Tailoring follow-up endoscopy in patients with severe oesophagitis.

Objective: We aimed to investigate the clinical utility of follow-up oesophagogastroduodenoscopy (OGD2) in patients with severe oesophagitis (Los Angeles grades C or D) through evaluating the yield of Barrett's oesophagus (BO), cancer, dysplasia and strictures. Second, we aimed to determine if the Clinical Frailty Scale (CFS) may be used to identify patients to undergo OGD2s.

Design/method: Patients in NHS Lothian with an index OGD (OGD1) diagnosis of severe oesophagitis between 1 January 2014 and 31 December 2015 were identified.

Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience.

Variceal haemorrhage is a severe complication of liver disease with high mortality. Human recombinant thrombin has gained popularity in the management of variceal haemorrhage. We report on the use of thrombin for gastric and ectopic varices at a regional tertiary care centre.

Differential visceral blood flow in the hyperdynamic circulation of patients with liver cirrhosis.

Background: With advancing liver disease and the development of portal hypertension, there are major alterations in somatic and visceral blood flow. Using phase-contrast magnetic resonance angiography, we characterised alterations in blood flow within the hepatic, splanchnic and extra-splanchnic circulations of patients with established liver cirrhosis.

Aim: To compare blood flow in splanchnic and extra-splanchnic circulations in patients with varying degrees of cirrhosis and healthy controls.

Randomised clinical study: comparison of acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic.

Background: Transnasal endoscopy (TNE) with ultrathin endoscopes has been advocated as an attractive alternative, for diagnostic upper endoscopy.

Aim: To assess tolerability, acceptability and quality of TNE, in comparison with standard upper endoscopy (SOGD, standard oesophago-gastro-duodenoscopy) under local anaesthetic.

Methods: We prospectively recruited 157 patients (83 females/74 males) mean age 57 years.

Cardiac and pulmonary issues in LT assessment candidates.

With the incidence of liver disease increasing worldwide, a growing number of patients are being referred for assessment for liver transplant (LT). Unfortunately, the donor pool is not expanding at the same rate, which consequentially results in increasing demand on a finite resource. It is therefore imperative that the candidate who undergoes an LT gets maximal benefit with a resultant maximal increase in life expectancy.

Human thrombin for the treatment of gastric and ectopic varices.

Aim: To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices.

Methods: Retrospective observational study in a Tertiary Referral Centre. Between January 1999-October 2005, we identified 37 patients who were endoscopically treated with human thrombin injection therapy for bleeding gastric and ectopic varices.

Increased whole-body and sustained liver cortisol regeneration by 11beta-hydroxysteroid dehydrogenase type 1 in obese men with type 2 diabetes provides a target for enzyme inhibition.

Objective: The cortisol-regenerating enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) amplifies glucocorticoid levels in liver and adipose tissue. 11β-HSD1 inhibitors are being developed to treat type 2 diabetes. In obesity, 11β-HSD1 is increased in adipose tissue but decreased in liver.

Gastrointestinal bleeding: Endoscopic cyanoacrylate therapy for gastric variceal bleeding.

Bleeding from gastric varices is relatively common and can be life threatening. The optimal treatment strategy for gastric variceal hemorrhage is controversial. Both interventional radiology and endoscopic therapies require a high level of clinical expertise.

Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed.

Unlabelled: Current therapy for preventing the first variceal bleed includes beta-blocker and variceal band ligation (VBL). VBL has lower bleeding rates, with no differences in survival, whereas beta-blocker therapy can be limited by side effects. Carvedilol, a non-cardioselective vasodilating beta-blocker, is more effective in reducing portal pressure than propranolol; however, there have been no clinical studies assessing the efficacy of carvedilol in primary prophylaxis.

Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts.

Background: Bleeding from ectopic varices is uncommon but can be difficult to manage.

Aim: To report our experience of the use of transjugular intrahepatic portosystemic stent shunts (TIPSS) in the management of uncontrolled bleeding from ectopic varices.

Methods: A retrospective study of patients who had TIPSS for bleeding ectopic varices.

Prevalence of coronary artery calcification in patients undergoing assessment for orthotopic liver transplantation.

Patients with advanced liver disease are at increased risk of cardiovascular events, especially following orthotopic liver transplantation (OLT). Coronary artery calcification (CAC) is a novel and independent predictor of cardiovascular risk, but its prevalence and utility in patients with cirrhosis are unknown. The aim of this study was to define the prevalence of CAC and its association with markers of disease severity and standard measures of cardiovascular risk in a large cohort of patients undergoing OLT assessment.

The cirrhosis epidemic in the UK: evaluating the causes in a European context.

'Epidemic' is defined as the occurrence of many cases of a disease within an area, whereas 'pandemic' is used to emphasize its occurrence over a wide geographical area. This article reviews the epidemiology of cirrhosis in Europe and particularly within Britain, illustrating the different mortality trends in different countries. The rapid rise in mortality rate in Scotland is discussed and potential explanations explored.

The use of transjugular intrahepatic portosystemic stent shunt in the management of acute oesophageal variceal haemorrhage.

Variceal haemorrhage is a common and serious complication of portal hypertension. Endoscopic therapy is successful in the majority in controlling bleeding but in those who continue to bleed transjugular intrahepatic portosystemic stent shunt is highly effective in achieving haemostasis, although the evidence base that this is associated with improved survival is limited. This review discusses initial management and then the particular role of transjugular intrahepatic portosystemic stent shunt.

Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score.

Introduction: Alcoholic hepatitis is associated with a high short term mortality. We aimed to identify those factors associated with mortality and define a simple score which would predict outcome in our population.

Methods: We identified 241 patients with alcoholic hepatitis.

Submillimeter heterodyne detection of interstellar carbon monoxide at 434 micrometers.

A submillimeter heterodyne radiometer, developed for astronomical applications, uses an optically pumped laser local oscillator and a quasi-optical Schottky diode mixer. The resultant telescope-mounted system, which has a noise temperature less than 4000 K (double sideband) and high frequency and spatial resolution, has been used to detect the J = 6 --> 5 rotational transition of carbon monoxide at 434 micrometers in the Orion molecular cloud. The measurements, when compared with previous millimeter-wave data, indicate that the broad carbon monoxide emission feature is produced by an optically thin gas whose temperature exceeds 180 K.