1
|
Conley TE, Parkes M, Moss S, Probert C. Assessing 'response' to the low-FODMAP diet in irritable bowel syndrome: Should we be reporting harder primary endpoints? Clin Nutr 2024; 43:1079-1086. [PMID: 38579370 DOI: 10.1016/j.clnu.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND & AIMS The low-FODMAP diet (LFD) has become almost synonymous with IBS care, yet the challenges associated with this rigorous therapeutic approach are often underacknowledged. Despite positive outcomes in RCTs, comparator groups frequently exhibit substantial response rates, raising questions about the definition of 'response'. Whilst the assessment of response in drug trials has evolved to utilize the more stringent FDA/EMA primary clinical endpoints, trials of the LFD have not yet followed. The aim of this article is to opine whether the current approach to the measurement of clinical response to the LFD in clinical trials should be reconsidered. METHODS A comprehensive literature review of LFD clinical trials from the past decade was conducted, focusing on recorded response metrics for primary clinical endpoints. RESULTS While response definitions vary, the 50-point IBS-SSS delta emerged as the predominant metric. Notably, no trials to date have adopted the more stringent primary clinical endpoints used in drug trials. Other response measures included binary response metrics (such as 'adequate clinical response'), changes in visual analogue scales or stool form/output, reductions in abdominal pain, as well as changes the magnitude of the IBS-SSS delta. Whether these metrics correspond to a clinically meaningful improvement for the patient is less clear, and as such aligning patient-clinician expectations can be challenging. CONCLUSIONS A paradigm shift in the conceptualization of 'response' coupled with an emphasis on harder clinical endpoints in the context of clinical trials may serve to better justify the trade-off between symptom-improvement and the inherent challenges associated with this burdensome therapeutic approach.
Collapse
Affiliation(s)
- Thomas Edward Conley
- University of Liverpool Institute of Integrative Biology, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Department of Gastroenterology, Liverpool, UK.
| | - Miles Parkes
- University of Cambridge Department of Medicine, Gastroenterology and Hepatology, Cambridge, Cambridgeshire, UK; Cambridge University Hospitals NHS Foundation Trust, Department of Gastroenterology, Cambridge, UK
| | - Stephen Moss
- University of Cambridge Department of Medicine, Gastroenterology and Hepatology, Cambridge, Cambridgeshire, UK; Cambridge University Hospitals NHS Foundation Trust, Department of Gastroenterology, Cambridge, UK
| | - Chris Probert
- University of Liverpool Institute of Integrative Biology, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Department of Gastroenterology, Liverpool, UK
| |
Collapse
|
2
|
Ardalan ZS, Yao CK, Green K, Probert C, Gill PA, Rosella S, Muir JG, Sparrow MP, Gibson PR. A novel Monash Pouch diet in patients with an ileoanal pouch is tolerable and has favorable metabolic luminal effects. JGH Open 2023; 7:942-952. [PMID: 38162853 PMCID: PMC10757501 DOI: 10.1002/jgh3.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024]
Abstract
Aims To evaluate a whole-food diet strategy (the Monash Pouch diet [MPD]) designed based on the interacting roles dietary factors play with pouch health. Specifically, its tolerability and acceptability, whether it achieved its dietary and metabolic goals, and the effects on symptoms and inflammation were examined. Methods In a 6-week open-label trial, patients with ileoanal pouches educated on the MPD were assessed regarding diet tolerability and acceptance, food intake (7-day food diaries), pouch-related symptoms (clinical pouchitis disease activity index), and, in 24-h fecal samples, calprotectin, fermentative biomarkers, and volatile organic compounds (VOC). Results Of 12 patients, 6 male, mean (SD) age 55 (5) and pouch age 13 (2) years, one withdrew with partial small bowel obstruction. Tolerability was excellent in 9 (75%) and acceptance was high (81%). Targeted changes in dietary intake were achieved. Fecal branched- to short-chain fatty acid ratio increased by median 60 [IQR: 11-80]% (P = 0.02). Fecal VOCs for 3 compounds were also increased, 2-methyl-5-propan-2-ylcyclohexa-1,3-diene (Fold-change [FC] 2.08), 1,3,3-trimethyl-2-oxabicyclo[2.2.2]octane (FC 3.86), propan-2-ol (FC 2.10). All six symptomatic patients achieved symptomatic remission (P = 0.03). Fecal calprotectin at baseline was 292 [176-527] μg/g and at week 5 was 205 [148-310] μg/g (P = 0.72). Conclusion Well tolerated and accepted, the MPD achieved targeted changes in intakes and fermentation of carbohydrates relative to that of protein. There were signals of improvement in symptoms. These results indicate the need for a randomized-controlled trial. (Trial registration: ACTRN12621000374864; https://www.anzctr.org.au/ACTRN12621000374864.aspx).
Collapse
Affiliation(s)
- Zaid S Ardalan
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Chu K Yao
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Kraig Green
- Department of Molecular and Clinical Cancer MedicineUniversity of LiverpoolLiverpoolUK
| | - Chris Probert
- Department of Molecular and Clinical Cancer MedicineUniversity of LiverpoolLiverpoolUK
| | - Paul A Gill
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Sam Rosella
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Jane G Muir
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Miles P Sparrow
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Peter R Gibson
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| |
Collapse
|
3
|
Wilson B, Kanno T, Slater R, Rossi M, Irving PM, Lomer MC, Probert C, Mason AJ, Whelan K. Faecal and urine metabolites, but not gut microbiota, may predict response to low FODMAP diet in irritable bowel syndrome. Aliment Pharmacol Ther 2023; 58:404-416. [PMID: 37313992 DOI: 10.1111/apt.17609] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The low FODMAP diet (LFD) leads to clinical response in 50%-80% of patients with irritable bowel syndrome (IBS). It is unclear why only some patients respond. AIMS To determine if differences in baseline faecal microbiota or faecal and urine metabolite profiles may separate clinical responders to the diet from non-responders allowing predictive algorithms to be proposed. METHODS We recruited adults fulfilling Rome III criteria for IBS to a blinded randomised controlled trial. Patients were randomised to sham diet with a placebo supplement (control) or LFD supplemented with either placebo (LFD) or 1.8 g/d B-galactooligosaccharide (LFD/B-GOS), for 4 weeks. Clinical response was defined as adequate symptom relief at 4 weeks after the intervention (global symptom question). Differences between responders and non-responders in faecal microbiota (FISH, 16S rRNA sequencing) and faecal (gas-liquid chromatography, gas-chromatography mass-spectrometry) and urine (1 H NMR) metabolites were analysed. RESULTS At 4 weeks, clinical response differed across the 3groups with adequate symptom relief of 30% (7/23) in controls, 50% (11/22) in the LFD group and 67% (16/24) in the LFD/B-GOS group (p = 0.048). In the control and the LFD/B-GOS groups, microbiota and metabolites did not separate responders from non-responders. In the LFD group, higher baseline faecal propionate (sensitivity 91%, specificity 89%) and cyclohexanecarboxylic acid esters (sensitivity 80%, specificity 78%), and urine metabolite profile (Q2 0.296 vs. randomised -0.175) predicted clinical response. CONCLUSIONS Baseline faecal and urine metabolites may predict response to the LFD.
Collapse
Affiliation(s)
- Bridgette Wilson
- Department of Nutritional Sciences, King's College London, London, UK
- Department of Nutrition and Dietetics, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Tokuwa Kanno
- King's College London, Institute of Pharmaceutical Science, London, UK
| | - Rachael Slater
- University of Liverpool, Institute of Systems, Molecular and Integrative Biology, Liverpool, UK
| | - Megan Rossi
- Department of Nutritional Sciences, King's College London, London, UK
| | - Peter M Irving
- Department of Gastroenterology, Guys and St Thomas' NHS Foundation Trust, London, UK
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Miranda C Lomer
- Department of Nutritional Sciences, King's College London, London, UK
- Department of Nutrition and Dietetics, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Chris Probert
- University of Liverpool, Institute of Systems, Molecular and Integrative Biology, Liverpool, UK
| | - A James Mason
- King's College London, Institute of Pharmaceutical Science, London, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| |
Collapse
|
4
|
Wyatt J, Fernando SM, Powell SG, Hill CJ, Arshad I, Probert C, Ahmed S, Hapangama DK. The role of iron in the pathogenesis of endometriosis: a systematic review. Hum Reprod Open 2023; 2023:hoad033. [PMID: 37638130 PMCID: PMC10457727 DOI: 10.1093/hropen/hoad033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
STUDY QUESTION What is the role of iron in the pathophysiology of endometriosis? SUMMARY ANSWER Iron excess is demonstrated wherever endometriotic tissues are found and is associated with oxidative stress, an inflammatory micro-environment, and cell damage; the iron-mediated oxidative stress is independently linked to subfertility, symptom severity, and malignant transformation. WHAT IS KNOWN ALREADY Iron is found in excess in endometriotic tissues, and multiple mechanisms have been studied and posited to explain this. It is clear that iron excess plays a vital role in promoting oxidative stress and cell damage. The evidence base is large, but no comprehensive reviews exist to summarize our understanding and highlight the overarching themes to further our understanding and suggest future directions of study for the field. STUDY DESIGN SIZE DURATION This systematic review with a thematic analysis retrieved studies from the PubMed, Embase, Web of Science, and Cochrane Library databases and searches were conducted from inception through to August 2022. Human and animal studies published in the English language were included and identified using a combination of exploded MeSH terms ('Iron' and 'Endometriosis') and free-text search terms ('Iron', 'Ferric', 'Ferrous', 'Endometriosis', 'Endometrioma'). PARTICIPANTS/MATERIALS SETTING METHODS This review was reported in accordance with the PRISMA guidelines. All studies reporting original data concerning the role of iron or iron complexes in the pathophysiology of endometriosis were included. Studies that did not report original data or provided a review of the field were excluded. Bias analysis was completed for each included study by using the Newcastle-Ottawa scoring system. MAIN RESULTS AND THE ROLE OF CHANCE There were 776 records identified and these were screened down to 53 studies which met the eligibility criteria, including 6 animal and 47 human studies, with 3556 individual participants. Iron excess is demonstrated in various tissues and fluids, including ovarian endometriomas, ovarian follicles, ectopic endometriotic lesions, and peritoneal fluid. Markers of oxidative stress are strongly associated with high iron levels, and aberrant expression of iron-transport proteins has been demonstrated. Abnormal resistance to ferroptosis is likely. Iron-mediated oxidative stress is responsible for a pro-inflammatory micro-environment and is linked to subfertility, symptom severity, and, possibly, malignant transformation. LIMITATIONS REASONS FOR CAUTION A minority of the included studies were of objectively low quality with a high risk of bias and may lead to misleading conclusions. Additionally, multiple studies failed to appropriately characterize the included patients by known confounding variables, such as menstrual cycle phase, which may introduce bias to the findings. WIDER IMPLICATIONS OF THE FINDINGS Current literature depicts a central role of aberrant iron mechanics and subsequent oxidative stress in endometriosis. It is likely that iron excess is at least partly responsible for the persistence and proliferation of ectopic endometriotic lesions. As such, iron mechanics represent an attractive target for novel therapeutics, including iron chelators or effectors of the iron-oxidative stress pathway. There are significant gaps in our current understanding, and this review highlights and recommends several topics for further research. These include the role of iron chelation, resistance to ferroptosis, the relationship between iron excess and localized hypoxia, systemic iron pathophysiology in endometriosis, and the role of oxidative stress in malignant transformation. STUDY FUNDING/COMPETING INTERESTS J.W. and S.G.P. are supported by clinical fellowships at Liverpool University Hospital NHS Foundation trust. No additional funding was requested or required for the completion of this work. C.J.H. is supported by a Wellbeing of Women project grant (RG2137). D.K.H. is supported by a Wellbeing of Women project grant (RG2137) and an MRC clinical research training fellowship (MR/V007238/1). The authors have no conflicts of interest to declare. REGISTRATION NUMBER A protocol was prospectively registered with the PROSPERO database in August 2021 (CRD42021272818).
Collapse
Affiliation(s)
- James Wyatt
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sean M Fernando
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Simon George Powell
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christopher J Hill
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Ilyas Arshad
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool, UK
| | - Chris Probert
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Shakil Ahmed
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Dharani K Hapangama
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
5
|
Young G, Berrington JE, Cummings S, Dorling J, Ewer AK, Frau A, Lett L, Probert C, Juszczak E, Kirby J, Beck LC, Renwick VL, Lamb C, Lanyon CV, McGuire W, Stewart C, Embleton N. Mechanisms affecting the gut of preterm infants in enteral feeding trials: a nested cohort within a randomised controlled trial of lactoferrin. Arch Dis Child Fetal Neonatal Ed 2022; 108:272-279. [PMID: 36396443 PMCID: PMC10176413 DOI: 10.1136/archdischild-2022-324477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the impact of supplemental bovine lactoferrin on the gut microbiome and metabolome of preterm infants. DESIGN Cohort study nested within a randomised controlled trial (RCT). Infants across different trial arms were matched on several clinical variables. Bacteria and metabolite compositions of longitudinal stool and urine samples were analysed to investigate the impact of lactoferrin supplementation. SETTING Thirteen UK hospitals participating in a RCT of lactoferrin. PATIENTS 479 infants born <32 weeks' gestation between June 2016 and September 2017. RESULTS 10 990 stool and 22 341 urine samples were collected. Analyses of gut microbiome (1304 stools, 201 infants), metabolites (171 stools, 83 infants; 225 urines, 90 infants) and volatile organic compounds (314 stools, 117 infants) were performed. Gut microbiome Shannon diversity at 34 weeks corrected age was not significantly different between infants in the lactoferrin (mean=1.24) or placebo (mean=1.06) groups (p=0.11). Lactoferrin receipt explained less than 1% variance in microbiome compositions between groups. Metabolomic analysis identified six discriminative features between trial groups. Hospital site (16%) and postnatal age (6%) explained the greatest variation in microbiome composition. CONCLUSIONS This multiomic study identified minimal impacts of lactoferrin but much larger impacts of hospital site and postnatal age. This may be due to the specific lactoferrin product used, but more likely supports the findings of the RCT in which this study was nested, which showed no impact of lactoferrin on reducing rates of sepsis. Multisite mechanistic studies nested within RCTs are feasible and help inform trial interpretation and future trial design.
Collapse
Affiliation(s)
- Greg Young
- Applied Sciences, Northumbria University Faculty of Health and Life Sciences, Newcastle upon Tyne, England, UK.,Microbial Environments, Hub for Biotechnology in the Built Environment, Newcastle upon Tyne, England, UK
| | - Janet E Berrington
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK .,Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Stephen Cummings
- School of Health and Life Sciences, Teesside University, Middlesbrough, North Yorkshire, UK
| | - Jon Dorling
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew K Ewer
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Alessandra Frau
- Gastroenterology Research Unit, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Lauren Lett
- Gastroenterology Research Unit, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Chris Probert
- Gastroenterology Research Unit, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ed Juszczak
- School of Medicine, University of Nottingham School of Medicine, Nottingham, Notts, UK
| | - John Kirby
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lauren C Beck
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Victoria L Renwick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Lamb
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare V Lanyon
- Applied Sciences, Northumbria University Faculty of Health and Life Sciences, Newcastle upon Tyne, England, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Christopher Stewart
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicholas Embleton
- Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
6
|
Lett L, George M, Slater R, De Lacy Costello B, Ratcliffe N, García-Fiñana M, Lazarowicz H, Probert C. Investigation of urinary volatile organic compounds as novel diagnostic and surveillance biomarkers of bladder cancer. Br J Cancer 2022; 127:329-336. [PMID: 35352020 PMCID: PMC9296481 DOI: 10.1038/s41416-022-01785-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The diagnosis and surveillance of urothelial bladder cancer (UBC) require cystoscopy. There is a need for biomarkers to reduce the frequency of cystoscopy in surveillance; urinary volatile organic compound (VOC) analysis could fulfil this role. This cross-sectional study compared the VOC profiles of patients with and without UBC, to investigate metabolomic signatures as biomarkers. METHODS Urine samples were collected from haematuria clinic patients undergoing diagnostic cystoscopy and UBC patients undergoing surveillance. Urinary headspace sampling utilised solid-phase microextraction and VOC analysis applied gas chromatography-mass spectrometry; the output underwent metabolomic analysis. RESULTS The median participant age was 70 years, 66.2% were male. Of the haematuria patients, 21 had a new UBC diagnosis, 125 had no cancer. In the surveillance group, 75 had recurrent UBC, 84 were recurrence-free. A distinctive VOC profile was observed in UBC patients compared with controls. Ten VOCs had statistically significant abundances useful to classify patients (false discovery rate range 1.9 × 10-7-2.8 × 10-2). Two prediction models were evaluated using internal validation. An eight-VOC diagnostic biomarker panel achieved AUROC 0.77 (sensitivity 0.71, specificity 0.72). A six-VOC surveillance biomarker panel obtained AUROC 0.80 (sensitivity 0.71 and specificity 0.80). CONCLUSIONS Urinary VOC analysis could aid the diagnosis and surveillance of UBC.
Collapse
Affiliation(s)
- Lauren Lett
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GE, UK
| | - Michael George
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GE, UK
- School of Medicine, Cedar House, University of Liverpool, Liverpool, L69 3GE, UK
| | - Rachael Slater
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GE, UK
| | - Ben De Lacy Costello
- Centre of Research in Biosciences, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, UK
| | - Norman Ratcliffe
- Centre of Research in Biosciences, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, UK
| | - Marta García-Fiñana
- Department of Health Data Science, University of Liverpool, Liverpool, L69 3GE, UK
| | - Henry Lazarowicz
- Department of Urology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Trust, Liverpool, L7 8XP, UK
| | - Chris Probert
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GE, UK.
| |
Collapse
|
7
|
De Pablo-Fernandez E, Gebeyehu GG, Flain L, Slater R, Frau A, Ijaz UZ, Warner T, Probert C. The faecal metabolome and mycobiome in Parkinson's disease. Parkinsonism Relat Disord 2022; 95:65-69. [PMID: 35045378 DOI: 10.1016/j.parkreldis.2022.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/07/2021] [Accepted: 01/07/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gut fungal composition and its metabolites have not been assessed simultaneously in Parkinson's disease (PD) despite their potential pathogenic contribution. OBJECTIVE To evaluate the faecal metabolome and mycobiome in PD by assessing volatile organic compounds (VOCs) and fungal rRNA. METHODS Faecal VOCs from 35 PD patients and two control groups (n = 35; n = 15) were assessed using gas chromatography and mass spectrometry. DNA was extracted from 44 samples: 18S rRNA gene amplicons were prepared and sequenced. Metabolomics, mycobiome and integrated analyses were performed. RESULTS Several VOCs were more abundant and short chain fatty acids were less abundant in PD. Hanseniaspora, Kazachstania, uncultured Tremellaceae and Penicillium genera were more abundant, and Saccharomyces less abundant in PD (FDR<0.0007). Torulaspora was associated with PD and two VOCs. CONCLUSION PD patients had a distinct metabolome and mycobiome suggesting that fungal dysbiosis may contribute to PD pathogenesis.
Collapse
Affiliation(s)
- Eduardo De Pablo-Fernandez
- Reta Lila Weston Institute of Neurological Studies and Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, WC1N 1PJ, London, United Kingdom.
| | - Gerum Gashaw Gebeyehu
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, The Henry Wellcome Laboratory, Nuffield Building, Crown Street, L69 3GE, Liverpool, United Kingdom.
| | - Luke Flain
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, The Henry Wellcome Laboratory, Nuffield Building, Crown Street, L69 3GE, Liverpool, United Kingdom
| | - Rachael Slater
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, The Henry Wellcome Laboratory, Nuffield Building, Crown Street, L69 3GE, Liverpool, United Kingdom
| | - Alessandra Frau
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, The Henry Wellcome Laboratory, Nuffield Building, Crown Street, L69 3GE, Liverpool, United Kingdom
| | - Umer Zeeshan Ijaz
- James Watt School of Engineering, University of Glasgow, Rankine Building, Oakfield Avenue, G12 8QQ, Glasgow, United Kingdom
| | - Thomas Warner
- Reta Lila Weston Institute of Neurological Studies and Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, WC1N 1PJ, London, United Kingdom
| | - Chris Probert
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, The Henry Wellcome Laboratory, Nuffield Building, Crown Street, L69 3GE, Liverpool, United Kingdom
| |
Collapse
|
8
|
Akbar A, Arnott I, Kennedy NA, Nolan J, Peake S, Whiteoak SR, Probert C, Fraser A, Cheshire A, Lewis A, Sugrue K, Laird S, Scott G. Recommendations for the optimal use of mesalazine in the management of patients with mild to moderate ulcerative colitis. Br J Hosp Med (Lond) 2021; 82:1-11. [PMID: 34726945 DOI: 10.12968/hmed.2021.0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The 2021 National report from IBD UK included responses from over 10 000 patients with inflammatory bowel disease, over 70% of whom reported having at least one flare in the last 12 months. As the first-line treatment for patients with mild and moderate ulcerative colitis, the action and delivery mechanisms of mesalazine are crucial for successful management of the disease. The choice of the most appropriate formulation of mesalazine and securing patient concordance and adherence to treatment remains a challenge for healthcare professionals. This article details the outcome of a roundtable discussion involving a group of gastroenterology consultants and specialist nurses which considered the importance of ensuring that patients have individualised mesalazine therapy before escalation to other treatments and gives recommendations for the management of patients with mild or moderate ulcerative colitis.
Collapse
Affiliation(s)
- Ayesha Akbar
- Consultant Gastroenterologist, St Marks Hospital, Harrow, Middlesex, UK
| | - Ian Arnott
- Consultant Gastroenterologist, Western General Hospital, Edinburgh, UK
| | - Nicholas A Kennedy
- Consultant Gastroenterologist, Royal Devon & Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Jonathan Nolan
- Consultant Gastroenterologist, Kingston Hospital, Kingston Upon Thames, UK
| | - Simon Peake
- Consultant Gastroenterologist, Imperial College Healthcare NHS Trust, London, UK
| | - Simon R Whiteoak
- Consultant Gastroenterologist, University Hospitals Dorset, Bournemouth, UK
| | - Chris Probert
- Professor of Gastroenterology, University of Liverpool, Liverpool, UK
| | - Aileen Fraser
- IBD Advanced Clinical Practitioner, University Hospitals Bristol & Weston, UK
| | - Alex Cheshire
- Day Case Unit/Endoscopy Nurse Team Lead, Queen Mary's Hospital, St George's University Hospital Trust, London, UK
| | - Allyson Lewis
- IBD Specialist Nurse, Royal Gwent Hospital, Newport, UK
| | - Kathleen Sugrue
- Advanced Nurse Practitioner, Mercy University Hospital, Cork, Ireland
| | - Susan Laird
- IBD Clinical Nurse Specialist Team Lead, Queen Elizabeth University Hospital, Glasgow, UK
| | - Glyn Scott
- Consultant Nurse Gastroenterology/Endoscopy/IBD, East Kent Hospital, Canterbury, UK
| |
Collapse
|
9
|
Frau A, Lett L, Slater R, Young GR, Stewart CJ, Berrington J, Hughes DM, Embleton N, Probert C. The Stool Volatile Metabolome of Pre-Term Babies. Molecules 2021; 26:3341. [PMID: 34199338 PMCID: PMC8199543 DOI: 10.3390/molecules26113341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
The fecal metabolome in early life has seldom been studied. We investigated its evolution in pre-term babies during their first weeks of life. Multiple (n = 152) stool samples were studied from 51 babies, all <32 weeks gestation. Volatile organic compounds (VOCs) were analyzed by headspace solid phase microextraction gas chromatography mass spectrometry. Data were interpreted using Automated Mass Spectral Deconvolution System (AMDIS) with the National Institute of Standards and Technology (NIST) reference library. Statistical analysis was based on linear mixed modelling, the number of VOCs increased over time; a rise was mainly observed between day 5 and day 10. The shift at day 5 was associated with products of branched-chain fatty acids. Prior to this, the metabolome was dominated by aldehydes and acetic acid. Caesarean delivery showed a modest association with molecules of fungal origin. This study shows how the metabolome changes in early life in pre-term babies. The shift in the metabolome 5 days after delivery coincides with the establishment of enteral feeding and the transition from meconium to feces. Great diversity of metabolites was associated with being fed greater volumes of milk.
Collapse
Affiliation(s)
- Alessandra Frau
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 3GE, UK; (L.L.); (R.S.); (C.P.)
| | - Lauren Lett
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 3GE, UK; (L.L.); (R.S.); (C.P.)
| | - Rachael Slater
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 3GE, UK; (L.L.); (R.S.); (C.P.)
| | - Gregory R. Young
- Hub for Biotechnology in the Built Environment, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Christopher J. Stewart
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 8ST, UK; (C.J.S.); (J.B.)
| | - Janet Berrington
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 8ST, UK; (C.J.S.); (J.B.)
- Department of Neonatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 8ST, UK;
| | - David M. Hughes
- Department of Health Data Science, University of Liverpool, Liverpool, Merseyside L69 3GA, UK;
| | - Nicholas Embleton
- Department of Neonatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 8ST, UK;
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 8ST, UK
| | - Chris Probert
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 3GE, UK; (L.L.); (R.S.); (C.P.)
| |
Collapse
|
10
|
Coyle S, Chapman E, Baker J, Coleman H, Norman B, Hughes D, Davison A, Mason S, Boyd M, Ellershaw JE, Probert C. Predicting dying from lung cancer: Urine metabolites predict the last weeks and days of life. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12030 Background: Recognising dying is difficult. We believe there is a predictable biological process to dying and previously demonstrated that urinary volatile organic compounds change in the last weeks and days of life of patients with lung cancer. We further analysed our urine samples using a different metabolomic platform, Liquid Chromatography QTOF Mass Spectrometry (LC-QTOF-MS). Methods: We prospectively collected urine samples from people with lung cancer many of whom were in the last 4 weeks of life. The samples were analysed using a LC-QTOF-MS. Volcano plots identified metabolites that changed 2 fold for different time periods (0-28 days, 0-14 days, 0-7days, 0-5 days and 0-3 days). All metabolites were also grouped into weeks. A One-way ANOVA between the groups identified metabolites that changed significantly. Cox regression with Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was used to analyse the data and create a statistical model. Results: 234 urine samples from 112 patients were analysed by LC-QTOF-MS. 90 metabolites were identified that increase or decrease in the last weeks or days. Pathway Analysis using MetaboAnalyst demonstrated a number of biochemical pathways affected during different time intervals; 0-2 weeks and 0-3 days before death. Cox LASSO regression analysis was performed for the last 28 days. A model using 21 metabolites, prognosticates for each day in the last 28 days with high AUC values (88-90%). Patients can be categorized into high, medium and low risk of death. A Kaplan-Meier survival analysis demonstrated the groups were well separated. Conclusions: The results confirm urine metabolites predict when people with lung cancer are in the last weeks and days of life. Our model, using 21 metabolites, prognosticates for each of the last 28 days of life and is approximately 88% -90% accurate. This is the only model able to prognosticate for the last week or days of life.
Collapse
Affiliation(s)
| | | | - James Baker
- University of Liverpool, Liverpool, United Kingdom
| | | | | | - David Hughes
- University of Liverpool, Liverpool, United Kingdom
| | - Andrew Davison
- Liverpool University Hospitals Trust, Liverpool, United Kingdom
| | | | - Mark Boyd
- University of Liverpool, Liverpool, United Kingdom
| | - John E Ellershaw
- Marie Curie Palliative Care Institute, Liverpool, United Kingdom
| | | |
Collapse
|
11
|
Slater R, Frau A, Hodgkinson J, Archer D, Probert C. A Comparison of the Colonic Microbiome and Volatile Organic Compound Metabolome of Anoplocephala perfoliata Infected and Non-Infected Horses: A Pilot Study. Animals (Basel) 2021; 11:ani11030755. [PMID: 33803473 PMCID: PMC7999024 DOI: 10.3390/ani11030755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary In horses, tapeworm infection is associated with specific forms of colic (abdominal pain) that can be life-threatening without surgical treatment. There is growing evidence that intestinal parasites interact with the gut bacteria, and the consequences of these interactions may influence the ability of the host to resist infection and parasite-associated disease. We aimed to compare the intestinal bacteria and the gases produced by metabolic processes in the gut between horses that had varying levels of tapeworms and those with no tapeworm present. Overall, the diversity of gut bacteria was similar in horses with and without tapeworms. There were some decreases in beneficial bacteria in horses with tapeworms, indicating a possible negative consequence of infection. Intestinal gases correlated with some bacteria indicating their functionality and use as potential markers of active bacteria. Our study validates further research investigating tapeworm and gut bacteria interactions in the horse. Abstract Anoplocephala perfoliata is a common equine tapeworm associated with an increased risk of colic (abdominal pain) in horses. Identification of parasite and intestinal microbiota interactions have consequences for understanding the mechanisms behind parasite-associated colic and potential new methods for parasite control. A. perfoliata was diagnosed by counting of worms in the caecum post-mortem. Bacterial DNA was extracted from colonic contents and sequenced targeting of the 16S rRNA gene (V4 region). The volatile organic compound (VOC) metabolome of colonic contents was characterised using gas chromatography mass spectrometry. Bacterial diversity (alpha and beta) was similar between tapeworm infected and non-infected controls. Some compositional differences were apparent with down-regulation of operational taxonomic units (OTUs) belonging to the symbiotic families of Ruminococcaceae and Lachnospiraceae in the tapeworm-infected group. Overall tapeworm burden accounted for 7–8% of variation in the VOC profile (permutational multivariate analysis of variance). Integration of bacterial OTUs and VOCs demonstrated moderate to strong correlations indicating the potential of VOCs as markers for bacterial OTUs in equine colonic contents. This study has shown potential differences in the intestinal microbiome and metabolome of A. perfoliata infected and non-infected horses. This pilot study did not control for extrinsic factors including diet, disease history and stage of infection.
Collapse
Affiliation(s)
- Rachael Slater
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 3GE, UK; (A.F.); (C.P.)
- Correspondence:
| | - Alessandra Frau
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 3GE, UK; (A.F.); (C.P.)
| | - Jane Hodgkinson
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Leahurst Campus, Chester High Road, Wirral CH64 7TE, UK; (J.H.); (D.A.)
| | - Debra Archer
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Leahurst Campus, Chester High Road, Wirral CH64 7TE, UK; (J.H.); (D.A.)
| | - Chris Probert
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 3GE, UK; (A.F.); (C.P.)
| |
Collapse
|
12
|
Lloyd K, Papoutsopoulou S, Smith E, Stegmaier P, Bergey F, Morris L, Kittner M, England H, Spiller D, White MHR, Duckworth CA, Campbell BJ, Poroikov V, Martins Dos Santos VAP, Kel A, Muller W, Pritchard DM, Probert C, Burkitt MD. Using systems medicine to identify a therapeutic agent with potential for repurposing in inflammatory bowel disease. Dis Model Mech 2020; 13:dmm044040. [PMID: 32958515 PMCID: PMC7710021 DOI: 10.1242/dmm.044040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 09/08/2020] [Indexed: 12/11/2022] Open
Abstract
Inflammatory bowel diseases (IBDs) cause significant morbidity and mortality. Aberrant NF-κB signalling is strongly associated with these conditions, and several established drugs influence the NF-κB signalling network to exert their effect. This study aimed to identify drugs that alter NF-κB signalling and could be repositioned for use in IBD. The SysmedIBD Consortium established a novel drug-repurposing pipeline based on a combination of in silico drug discovery and biological assays targeted at demonstrating an impact on NF-κB signalling, and a murine model of IBD. The drug discovery algorithm identified several drugs already established in IBD, including corticosteroids. The highest-ranked drug was the macrolide antibiotic clarithromycin, which has previously been reported to have anti-inflammatory effects in aseptic conditions. The effects of clarithromycin effects were validated in several experiments: it influenced NF-κB-mediated transcription in murine peritoneal macrophages and intestinal enteroids; it suppressed NF-κB protein shuttling in murine reporter enteroids; it suppressed NF-κB (p65) DNA binding in the small intestine of mice exposed to lipopolysaccharide; and it reduced the severity of dextran sulphate sodium-induced colitis in C57BL/6 mice. Clarithromycin also suppressed NF-κB (p65) nuclear translocation in human intestinal enteroids. These findings demonstrate that in silico drug repositioning algorithms can viably be allied to laboratory validation assays in the context of IBD, and that further clinical assessment of clarithromycin in the management of IBD is required.This article has an associated First Person interview with the joint first authors of the paper.
Collapse
Affiliation(s)
- Katie Lloyd
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool L69 3GE, UK
| | - Stamatia Papoutsopoulou
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool L69 3GE, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Emily Smith
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | | | | | | | | | - Hazel England
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Dave Spiller
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Mike H R White
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Carrie A Duckworth
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool L69 3GE, UK
| | - Barry J Campbell
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool L69 3GE, UK
| | | | | | | | - Werner Muller
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - D Mark Pritchard
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool L69 3GE, UK
| | - Chris Probert
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool L69 3GE, UK
| | - Michael D Burkitt
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool L69 3GE, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| |
Collapse
|
13
|
Aggarwal P, Baker J, Boyd MT, Coyle S, Probert C, Chapman EA. Optimisation of Urine Sample Preparation for Headspace-Solid Phase Microextraction Gas Chromatography-Mass Spectrometry: Altering Sample pH, Sulphuric Acid Concentration and Phase Ratio. Metabolites 2020; 10:metabo10120482. [PMID: 33255680 PMCID: PMC7760603 DOI: 10.3390/metabo10120482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
Headspace-solid phase microextraction gas chromatography-mass spectrometry (HS-SPME-GC-MS) can be used to measure volatile organic compounds (VOCs) in human urine. However, there is no widely adopted standardised protocol for the preparation of urine samples for analysis resulting in an inability to compare studies reliably between laboratories. This paper investigated the effect of altering urine sample pH, volume, and vial size for optimising detection of VOCs when using HS-SPME-GC-MS. This is the first, direct comparison of H2SO4, HCl, and NaOH as treatment techniques prior to HS-SPME-GC-MS analysis. Altering urine sample pH indicates that H2SO4 is more effective at optimising detection of VOCs than HCl or NaOH. H2SO4 resulted in a significantly larger mean number of VOCs being identified per sample (on average, 33.5 VOCs to 24.3 in HCl or 12.2 in NaOH treated urine) and more unique VOCs, produced a more diverse range of classes of VOCs, and led to less HS-SPME-GC-MS degradation. We propose that adding 0.2 mL of 2.5 M H2SO4 to 1 mL of urine within a 10 mL headspace vial is the optimal sample preparation prior to HS-SPME-GC-MS analysis. We hope the use of our optimised method for urinary HS-SPME-GC-MS analysis will enhance our understanding of human disease and bolster metabolic biomarker identification.
Collapse
Affiliation(s)
- Prashant Aggarwal
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK; (P.A.); (J.B.); (C.P.)
- School of Medicine, Cedar House, University of Liverpool, Liverpool L69 3GE, UK
| | - James Baker
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK; (P.A.); (J.B.); (C.P.)
- School of Medicine, Cedar House, University of Liverpool, Liverpool L69 3GE, UK
| | - Mark T. Boyd
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, Cancer Research Centre, University of Liverpool, Liverpool L3 9TA, UK;
| | - Séamus Coyle
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, Liverpool L3 9TA, UK;
- Clatterbridge Cancer Centre, Liverpool L7 8YA, UK
| | - Chris Probert
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK; (P.A.); (J.B.); (C.P.)
| | - Elinor A. Chapman
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK; (P.A.); (J.B.); (C.P.)
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, Liverpool L3 9TA, UK;
- School of Medical Sciences, Bangor University, Bangor, Gwynedd LL57 2DG, UK
- Correspondence:
| |
Collapse
|
14
|
Ahmed A, Slater R, Lewis S, Probert C. Using Volatile Organic Compounds to Investigate the Effect of Oral Iron Supplementation on the Human Intestinal Metabolome. Molecules 2020; 25:molecules25215113. [PMID: 33153225 PMCID: PMC7662922 DOI: 10.3390/molecules25215113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with iron deficiency anaemia are treated with oral iron supplementation, which is known to cause gastrointestinal side effects by likely interacting with the gut microbiome. To better study this impact on the microbiome, we investigated oral iron-driven changes in volatile organic compounds (VOCs) in the faecal metabolome. Stool samples from patients with iron deficiency anaemia were collected pre- and post-treatment (n = 45 and 32, respectively). Faecal headspace gas analysis was performed by gas chromatography–mass spectrometry and the changes in VOCs determined. We found that the abundance of short-chain fatty acids and esters fell, while aldehydes increased, after treatment. These changes in pre- vs. post-iron VOCs resemble those reported when the gut is inflamed. Our study shows that iron changes the intestinal metabolome, we suggest by altering the structure of the gut microbial community.
Collapse
Affiliation(s)
- Ammar Ahmed
- The Henry Wellcome Laboratory, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK; (A.A.); (R.S.)
| | - Rachael Slater
- The Henry Wellcome Laboratory, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK; (A.A.); (R.S.)
| | - Stephen Lewis
- Department of Gastroenterology, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK;
| | - Chris Probert
- The Henry Wellcome Laboratory, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK; (A.A.); (R.S.)
- Correspondence: ; Tel.: +44-(0)-151-795-4010
| |
Collapse
|
15
|
Din S, Kent A, Pollok RC, Meade S, Kennedy NA, Arnott I, Beattie RM, Chua F, Cooney R, Dart RJ, Galloway J, Gaya DR, Ghosh S, Griffiths M, Hancock L, Hansen R, Hart A, Lamb CA, Lees CW, Limdi JK, Lindsay JO, Patel K, Powell N, Murray CD, Probert C, Raine T, Selinger C, Sebastian S, Smith PJ, Tozer P, Ustianowski A, Younge L, Samaan MA, Irving PM. Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic: a RAND appropriateness panel. Gut 2020; 69:1769-1777. [PMID: 32513653 PMCID: PMC7299646 DOI: 10.1136/gutjnl-2020-321927] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Management of acute severe UC (ASUC) during the novel COVID-19 pandemic presents significant dilemmas. We aimed to provide COVID-19-specific guidance using current British Society of Gastroenterology (BSG) guidelines as a reference point. DESIGN We convened a RAND appropriateness panel comprising 14 gastroenterologists and an IBD nurse consultant supplemented by surgical and COVID-19 experts. Panellists rated the appropriateness of interventions for ASUC in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Median scores and disagreement index (DI) were calculated. Results were discussed at a moderated meeting prior to a second survey. RESULTS Panellists recommended that patients with ASUC should be isolated throughout their hospital stay and should have a SARS-CoV-2 swab performed on admission. Patients with a positive swab should be discussed with COVID-19 specialists. As per BSG guidance, intravenous hydrocortisone was considered appropriate as initial management; only in patients with COVID-19 pneumonia was its use deemed uncertain. In patients requiring rescue therapy, infliximab with continuing steroids was recommended. Delaying colectomy because of COVID-19 was deemed inappropriate. Steroid tapering as per BSG guidance was deemed appropriate for all patients apart from those with COVID-19 pneumonia in whom a 4-6 week taper was preferred. Post-ASUC maintenance therapy was dependent on SARS-CoV-2 status but, in general, biologics were more likely to be deemed appropriate than azathioprine or tofacitinib. Panellists deemed prophylactic anticoagulation postdischarge to be appropriate in patients with a positive SARS-CoV-2 swab. CONCLUSION We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel.
Collapse
Affiliation(s)
- Shahida Din
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
- Gastroenterology and Hepatology Unit, University of Edinburgh, Edinburgh, UK
| | - Alexandra Kent
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust, London, UK
- Institute of Infection and Immunity, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Susanna Meade
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter IBD Research Group, University of Exeter, Exeter, UK
| | - Ian Arnott
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Rachel Cooney
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Robin J Dart
- Department of Gastroenterology, Royal Free Hospital, London, UK
| | - James Galloway
- Department of Rheumatology, King's College Hospital, London, UK
| | - Daniel R Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Subrata Ghosh
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mark Griffiths
- Peri-operative Medicine, Barts Health NHS Trust, London, UK
- Faculty of Medicine, National Heart and Lung Institute, London, UK
| | - Laura Hancock
- Department of General Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Hansen
- Paediatric Gastroenterology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Ailsa Hart
- IBD Unit, St Mark's Hospital, London, UK
- Antigen Presentation Research Group, Imperial College London, London, UK
| | - Christopher Andrew Lamb
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - James O Lindsay
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Kamal Patel
- Department of Gastroenterology, St George's Healthcare NHS Trust, London, UK
| | - Nick Powell
- Division of Digestive Diseases, Imperial College London, London, UK
| | | | - Chris Probert
- Gastroenterology Research Unit, Department of Cellular and Molecular Physiology, University of Liverpool Institute of Translational Medicine, Liverpool, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Department of Immunuology and Inflammation, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Phil Tozer
- IBD Unit, St Mark's Hospital, London, UK
| | - Andrew Ustianowski
- Department of Infectious Disease, North Manchester General Hospital, Manchester, UK
| | - Lisa Younge
- IBD Unit, St Mark's Hospital, London, UK
- Crohn's and Colitis UK, Saint Albans, UK
| | - Mark A Samaan
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| |
Collapse
|
16
|
Qualter P, Rouncefield-Swales A, Bray L, Blake L, Allen S, Probert C, Crook K, Carter B. Depression, anxiety, and loneliness among adolescents and young adults with IBD in the UK: the role of disease severity, age of onset, and embarrassment of the condition. Qual Life Res 2020; 30:497-506. [PMID: 32997335 PMCID: PMC7886765 DOI: 10.1007/s11136-020-02653-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/23/2022]
Abstract
Purpose Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) report higher depressive symptoms and anxiety compared to healthy controls, with disease severity and abdominal pain being important factors. In the current study, building on what young people had told us in our previous work, we examined whether embarrassment of the condition, social self-efficacy, and friendship quality mediated the relationship between abdominal pain and disease severity, and mental health/well-being. We also included loneliness as a component of well-being. Methods Data on depression, anxiety, loneliness, friendship quality, social self-efficacy, and disease embarrassment were collected from 130 AYA with IBD ages 14–25 years; data on disease severity and abdominal pain were taken from their medical records. Structural Equation Modeling (SEM) was used to test the relationships between the variables. Results Using SEM, we established that higher IBD disease activity negatively impacted how AYA felt about their friendships and how embarrassed they were about their condition; embarrassment then influenced reports of mental health, including loneliness. Abdominal pain, disease onset, and social self-efficacy directly predicted internalising problems. Conclusion In this sample of 14–25-year-old patients with IBD, specifics about the disease (severity and pain) predicted poorer mental health, suggesting discussion of mental health should be part of the clinical dialogue between patient and consultant. In addition, embarrassment about their condition increased depression, anxiety, and loneliness, mediating the relationship between disease severity and well-being. Thus, it is important to consider how perceived stigma affects those with chronic illness, and those issues should be explored in clinic.
Collapse
Affiliation(s)
- Pamela Qualter
- Institute of Education, University of Manchester, Manchester Oxford Road, Manchester, M13 9PL, UK.
| | - Alison Rouncefield-Swales
- Children, Young People and Families, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK
| | - Lucy Bray
- Children, Young People and Families, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK
| | - Lucy Blake
- Children, Young People and Families, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK
| | - Steven Allen
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Chris Probert
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kay Crook
- St Marks & Northwick Park, London North West University Healthcare NHS Trust, London, UK
| | - Bernie Carter
- Children, Young People and Families, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK.
| |
Collapse
|
17
|
Affiliation(s)
- Thomas E Conley
- Department of Gastroenterology, Liverpool University Foundation Hospitals NHS Trust, Liverpool, UK
| | - Chris Probert
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool
| | - Sreedhar Subramanian
- Department of Gastroenterology, Liverpool University Foundation Hospitals NHS Trust, Liverpool, UK,Corresponding author: Sreedhar Subramanian, MD, MRCP, Consultant Gastroenterologist and Honorary Senior Lecturer, epartment of Gastroenterology, Liverpool University Hospital Foundation NHS Trust and University of Liverpool, Prescot Street, Liverpool L7 8XP, UK,
| |
Collapse
|
18
|
Probert C, Greenwood R, Mayor A, Hughes D, Aggio R, Jackson RE, Simcox L, Barrow H, García-Finana M, Ewer AK. Faecal volatile organic compounds in preterm babies at risk of necrotising enterocolitis: the DOVE study. Arch Dis Child Fetal Neonatal Ed 2020; 105:474-479. [PMID: 31871055 DOI: 10.1136/archdischild-2019-318221] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Early diagnosis of necrotising enterocolitis (NEC) may improve prognosis but there are no proven biomarkers. OBJECTIVE To investigate changes in faecal volatile organic compounds (VOCs) as potential biomarkers for NEC. DESIGN Multicentre prospective study. SETTINGS 8 UK neonatal units. PATIENTS Preterm infants <34 weeks gestation. METHODS Daily faecal samples were collected prospectively from 1326 babies of whom 49 subsequently developed definite NEC. Faecal samples from 32 NEC cases were compared with samples from frequency-matched controls without NEC. Headspace, solid phase microextraction gas chromatography/mass spectrometry was performed and VOCs identified from reference libraries. VOC samples from cases and controls were compared using both discriminant and factor analysis methods. RESULTS VOCs were found to cluster into nine groups (factors), three were associated with NEC and indicated the possibility of disease up to 3-4 days before the clinical diagnosis was established. For one factor, a 1 SD increase increased the odds of developing NEC by 1.6 times; a similar decrease of the two other factors was associated with a reduced risk (OR 0.5 or 0.7, respectively). Discriminant analyses identified five individual VOCs, which are associated with NEC in babies at risk, each with an area under the receiver operating characteristics curve of 0.75-0.76, up to 4 days before the clinical diagnosis was made. CONCLUSIONS Faecal VOCs are altered in preterm infants with NEC. These data are currently insufficient to enable reliable cotside detection of babies at risk of developing NEC and further work is needed investigate the role of VOCs in clarifying the aetiology of NEC.
Collapse
Affiliation(s)
- Chris Probert
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Rosemary Greenwood
- Department of Research and Innovation, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arno Mayor
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - David Hughes
- Department of Biostatistics, Institute of Translation Medicine, University of Liverpool, Liverpool, UK
| | - Raphael Aggio
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Liz Simcox
- Neonatal Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Heather Barrow
- Neonatal Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Marta García-Finana
- Department of Biostatistics, Institute of Translation Medicine, University of Liverpool, Liverpool, UK
| | - Andrew K Ewer
- Neonatal Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK .,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, Universityof Birmingham, Birmingham, UK
| |
Collapse
|
19
|
Townsend T, Probert C. Editorial: peristomal pyoderma gangrenosum-a challenge for patients, healthcare professionals and research. Aliment Pharmacol Ther 2020; 52:404-405. [PMID: 32592244 DOI: 10.1111/apt.15822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Tristan Townsend
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Chris Probert
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
20
|
Affiliation(s)
- Chris Probert
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
21
|
Townsend T, Campbell F, O’Toole P, Probert C. Microscopic colitis: diagnosis and management. Frontline Gastroenterol 2019; 10:388-393. [PMID: 31656564 PMCID: PMC6788131 DOI: 10.1136/flgastro-2018-101040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 02/04/2023] Open
Abstract
Microscopic colitis (MC) is a common cause of chronic, non-bloody, watery diarrhoea in older patients. The diagnosis depends on characteristic histological findings. Bile acid malabsorption and autoimmune conditions, including coeliac disease, are more frequently found in patients with MC, but colorectal neoplasia and mortality are not increased. Non-steroidal anti-inflammatory drugs, proton-pump inhibitors, selective serotonin reuptake inhibitors and smoking tobacco confer an increased risk of developing MC. Although a so-called benign disease, which rarely causes serious complications, it does have an impact on the quality of life. Several treatment options exist, but budesonide is the only treatment proven in randomised-controlled trials to be effective and safe for induction and maintenance of remission. This article provides a practical overview for the gastroenterologist looking after patients with MC.
Collapse
Affiliation(s)
- Tristan Townsend
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Fiona Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK
| | - Paul O’Toole
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Chris Probert
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
22
|
Salem SE, Hough R, Probert C, Maddox TW, Antczak P, Ketley JM, Williams NJ, Stoneham SJ, Archer DC. A longitudinal study of the faecal microbiome and metabolome of periparturient mares. PeerJ 2019; 7:e6687. [PMID: 30976468 PMCID: PMC6451438 DOI: 10.7717/peerj.6687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background Periparturient mares are at increased risk of colic including large colon volvulus, which has a high mortality rate. Alterations in colonic microbiota related to either physiological or management changes, or both, that occur at this time have been suggested as potential causes for increased colic risk in this population of horses. Although the effect of management changes on the horse faecal microbiota has been investigated, limited work has been conducted to investigate changes in faecal microbiota structure and function in the periparturient period. The objectives of the current study were to investigate temporal stability of the faecal microbiota and volatile organic compounds (VOCs) of the faecal metabolome in periparturient mares. Methods Faecal samples were collected weekly from five pregnant mares from 3 weeks pre-foaling to 7 weeks post-foaling. The microbiome data was generated by PCR amplification and sequencing of the V1–V2 regions of the bacterial 16S rRNA genes, while the VOC profile was characterised using headspace solid phase microextraction gas chromatography mass spectrometry. Results The mare faecal microbiota was relatively stable over the periparturient period and most variation was associated with individual mares. A small number of operational taxonomic units were found to be significantly differentially abundant between samples collected before and after foaling. A total of 98 VOCs were identified. The total number of VOCs did not vary significantly between individual mares, weeks of sample collection and feeds available to the mares. Three VOCs (decane, 2-pentylfuran, and oct-2-ene) showed significant increase overtime on linear mixed effects modelling analysis. These results suggest that the mare faecal microbiota is structurally and functionally stable during the periparturient period. The findings also suggest that if changes in the gut microbiota are related to development of colic postpartum, altered risk may be due to inherent differences between individual mares. VOCs offer a cost-effective means of looking at the functional changes in the microbiome and warrant further investigation in mares at risk of colic.
Collapse
Affiliation(s)
- Shebl E Salem
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst campus, Wirral, UK.,Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Al Sharquiya, Egypt
| | - Rachael Hough
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Chris Probert
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Thomas W Maddox
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Philipp Antczak
- Computational Biology Facility, Institute of Integrative Biology, University of Liverpool, Liverpool, UK
| | - Julian M Ketley
- Department of Genetics and Genome Biology, College of Life Sciences, University of Leicester, Leicester, UK
| | - Nicola J Williams
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst campus, Wirral, UK
| | | | - Debra C Archer
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst campus, Wirral, UK
| |
Collapse
|
23
|
Bond A, Greenwood R, Lewis S, Corfe B, Sarkar S, O'Toole P, Rooney P, Burkitt M, Hold G, Probert C. Volatile organic compounds emitted from faeces as a biomarker for colorectal cancer. Aliment Pharmacol Ther 2019; 49:1005-1012. [PMID: 30828825 PMCID: PMC6593415 DOI: 10.1111/apt.15140] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/23/2018] [Accepted: 12/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colorectal cancer remains a leading cause of mortality and morbidity. The UK Bowel Cancer Screening Programme (BCSP) has demonstrated that detection of colorectal cancer at an earlier stage and identification of advanced pre-malignant adenomas reduces mortality and morbidity. AIM To assess the utility of volatile organic compounds as a biomarker for colorectal neoplasia. METHODS Faeces were collected from symptomatic patients and people participating in the UK BCSP, prior to colonoscopy. Headspace extraction followed by gas chromatography mass spectrometry was performed on faeces to identify volatile organic compounds. Logistic regression modelling and 10-fold cross-validation were used to test potential biomarkers. RESULTS One hundred and thirty-seven participants were included (mean age 64 years [range 22-85], 54% were male): 60 had no neoplasia, 56 had adenomatous polyp(s) and 21 had adenocarcinoma. Propan-2-ol was significantly more abundant in the cancer samples (P < 0.0001, q = 0.004) with an area under ROC (AUROC) curve of 0.76. When combined with 3-methylbutanoic acid the AUROC curve was 0.82, sensitivity 87.9% (95% CI 0.87-0.99) and specificity 84.6% (95% CI 0.65-1.0). Logistic regression analysis using the presence/absence of specific volatile organic compounds, identified a three volatile organic compound panel (propan-2-ol, hexan-2-one and ethyl 3-methyl- butanoate) to have an AUROC of 0.73, with a person six times more likely to have cancer if all three volatile organic compounds were present (P < 0.0001). CONCLUSIONS Volatile organic compound analysis may have a superior diagnostic ability for the identification of colorectal adenocarcinoma, when compared to other faecal biomarkers, including those currently employed in UK. Clinical trial details: National Research Ethics Service Committee South West - Central Bristol (REC reference 14/SW/1162) with R&D approval from University of Liverpool and Broadgreen University Hospital Trust (UoL 001098).
Collapse
Affiliation(s)
- Ashley Bond
- Royal Liverpool and Broadgreen University Hospital TrustLiverpoolUK
| | - Rosemary Greenwood
- Research Design ServiceSchool of Social and Community MedicineUniversity of BristolBristolUK
| | | | - Bernard Corfe
- Molecular Gastroenterology Research GroupDepartment of OncologyUniversity of SheffieldSheffieldUK,Insigneo Institute for in silico MedicineUniversity of SheffieldSheffieldUK
| | - Sanchoy Sarkar
- Royal Liverpool and Broadgreen University Hospital TrustLiverpoolUK
| | - Paul O'Toole
- Royal Liverpool and Broadgreen University Hospital TrustLiverpoolUK
| | - Paul Rooney
- Royal Liverpool and Broadgreen University Hospital TrustLiverpoolUK
| | - Michael Burkitt
- Royal Liverpool and Broadgreen University Hospital TrustLiverpoolUK,Gastroenterology Research UnitDepartment of Molecular and Cellular PhysiologyInstitute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| | - Georgina Hold
- Microbiome Research CentreSt George & Sutherland Clinical SchoolUNSWSydneyNSWAustralia
| | - Chris Probert
- Royal Liverpool and Broadgreen University Hospital TrustLiverpoolUK,Gastroenterology Research UnitDepartment of Molecular and Cellular PhysiologyInstitute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
24
|
Bond A, Probert C. Editorial: metabolomic biomarkers for colorectal adenocarcinoma and in the differentiation between irritable bowel syndrome and ulcerative colitis in clinical remission - confounded by the gut microbiome? Authors' reply. Aliment Pharmacol Ther 2019; 49:1087-1088. [PMID: 30920048 DOI: 10.1111/apt.15196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ashley Bond
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | |
Collapse
|
25
|
Miehlke S, Acosta MBD, Bouma G, Carpio D, Magro F, Moreels T, Probert C. Oral budesonide in gastrointestinal and liver disease: A practical guide for the clinician. J Gastroenterol Hepatol 2018; 33:1574-1581. [PMID: 29603368 DOI: 10.1111/jgh.14151] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/26/2018] [Accepted: 03/17/2018] [Indexed: 01/10/2023]
Abstract
Oral budesonide is a second-generation steroid that allows local, selective treatment of the gastrointestinal tract and the liver, minimizing systemic exposure. The results of randomized trials comparing budesonide versus placebo or active comparators have led to expert recommendations that budesonide be used to treat mild or moderate active ileocecal Crohn's disease, microscopic colitis (including both collagenous and lymphocytic colitis), ulcerative colitis, and non-cirrhotic autoimmune hepatitis. The mechanism of budesonide action obviates the need for dose tapering due to safety reasons after induction therapy. Where low-dose budesonide is used to maintain remission, usually in microscopic colitis, it does not appear to have adverse safety implications other than slight reductions in cortisol levels on rare occasions. As a gut-selective and liver-selective corticosteroid, budesonide offers an appealing alternative to conventional systemic glucocorticoids in diseases of these organs.
Collapse
Affiliation(s)
- Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany
| | - Manuel Barreiro-de Acosta
- Intestinal Inflammatory Disease Unit, Department of Gastroenterology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gerd Bouma
- Department of Gastroenterology, Vrije University Medical Center, Amsterdam, The Netherlands
| | - Daniel Carpio
- Digestive System Service, University Hospital of Pontevedra Complex, Pontevedra, Spain
| | - Fernando Magro
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Tom Moreels
- Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Chris Probert
- Department of Gastroenterology, Institute of Translational Medicine, Liverpool, UK
| |
Collapse
|
26
|
Kennedy NA, Lamb CA, Berry SH, Walker AW, Mansfield J, Parkes M, Simpkins R, Tremelling M, Nutland S, Parkhill J, Probert C, Hold GL, Lees CW. The Impact of NOD2 Variants on Fecal Microbiota in Crohn's Disease and Controls Without Gastrointestinal Disease. Inflamm Bowel Dis 2018; 24:583-592. [PMID: 29462388 PMCID: PMC6176884 DOI: 10.1093/ibd/izx061] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS Current models of Crohn's disease (CD) describe an inappropriate immune response to gut microbiota in genetically susceptible individuals. NOD2 variants are strongly associated with development of CD, and NOD2 is part of the innate immune response to bacteria. This study aimed to identify differences in fecal microbiota in CD patients and non-IBD controls stratified by NOD2 genotype. METHODS Patients with CD and non-IBD controls of known NOD2 genotype were identified from patients in previous UK IBD genetics studies and the Cambridge bioresource (genotyped/phenotyped volunteers). Individuals with known CD-associated NOD2 mutations were matched to those with wild-type genotype. We obtained fecal samples from patients in clinical remission with low fecal calprotectin (<250 µg/g) and controls without gastrointestinal disease. After extracting DNA, the V1-2 region of 16S rRNA genes were polymerase chain reaction (PCR)-amplified and sequenced. Analysis was undertaken using the mothur package. Volatile organic compounds (VOC) were also measured. RESULTS Ninety-one individuals were in the primary analysis (37 CD, 30 bioresource controls, and 24 household controls). Comparing CD with nonIBD controls, there were reductions in bacterial diversity, Ruminococcaceae, Rikenellaceae, and Christensenellaceae and an increase in Enterobacteriaceae. No significant differences could be identified in microbiota by NOD2 genotype, but fecal butanoic acid was higher in Crohn's patients carrying NOD2 mutations. CONCLUSIONS In this well-controlled study of NOD2 genotype and fecal microbiota, we identified no significant genotype-microbiota associations. This suggests that the changes associated with NOD2 genotype might only be seen at the mucosal level, or that environmental factors and prior inflammation are the predominant determinant of the observed dysbiosis in gut microbiota.
Collapse
Affiliation(s)
- Nicholas A Kennedy
- GI Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK,IBD Pharmacogenetics Group, University of Exeter, UK,Address correspondence to: Dr Nicholas Kennedy, IBD Pharmacogenetics Group, RILD South, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW. E-mail:
| | | | - Susan H Berry
- Gastrointestinal Research Group, University of Aberdeen, Aberdeen, UK
| | - Alan W Walker
- Pathogen Genomics Group, Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, UK,Microbiology Group, The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - John Mansfield
- Dept of Gastroenterology, Royal Victoria Infirmary, Newcastle, UK
| | - Miles Parkes
- Dept of Gastroenterology, Addenbrookes Hospital, Cambridge, UK
| | | | - Mark Tremelling
- Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Julian Parkhill
- Pathogen Genomics Group, Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, UK
| | - Chris Probert
- Institute of Translational Medicine, University of Liverpool, UK
| | - Georgina L Hold
- Gastrointestinal Research Group, University of Aberdeen, Aberdeen, UK
| | - Charlie W Lees
- GI Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK,Gastrointestinal Research Group, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
27
|
Rossi M, Aggio R, Staudacher HM, Lomer MC, Lindsay JO, Irving P, Probert C, Whelan K. Volatile Organic Compounds in Feces Associate With Response to Dietary Intervention in Patients With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2018; 16:385-391.e1. [PMID: 28993261 DOI: 10.1016/j.cgh.2017.09.055] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Dietary interventions are effective in management of patients with irritable bowel syndrome (IBS), although responses vary. We investigated whether fecal levels of volatile organic compounds (VOCs) associate with response to dietary interventions in patients with IBS. METHODS Adults who fulfilled the Rome III criteria for IBS were recruited to a 2x2 factorial randomized controlled trial. Patients were randomly assigned to a group counselled to follow a diet low in fructans, galacto-oligosaccharides, lactose, fructose, and polyols (low-FODMAP diet, n = 46) or a group that received placebo dietary advice (sham diet, n = 47) for 4 weeks. Patients from each group were also given either a multi-strain probiotic or placebo supplement. Response was defined as a reduction of 50 points or more on the validated IBS symptom scoring system. Fecal samples were collected from participants at baseline and end of the 4-week study period; VOCs were analyzed by a gas-chromatography sensor device. VOC profiles were determined using a pipeline involving wavelet transformation followed by feature selection based on random forest. A partial least squares classifier was constructed to classify VOC profiles by response and accuracies were determined using 10-fold cross-validation. RESULTS Data from 93 patients who completed the study (63 female) were used in the final analysis. More patients responded to the low-FODMAP diet (37/46, 80%) than the sham diet (21/47, 45%) (P < .001), but there was no difference in response between patients given the probiotic (31/49, 63%) vs the placebo (27/44, 61%) (P = .850), with no interaction between the diet and supplement interventions. At baseline, VOC profiles contained 15 features that classified response to the low-FODMAP diet with a mean accuracy of 97% (95% CI, 96%-99%) and 10 features that classified response to probiotic with a mean accuracy of 89% (95% CI, 86%-92%). End of treatment models achieved similar predictive powers and accuracies. CONCLUSION Fecal VOC profiling is a low cost, non-invasive tool that might be used to predict responses of patients with IBS to low-FODMAP diet and probiotics and identify their mechanisms of action. ISRCTN registry no: 02275221.
Collapse
Affiliation(s)
- Megan Rossi
- Department of Nutritional Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom
| | - Raphael Aggio
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Heidi M Staudacher
- Department of Nutritional Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom
| | - Miranda C Lomer
- Department of Nutritional Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom
| | - James O Lindsay
- Bart's Health NHS Trust, Department of Gastroenterology, United Kingdom, and Barts and the London School of Medicine, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Peter Irving
- Department of Nutritional Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom
| | - Chris Probert
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom.
| |
Collapse
|
28
|
Bond A, Burkitt MD, Cox T, Smart HL, Probert C, Haslam N, Sarkar S. Dual-focus Magnification, High-Definition Endoscopy Improves Pathology Detection in Direct-to-Test Diagnostic Upper Gastrointestinal Endoscopy. J Gastrointestin Liver Dis 2017; 26:19-24. [PMID: 28338109 DOI: 10.15403/jgld.2014.1121.261.gen] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In the UK, the majority of diagnostic upper gastrointestinal (UGI) endoscopies are a result of direct-to-test referral from the primary care physician. The diagnostic yield of these tests is relatively low, and the burden high on endoscopy services. Dual-focus magnification, high-definition endoscopy is expected to improve detection and classification of UGI mucosal lesions and also help minimize biopsies by allowing better targeting. METHODS This is a retrospective study of patients attending for direct-to-test UGI endoscopy from January 2015 to June 2015. The primary outcome of interest was the identification of significant pathology. Detection of significant pathology was modelled using logistic regression. RESULTS 500 procedures were included. The mean age of patients was 61.5 (±15.6) years; 60.8% of patients were female. Ninety-four gastroscopies were performed using dual-focus magnification high-definition endoscopy. Increasing age, male gender, type of endoscope, and type of operator were all identified as significant factors influencing the odds of detecting significant mucosal pathology. Use of dual-focus magnification, high-definition endoscopy was associated with an odds ratio of 1.87 (95%CI 1.11-3.12) favouring the detection of significant pathology. Subsequent analysis suggested that the increased detection of pathology during dual-focus magnification, high-definition endoscopy also influenced patient follow-up and led to a 3.0 fold (p=0.04) increase in the proportion of patients entered into an UGI endoscopic surveillance program. CONCLUSION Dual-focus magnification, high-definition endoscopy improved the diagnostic yield for significant mucosal pathology in patients referred for direct-to-test endoscopy. If this finding is recapitulated elsewhere it will have substantial impact on the provision of UGI endoscopic services.
Collapse
Affiliation(s)
- Ashley Bond
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust;Clinical Cancer Trials Unit, University of Liverpool,Liverpool, UK
| | - Michael D Burkitt
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust;Clinical Cancer Trials Unit, University of Liverpool,Liverpool, UK
| | - Trevor Cox
- Department of Cellular and Unit of Gastroenterology Research Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Howard L Smart
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
| | - Chris Probert
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust;Clinical Cancer Trials Unit, University of Liverpool,Liverpool, UK
| | - Neil Haslam
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
| | - Sanchoy Sarkar
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK.
| |
Collapse
|
29
|
Reid VL, McDonald R, Nwosu AC, Mason SR, Probert C, Ellershaw JE, Coyle S. A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying. PLoS One 2017; 12:e0175123. [PMID: 28384249 PMCID: PMC5383239 DOI: 10.1371/journal.pone.0175123] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/21/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The Neuberger review made a number of recommendations to improve end of life care, including research into the biology of dying. An important aspect of the biology of dying is the identification of biomarkers as indices of disease processes. Biomarkers have the potential to inform the current, limited understanding of the dying process and assist clinicians in recognising dying, in particular how to distinguish dying from reversible acute deterioration. OBJECTIVES To critically appraise the literature on biological factors that may be used as prognostic indicators in advanced cancer patients and to identify candidate biomarkers of the dying process that can be measured serially in cancer patients' bodily fluids. METHODS A systematically structured review was conducted using three electronic databases. A hand search of six peer-reviewed journals and conference abstracts was also conducted. Studies reporting prognostic biomarkers in cancer patients with a median survival of ≤90 days and post-mortem studies were included. Final levels of evidence and recommendations were made using the Evidence Based Medicine modified GRADE system. RESULTS 30 articles were included. Seven prognostic biological factors demonstrated Grade A evidence (lymphocyte count, white blood cell count, serum C-reactive protein, albumin, sodium, urea and alkaline phosphatase). An additional eleven prognostic factors were identified with Grade B evidence (platelet count, international normalised ratio, serum vitamin B12, prealbumin, bilirubin, cholesterol, aspartate aminotransferase, alanine transaminase, lactate dehydrogenase, pseudocholinesterase and urate). A number of biomarkers were specifically identified in the last two weeks of life but limitations exist. No post-mortem studies met the inclusion criteria. CONCLUSION The biology of dying is an important area for future research, with the evidence focused on signs, symptoms and prognostic factors. This review identifies a number of common themes shared amongst advanced cancer patients and highlights candidate biomarkers which may be indicative of a common biological process to dying.
Collapse
Affiliation(s)
- Victoria Louise Reid
- The Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
| | - Rachael McDonald
- Renal Medicine, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Amara Callistus Nwosu
- The Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
| | - Stephen R. Mason
- The Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
| | - Chris Probert
- Department of Gastroenterology, University of Liverpool, Liverpool, United Kingdom
| | - John E. Ellershaw
- The Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
| | - Séamus Coyle
- The Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
30
|
Gillespie D, Farewell D, Barrett-Lee P, Casbard A, Hawthorne AB, Hurt C, Murray N, Probert C, Stenson R, Hood K. The use of randomisation-based efficacy estimators in non-inferiority trials. Trials 2017; 18:117. [PMID: 28274254 PMCID: PMC5343391 DOI: 10.1186/s13063-017-1837-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 02/13/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In a non-inferiority (NI) trial, analysis based on the intention-to-treat (ITT) principle is anti-conservative, so current guidelines recommend analysing on a per-protocol (PP) population in addition. However, PP analysis relies on the often implausible assumption of no confounders. Randomisation-based efficacy estimators (RBEEs) allow for treatment non-adherence while maintaining a comparison of randomised groups. Fischer et al. have developed an approach for estimating RBEEs in randomised trials with two active treatments, a common feature of NI trials. The aim of this paper was to demonstrate the use of RBEEs in NI trials using this approach, and to appraise the feasibility of these estimators as the primary analysis in NI trials. METHODS Two NI trials were used. One comparing two different dosing regimens for the maintenance of remission in people with ulcerative colitis (CODA), and the other comparing an orally administered treatment to an intravenously administered treatment in preventing skeletal-related events in patients with bone metastases from breast cancer (ZICE). Variables that predicted adherence in each of the trial arms, and were also independent of outcome, were sought in each of the studies. Structural mean models (SMMs) were fitted that conditioned on these variables, and the point estimates and confidence intervals compared to that found in the corresponding ITT and PP analyses. RESULTS In the CODA study, no variables were found that differentially predicted treatment adherence while remaining independent of outcome. The SMM, using standard methodology, moved the point estimate closer to 0 (no difference between arms) compared to the ITT and PP analyses, but the confidence interval was still within the NI margin, indicating that the conclusions drawn would remain the same. In the ZICE study, cognitive functioning as measured by the corresponding domain of the QLQ-C30, and use of chemotherapy at baseline were both differentially associated with adherence while remaining independent of outcome. However, while the SMM again moved the point estimate closer to 0, the confidence interval was wide, overlapping with any NI margin that could be justified. CONCLUSION Deriving RBEEs in NI trials with two active treatments can provide a randomisation-respecting estimate of treatment efficacy that accounts for treatment adherence, is straightforward to implement, but requires thorough planning during the design stage of the study to ensure that strong baseline predictors of treatment are captured. Extension of the approach to handle nonlinear outcome variables is also required. TRIAL REGISTRATION The CODA study: ClinicalTrials.gov, identifier: NCT00708656 . Registered on 8 April 2008. The ZICE study trial: ClinicalTrials.gov, identifier: NCT00326820 . Registered on 16 May 2006.
Collapse
Affiliation(s)
- David Gillespie
- South East Wales Trials Unit, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences Cardiff University, Cardiff, UK
| | | | - Angela Casbard
- Wales Cancer Trials Unit, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Chris Hurt
- Wales Cancer Trials Unit, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nick Murray
- North Adelaide Oncology, Kimberley House, Calvary North Adelaide Hospital, 89 Strangways Terrace, North Adelaide, SA Australia
| | - Chris Probert
- Gastroenterology Research Unit, Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Ashton Street, Liverpool, UK
| | - Rachel Stenson
- Division of Infection and Immunity Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
31
|
Reid V, McDonald R, Nwosu AC, Mason SR, Probert C, Ellershaw JE, Coyle S. O-5 A systematically structured review on biomarkers of dying in cancer patients at the end of life; an exploration of potential mechanisms for the biology of dying. BMJ Support Palliat Care 2017. [DOI: 10.1136/bmjspcare-2017-00133.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
Coyle S, Scott A, Nwosu AC, Latten R, Wilson J, Mayland CR, Mason S, Probert C, Ellershaw J. Collecting biological material from palliative care patients in the last weeks of life: a feasibility study. BMJ Open 2016; 6:e011763. [PMID: 28186928 PMCID: PMC5128854 DOI: 10.1136/bmjopen-2016-011763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the feasibility of prospectively collecting biological samples (urine) from palliative care patients in the last weeks of life. SETTING A 30-bedded specialist hospice in the North West of England. PARTICIPANTS Participants were adults with a diagnosis of advanced disease and able to provide written informed consent. METHOD Potential participants were identified by a senior clinician over a 12-week period in 2014. They were then approached by a researcher and invited to participate according to a developed recruitment protocol. OUTCOMES Feasibility targets included a recruitment rate of 50%, with successful collection of samples from 80% who consented. RESULTS A total of 58 patients were approached and 33 consented (57% recruitment rate). Twenty-five patients (43%) were unable to participate or declined; 10 (17%) became unwell, too fatigued, lost capacity, died or were discharged home; and 15 (26%) refused, usually these patients had distressing pain, low mood or profound fatigue. From the 33 recruited, 20 participants provided 128 separate urine samples, 12 participants did not meet the inclusion criteria at the time of consent and 1 participant was unable to provide a sample. The criterion for a urinary catheter was removed for the latter 6 weeks. The collection rate during the first 6 weeks was 29% and 93% for the latter 6 weeks. Seven people died while the study was ongoing, and another 4 participants died in the following 4 weeks. CONCLUSIONS It is possible to recruit and collect multiple biological samples over time from palliative care patients in the last weeks and days of life even if they have lost capacity. Research into the biological changes at the end of life could develop a greater understanding of the biology of the dying process. This may lead to improved prognostication and care of patients towards the end of life.
Collapse
Affiliation(s)
- Séamus Coyle
- Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | | | - Amara Callistus Nwosu
- Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Richard Latten
- Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - James Wilson
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Catriona R Mayland
- Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Stephen Mason
- Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Chris Probert
- Department of Gastroenterology, University of Liverpool, Liverpool, UK
| | - John Ellershaw
- Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| |
Collapse
|
33
|
Affiliation(s)
- Corrado Minetti
- Vector Biology Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rachel M Chalmers
- Cryptosporidium Reference Unit, Public Health Wales Microbiology ABM, Singleton Hospital, Swansea, UK
| | - Nick J Beeching
- Clinical Sciences Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Chris Probert
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | |
Collapse
|
34
|
Bond A, Vernon A, Reade S, Mayor A, Minetti C, Wastling J, Lamden K, Probert C. Investigation of Volatile Organic Compounds Emitted from Faeces for the Diagnosis of Giardiasis. J Gastrointestin Liver Dis 2016; 24:281-6. [PMID: 26405699 DOI: 10.15403/jgld.2014.1121.243.abo] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Giardiasis is a common intestinal infection caused by the flagellated intestinal protozoan Giardia duodenalis. Several methods are available for the laboratory diagnosis of Giardia, ranging from the microscopic identification of the parasite trophozoite and cyst stages, to immunodiagnosis and PCR. Giardia has unique metabolic pathways resulting from its lack of mitochondria, making it an ideal target for volatile organic compound (VOC) profiling. AIM To characterise the VOC profile of stool infected with Giardia to detect differences from those found in samples of diarrhoea without Giardia or other infections. METHOD Stool was obtained from patients with confirmed Giardia infection and controls with diarrhoea but no identifiable infection. Faecal headspace gas extraction and gas chromatography-mass spectrometry were used to extract and identify VOCs. RESULTS More than 100 VOCs were identified when control and Giardia groups were combined, of which 24 showed significant differences between the two groups (p<0.05). Three VOCs had a significantly greater prevalence amongst Giardia cases (p<0.0001) and 9 VOCs showed a significant difference in terms of abundance (p<0.05). AUROC analysis demonstrated a value of 0.902. CONCLUSION There is a significant difference in the VOC profile of stool from subjects infected with Giardia spp, when compared with non-infected controls. These findings can be explained by the unique metabolism of Giardia.
Collapse
Affiliation(s)
- Ashley Bond
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool;UK
| | - April Vernon
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool;UK
| | - Sophie Reade
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool;UK
| | - Arno Mayor
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool;UK
| | - Corrado Minetti
- Department of Infection Biology, Institute of Infection and Global Health, University of Liverpool, Liverpool;UK
| | - Jonathan Wastling
- Department of Infection Biology, Institute of Infection and Global Health, University of Liverpool, Liverpool;UK
| | - Kenneth Lamden
- Cumbria and Lancashire Public Health England Centre, Public Health England, York House, Chorley, UK
| | - Chris Probert
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| |
Collapse
|
35
|
Ahmed I, Greenwood R, Costello B, Ratcliffe N, Probert C. Letter: faecal volatile organic metabolites, promising biomarkers in inflammatory bowel disease and Letter: faecal volatile organic metabolites as novel diagnostic biomarkers in inflammatory bowel disease. Authors' reply. Aliment Pharmacol Ther 2016; 43:1241-2. [PMID: 27137729 DOI: 10.1111/apt.13617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- I Ahmed
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | - R Greenwood
- Department of Research and Development, Bristol Royal Infirmary, Bristol, UK
| | - B Costello
- Institute of Biosensing Technology, University of the West of England, Bristol, UK
| | - N Ratcliffe
- Institute of Biosensing Technology, University of the West of England, Bristol, UK.
| | - C Probert
- Gastroenterology Research Unit, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
36
|
Gillespie D, Hood K, Farewell D, Hawthorne A, Probert C, Stenson R, Barrett-Lee P, Casbard A, Murray N. The use of randomisation-based efficacy estimators in non-inferiority trials. Trials 2015. [PMCID: PMC4660080 DOI: 10.1186/1745-6215-16-s2-p129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
37
|
Affiliation(s)
- Richard K Russell
- Department of Paediatric Gastroenterology, The Royal Hospital for Children Glasgow, Glasgow, UK
| | - Peter Irving
- Department of Gastroenterology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Chris Probert
- Gastroenterology Research Unit, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
38
|
McClements D, Probert C. Managing acute severe ulcerative colitis in the hosptialised setting. Frontline Gastroenterol 2015; 6:241-245. [PMID: 28839817 PMCID: PMC5369586 DOI: 10.1136/flgastro-2014-100459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/11/2014] [Accepted: 06/16/2014] [Indexed: 02/04/2023] Open
Abstract
Ulcerative colitis affects approximately 146 000 people in the UK and is the most common form of inflammatory bowel disease. The majority of patients will have uncomplicated disease, but around 1 in 10 patients will develop acute severe colitis. Despite modern medical management, colectomy rates of 27% and mortality rates of 1% are still reported. Good supportive care and intravenous corticosteroids remain the mainstay of treatment, but up to one-third of patents will not respond. The Travis criteria allow early recognition of those patients failing to improve by day 3, allowing timely planning of medical rescue therapy or surgery. Rescue therapy with either infliximab or ciclosporin appears equally efficacious. Patients naive to thiopurines seem to have better colectomy-free survival rates following rescue therapy than those previously exposed. We review the published evidence behind the conventional management of acute severe ulcerative colitis.
Collapse
Affiliation(s)
| | - Chris Probert
- Department of Gastroenterology, University of Liverpool, UK
| |
Collapse
|
39
|
Poon SS, Asher R, Jackson R, Kneebone A, Collins P, Probert C, Dibb M, Subramanian S. Body Mass Index and Smoking Affect Thioguanine Nucleotide Levels in Inflammatory Bowel Disease. J Crohns Colitis 2015; 9:640-6. [PMID: 25968584 DOI: 10.1093/ecco-jcc/jjv084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/05/2015] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Optimal levels of the thiopurine metabolite, 6-thioguanine nucleotides [6-TGN] correlate with remission of inflammatory bowel disease [IBD]. Apart from variations in the thiopurine methyl transferase [TPMT] gene, little is known about other predictors of 6-TGN levels. Obesity adversely affects response to infliximab and adalimumab and clinical course in IBD, but little is known about the interaction of thiopurines and obesity. We investigated the relationship between body mass index [BMI] and 6-TGN levels and sought to examine other predictors of 6-TGN levels. METHODS This retrospective cohort study included patients with concurrent measurements of 6-TGN and BMI. The association between 6-TGN and clinical variables including BMI was estimated using a multivariable linear regression model. RESULTS Of 132 observations, 77 [58%] had Crohn's disease and 55 [42%] ulcerative colitis. BMI, smoking, and TPMT levels were associated with 6-TGN levels in multivariable analysis. Every 5kg/m(2) increase in BMI was associated with an 8% decrease in 6-TGN (0.92; 95% confidence interval [CI] 0.87-0.98; p = 0.009). Smokers had higher 6-TGN levels in comparison with non-/ex-smokers [1.43; 95% CI 1.02-2.02; p = 0.041]. Patients with intermediate TPMT had higher 6-TGN compared to those with normal levels [2.13; 95% CI 1.62-2.80; p < 0.001]. Obese patients were more likely to have sub-therapeutic 6-TGN levels and a higher methyl mercaptopurine nucleotide [MMPN/TGN] ratio despite a similar dose of thiopurines. CONCLUSIONS Active smoking and intermediate TPMT values were associated with higher 6-TGN levels but increasing BMI resulted in lower 6-TGN and higher MMPN levels. This may explain the worse outcome that has been reported previously in obese IBD subjects.
Collapse
Affiliation(s)
- Shi Sum Poon
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Rebecca Asher
- Cancer Research UK Liverpool Cancer Trials Unit, Waterhouse Building, Liverpool, UK
| | - Richard Jackson
- Cancer Research UK Liverpool Cancer Trials Unit, Waterhouse Building, Liverpool, UK
| | - Andrew Kneebone
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Paul Collins
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Chris Probert
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Martyn Dibb
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Sreedhar Subramanian
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| |
Collapse
|
40
|
Abstract
The diagnosis of inflammatory bowel disease (IBD) remains a challenge for clinicians, and patients. Clinical suspicion of these disorders leads to a diagnostic pathway that may include stool testing, colonoscopy, radiological tests and capsule examinations. This workup is unpleasant, embarrassing, painful and occasionally dangerous. Alternative means of diagnosing IBD are being explored. Genetic testing and serology have not been found to be sufficiently specific or sensitive to be used for diagnosis. Faecal markers, however, have demonstrated some potential. Faecal lactoferrin and calprotectin may be used to differentiate IBD from non-inflammatory disorders and these tests are now commonly used, with support from the National Institute for Health and Care Excellence. Recent research has focused upon volatile organic compounds emitted from bodily fluids, including faeces, urine and breath. Headspace gas from faeces or urine may be analysed by gas chromatography/mass spectrometry. Models have been built based on these compounds to enable Crohn's disease and ulcerative colitis to be distinguished from irritable bowel syndrome (IBS) and from healthy controls. Similar work has found that headspace gases from urine may be used to diagnose IBS. Faecal samples are relatively easy to obtain, but patients dislike collecting samples, so a urinary test is an attractive alternative. Early data from breath samples also show potential and will be presented. Non-invasive diagnosis of IBD is becoming a reality that will save patients from discomfort, embarrassment and risk, and may mean significant savings for healthcare providers.
Collapse
Affiliation(s)
- Raphael Aggio
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | |
Collapse
|
41
|
Sawbridge D, Probert C. Population-based screening in colorectal cancer - current practice and future developments: faecal biomarkers review. J Gastrointestin Liver Dis 2014; 23:195-202. [PMID: 24949612 DOI: 10.15403/jgld.2014.1121.232.dsw1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND & AIMS Colorectal cancer (CRC) is the second most common form of malignancy in Europe and North America, and is one of the major causes of cancer death, with a 50.7% 5 year mortality rate. The majority of cases are of a sporadic nature and develop from a pre-cancerous lesion. Screening programmes have been introduced in many countries to detect and treat the condition. These mostly rely on a combination of faecal occult blood tests and endoscopy to guide diagnosis. They are expensive to establish and run, have a potential for false negatives (especially for high risk adenomas and right sided cancers) and they are often unacceptable to a significant percentage of the at-risk population. Consequently many groups have sought sensitive and specific diagnostic biomarkers for CRC and adenomas. These biomarkers form three broad categories: cytogenetic, enzymatic/protein and metabolomic. METHODS Pubmed and Medline databases were searched to identify relevant articles concerning colorectal cancer screening. CONCLUSION Here we provide a review of the current population-based screening possibilities and faecal biomarkers currently under investigation, an assessment of their cost-effectiveness, their efficacy and suggestions for the future of large scale screening in CRC.
Collapse
Affiliation(s)
- David Sawbridge
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| | - Chris Probert
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
42
|
Abstract
Steroids have been a mainstay of ulcerative colitis (UC) therapy for many years, based on a thoroughly established efficacy profile for the induction of remission. However, in light of the considerable side effects and negative perceptions they carry, it is important to ensure such treatments are used as effectively as possible. For severe UC, the need for steroids is rarely questioned, and rightly so; it is for moderate UC that the role of steroids should be considered. Both patients and clinicians place a high importance on rapid, effective resolution of symptoms, yet at the same time wish to avoid unnecessary side effects. Through consideration of the available evidence, it becomes clear that both steroids and high-dose 5-aminosalicylic acid (5-ASA) are supported by robust trials demonstrating their efficacy. Indeed, both therapies have been shown to give rise to resolution of symptoms after 2 weeks in many patients. However, a paucity of head-to-head comparisons makes conclusive interpretation challenging. This paper therefore presents a practical approach, which builds on the available evidence and is developed from informed discussions with patients. This approach involves initiating therapy with high-dose 5-ASA, followed by a review of symptom improvements after 2-3 weeks. Steroids can then be introduced, when needed, with minimal delay. In this way, symptoms can be resolved rapidly, yet many patients may avoid unpleasant side effects.
Collapse
Affiliation(s)
- Chris Probert
- Department of Gastroenterology, The Henry Wellcome Laboratory, Institute of Translational Medicine, University of Liverpool, Nuffield Building, Crown Street, Liverpool L69 3GE, UK
| |
Collapse
|
43
|
Affiliation(s)
- Gareth Walker
- Department of Gastroenterology, Bristol Royal Infirmary, University Hospitals Bristol Trust, Bristol, UK.
| | | | | | | | | |
Collapse
|
44
|
Probert C. Book Review: Fast Facts: Inflammatory Bowel Disease by David S Rampton and Fergus Shanahan Health Press Ltd. 2008 Paperback 135pp. Price £15.00 ISBN: 978-1-905832-46-0. Perspect Public Health 2009. [DOI: 10.1177/17579139091290010504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
45
|
Shufflebotham J, Hood S, Hendry J, Hince DA, Morris K, Nutt D, Probert C, Potokar J. Acute tryptophan depletion alters gastrointestinal and anxiety symptoms in irritable bowel syndrome. Am J Gastroenterol 2006; 101:2582-7. [PMID: 17029611 DOI: 10.1111/j.1572-0241.2006.00811.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the effect of acute changes in serotonin (5-HT) synthesis using the acute tryptophan depletion (ATD) paradigm on gastrointestinal (GI) and mood symptoms in irritable bowel syndrome (IBS). METHODS In a randomized double-blind crossover study, 29 subjects (18 patients with ROME II defined IBS and 11 age-matched controls) were studied under ATD and acute tryptophan increase (ATI) conditions. GI symptoms, mood and anxiety ratings, as well as plasma tryptophan concentrations were measured. RESULTS Total (and free) plasma tryptophan concentrations decreased on the ATD day in patients (73%[82%]) and controls (73%[80%]), and increased on the ATI day in patients (59%[143%]) and controls (61%[381%]). Compared with the ATD day, IBS patients reported more GI symptoms on the ATI day at +210 (p < 0.001) and at +270 (p < 0.05) min post drink. IBS patients also reported less anxiety on the ATI day compared with the ATD day at +270 min (p < 0.001). ATD and ATI did not affect these ratings in control participants. IBS patients had a lower mood compared with controls (p < 0.05), but this did not differ between the ATI and ATD days in either group. CONCLUSIONS IBS patients' GI and anxiety responses to changes in tryptophan load differ from controls. This suggests a difference in serotonergic functioning between these two groups and provides evidence to support the hypothesis that 5-HT dysfunction is involved in IBS.
Collapse
|
46
|
|
47
|
Jayaprakash A, Creed T, Stewart L, Colton B, Mountford R, Standen G, Probert C. Should we monitor vitamin B12 levels in patients who have had end-ileostomy for inflammatory bowel disease? Int J Colorectal Dis 2004; 19:316-8. [PMID: 14618349 DOI: 10.1007/s00384-003-0556-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS We examined whether vitamin B12 levels are low following surgery in those patients who have had end-ileostomy for inflammatory bowel disease. PATIENTS AND METHODS This prospective observational study used the database of a university teaching hospital to identify patients with inflammatory bowel disease with an end-ileostomy constructed more than 30 months previously. Precise diagnosis, disease distribution and details of their surgery were collected from case notes of the 39 eligible patients (18 Crohn's disease, 17 ulcerative colitis, 4 indeterminate colitis). Mean duration since ileostomy formation was 12.53 years. Patients found to be vitamin B12 deficient underwent further investigations to ascertain the cause of their vitamin B12 deficiency (<150 ng/l). RESULTS There was no significant difference between serum vitamin B12 levels in patients with Crohn's disease and those in patients with ulcerative colitis following end ileostomy formation. Two patients (5.1%) were identified as having vitamin B12 deficiency. One of these had had a panproctocolectomy for Crohn's disease, followed by subsequent resection for ileal obstruction and ongoing small intestinal disease. The other had had colectomy for ulcerative colitis, in whom no cause other than the ileostomy was found for the vitamin B12 deficiency. There was no significant correlation between serum vitamin B12 levels and duration of ileostomy overall or in the disease subgroups. CONCLUSION We do not recommend routine screening for vitamin B12 deficiency in this group of patients unless they have undergone additional small bowel resection or have ongoing small bowel inflammation.
Collapse
Affiliation(s)
- A Jayaprakash
- Department of Gastroenterology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK.
| | | | | | | | | | | | | |
Collapse
|
48
|
Brooklyn T, Probert C. A Crohn's repertoire: T cell receptor gammadelta. Inflamm Bowel Dis 2003; 9:213-4. [PMID: 12797352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
49
|
FitzGerald M, Crowley T, Greenhouse P, Probert C, Horner P. Teaching sexual history taking to medical students and examining it: experience in one medical school and a national survey. Med Educ 2003; 37:94-98. [PMID: 12558878 DOI: 10.1046/j.1365-2923.2003.01411.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To assess the feasibility and acceptability of training and examining medical students in taking a sexual history and to compare practice with other medical schools in the UK. DESIGN A training programme involving group work, role play and clinical attachments was developed and applied to 131 students at the University of Bristol Medical School. They then underwent an objective structured clinical assessment using simulated patients. The practice of other medical schools was surveyed by postal questionnaire. RESULT The students felt that the examination was a good test of their knowledge and skills. One student failed. Sexual history taking is taught in 17 of 22 medical schools but examined in only six. CONCLUSION Both teaching and examining of sexual history taking skills are possible and are likely to occur increasingly in UK medical schools.
Collapse
Affiliation(s)
- Mark FitzGerald
- Department of Genitourinary Medicine, Taunton and Somerset NHS Trust, Taunton and Somerset Hospital, UK.
| | | | | | | | | |
Collapse
|
50
|
Keatinge D, Scarfe C, Bellchambers H, McGee J, Oakham R, Probert C, Stewart L, Stokes J. The manifestation and nursing management of agitation in institutionalised residents with dementia. Int J Nurs Pract 2000; 6:16-25. [PMID: 10839037 DOI: 10.1046/j.1440-172x.2000.00177.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This participatory action research study is the first formal research study undertaken by nurses in a nursing development unit. The study emerged as the result of nurses brainstorming issues that they perceived to be problematic in their nursing practice and their unit environment. The nurses of the psycho-geriatric nursing development unit, Wallsend Aged Care Facility, New South Wales, Australia identified that the management of agitated behaviour manifested by their severely demented clients was a major challenge in their practice. As a result, a pilot participatory action research study was designed to measure how agitation manifested, to measure the severity of agitation and to identify current nursing practices used to manage it and their outcome. Results of the study demonstrated that nurse actions triggered the majority of most highly rated episodes of agitated behaviour in this group of elderly residents, and that the majority of these nurse actions related to those involved in carrying out activities of daily living for the residents.
Collapse
Affiliation(s)
- D Keatinge
- University of Newcastle, Callaghan, New South Wales, Australia.
| | | | | | | | | | | | | | | |
Collapse
|