Gastroenterology Today Summer 2019

Volume 29 No. 2
Summer 2019
Gastroenterology Today
Improving Quality in Endoscopy
Guess the three diagnoses in these Gastric Images to win an iPad
See page 3
What approach has 18 Week Support
taken with regards to building an
expert insourcing team?
Matthew’s Perspective:
Dr Matthew Banks is the Clinical Director for 18 Week Support Gastroenterology. He believes it starts with recruiting the
best clinicians. ‘At 18 Week Support we set the bar very high. We only recruit clinicians whose JAG performance data is well
above the national standards. In addition, we monitor each clinician’s KPIs while they work with 18 WS. While the JAG data
is an excellent quality indicator, we now want to go a step beyond that and monitor the Non-Technical skills (NTS) of each
clinician as well. We now know that NTS plays an important role in safe and effective team performance. Therefore, in our
quest to develop excellent teams who deliver a world-class service, we must focus on NTS’.
Tammy and Lisa’s Perspective:
Tammy Kingstree is Lead Nurse for Endoscopy.
‘It is extremely important that there are good working relationships within the team. This starts with strong leadership from
our senior nurse coordinators who are trained to manage the patient pathway, manage a team of staff they may not know
and to deal effectively with any issues which may arise on the day’.
Lisa Phillips is Lead Nurse for Endoscopy.
‘The team objectives are clear. Excellent patient experience and good patient outcomes. Because the objectives are clear,
team cohesion and focus are exceptionally good. It therefore shouldn’t matter that we are in an unfamiliar endoscopy unit,
the service should be seamless. If it isn’t, we do not stop until we get it right.
18 Week Support Gastroenterology:
Building Expert Teams
If you have an excellent NHS record and want to help clear NHS waiting list backlogs, reduce RTT waiting times and provide
high-quality patient care, get in touch by calling on 020 3892 6162 or email Gastro.Recruitment@18weeksupport.com

One 5-ASA
stands out
from the crowd;
so your UC patients
don’t have to.
Unique among 5-ASAs, only PENTASA has ethyl cellulose coated microgranules that release
mesalazine independent of pH. 1-10 Alongside this, PENTASA:
• Is effective in 2 weeks 11,12 and remission is maintained for 12 months 13,14
• Is effective throughout the entire colon including left-sided disease 1,13-15
• Offers a broad range of formulations allowing high dose * ,
once-daily dosing: 4 g – active, 2 g – remission 1,16-21
Giving your mild to moderate UC patients the confidence to enjoy life.
*1 g tablets, 1 g, 2 g and 4 g sachets
Prescribing Information: Pentasa ® all formulations. Please consult the full
Summary of Product Characteristics before prescribing. Name of Product(s):
Pentasa ® Sachet prolonged release granules 1g, 2g and 4g; Pentasa ® Slow Release
Tablets 500mg and 1g; Pentasa® Mesalazine Enema 1g; Pentasa ® Suppositories 1g.
Composition: Sachets: contain 1g, 2g or 4g mesalazine. Tablets: contain 500mg
or 1g mesalazine. Enema: contains 1g mesalazine in 100ml of aqueous suspension.
Suppositories: contain 1g mesalazine. Indication: Sachets and Tablets: Mild to
moderate ulcerative colitis. Enema: ulcerative colitis affecting the distal colon and
rectum. Suppositories: ulcerative proctitis. Dosage: Sachets and Tablets: Adults:
Active disease: up to 4g once daily or in 2–4 divided doses. Maintenance treatment:
2g once daily. Sachets and 500mg tablet: Children over 6 years old: Active disease:
individual dosing, starting with 30-50 mg/kg/day in divided doses (total dose should
not exceed 4g/day). Maintenance treatment: individual dosing, starting with 15-30
mg/kg/day in divided doses (total dose should not exceed 2g/day). Enema: Adults:
one enema at bedtime. Suppositories: Adults: 1 suppository daily.Contraindications:
patients with known hypersensitivity to salicylates or any of the excipients and patients
with severe liver and/or renal impairment. Special Warnings and Precautions:
Blood tests (differential blood count: liver function parameters such as ALT or AST;
serum creatinine) and urinary status should be determined prior to and during
treatment, at the discretion of the treating physician. Caution is recommended in
patients with impaired hepatic function. PENTASA should not be used in patients
with impaired renal function. Mesalazine- induced renal toxicity should be considered,
if renal function deteriorates during treatment. Patients with pulmonary disease, in
particular asthma, should be very carefully monitored during a course of treatment
with PENTASA. Patients with a history of adverse drug reactions to preparations
containing sulphasalazine (risk of allergy to salicylates), should be kept under close
medical surveillance on commencement of a course of treatment with PENTASA.
Should PENTASA cause acute intolerance reactions such as abdominal cramps,
acute abdominal pain, fever, severe headache and rash, the treatment should be
discontinued immediately. Mesalazine-induced cardiac hypersensitivity reactions
(myo- and pericarditis) have been reported rarely. Treatment should be discontinued
on suspicion or evidence of these reactions. In patients who are concomitantly treated
with azathioprine, or 6-mercaptopurine, or thioguanine, a possible increase in the
myelosuppressive effects of azathioprine, or 6-mercaptopurine, or thioguanine
should be taken into account. There may be a decrease in the anticoagulant effect
of warfarin. Do not use during pregnancy and lactation except when the potential
benefits outweigh the possible risk. Sachets: Caution is recommended in patients with
active peptic ulcer disease. The concurrent use of other known nephrotoxic agents,
such as NSAID’s and azathioprine, may increase the risk of other renal reactions.
Enema and Suppositories: If a patient develops dehydration while on treatment with
mesalazine, normal electrolyte levels and fluid balance should be restored as soon as
possible. Side effects: For the full list of side effects please consult the Summaries of
Product Characteristics. PENTASA 1g 2g 4g sachets: Common: Headache, Diarrhoea,
Abdominal pain, Nausea, Vomiting, Flatulence. Rare: Acute pancreatitis. Very rare:
Benign intracranial hypertension, Pericardial effusion, Quincke’s oedema, Dermatitis
allergic, Hypersensitivity reaction including anaphylactic reaction, Drug Reaction
with Eosinophilia and Systemic Symptoms (DRESS). Pentasa all formulations: Rare:
Dizziness, Myocarditis, Pericarditis, Photosensitivity. Very rare: Altered blood counts,
Hypersensitivity reaction such as Allergic exanthema, Drug fever, Lupus erythematosus
syndrome, Pancolitis, Peripheral neuropathy, Allergic and Fibrotic lung reactions,
Changes in liver function parameters, Hepatitis and Cholestatic hepatitis, (Reversible)
Alopecia, Renal function impairment interstitial, nephritis (incl. acute and chronic) Renal
insufficiency, reversible Oligospermia. PENTASA 1g 2g 4g sachets, 1g enema and 1g
suppository: Common: Rash. Rare: Increased amylase. Very rare: Cirrhosis, Hepatic
failure, Erythema multiforme Stevens Johnson Syndrome (SJS), Nephrotic syndrome,
Urine discolouration. PENTASA 500mg and 1g tablets, 1g enema and 1g suppository:
Rare: Abdominal pain, Diarrhoea, Flatulence, Nausea, Vomiting, Headache. Very Rare:
Acute Pancreatitis. Nature and Contents of Container: Sachets: Cartons contain 50 x
1g sachets, 60 x 2g sachets or 30 x 4g sachets. Tablets: Cartons contain 100 x 500mg and
60 x 1g tablets in blister strips. Enema: Cartons contain 7 x 100ml enemas. Suppositories:
Cartons contain 28 x 1g suppositories in blister strips.Marketing Authorisation
Number: Sachet 1g: 03194/0075. Sachet 2g: 03194/0102. Sachet 4g: PL 03194/0117.
Tablets 500mg: 03194/0044. Tablets 1g: 3194/0108. Enema: 03194/0027. Suppositories:
03194/0045. Marketing Authorisation Holder: Ferring Pharmaceuticals Ltd., Drayton
Hall, Church Road, West Drayton, UB7 7PS, United Kingdom. Legal Category: POM.
Basic NHS Price: £30.74 for 50 x 1g sachets. £73.78 for 60 x 2g sachets. £73.78 for
30 x 4g sachets. £30.74 for 100 x 500mg Tablets. £36.89 for 60 x 1g Tablets. £17.73
for 7 x enemas. £40.01 for 28 x 1g suppositories. Date of Preparation of Prescribing
Information: January 2019. Pentasa ® is a registered trademark. PA/035/2019/UK.
Adverse events should be reported. Reporting forms
and information can be found at www.mhra.gov.uk/
yellowcard. Adverse events should also be reported
to Ferring Pharmaceuticals Ltd. Tel: 0800 111 4126.
Email: medical@ferring.com
References: 1. Pentasa Slow Release Tablets 500 mg. SmPC.
2. Sulfasalazine 250 mg/5 ml Oral Suspension. SmPC. 3. Octasa 400
mg MR Tablets. SmPC. 4. Asacol 400 mg MR Tablets. SmPC. 5. Mezavant
XL 1200 mg, Gastro-resistant, Prolonged Release Tablets. SmPC.
6. Salofalk 500 mg Gastro-resistant Prolonged Release Granules. SmPC.
7. Colazide 750 mg Capsules. SmPC. 8. Olsalazine Sodium 250 mg Capsules.
SmPC. 9. Salazopyrin En-Tabs. SmPC. 10. Salazopyrin Tablets SmPC.
11. Probert C.S.J, et al. J Crohn’s Colitis. 2014;8:200–7. 12. Marteau P, et al. Gut.
2005;54(7):960–5. 13. Dignass AU, et al. Clin Gastroenterol Hepatol. 2009;7(7):762–
9. 14. Bokemeyer B, et al. J Crohn’s Colitis. 2012;6:476-82. 15. Flourie B,
et al. Aliment Pharmacol Ther. 2013;37(8):767–75. 16. Pentasa Slow Release Tablets 1 g.
SmPC. 17. Pentasa Sachet 1 g. SmPC. 18. Pentasa Sachet 2 g. SmPC. 19. Pentasa
Sachet 4 g. SmPC. 20. Pentasa Enema 1 g. SmPC. 21. Pentasa Suppositories 1 g. SmPC.
Date of preparation: May 2019. Job code: PA/323/2019/UKa
MAKING A
Positive UC action. Positive UC outcomes.
DIFFERENCE
Positive UC a

CONTENTSMatthew’s Perspective:
5 EDITORS COMMENT
6 CASE REPORT Primary Aorto-enteric Fistula
14 FEATURE Showing the true value of probiotics
17 NEWS
26 COMPANY NEWS
What approach has 18 Week Support
CONTENTS
taken with regards to building an
expert insourcing team?
Gastroenterology Today
Dr Matthew Banks is the Clinical Director for 18 Week Support Gastroenterology. He believes it starts with recruiting the
best clinicians. ‘At 18 Week Support we set the bar very high. We only recruit clinicians whose JAG performance data is well
above the national standards. In addition, we monitor each clinician’s KPIs while they work with 18 WS. While the JAG data
is an excellent quality indicator, we now want to go a step beyond that and monitor the Non-Technical skills (NTS) of each
clinician as well. We now know that NTS plays an important role in safe and This effective issue team performance. edited by: Therefore, in our
quest to develop excellent teams who deliver a world-class service, we must focus on NTS’.
Dr Ben Shandro
Tammy and Lisa’s Perspective:
c/o Media Publishing Company
Tammy Kingstree is Lead Nurse for Endoscopy.
Media House
‘It is extremely important that there are good working relationships within the team. This starts with strong leadership from
48 High Street
our senior nurse coordinators who are trained to manage the patient pathway, manage a team of staff they may not know
SWANLEY, Kent BR8 8BQ
and to deal effectively with any issues which may arise on the day’.
Lisa Phillips is Lead Nurse for Endoscopy.
ADVERTISING & CIRCULATION:
‘The team objectives are clear. Excellent patient experience and good patient outcomes. Because the objectives are clear,
Media Publishing Company
team cohesion and focus are exceptionally good. It therefore shouldn’t matter that we are in an unfamiliar endoscopy unit,
the service should be seamless. If it isn’t, we do not stop until we get it right. Media House, 48 High Street
SWANLEY, Kent, BR8 8BQ
If you have an excellent NHS record and want to help clear NHS waiting list Tel: backlogs, 01322 reduce 660434 RTT waiting Fax: times 01322 and provide 666539
high-quality patient care, get in touch by calling on 020 3892 6162 or email Gastro.Recruitment@18weeksupport.com
E: info@mediapublishingcompany.com
www.MediaPublishingCompany.com
COVER STORY
What are the three diagnoses evident in these
gastric images?
Submit your answers to jawuku@18weeksupport.com to enter our prize
draw to win an iPad! The Competition will end on the 21st of June.
The winner will be announced on the 18 Week Support website.
What approach has 18 Week Support taken with regards to building an
expert insourcing team?
Matthew’s Perspective:
Dr Matthew Banks is the Clinical Director for 18 Week Support Gastroenterology.
He believes it starts with recruiting the best clinicians. ‘At 18 Week Support we
set the bar very high. We only recruit clinicians whose JAG performance data
is well above the national standards. In addition, we monitor each clinician’s
KPIs while they work with 18 WS. While the JAG data is an excellent quality
indicator, we now want to go a step beyond that and monitor the Non-Technical
skills (NTS) of each clinician as well. We now know that NTS plays an important
role in safe and effective team performance. Therefore, in our quest to develop
excellent teams who deliver a world-class service, we must focus on NTS’.
Tammy and Lisa’s Perspective:
Tammy Kingstree is Lead Nurse for Endoscopy.
‘It is extremely important that there are good working relationships within the team.
This starts with strong leadership from our senior nurse coordinators who are trained
to manage the patient pathway, manage a team of staff they may not know and to
deal effectively with any issues which may arise on the day’.
Lisa Phillips is Lead Nurse for Endoscopy.
‘The team objectives are clear. Excellent patient experience and good patient outcomes.
Because the objectives are clear, team cohesion and focus are exceptionally good.
It therefore shouldn’t matter that we are in an unfamiliar endoscopy unit, the service
should be seamless. If it isn’t, we do not stop until we get it right.
For more information please contact: Ian Yuill, Director of Business Development
& Recruitment on 0203 869 8792 or visit www.18weeksupport.com
PUBLISHING DATES:
February, June and October.
COPYRIGHT:
Media Publishing Company
Media House
48 High Street
SWANLEY, Kent, BR8 8BQ
PUBLISHERS STATEMENT:
The views and opinions expressed in
this issue are not necessarily those of
the Publisher, the Editors or Media
Publishing Company.
Next Issue Autumn 2019
Subscription Information – Summer 2019
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GASTROENTEROLOGY TODAY - SUMMER 2019
3

Getting on with
their lives
By getting on with
their steroid
For autoimmune hepatitis
The only budesonide with three indications
For induction of remission of mild to moderate active
ileo-caecal Crohn’s disease
For induction of remission of active collagenous colitis
Budesonide, the Dr Falk way
Efficacy localised at the site of the diseases 1-4
Limiting the risk of systemic side effects 2-4
Prescribing Information (Please refer to full SPC before prescribing)
Presentation: Budenofalk ® gastro-resistant granules, each sachet
contains 9mg budesonide, Budenofalk ® gastro-resistant capsules, each
containing 3mg budesonide. Indications: Induction of remission of
mild to moderate active Crohn’s disease affecting the ileum and/or the
ascending colon. Induction of remission of active collagenous colitis.
Autoimmune hepatitis (capsules only). Dosage: Adults: For Crohn’s
disease and collagenous colitis: one sachet or three capsules daily with
liquid half an hour before food, without chewing or crushing, or one
capsule three times daily. Limit treatment to 8 weeks, then withdraw
gradually. For autoimmune hepatitis: one capsule three times daily.
Possibly combine with azathioprine. Maintenance of remission: one
capsule twice daily. Revert to 3 capsules daily if transaminases ALAT and/
or ASAT elevate again. Treat until remission is achieved or 24 months.
Children: Not recommended; safety and efficacy not established. Contraindications:
hypersensitivity to any constituent. Hepatic cirrhosis.
Warnings/Precautions: Change from other steroids may result in
symptoms due to reduced systemic steroids. Use with caution in patients
with tuberculosis, hypertension, diabetes mellitus, osteoporosis, peptic
ulcer, glaucoma, cataracts or family history of glaucoma or diabetes or any
condition in which glucocorticosteroids may have undesirable effects.
Not appropriate for upper GI Crohn’s or extraintestinal symptoms.
Long term, high dose use may result in glucocorticosteroid systemic
effects. Infection: suppression of the inflammatory response and
immune function increases susceptibility to infections and their severity.
Clinical presentation of infections may be atypical and presentation of
serious infections may be masked. Chickenpox and herpes zoster are
of particular concern. Passive immunisation needed within 10 days in
exposed non-immune patients taking systemic glucocorticosteroids.
Urgent specialist care required on confirmed chickenpox. Give normal
immunoglobulin immediately after measles exposure. Do not give
live vaccines to those with chronic glucocorticosteroid use. Antibody
response to other vaccines may be diminished. With severe liver
function disorders: increased systemic bioavailability. Central serous
chorioretinopathy or other causes may result in blurred vision/visual
disturbances. Consider referral to ophthalmologist. Suppression of
the HPA axis and reduced stress response: supplementary systemic
glucocorticoid treatment may be needed. Avoid concomitant treatment
with CYP3A4 inhibitors. Do not use in patients with galactose or fructose
intolerance, glucose – galactose malabsorption, sucrase – isomaltase
insufficiency or Lapp lactase deficiency or congenital lactase deficiency.
In autoimmune hepatitis evaluate transaminase levels every 2 weeks
for the first month and then every 3 months. Interactions: Co-treatment
with CYP3A inhibitors including cobicistat containing products may
increase side effects and should be avoided where possible. Beware
concomitant administration of cardiac glycosides and saluretics.
CYP3A4 inhibitors: avoid concomitant administration. CYP3A4
inducers: may reduce systemic and local exposure, necessitating dose
adjustment of budesonide. CYP3A4 substrates: may compete with
budesonide increasing plasma concentrations depending on relative
affinities. Small, non-significant effect of cimetidine on budesonide
kinetic effects. Oestrogens/oral contraceptives may elevate plasma
concentrations and enhance corticosteroid effects. Steroid-binding
compounds and antacids may reduce budesonide efficacy; administer
at least 2 hours apart. Because adrenal function may be supressed,
an ACTH stimulation test for diagnosing pituitary insufficiency might
show false results (low values). Use in pregnancy and lactation: Avoid
use in pregnancy unless essential. Do not breastfeed during Budenofalk
treatment. Undesirable effects: Cushing’s syndrome, growth retardation
in children, glaucoma, cataracts, blurred vision, dyspepsia, abdominal
pain, constipation, gastric or duodenal ulcers, pancreatitis, increase in
risk of infections, muscle and joint pain and weakness and twitching,
osteoporosis, osteonecrosis, headache, pseudotumor cerebri (including
papilloedema) in adolescents, depression, irritability and euphoria,
www.drfalk.co.uk
Dr Falk Pharma UK Ltd, Unit K, Bourne End Business Park, Cores End Rd, Bourne End, SL8 5AS. Registered in England No: 2307698
psychomotor hyperactivity, anxiety, aggression, allergic exanthema,
petechiae, ecchymosis, contact dermatitis, delayed wound healing,
increased risk of thrombosis, vasculitis (after withdrawal from longterm
treatment), fatigue, malaise. Side effects characteristic of systemic
glucocorticosteroid therapy may occur. Exacerbation or reappearance of
extraintestinal manifestations when switching from systemically acting
glucocorticosteroids may occur. Frequency is likely to be lower than
with equivalent dosage of prednisolone. Legal category: POM. Costs:
UK NHS: 60 sachets £135.00; 100 capsules £75.05. Ireland (PtW):
60 sachets: €149.49; 100 capsules: €78.96. Licence holder: Dr Falk
Pharma GmbH, Leinenweberstr.5, D-79108 Freiburg, Germany. Licence
numbers: (granules) PL08637/0020 (UK) PA573/2/3 (IE) (capsules)
PL08637/0002 (UK) PA573/2/1 (IE). Prepared: February 2019.
Further information available on request.
Adverse events should be reported. Reporting forms and information
can be found at www.mhra.gov.uk/yellowcard or search for MHRA
Yellow Card in the Google Play, Apple App Store (UK residents) or
at email: medsafety@hpra.ie or at http://www.hpra.ie/homepage/
about-us/report-an-issue/human-adverse-reaction-form (residents
in Ireland). Adverse events should also be reported to Dr Falk
Pharma UK Ltd.
References:
1. Bar-Meir S et al. Gastroenterol 1998; 115(4): 835-40. 2. De Cassan C
et al. Dig Des 2012; 30(4): 368-75. 3. Czaja AJ. Dig Dis Sci 2012; 57(8):
1996-2010. 4. Miehlke S et al. Gastroenterol 2002; 123(4): 978-84.
DrF19/003
Date of preparation: March 2019

EDITORS COMMENT
EDITORS COMMENT
Seek and ye shall find
“As with
all rare
diagnoses,
the critical
first step
is to
consider
it.”
The case-report by Arakkal et al. included in this edition of Gastroenterology Today presents
a rare cause of a common presentation, and highlights the importance of including these in
the differential diagnosis.
Arakkal et al. describe a case of acute upper GI bleeding secondary to primary aortoenteric
fistula. The diagnosis of primary aorto-enteric fistula requires cross-sectional
imaging, which does not form part of the GI bleeding pathway in most international
guidelines. These patients could exsanguinate whilst awaiting their colonoscopy or video
capsule endoscopy, the two investigations usually advocated after negative upper GI
endoscopy. If this rare diagnosis had not been considered, and the CT scan requested,
then the diagnosis could not have been made.
Early identification of patients with aorto-enteric fistula is paramount, as it is common
to present with a smaller herald bleed prior to catastrophic GI haemorrhage. Presenting
symptoms are non-specific. Routine physical examination is only moderately sensitive for
detecting abdominal aortic aneurysm (AAA), even when the physical examination is directed
specifically to the detection of AAA.
In contrast, ultrasound and CT imaging are highly sensitive. Could there be a role for
focussed ultrasound scanning in the emergency department for at-risk patients who present
with GI bleeding, such as those aged over 60 years?
As with all rare diagnoses, the critical first step is to consider it.
Dr Ben Shandro
Research Fellow in Gastroenterology
St George’s Hospital
GASTROENTEROLOGY TODAY - SUMMER 2019
5

CASE REPORT
PRIMARY AORTO-ENTERIC FISTULA -
A CASE REPORT
1. Dr Mohammed Shaheer Pandara Arakkal, Senior Clinical Fellow , Gastroenterology, Morriston hospital, Swansea Wales, UK
2. Dr.Umakant Dave, Consultant Gastroenterologist, , Morriston Hospital, Swansea Wales, UK
3. Victoria Trainer, Consultant Radiologist, Singleton Hospital, Swansea Wales, UK
Abstract
Aorto-enteric fistula is a life threatening condition and is defined as
an abnormal communication between the abdominal aorta and
gastrointestinal tract. It is most often secondary to either erosion of an
aortic prosthetic graft or other vascular procedure on the aorta, known as
secondary aorto-enteric fistulae (SAEF). Primary aorto-enteric fistula (PAEF)
occurs as a result of compression of an abdominal aortic aneurysm (AAA)
against the surrounding gastrointestinal structures causing spontaneous
communication between them. We describe a case of PAEF in an 85 year
old woman who was known to have AAA who presented with acute upper
gastrointestinal haemorrhage to the emergency department. This report
highlights the importance of high index of suspicion in diagnosing aortoenteric
fistula, especially if the patient is known to have AAA.
Introduction
Primary aorto-enteric fistula (PAEF) is an abnormal communication
between abdominal aorta and gastrointestinal (GI) tract in the absence of
any vascular intervention on aorta. Secondary aorto-enteric fistula occurs
as a complication of endovascular procedures with prosthesis or stent
graft or a surgical procedure usually for an AAA repair. Primary aortoenteric
fistula (PAEF) is a rare but serious differential diagnosis that must
be considered in any patients who presents with upper gastro intestinal
(GI) haemorrhage, especially if the patient is known to have an abdominal
aortic aneurysm (AAA). Although aorto-enteric fistula (AEF) has several
aetiologies, the most common cause of PAEF is AAA. As PAEF is quite
a challenging diagnosis for the treating physician, early detection and
treatment is vital for the patient survival. If left untreated mortality is 100%.
This is a case report of a patient with known AAA who was found to have
Aorto- duodenal fistula while investigating for Upper GI haemorrhage.
Case Report
An 85 year old lady presented to the Emergency department (ED) in
October 2018 with two episodes of haematemesis and one episode
melaena. She had a further episode of melaena in the ED. She had a
background history of coronary artery bypass graft (CABG) in 1993, chronic
obstructive pulmonary disease (COPD), osteoporosis, varicose eczema
and high cholesterol. She was an ex-heavy smoker with a 50 pack-year
smoking history and consumed alcohol occasionally. No previous history
of upper GI haemorrhage. Her regular medications were Co-Codamol,
Alendronic acid, Lansoprazole, Oxybutynin, Gabapentin, GTN spray,
Isosorbide mononitrate, Paroxetine, Diltiazem, Aspirin and Atorvastatin.
GASTROENTEROLOGY TODAY - SUMMER 2019
6
Image [1] CT image on previous admission showing A-Abdominal
Aortic Aneurysm (AAA) belly. B-Duodenum clinging around the aortic
aneurysm, but no gas with in the aneurysm
Image 1
Three months prior to the last admission she presented to the ED after
a fall and sustained a fracture dislocation of the left shoulder. A chest
X-ray then showed a small density in the left upper zone measuring
approximately 12mm. She underwent surgery for her fracture and was
discharged from the hospital. An outpatient CT thorax and abdomen
performed two months later to evaluate the lung mass incidentally
revealed a 6.4 cm abdominal aortic aneurysm, which extended down
to the bifurcation. The descending thoracic aorta was also aneurysmal
[Image 1]. The mass in the lung was reported as possible fibrosis. She
was referred to vascular surgeons for further management of AAA.
A decision was made by the vascular surgery team not to intervene
because of the morphology of aneurysm, as well as patient’s age,
comorbidities and frailty.
Blood results during the last admission with GI haemorrhage revealed
an Hb of 94 g/L (112 g/L when discharged home from previous
admission), white cell count of 34.1 x10^9/L (neutrophil count 30.8
x10^9/L), platelet count of 352 x10^9/L, MCV of 90 fL. U&Es revealed
Na-143 mmol/L, K-4.5 mmol/L, Urea 8.6 mmol/L, creatinine 95 umol/L,
CRP-20 mg/L, normal LFTs and normal clotting parameters.

CASE REPORT
You’ve probably
never seen an oral iron
like FERACCRU ® before
For the treatment of adults with iron defi ciency
anaemia (IDA) 1
PRESCRIBING INFORMATION: Feraccru 30mg hard
capsules (ferric maltol)
Please refer to the full Summary of Product Characteristics
(SmPC) before prescribing.
Presentation: Red hard capsules. Each capsule contains
30 mg iron (as ferric maltol). Indication: Feraccru is
indicated in adults for the treatment of iron defi ciency.
Dosage and Administration: Adults: Feraccru should be
taken orally. The whole capsule should be taken on an
empty stomach (with half a glass of water). The
recommended dose is one capsule twice daily, in the
morning and evening. The absorption of iron is reduced
when Feraccru is taken with food. Treatment duration will
depend on the severity of iron defi ciency but generally at
least 12 weeks treatment is required. The treatment should
be continued as long as necessary to replenish the body
iron stores according to blood tests. Elderly: No dose
adjustment is necessary. Children: The safety and effi cacy
of Feraccru in children (17 years and under) has not yet
been established. No data are available. Patients with
hepatic or renal impairment: No clinical data is available
in this patient population. Contraindications:
Hypersensitivity to the active substance or to any of the
excipients; Haemochromatosis and other iron overload
syndromes; Patients receiving repeated blood
transfusions. Warnings and precautions: Feraccru should
not be used in patients with infl ammatory bowel disease
(IBD) fl are or in IBD patients with haemoglobin (Hb) levels

CASE REPORT
Examination revealed HR-95 b/m, BP 130/70 mm Hg, oxygen saturation
96% on 2 Litres of oxygen and normal temperature. Abdominal
examination revealed a large pulsatile abdominal mass. PR examination
revealed melaena on glove. She scored 10 points on the Glasgow-
Blatchford Bleeding Score.
After resuscitation with IV fluids and blood products the patient was
transferred to the ward. She had 3 further large episodes of melaena
on the same day and was taken to the endoscopy unit for upper GI
endoscopy which did not reveal blood in the upper GI tract, but did
show a deep ulcer in the second part of duodenum (D2) [Image 2&3].
Post- endoscopy Rockall Score was 6. The consultant who performed
the endoscopy was concerned about the morphology of the ulcer
and recommended a CT scan and urgent surgical review to rule out
a primary aorto-enteric fistula [PAEF]. In view of high suspicion of a
PAEF, the endoscopist elected not to perform endotherapy used for
bleeding duodenal ulcer. A 3 phase CT abdomen and pelvis revealed
an increase in size of the infrarenal abdominal aortic aneurysm [AAA]
which measured 8 cm [Image 4] (6.4cm previously [Image 1]). New
gas locules within the inferior aspect of aneurysm sac were highly
suggestive of aorto-enteric fistulation. The aortic sac was inseparable
from the proximal duodenum and tracking gas locules were suggestive
of a communication between aneurysm sac and second part of
duodenum [Image 4]. An urgent vascular review was requested and
vascular surgeons decided not to surgically intervene as the patient
was very frail and unlikely to survive a repair. This was discussed with
the patient and her daughter and decision for palliation was made. The
patient had another massive haematemesis and melaena early in the
morning of the next day and died after a few hours.
Discussion
Formation of fistula between aorta and intestinal tract was first described
by an English Surgeon Sir Ashley Cooper in 1829 [1]. But the first case
report of PAEF was published by Salmon in 1843. Since then only about
400 of PAEF cases have been reported up until now [2&3]. PAEF is a
potentially fatal and a rare complication of untreated aortic aneurysm,
which warrants a high index of clinical suspicion when presented with
upper GI haemorrhage. The fistula most commonly erodes into an
area of intestine (most commonly the third part of duodenum) which
has close contact with the pulsating aortic segment [4, 5&6]
The classical triad of symptoms with abdominal pain, pulsatile
abdominal mass and gastrointestinal haemorrhage are only found
in 6-12% of patients [7&8]. The most common presentation is upper
GI haemorrhage. Often the initial GI bleeding is small (herald bleed),
but one third of the patients presents with massive recurrent bleeding
within 6 hours [9]. Many patients with aorto-enteric fistula (AEF) die
before an accurate diagnosis is made due to its variable clinical
manifestations and insufficient awareness of this rare entity among
non-specialty clinicians. Although literature review suggests the most
common aetiology for PAEF are atherosclerotic and traumatic AAA,
other causes include radiation, cancer, metastasis, gallstone erosion,
ulcers, diverticulitis appendicitis, aortitis, infections like TB, pancreatic
pseudo cyst penetration and foreign body ingestion[10&3].
Unusual features of this case include the fistulous connection between
the AAA and second part of duodenum and the presence of a deep
ulcer on endoscopy. Even though no literature is available to confirm,
it is possible that standard endotherapy for bleeding duodenal ulcer
(adrenaline injection, heater probe, gold probe coagulation and
endoclip placement) may lead to massive haemorrhage in patients
with aorto-enteric fistula. In our patient, possibility of PAEF was
considered very high and endotherapy was not attempted.
Though less frequent, there are reports in literature that described
abnormal communication between aorta and other pat of GI tract such
as the oesophagus, jejunum, ileum and colon, but most of these were
secondary to endovascular or other surgical procedures on aorta
causing secondary fistulation [11].
GASTROENTEROLOGY TODAY - SUMMER 2019
Image [2] A-Endoscopic view of deep ulcer in D2
Image [3] A-Endoscopic view of deep ulcer in D2
Image 2
8
Image 3

Life feels good when they’re under control 1-8
CASE REPORT
CROHN’S DISEASE
Indicated for the induction of
remission in patients with mild to
moderate active Crohn’s disease
affecting the ileum and/or the
ascending colon 9
ULCERATIVE COLITIS
Indicated for ulcerative
colitis involving rectal and
recto-sigmoid disease 10
MICROSCOPIC
COLITIS
Indicated for the induction
and maintenance of remission
in patients with microscopic
colitis 9
Entocort ® CR is the ONLY
LICENSED TREATMENT
for the induction and
maintenance of remission
in microscopic colitis 9
ENTOCORT CR 3mg Capsules (budesonide) - Prescribing Information
Please consult the Summary of Product Characteristics (SmPC) for full
prescribing Information
Presentation: Hard gelatin capsules for oral administration with an opaque,
light grey body and an opaque, pink cap marked CIR 3mg in black radial print.
Contains 3mg budesonide. Indications: Induction of remission in patients with
mild to moderate Crohn’s disease affecting the ileum and/or the ascending
colon. Induction of remission in patients with active microscopic colitis.
Maintenance of remission in patients with microscopic colitis. Dosage and
administration: Active Crohn’s disease (Adults): 9mg once daily in the morning
for up to eight weeks. Full effect achieved in 2-4 weeks. When treatment is to
be discontinued, dose should normally be reduced in final 2-4 weeks. Active
microscopic colitis (Adults): 9mg once daily in the morning. Maintenance of
microscopic colitis (Adults): 6mg once daily in the morning, or the lowest
effective dose. Paediatric population: Not recommended. Older people: No
special dose adjustment recommended. Swallow whole with water. Do not
chew. Contraindications: Hypersensitivity to the active substance or any of the
excipients. Warnings and Precautions: Side effects typical of corticosteroids
may occur. Visual disturbances may occur. If a patient presents with symptoms
such as blurred vision or other visual disturbances they should be considered
for referral to an ophthalmologist for evaluation of the possible causes.
Systemic effects may include glaucoma and when prescribed at high doses for
prolonged periods, Cushing’s syndrome, adrenal suppression, growth
retardation, decreased bone mineral density and cataract. Caution in patients
with infection, hypertension, diabetes mellitus, osteoporosis, peptic ulcer,
glaucoma or cataracts or with a family history of diabetes or glaucoma.
Particular care in patients with existing or previous history of severe affective
disorders in them or their first degree relatives. Caution when transferring from
glucocorticoid of high systemic effect to Entocort CR. Chicken pox and measles
may have a more serious course in patients on oral steroids. They may also
suppress the HPA axis and reduce the stress response. Reduced liver function
may increase systemic exposure. When treatment is discontinued, reduce
dose over last 2-4 weeks. Concomitant use of CYP3A inhibitors, such as
ketoconazole and cobicistat-containing products, is expected to increase the
risk of systemic side effects and should be avoided unless the benefits
outweigh the risks. Excessive grapefruit juice may increase systemic exposure
and should be avoided. Patients with fructose intolerance, glucose-galactose
malabsorption or sucrose-isomaltase insufficiency should not take Entocort CR.
Monitor height of children who use prolonged glucocorticoid therapy for risk of
growth suppression. Interactions: Concomitant colestyramine may reduce
Entocort CR uptake. Concomitant oestrogen and contraceptive steroids may
increase effects. CYP3A4 inhibitors may increase systemic exposure. CYP3A4
inducers may reduce systemic exposure. May cause low values in ACTH
stimulation test. Fertility, pregnancy and lactation: Only to be used during
pregnancy when the potential benefits to the mother outweigh the risks for the
foetus. May be used during breast feeding. Adverse reactions: Common:
Cushingoid features, hypokalaemia, behavioural changes such as nervousness,
insomnia, mood swings and depression, palpitations, dyspepsia, skin reactions
(urticaria, exanthema), muscle cramps, menstrual disorders. Uncommon:
anxiety, tremor, psychomotor hyperactivity. Rare: aggression, glaucoma,
cataract, blurred vision, ecchymosis. Very rare: Anaphylactic reaction, growth
retardation. Prescribers should consult the summary of product characteristics
in relation to other adverse reactions. Marketing Authorisation Numbers,
Package Quantities and basic NHS price: PL 36633/0006. Packs of 100
capsules: £84.15. Legal category: POM. Marketing Authorisation Holder:
Tillotts Pharma UK Ltd, The Stables, Wellingore Hall, Wellingore, Lincoln, LN5
0HX. Date of preparation of PI: November 2018
ENTOCORT (budesonide) ENEMA - Prescribing Information
Please consult the Summary of Product Characteristics (SmPC) for full
prescribing Information
Presentation: 0.02 mg/ml budesonide (2 mg budesonide/100 ml) solution for
rectal suspension. Each Entocort Enema consists of 2 components: a 2.3 mg
faintly yellow, circular biconvex tablet with the engraving BA1 on one side and
2.3 on the other side; a 115 ml clear colourless solution. Indications: Ulcerative
colitis involving rectal and recto-sigmoid disease. Dosage and administration:
Route of administration: rectal. Adults: One Entocort Enema nightly for 4
weeks. Full effect is usually achieved within 2–4 weeks. If the patient is not in
remission after 4 weeks, treatment may be prolonged to 8 weeks. Paediatric
population: Not recommended. Older people: Dosage as for adults. No dosage
reduction in patients with reduced liver function. Instruct the patient to read the
instructions for use. Reconstitute the enema immediately before use. Ensure
the tablet is completely dissolved. Administer in the evening before bed.
Contraindications: Hypersensitivity to the active substance or the excipients.
Warnings and Precautions: Side effects typical of corticosteroids may occur,
including glaucoma. Visual disturbances may occur. If a patient presents with
symptoms such as blurred vision or other visual disturbances they should be
considered for referral to an ophthalmologist for evaluation. When patients are
transferred from steroids of higher systemic effect they may have adrenocortical
suppression; monitoring may be considered and the dose of systemic steroid
should be reduced cautiously. Replacement of high systemic effect steroid
treatment with Entocort enema sometimes unmasks allergies which were
previously controlled by the systemic drug. Reduced liver function affects the
elimination of glucocorticosteroids, causing lower elimination rate and higher
systemic exposure, with possible systemic side effects. Care when considering
systemic corticosteroids in patients with existing or previous history of severe
affective disorders in themselves or first degree relatives e.g. depressive or
manic-depressive illness and previous steroid psychosis. Systemic effects
of steroids may occur, particularly at high doses and for prolonged periods,
including Cushing’s syndrome, adrenal suppression, growth retardation,
decreased bone mineral density, cataract, glaucoma and very rarely a wide
range of psychiatric/behavioural effects. Contains lactose and methyl-,
propyl-parahydroxybenzoate. Caution in patients with hypersensitivity to
these. Some patients may feel unwell in a non-specific way during withdrawal.
When Entocort Enema is used chronically in excessive doses, systemic
glucocorticosteroid effects may appear. However, the dosage form and the
route of administration make any prolonged overdosage unlikely. Interactions:
Raised plasma concentrations and enhanced effects of corticosteroids have
been reported in women also treated with oestrogens and contraceptive
steroids. Inhibitors of CYP3A4 can increase systemic exposure to budesonide
several times and the combination should be avoided. If this is not possible, the
period between treatments should as long as possible, and a reduction of the
budesonide dose could also be considered. Other potent inhibitors of CYP3A4
are also likely to markedly increase plasma levels of budesonide. Concomitant
treatment with CYP3A4 inducers may reduce budesonide exposure and
require a dose increase. Because adrenal function may be suppressed, an
ACTH stimulation test for diagnosing pituitary insufficiency might show low
values. Fertility, pregnancy and lactation: Only to be used during pregnancy
when the potential benefits to the mother outweigh the risks for the foetus. May
be used during breast feeding. Adverse reactions: Common: depression,
gastrointestinal disturbances (flatulence, nausea, diarrhoea), skin reactions
(urticaria, exanthema). Uncommon: agitation, insomnia, anxiety, psychomotor
hyperactivity, duodenal or gastric ulcer. Rare: signs or symptoms of systemic
glucocorticosteroid effects, aggression, glaucoma, cataract including
subcapsular cataract, blurred vision, pancreatitis, ecchymosis, osteonecrosis.
Very rare: anaphylactic reaction. Prescribers should consult the summary
of product characteristics in relation to other adverse reactions. Marketing
Authorisation Numbers, Package Quantities and basic NHS price: PL
36633/0007. Packs of 7 enemas: £33.66. Legal category: POM. Marketing
Authorisation Holder: Tillotts Pharma UK Ltd, The Stables, Wellingore Hall,
Wellingore, Lincoln, LN5 0HX. Date of preparation of PI: March 2018
Adverse events should be reported. Reporting forms and
information can be found at https://yellowcard.mhra.gov.uk.
Adverse events should also be reported to Tillotts Pharma
UK Ltd. Tel: 01522 813500.
References: 1. Greenberg GR et al. N Engl J Med 1994;331:836-841.
2. Rezaie A et al. Cochrane Database Syst Rev 2015;6:CD000296.
3. Madisch A et al. Int J Colorectal Dis 2005;20(4):312-316. 4. Hofer KN. Ann
Pharmacother 2003;37:1457-1464. 5. Miehlke S et al. Gastroenterology
2008;135:1510-1516. 6. Gross V et al. Aliment Pharmacol Ther 2006;23:303-
312. 7. Hartmann F et al. Aliment Pharmacol Ther 2010;32(3):368-376.
8. Danielsson A et al. Scand J Gastroenterol 1992;27(1):9-12. 9. Entocort ® CR
3mg Capsules – Summary of Product Characteristics. November 2018.
10. Entocort ® Enema – Summary of Product Characteristics. March 2018.
Date of
preparation:
December 2018.
PU-00225.
GASTROENTEROLOGY TODAY - SUMMER 2019
9

CASE REPORT
GASTROENTEROLOGY TODAY - SUMMER 2019
10
The diagnosis of aorto-enteric fistula typically is delayed, as long as 1
month in 50% of patients in one series, with the diagnosis being made
within 10 days of hospitalization in only 15% of cases [12]. Urgent upper
GI endoscopy is important for exclusion of common causes of massive
upper GI bleeding; but the diagnostic sensitivity for aorto-enteric fistula
has been reported to be as low as 25% [12]. Gastrointestinal bleeding
with endoscopically unclear findings in a patient with aortic aneurysm or
history of aortic repair should points towards an aorto-enteric fistula [13].
The most valuable tool for diagnosing AEF is a CT scan with contrast,
which may reveal gas within the aneurysm, destruction of the fat plane
between the aneurysm and duodenum, proximity and connection
between aorta and intestine and leaking of the contrast into the GI lumen;
all highly suggestive of AEF [14]. MRI is less useful because of its limited
availability in the emergency setting, longer acquisition time, need for
local technical expertise, and potential difficulties differentiating peri-graft
gas from aortic wall calcification. All other investigation modalities like
white blood cell scan are of limited value in diagnosing AEF. Percutaneous
angiography has a sensitivity of 94 percent and a specificity of 85 percent
for detecting aorto-enteric fistula (AEF); but is rarely considered as
most patients are critically ill by the time of a decision is made to do it
[15&16]. ]. A high index of suspicion is paramount, supplemented by the
judicious use of upper endoscopy and CT, and the attending physician
must be willing to recommend exploratory laparotomy if clinical suspicion
is sufficiently high. As immediate and correct diagnosis is difficult, the
mortality is very high and an untreated AEF has 100% mortality. Mortality
of invasively treated patients is approximately 50 %. [17].
Conclusion
Although AEF is an extremely rare cause of upper GI haemorrhage, it
must always be considered and ruled out in GI haemorrhages. A herald
Image [4] Coronal reconstruction on this portal venous CT study
demonstrates A-Abdominal Aortic Aneurysm (AAA) belly which has
increased in size compared to previous CT image B-New gas locule
within the inferior aspect of aneurysm sac C-Inseparable aortic sac
from the proximal duodenum and tracking gas locules suggestive of a
Image communication 4 between aneurysm sac and second part of duodenum
bleed followed by a an endoscopy is usually the first step in diagnosis.
This case highlights the importance of high index of suspicions in
diagnosing AEF, especially if the patient is known to have AAA. PAEF
is rare if the patient is not known to have AAA; but an accurate clinical
evaluation to rule out an abdominal bruit or pulsatile mass should be
done to rule out AEF. AEF is potentially fatal. An early diagnosis with
prompt surgical management has huge prognostic benefits.
References
1. Cooper A. Lectures on the Principles and Practice of Surgery, London 1829
2. Abdu Hassan Alzobydi and Shaista Salman Guraya. Primary aortoduodenal fistula: A case
reportWorld J Gastroenterol. 2013 Jan 21; 19(3): 415–417.Published online 2013 Jan
21. doi: 10.3748/wjg.v19.i3.415
3. Daniele Bissacco, Luca Freni, Luca Attisani, Iacopo Barbetta, Raffaello Dallatana, and
Piergiorgio Settembrini. Unusual clinical presentation of primaryaortoduodenal fistula.
Gastroenterol Rep (oxf). 2015 may; 3(2): 170–174. Published online 2014 Jun 30. doi:
10.1093/gastro/gou040
4. Jarboui S, Jarraya H, Mahjoub W, Baccar M, Kacem C, Abdesselem MM, Zaouche A.
Primary aorto-enteric fistula in a 52-year-old man. Tunis Med. 2008 Sep; 86(9):830-2.
5. Debonnaire P, Van Rillaer O, Arts J, Ramboer K, Tubbax H, Van Hootegem P. Primary aorto
enteric fistula: Report of 18 Belgian cases and literature review. Acta Gastroenterol Belg.
2008 Apr-Jun; 71(2):250-8.
6. O’Mara C, Imbembo AL. Paraprosthetic-enteric fistula. Surgery. 1977 May; 81(5):556-66.
7. Calligaro KD, Bergen WS, Savarese RP, Westcott CJ, Azurin DJ, Delaurentis DA. Primary
aortoduodenal fistula due to septic aortitis. J Cardiovasc Surg (Torino). 1992 Mar-Apr;
33(2):192-8.
8. Voorhoeve R,Moll FL, De letter JA, Bast TJ Wester JP, Slee PH. Primary aortoenteric
fistula: Report of eight new cases and review of the literature. Ann Vasc Surg. 1996 Jan;
10(1):40-8.
9. Fernández de Sevilla E, Echeverri JA, Boqué M, Valverde S, Ortega N, Gené A, Rodríguez
N, Balibrea JM, Armengol M. Life-threating upper gastrointestinal bleeding due to
a primary aorto-jejunal fistula. Int J Surg Case Rep. 2015; 8C:25-8. doi: 10.1016/j.
ijscr.2015.01.010. Epub 2015 Jan 9.
10. Sharma K, Kibria R, Ali S, Rao P. Primary aortoenteric fistula caused by an infected
abdominal aortic aneurysm with Mycobacterium avium complex in an HIV patient. Acta
Gastroenterol Belg. 2010 Apr-Jun; 73(2):280-2.
11. Sin-Jae Kang, Dong-LK, Kim, Se-Ho Huh, Byung-Boong Lee, Duk-Kyung Kim, and
Young-Soo Do. Coexisting aortocolic and aortovesical fistulae in an abdominal aortic
aneurysm: Report of a case. Surgery today. June 2003, Volume 33, Issue 6, pp 441–443.
12. Pipinos II, Carr, J.A., Haithcock, B.E., Anagnostopoulos, P.V., Dossa, C.D., and Reddy, D.J.
Secondary aorto-enteric fistula. Ann Vasc Surg. 2000; 14: 688–696).
13. Franke S, Debus ES, Voit R. Aorto-intestinal fistula as a possible cause of endoscopically
undetermined gastrointestinal hemorrhage. [Article in German]. Chirurg. 1995 Feb;
66(2):112-9
14. Saers SJ, Scheltinga MR. Diagnostic image (154). A man with haematemesis and gas in
the aorta. Primary aorto-enteric fistula. [Article in Dutch]. Ned tijdschr geneeskd. 2003
Aug 30; 147(35):1686
15. Yeong KY. Angiographic demonstration of primary aorto-enteric fistula--A case report.
Ann Acad Med Singapore. 1995 May; 24(3):467-9.
16. Huges FM1, Kavanagh D Barry M, Owen A, Macerlaine DP, Malone de, Aortoenteric
Fistula: a diagnostic dialemma. Abdom imaging.2007 May-Jun; 32(3):398-402.epub
2006 Aug 25
17. Behrendt CA, Wipper S, Debus SE, von Kodolitsch Y, Püschel K, Kammal M, Kammal
A. Primary aorto-enteric fistula as a rare cause of massive gastrointestinal haemorrhage.
Vasa. 2017 Oct; 46(6):425-430. doi: 10.1024/0301-1526/a000646. Epub 2017 Jun 30.
Consent for Publication
Written consent obtained
Address for correspondence
Dr Mohammed Shaheer Pandara Arakkal, Senior Clinical fellow in
Gastroenterology, House G, Morriston Hospital, Swansea SA6 6NL

FEATURE
INDEPENDENTLY
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TO ARRIVE, SURVIVE, AND
THRIVE IN THE GUT
A unique, water-based
formulation to help
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Its multi-strain bacteria arrives
in a live and active state,
ready to act in the gut
Its water-based nature survives
stomach acid, allowing the
bacteria to reach the gut intact
Bacteria are clinically proven
to rapidly colonise in the
gut, contributing to gut
microbiome balance
To find out more about Symprove TM contact
01252 413 600 or support@symprove.com
www.symprove.com/bioscience
GASTROENTEROLOGY TODAY - SUMMER 2019
References:
1. Freuda-Agyeman, M et al. (2014). Comparative survival of commercial probiotic formulations: tests in biorelevant gastric fluids and real-time measurements using
microcalorimetry. Beneficial Microbes. 6(1). 141-151
2. Data on file. Results from a Symprove TM Customer Survey
3. Wang, B et al. (2017). The human microbiota in health and disease. Engineering 3(1). 71-82
4. Sisson G, Ayis S, Sherwood RA and Bjarnason I. (2014). Randomised clinical trial: A liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome
– a 12 week double-blind study. Aliment Pharmacol Ther 40. 51-62
11

Dr. Daniel Vinteler
CEO and Founder of Plasmabiotics, invented the PlasmaTYPHOON
and PlasmaBAG; a device designed to minimize the risk of bacterial
contamination in endoscopy. Daniel Vinteler has been in close contact
with patients from the very beginning. This has provided him with a
comprehensive understanding of the hygiene risks in endoscopy and
this revolutionary new way to reduce them.
‘Drying is a possible pitfall for hygiene
in endoscopy’
The diagnostic and therapeutic utility of Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has been well demonstrated
for a variety of disorders, such as the management and treatment of biliopancreatic diseases. Due to their complex design,
duodenoscopes have been long recognized to require thorough processes and precise execution to properly disinfect.
As the importance of ERCP procedures and their impact on patients’ lives remains unwavering. We speak to Dr. Daniel Vinteler
(PlasmaBiotics) and Ulrike Beilenhoff (ESGENA) about their ideas concerning the challenges and solutions for the future of
endoscopy and PlasmaBiotics latest technology, the PlasmaTYPHOON.
How important is it to raise awareness
about the risk of infection, during endoscopy
procedures in a cross functional
way?
Ulrike Beilenhoff: Hygiene is an important
concern as it relates to patient’s safety.
Hospitals have the task to ensure a safe
environment in order to prevent any adverse
events and complications. The patient is in a
vulnerable situation, they may have existing
health problems, they are undergoing an
endoscopy procedure, and when you expose
the patient to additional germs, you create
an additional risk. Since the early 2000s
we are experiencing problems with multidrug
resistant bacteria. If a patient is ill
and subsequently exposed to this bacteria,
hospitals have limited options to treat the
patient. The aim is to avoid any additional risk
and therefore hygiene is really a core focus in
this commitment. Thus, establishing hygiene
as a commitment to the patient’s safety.
What are the hygiene issues inherent to
endoscope handling and storage?
Daniel Vinteler: Every step of endoscope
reprocessing is crucial to ensure a hygienic
procedure: the pre-cleaning, cleaningdisinfection,
drying and storage. If one of
these steps is not performed correctly,
hygiene is not guaranteed. In practice, the
drying of the endoscope is often underestimated
and therefore a possible pitfall for
hygiene and reprocessing steps. If the scope
is not dried properly, all the steps before are
undercut.
Why is it so crucial to dry an endoscope
after the device has been disinfected?
Ulrike Beilenhoff: Publications showed that
several outbreaks have been caused by
insuffi cient dyring. If you do not clean the
endoscope properly then you leave residual
debris. If you do not dry the endoscope
it creates a perfect environment to breed
germs. Nurses are aware of both of these
steps. A perfectly dried endoscope stops
bacterial proliferation.
What are the key challenges and
constraints in endoscope drying and
storage? Why are these steps sometimes
not perfectly carried out?
Ulrike Beilenhoff: Time constraints in hospitals
present challenges to effective drying and
storage. Surveys showed that nurses and
reprocessing staff work under time pressure.
Even though they are aware of the importance
of thorough cleaning and drying, it can be
challenging. Suffi cient time is the prerequisite
for correct reprocessing of endoscopes and
this also includes suffi cient time for drying
before storage.
It is the responsibility of hospitals as service
providers to ensure a proper training for all
staff involved in endoscope reprocessing.

advertorial
Nurses are not the only individuals working
in scope reprocessing. If staff are not trained
to understand the endoscope channels in
detail, they may struggle to effectively dry the
endoscope.
How does the PlasmaTYPHOON device
completely dry an endoscope?
Daniel Vinteler: The PlasmaTYPHOON offers
a new way to dry and store the scope
with plasma, thereby reducing the risk of
contamination. The drying process with the
PlasmaTYPHOON is managed by a patented
curve of pressure. The unit uses a laminar
fl ow to eliminate the water and a turbulent
heated fl ow to dry the walls.
At PENTAX Medical we are committed
to addressing the hygiene challenges in
endoscopy by offering solutions that minimize
the risk of infections, improve clinical
outcomes, enhance provider experience,
and increase healthcare productivity. We
are actively listening to our customers
and stakeholders, so we understand the
complexity of the procedures and the risk of
infection.
How does the system improve on
existing solutions? What advantages
can staff expect while using the
PlasmaTYPHOON?
Daniel Vinteler: The PlasmaTYPHOON is the
fi rst solution to guarantee a dry endoscope
in up to 5 minutes 1 (the drying time depends
on the endoscope type), and storage up to
31 days 2,3 in a fully controlled environment.
The advantages for staff are numerous
and include saving time and space, cost
reductions, mobility of the scopes while they
are stored in the PlasmaBAG, and of course
an improved level of hygiene.
What advantage do you foresee in a
system such as the PlasmaTYPHOON
and BAG, which dries the scope perfectly
in an automatized way and stores the
scope in a protected environment?
Ulrike Beilenhoff: Hospitals need an easy and
fast system to dry endoscopes. Often medical
professionals cannot visibly see that the
endoscope is wet, as the exterior appears dry,
thus presenting a hygiene challenge.
Daniel Vinteler: The PlasmaTYPHOON offers
a solution to these challenges, by perfectly
drying the endoscope and doing so in an
easy and fast manner. The PlasmaTYPHOON
is the most advantageous option for
endoscope reprocessing as it completes the
task quickly and easily, without compromising
effectiveness.
1. Evaluation of the efficacy of a drying unit for internal channels of endoscopes according to NF S98-030- Test Report by Biotech-Germande February 2015.
2. Evaluation of the ability of a storage system (Plasmabiotics) to maintain the microbiological quality of heat sensitive endoscope. Report by Biotech-Germande April 2017.
3. The maximum storage time may be subject to local regulations on endoscope storage. The country regulation can restrict the maximum storage time to 7 days. Please refer to the relevant regulations or recommendation of your country.
Ulrike Beilenhoff,
Scientifi c Secretary and former President of
the European Society of Gastroenterology and
Endoscopy Nurses and Associates (ESGENA).
Ulrike has important insights concerning
the hygiene challenge in endoscopy;
specialized in endoscopy nursing, with 16
years of experience as head nurse in German
Endoscopy Departments.

FEATURE
SHOWING THE TRUE VALUE OF
PROBIOTICS – UNDERSTANDING
THE SCIENCE AND HISTORY IS KEY
Written by Mike Butler, CEO, Symprove
Therapeutic use of probiotics isn’t new. The use of
fermented foods to improve intestinal health has
been recorded back thousands of years, a long time
before there was an ounce of understanding of the gut
microbiome and the importance of its managment. 1
The Russian scientist Eli Metchnikoff (generally believed to be the
‘father of probiotics’) first hypothesised that lactic acid bacteria
provided either a type of protection from, or reversal of, intestinal
auto-intoxication. He won the Nobel Prize in medicine in 1908 by
demonstrating harmful microbes can be replaced by beneficial
microbes to treat intestinal illnesses. His regimen became sour
milk in the hope of populating his digestive tract with Bulgarian
bacillus (Lactobacillus bulgaricus) – the first use of ‘probiotics’
as a dietary supplement. Mehcnikoff laid the foundations for
faecal transplantation, predicted the existence of bacterial
translocation from the intestinal lumen into the bloodstream and
lymphatic system and theories linking chronic inflammation with
atherosclerosis. 2
As our knowledge of the gut microbiome has grown, so has our
scepticism of probiotics. Some of this scepticism is fair, some
not so, as we bucket a group of probiotics which come in various
different shapes and sizes and treat them as equal. This is just
not the case as there are various formulations, bacterial strains,
mode of delivery and impact on microbiota to consider. 3 So what
do we need to do to change perceptions and show the value of
probiotics?
Firstly, we need to be brave like Mehcnikoff and explore the
Health Diagnostics for Digestive Health Management
Meet the experts at BSG
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GASTROENTEROLOGY TODAY - SUMMER 2019
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Monitoring
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Rapid Test for anti-TNFα
Therapeutic Drug Monitoring
Tel: 023 8048 3000 | Web: www.alphalabs.co.uk
M / F
14
DDH+BSG-2019_FINAL_13May19.indd 1 13/05/2019 16:30:55

FEATURE
possibilities of human health beyond our existing beliefs. Our gut
microbiota contains tens of trillions of micro-organisms, including
at least 1,000 different species of known bacteria with more than
3 million genes (150 times more than human genes). To put it in
perspective, the Human Genome Project took 15 years to complete
so we inevitably have far more to understand about the makeup
of the gut microbiome. However, already we are seeing positive
results for some probiotics in improving people’s health. It will take
time to know the exact potential of probiotics work and also our
understanding of the gut microbiome, its full role and where it can
be adapted to improve lives, but we are working with safe food
supplements which allow us to be braver with their application.
LUTATHERA ® ▼ LUTETIUM
( 177 Lu) OXODOTREOTIDE
Secondly, the balance between science driven and commercial
goals needs to be heavily weighted towards the former. As
probiotics are a safe food supplement, it is easy for some to focus
on market penetration and not mode of action. However, if we are
going to realise the potential of probiotics, an evidence based,
long-term approach needs to be undertaken for all manufacturers
of probiotics.
By following the science, there is a real possibility that we might
find something that is ‘game-changing’. This is already a growing
appetite to push our current perceptions, understanding and
application of probiotics. For example, trials are now looking at the
link between the microbiome Parkinson’s and the gut brain-axis. 4
As we continue to learn about the different ‘good’ bacteria,
the way they arrive in the gut in an alive state, survive hostile
gastric conditions and thrive in the colon, we will get a better
understanding of this complex microsystem that is living inside all
of us.
Ten years from now, I am confident that we will be looking back
at today as the cusp of a revolution, one in which the science-led
probiotics will have an important part to play.
References:
1. Ozen M and Dinleyici EC. The history of probiotics: the untold
story. Benef Microbes. 2015;6(2):159-65.
2. Mackowiak PA. Recycling Metchnikoff: Probiotics, the Intestinal
Microbiome and the Quest for Long Life. Front Public Health.
2013; 1: 52.
3. Gaisford S. et al. Comparative survival of commercial probiotic
formulations: Tests in biorelevant gastric fluids and real-time
measurements using microcalorimetry. Beneficial Microbes
6(1): 1-11 · October 2014
4. Chaudhuri R. Kings Colledge London. Oral Symprove (a
probiotic) for the management of motor and non-motor
symptoms in people with Parkinson’s: a novel randomised,
double-blind, placebo-controlled pilot study.
Lutathera ® ▼ lutetium ( 177 Lu) oxodotreotide is indicated for
the treatment of unresectable or metastatic, progressive,
well differentiated (G1 and G2), somatostatin receptor
positive gastroenteropancreatic neuroendocrine tumours
(GEP NETs) in adults.
www.lutathera.com
Adverse events should be reported. Reporting forms and information can be found at
www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Advanced Accelerator Applications at:
pharmacovigilance@adacap.com
pv@imagingequipment.co.uk
Tel: 33 (0) 785 61 90 66, Switchboard +334 50 99 30 70, Fax +334 50 99 30 71
Prescribing Information; Lutathera 370 MBq/mL solution for infusion. Lutetium ( 177 Lu)
oxodotreotide Presentation: Solution for infusion. Clear, colourless to slightly yellow solution. One
mL of solution contains 370 MBq of lutetium ( 177 Lu) oxodotreotide at the date and time of calibration.
The total amount of radioactivity per single dose vial is 7,400 MBq at the date and time of infusion.
Uses: Lutathera is indicated for the treatment of unresectable or metastatic, progressive, well
differentiated (G1 and G2), somatostatin receptor positive gastroenteropancreatic neuroendocrine
tumours (GEP NETs) in adults. Administration: Lutathera should be administered only by persons
authorised to handle radiopharmaceuticals in designated clinical settings and after evaluation of
the patient by a qualified physician. Before starting treatment with Lutathera, somatostatin receptor
imaging (scintigraphy or positron emission tomography [PET]) must confirm the overexpression of
these receptors in the tumour tissue with the tumour uptake at least as high as normal liver uptake
(tumour uptake score ≥ 2). Additionally before each administration and during the treatment, tests are
required to re assess the patient’s condition and adapt the therapeutic protocol if necessary (dose,
infusion interval, number of infusions). See SmPC for further details. The recommended treatment
regimen of Lutathera in adults consists of 4 infusions of 7,400 MBq each. The recommended interval
between each administration is 8 weeks which could be extended up to 16 weeks in case of dose
modifying toxicity (DMT). For renal protection purpose, an amino acid solution must be administered
intravenously. See SmPC for further details. Given the fixed volumetric activity of 370 MBq/mL at the
date and time of calibration, the volume of the solution is adjusted between 20.5 mL and 25.0 mL
in order to provide the required amount of radioactivity at the date and time of infusion. Lutathera
must be administered by slow intravenous infusion over approximately 30 minutes, concomitantly
with amino acid solution administered by contralateral intravenous infusion (separate intravenous
catheter and initiated 30 minutes prior to Lutathera). This medicinal product must not be injected
as a bolus. Premedication with antiemetics should be injected 30 minutes before the start of amino
acid solution infusion. The recommended infusion method for administration of Lutathera is the
gravity method. During the administration the recommended precaution measures should be
undertaken. Lutathera should be infused directly from its original container. The vial must not be
opened or the solution transferred to another container. During the administration only disposable
materials should be used. The medicinal product should be infused through an intravenous catheter
placed in the vein exclusively for its infusion. See SmPC for further details of storage, room and
equipment requirements, as well as detailed administration procedure. In some circumstances,
it might be necessary to temporarily discontinue treatment with Lutathera, adapt the dose after
the first administration or discontinue the treatment. General Warnings: Contraindications
include hypersensitivity to the active substance, to any of the excipients, established or suspected
pregnancy or when pregnancy has not been excluded, kidney failure with creatinine clearance
< 30 mL/min. Special precautions should be taken where patients have renal or urinary tract
morphological abnormalities, urinary incontinence, mild to moderate chronic kidney disease with
creatinine clearance ≥ 50 mL/min, haematologic toxicity greater or equal to grade 2 (CTCAE) before
treatment other than lymphopenia, bone metastasis or have had previous chemotherapy. Late-onset
myelodisplastic syndrome (MDS) and acute leukaemia (AL) have been observed after treatment with
Lutathera, factors such as age >70 years, impaired renal function, baseline cytopenias, prior number
of therapies, prior exposure to chemotherapeutic agents (specifically alkylating agents), and prior
radiotherapy are suggested as potential risks and/or predictive factors. Crises due to excessive
release of hormones or bioactive substances may occur and overnight hospitalisation should be
considered for vulnerable patients. Radioprotection rules should be followed including special
care in the event of extravasation and urinary incontinence, see SmPC for full details or radio
protective measures. The product contains up to 3.5 mmol sodium and this should be considered
in patients on a sodium controlled diet. Undesirable effects: Common side effects include bone
marrow toxicity with thrombocytopenia, lymphopenia, anaemia
or pancytopenia. Nephrotoxicity with haematuria, renal failure,
proteinuria. Blood creatinine increased, nausea, vomiting,
fatigue, QT prolonged, hypertension, flushing, hypotension,
dyspnoea, abdominal distension, diarrhoea, abdominal pain,
constipation, dyspepsia, gastritis, hyperbilirubinaemia, alopecia,
musculoskeletal pain, muscle spasms, acute kidney injury,
increased LFTs. Marketing Authorisation Holder: Advanced
Accelerator Applications 20 rue Diesel 01630 Saint Genis Pouilly
France Marketing Authorisation Number EU/1/17/1226/001
Legal Category: POM Price: £17,875 per vial Date of
preparation of PI: October 2017
Date of preparation: May 2019
Job ID Number: AAA.Lu177-UKI-0013
AAA-Lu177-GL-0028
GASTROENTEROLOGY TODAY - SUMMER 2019
15

From Norgine, the company that brought you
MOVIPREP
NEWS
® (Macrogol 3350, sodium sulphate, ascorbic acid, sodium ascorbate and electrolytes)
The first 1 litre PEG bowel preparation 1-3
Improve the efficacy
cut the volume
vs MOVIPREP ®1
PLENVU® PM/AM dosing was
superior to MOVIPREP® in the per
protocol population (successful
overall cleansing 97.3% vs 92.2%,
p=0.014)
Safety profile comparable to
MOVIPREP® 1,4-6
Powder for Oral Solution
PEG 3350, Sodium Ascorbate, Sodium
Sulfate, Ascorbic Acid, Sodium Chloride,
and Potassium Chloride
UK AND IE PRESCRIBING INFORMATION: Plenvu powder for oral solution
(Macrogol 3350 + Sodium ascorbate + Ascorbic acid + Sodium sulfate
anhydrous + Potassium chloride + Sodium chloride)
Please refer to the full Summary of Product Characteristics (SmPC)
before prescribing.
Presentation: Plenvu powder for oral solution is administered in two doses. Dose
one is made up of 1 sachet containing: macrogol 3350 100g, sodium sulfate
anhydrous 9g, sodium chloride 2g, potassium chloride 1g. Dose 2 is made up of
2 sachets (A and B). Sachet A contains: macrogol 3350 40g, sodium chloride 3.2g,
potassium chloride 1.2g. Sachet B contains: sodium ascorbate 48.11g, ascorbic
acid 7.54g.
Indication: For bowel cleansing in adults, prior to any procedure requiring a clean
bowel.
Dosage and administration: For oral use. Adults and elderly: A course of
treatment consists of two separate non-identical 500ml doses of Plenvu. At least
500ml of additional clear fluid must be taken with each dose. Treatment can be
taken according to a two-day or one-day dosing schedule. Two-day dosing schedule:
First dose taken the evening before the procedure. Second dose in the early morning
of the day of the procedure. Morning only dosing schedule: Both doses taken the
morning of the procedure. The two doses should be separated by a minimum of
1 hour. Day before dosing schedule: Both doses taken the evening before the
procedure. The two doses should be separated by a minimum of 1 hour. No solid
food should be taken from the start of the course of treatment until after the clinical
procedure. Consumption of all fluids should be stopped at least 2 hours prior to a
procedure under general anaesthesia or 1 hour prior to a procedure without general
anaesthesia. Children: Not recommended for use in children below 18 years of
age. Patients with renal or hepatic impairment: No special dosage adjustment
is deemed necessary in patients with mild to moderate renal or hepatic impairment.
GASTROENTEROLOGY TODAY - SUMMER 2019
Patients should be advised to allow adequate time after bowel movements have
subsided to travel to the clinical unit.
Contraindications: Hypersensitivity to the active substances or to any of the
excipients, gastrointestinal obstruction or perforation, ileus, disorders of gastric
emptying (gastroparesis, gastric retention), phenylketonuria, glucose-6-phosphate
dehydrogenase deficiency, toxic megacolon.
Warnings and precautions: The fluid content of reconstituted Plenvu does not
replace regular fluid intake. Adequate fluid intake must be maintained. As with
other macrogol containing products, allergic reactions including rash, urticaria,
pruritus, angioedema and anaphylaxis are a possibility. Caution should be used
with administration to frail or debilitated patients, in patients with impaired gag
reflex, with the possibility of regurgitation or aspiration, or with diminished levels
of consciousness, severe renal impairment, cardiac failure (grade III or IV of NYHA),
those at risk of arrhythmia, dehydration or severe acute inflammatory bowel disease.
16
In debilitated fragile patients, patients with poor health, those with clinically significant
renal impairment, arrhythmia and those at risk of electrolyte imbalance, the physician
should consider performing a baseline and post-treatment electrolyte, renal function
test and ECG as appropriate.
Any suspected dehydration should be corrected for before use of Plenvu.
There have been rare reports of serious arrhythmias including atrial fibrillation
associated with the use of ionic osmotic laxatives for bowel preparation, predominantly
in patients with underlying cardiac risk factors and electrolyte disturbance.
If patients develop any symptoms indicating arrhythmia or shifts of fluid/electrolytes
during or after treatment, plasma electrolytes should be measured, ECG monitored
and any abnormality treated appropriately.
If patients experience severe bloating, abdominal distension, or abdominal pain,
administration should be slowed or temporarily discontinued until the symptoms
subside.
The sodium content, 458.5mmol (10.5g), should be taken into consideration for
patients on a controlled sodium diet. The potassium content, 29.4mmol (1.1g), should
be taken into consideration by patients with reduced kidney function or those on a
controlled potassium diet.
Interactions: Medicinal products taken orally within one hour of starting colonic
lavage with Plenvu may be flushed from the gastrointestinal tract unabsorbed. The
therapeutic effect of drugs with a narrow therapeutic index or short half-life may be
particularly affected.
Fertility, pregnancy and lactation: There are no data on the effects of Plenvu on
fertility in humans. There were no effects on fertility in studies in male and female rats.
It is preferable to avoid the use of Plenvu during pregnancy.
It is unknown whether Plenvu active ingredients/metabolites are excreted in human
milk. A risk to the newborns/infants cannot be excluded. A decision must be made
whether to discontinue breast-feeding or to abstain from Plenvu therapy taking into
account the benefit of breast-feeding for the child and the benefit of therapy for
the woman.
Effects on ability to drive and use machines: Plenvu has no influence on the ability
to drive and use machines.
Undesirable effects: Diarrhoea is an expected outcome.
Common: vomiting, nausea, dehydration. Uncommon: abdominal distension,
anorectal discomfort, abdominal pain, drug hypersensitivity, headache, migraine,
somnolence, thirst, fatigue, asthenia, chills, pains, aches, palpitation, sinus
tachycardia, transient increase in blood pressure, hot flush, transient increase in
liver enzymes, hypernatraemia, hypercalcaemia, hypophosphataemia, hypokalaemia,
decreased bicarbonate, anion gap increased/ decreased, hyperosmolar state.
Refer to the SmPC for a full list and frequency of adverse events.
UNITED KINGDOM:
Price and pack sizes: £12.43 (3 sachet)
Legal category: Pharmacy medicine
MA Number: PL 20011/0040
MA Holder: Norgine Pharmaceuticals Limited, Norgine House, Widewater Place,
Moorhall Road, Harefield, Uxbridge, UB9 6NS, UK
IRELAND
Legal category: Product subject to medical prescription which may be renewed
MA Number: PA 1336/005/001
MA Holder: Norgine BV, Hogehilweg 7, 1101CA Amsterdam ZO, The Netherlands
Additional information is available on request or in the SmPC. For further
information contact: Norgine Pharmaceuticals Limited, Norgine House,
Moorhall Road, Harefield, Middlesex, United Kingdom UB9 6NS. Telephone:
+44(0)1895 826606. Email: medinfo@norgine.com
Date of preparation: March 2019
Company reference: UK/PLV/0319/0147
United Kingdom
Adverse events should be reported. Reporting forms and
information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported
to Norgine Pharmaceuticals Ltd on:
Tel: +44 (0)1895 826 606 Email: medinfo@norgine.com
References: 1. Bisschops R, et al. Endoscopy 2018; doi: 10.1055/a-0638-8125. 2. Schreiber S, et al. Endoscopy 2018; doi: 10.1055/a-0639-5070. 3. DeMicco MP, et al. Gastrointest Endosc 2018; doi: 10.1016/j.gie.2017.07.047. 4. PLENVU ® UK Summary of Product
Characteristics. October 2018. 5. MOVIPREP ® UK Summary of Product Characteristics. September 2018. 6. MOVIPREP ® Orange UK Summary of Product Characteristics. August 2017.
UK/PLV/0519/0164
Date of preparation: May 2019
Ireland
Healthcare professionals are asked to report any suspected
adverse reactions via HPRA Pharmacovigilance, Earlsfort
Terrace, IRL - Dublin 2; Tel: +353 1 6764971;
Fax: +353 1 6762517.
Website: www.hpra.ie; E-mail: medsafety@hpra.ie.
Adverse events should also be reported to Norgine
Pharmaceuticals Ltd on:
Tel: +44 (0)1895 826 606 Email: medinfo@norgine.com

Moviprep and Moviprep Orange (Macrogol 3350, sodium sulphate,
ascorbic acid, sodium ascorbate and electrolytes) Prescribing
Information
REFER TO THE SUMMARY OF PRODUCT CHARACTERISTICS (SmPC)
BEFORE PRESCRIBING
Presentation: A box containing two transparent bags, each containing
two separate sachets, A and B. Sachet A contains macrogol 3350 100g;
sodium sulphate anhydrous 7.5g; sodium chloride 2.691g and potassium
chloride 1.015g as white to yellow powder. Sachet B contains ascorbic acid
4.7g and sodium ascorbate 5.9g as white to light brown powder. Moviprep
also contains aspartame (E951), acesulfame potassium (E950) and a lemon
or orange flavour. Uses: Bowel cleansing prior to any clinical procedure
requiring a clean bowel. Dosage and administration: Adults and Older
People: A course of treatment consists of two litres of Moviprep. A litre of
Moviprep consists of one Sachet A and one Sachet B dissolved together
in water to make one litre. This one litre reconstituted solution should be
drunk over a period of one to two hours. This process should be repeated
with a second litre of Moviprep to complete the course. A further litre of
clear fluid is recommended during the course of treatment. This course of
treatment can be taken either as divided or as single doses and timing is
dependent on whether the clinical procedure is conducted with or without
general anaesthesia as specified below: For procedures conducted
under general anaesthesia: 1. Divided doses: one litre of Moviprep in
the evening before and one litre of Moviprep in the early morning of the
day of the clinical procedure. Ensure consumption of Moviprep as well as
any other clear fluids has finished at least two hours before the start of the
clinical procedure. 2. Single dose: two litres of Moviprep in the evening
before the clinical procedure or two litres of Moviprep in the morning of the
clinical procedure. Ensure consumption of Moviprep as well as any other
clear fluids has finished at least two hours before the start of the clinical
procedure. For procedures conducted without general anaesthesia:
1. Divided doses: one litre of Moviprep in the evening before and one litre of
Moviprep in the early morning of the day of the clinical procedure. Ensure
consumption of Moviprep as well as any other clear fluids has finished at
least one hour before the start of the clinical procedure. 2. Single dose: two
litres of Moviprep in the evening before the clinical procedure or two litres
of Moviprep in the morning of the clinical procedure. Ensure consumption
of Moviprep has finished at least two hours before the start of the clinical
procedure. Ensure consumption of any clear fluids has finished at least
one hour before the clinical procedure. Patients should be advised to
allow for appropriate time to travel to the colonoscopy unit. No solid food
should be taken from the start of the course of treatment until after the
clinical procedure. Children: Not recommended in children below 18 years
of age. Contra-indications, warnings etc: Contra-indications: Known
or suspected hypersensitivity to any of the ingredients, gastrointestinal
obstruction or perforation, disorders of gastric emptying, ileus,
phenylketonuria, glucose-6-phosphate dehydrogenase deficiency, toxic
megacolon which complicates very severe inflammatory conditions of the
intestinal tract. Do not use in unconscious patients. Warnings: Diarrhoea is
an expected effect. Administer with caution to fragile patients in poor health
or patients with serious clinical impairment such as impaired gag reflex,
or with a tendency to aspiration or regurgitation, impaired consciousness,
severe renal insufficiency, cardiac impairment (NYHA grade III or IV), those at
risk of arrhythmia, dehydration, severe acute inflammatory bowel disease.
Dehydration, if present, should be corrected before using Moviprep. The
reconstituted Moviprep does not replace regular fluid intake and adequate
fluid intake must be maintained. Semi-conscious patients or patients prone
to aspiration should be closely monitored during administration, particularly
if this is via a naso-gastric route. If symptoms indicating arrhythmia or shifts
of fluid or electrolytes occur, plasma electrolytes should be measured,
ECG performed and any abnormality treated appropriately. In debilitated
fragile patients, patients with poor health, those with clinically significant
renal impairment, arrhythmia and those at risk of electrolyte imbalance,
the physician should consider performing baseline and post-treatment
electrolyte, renal function test and ECG as appropriate. The possibility
of serious arrhythmias, predominantly in those with underlying cardiac
risk factors and electrolyte disturbance cannot be ruled out. If patients
experience symptoms which make it difficult to continue the preparation,
they may slow down or temporarily stop consuming the solution and should
consult their doctor. Moviprep containing orange flavour is not recommended
for patients with glucose and galactose malabsorption. Moviprep contains
56.2 mmol of absorbable sodium per litre (caution in patients on a
controlled sodium diet), 14.2 mmol potassium per litre (caution in patients
with reduced kidney function or patients on a controlled potassium diet).
Interactions: Oral medication should not be taken within one hour of
administration as it may be flushed from the GI tract and not absorbed.
Pregnancy and lactation: There is no experience of use in pregnancy or
lactation so it should only be used if judged essential by the physician. Side
Effects: Very common or common: abdominal pain, nausea, abdominal
distension, anal discomfort, malaise, pyrexia, vomiting, dyspepsia, hunger,
thirst, sleep disorder, headache, dizziness, and rigors. Uncommon or
unknown: Dysphagia, discomfort, abnormal liver function tests, allergic
reactions including rash, urticaria, pruritus, erythema, angioedema and
anaphylaxis, dyspnoea, electrolyte disturbances, dehydration, convulsions
associated with severe hyponatraemia, transient increase in blood pressure,
arrhythmia, palpitations, flatulence and retching. Refer to the Summary of
Product Characteristics (SmPC) for full list and frequency of adverse events.
Overdose: In case of gross accidental overdosage, conservative measures
are usually sufficient. In the rare event of severe metabolic derangement,
intravenous rehydration may be used. Pharmaceutical Particulars:
Sachets: Store in the original package below 25°C. Reconstituted solution:
Keep covered. May be stored for up to 24 hours below 25°C or in a
refrigerator. Legal Category: UK – Pharmacy only, Ireland - Prescription
medicine. Packs: One pack of Moviprep or Moviprep Orange contains a
single treatment. Basic NHS Price: UK £10.36, Ireland €13.26 Marketing
Authorisation Number: UK: PL 20142/0005 (Moviprep), PL 20011/0006
(Moviprep Orange). IE: PA 1336/1/1(Moviprep), PA 1336/1/2 (Moviprep
Orange). For further information contact: Norgine Pharmaceuticals Ltd,
Moorhall Road, Harefield, Middlesex UB9 6NS Tel: +44 (0) 1895 826606
E-mail: medinfo@norgine.com Date of preparation/revision: March 2018.
Ref UK/MPR/0318/0182
United Kingdom Adverse events should be reported. Reporting forms
and information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Medical Information at
Norgine Pharmaceuticals Ltd on 01895 826606.
Ireland Healthcare professionals are asked to report any suspected
adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace,
IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517.
Website: www.hpra.ie; E-mail: medsafety@hpra.ie.
Norgine Adverse events should also be reported to
Medical Information at Norgine Pharmaceuticals on +44 1895 826606
or E-mail: medinfo@norgine.com
PLENVU, MOVIPREP, NORGINE and
the sail logo are registered trademarks
of the Norgine group of companies.
NVU UK IRE GASTRO TODAY JUNE AD 210x297_FINAL.indd 23/05/2019 11:11 2
Raising the bar for IBD
care - launch of 2019 IBD
Standards
By Rukshana Kapasi, Chair of IBD UK
The 2019 BSG conference sees the launch
of the revised UK-wide IBD Standards, new
exciting guidelines which could lead to
drastic changes in how we care for people
with Crohn’s or Colitis.
These build on the previous IBD Standards
(published in 2009 and updated in 2013)
and have been devised by IBD UK, a
partnership of 17 patient and professional
organisations, including the British Society of
Gastroenterology, Royal College of Nursing,
Crohn’s & Colitis UK, CIRCA and Ileostomy
Association, who are working together for
everyone affected by Inflammatory Bowel
Disease.
The first audit of IBD Services in 2006
highlighted wide variation in the quality and
consistency of care for people with Crohn’s
and Colitis, and whilst significant improvements
have been made, this is unfortunately still the
case. Not only this, the way we care for people
with Crohn’s and Colitis has changed in the
intervening years, with new therapy options, and
a shift to self-management and personalised
care and support.
This version of the standards has seen a
transformation, putting the patient at the centre
and ensuring that everything we are asking for
will ultimately make a difference to people with
the conditions.
When revising the standards, it was also
important for us to consider technological
advances, which have led to a huge change
in the way we treat patients. Alongside this,
society now takes a more holistic view towards
care, not just for people with Crohn’s and
Colitis, but across condition areas.
The 2019 IBD Standards are a framework
of statements that define what should be
put in place to deliver safe, high-quality,
personalised care for people with Crohn’s and
Colitis. They cover all stages of the patient
journey: pre-diagnosis, newly diagnosed,
flare management, surgery, inpatient care and
ongoing care, and how the IBD service should
NEWS
be organised to deliver this. The Standards
complement the recently published BSG and
ACPGBI IBD guidelines.
All IBD Services should be working towards
delivering the IBD Standards and the IBD UK
website will house guidance and resources
to help services implement these. Also being
launched is a benchmarking tool which
will allow the IBD Service to compare its
performance against the standards, as well as
with other services.
It is important to note that benchmarking is an
extremely positive tool for IBD Services – as
well as highlighting the things they are doing
brilliantly at; it can be an opportunity to push
through some real changes. It is designed
to help with putting together business cases
based on empirical evidence, to make the best
use of resources and establish priorities.
From the launch date in June to August, one
person from the IBD Service (representing
the team) can register to sign up the
benchmarking tool on the IBD UK website. The
period of September to December is when the
tool will need to be filled out. This will involve
answering questions that align with the IBD
Standards statements.
Alongside this, IBD UK, supported by Crohn’s
& Colitis UK, will be launching the first UK-wide
IBD patient survey to ensure that the patient
perspective is central, and that the patient
experience helps shape the IBD service.
People with Crohn’s and Colitis will be able to
anonymously feedback on the Service.
The benchmarking tool together with the
patient survey are valuable tools that will
enable IBD Services to be more effective
with their team and efficient with resources
and finances. This is an exciting and ground
breaking opportunity for services and patients
to work collaboratively leading to the shared
priority of improving the lives of people with
Crohn’s and Colitis.
The Standards have been produced by
patients and professionals working together
and it is fundamental that this partnership
approach continues to make them a reality.
We need everybody to get involved to
make a difference. To find out more about
the IBD Standards and to register for the
benchmarking tool visit ibduk.org.uk
GASTROENTEROLOGY TODAY - SUMMER 2019
17

NEWS
ARE YOU DOING YOUR BEST
FOR PBC PATIENTS?
Inadequate or intolerant response to UDCA is defined as
ALP >1.67 x ULN (>200 IU/L) and/or bilirubin 2 x ULN 1
1
PBC expertise is closer
than you think...
Consider referral to 1 of 26
PBC hubs in the UK comprised
of specialist multidisciplinary
teams for individualised patient
treatment and second line therapy.
6
3 4
2
26
11
32
15
9
7
24
23
16
17
12
13
25
21 8
14
Find your nearest PBC referral
hub at www.uk-pbc.com/
newtherapiesinpbc/
5
31
28
29
18
22
10
20
27 19
Liver Centres
PBC Hubs
30
1. Aberdeen Royal Infirmary
2. Ninewells Hospital, Dundee
3. Glasgow Royal Infirmary
4. Edinburgh Royal Infirmary
5. University Hospital Wales,
Cardiff
6. Royal Victoria Hospital,
Belfast
7. Aintree Univ Hosp NHS FT
8. Barts Health NHS Trust
9. Bradford Teaching
10. Cambridge Univ Hosp
NHS FT
11. East Lancashire Hosps
NHS Trust
12. Hull & East Yorkshire
NHS Trust
13. King’s College Hosp
NHS FT
14. Imperial College
Healthcare Trust
15. Leeds Teaching Hosp
NHS Trust
16. Manchester University
NHS FT
17. Nottingham Univ Hosp
NHS Trust
18. Oxford Univ Hosps
NHS FT
19. Portsmouth Hosps
NHS Trust
20. Royal Devon & Exeter FT
21. Royal Free London NHS FT
22. Royal Surrey County Hosp
NHS FT
23. Royal L’pool/Broadgreen
Univ Trust
24. Sheffield Teaching
Hosp FT
25. St George’s Univ Hosps
NHS FT
26. The Newcastle upon Tyne
Hosps FT
27. Univ Hosp Southampton
NHS FT
28. Univ Hosps Birmingham
NHS FT
29. Univ Hosps Leicester
NHS Trust
30. Univ Hosps Plymouth
NHS Trust
31. University Hosp Bristol
NHS FT
32. York Teaching Hospital
NHS FT
Find out more information in the BSG guidelines at www.bsg.org.uk/clinical/bsg-guidelines.html
GASTROENTEROLOGY TODAY - SUMMER 2019
Abbreviated Prescribing Information
OCALIVA ® (obeticholic acid)
(Please refer to the Full Summary of Product Characteristics (SmPC) before prescribing)
Presentation: OCALIVA supplied as film-coated tablets containing 5 mg
and 10 mg obeticholic acid. Indication: For the treatment of primary
biliary cholangitis (also known as primary biliary cirrhosis) in combination
with ursodeoxycholic acid (UDCA) in adults with an inadequate response
to UDCA or as monotherapy in adults unable to tolerate UDCA. Dosage
and administration: Oral administration. Hepatic status must be known
before initiating treatment. In patients with normal or mildly impaired
(Child Pugh Class A) hepatic function, the starting dose is 5 mg once
daily. Based on an assessment of tolerability after 6 months, the dose
should be increased to 10 mg once daily if adequate reduction of alkaline
phosphatase (ALP) and/or total bilirubin have not been achieved. No
dose adjustment of concomitant UDCA is required in patients receiving
obeticholic acid. For cases of severe pruritus, dose management includes
reduction, temporal interruption or discontinuation for persistent
intolerable pruritus; use of bile acid binding agents or antihistamines
(see SmPC). Moderate to Severe Hepatic Impairment: In patients with
Child-Pugh B or C hepatic impairment, a reduced starting dose of 5mg
once weekly is required. After 3 months, depending on response and
tolerability, the starting dose may be titrated to 5 mg twice weekly and
subsequently to 10 mg twice weekly (at least 3 days between doses)
if adequate reductions in ALP and/or total bilirubin have not been
achieved. No dose adjustment required in Child Pugh Class A function.
Mild or moderate renal impairment: No dose adjustments are required.
Paediatric population: No data. Elderly: No dose adjustment required;
limited data exists. Contraindications: Hypersensitivity to the active
substance or any excipients. Complete biliary obstruction. Special
warnings and precautions for use: After initiation, patients should be
monitored for progression of PBC with frequent clinical and laboratory
assessment of those at increased risk of hepatic decompensation. Dose
frequency should be reduced in patients who progress from Child Pugh
A to Child Pugh B or C Class disease. Serious liver injury and death have
been reported in patients with moderate/severe impairment who did not
receive appropriate dose reduction. Liver-related adverse events have
been observed within the first month of treatment and have included
elevations in alanine amino transferase (ALT), aspartate aminotransferase
(AST) and hepatic decompensation. Interactions: Following coadministration
of warfarin and obeticholic acid, International Normalised
Ratio (INR) should be monitored and the dose of warfarin adjusted, if
needed, to maintain the target INR range. Therapeutic monitoring of
CYP1A2 substrates with narrow therapeutic index (e.g. theophylline and
tizanidine) is recommended. Obeticholic acid should be taken at least
4-6 hours before or after taking a bile acid binding resin, or at as great
an interval as possible. Fertility, pregnancy and lactation: Avoid use in
pregnancy. Either discontinue breast-feeding or discontinue/abstain from
obeticholic acid therapy taking into account the benefit of breast-feeding
for the child and the benefit of therapy for the woman. No clinical data
on fertility effects. Undesirable effects: Very common (≥1/10) adverse
reactions were pruritus, fatigue, and abdominal pain and discomfort. The
most common adverse reaction leading to discontinuation was pruritus.
The majority of pruritus occurred within the first month of treatment
and tended to resolve over time with continued dosing. Other commonly
(≥ 1/100 to < 1/10) reported adverse reactions are, thyroid function
abnormality, dizziness, palpitations, oropharyngeal pain, constipation,
eczema, rash, arthralgia, peripheral oedema, and pyrexia. Please refer to
the SmPC for a full list of undesirable effects. Overdose: Liver-related
adverse reactions were reported with higher than recommended doses of
obeticholic acid. Patients should be carefully observed, and supportive
care administered, as appropriate.
Legal category: POM
Marketing authorisation numbers: EU/1/16/1139/001 & 002 Marketing
authorisation holder: Intercept Pharma Ltd,
2 Pancras Square, London, N1C 4AG, United Kingdom Package
Quantities and Basic NHS cost: OCALIVA 5 mg and 10 mg £2,384.04
per bottle of 30 tablets.
Date of revision: 11th April 2018
Adverse events should be reported. Reporting forms and
information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to
Intercept Pharma Ltd on +44 (0)330 100 3694
or email: drugsafety@interceptpharma.com
18
ALP, alkaline phosphatase; PBC, primary biliary cholangitis, UDCA, ursodeoxycholic acid; ULN, upper limit of normal.
1. EASL guidelines. J Hepatol. 2017;67:145–172
UK-PP-PB-0376 May 2019

NEWS
New biosimilar safety
monitoring initiative in IBD
The introduction of biological treatments
has made a significant difference in the
lives of many IBD patients. The advent of
multiple biosimilars (generic medicines that
are biologically similar to the originator)
increases the affordability and so availability
of these life-changing treatments.
How can sites participate?
We are starting our monitoring of biosimilars
with Hyrimoz (adalimumab), with Zessly
(infliximab) coming soon.
If your IBD service is using one of these
biosimilars, please get in touch with us if you
would like to participate in these important
studies. The wider the data collection, the
more closely it reflects real-world effects,
so we encourage you to join with us to gather
the evidence.
We will be initiating a number of similar studies
shortly.
For further information or to get involved
please contact the IBD Registry email:
support@ibdregistry.org.uk
Tel 020 3393 3969
A primary aim of the IBD Registry is to help
improve the quality of life for people with IBD,
by using our UK-wide reach to collect and
analyse relevant data. With over 54,000 patient
records, the UK IBD Registry is one of the
largest IBD registries in Europe.
The recent introduction of biosimilar medicines
has placed the Registry in a key position to
facilitate the collection of crucial, on-going
safety data as these treatments become more
widely used.
We are pleased to announce that the
Registry will soon be facilitating a series of
observational post market authorisation safety
studies using our existing web-based data
collection systems. Our first study will monitor
the use of Hyrimoz, an adalimumab biosimilar,
produced by Sandoz. The study is part of
routine clinical care, but patients will be asked
to consent to their data being used in the
study.
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INFO@GI-COGNITION.COM
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• Hospitals book their patients in
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• GI Cognition take equipment,
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GASTROENTEROLOGY TODAY - SUMMER 2019
19

NEWS
National charity Coeliac UK
and Innovate UK announce
£750k boost to research that
unlocks gluten free challenges
Coeliac UK, the national charity for
people who need to live gluten free, has
combined forces with Innovate UK, the UK’s
innovation agency, to drive improvements
worth £750,000 in the food technology,
diagnostics and digital care industries.
The funding will support projects based in
Birmingham, Newcastle and Edinburgh and is
part of Innovate UK’s partnership with the third
sector on health research projects, bringing direct
benefits to both patients and UK businesses.
The UK has been at the forefront of the most
dynamic growth area in free from food retailing
and Coeliac UK is the world’s largest support
organisation for people with coeliac disease.
This collaboration will build on these strengths by
Sarah Sleet, chief executive of Coeliac UK
said: “Coeliac UK is a world leader on coeliac
disease, supporting research that makes a
real world impact. This new research to create
a different diagnostic test could help unlock
a worldwide problem for millions of people
without a proper diagnosis of coeliac disease,
while the research on innovative gluten free
ingredients will keep the UK ahead in the food
industry’s expansion into gluten free. Meanwhile
our third funded project could offer real savings
to the NHS in the management of the lifelong
autoimmune condition that is coeliac disease
providing a service model for the many other
chronic long term conditions in the UK.”
Dr Kath Mackay, Director of Ageing Society,
Health and Nutrition at Innovate UK, said:
“Stimulating innovation in our food and
health sectors are crucial components of the
government’s industrial strategy. By working
with Coeliac UK we will be able to offer funding
that results in improved quality of life for
people with this condition and support and
stimulate our vibrant health care and food
technology sectors.”
supporting research advances in food technology,
GastroToday_Jan_2019_v4 26/01/2019 09:39 Page 1
diagnostic techniques and digital care.
The three projects reflect the key challenges
of living with coeliac
disease and a gluten
free life:
New test to provide
a less invasive
way of diagnosing
coeliac disease
- Nonacus Ltd,
Birmingham
new test will rely on a proprietary laboratory
test in conjunction with a patented computer
algorithm. It’s a completely new way of looking
at the immune cells and can identify patients
with coeliac disease by predicting how likely
immune cells are to be responding to gluten.
It aims to develop a coeliac disease test for
people who have already adopted a gluten
free diet, as well as an improvement on the
current method of analysing biopsy samples.
This will not only save considerable patient
suffering but will also provide savings to the
NHS speeding up diagnosis journeys.
Development of three new plant proteins to
help improve the ingredients used in gluten
free bread - Nandi Proteins Ltd, Scotland
To improve gluten free bread by developing
revolutionary new ingredients. Nandi Proteins
Ltd (a protein technology company), Genius
Foods (gluten free food manufacturer) AB Mauri
(distributor of bakery ingredients) and Agrii (a
plant science and technology company) will join
researchers at Heriot Watt University to develop
three kinds of new plant proteins. The proteins
will be derived from crops which are underused
in the UK: rapeseed cake, faba beans and
naked oats. These new ingredients could
replace the expensive egg and dairy based
ingredients currently used, improve the nutrient
profile, taste and texture of gluten free bread
and reduce the need for E number additives.
Development of these new ingredients will
also open up new markets for UK grown crops
and add value to the UK economy. Overall
consumers could see cheaper and better
quality gluten free products.
GASTROENTEROLOGY TODAY - SUMMER 2019
The average time
to gain a coeliac
disease diagnosis is
13 years and there
are half a million
people in the UK
undiagnosed – and
in the tens of millions
worldwide. Nonacus
Ltd, working with
researchers at
the University of
Cambridge led by Dr
Elizabeth Soilleux,
will together develop
a test for coeliac
disease. Current
tests only work if
patients are still
eating gluten. The
Software innovation to help in the ongoing
management of coeliac disease - Cievert
Ltd, Newcastle
Software will be developed to better manage
coeliac disease. Working with leading
researchers from Sheffield University, the goal
is to find patients with coeliac disease that need
more support, compared to those who are living
well. The software, when developed, will let
people receive the assurance of being clinically
followed up without the inconvenience, time and
cost of hospital appointments. Whilst those who
need additional care will be identified quickly
and easily so that they can access crucial
support when they need it most. This could be
technology that is applied to other conditions
in the future resulting in substantial savings for
the NHS.
20

IMPROVING QUALITY IN
NEWS
DIAGNOSTIC ENDOSCOPY
WITH 18 WEEK SUPPORT
th
Standards in colonoscopy have improved
greatly over the last decade although there
is still variability in the adenoma detection
rates (ADR) and cancer miss rates across
the UK. The bowel cancer screening program
has also helped to improve standards with
the introduction of competency assessment.
Upper GI endoscopy however has fallen
behind and cancer miss rates in the upper
gastrointestinal tract remain far too high
reaching between 10% and over 20%.
How can we continue to improve diagnostic
performance?
The Endoscopy Quality Improvement Program
(EQIP) for colonoscopy and endoscopy
is being rolled out across the UK and has
had excellent feedback from delegates.
Furthermore, there is evolving evidence that
training bundles are effective in improving
ADR, in particular the use of position change,
cleansing agents, muscular relaxants
and extended withdrawal. There are other
techniques which improve polyp detection
including the Endocuff Vision and water
exchange colonoscopy. At 18 Weeks our
nurses independently measure withdrawal
times and routinely polyp spot to try and
improve the ADR.
about Endoscopy?
18 Week Support
nce
has
00
will
n
rces
The technical aspects of upper GI endoscopy
that are likely to improve the detection and
diagnostic accuracy of pathology include
the use of cleansing agents, in particular
simethicone and N-acetyl cysteine as a
mucolytic. Buscopan can aid in gastric
Endoscopy views, as can services adequate gastric insufflation
Our as small specialist cancers Endoscopy can hide insourcing behind gastric
services folds. In have addition, been there developed is evidence to support to support
NHS endoscopic trusts with: inspection time for example the
Barretts 2WW Urgent inspection referrals time (BIT) taking 1 minute
to Routine view each referrals 1cm of Barretts, as well as 7
minutes Surveillance for the cases pre-cancerous stomach.
Bowel cancer screening services
The Enhanced above mentioned sedation (Propofol) techniques lists allow
enhanced mucosal visualisation, however the
Additionally, endoscopist we also can needs support the Direct skills to Access detect
and Rapid characterise Access endoscopy mucosal pathology. referrals by The
working eyes only with sees the what local the clinical mind leads is prepared to agree to
strong comprehend, governance and for thus the pattern management recognition of
these of pathology patients. is the key to detection and
characterisation. There have been a number
Criteria of recent & studies Qualitydemonstrating how detection
We and select characterisation Endoscopists skills with can endoscopy be improved
orientated career path and performance
measures above the national average. JAG
audit data is constantly monitored to ensure
through image and videos based training
modules. These modules can easily be
viewed remotely and have the potential to
improve performance both for upper and lower
endscopy.
18 Weeks is planning to roll out video and
image training modules over the next year
for 18 Weeks nurses and consultants which
will be opened up to all UK based staff. Our
aim is to improve endoscopic detection and
characterisation.
Endoscopy services
Our specialist Endoscopy insourcing services
have been developed to support NHS trusts
with:
• 2WW Urgent referrals
• Routine referrals
• Surveillance cases
• Bowel cancer screening services
• Enhanced sedation (Propofol) lists
Raising the standard of care
Our clinical teams are committed to
Criteria & Quality
working weekends to provide a wide range
We select Endoscopists with an endoscopy
of clinical services. Many of our clinical leads
orientated career path and performance
are experts in their field. So not only do
measures above the national average. JAG
patients benefit from the work our teams do,
audit data is constantly monitored to ensure
there is also an opportunity for NHS Trust
ongoing quality. Furthermore, we have a
teams to improve efficiencies through new
clinical governance department that is crucial
techniques or approaches.
How our insourcing
service works
18 Week Support
Clinical team
Weekend
NHS Facility NHS Staff NHS
processes
Happy patient
Who we’re looking for
We are interested in meeting with Consultant
to maintaining quality and safety but also
provides support to both Endoscopists and
the units within which we work.
Raising the standard of care
Our clinical teams are committed to working
weekends to provide a wide range of clinical
services. Many of our clinical leads are experts
in their field. So not only do patients benefit
from the work our teams do, there is also an
opportunity for NHS Trust teams to improve
efficiencies through new techniques or
approaches.
An ethical company
We’re an ethical and transparent company
that’s s financially accountable and financially
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Who we’re looking for
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Our remuneration package is second to none
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About you
If you have an excellent NHS record and
want to help clear NHS waiting list backlogs,
reduce RTT waiting times and provide
high-quality patient care, get in touch by
calling on 020 3892 6162 or email Gastro.
Recruitment@18weeksupport.com
18 Week Support
www.18weeksupport.com
A CQC Registered provider offering high
quality clinical support services to NHS Trusts
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London
3rd Floor, 19-21 Great Tower Street London
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020 3869 8790
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GASTROENTEROLOGY TODAY - SUMMER 2019
21

NEWS
Is your IBS actually
undiagnosed coeliac
disease?
• 97%¹ of people don’t realise IBS symptoms
could be coeliac disease
• 1 in 4 people with coeliac disease were
previously misdiagnosed with IBS
• Half a million people in the UK are living with
coeliac disease without knowing it
With only 3% 1 of British adults aware that the
symptoms of IBS (irritable bowel syndrome)
are also common symptoms of coeliac
disease, national charity Coeliac UK, is
calling on greater awareness of the similarity
of symptoms and urges anyone with IBS to
ask their GP for a coeliac disease blood test,
if they have not already had one.
policy, research and campaigns said: “It is
essential that awareness of the similarity of the
symptoms increases and that GPs adhere to
the NICE (National Institute for Health and Care
Excellence) guideline which states that anyone
with IBS symptoms should be tested for coeliac
disease before a diagnosis of IBS is made.”
Coeliac disease is not an allergy or an
intolerance but an autoimmune disease where
the body’s immune system damages the lining
of the small bowel when gluten, a protein
(found in wheat, barley and rye) is eaten.
There is no cure and no medication; the only
treatment is a strict gluten free diet for life.
1 in 100 people in the UK is estimated to
have coeliac disease but of these, only 30%
are currently diagnosed, meaning there are
nearly half a million people in the UK with
undiagnosed coeliac disease.
gluten ataxia and neuropathy, and although
rare, there is an increased risk of small bowel
cancer and intestinal lymphoma.
“The first step to diagnosing coeliac disease is
a simple, inexpensive blood test done in primary
care, but thousands of people are not getting the
necessary testing and are being left undiagnosed
including those with IBS symptoms. This not
only causes years of unnecessary suffering but
also wasted costs to the NHS with repeated
appointments and investigations.
We urge anyone who has symptoms such as
ongoing bloating, diarrhoea or constipation
and has been given a diagnosis of IBS but not
been tested for coeliac disease to ask their GP
to test them for coeliac disease. However, it is
essential to keep eating gluten until all tests are
completed as otherwise these tests may give a
false negative result,” continued Ms McGough.
As many as 1 in 4 people with coeliac disease
were previously misdiagnosed with IBS
as many of the symptoms for IBS such as
bloating, stomach pains or cramps, diarrhoea
or constipation and feeling exhausted are the
same as the symptoms of coeliac disease.
Norma McGough Coeliac UK director of
The average time it takes for someone to
get a diagnosis is 13 years from the onset of
symptoms; by which time, they may already be
suffering with added complications caused by
the disease. If left untreated, coeliac disease
can lead to a number of serious complications,
including: anaemia, osteoporosis, unexplained
infertility, neurological conditions such as
Coeliac UK’s online assessment www.coeliac.
org.uk/isitcoeliacdisease, based on the NICE
guideline NG20, gives people greater confidence
to seek further medical advice from their GP.
Upon completion of the assessment, the
respondent will receive an email with their results,
which will indicate whether their symptoms are
potentially linked to coeliac disease.
WHY NOT WRITE FOR US?
GASTROENTEROLOGY TODAY - SUMMER 2019
Gastroenterology Today welcomes the submission of
clinical papers and case reports or news that
you feel will be of interest to your colleagues.
Material submitted will be seen by those working within all
UK gastroenterology departments and endoscopy units.
All submissions should be forwarded to info@mediapublishingcompany.com
If you have any queries please contact the publisher Terry Gardner via:
info@mediapublishingcompany.com
22
1
Reference YouGov Survey
When answering the question: ‘What do you think are common symptoms of coeliac disease?’, only 3% of respondents answered IBS symptoms.
All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 8423 adults. Fieldwork was undertaken between 20th December 2018 - 2nd January 2019.
The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).

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GASTROENTEROLOGY TODAY - SUMMER 2019
23

NEWS
suicide is higher in the first six months
unaddressed can have a huge detrimental
Half of patients with
deadliest common cancer
have unmet support needs,
first ever UK survey reveals
of diagnosis and particularly for patients
whose cancer had spread to other organs,
underlining the importance of patients
receiving specialist psychological care as
early as possible.
impact on their quality of life. Pancreatic
cancer is a complex disease that can
progress devastatingly quickly, often
leaving those affected with little time with
their loved ones. We want to see support
needs assessed for all pancreatic cancer
GASTROENTEROLOGY TODAY - SUMMER 2019
Physical and psychological support need
of patients with the deadliest common
cancer are not being met according
to the first ever UK survey into the
experiences of people with pancreatic
cancer. Commissioned by leading
charity Pancreatic Cancer UK, the survey
revealed that half of all respondents
(49 per cent) had one or more unmet
support needs considered either high or
moderate in severity. The findings show
a clear gap in the supportive care being
offered to pancreatic cancer patients –
a group which the charity believes has
been neglected for decades.
The survey, conducted by Oxford Brookes
University and The Picker Institute on behalf
of the charity, recorded the care experiences
and support needs of 274 people with
pancreatic cancer. The majority (87 per
cent) reported one or more support needs,
ranging from depression, fatigue, and
financial pressures, to changes to appetite.
Pancreatic Cancer UK is concerned that
a significant proportion of these needs
are not being met. It is now calling for
the Government and NHS to introduce a
holistic needs assessment to ensure that
patients have access to personalised care
immediately after diagnosis.
One survey respondent said: “I was not
offered counselling though I really felt I
needed it. My physical needs were very well
met but my emotional needs have never
been addressed. I had no idea where to
go for the help I needed and had to search
online for information.”
Patients reported that psychological care
needs were the most likely to be unmet;
almost a third said fears about the future
(31 per cent) or fears about the cancer
spreading (30 per cent) were not being
addressed. This is extremely concerning as
pancreatic cancer has the lowest survival of
all common cancers – less than 7 per cent
of people living for 5 years - and the second
highest risk of suicide after diagnosis
compared to other cancers. This risk of
Currently there are no established
psychological interventions for people
with pancreatic cancer due to a lack
of evidence, and the NICE guidelines
on the disease cite this as a key
area for improvement. The charity is
urging the National Institute for Health
Research (NIHR) to prioritise and invest
research funding for the development of
psychological interventions for people living
with and beyond pancreatic cancer.
Most patients were positive about the
care they received, however, the findings
indicated key differences between the
experiences of people who were eligible to
receive surgery, the only potentially curative
treatment for the disease, and those whose
pancreatic cancer was inoperable. People
with operable pancreatic cancer were
more likely to feel that their diagnosis had
definitely or to some extent been given in
a sensitive way (87 per cent), compared to
inoperable patients (74 per cent). Similarly,
37 per cent of people with inoperable
pancreatic cancer reported that they had
not been given enough information at the
point of diagnosis, compared to 27 per cent
for people with operable disease.
The extent and breadth of needs and the
variations in care experienced by people
with pancreatic cancer has previously
gone unreported because they are not all
captured by the National Cancer Patient
Experience Survey (NCPES). The NCPES
is distributed within six to nine months
of diagnosis when many people with
pancreatic cancer have already died or are
too sick to respond. The low number of
responses mean that pancreatic cancer is
grouped with Upper Gastrointestinal (UGI)
cancers. The NCPES also does not capture
the experience of those living beyond their
diagnosis and treatment.
Anna Jewell, Director of Services at
Pancreatic Cancer UK, said: “For so
many pancreatic cancer patients to tell us
they have unmet support needs is heartbreaking
- these are live needs which if left
patients immediately after diagnosis so that
they can be helped to maintain as good a
quality of life as possible.
No one affected by pancreatic cancer should
be left to struggle in isolation. Specialist
support is available through the Pancreatic
Cancer UK Support Line. Our dedicated
team of nurses are there to help patients
and their families but we need fellow health
professionals to signpost them to us.
The needs of pancreatic cancer patients
have been neglected for far too long. It’s
imperative that these findings now prompt
further research into the most effective
interventions, particularly around mental
health, so that people with pancreatic cancer
receive the very best care and support.”
Amy Tallett, Head of Research at Picker,
commented: “Picker is proud to have
worked with Pancreatic Cancer UK and
Oxford Brookes University on this important
research, and we hope that the findings
provide an essential evidence base to
inform continued conversation and actions
to improve care experiences for people
affected by pancreatic cancer. Thank you to
everybody that took part in this research.”
Eila Watson, Professor Supportive Cancer
Care at Oxford Brookes University,
said: “This survey highlights the unmet
information and support needs that
pancreatic cancer patients have across
the cancer trajectory. Needs should be
assessed from the point of diagnosis and
monitored regularly, with supportive care
interventions implemented to help patients
live as good a quality of life as possible.
Further research is needed to work out how
best to support patients and their families.”
Pancreatic Cancer UK operates the only
dedicated support line for people affected by
pancreatic cancer staffed by specialist nurses.
The Pancreatic Cancer UK Support Line is
free to call on 0808 801 0707 with support
available on weekdays 10am-4pm and via
email: nurse@pancreaticcancer.org.uk
24

The only licensed treatment for the
reduction in recurrence of overt
hepatic encephalopathy (OHE) 1
NEWS
At home they
are still at risk;
…TARGAXAN ®
rifaximin-α
reduces the risk
of recurrence
of overt hepatic
encephalopathy. 2
Long-term secondary prophylaxis in hepatic
encephalopathy (HE) 3
UK&IE Prescribing Information: Targaxan 550mg (rifaximin-α)
REFER TO FULL SUMMARY OF PRODUCT CHARACTERISTICS (SmPC)
BEFORE PRESCRIBING
Presentation: Film-coated tablet containing rifaximin 550 mg.
Uses: Targaxan is indicated for the reduction in recurrence of episodes
of overt hepatic encephalopathy in patients ≥ 18 years of age.
Dosage and administration: Adults 18 years of age and over: 550 mg
twice daily, with a glass of water, with or without food for up to 6 months.
Treatment beyond 6 months should be based on risk benefit balance
including those associated with the progression of the patients hepatic
dysfunction. No dosage changes are necessary in the elderly or those
with hepatic insufficiency. Use with caution in patients with renal
impairment.
Contraindications: Contraindicated in hypersensitivity to rifaximin,
rifamycin-derivatives or to any of the excipients and in cases of
intestinal obstruction.
Warnings and precautions for use: The potential association of
rifaximin treatment with Clostridium difficile associated diarrhoea and
pseudomembranous colitis cannot be ruled out. The administration
of rifaximin with other rifamycins is not recommended. Rifaximin
may cause a reddish discolouration of the urine. Use with caution
in patients with severe (Child-Pugh C) hepatic impairment and in
patients with MELD (Model for End-Stage Liver Disease) score > 25.
In hepatic impaired patients, rifaximin may decrease the exposure of
concomitantly administered CYP3A4 substrates (e.g. warfarin,
antiepileptics, antiarrhythmics, oral contraceptives). Both decreases and
increases in international normalized ratio (in some cases with bleeding
events) have been reported in patients maintained on warfarin and
prescribed rifaximin. If co-administration is necessary, the international
normalized ratio should be carefully monitored with the addition or
withdrawal of treatment with rifaximin. Adjustments in the dose of
oral anticoagulants may be necessary to maintain the desired level of
anticoagulation. Ciclosporin may increase the rifaximin Cmax
Pregnancy and lactation: Rifaximin is not recommended during
pregnancy. The benefits of rifaximin treatment should be assessed
against the need to continue breastfeeding.
Side effects: Common effects reported in clinical trials are dizziness,
headache, depression, dyspnoea, upper abdominal pain, abdominal
distension, diarrhoea, nausea, vomiting, ascites, rashes, pruritus, muscle
spasms, arthralgia and peripheral oedema. Other effects that have
been reported include: Clostridial infections, urinary tract infections,
candidiasis, pneumonia cellulitis, upper respiratory tract infection and
rhinitis. Blood disorders (e.g. anaemia, thrombocytopenia). Anaphylactic
reactions, angioedemas, hypersensitivity. Anorexia, hyperkalaemia and
dehydration. Confusion, sleep disorders, balance disorders, convulsions,
hypoesthesia, memory impairment and attention disorders.
Hypotension, hypertension and fainting. Hot flushes. Breathing difficulty,
pleural effusion, COPD. Gastrointestinal disorders and skin reactions.
Liver function test abnormalities. Dysuria, pollakiuria and proteinuria.
Oedema. Pyrexia. INR abnormalities. Prescribers should consult the
SmPC in relation to all adverse reactions.
UNITED KINGDOM
Legal category: POM
Cost: Basic NHS price £259.23 for 56 tablets
Marketing Authorisation holder: Norgine Pharmaceuticals Limited,
Norgine House, Widewater Place, Moorhall Road, Harefield, Uxbridge,
UB9 6NS, UK
Marketing Authorisation number: PL 20011/0020
IRELAND
Legal category: Prescription only
Cost: €262.41 for 56 tablets
Marketing Authorisation holder: Norgine B.V. Hogehilweg 7, 1101 CA
Amsterdam ZO, Netherlands
Marketing Authorisation number: PA 1336/009/001
For further information contact:
Norgine Pharmaceuticals Limited, Norgine House, Moorhall Road,
Harefield, Middlesex UB9 6NS
Telephone: 01895 826 606
E-mail: Medinfo@norgine.com
Ref: UK/XIF5/0119/0477
Date of preparation: January 2019
United Kingdom
Adverse events should be reported. Reporting forms and
information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Medical
Information at Norgine Pharmaceuticals Ltd on:
Tel. +44 (0)1895 826 606
Email Medinfo@norgine.com
Ireland
Healthcare professionals are asked to report any
suspected adverse reactions via HPRA Pharmacovigilance,
Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971;
Fax: +353 1 6762517. Website: www.hpra.ie;
E-mail: medsafety@hpra.ie. Adverse events should
also be reported to Medical Information at
Norgine Pharmaceuticals Ltd on: Tel. +44 (0)1895 826 606
Email Medinfo@norgine.com
References:
1. National Institute for Health and Care Excellence.
Rifaximin for preventing episodes of overt hepatic encephalopathy:
appraisal guidance TA337 for rifaximin.
Available from: http://www.nice.org.uk/guidance/ta337
2. TARGAXAN ® 550 Summary of Product Characteristics.
Available for the UK from: https://www.medicines.org.uk/emc
Available for Ireland from: www.medicines.ie
3. Mullen KD, et al. Clin Gastroenterol Hepatol
2014;12(8):1390-97.
Product under licence from Alfasigma S.p.A. TARGAXAN is a
registered trademark of the Alfasigma group of companies, licensed
to the Norgine group of companies. NORGINE and the sail logo are
registered trademarks of the Norgine group of companies.
UK/XIF5/0219/0487
Date of preparation: February 2019.
GASTROENTEROLOGY TODAY - SUMMER 2019
25

COMPANY NEWS
THE INFECTION RISK IS REAL
In 2010, Cantel (UK) Ltd became the first company to offer
sterile single-use endoscope valves and in 2018 became the first
supplier in the UK to provide sterile single-use valves compatible
with GI endoscopes from Olympus, Pentax and Fujifilm.
Reducing the risk of infections for endoscopy patients is critically
important. More Healthcare Associated Infections (HAIs) and outbreaks
have been linked to contaminated endoscopes than to any other
medical device. 1 For patients who contract HAIs the consequences
can be significant. In the UK, HAIs are estimated to cost the NHS
approximately £1 billion a year. 2
The risk of infection from improperly cleaned and disinfected reusable
endoscope valves is extremely high due to their complex design. A
laboratory study of “patient-ready” valves found 56% were contaminated
with bacteria, yeast, moulds and bacterial spores. 3 Meticulous brushing
is required during reprocessing and that still may not be sufficient to
ensure a safe, patient-ready endoscope. DEFENDO Sterile Singleuse
Valves solve the issue of reusable valve reprocessing by offering a
single-use option which ensures sterile valves for every procedure.
DEFENDO Valves are high-performance, high-quality products that
support procedural control and efficiency. Cantel’s verification testing
includes multiple tests for force and suction to help create valves that
don’t exhibit some of the common issues with reusable and other
single-use valves: clogging, sticking and loss of insufflation. When you
experience these issues during a procedure, the result can be a longer,
more difficult procedure.
With every guideline update, there is clear direction that singleuse
accessories are highly recommended. The British Society of
Gastroenterology guidance states “’Single-use’ accessories should
always be used” 4 and the recently updated ESGENA guidelines state
that “endoscope valves can also show contamination after reprocessing
and may be the source of infections if cleaning, drying, storage, and
hand hygiene are inadequate. There is an increasing trend for using
detachable endoscope components as single-use products to enable
full traceability and to prevent cross-infection caused by inadequately
reprocessed detachable components such as valves and distal caps”. 5
DEFENDO Valves provide the most advanced protection for your
patients by helping to create consistent practices and reducing the risk
of potential errors. Single-use valves are supplied by Cantel (UK) Ltd
in a number of convenient kits which include: Air/ Water, Suction and
Biopsy Valves, as well as a Single Use Auxiliary Water Jet Connector.
Contact Cantel on 01702 291878 to arrange a free demonstration of
DEFENDO Sterile Single-Use Valves.
www.cantelmedical.co.uk
References
1. Rutala, W.A., Weber, D. J., and the Healthcare Infection Control
Practices Advisory Committee (2008). Guideline for Disinfection
and Sterilization in Healthcare Facilities (Last update: February 15,
2017). Retrieved from CDC: https://www.cdc.gov/ infectioncontrol/
pdf/guidelines/disinfection-guidelines.pdf
2. National costing statement: Infection prevention and control (2012,
March)
3. Pearce, P.J. (2011, August). A Report on the Widespread
Inadequate Reprocessing of Endoscope Air/Water and Suction
Valves by Healthcare Facilities. Retrieved from: http://www.
medivators.com/sites/default/files/minntech/documents/
Improper%20Valve%20Reprocessing%20Study_Sept%20
2017_50098-1504%20Rev%20A.pdf
4. BSG. “Guidance for Decontamination of Equipment for
Gastrointestinal Endoscopy.” (2016, November)
5. Reprocessing of flexible endoscopes and endoscopic accessories
used in gastrointestinal endoscopy: Position Statement of the
European Society of Gastrointestinal Endoscopy (ESGE) and
European Society of Gastroenterology Nurses and Associates
(ESGENA) – Update 2018
GASTROENTEROLOGY TODAY - SUMMER 2019
26

COMPANY NEWS
GASTROENTEROLOGY TODAY - SUMMER 2019
27

COMPANY NEWS
IMPORTANT NEW TRIAL WITH ORAL FERACCRU ® SHOWS COMPARABLE
EFFICACY TO IV IRON (FERRIC CARBOXYMALTOSE), OFFERING A REAL
ALTERNATIVE TO HOSPITAL ADMINISTRATION FOR MANY PATIENTS [4]
• FERACCRU ® (Ferric Maltol) met primary endpoint against Ferinject ® (IV
Ferric Carboxymaltose (FCM)) and shows clear benefits to Iron Deficiency
Anaemia (IDA) patients with inactive Inflammatory Bowel Disease (IBD) 4
• FERACCRU ® delivered a haemoglobin (Hb) response rate at 12 weeks that
was within 9% of the effect seen with a market leading IV iron treatment
(IVI FCM), but without the need for hospital-based administration 4
• FERACCRU ® was efficiently absorbed and well tolerated over the extended
treatment period, in line with previous studies 2
Shield Therapeutics plc (Shield) and Norgine B.V. (Norgine) have
announced positive results from the AEGIS Head-to-Head (H2H) clinical
trial, which compared FERACCRU ® (ferric maltol), a novel oral iron
replacement therapy, to Ferinject ® (ferric carboxymaltose (FCM)), a
market-leading intravenously delivered iron replacement therapy 4 .
In the AEGIS-H2H study, ferric maltol demonstrated increases in the mean
Hb levels that were comparable to IV FCM. Patients with Iron Deficiency
Anaemia (IDA), whose Inflammatory Bowel Disease (IBD) is inactive now
have an important alternative treatment option, which is both effective
over the long term and well tolerated, therefore reducing the need for
time-consuming and expensive hospital administration. Current oral iron
treatments can be poorly tolerated and don’t always work 7 , which leads to
many unwell patients having to receive IV iron in hospital.
“The results of this study provide an important opportunity to change
clinical practice to improve patients’ lives. Patients with inactive
Inflammatory Bowel Disease who are unwell as a result of Iron Deficiency
Anaemia have often tried a number of oral iron treatments which didn’t
work or they couldn’t tolerate,” commented Dr Alastair Benbow, Chief
Medical and Development Officer at Norgine. “Previously, they would
have needed to go to hospital for time-consuming and expensive IV
administration. Now many patients can be treated at home with an
effective and well-tolerated oral iron alternative,” he added.
More detailed analyses of the data, including the secondary endpoints
and safety parameters, will be presented at Shield’s upcoming
presentation of its preliminary results for 2018, scheduled for early
April 2019, whilst the full data will be submitted for peer-review and
subsequent presentation by the study’s lead investigators at upcoming
scientific meetings.
FERACCRU ® is a novel, effective and well tolerated treatment, which
is approved and marketed in the European Union for the treatment of
iron deficiency (ID) in adults and in Switzerland for the treatment of iron
deficiency anaemia (IDA) in adults with inflammatory bowel disease
(IBD) 1-3 . A New Drug Application in the USA is being reviewed by the
FDA with a PDUFA date of 27 July 2019.
On 19 September 2018, Norgine entered into an exclusive licence
agreement with Shield Therapeutics plc for the commercialisation of the
product in Europe, Australia and New Zealand.
WHY NOT WRITE FOR US?
GASTROENTEROLOGY TODAY - SUMMER 2019
Gastroenterology Today welcomes the submission of
clinical papers and case reports or news that
you feel will be of interest to your colleagues.
Material submitted will be seen by those working within all
UK gastroenterology departments and endoscopy units.
All submissions should be forwarded to info@mediapublishingcompany.com
If you have any queries please contact the publisher Terry Gardner via:
info@mediapublishingcompany.com
28

COMPANY NEWS
GASTROENTEROLOGY TODAY - SUMMER 2019
29

COMPANY NEWS
NORGINE NEW STUDY HIGHLIGHTS NEED TO
INCREASE PUBLIC UNDERSTANDING OF IMPORTANT
ROLE OF COLONOSCOPY IN PREVENTING AND
DIAGNOSING GASTROINTESTINAL DISEASES,
INCLUDING COLORECTAL CANCER
GASTROENTEROLOGY TODAY - SUMMER 2019
30
• Those with no previous experience of colonoscopy were
considerably more nervous about the procedure than those
who had already undergone colonoscopy (74% vs 49%)
• Current lack of public understanding around colonoscopy
may be negatively impacting on number of eligible people
attending their colonoscopy appointment
• Less than half (45%) of those who had not had the
procedure knew that a colonoscopy could prevent colorectal
cancer
AMSTERDAM, April 4, 2019 /PRNewswire/ -- NORGINE B.V. (Norgine)
today published the findings of a public survey at the European Society
of Gastrointestinal Endoscopy (ESGE) Days in Prague as we celebrate
the 50th anniversary of the first colonoscopy. [1],[2],[3] This important study
highlights the need to increase public understanding of the important
role of colonoscopy in the prevention and diagnosis of gastrointestinal
diseases including colorectal cancer. The survey was conducted across
five major European countries and included both people who had
undergone a colonoscopy and those who have no previous experience
with the procedure.
The study findings highlighted the misconceptions and strong negative
associations about colonoscopy amongst those who have had no
previous experience with the procedure. Those with no previous
experience of colonoscopy were considerably more nervous about the
procedure than those who had already undergone colonoscopy (74% vs
49%). This may be one of the reasons why many eligible people do not
attend their colonoscopy appointments each year [4] - a vital procedure
for the prevention and diagnosis of gastrointestinal diseases, including
colorectal cancer. The target population for colorectal cancer screening
in the EU is close to 69,000,000, but only 14% of the target population is
currently being screened. [4]
This study has highlighted the benefit of public education to increase
understanding of the importance of the colonoscopy procedure, and
particularly its important role in preventing colorectal cancer. Less
than half (45%) of those who had not had the procedure knew that a
colonoscopy could prevent colorectal cancer. Other findings suggested
the need to improve patient experience of the procedure, including
bowel preparation and the provision of relevant information. This may
provide an opportunity for healthcare professionals to further support
their patients.
“This survey highlights the lack of information about colonoscopy in
public domain. Clinicians need to provide easily accessible and clear
information about colonoscopy to improve the uptake of bowel cancer
screening program in our fight against colorectal cancer,” said Professor
Pradeep Bhandari, Consultant Gastroenterologist, QA Hospital,
Portsmouth.
In the 50 years since the first colonoscopy, the procedure has become a
crucial tool in the prevention and detection of gastrointestinal disorders,
including colorectal cancer. Despite significant advances, however, the
variation in uptake across Europe continues to prevent the potential of
colonoscopy being fully realised for patients and health systems.
The survey asked 500 and 2500 people with and without colonoscopy
experience across five main EU countries (UK, Germany, France, Spain
and Italy) about their experience and understanding of colonoscopy.
[1],[2],[3]
Follow us @norgine
www.norgine.com
References
[1] Bhandari P, Amlani B, Radaelli F. ePP31 Public attitudes to
colonoscopy: The purpose of colonoscopy. Presented at ESGE
2019, Prague. https://www.professionalabstracts.com/esge2019/
iplanner/#/presentation/336 Last accessed April 2019
[2] Amlani B, Bhandari P, Radaelli F. ePP92 Public attitudes to
colonoscopy: Experience of colonoscopy. Presented at ESGE
2019, Prague. https://www.professionalabstracts.com/esge2019/
iplanner/#/presentation/409 Last accessed April 2019
[3] Bhandari P, Amlani B, Radaelli F. OP362 Public attitudes to
colonoscopy: Embarrassment levels and colonoscopy. Presented
at ESGE 2019, Prague. https://www.professionalabstracts.com/
esge2019/iplanner/#/presentation/890 Last accessed April 2019
[4] European Commission, Cancer Screening in the European Union,
Report on the implementation of the Council recommendation on
cancer screening, 2017. https://ec.europa.eu/health/sites/health/
files/major_chronic_diseases/docs/2017_cancerscreening_2ndrepo
rtimplementation_en.pdf Last accessed April 2019

COMPANY NEWS
driving scientific advancements in digestive health
October 19-23, 2019
Venue: Fira Gran Via, Barcelona
Ahead of UEG Week Barcelona 2019, UEG
President Professor Paul Fockens discusses
why he is looking forward to one of the
world’s premier digestive health meetings.ngs.
UEG Week is the largest
and most prestigious
gastroenterology meeting
of its kind, with more than 14,000
delegates from over 110 countries
worldwide.
The UEG Scientific Committee is
developing a state-of-the-art
scientific programme, featuring the
latest advancements and most exciting
research in digestive health.
This will ensure the delivery of
world-class presentations across a
range of specialties, covering clinical,
translational and basic science. An
inclusive offering is provided for all
attendees, whatever their level of
expertise, featuring a broad variety
of sessions that include symposia,
live endoscopy and abstract-based
sessions. Different interactive formats
allow lively interaction between the
audience, chairs and speakers.
The two-day Postgraduate Teaching
Programme will provide profound
updates on a wide range of
gastrointestinal and hepatology topics
that suit both gastroenterologists
in training as well as established
physicians and general practitioners.
The programme focuses on the
relevance for the clinical day-to-day
business and enables participants
to get perfectly prepared for their
professional career. 2019 marks year 3
of our rolling 3-year curriculum.
UEG Week will once again host the
hugely successful ‘Today’s Science,
Tomorrow’s Medicine’ initiative and
this year’s theme will be ‘Microbiota:
Moving towards clinics’. Here, topclass
scientists will be invited to
discuss how current knowledge and
thinking is ready to be used in clinical
practice and establish strategies to
foster further progression in this area.
UEG Week provides an exceptional
opportunity for investigators from
around the globe to submit and
present their latest findings. UEG will
present a number of awards at the
congress, including the Top Abstract
Prizes, the UEG Research Prize and the
UEG Rising Star Awards.
I am anticipating a very exciting
week of scientific advances and
updates from leading digestive health
experts and thoroughly look forward
to welcoming new and returning
delegates to UEG Week Barcelona
2019.
To find out more,
visit: ueg.eu/week
Benefit from
reduced delegate
fees until
September 5,
2019
Late-breaking
abstract
submission
opens August
19, 2019
GASTROENTEROLOGY TODAY - SUMMER 2019
31

COMPANY NEWS
NEW CHIEF EXECUTIVE OFFICER ANNOUNCEMENT
Coeliac UK, the national charity for people who need to live
gluten free, has appointed Hilary Croft as its new CEO from
3 June 2019, succeeding Sarah Sleet.
Ms Croft’s professional background lies in business transformation
within complex, multifaceted organisations. Her senior management
career started in marketing with Capgemini, a global leader in consulting,
technology and digital transformation services, where she worked with a
variety of organisations, such as Virgin Atlantic, Sky, Lego and Royal Mail.
Hilary Croft also has vast knowledge and interest in the food and drink
sector through previous positions with Marks and Spencer, Coca-Cola,
Compass Group and World Duty Free Europe. More recently, as CEO
of the Felix Project, she developed significant partnerships with food
suppliers and re-distributers to reduce food waste and food poverty
across London.
About her appointment, Ms Croft said: “I am excited to be taking
up the CEO role at Coeliac UK, a charity with a truly unique health
and food scope. I look forward to developing the charity’s strong
reputation, bringing fresh ideas and strategic insights. Naturally, my
direct experience of coeliac disease, through my son’s condition, further
motivates me to achieve real and lasting change for the gluten free
community.”
Mike Elliott, Coeliac UK’s Chair of Governors, said: “Hilary’s business
and strategic acumen will bring new drive and impetus at this exciting
time in Coeliac UK’s journey. The charity is currently entering a new ten
year strategic review and requires an experienced change leader to
adapt to a constantly evolving, complex environment. We feel Hilary is
exceptionally qualified to lead Coeliac UK into the future and we look
forward to welcoming her.”
Ms Croft is also a trustee of Age UK Ealing and a global fundraising
committee member for Tearfund, a charity that helps communities
around the world escape the very worst effects of poverty and disaster.
About Coeliac UK
Coeliac UK campaigns for better access to diagnosis of coeliac disease
and funds critical research into potential cures. It provides expert and
independent information to 65,000 members to manage their health and
gluten free diet.
The charity also fights for wider availability of gluten free food by working
with food manufacturers, service providers and venues. Currently 3,000
products and 200 companies use the charity’s Crossed Grain certification
scheme and 3,200 food outlets, cafés and restaurants have achieved its
Gluten Free accreditation. In 2018, the charity’s total income was £4.1m
with research expenditure increasing from £204k to £496k.
WHY NOT WRITE FOR US?
Gastroenterology Today welcomes the submission of
clinical papers and case reports or news that
you feel will be of interest to your colleagues.
GASTROENTEROLOGY TODAY - SUMMER 2019
Material submitted will be seen by those working within all
UK gastroenterology departments and endoscopy units.
All submissions should be forwarded to info@mediapublishingcompany.com
If you have any queries please contact the publisher Terry Gardner via:
info@mediapublishingcompany.com
32

COMPANY NEWS
THE GUT HEALTH EXPERTS
One of the
UK’s leading
digestive
brands *
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studied
strains
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experience
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It has literally changed
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freedom with my life.
Your product is amazing.
- S.Firth, 2019
GASTROENTEROLOGY TODAY - SUMMER 2019
*based on Euromonitor brand sales
www.bioglan.co.uk
33

COMPANY NEWS
NORGINE: NEW REAL WORLD STUDY SHOWS
RIFAXIMIN-A SIGNIFICANTLY REDUCED
HOSPITALISATION IN PATIENTS WITH OVERT HEPATIC
ENCEPHALOPATHY (HE) WHEN ADDED TO LACTULOSE
• Rifaximin-a in combination with lactulose, the standard of
care (SOC) treatment resulted in significant reductions
(p

COMPANY NEWS
GASTROENTEROLOGY TODAY - SUMMER 2019
35

Helicobacter Test INFAI ®
The most used 13 C-urea breath test for the
diagnosis of Hp-infection worldwide
• more than 4.5 million INFAI tests performed in Europe
• approved for children from the ages of 3 to 11
• special INFAI test for patients with dyspepsia taking PPIs
• cost-effective CliniPac Basic version for hospital use
INFAI Institute for Biomedical Analysis & NMR Imaging, INFAI UK Ltd
Innovation Centre, University Science Park, University Road, Heslington, YORK YO10 5DG, UK
Phone +44 1904 435 228 - Fax +44 1904 435 229 - mail: info@infai.co.uk - Visit us at www.infai.com