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Optimising use of thiopurines in inflammatory bowel disease

Thiopurines continue to provide the most popular option for long term control of inflammatory bowel disease. Despite several decades of experience, the use of thiopurines continues to challenge even the most experienced gastroenterologist. This clearly written review by Raj and Hawthorne demystifies the key issues and provides a clear blue print for clinical teams to follow.

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The characteristics of an excellent endoscopy trainer

Pressure to reduce waits, reduced working hours for trainees and a greater focus on safety and the patient experience means we must train more efficiently. To achieve more efficient training we need excellent trainers. Wells’ description of the characteristics of an excellent endoscopy trainer is a must read for both endoscopic trainers and trainees.

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Clinical lesson: eosinophilic oesophagitis, a new diagnosis to swallow

Eosinophilic oesophagitis is not a common condition but correct management will have a huge impact on affected patients. Every gastroenterologist should be aware of this newly described condition and ways of managing it. Lamb et al’s description of three patients and the accompanying editorial bring to life the clinical presentation of eosinophilic oesophagitis and options for treatment.

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Circumstances in which colonoscopy misses cancer

Colonoscopy is regarded to be the gold standard technique for examining the colon, but recent evidence suggests that it is far from perfect. Rabeneck and Paszat’s timely review focuses on the factors that are linked with missing cancer and proposes ways of improving miss rates. This paper is an essential read for all colonoscopists and the staff that support them.

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Nutritional training in gastroenterology

Many gastroenterologists are ill-equipped to provide high quality nutritional support both for patients in wards and out patients. Harvey and Neild argue the importance of having a gastroenterology workforce that is competent to manage nutritional problems. They describe the current challenge of achieving this goal, and the case for more formal nutritional training for gastroenterologists.

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Ethical issues in nutrition support: a view from the coalface

Differences of opinion about nutrition support for patients who are not competent to voice an opinion are commonplace. There are guidelines, precedents and the law to consider when making the best judgement for patients. It has never been so complicated. Simmonds demystifies the issues, providing an excellent overview of what needs to be considered, real life examples and a framework to support clinicians make the best decisions.

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NREG: old banger or new vehicle for research?

Generating new evidence is a challenging business and particularly difficult to achieve in small isolated groups. NREG is a research network which brings together all endoscopy units in the north east of England. This article by Rees and Rutter explains how NREG was formed and describes what it has achieved in a short space of time. The impact of following the NREG model, whether it be in endoscopy or other services, will be a much improved evidence base achieved more efficiently.

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Mortality in ulcerative colitis — what should we tell our patients? Three year mortality following admission for the treatment of ulcerative colitis: a 6 year retrospective case review

This article by Falvey et al provides reassuring evidence that patients with ulcerative colitis have a low mortality following admission for an acute relapse of their disease. Mortality was associated with age and co-morbid disease and outcome for the most severely affect patients was very good. On the basis of this evidence we can be very reassuring to our patients – providing guidance for managing patients is followed.

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