA diet characterised by healthy plant-based foods was associated with lower risk and severity of COVID-19. This association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.
      Keywords: Editor's choice, Gut, COVID-19
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-325353
      Issue No: Vol. 70, No. 11 (2021)
       
  • Human and preclinical studies of the host-gut microbiome co-metabolite
           hippurate as a marker and mediator of metabolic health

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      Authors: Brial, F; Chilloux, J, Nielsen, T, Vieira-Silva, S, Falony, G, Andrikopoulos, P, Olanipekun, M, Hoyles, L, Djouadi, F, Neves, A. L, Rodriguez-Martinez, A, Mouawad, G. I, Pons, N, Forslund, S, Le-chatelier, E, Le Lay, A, Nicholson, J, Hansen, T, Hyötyläinen, T, Clement, K, Oresic, M, Bork, P, Ehrlich, S. D, Raes, J, Pedersen, O. B, Gauguier, D, Dumas, M.-E.
      Pages: 2105 - 2114
      Abstract: ObjectiveGut microbial products are involved in regulation of host metabolism. In human and experimental studies, we explored the potential role of hippurate, a hepatic phase 2 conjugation product of microbial benzoate, as a marker and mediator of metabolic health.DesignIn 271 middle-aged non-diabetic Danish individuals, who were stratified on habitual dietary intake, we applied 1H-nuclear magnetic resonance (NMR) spectroscopy of urine samples and shotgun-sequencing-based metagenomics of the gut microbiome to explore links between the urine level of hippurate, measures of the gut microbiome, dietary fat and markers of metabolic health. In mechanistic experiments with chronic subcutaneous infusion of hippurate to high-fat-diet-fed obese mice, we tested for causality between hippurate and metabolic phenotypes.ResultsIn the human study, we showed that urine hippurate positively associates with microbial gene richness and functional modules for microbial benzoate biosynthetic pathways, one of which is less prevalent in the Bacteroides 2 enterotype compared with Ruminococcaceae or Prevotella enterotypes. Through dietary stratification, we identify a subset of study participants consuming a diet rich in saturated fat in which urine hippurate concentration, independently of gene richness, accounts for links with metabolic health. In the high-fat-fed mice experiments, we demonstrate causality through chronic infusion of hippurate (20 nmol/day) resulting in improved glucose tolerance and enhanced insulin secretion.ConclusionOur human and experimental studies show that a high urine hippurate concentration is a general marker of metabolic health, and in the context of obesity induced by high-fat diets, hippurate contributes to metabolic improvements, highlighting its potential as a mediator of metabolic health.
      Keywords: Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323314
      Issue No: Vol. 70, No. 11 (2021)
       
  • Multicentre, prospective, randomised study comparing the diagnostic yield
           of colon capsule endoscopy versus CT colonography in a screening
           population (the TOPAZ study)

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      Authors: Cash, B. D; Fleisher, M. R, Fern, S, Rajan, E, Haithcock, R, Kastenberg, D. M, Pound, D, Papageorgiou, N. P, Fernandez-Urien, I, Schmelkin, I. J, Rex, D. K.
      Pages: 2115 - 2122
      Abstract: ObjectiveColon capsule endoscopy (CCE) has shown promise for colorectal neoplasia detection compared with optical colonoscopy (OC), but has not been compared with other screening tests in average risk screening patients.DesignPatients 50 to 75 years of age (African Americans, 45–75 years) were randomised to CCE or CT colonography (CTC) and subsequent blinded OC. The primary endpoint was diagnostic yield of polyps ≥6 mm with CCE or CTC. Secondary endpoints included accuracy for size and histology, examination completeness, number/proportion of subjects with polyps and adenomas ≥6 mm and ≥10 mm, subject satisfaction and safety.ResultsFrom 320 enrolled subjects, data from 286 (89.4%) were evaluable. The proportion of subjects with any polyp ≥6 mm confirmed by OC was 31.6% for CCE versus 8.6% for CTC (pPr non-inferiority and superiority=0.999). The diagnostic yield of polyps ≥10 mm was 13.5% with CCE versus 6.3% with CTC (pPr non-inferiority=0.9954). The sensitivity and specificity of CCE for polyps ≥6 mm was 79.2% and 96.3% while that of CTC was 26.8% and 98.9%. The sensitivity and specificity of CCE for polyps ≥10 mm was 85.7% and 98.2% compared with 50% and 99.1% for CTC. Both tests were well tolerated/safe.ConclusionCCE was superior to CTC for detection of polyps ≥6 mm and non-inferior for identification of polyps ≥10 mm. CCE should be considered comparable or superior to CTC as a colorectal neoplasia screening test, although neither test is as effective as OC.Trial registration numberClinicalTrials.gov no: NCT02754661.
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-322578
      Issue No: Vol. 70, No. 11 (2021)
       
  • F. nucleatum targets lncRNA ENO1-IT1 to promote glycolysis and oncogenesis
           in colorectal cancer

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      Authors: Hong, J; Guo, F, Lu, S.-Y, Shen, C, Ma, D, Zhang, X, Xie, Y, Yan, T, Yu, T, Sun, T, Qian, Y, Zhong, M, Chen, J, Peng, Y, Wang, C, Zhou, X, Liu, J, Liu, Q, Ma, X, Chen, Y.-X, Chen, H, Fang, J.-Y.
      Pages: 2123 - 2137
      Abstract: ObjectiveMicrobiota disorder promotes chronic inflammation and carcinogenesis. High glycolysis is associated with poor prognosis in patients with colorectal cancer (CRC). However, the potential correlation between the gut microbiota and glucose metabolism is unknown in CRC.Design 18F-FDG (18F-fluorodeoxyglucose) PET (positron emission tomography)/CT image scanning data and microbiota PCR analysis were performed to measure the correlation between metabolic alterations and microbiota disorder in 33 patients with CRC. Multiple colorectal cancer models, metabolic analysis and Seahorse assay were established to assess the role of long non-coding RNA (lncRNA) enolase1-intronic transcript 1 (ENO1-IT1) in Fusobacterium (F.) nucleatum-induced glucose metabolism and colorectal carcinogenesis. RNA immunoprecipitation and chromatin immunoprecipitation sequencing were conducted to identify potential targets of lncRNA ENO1-IT1.ResultsWe have found F. nucleatum abundance correlated with high glucose metabolism in patients with CRC. Furthermore, F. nucleatum supported carcinogenesis via increasing CRC cell glucose metabolism. Mechanistically, F. nucleatum activated lncRNA ENO1-IT1 transcription via upregulating the binding efficiency of transcription factor SP1 to the promoter region of lncRNA ENO1-IT1. Elevated ENO1-IT behaved as a guider modular for KAT7 histone acetyltransferase, specifying the histone modification pattern on its target genes, including ENO1, and consequently altering CRC biological function.Conclusion F. nucleatum and glucose metabolism are mechanistically, biologically and clinically connected to CRC. Targeting ENO1 pathway may be meaningful in treating patients with CRC with elevated F. nucleatum.
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-322780
      Issue No: Vol. 70, No. 11 (2021)
       
  • Evaluating the utility of tumour mutational signatures for identifying
           hereditary colorectal cancer and polyposis syndrome carriers

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      Authors: Georgeson, P; Pope, B. J, Rosty, C, Clendenning, M, Mahmood, K, Joo, J. E, Walker, R, Hutchinson, R. A, Preston, S, Como, J, Joseland, S, Win, A. K, Macrae, F. A, Hopper, J. L, Mouradov, D, Gibbs, P, Sieber, O. M, O'Sullivan, D. E, Brenner, D. R, Gallinger, S, Jenkins, M. A, Winship, I. M, Buchanan, D. D.
      Pages: 2138 - 2149
      Abstract: ObjectiveGermline pathogenic variants (PVs) in the DNA mismatch repair (MMR) genes and in the base excision repair gene MUTYH underlie hereditary colorectal cancer (CRC) and polyposis syndromes. We evaluated the robustness and discriminatory potential of tumour mutational signatures in CRCs for identifying germline PV carriers.DesignWhole-exome sequencing of formalin-fixed paraffin-embedded (FFPE) CRC tissue was performed on 33 MMR germline PV carriers, 12 biallelic MUTYH germline PV carriers, 25 sporadic MLH1 methylated MMR-deficient CRCs (MMRd controls) and 160 sporadic MMR-proficient CRCs (MMRp controls) and included 498 TCGA CRC tumours. COSMIC V3 single base substitution (SBS) and indel (ID) mutational signatures were assessed for their ability to differentiate CRCs that developed in carriers from non-carriers.ResultsThe combination of mutational signatures SBS18 and SBS36 contributing >30% of a CRC’s signature profile was able to discriminate biallelic MUTYH carriers from all other non-carrier control CRCs with 100% accuracy (area under the curve (AUC) 1.0). SBS18 and SBS36 were associated with specific MUTYH variants p.Gly396Asp (p=0.025) and p.Tyr179Cys (p=5x10-5), respectively. The combination of ID2 and ID7 could discriminate the 33 MMR PV carrier CRCs from the MMRp control CRCs (AUC 0.99); however, SBS and ID signatures, alone or in combination, could not provide complete discrimination (AUC 0.79) between CRCs from MMR PV carriers and sporadic MMRd controls.ConclusionAssessment of SBS and ID signatures can discriminate CRCs from biallelic MUTYH carriers and MMR PV carriers from non-carriers with high accuracy, demonstrating utility as a potential diagnostic and variant classification tool.
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2019-320462
      Issue No: Vol. 70, No. 11 (2021)
       
  • Identification and validation of a multivariable prediction model based on
           blood plasma and serum metabolomics for the distinction of chronic
           pancreatitis subjects from non-pancreas disease control subjects

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      Authors: Adam, M. G; Beyer, G, Christiansen, N, Kamlage, B, Pilarsky, C, Distler, M, Fahlbusch, T, Chromik, A, Klein, F, Bahra, M, Uhl, W, Grützmann, R, Mahajan, U. M, Weiss, F. U, Mayerle, J, Lerch, M. M.
      Pages: 2150 - 2158
      Abstract: ObjectiveChronic pancreatitis (CP) is a fibroinflammatory syndrome leading to organ dysfunction, chronic pain, an increased risk for pancreatic cancer and considerable morbidity. Due to a lack of specific biomarkers, diagnosis is based on symptoms and specific but insensitive imaging features, preventing an early diagnosis and appropriate management.DesignWe conducted a type 3 study for multivariable prediction for individual prognosis according to the TRIPOD guidelines. A signature to distinguish CP from controls (n=160) was identified using gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry on ethylenediaminetetraacetic acid (EDTA)-plasma and validated in independent cohorts.ResultsA Naive Bayes algorithm identified eight metabolites of six ontology classes. After algorithm training and computation of optimal cut-offs, classification according to the metabolic signature detected CP with an area under the curve (AUC) of 0.85 ((95% CI 0.79 to 0.91). External validation in two independent cohorts (total n=502) resulted in similar accuracy for detection of CP compared with non-pancreatic controls in EDTA-plasma (AUC 0.85 (95% CI 0.81 to 0.89)) and serum (AUC 0.87 (95% CI 0.81 to 0.95)).ConclusionsThis is the first study that identifies and independently validates a metabolomic signature in plasma and serum for the diagnosis of CP in large, prospective cohorts. The results could provide the basis for the development of the first routine laboratory test for CP.
      Keywords: Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-320723
      Issue No: Vol. 70, No. 11 (2021)
       
  • Reticulon 3-mediated Chk2/p53 activation suppresses hepatocellular
           carcinogenesis and is blocked by hepatitis B virus

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      Authors: Song, S; Shi, Y, Wu, W, Wu, H, Chang, L, Peng, P, Zhang, L, Fan, J, Gu, J, Ruan, Y.
      Pages: 2159 - 2171
      Abstract: ObjectiveDysfunction of endoplasmic reticulum (ER) proteins is closely related to homeostasis disturbance and malignant transformation of hepatocellular carcinoma (HCC). Reticulons (RTN) are a family of ER-resident proteins critical for maintaining ER function. Nevertheless, the precise roles of RTN in HCC remain largely unclear. The aim of the study is to examine the effect of reticulon family member RTN3 on HCC development and explore the underlying mechanisms.DesignClinical HCC samples were collected to assess the relationship between RTN3 expression and patients’ outcome. HCC cell lines were employed to examine the effects of RTN3 on cellular proliferation, apoptosis and signal transduction in vitro. Nude mice model was used to detect the role of RTN3 in modulating tumour growth in vivo.ResultsWe found that RTN3 was highly expressed in normal hepatocytes but frequently downregulated in HCC. Low RTN3 expression predicted poor outcome in patients with HCC in TP53 gene mutation and HBV infection status-dependent manner. RTN3 restrained HCC growth and induced apoptosis by activating p53. Mechanism studies indicated that RTN3 facilitated p53 Ser392 phosphorylation via Chk2 and enhanced subsequent p53 nuclear localisation. RTN3 interacted with Chk2, recruited it to ER and promoted its activation in an ER calcium-dependent manner. Nevertheless, the tumour suppressive effects of RTN3 were abrogated in HBV-positive cells. HBV surface antigen competed with Chk2 for RTN3 binding and blocked RTN3-mediated Chk2/p53 activation.ConclusionThe findings suggest that RTN3 functions as a novel suppressor of HCC by activating Chk2/p53 pathway and provide more clues to better understand the oncogenic effects of HBV.
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-321386
      Issue No: Vol. 70, No. 11 (2021)
       
  • Cost-effectiveness of antiviral treatment in adult patients with
           immune-tolerant phase chronic hepatitis B

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      Authors: Kim, H.-L; Kim, G.-A, Park, J.-A, Kang, H.-R, Lee, E.-K, Lim, Y.-S.
      Pages: 2172 - 2182
      Abstract: ObjectiveThe cost-effectiveness of antiviral treatment in adult immune-tolerant (IT) phase chronic hepatitis B (CHB) patients is uncertain.DesignWe designed a Markov model to compare expected costs and quality-adjusted life-years (QALYs) of starting antiviral treatment at IT-phase (‘treat-IT’) vs delaying the therapy until active hepatitis phase (‘untreat-IT’) in CHB patients over a 20-year horizon. A cohort of 10 000 non-cirrhotic 35-year-old patients in IT-phase CHB (hepatitis B e antigen-positive, mean serum hepatitis B virus (HBV) DNA levels 7.6 log10 IU/mL, and normal alanine aminotransferase levels) was simulated. Input parameters were obtained from previous studies at Asan Medical Center, Korea. The incremental cost-effectiveness ratio (ICER) between the treat-IT and untreat-IT strategies was calculated.ResultsFrom a healthcare system perspective, the treat-IT strategy with entecavir or tenofovir had an ICER of US$16 516/QALY, with an annual hepatocellular carcinoma (HCC) incidence of 0.73% in the untreat-IT group. With the annual HCC risk ≥0.54%, the treat-IT strategy was cost-effective at a willingness-to-pay threshold of US$20 000/QALY. From a societal perspective considering productivity loss by premature death, the treat-IT strategy was extremely cost-effective, and was dominant (ICER
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-321309
      Issue No: Vol. 70, No. 11 (2021)
       
  • Hepatic Krüppel-like factor 16 (KLF16) targets PPAR{alpha} to improve
           steatohepatitis and insulin resistance

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      Authors: Sun, N; Shen, C, Zhang, L, Wu, X, Yu, Y, Yang, X, Yang, C, Zhong, C, Gao, Z, Miao, W, Yang, Z, Gao, W, Hu, L, Williams, K, Liu, C, Chang, Y, Gao, Y.
      Pages: 2183 - 2195
      Abstract: ObjectiveImpaired hepatic fatty acids oxidation results in lipid accumulation and redox imbalance, promoting the development of fatty liver diseases and insulin resistance. However, the underlying pathogenic mechanism is poorly understood. Krüppel-like factor 16 (KLF16) is a transcription factor that abounds in liver. We explored whether and by what mechanisms KLF16 affects hepatic lipid catabolism to improve hepatosteatosis and insulin resistance.DesignKLF16 expression was determined in patients with non-alcoholic fatty liver disease (NAFLD) and mice models. The role of KLF16 in the regulation of lipid metabolism was investigated using hepatocyte-specific KLF16-deficient mice fed a high-fat diet (HFD) or using an adenovirus/adeno-associated virus to alter KLF16 expression in mouse primary hepatocytes (MPHs) and in vivo livers. RNA-seq, luciferase reporter gene assay and ChIP analysis served to explore the molecular mechanisms involved.ResultsKLF16 expression was decreased in patients with NAFLD, mice models and oleic acid and palmitic acid (OA and PA) cochallenged hepatocytes. Hepatic KLF16 knockout impaired fatty acid oxidation, aggravated mitochondrial stress, ROS burden, advancing hepatic steatosis and insulin resistance. Conversely, KLF16 overexpression reduced lipid deposition and improved insulin resistance via directly binding the promoter of peroxisome proliferator-activated receptor α (PPARα) to accelerate fatty acids oxidation and attenuate mitochondrial stress, oxidative stress in db/db and HFD mice. PPARα deficiency diminished the KLF16-evoked protective effects against lipid deposition in MPHs. Hepatic-specific PPARα overexpression effectively rescued KLF16 deficiency-induced hepatic steatosis, altered redox balance and insulin resistance.ConclusionsThese findings prove that a direct KLF16–PPARα pathway closely links hepatic lipid homeostasis and redox balance, whose dysfunction promotes insulin resistance and hepatic steatosis.
      Keywords: Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-321774
      Issue No: Vol. 70, No. 11 (2021)
       
  • Alternative treatments for type 2 diabetes and associated metabolic
           

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      Authors: van Baar, A. C. G; Meiring, S, Holleman, F, Hopkins, D, Mingrone, G, Deviere, J, Nieuwdorp, M, Bergman, J. J. G. H. M.
      Pages: 2196 - 2204
      Abstract: Key messages
      Despite important and promising advances in oral and injectable glucose-lowering medications for type 2 diabetes, overall control of blood glucose remains suboptimal in most patients.
      Bariatric surgery has revealed the proximal small bowel as an important contributor to metabolic benefits post surgery, making it a target for endoscopic treatment options.
      Duodenal mucosal resurfacing (DMR) is an endoscopic procedure where the duodenal mucosa is ablated to treat type 2 diabetes.
      DMR leads to improved glycaemia and additional metabolic improvements, such as liver fat reduction, without the disadvantages of anatomy-changing surgery.
      Clinical studies suggest that DMR has the best resultsin patients with high insulin resistance at study entry, pointing at an important role for patient selection.
      DMR may not be the only way to safely and effectively ablate the duodenal mucosa. New duodenal ablation techniques are under investigation, such as submucosal...
      Keywords: GUT Recent advances in clinical practice, Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323931
      Issue No: Vol. 70, No. 11 (2021)
       
  • GI highlights from the literature

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      Authors: Smith; P. J.
      Pages: 2205 - 2206
      Abstract: Basic scienceGaining deeper mechanistic insights into immunotherapy-mediated liver toxicity Llewellyn H, Arat S, Gao J, et al. T cells and monocyte-derived myeloid cells mediate immunotherapy-related hepatitis in a mouse model. J Hepatol 2021; S0168-8278(21)01887-0. doi: 10.1016/j.jhep.2021.06.037. Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated protein 4, programmed cell death 1 or indoleamine 2,3-dioxygenase 1 have demonstrated antitumour efficacy in several types of cancers. Normally, these inhibitory pathways, or checkpoints, maintain the balance between T-cell activation and inhibition. Disruption of these checkpoints results in enhanced antitumour immune response but can cause undesirable off-target immune-mediated inflammatory events such as hepatitis. ICI-associated hepatitis has morphologic characteristics that are generally reminiscent of autoimmune disease. However, the exact mechanisms of these events have not been elucidated and there are no animal models exhibiting ICI-induced hepatitis. In a recently developed PD1–/– mouse model, ICI combination-induced hepatitis and the 4-1BB (tumour necrosis factor ligand superfamily...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-326159
      Issue No: Vol. 70, No. 11 (2021)
       
  • There is still a place for optimised thiopurine therapy in IBD

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      Authors: Crouwel, F; Buiter, H. J. C, de Boer, N. K. H.
      Pages: 2207 - 2207
      Abstract: With great interest, we have read the letter by Verstockt et al1 considering the response rate and outcome of thiopurine monotherapy in patients with Crohn’s disease (CD). The title, however, stating that thiopurine monotherapy has a limited place in treatment of patients with mild-to-moderate CD raised some questions. Almost all patients in this retrospective cohort were treated with azathioprine (AZA) and nowhere is mentioned if patients who experience intolerance were switched to another thiopurine or received a rechallenge. A retrospective study among 1327 patients exposed both to AZA or mercaptopurine (MP) demonstrated, however, that almost half of patients intolerant to the first thiopurine were able to tolerate the second.2 In addition, another study demonstrated that almost 65% had clinical improvement during thioguanine (TG) treatment after AZA or MP failure, so switching could potentially lead to a higher response rate.3 Moreover, the discussed lack...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323481
      Issue No: Vol. 70, No. 11 (2021)
       
  • Does water immersion WASH in bowel scope'

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      Authors: Ishaq, S; Siau, K, Cadoni, S.
      Pages: 2208 - 2208
      Abstract: Rutter et al1 should be congratulated on this first randomised controlled trial (RCT) comparing water-assisted sigmoidoscopy (WAS) versus carbon dioxide (CO2) insufflation in patients undergoing English Bowel Scope Screening (BSS). The authors reported no significant difference in the primary outcome of recalled pain, or in secondary outcomes of adenoma detection rate (ADR) between WAS and CO2 insufflation groups. Before we consider the study findings, we would like to discuss the following points with the esteemed authors of this study. First, the WAS technique deserves mention. The authors used the water immersion (WI) technique to facilitate progression of scope with CO2 insufflation when required and the infused water was aspirated during withdrawal. The gold standard water exchange (WE) technique was not chosen for the study, which would have removed the infused water mainly during insertion without any gas insufflation along with removing all residual gas pockets to achieve...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323393
      Issue No: Vol. 70, No. 11 (2021)
       
  • Association between duodenal bile salts and gastric emptying in patients
           with functional dyspepsia

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      Authors: Wauters, L; Ceulemans, M, Lambaerts, M, Accarie, A, Toth, J, Mols, R, Augustijns, P, Tack, J, Vanuytsel, T.
      Pages: 2208 - 2210
      Abstract: We read with interest the study by Higuchi et al, which identified mechanisms of increased satiation in Cyp8b1–/– mice via slowed gastric empting.1 Following data showing that deleting Cyp8b1, which is required to produce 12α-hydroxylated bile acids, impaired intestinal lipid absorption in mice, the authors convincingly demonstrated that lowering 12α-hydroxylated bile acids slowed gastric emptying in Cyp8b1–/– mice.1 Duodenal lipid infusion affects gastric function, and duodenal hypersensitivity to lipids has been studied in GI disorders with gastric dysmotility, such as functional dyspepsia (FD).2 FD is defined by upper GI symptoms originating from the gastroduodenal region with no structural disease on routine investigation.3 Although studies showed that lipids are a major trigger of dyspeptic symptoms, the effect was only partially explained by duodenal release of cholecystokinin.4 Interestingly, the release of bile salts has been linked to the generation of dyspeptic...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323598
      Issue No: Vol. 70, No. 11 (2021)
       
  • Response to faecal microbiota transplantation in ulcerative colitis is not
           sustained long term following induction therapy

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      Authors: Haifer, C; Saikal, A, Paramsothy, R, Kaakoush, N. O, Leong, R. W, Borody, T. J, Kamm, M. A, Paramsothy, S.
      Pages: 2210 - 2211
      Abstract: We read with interest the paper by Ng et al,1 which discussed the need to optimise faecal microbiota transplantation (FMT) processes in order to increase its therapeutic potential, especially in inflammatory bowel disease (IBD). While there is randomised controlled trial evidence that FMT can be effective in the induction of remission in patients with ulcerative colitis (UC),2–5 the durability of therapeutic response following FMT cessation is unknown. Furthermore, there is limited long-term safety data following FMT, especially in patients with IBD. In the FOCUS study, FMT delivered via an initial colonoscopy infusion, followed by enema therapy for 8 weeks was effective in mild to moderate UC remission induction.2 Here, we report the long-term outcomes from the FOCUS study. Enrolled study participants who received FMT (2013–2015) were contacted to assess time to disease relapse for patients in clinical...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323581
      Issue No: Vol. 70, No. 11 (2021)
       
  • Lack of relationship of AT1001 to zonulin and prehaptoglobin-2: clinical
           implications

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      Authors: Sollid, L. M; Koning, F.
      Pages: 2211 - 2212
      Abstract: We read with interest the letter to the editor by Massier et al1 and the accompanying response by Fasano.2 We would like to point out one critical issue that has not been addressed, namely, the relationship between AT1001, zonulin and prehaptoglobin-2. AT1001 is an octapeptide that was thought to represent the N-terminal sequence of zonulin.3 4 However, in all likelihood this octapeptide sequence (GGVLVQPG) derives from immunoglobulin. In their attempt to identify the human homolog of the Vibrio cholera zonula occludens toxin (Zot), Fasano and colleagues performed immunoprecipitation of human tissue homogenates with a Zot-specific rabbit polyclonal antibody, which yielded several proteins of 47 kD with slightly different N-terminal sequences. While these proteins were thought to represent tissue specific variants of zonulin, their sequences match the N-terminal part of immunoglobulin heavy chain, so they likely derive from the rabbit antibody used...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323829
      Issue No: Vol. 70, No. 11 (2021)
       
  • Risk stratification for proton pump inhibitor-associated type 2 diabetes:
           a population-based cohort study

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      Authors: He, Q; Yang, M, Qin, X, Fan, D, Yuan, J, Pan, Y.
      Pages: 2212 - 2213
      Abstract: We have recently reported in GUT that regular proton pump inhibitor (PPI) use was associated with a 24% increased risk of type 2 diabetes mellitus (T2DM).1 This was the first study demonstrating an association between PPIs and diabetes. However, all included participants were healthcare professionals and the findings have not been verified in general populations. Additionally, investigation of subgroups at high absolute risk of diabetes among PPI users is still lacking. Because the absolute effects of interventions tend to increase with baseline risk, individualised treatment based on the patients’ underlying risk may confer benefits and reduce harms. Such risk stratification strategy had been applied to select patients for antihypertensive and statin therapy.2 3 In the present study, we conducted a prospective analysis of the UK-Biobank to (1)confirm the association between PPI use and T2DM in general population and (2) to investigate which population...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323816
      Issue No: Vol. 70, No. 11 (2021)
       
  • Rescue of male fertility following faecal microbiota transplantation from
           alginate oligosaccharide-dosed mice

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      Authors: Zhang, C; Xiong, B, Chen, L, Ge, W, Yin, S, Feng, Y, Sun, Z, Sun, Q, Zhao, Y, Shen, W, Zhang, H.
      Pages: 2213 - 2215
      Abstract: A very recent publication in Gut highlights that faecal microbiota transplantation (FMT) from alginate oligosaccharide (AOS)-dosed animals improves mouse sperm quality and spermatogenesis after busulfan treatment.1 The results suggest the potential of FMT for the improvement of infertility,1 since worldwide 10%–15% of couples are infertile and many of them have failed spermatogenesis.1 2 In addition, many investigations have found that gut microbiota may affect male or female reproduction.3 4 Although the improvement of male infertility is an emerging novel area of interest and many investigations have attempted to ameliorate spermatogenesis by various methods, little progress has been achieved.5 6 In the study done by Zhang et al,1 FMT from AOS-dosed animals increased spermatozoa quality and the process of spermatogenesis; however, that gut microbiota from AOS-dosed animals can actually increase fertility rate...
      Keywords: Open access, Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323593
      Issue No: Vol. 70, No. 11 (2021)
       
  • Colorectal cancer and absolute risks

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      Authors: Lawrence, B. J; Alexander, E, Grant, H, O'Connor, M.
      Pages: 2215 - 2216
      Abstract: We read the umbrella review and meta-analysis by Chapelle et al,1 which summarised the evidence from 80 meta-analyses examining medications and dietary factors associated with prevention of colorectal cancer. The main findings showed that aspirin, non-steroidal anti-inflammatory drugs, magnesium, folate and high consumption of fruits, vegetables, fibre and dairy products were associated with decreased incidence of colorectal cancer. Whereas frequent consumption of alcohol and meat were associated with increased incidence of colorectal cancer. Chapelle et al also reported the quality of evidence as overwhelmingly very low to low and concluded their review by suggesting that these findings will assist clinicians when advising average risk patients, yet they did not report the statistical result most relevant to an average risk patient living in the community: absolute risk. Absolute risk is the estimate of the likelihood of the occurrence of an outcome. For example, the estimated global absolute risk...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323505
      Issue No: Vol. 70, No. 11 (2021)
       
  • Where should ascitic drains be placed' Revisiting anatomical landmarks
           for paracentesis

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      Authors: Siau, K; Robson, N, Bollipo, S, Global Online Alliance for Liver Studies (GOAL), On behalf of the Global Online Alliance for Liver Studies (GOAL), Kapuria, Rabiee, Ben-Yakov, Kumar, Congly, Turnes, Dhanasekaran, Lui, Lee
      Pages: 2216 - 2217
      Abstract: We welcome the recent publication of the BSG/BASL guidelines on the management of ascites in cirrhosis which will serve as a framework for patient management across the world.1 Following clinician feedback on Twitter,2 we wish to respectfully highlight concerns regarding their guidance on landmarks for therapeutic paracentesis. Our first concern relates to the description of the landmarks. The authors recommend this to be ‘at least 8 cm (laterally) from the midline and 5 cm above the symphysis (pubis)’.1 This was predicated on three studies (two laparoscopic; one cadaveric) on the anatomical course of the inferior epigastric artery.3–5 While this approach avoids puncturing the vessel, there remains a risk of injury to underlying solid organs which can result in haemorrhage or perforation. Of note, these studies may not be generalisable to patients with distortion of the abdominal cavity due to...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2020-323731
      Issue No: Vol. 70, No. 11 (2021)
       
  • Guts UK 50 years old: onwards and upwards

    • Free pre-print version: Loading...

      Authors: Harrington, J; McLaughlin, J, Rhodes, J. M.
      Pages: 2217 - 2218
      Abstract: Guts UK is 50 years old. Despite many advances since its foundation, there is plenty left to be done. Funding for research into gut, liver and pancreas diseases has always been modest compared with their clinical impact.1 The UK Medical Research Council was established in 19192 when gastroenterology barely existed as a specialty—the British Society of Gastroenterology (BSG) was not formed until 1937.3 Medical Research Council funding reflected priorities of the day such as infectious disease and neurological disorders. In 1971, the Council of the BSG, noting the paucity of research funding, set up the Digestive Disorders Trust Fund with Dr Thomas Hunt, a founder member of the BSG, as its first President. Sir Francis Avery Jones succeeded Dr Hunt from 1980 and the charity gradually expanded its research support and developed a very successful patient information programme. In the modern era, gastroenterology...
      Keywords: Gut
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-325324
      Issue No: Vol. 70, No. 11 (2021)
       
  • SARS-CoV-2 transmission via endoscopy in the COVID-19 era

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      Authors: Voiosu, T. A; Puscasu, C. I, Voiosu, A.
      Pages: 2218 - 2219
      Abstract: We have read with interest the latest paper by Boškoski et al1 on the virological status of reprocessed endoscopes used for critically ill patients during the COVID-19 pandemic. Proper reprocessing of endoscopes and accessories is essential to patient safety. Although existing data suggest that the risk of viral transmission via endoscopic equipment is extremely low (with virtually no reported cases of hepatitis B and C or HIV transmission following current disinfection guidelines2), the present COVID-19 pandemic has put a spotlight on quality control as a guarantor of patient and healthcare worker safety. Boškoski et al report no evidence of viral contamination of endoscopes in critically ill patients undergoing upper and lower GI endoscopy as well as biliopancreatic procedures (endoscopic ultrasound and endoscopic retrograde cholangiopancreatography). This is in accordance with previous studies suggesting that the risk of fomite transmission of SARS-CoV-2, although plausible,3 remains...
      Keywords: Gut, COVID-19
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-324276
      Issue No: Vol. 70, No. 11 (2021)
       
  • Enhanced donor screening for faecal microbial transplantation during
           COVID-19

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      Authors: Parvathy, S. N; Lenehan, J. G, Fernandes, R, Poutanen, S. M, Hota, S, Maleki Vareki, S, Silverman, M.
      Pages: 2219 - 2220
      Abstract: We read with interest the recent article by Ianiro et al1 which is a guidance document on faecal microbial transplantation (FMT) during the COVID-19 pandemic. This guidance document advocated stool testing for SARS-CoV-2 and nasopharyngeal sampling was recommended. The pandemic has imposed new challenges to healthcare systems around the world. Since SARS-CoV-2 RNA can be found in the stool of infected individuals,2 this has raised safety concerns for administering FMTs. The US Food and Drug Administration has recommended that only FMT products generated from stools donated before 1 December 2019 should be used until further guidance on SARS-CoV-2 testing protocols are available.3 However, the supply of prestored samples has dwindled and the stability of the microbes and the efficacy of FMT after prolonged storage are questionable.4 Currently many FMT centres are closed with no available FMT treatment for recurrent Clostridioides difficile...
      Keywords: Open access, Gut, COVID-19
      PubDate: 2021-10-07T01:40:13-07:00
      DOI: 10.1136/gutjnl-2021-324593
      Issue No: Vol. 70, No. 11 (2021)
       
 
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