Publications by authors named "Craig Mowat"

Aim: Since December 2015, a faecal immunochemical test (FIT) has been provided to primary care in NHS Tayside as an adjunct to clinical acumen in the assessment of new-onset bowel symptoms. The aim of this work was to assess the impact of this approach on time to diagnosis of colorectal cancer (CRC).

Method: NHS Tayside Cancer audit data from January 2013 to December 2019 were reviewed to identify all CRC patients diagnosed via the primary-care referral pathway for a period before and after the introduction of FIT.

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Introduction: Adults aged 70 years and over account for almost 60% of colorectal cancer (CRC) diagnoses in the United Kingdom. Whilst emergency presentation of CRC is known to be associated with poorer outcomes across all ages, older adults are less likely to be treated with curative intent and have poorer overall survival (OS). We aimed to investigate whether presentation, management, or outcome differed in older (≥70 years) versus younger (<70 years) adults in our population.

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  • The study aimed to improve colorectal cancer (CRC) detection by using risk scoring models (RSMs) alongside faecal immunochemical testing (FIT) in symptomatic patients, potentially reducing the need for endoscopies.
  • By analyzing data from nearly 19,000 patients, key factors such as faecal haemoglobin levels, age, sex, and iron deficiency were identified to create a risk score that improved sensitivity for detecting CRC compared to standard f-Hb thresholds.
  • The findings suggest that while RSMs may enhance detection in some cases, they did not significantly help patients with very low f-Hb levels, indicating a need for alternative strategies that incorporate additional risk factors beyond just FIT.
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Background: Management strategies and clinical outcomes vary substantially in patients newly diagnosed with Crohn's disease. We evaluated the use of a putative prognostic biomarker to guide therapy by assessing outcomes in patients randomised to either top-down (ie, early combined immunosuppression with infliximab and immunomodulator) or accelerated step-up (conventional) treatment strategies.

Methods: PROFILE (PRedicting Outcomes For Crohn's disease using a moLecular biomarker) was a multicentre, open-label, biomarker-stratified, randomised controlled trial that enrolled adults with newly diagnosed active Crohn's disease (Harvey-Bradshaw Index ≥7, either elevated C-reactive protein or faecal calprotectin or both, and endoscopic evidence of active inflammation).

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Background & Aims: DNA methylation alterations may provide important insights into gene-environment interaction in cancer, aging, and complex diseases, such as inflammatory bowel disease (IBD). We aim first to determine whether the circulating DNA methylome in patients requiring surgery may predict Crohn's disease (CD) recurrence following intestinal resection; and second to compare the circulating methylome seen in patients with established CD with that we had reported in a series of inception cohorts.

Methods: TOPPIC was a placebo-controlled, randomized controlled trial of 6-mercaptopurine at 29 UK centers in patients with CD undergoing ileocolic resection between 2008 and 2012.

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  • A study aimed to create a risk-scoring model for colorectal cancer by analyzing faecal haemoglobin levels and other factors in participants of the Scottish Bowel Screening Programme.
  • Data from over 232,000 participants revealed that only faecal haemoglobin concentration and age were significantly linked to colorectal cancer, with a notable interval cancer rate, particularly higher in women (38.1%) than men (27.5%).
  • The findings suggest that developing a risk scoring model was not achievable, but adjusting faecal haemoglobin thresholds by age may help address the gender disparity in cancer detection rates.
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  • The study assessed the impact of faecal immunochemical testing (FIT) on colorectal cancer (CRC) diagnosis in NHS Tayside since its introduction in 2015.
  • A review of cancer audit data from 2016 to 2019 showed that 75.7% of primary care patients diagnosed with CRC underwent FIT prior to referral, with an increase in FIT usage over the years.
  • While FIT triage led to a higher rate of non-emergency presentations for CRC, it did not affect the stage at which the cancer was diagnosed.
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Background: Emerging data showed patients with chronic inflammatory disorders, including inflammatory bowel disease, are more likely to develop atherosclerotic cardiovascular diseases, heart failure, and atrial fibrillation. This article aims to review the evidence of those associations.

Methods: PubMed was searched from inception to January 2022 using the keywords, including inflammatory bowel diseases, Crohn disease, ulcerative colitis, atherosclerotic cardiovascular disease, coronary artery disease, cardiovascular disease, atrial fibrillation, heart failure, and premature coronary artery disease.

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Aim: The faecal immunochemical test (FIT) for faecal haemoglobin (f-Hb) helps determine the risk of colorectal cancer (CRC) and has been integrated into symptomatic referral pathways. 'Safety netting' advice includes considering referral for persistent symptoms, but no published data exists on repeated FITs. We aimed to examine the prevalence of serial FITs in primary care and CRC risk in these patients.

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Background: Polypectomy may be performed at colonoscopy and then subsequent surveillance undertaken. It is thought that faecal haemoglobin concentration (f-Hb), estimated by quantitative faecal immunochemical tests (FIT), might be a useful tumour marker.

Methods: Consecutive patients enrolled in colonoscopy surveillance were approached at two hospitals.

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Background: Difficulties in establishing diagnosis of small bowel (SB) disorders, prevented their effective treatment. This problem was largely resolved by wireless capsule endoscopy (WCE), which has since become the first line investigation for suspected SB disorders. Several types of WCE pills are now used in clinical practice, despite their limitations and complications.

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  • * The National Institute for Health and Care Excellence has identified key symptoms like rectal bleeding and iron deficiency anemia, but many cases yield low rates of CRC (only 2-3%) when assessed based solely on symptoms.
  • * The faecal immunochemical test (FIT) is beneficial for GPs, as a negative result indicates a low risk of significant bowel disease, while a high f-Hb level requires immediate further investigation.
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Background And Aim: Ustekinumab is a monoclonal antibody that targets interleukin-12/23. In Scotland, it was approved for the treatment of moderate to severe Crohn's disease in 2017. The objective of this study was to establish the real-world effectiveness and safety of ustekinumab in the treatment of Crohn's disease.

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  • Faecal haemoglobin concentration (f-Hb) is a useful tool in primary care for assessing the risk of colorectal cancer (CRC) in patients with lower gastrointestinal symptoms.
  • *The study evaluated various f-Hb thresholds to determine when a patient can be reassured versus when they need further investigation, showing that lower thresholds allow for higher percentages of patients to be managed without additional procedures.
  • *Overall, the findings suggest that measuring f-Hb, along with clinical evaluations, helps to make informed decisions about CRC risk and patient management in a primary care setting.
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  • Lower gastrointestinal symptoms are not very effective in predicting colorectal cancer (CRC), so this study evaluated how well faecal haemoglobin (f-Hb) levels predict CRC during colonoscopy for symptomatic patients.
  • The study involved 4,841 patients in three Scottish NHS Boards, finding that only 0.6% of those with low f-Hb (<10 µg/g) were diagnosed with CRC, compared to 9.4% of those with f-Hb ≥10 µg/g and 22.4% with f-Hb ≥400 µg/g.
  • The results suggest that patients with f-Hb ≥10 µg/g should be further investigated for CRC, while those with f-Hb <10 µ
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  • * Among 1,447 patients, it was found that 20.5% were diagnosed with significant bowel disease (SBD) through colonoscopy; notably, most cases of SBD were in patients with higher fecal hemoglobin levels (≥10 g Hb/g feces).
  • * The results suggest that patients with rectal bleeding and low fecal hemoglobin levels (<10 g Hb/g feces) are less likely to have serious bowel disease and could potentially be evaluated with a simpler sigmoidoscopy
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  • Faecal immunochemical tests for haemoglobin (FIT) are essential for colorectal cancer screening, guiding follow-up investigations based on faecal haemoglobin concentration (f-Hb) thresholds.
  • A study analyzed f-Hb distributions among 887,248 screening participants in Scotland, revealing variations based on sex, age, deprivation levels, and geographical region.
  • Findings indicated that f-Hb is consistently higher in men, increases with age and deprivation, and suggests the need for tailored investigation thresholds, contrasting with previous evaluations from other countries.
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  • The study evaluated the accuracy of faecal immunochemical tests (FIT) in detecting colorectal cancer (CRC) in high-risk patients undergoing surveillance colonoscopy.
  • Out of 1103 patients invited, 639 completed the test, and some were found to have advanced neoplasia, revealing a significant correlation between detectable faecal haemoglobin (f-Hb) and the presence of neoplasia.
  • The findings suggest that measuring f-Hb can effectively indicate risk levels for advanced neoplasia, potentially allowing for more personalized scheduling of colonoscopies in high-risk individuals.
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  • Many primary care patients have lower bowel symptoms, but serious bowel diseases like colorectal cancer and inflammatory bowel disease are rare; fecal immunochemical tests (FIT) help identify those who should get further colonoscopic evaluation.
  • This study looked at data from a Scottish NHS Board to see if the FAST score, which includes fecal hemoglobin, age, and sex, improves decision-making for colonoscopy referrals based on FIT results from nearly 5,700 specimens collected in the first year.
  • Results showed that while a significant number of patients with serious bowel disease had high fecal hemoglobin levels, using the FAST score could reduce referrals but risked missing some cases, highlighting a balance needed between sensitivity and practicality in screening.
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  • - The study aimed to determine the effectiveness of flexible sigmoidoscopy as an addition to traditional faecal occult blood test (FOBT) screening for colorectal cancer in individuals around age 60.
  • - Conducted in Scotland with over 51,000 participants, the trial found that flexible sigmoidoscopy had a low uptake (17.8%), with higher rates in men and less in more deprived areas; however, it did detect more neoplasia compared to FOBT alone.
  • - Results showed no difference in overall colorectal cancer detection between the two groups, but flexible sigmoidoscopy did significantly increase adenoma and total neoplasia detection rates, indicating it may be a beneficial complementary screening method.
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  • A study aimed to see if a faecal immunochemical test (FIT) for faecal haemoglobin (f-Hb) can be safely used in primary care to rule out serious bowel diseases like colorectal cancer (CRC) and inflammatory bowel disease (IBD).
  • The research involved 5422 patients who submitted FIT samples, revealing a positivity rate of 21.9%, with 20.5% of those completing a colonoscopy having significant bowel disease.
  • The findings suggest that f-Hb testing, alongside clinical evaluation, is an effective way to assess patients' risk for serious bowel diseases in a primary care setting.
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