<i>Background</i>. Recent epidemiological studies in inflammatory bowel disease (IBD) indicate that paediatric onset of IBD (pIBD) more often requires biological therapy compared to adult onset of IBD (aIBD). Whether this is due to a more aggressive disease phenotype or lower threshold of prescribing biologicals is unknown. In order to expand these findings in a clinical setting, we compared the inflammatory burden in pIBD and aIBD patients requiring biological therapy. <i>Methods</i>. We retrospectively included 70 pIBD and 83 aIBD patients initiating biological therapy. Symptoms and biomarker levels were recorded prior to and 6, 14, 22, and 52 weeks after initiation of biological therapy. <i>Results</i>. In Crohn’s disease (CD), the baseline levels of faecal calprotectin and C-reactive protein (CRP) were increased in paediatric CD patients compared to adult CD patients (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M1" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="34.448pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 34.448 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,50.529,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g></svg></span> and <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M2" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.921pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 21.921 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-50"/></g></svg>,</span></span> respectively). No significant differences were seen in ulcerative colitis (UC). In CD, baseline vitamin D <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="39.696pt" style="vertical-align:-1.1198pt" id="M3" height="10.4277pt" version="1.1" viewBox="-0.0498162 -9.3079 39.696 10.4277"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g190-109" d="M238 0V26C174 32 166 38 166 104V712C132 700 70 683 18 677V653C81 647 87 645 87 577V104C87 38 78 32 15 26V0H238Z"/></g><g transform="matrix(.013,0,0,-0.013,3.289,0)"><path id="g190-102" d="M380 106C343 72 306 56 265 56C195 56 116 112 115 248C235 252 361 262 377 265C396 269 400 277 400 297C400 374 333 449 250 449H249C198 449 144 421 103 376S37 269 37 201C37 88 109 -12 232 -12C263 -12 332 6 395 84L380 106ZM225 412C281 412 315 364 314 312C314 297 308 292 290 292C232 290 176 289 120 289C135 370 180 412 225 412Z"/></g><g transform="matrix(.013,0,0,-0.013,8.918,0)"><path id="g190-119" d="M478 437H300V411C357 404 363 393 347 345C325 280 293 190 258 107C229 178 188 284 163 354C147 397 149 405 203 411V437H-2V411C52 403 59 396 82 339C130 222 176 109 220 -11H248C304 138 356 261 390 336C417 395 425 404 478 411V437Z"/></g><g transform="matrix(.013,0,0,-0.013,14.833,0)"><use xlink:href="#g190-102"/></g><g transform="matrix(.013,0,0,-0.013,20.306,0)"><use xlink:href="#g190-109"/></g><g transform="matrix(.013,0,0,-0.013,23.556,0)"><path id="g190-116" d="M319 325C317 349 306 409 297 431C277 440 250 449 209 449C117 449 57 389 57 319C57 243 122 209 182 182C232 159 261 135 261 91C261 48 227 21 190 21C130 21 85 79 68 145L41 140C41 104 51 36 58 22C75 7 121 -12 172 -12C252 -12 337 35 337 126C337 195 286 231 210 262C166 281 126 304 126 348C126 388 152 417 191 417C240 417 274 378 294 318L319 325Z"/></g><g transform="matrix(.013,0,0,-0.013,32.065,0)"><path id="g117-94" d="M531 285V335L57 550V494L473 310L57 127V71L531 285ZM531 -40V10H57V-40H531Z"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="12.655pt" style="vertical-align:-1.1198pt" height="10.4277pt" version="1.1" viewBox="43.2781838 -9.3079 12.655 10.4277"><g transform="matrix(.013,0,0,-0.013,43.328,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g><g transform="matrix(.013,0,0,-0.013,49.57,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg></span> nmol/L and baseline CRP <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="39.696pt" style="vertical-align:-0.6369991pt" id="M4" height="9.9449pt" version="1.1" viewBox="-0.0498162 -9.3079 39.696 9.9449"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g190-109"/></g><g transform="matrix(.013,0,0,-0.013,3.289,0)"><use xlink:href="#g190-102"/></g><g transform="matrix(.013,0,0,-0.013,8.918,0)"><use xlink:href="#g190-119"/></g><g transform="matrix(.013,0,0,-0.013,14.833,0)"><use xlink:href="#g190-102"/></g><g transform="matrix(.013,0,0,-0.013,20.306,0)"><use xlink:href="#g190-109"/></g><g transform="matrix(.013,0,0,-0.013,23.556,0)"><use xlink:href="#g190-116"/></g><g transform="matrix(.013,0,0,-0.013,32.065,0)"><use xlink:href="#g117-91"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="6.392pt" style="vertical-align:-0.6369991pt" height="9.9449pt" version="1.1" viewBox="43.2781838 -9.3079 6.392 9.9449"><g transform="matrix(.013,0,0,-0.013,43.328,0)"><use xlink:href="#g113-54"/></g></svg></span> mg/L were associated with higher remission rate (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M5" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.921pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 21.921 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g></svg>)</span></span> at the end of follow-up. Moreover, aIBD patients had a higher risk of loss of response to biological therapy and treatment discontinuation compared to pIBD patients (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="29.361pt" style="vertical-align:-0.2063904pt" id="M6" height="8.73137pt" version="1.1" viewBox="-0.0498162 -8.52498 29.361 8.73137"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g190-73" d="M729 650H468V622C546 615 554 610 554 527V365H213V527C213 610 221 616 297 622V650H38V622C120 616 128 611 128 527V123C128 39 120 34 40 28V0H303V28C221 34 213 40 213 123V322H554V123C554 39 546 34 460 28V0H728V28C647 34 639 39 639 123V527C639 610 647 615 729 622V650Z"/></g><g transform="matrix(.013,0,0,-0.013,9.958,0)"><path id="g190-83" d="M631 18C609 24 585 35 559 65C534 91 514 117 478 169C448 214 406 281 389 313C462 346 516 399 516 485C516 545 490 590 449 616C412 641 363 650 290 650H42V622C120 615 128 612 128 527V125C128 40 120 34 38 28V0H300V28C221 34 212 40 212 125V284H244C295 284 312 272 329 244C359 195 395 133 430 84C475 19 516 -3 592 -7C603 -8 615 -8 627 -8L631 18ZM212 316V563C212 591 215 602 223 607C231 613 248 617 277 617C352 617 423 577 423 469C423 415 407 375 368 345C343 324 310 316 260 316H212Z"/></g><g transform="matrix(.013,0,0,-0.013,21.73,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.63pt" style="vertical-align:-0.2063904pt" height="8.73137pt" version="1.1" viewBox="32.9431838 -8.52498 15.63 8.73137"><g transform="matrix(.013,0,0,-0.013,32.993,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,39.234,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,42.198,0)"><use xlink:href="#g113-56"/></g></svg></span> [1.6-13.4], <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M7" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.184pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 28.184 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><use xlink:href="#g113-53"/></g></svg>).</span></span> <i>Conclusions</i>. pCD patients had increased inflammation markers compared to aCD patients prior to biological treatment. In addition to this, <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="63.441pt" style="vertical-align:-0.6370001pt" id="M8" height="9.16198pt" version="1.1" viewBox="-0.0498162 -8.52498 63.441 9.16198"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g190-119"/></g><g transform="matrix(.013,0,0,-0.013,6.058,0)"><path id="g190-106" d="M135 536C164 536 186 560 186 587C186 617 164 639 136 639C109 639 85 617 85 587C85 560 109 536 135 536ZM252 0V26C188 32 181 38 181 106V451C138 433 90 420 39 412V388C99 379 102 374 102 312V106C102 38 95 32 32 26V0H252Z"/></g><g transform="matrix(.013,0,0,-0.013,9.386,0)"><path id="g190-117" d="M298 36L289 62C276 55 253 45 228 45C202 45 169 60 169 141V397H276C289 405 292 426 282 437H169V574L155 576L90 509V437H45L17 408L21 397H90V107C90 28 125 -12 188 -12C198 -12 213 -8 230 1L298 36Z"/></g><g transform="matrix(.013,0,0,-0.013,13.429,0)"><path id="g190-98" d="M433 39L423 65C413 59 399 54 387 54C370 54 352 69 352 114V299C352 352 342 392 307 422C285 440 255 449 225 449C168 437 102 399 75 379C56 365 44 353 44 339C44 315 69 296 87 296C101 296 111 303 116 319C124 349 133 371 145 385C156 397 171 404 190 404C241 404 275 364 275 291V274C253 256 180 229 120 209C65 190 39 159 39 110C39 47 88 -12 159 -12C189 -12 237 25 277 52C282 35 288 21 301 8C312 -3 333 -12 348 -12L433 39ZM275 84C256 65 221 48 195 48C164 48 124 73 124 124C124 161 146 180 185 198C206 208 254 229 275 240V84Z"/></g><g transform="matrix(.013,0,0,-0.013,19.018,0)"><path id="g190-110" d="M797 0V26C739 32 732 36 732 103V296C732 394 682 449 605 449C576 449 550 437 529 423C504 407 475 389 446 366C425 418 382 449 334 449C303 449 279 437 253 421C222 403 201 385 180 371V452C135 432 85 419 41 411V388C99 379 102 374 102 310V103C102 38 93 32 27 26V0H238V26C189 32 180 38 180 103V338C210 363 250 390 289 390C351 390 377 348 377 275V103C377 37 368 32 306 26V0H520V26C465 32 456 38 456 101V296C456 314 455 326 453 338C491 369 529 390 565 390C628 390 653 345 653 274V107C653 36 642 32 583 26V0H797Z"/></g><g transform="matrix(.013,0,0,-0.013,29.665,0)"><use xlink:href="#g190-106"/></g><g transform="matrix(.013,0,0,-0.013,33.149,0)"><path id="g190-111" d="M524 0V26C466 32 460 36 460 104V297C460 393 411 449 331 449C302 449 276 437 248 419C223 402 201 387 181 372V451C137 432 90 420 42 411V388C96 378 102 374 102 310V104C102 38 97 33 29 26V0H246V26C187 32 181 36 181 104V339C211 365 250 390 290 390C357 390 381 345 381 276V109C381 40 374 32 315 26V0H524Z"/></g><g transform="matrix(.013,0,0,-0.013,42.587,0)"><path id="g190-69" d="M43 650V622C120 616 128 612 128 526V124C128 39 120 33 34 27V0H270C392 0 492 25 567 83C643 141 690 230 690 350C690 444 655 517 605 565C543 625 450 650 323 650H43ZM213 547C213 587 217 598 226 604C236 612 262 617 304 617C371 617 429 604 474 576C554 529 592 439 592 336C592 176 505 36 319 36C246 36 213 55 213 131V547Z"/></g><g transform="matrix(.013,0,0,-0.013,55.81,0)"><use xlink:href="#g117-91"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="12.655pt" style="vertical-align:-0.6370001pt" height="9.16198pt" version="1.1" viewBox="67.0231838 -8.52498 12.655 9.16198"><g transform="matrix(.013,0,0,-0.013,67.073,0)"><use xlink:href="#g113-56"/></g><g transform="matrix(.013,0,0,-0.013,73.315,0)"><use xlink:href="#g113-54"/></g></svg></span> nmol/L and high CRP levels predicted poor response to treatment in IBD patients.

Meyya Bouazzi

Nina F. Bak

J&#x00F8;rgen Agnholt

Vibeke Wewer

Mikkel Malham

Mia Bendix

Paediatric Crohn&#x2019;s Disease Patients Have Increased Inflammatory Markers Compared to Adult Patients prior to Biological Treatment

The Edinburgh Dysphagia Score (EDS) was previously developed to identify patients referred to secondary care with dysphagia, who were most likely to have oesophageal cancer. The aim of this study was to use the EDS prospectively during the COVID pandemic to risk stratify patients to either urgent or routine investigation of dysphagia. Between 1<sup>st</sup> April and 1<sup>st</sup> July 2020, 283 patients were referred to NHS Lothian with dysphagia. An EDS score was calculated utilizing information in the GP referral letter or information gained in a “HOT clinic.” Patients with a <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="38.391pt" style="vertical-align:-1.11981pt" id="M1" height="9.46863pt" version="1.1" viewBox="-0.0498162 -8.34882 38.391 9.46863"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g190-116" d="M319 325C317 349 306 409 297 431C277 440 250 449 209 449C117 449 57 389 57 319C57 243 122 209 182 182C232 159 261 135 261 91C261 48 227 21 190 21C130 21 85 79 68 145L41 140C41 104 51 36 58 22C75 7 121 -12 172 -12C252 -12 337 35 337 126C337 195 286 231 210 262C166 281 126 304 126 348C126 388 152 417 191 417C240 417 274 378 294 318L319 325Z"/></g><g transform="matrix(.013,0,0,-0.013,4.875,0)"><path id="g190-100" d="M390 111C344 68 312 56 269 56C212 56 118 102 118 241C118 346 175 401 241 401C277 401 312 388 342 360C350 352 355 349 361 349C372 349 394 371 394 392C394 403 391 411 378 422C362 436 329 449 288 449H287C250 449 190 432 138 392C71 341 37 274 37 197C37 90 112 -12 238 -12C297 -12 363 32 407 90L390 111Z"/></g><g transform="matrix(.013,0,0,-0.013,10.374,0)"><path id="g190-112" d="M257 449C165 449 37 374 37 209C37 98 119 -12 256 -12C355 -12 473 65 473 226C473 349 381 449 257 449ZM244 416C333 416 380 320 380 204C380 67 329 21 267 21C184 21 130 115 130 241C130 354 184 416 244 416Z"/></g><g transform="matrix(.013,0,0,-0.013,16.848,0)"><path id="g190-115" d="M181 342V451C133 431 89 419 40 411V388C98 381 102 377 102 311V104C102 38 95 32 33 26V0H263V26C186 32 181 38 181 104V287C203 343 235 372 261 372C277 372 289 366 304 352C310 346 318 345 330 350C349 359 362 379 362 399C362 422 338 449 304 449C256 449 213 393 183 342H181Z"/></g><g transform="matrix(.013,0,0,-0.013,21.501,0)"><path id="g190-102" d="M380 106C343 72 306 56 265 56C195 56 116 112 115 248C235 252 361 262 377 265C396 269 400 277 400 297C400 374 333 449 250 449H249C198 449 144 421 103 376S37 269 37 201C37 88 109 -12 232 -12C263 -12 332 6 395 84L380 106ZM225 412C281 412 315 364 314 312C314 297 308 292 290 292C232 290 176 289 120 289C135 370 180 412 225 412Z"/></g><g transform="matrix(.013,0,0,-0.013,30.76,0)"><path id="g117-94" d="M531 285V335L57 550V494L473 310L57 127V71L531 285ZM531 -40V10H57V-40H531Z"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.63pt" style="vertical-align:-1.11981pt" height="9.46863pt" version="1.1" viewBox="41.9731838 -8.34882 15.63 9.46863"><g transform="matrix(.013,0,0,-0.013,42.023,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g><g transform="matrix(.013,0,0,-0.013,48.263,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,51.227,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg></span> were prioritized for investigation under the “urgent suspicion of cancer” pathway. 243 patients underwent investigations. 18 patients were diagnosed with oesophageal cancer, all of whom had an <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="34.451pt" style="vertical-align:-1.11981pt" id="M2" height="9.87315pt" version="1.1" viewBox="-0.0498162 -8.75334 34.451 9.87315"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g190-70" d="M517 162C503 123 484 88 467 68C445 42 417 34 341 34C291 34 256 34 237 47C219 59 213 81 213 128V317H308C395 317 402 311 415 240H444V431H415C403 364 398 356 307 356H213V584C213 613 215 616 246 616H322C394 616 421 609 435 587C448 566 458 544 467 502L496 506C493 557 488 625 488 650H42V622C120 616 128 612 128 523V125C128 43 120 35 29 28V0H511C520 31 540 125 546 158L517 162Z"/></g><g transform="matrix(.013,0,0,-0.013,7.384,0)"><path id="g190-69" d="M43 650V622C120 616 128 612 128 526V124C128 39 120 33 34 27V0H270C392 0 492 25 567 83C643 141 690 230 690 350C690 444 655 517 605 565C543 625 450 650 323 650H43ZM213 547C213 587 217 598 226 604C236 612 262 617 304 617C371 617 429 604 474 576C554 529 592 439 592 336C592 176 505 36 319 36C246 36 213 55 213 131V547Z"/></g><g transform="matrix(.013,0,0,-0.013,16.939,0)"><path id="g190-84" d="M409 504C401 567 396 607 392 642C354 654 312 665 266 665C137 665 60 583 60 487C60 374 161 325 225 290C300 250 355 215 355 141C355 68 311 21 235 21C131 21 86 122 71 183L41 176C48 128 61 42 68 21C78 16 93 8 118 0C142 -7 175 -15 216 -15C349 -15 438 69 438 174C438 287 344 333 265 374C186 414 138 449 138 522C138 576 172 631 249 631C336 631 363 562 380 499L409 504Z"/></g><g transform="matrix(.013,0,0,-0.013,26.82,0)"><use xlink:href="#g117-94"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.63pt" style="vertical-align:-1.11981pt" height="9.87315pt" version="1.1" viewBox="38.0321838 -8.75334 15.63 9.87315"><g transform="matrix(.013,0,0,-0.013,38.082,0)"><use xlink:href="#g113-52"/></g><g transform="matrix(.013,0,0,-0.013,44.323,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,47.287,0)"><use xlink:href="#g113-54"/></g></svg></span> (range 4-10). Approximately one third of patients with dysphagia had a score of &lt;3.5. Using this cut-off, sensitivity was 100% and negative predictive value 100%. This study shows that the EDS can be used prospectively when triaging patients referred to secondary care with dysphagia. The high negative predictive value using the EDS means that patients who have an <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="34.451pt" style="vertical-align:-0.6370001pt" id="M3" height="9.39034pt" version="1.1" viewBox="-0.0498162 -8.75334 34.451 9.39034"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g190-70"/></g><g transform="matrix(.013,0,0,-0.013,7.384,0)"><use xlink:href="#g190-69"/></g><g transform="matrix(.013,0,0,-0.013,16.939,0)"><use xlink:href="#g190-84"/></g><g transform="matrix(.013,0,0,-0.013,26.82,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.63pt" style="vertical-align:-0.6370001pt" height="9.39034pt" version="1.1" viewBox="38.0321838 -8.75334 15.63 9.39034"><g transform="matrix(.013,0,0,-0.013,38.082,0)"><use xlink:href="#g113-52"/></g><g transform="matrix(.013,0,0,-0.013,44.323,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,47.287,0)"><use xlink:href="#g113-54"/></g></svg></span> can be downgraded to a routine waiting list without leading to delays in diagnosing oesophageal malignancy. This will enable faster investigations for patients who remain on the “urgent suspicion of cancer” waiting list. In the age of COVID-19, with increasingly long waiting lists, the EDS is a useful scoring system to identify patients with the greatest need for urgent endoscopy.

Hannah B. Walton

Dean McAvoy

Rahul Kalla

Norma McAvoy

Nicholas Church

Ian D. Penman

Andrew Williams

Kenneth Trimble

Gail S. M. Masterton

John N. Plevris

On behalf of EGAR (Edinburgh GI Audit Research) Collaborative

Prospective Validation of Edinburgh Dysphagia Score as a Triaging Tool beyond the COVID-19 Era

<i>Background</i>. The number of gastrointestinal endoscopies in children is rapidly increasing without evidence of a parallel increase in disease burden. The positive yield of paediatric endoscopies outside certain conditions is small but the impact of normal “negative” results on clinical management is poorly studied. Routine mucosal biopsy in all paediatric endoscopies is common practice. We aimed to assess the impact of normal endoscopy on patient care, defined by symptom improvement and discharge from hospital follow-up, and calculate the correlation between endoscopic and histological findings. <i>Methods</i>. Retrospective analysis of the first diagnostic endoscopy in children (2015–2019) from Evelina London Children’ Hospital, in London, UK. Endoscopy and histology findings were recorded. Symptoms and follow-up were reviewed up to six months after the endoscopy. <i>Results</i>. 362 children were included; 46.7% were female. Mean age 10.5 (±4.1) years, 66.3% underwent OGDs, and 33.7% underwent combined OGD and colonoscopies. 72.9% of endoscopies and 57.2% of all biopsies were normal. There was a strong positive correlation between endoscopic findings and biopsy results (phi 0.68 <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M1" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.921pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 21.921 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,25.569,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g></svg>).</span></span> 31.2% of children reported symptom improvement and were discharged from further follow-up after undergoing endoscopy after 1.9 (±1.5) clinics, phi 0.2 <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M2" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-91"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.184pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 28.184 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><use xlink:href="#g113-50"/></g></svg></span> between normal endoscopy and discharge. <i>Conclusion</i>. Negative endoscopy appears to influence clinical management and discharge from hospital follow-up in about a third of children undergoing endoscopy. The practice of routine biopsies in all paediatric endoscopies should be considered due to a strong positive correlation between normal endoscopies and normal biopsies.

Mara Popescu

Junaid Naveed

Ifrah Hasan

Mohamed Mutalib

Clinical Utility of Paediatric Endoscopy and Correlation between Endoscopic and Histological Findings

<i>Background</i>. Vedolizumab is a gut-selective monoclonal anti-<i>α</i><sub>4</sub><i>β</i><sub>7</sub>-integrin antibody approved for the treatment of adults with moderately to severely active Crohn’s disease (CD). <i>Aim</i>. To conduct a systematic literature review and meta-analysis of published real-world studies examining mucosal healing (MH) rates in patients with CD treated with vedolizumab in routine clinical practice. <i>Methods</i>. MEDLINE-, Cochrane-, and EMBASE-indexed publications from January 2014 to January 2020 and 2018-2019 conference abstracts were searched for real-world studies reporting MH-related outcomes in vedolizumab-treated adults with CD. A meta-analysis was conducted in R to generate pooled estimates of MH. The primary analysis included studies reporting point estimates of MH/endoscopic remission as absence of ulcers/erosions and/or Simple Endoscopic Score for CD (SES-CD) <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="73.677pt" style="vertical-align:-3.16848pt" id="M1" height="11.5173pt" version="1.1" viewBox="-0.0498162 -8.34882 73.677 11.5173"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g190-100" d="M390 111C344 68 312 56 269 56C212 56 118 102 118 241C118 346 175 401 241 401C277 401 312 388 342 360C350 352 355 349 361 349C372 349 394 371 394 392C394 403 391 411 378 422C362 436 329 449 288 449H287C250 449 190 432 138 392C71 341 37 274 37 197C37 90 112 -12 238 -12C297 -12 363 32 407 90L390 111Z"/></g><g transform="matrix(.013,0,0,-0.013,5.59,0)"><path id="g190-118" d="M518 50L491 51C452 54 444 60 444 110V444C429 441 405 437 377 434C348 430 314 427 287 426V403L323 397C356 392 365 386 365 333V99C331 66 293 51 257 51C212 51 169 75 169 164V299C169 366 169 413 172 444C156 441 128 437 101 433C75 430 50 427 29 426V403L57 397C82 391 90 386 90 333V137C90 29 147 -12 214 -12C241 -12 262 -4 291 13S342 48 365 65V-6L371 -12C390 -7 415 1 441 8C468 15 496 21 518 24V50Z"/></g><g transform="matrix(.013,0,0,-0.013,12.337,0)"><path id="g190-117" d="M298 36L289 62C276 55 253 45 228 45C202 45 169 60 169 141V397H276C289 405 292 426 282 437H169V574L155 576L90 509V437H45L17 408L21 397H90V107C90 28 125 -12 188 -12C198 -12 213 -8 230 1L298 36Z"/></g><g transform="matrix(.013,0,0,-0.013,19.269,0)"><path id="g117-33" d="M535 230V280H52V230H535Z"/></g><g transform="matrix(.013,0,0,-0.013,29.805,0)"><path id="g190-113" d="M169 380V459C122 440 66 423 24 416V392C86 384 90 382 90 317V-135C90 -201 81 -207 17 -213V-240H253V-213C176 -207 169 -201 169 -125V6C182 -1 208 -11 238 -12C368 12 487 109 487 260C487 358 421 449 310 449C298 449 279 444 261 433L169 380ZM169 346C196 367 237 389 269 389C341 389 403 329 403 221C403 109 347 37 263 37C228 37 191 53 169 76V346Z"/></g><g transform="matrix(.013,0,0,-0.013,36.735,0)"><path id="g190-112" d="M257 449C165 449 37 374 37 209C37 98 119 -12 256 -12C355 -12 473 65 473 226C473 349 381 449 257 449ZM244 416C333 416 380 320 380 204C380 67 329 21 267 21C184 21 130 115 130 241C130 354 184 416 244 416Z"/></g><g transform="matrix(.013,0,0,-0.013,43.208,0)"><path id="g190-106" d="M135 536C164 536 186 560 186 587C186 617 164 639 136 639C109 639 85 617 85 587C85 560 109 536 135 536ZM252 0V26C188 32 181 38 181 106V451C138 433 90 420 39 412V388C99 379 102 374 102 312V106C102 38 95 32 32 26V0H252Z"/></g><g transform="matrix(.013,0,0,-0.013,46.692,0)"><path id="g190-111" d="M524 0V26C466 32 460 36 460 104V297C460 393 411 449 331 449C302 449 276 437 248 419C223 402 201 387 181 372V451C137 432 90 420 42 411V388C96 378 102 374 102 310V104C102 38 97 33 29 26V0H246V26C187 32 181 36 181 104V339C211 365 250 390 290 390C357 390 381 345 381 276V109C381 40 374 32 315 26V0H524Z"/></g><g transform="matrix(.013,0,0,-0.013,53.555,0)"><use xlink:href="#g190-117"/></g><g transform="matrix(.013,0,0,-0.013,57.52,0)"><path id="g190-116" d="M319 325C317 349 306 409 297 431C277 440 250 449 209 449C117 449 57 389 57 319C57 243 122 209 182 182C232 159 261 135 261 91C261 48 227 21 190 21C130 21 85 79 68 145L41 140C41 104 51 36 58 22C75 7 121 -12 172 -12C252 -12 337 35 337 126C337 195 286 231 210 262C166 281 126 304 126 348C126 388 152 417 191 417C240 417 274 378 294 318L319 325Z"/></g><g transform="matrix(.013,0,0,-0.013,66.046,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="6.42pt" style="vertical-align:-3.16848pt" height="11.5173pt" version="1.1" viewBox="77.2591838 -8.34882 6.42 11.5173"><g transform="matrix(.013,0,0,-0.013,77.309,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g></svg>,</span></span> at 6 and 12 months. <i>Results</i>. The systematic literature review included 36 studies, predominantly of antitumour necrosis factor-experienced patients. MH and endoscopic remission were the most frequently reported endpoints. MH rates were 10.1%-46.0% at 6 months (ten studies) and 21.2%-62.5% at 12 months (eight studies). Fifteen studies defining MH as absence of ulcers/erosions and/or SES-CD <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="73.677pt" style="vertical-align:-3.16848pt" id="M2" height="11.5173pt" version="1.1" viewBox="-0.0498162 -8.34882 73.677 11.5173"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g190-100"/></g><g transform="matrix(.013,0,0,-0.013,5.59,0)"><use xlink:href="#g190-118"/></g><g transform="matrix(.013,0,0,-0.013,12.337,0)"><use xlink:href="#g190-117"/></g><g transform="matrix(.013,0,0,-0.013,19.269,0)"><use xlink:href="#g117-33"/></g><g transform="matrix(.013,0,0,-0.013,29.805,0)"><use xlink:href="#g190-113"/></g><g transform="matrix(.013,0,0,-0.013,36.735,0)"><use xlink:href="#g190-112"/></g><g transform="matrix(.013,0,0,-0.013,43.208,0)"><use xlink:href="#g190-106"/></g><g transform="matrix(.013,0,0,-0.013,46.692,0)"><use xlink:href="#g190-111"/></g><g transform="matrix(.013,0,0,-0.013,53.555,0)"><use xlink:href="#g190-117"/></g><g transform="matrix(.013,0,0,-0.013,57.52,0)"><use xlink:href="#g190-116"/></g><g transform="matrix(.013,0,0,-0.013,66.046,0)"><use xlink:href="#g117-91"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="6.42pt" style="vertical-align:-3.16848pt" height="11.5173pt" version="1.1" viewBox="77.2591838 -8.34882 6.42 11.5173"><g transform="matrix(.013,0,0,-0.013,77.309,0)"><use xlink:href="#g113-53"/></g></svg></span> were included for meta-analysis. Pooled MH rates for the primary analysis were 31.8% at 6 months (95% confidence interval (CI): 25.6-38.3; five studies, <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="22.173pt" style="vertical-align:-0.2064009pt" id="M3" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 22.173 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-79" d="M822 650H589L583 622C660 617 677 607 674 561C672 534 664 481 647 390L600 137H596L273 650H126L120 622C176 620 194 615 207 594C221 571 225 557 214 504L161 257C141 166 129 112 121 85C108 42 83 30 29 28L23 0H260L266 28C193 33 173 42 176 89C178 122 186 172 202 255L256 527H259L583 -8H612L690 390C708 481 720 535 728 558C744 603 756 619 816 622L822 650Z"/></g><g transform="matrix(.013,0,0,-0.013,14.542,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.956pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="25.7551838 -8.6359 18.956 8.8423"><g transform="matrix(.013,0,0,-0.013,25.805,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,32.045,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,38.285,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g></svg>)</span></span> and 33.4% at 12 months (95% CI: 25.9-41.4; three studies, <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="22.173pt" style="vertical-align:-0.2064009pt" id="M4" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 22.173 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-79"/></g><g transform="matrix(.013,0,0,-0.013,14.542,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.956pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="25.7551838 -8.6359 18.956 8.8423"><g transform="matrix(.013,0,0,-0.013,25.805,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,32.045,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g><g transform="matrix(.013,0,0,-0.013,38.285,0)"><use xlink:href="#g113-50"/></g></svg>).</span></span> <i>Conclusion</i>. Approximately one-third of vedolizumab-treated patients with CD achieved MH at both 6 and 12 months in real-world clinical settings, despite utilisation in largely biologic-refractory patients. These findings confirm the effectiveness of vedolizumab for achieving MH in patients with CD.

Silvio Danese

Pravin Kamble

Jin Yang

Jean-Gabriel Le Moine

Shahnaz Khan

Emma Hawe

Christian Agboton

Song Wang

Peter M. Irving

Systematic Literature Review and Meta-analysis: Real-World Mucosal Healing in Vedolizumab-Treated Patients with Crohn&#x2019;s Disease

Although acute pancreatitis is one of the most common conditions that physicians face in daily practice, different approaches are still being followed. Given that in 20&#x2013;30&#x0025; of cases, acute pancreatitis progresses to the severe form with single- or multiorgan failure and is often associated with admission to the intensive care unit, proper management is important. This article is aimed at emphasizing the importance of proper conservative treatment of acute pancreatitis and at focusing on intervention criteria in case of complications, analyzing additionally the step-up endoscopic and surgical approaches. The most common mistakes in conservative treatment include inadequate initial fluid resuscitation, abuse in the administration of antibiotics, insufficient analgesia, avoidance of oral feeding, and inappropriate use of imaging techniques. Moreover, the timing and indications for endoscopic retrograde cholangiopancreatography and cholecystectomy are crucial. Furthermore, in case of unsatisfying response to conservative treatment, which mainly happens during necrotic pancreatitis, early intervention is not indicated and a minimally invasive approach must be adopted firstly, 4 weeks after the onset of the disease, and before any surgical intervention. Each medical procedure has specific indications and must be used in the appropriate occasion. As a result, clinical doctors must be familiar both with the intervention criteria and the indications of each method. The proper management of acute pancreatitis is essential and life-saving. That is valid both for the conservative treatment and for the invasive approaches.

Michail I. Giakoumakis

Ioannis G. Gkionis

Anastasios I. Marinis

Mathaios E. Flamourakis

Konstantinos G. Spiridakis

Eleni S. Tsagkataki

Eleni I. Kaloeidi

Andreas F. Strehle

Emmanouil N. Bachlitzanakis

Manousos S. Christodoulakis

Management of Acute Pancreatitis: Conservative Treatment and Step-Up Invasive Approaches&#x2014;Evidence-Based Guidance for Clinicians

<i>Background</i>. Evidence regarding the use of proton-pump inhibitors (PPIs) in COVID-19 patients remains elusive. <i>Aim.</i> To examine the potential effects of PPI use on the clinical outcomes of COVID-19 patients in a territory-wide cohort. <i>Methods</i>. A retrospective cohort study was performed using data from a territory-wide database in Hong Kong. Patients diagnosed with COVID-19 from 23 January 2020 to 1 January 2021 were identified by virological results. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death. PPI users were identified by PPI use within 12 months prior to their diagnosis of COVID-19. <i>Results</i>. We identified 8,675 COVID-19 patients (mean age 46 years, 49% male, 97.6% of all reported cases in Hong Kong), of which 579 (6.7%) patients had used PPI. PPI users were found to be older, more likely to have comorbidities, concomitant medications and unfavourable laboratory parameters than nonusers. Of the 8,675 COVID-19 patients, 500 (5.8%) developed the primary endpoint. After propensity score (PS) balancing for patients’ demographics, comorbidities, laboratory parameters, and use of medications, PPI use was not found to be associated with the development of primary endpoint in PS weighting (weighted hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.82–1.46, <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.2064009pt" id="M1" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.182pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="22.8711838 -8.6359 28.182 8.8423"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,44.605,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g></svg>),</span></span> and PS matching analysis (weighted HR 0.79, 95% CI 0.56–1.13, <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.2064009pt" id="M2" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.182pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="22.8711838 -8.6359 28.182 8.8423"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-58"/></g><g transform="matrix(.013,0,0,-0.013,44.606,0)"><path id="g113-57" d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"/></g></svg>).</span></span> Consistent nonassociation was observed after multivariable adjustment (adjusted HR 0.84, 95% CI 0.67–1.06, <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.2064009pt" id="M3" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.182pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="22.8711838 -8.6359 28.182 8.8423"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,44.605,0)"><use xlink:href="#g113-51"/></g></svg>),</span></span> and in subgroups of current and past PPI users. <i>Conclusion</i>. PPI use is not found to be associated with adverse clinical outcomes in COVID-19 patients. The result remains robust after PS weighting, PS matching, and multivariable adjustment.

Terry Cheuk-Fung Yip

Francis Ka-Leung Chan

Grace Chung-Yan Lui

Vincent Wai-Sun Wong

Henry Lik-Yuen Chan

Sunny Hei Wong

Joyce Wing-Yan Mak

Siew-Chien Ng

David Shu-Cheong Hui

Grace Lai-Hung Wong

Use of Proton-Pump Inhibitor Is Not Associated with Adverse Clinical Outcomes in COVID-19 Patients: A Territory-Wide Cohort Study

About this journal

<p><em>GastroHep</em> is an international, peer reviewed, high quality publication focussing on current and cutting edge research in academic and clinical gastroenterology and hepatology.&nbsp;</p>


Journal profile

Meet the editorial board

<p><em>GastroHep&nbsp;</em>maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.</p>


Editor spotlight

Find out more

<p>John Wiley and Sons, Inc. and Hindawi collaborate on an Open Access publishing partnership.&nbsp;</p>


Publishing collaboration

Author guidelines

Editorial board

Databases and indexing

title

GastroHep is an international, peer reviewed, high quality publication focussing on current and cutting edge research in academic and clinical gastroenterology and hepatology. 

GastroHep