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Article: Role of endoscopy in patients with familial adenomatous polyposis.

Hopper, Andrew D

2022 Volume 13, Issue e1, Page(s) e72–e79

Abstract: Familial adenomatous polyposis (FAP) is a hereditary disease that, without intervention, will cause nearly all patients to develop colorectal cancer by the age of 45. However, even after prophylactic colorectal surgery the eventual development of ... ...

Abstract	Familial adenomatous polyposis (FAP) is a hereditary disease that, without intervention, will cause nearly all patients to develop colorectal cancer by the age of 45. However, even after prophylactic colorectal surgery the eventual development of duodenal adenomas leads to an additional risk of duodenal and ampullary cancers. Endoscopy is an essential part of the multidisciplinary management of FAP to aid the early identification or prevention of advanced gastrointestinal malignancy. This review article details the current evidence and consensus guidance available regarding the role of endoscopic surveillance and treatment strategies for FAP.
Language	English
Publishing date	2022-06-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2521857-8
ISSN	2041-4137
ISSN	2041-4137
DOI	10.1136/flgastro-2022-102125
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Zs.A 6880: Show issues

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Article: Improving the diagnosis and management of GORD in adults.

Hopper, Andrew D

The Practitioner

2015 Volume 259, Issue 1781, Page(s) 27–32, 3

Abstract: Gastro-oesophageal reflux disease (GORD) is defined as a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Many patients with GORD complications such as oesophagitis, and up to a third of ... ...

Abstract	Gastro-oesophageal reflux disease (GORD) is defined as a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Many patients with GORD complications such as oesophagitis, and up to a third of patients with Barrett's oesophagus have no reflux or heartburn symptoms. Conversely, patients can be symptomatic even when normal reflux levels are found and there is an absence of mucosal damage. Significant GORD symptoms occur at least once a week in 8.8-26% of Europeans, with equal prevalence of symptoms in men and women. The frequency and severity of symptoms do not accurately predict the degree of oesophageal damage. If patients with GORD also describe symptoms of dyspepsia this should be considered first with H. py/oritesting or direct referral for gastroscopy if the patient is over 55 given the risk of gastric cancer in these patients. Oesophageal disease can account for up to 20% of cases of chronic cough. Symptoms of GORD occur in more than 45% of patients with asthma, and erosive oesophagitis on endoscopy has a 50% higher likelihood of a diagnosis of asthma. GORD is a risk factor for Barrett's oesophagus and oesophageal adenocarcinoma. The risk increases with duration, severity and frequency. Endoscopy should not be routinely offered at initial presentation unless the patient has dysphagia or other symptoms suggestive of upper GI cancer. Smoking cessation and weight loss are beneficial in reducing GORD symptoms. Abdominal obesity causes GORD by elevating intra-abdominal pressure, which promotes reflux and the development of hiatus hernia. GORD symptoms are increased by 70% among daily smokers who have been smoking for more than 20 years.
MeSH term(s)	Adult ; Barrett Esophagus/etiology ; Barrett Esophagus/prevention & control ; Diagnosis, Differential ; Disease Management ; Dyspepsia/etiology ; Endoscopy, Digestive System/methods ; Esophagitis/etiology ; Esophagitis/prevention & control ; Female ; Gastroesophageal Reflux/complications ; Gastroesophageal Reflux/diagnosis ; Gastroesophageal Reflux/physiopathology ; Gastroesophageal Reflux/therapy ; Heartburn/etiology ; Helicobacter Infections/diagnosis ; Humans ; Life Style ; Male ; Middle Aged ; Proton Pump Inhibitors/therapeutic use ; Risk Factors ; Stomach Neoplasms/diagnosis
Chemical Substances	Proton Pump Inhibitors
Language	English
Publishing date	2015-04
Publishing country	England
Document type	Journal Article
ZDB-ID	124095-x
ISSN	0032-6518
ISSN	0032-6518
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Zs.B 228: Show issues

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Article: Early endoscopy improves survival in gastric cancer.

Hopper, Andrew D

The Practitioner

2014 Volume 258, Issue 1773, Page(s) 23–7, 2

Abstract: Gastric cancer often presents late and the mortality ratio remains one of the highest compared with more common cancers. Early diagnosis improves survival in this potentially curable cancer. Men are twice as likely as women to develop gastric cancer. The ...

Abstract	Gastric cancer often presents late and the mortality ratio remains one of the highest compared with more common cancers. Early diagnosis improves survival in this potentially curable cancer. Men are twice as likely as women to develop gastric cancer. The vast majority (96%) of cases occur in people above the age of 55. Dysphagia, weight loss and age over 55 are significant predictors of cancer. All patients presenting with dyspepsia and either alarm features or known conditions that increase the risk of gastric cancer should be referred for urgent endoscopy. Given that the majority of gastric 0032-6518 cancer cases occur in people over 55, urgent endoscopy is also recommended in this group with new uncomplicated dyspepsia prior to treatment, even without alarm symptoms or if the symptoms respond to treatment. Upper GI endoscopy with biopsy is the recommended investigation to confirm gastric cancer. Patients deemed medically fit should undergo surgical resection to cure early gastric cancer and chemotherapy followed by surgical resection for higher stage tumours. More than half of all patients with gastric cancer present with incurable advanced disease; palliative chemotherapy has a small but significant effect on survival.
MeSH term(s)	Aged ; Early Diagnosis ; Endoscopy, Digestive System ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Stomach Neoplasms/diagnosis ; Stomach Neoplasms/mortality ; Stomach Neoplasms/therapy ; Survival Rate
Language	English
Publishing date	2014-07
Publishing country	England
Document type	Journal Article
ZDB-ID	124095-x
ISSN	0032-6518
ISSN	0032-6518
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Article ; Online: Improving future studies in chronic pancreatitis: a paradigm shift in our understanding?

Hopper, Andrew D / Campbell, Jennifer A

Gut

2018 Volume 67, Issue 7, Page(s) 1365–1366

MeSH term(s)	Chronic Disease ; Exocrine Pancreatic Insufficiency ; Humans ; Pancreas ; Pancreatic Elastase ; Pancreatitis ; Pancreatitis, Chronic
Chemical Substances	Pancreatic Elastase (EC 3.4.21.36)
Language	English
Publishing date	2018
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	80128-8
ISSN	1468-3288 ; 0017-5749
ISSN (online)	1468-3288
ISSN	0017-5749
DOI	10.1136/gutjnl-2017-315067
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Article ; Online: Computed Tomographic Sarcopenia in Pancreatic Cancer: Further Utilization to Plan Patient Management.

Jalal, Mustafa / Campbell, Jennifer A / Wadsley, Jonathan / Hopper, Andrew D

Journal of gastrointestinal cancer

2021 Volume 52, Issue 3, Page(s) 1183–1187

Abstract: Purpose: The presence of a sarcopenia adversely affects the prognosis of patients with pancreatic cancer. There is an emerging role for using computed tomography (CT) to calculate skeletal muscle index (SMI) and the presence of sarcopenia. The aim of ... ...

Abstract	Purpose: The presence of a sarcopenia adversely affects the prognosis of patients with pancreatic cancer. There is an emerging role for using computed tomography (CT) to calculate skeletal muscle index (SMI) and the presence of sarcopenia. The aim of this study was to assess if detecting 'computed tomographic sarcopenia' is feasible and can contribute to the management of patients with locally advanced pancreatic cancer (LAPC). Methods: Patients diagnosed with LAPC referred for endoscopic ultrasound-guided biopsy (EUS-B) by our regional cancer network were identified. Age, body mass index (BMI), and Eastern Cooperative Oncology Group performance status (ECOG-PS) were noted. CT images were analysed for SMI and the presence of sarcopenia. Decision outcomes on receiving chemotherapy or not were collected from the regional oncology database. Results: In total, 51/204 (25%) patients with LAPC who underwent EUS-B were not given chemotherapy and received best supportive care (BSC) only. The prevalence of sarcopenia (p = 0.0003), age ≥ 75 years old (p = 0.03), and ECOG-PS 2-3 (p = 0.01) were significantly higher in the patients receiving BSC only. Logistic regression analysis demonstrated that SMI was the only independent associated factor identifying patients with LAPC who were treated with BSC only and not chemotherapy after adjusting for age and ECOG-PS. Conclusion: Our study has shown that computed tomographic skeletal muscle analysis at the time of a diagnostic CT for patients with pancreatic cancer is feasible and can detect sarcopenia and malnourished patients who are much less likely to take up chemotherapy. These patients could be triaged to oncology assessment prior to EUS-B to avoid unnecessary investigations.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Clinical Decision-Making ; Female ; Humans ; Male ; Middle Aged ; Muscle, Skeletal/diagnostic imaging ; Muscle, Skeletal/pathology ; Pancreatic Neoplasms/complications ; Pancreatic Neoplasms/diagnostic imaging ; Prognosis ; Prospective Studies ; Sarcopenia/complications ; Sarcopenia/diagnostic imaging ; Sarcopenia/epidemiology ; Tomography, X-Ray Computed ; United Kingdom
Language	English
Publishing date	2021-07-22
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2452514-5
ISSN	1941-6636 ; 1559-0739 ; 1941-6628 ; 1537-3649
ISSN (online)	1941-6636 ; 1559-0739
ISSN	1941-6628 ; 1537-3649
DOI	10.1007/s12029-021-00672-4
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Article ; Online: Narrow-band imaging for optical diagnosis of duodenal villous atrophy in patients with suspected coeliac disease: A systematic review and meta-analysis.

Shiha, Mohamed G / Nandi, Nicoletta / Oka, Priya / Raju, Suneil A / Penny, Hugo A / Hopper, Andrew D / Elli, Luca / Sanders, David S

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

2023

Abstract: Background: Narrow-band imaging (NBI) is a readily accessible imaging technique that enhances mucosal visualisation, allowing for a more accurate assessment of duodenal villi. However, its role in the diagnosis of coeliac disease (CD) in clinical ... ...

Abstract	Background: Narrow-band imaging (NBI) is a readily accessible imaging technique that enhances mucosal visualisation, allowing for a more accurate assessment of duodenal villi. However, its role in the diagnosis of coeliac disease (CD) in clinical practice remains limited. Methods: We systematically searched several databases in June 2023 for studies evaluating the diagnostic accuracy of NBI for detecting duodenal villous atrophy (VA) in patients with suspected CD. We calculated the summary sensitivity, specificity, and likelihood ratios using a bivariate random-effects model. The study followed PRISMA guidelines and was registered at PROSPERO (CRD42023428266). Results: A total of 6 studies with 540 participants were included in the meta-analysis. The summary sensitivity of NBI to detect VA was 93% (95% CI, 81% - 98%), and the summary specificity was 95% (95% CI, 92% - 98%). The area under the summary receiver operating characteristic curve was 0.98 (95% CI, 96 - 99). The positive and negative predictive values of NBI were 94% (95% CI, 92% - 97%) and 92% (95% CI, 90% - 94%), respectively. Conclusion: NBI is an accurate non-invasive tool for identifying and excluding duodenal VA in patients with suspected CD. Further studies using a validated classification are needed to determine the optimal role of NBI in the diagnostic algorithm for CD.
Language	English
Publishing date	2023-09-02
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1459373-7
ISSN	1878-3562 ; 1125-8055
ISSN (online)	1878-3562
ISSN	1125-8055
DOI	10.1016/j.dld.2023.08.053
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Article ; Online: Are we missing pancreatic exocrine insufficiency in 'at-risk' groups? Prospective assessment of the current practice and yield of faecal elastase testing in patients with diabetes mellitus, HIV and/or high alcohol intake.

Jalal, Mustafa / Leeds, John S / Ching, Hey-Long / Oprescu, Andrei / Tunbridge, Ann / Greig, Julia / Tesfaye, Solomon / Hopper, Andrew D

Clinical medicine (London, England)

2023 Volume 23, Issue 6, Page(s) 588–593

Abstract: There is cumulative evidence that pancreatic exocrine insufficiency (PEI) is under-recognised and can occur in patients with 'at-risk' conditions. Thus, we aimed to assess the current practice and yield of requesting faecal elastase (FEL-1), an indicator ...

Abstract	There is cumulative evidence that pancreatic exocrine insufficiency (PEI) is under-recognised and can occur in patients with 'at-risk' conditions. Thus, we aimed to assess the current practice and yield of requesting faecal elastase (FEL-1), an indicator of PEI, in patients with 'at-risk' conditions. We prospectively recruited patients attending secondary care clinics with diabetes mellitus (DM), people living with HIV (PLHIV) and inpatients admitted to hospital with high alcohol intake (HAI). All patients underwent testing with FEL-1. Those patients with PEI (FEL-1 <200 μg/g) were contacted and offered a follow-up review in gastroenterology clinic. In total, 188 patients were recruited (HAI, n=78; DM, n=64; and PLHIV, n=46). Previous FEL-1 testing had not been performed in any of the patients. The return rate of samples was 67.9% for patients with HAI, 76.6% for those with DM and 56.5% for those with PLHIV. The presence of PEI was shown in 20.4% of patients with DM, 15.4% of patients with PLHIV and 22.6% in those with HAI. Diarrhoea and bloating were the most reported symptoms in followed-up patients with low FEL-1 (31.8% and 22.7% of patients, respectively). Follow-up computed tomography (CT) scans in those patients with PEI identified chronic pancreatitis changes in 13.6% and pancreatic atrophy in 31.8% of patients. These results suggest that there is a lack of testing for PEI in 'at-risk' groups. Our findings also suggest that using FEL-1 to test for PEI in patients with DM, PLHIV and HAI has a significant impact, although further studies are required to validate these findings.
MeSH term(s)	Humans ; Pancreatic Elastase ; Prospective Studies ; Feces ; Diabetes Mellitus ; Exocrine Pancreatic Insufficiency/etiology ; Exocrine Pancreatic Insufficiency/complications ; HIV Infections/complications ; Alcohol Drinking
Chemical Substances	Pancreatic Elastase (EC 3.4.21.36)
Language	English
Publishing date	2023-12-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2048646-7
ISSN	1473-4893 ; 1470-2118
ISSN (online)	1473-4893
ISSN	1470-2118
DOI	10.7861/clinmed.2023-0185
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Article ; Online: Letter: the under-treatment and under-diagnosis of pancreatic exocrine insufficiency in chronic pancreatitis and pancreatic cancer is just the tip of the iceberg.

Shiha, Mohamed G / Hopper, Andrew D / Campbell, Jennifer A / Sanders, David S

Alimentary pharmacology & therapeutics

2020 Volume 52, Issue 4, Page(s) 742–743

MeSH term(s)	Enzyme Replacement Therapy ; Exocrine Pancreatic Insufficiency/diagnosis ; Exocrine Pancreatic Insufficiency/etiology ; Humans ; Pancreas ; Pancreatic Neoplasms/complications ; Pancreatic Neoplasms/diagnosis ; Pancreatitis, Chronic/complications ; Pancreatitis, Chronic/diagnosis
Language	English
Publishing date	2020-09-04
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	639012-2
ISSN	1365-2036 ; 0269-2813 ; 0953-0673
ISSN (online)	1365-2036
ISSN	0269-2813 ; 0953-0673
DOI	10.1111/apt.15913
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Article: Early diagnosis of oesophageal cancer improves outcomes.

Hopper, Andrew D / Campbell, Jennifer A

The Practitioner

2016 Volume 260, Issue 1791, Page(s) 23–8, 3

Abstract: There are two main types of oesophageal cancer, oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC). They present in the same manner and both carry a five-year survival of only 16%. In the UK there is a 2:1 male to female ... ...

Abstract	There are two main types of oesophageal cancer, oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC). They present in the same manner and both carry a five-year survival of only 16%. In the UK there is a 2:1 male to female ratio for oesophageal cancer. Peak incidence at presentation is in the 65-75 age group, with 95% of cases presenting in those over 50. Smoking is a major risk factor for both types and is linked to an estimated 66% of cases in the UK. OSCC is linked to alcohol, smoking, and chewing betel quid. OAC is associated with the presence of GORD, and its duration, and obesity (especially increased waist circumference). Oesophageal cancer commonly presents with dysphagia or odynophagia. This can be associated with weight loss and vomiting. All patients with recent onset dysphagia should be referred for rapid access endoscopy. Referral for urgent endoscopy should still be considered in the presence of dysphagia regardless of previous history or medication. Dysphagia is not always present so all patients with alarm symptoms should be considered for endoscopy. NICE recommends referral for urgent direct access upper GI endoscopy to assess for oesophageal cancer for patients with dysphagia or aged 55 and over with weight loss and any of the following: upper abdominal pain; reflux; dyspepsia.
MeSH term(s)	Deglutition Disorders/etiology ; Early Diagnosis ; Esophageal Neoplasms/diagnosis ; Esophageal Neoplasms/therapy ; Esophagoscopy ; Humans ; Risk Factors
Language	English
Publishing date	2016-03
Publishing country	England
Document type	Journal Article
ZDB-ID	124095-x
ISSN	0032-6518
ISSN	0032-6518
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Article ; Online: Identification of "Digital Sarcopenia" Can Aid the Detection of Pancreatic Exocrine Insufficiency and Malnutrition Assessment in Patients with Suspected Pancreatic Pathology.

Jalal, Mustafa / Rosendahl, Jonas / Campbell, Jennifer A / Vinayagam, Ragu / Al-Mukhtar, Ahmed / Hopper, Andrew D

Digestive diseases (Basel, Switzerland)

2021 Volume 40, Issue 3, Page(s) 335–344

Abstract: Background: Pancreatic exocrine insufficiency (PEI) and subsequent malnutrition can be difficult to diagnose but lead to sarcopenia and increased mortality and morbidity even in benign disease. Digital skeletal muscle analysis has been increasingly ... ...

Abstract	Background: Pancreatic exocrine insufficiency (PEI) and subsequent malnutrition can be difficult to diagnose but lead to sarcopenia and increased mortality and morbidity even in benign disease. Digital skeletal muscle analysis has been increasingly recognised as a tool to diagnose sarcopenia. Objective: The aim of the study was to assess the prevalence of sarcopenia in patients with PEI secondary to benign disease using novel skeletal muscle recognition software. Methods: Prospective recruitment of patients referred for endoscopic ultrasound (EUS) with suspected pancreatic pathology. Patients with suspected pancreatic cancer on initial computed tomography (CT) were excluded. The diagnosis of chronic pancreatitis (CP) was based on CT and EUS findings. PEI was assessed with faecal elastase-1. Digital measurement of skeletal muscle mass identified sarcopenia, with demographic and comorbidity data also collected. Results: PEI was identified in 45.1% (46/102) of patients recruited, and 29.4% (30/102) had changes of CP. Sarcopenia was significantly more prevalent in PEI 67.4% (31/46) than no-PEI 37.5% (21/56) (37.5%), regardless of CP changes (p < 0.003). The prevalence of sarcopenia (67% vs. 35%; p = 0.02) and sarcopenic obesity (68.4% vs. 25%; p = 0.003) was significantly higher when PEI was present without a radiological diagnosis of CP. Multivariate analysis identified sarcopenia and diabetes to be independently associated with PEI (odds ratio 4.8 and 13.8, respectively, p < 0.05). Conclusion: Sarcopenia was strongly associated with PEI in patients undergoing assessment for suspected benign pancreatic pathology. Digital skeletal muscle assessment can be used as a tool to aid identification of sarcopenia in patients undergoing CT scan for pancreatic symptoms.
MeSH term(s)	Exocrine Pancreatic Insufficiency/diagnostic imaging ; Exocrine Pancreatic Insufficiency/epidemiology ; Humans ; Malnutrition/complications ; Malnutrition/diagnosis ; Malnutrition/epidemiology ; Pancreas/pathology ; Pancreatitis, Chronic/diagnosis ; Pancreatitis, Chronic/diagnostic imaging ; Prospective Studies ; Sarcopenia/diagnostic imaging ; Sarcopenia/epidemiology
Language	English
Publishing date	2021-06-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	632798-9
ISSN	1421-9875 ; 0257-2753
ISSN (online)	1421-9875
ISSN	0257-2753
DOI	10.1159/000517554
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