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Article ; Online: Biomarkers of Colorectal Cancer Risk Decrease 6 months After Roux-en-Y Gastric Bypass Surgery.

Afshar, Sorena / Malcomson, Fiona / Kelly, Seamus B / Seymour, Keith / Woodcock, Sean / Mathers, John C

2017 Volume 28, Issue 4, Page(s) 945–954

Abstract: Purpose: The impact of weight loss on obesity-related colorectal cancer (CRC) risk is not well defined. Previous studies have suggested that Roux-en-Y gastric bypass (RYGB) surgery may have an unexpected adverse impact on CRC risk. This study aimed to ... ...

Abstract	Purpose: The impact of weight loss on obesity-related colorectal cancer (CRC) risk is not well defined. Previous studies have suggested that Roux-en-Y gastric bypass (RYGB) surgery may have an unexpected adverse impact on CRC risk. This study aimed to investigate the impact of RYGB on biomarkers of CRC risk. Materials and methods: Rectal mucosal biopsies and blood were obtained from patients undergoing RYGB (n = 22) and non-obese control participants (n = 20) at baseline and at a median of 6.5 months after surgery. Markers of systemic inflammation and glucose homeostasis were measured. Expression of pro-inflammatory genes and proto-oncogenes in the rectal mucosa was quantified using qPCR. Crypt cell proliferation state of the rectal mucosa was assessed by counting mitotic figures in whole micro-dissected crypts. Results: At 6.5 months post-surgery, participants had lost 29 kg body mass and showed improvements in markers of glucose homeostasis and in systemic inflammation. Expression of pro-inflammatory genes in the rectal mucosa did not increase and COX-1 expression fell significantly (P = 0.019). The mean number of mitoses per crypt decreased from 6.5 to 4.3 (P = 0.028) after RYGB. Conclusion: RYGB in obese adults led to lower rectal crypt cell proliferation, reduced systemic and mucosal markers of inflammation and improvements in glucose regulation. These consistent findings of reduced markers of tumourigenic potential suggest that surgically induced weight loss may lower CRC risk.
MeSH term(s)	Adolescent ; Adult ; Aged ; Biomarkers/analysis ; Biomarkers/blood ; Biomarkers/metabolism ; Biopsy ; Case-Control Studies ; Colorectal Neoplasms/blood ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/etiology ; Colorectal Neoplasms/pathology ; Down-Regulation ; Female ; Follow-Up Studies ; Gastric Bypass ; Humans ; Inflammation/blood ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Obesity, Morbid/blood ; Obesity, Morbid/complications ; Obesity, Morbid/pathology ; Obesity, Morbid/surgery ; Rectum/pathology ; Risk Factors ; Time Factors ; Weight Loss/physiology ; Young Adult
Chemical Substances	Biomarkers
Language	English
Publishing date	2017-08-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-017-2953-6
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Article ; Online: The Effects of Bariatric Procedures on Bowel Habit.

Afshar, Sorena / Kelly, Seamus B / Seymour, Keith / Woodcock, Sean / Werner, Anke-Dorothee / Mathers, John C

Obesity surgery

2016 Volume 26, Issue 10, Page(s) 2348–2354

Abstract: Background: Bariatric procedures are increasingly being used to combat the rising obesity epidemic. The aim of this study was to assess the effect of these interventions on bowel habit.: Methods: We recruited obese adults listed for a bariatric ... ...

Abstract	Background: Bariatric procedures are increasingly being used to combat the rising obesity epidemic. The aim of this study was to assess the effect of these interventions on bowel habit. Methods: We recruited obese adults listed for a bariatric procedure. Demographic data, medical history, medications and anthropometric measurements were recorded. Bowel habit was characterized using a 7-day Bristol Stool Form Scale (BSFS) diary. A validated food frequency questionnaire (FFQ) was used to assess diet. Results: Twenty-six patients were assessed pre-operatively and at a median of 6.4 months post-operatively. Nineteen had a Roux-en-Y gastric bypass (RYGB), five had a sleeve gastrectomy (SG) and two had an intra-gastric balloon (IGB) with median percentage excess weight loss (% EWL) of 67.9, 52.4 and 31.3 %, respectively. Dietary fibre intake decreased from 24.4 (±12.1) g/day pre-operatively to 17.5 (±7.3) g/day post-operatively (P = 0.008). Frequency of bowel motions decreased from 8.6 (±3.5) to 5.7 (±3.5) motions/week (P = 0.001). Mean usual BSFS score decreased (towards firmer stool) from 4.1 (±1.3) pre-operatively to 3.1 (±1.9) post-operatively (P = 0.016). Constipation increased from 8 to 27 %, but this did not reach statistical significance (P = 0.125). Conclusions: Constipation is a common problem after bariatric surgery. The decrease in bowel motion frequency and change towards firmer stools suggest prolonged intestinal transit time after bariatric procedures. Reduction in dietary fibre intake is likely to be a contributory factor.
MeSH term(s)	Adolescent ; Adult ; Aged ; Bariatric Surgery/adverse effects ; Bariatric Surgery/methods ; Constipation/diagnosis ; Constipation/etiology ; Defecation/physiology ; Dietary Fiber ; Female ; Humans ; Male ; Middle Aged ; Obesity/surgery ; Young Adult
Language	English
Publishing date	2016-10
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-016-2100-9
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Article ; Online: Changes in physical activity after bariatric surgery: using objective and self-reported measures.

Afshar, Sorena / Seymour, Keith / Kelly, Seamus B / Woodcock, Sean / van Hees, Vincent T / Mathers, John C

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

2017 Volume 13, Issue 3, Page(s) 474–483

Abstract: Background: Many studies using self-reported physical activity (PA) assessment tools have suggested there is an increase in PA after bariatric surgery.: Objectives: Our aim was to assess PA and sedentary behavior before bariatric surgery and at 6 ... ...

Abstract	Background: Many studies using self-reported physical activity (PA) assessment tools have suggested there is an increase in PA after bariatric surgery. Objectives: Our aim was to assess PA and sedentary behavior before bariatric surgery and at 6 months after, using subjective and objective tools. Setting: Bariatric surgery candidates were recruited from a single center. Methods: Demographic data, medical history, current medications, and anthropometric measurements were recorded. Participants were asked to complete a PA and lifestyle questionnaire and to wear an accelerometer on their nondominant wrist. Data were collected before and at 6 months after surgery. Results: Twenty-two participants were included (17 gastric bypass; 4 sleeve gastrectomy; 1 intragastric balloon). Mean age was 46 years and the majority were female (72%). At a median of 6.3 months follow-up, there were significant reductions in measures of body fatness with a mean reduction of 27 kg in weight. The majority of daytime (12.5±1.1 out of 16 h) was spent in sedentary behavior presurgery with little change postsurgery (12.2±1.2; P = .186). Objectively measured mean moderate-vigorous PA did not change significantly from pre- to postsurgery (mean 11.5±13.9 and 11.6±13.1 min/d, respectively; P = .971). Self-reported total nonoccupational PA did not change significantly (P = .390). Conclusions: The majority of bariatric surgery candidates were physically inactive presurgery, and there was no significant change in either subjectively or objectively measured PA at follow-up. This patient group may benefit from objective PA assessment and interventions aimed at increasing PA.
Language	English
Publishing date	2017-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2274243-8
ISSN	1878-7533 ; 1550-7289
ISSN (online)	1878-7533
ISSN	1550-7289
DOI	10.1016/j.soard.2016.09.012
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Article ; Online: Ascertaining the Place of Social Media and Technology for Bariatric Patient Support: What Do Allied Health Practitioners Think?

Graham, Yitka N H / Hayes, Catherine / Mahawar, Kamal K / Small, Peter K / Attala, Anita / Seymour, Keith / Woodcock, Sean / Ling, Jonathan

Obesity surgery

2017 Volume 27, Issue 7, Page(s) 1691–1696

Abstract: Background: There is an increasing presence of patient-led social media, mobile apps and patient support technology, but little is known about the role of these in the support of bariatric surgery patients in the UK. This study aimed to seek the views ... ...

Abstract	Background: There is an increasing presence of patient-led social media, mobile apps and patient support technology, but little is known about the role of these in the support of bariatric surgery patients in the UK. This study aimed to seek the views of allied health professionals (AHPs) working in bariatric surgical teams to understand their current perceptions of the role of social media, mobile apps and patient-support technology within bariatric surgery in the UK. Methods: A confidential, printed survey was distributed to the AHPs at the British Obesity and Metabolic Surgery Society (BOMSS) 7th Annual Scientific Conference in January 2016. An email to AHPs who did not attend the conference was sent requesting voluntary participation in the same survey online through Survey Monkey® within 2 weeks of the conference. Results: A total of 95 responses were received, which was a 71% response rate (n = 134). Responses were from nurses (34%, n = 46), dietitians (32%, n = 32), psychologists (16%, n = 12) and 1 nutritionist, 1 physiotherapist, 1 patient advocate, 1 surgeon and 9 respondents did not fill in their title. Conclusion: The use of social media and mobile apps by patients is increasing, with AHPs concerned about misinformation; advice may differ from what is given in clinic. Technologies, e.g. telehealth and videoconferencing are not widely used in bariatric surgery in the UK. AHPs are unclear about the role of technologies for bariatric surgical patient support. Further discussions are needed to understand the potential of technology with AHPs supporting/facilitating patients as this becomes more commonplace.
MeSH term(s)	Allied Health Personnel/psychology ; Attitude of Health Personnel ; Bariatric Surgery ; Health Care Surveys ; Humans ; Mobile Applications ; Obesity/surgery ; Obesity/therapy ; Perception ; Social Media ; Social Support ; Telemedicine ; United Kingdom ; Videoconferencing
Language	English
Publishing date	2017-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-016-2527-z
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Article ; Online: The effects of bariatric surgery on colorectal cancer risk: systematic review and meta-analysis.

Afshar, Sorena / Kelly, Seamus B / Seymour, Keith / Lara, Jose / Woodcock, Sean / Mathers, John C

Obesity surgery

2014 Volume 24, Issue 10, Page(s) 1793–1799

Abstract: Obesity is an established risk factor for colorectal cancer (CRC) but the effects of bariatric surgery on CRC incidence are uncertain. A systematic review of six electronic databases identified 3691 articles. Four observational studies met our inclusion ... ...

Abstract	Obesity is an established risk factor for colorectal cancer (CRC) but the effects of bariatric surgery on CRC incidence are uncertain. A systematic review of six electronic databases identified 3691 articles. Four observational studies met our inclusion criteria and results were pooled using a random effects model. Meta-analysis of these four studies revealed that bariatric surgery was associated with a significantly (p = 0.004) lower CRC incidence (RR = 0.73, 95 % confidence interval, 0.58 - 0.90) when compared with obese non-operated individuals, i.e., bariatric surgery is associated with a 27 % lower CRC risk. However the evidence base is limited and these findings should be confirmed by future studies with improved designs.
MeSH term(s)	Bariatric Surgery ; Colorectal Neoplasms/etiology ; Colorectal Neoplasms/prevention & control ; Humans ; Incidence ; Obesity/complications ; Obesity/surgery ; Risk ; Risk Factors
Language	English
Publishing date	2014-06-06
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-014-1359-y
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Article ; Online: Impact of a care pathway in acute pancreatitis.

McCallum, Iain J D / Hicks, Gareth J / Attwood, Stephen / Seymour, Keith

Postgraduate medical journal

2011 Volume 87, Issue 1027, Page(s) 379–381

Abstract: Background: Previous studies have shown that accurate process of care predicts quality of care. Few examples currently exist for process of care for the acute surgical patient. A recent region wide audit had identified good outcomes for patients with ... ...

Abstract	Background: Previous studies have shown that accurate process of care predicts quality of care. Few examples currently exist for process of care for the acute surgical patient. A recent region wide audit had identified good outcomes for patients with acute pancreatitis at our institution but aspects of care that could be improved. Methods: For this re-audit, a simple written care pathway for the management of those presenting with acute pancreatitis was introduced in our institution from February to July 2009. The audit standards were set against the British Society of Gastroenterology (BSG) guidelines for management of acute pancreatitis and were compared with the previous region wide audit. Results: Marked improvements were noted in the rates of abdominal imaging achieved within 24 h of diagnosis (35.2% vs 47.7%), severity stratification within 48 h of diagnosis (28.7% vs 75%), critical care admission for those classified as severe (39.3% vs 63.6%) and definitive treatment during index admission (22.2% vs 38.5%). Survival rates were 100% for this audit cycle and 95% for all patients within the region wide audit. Despite these improvements, care still does not reach the standards set out by BSG. Conclusion: Predefined processes of care may help to recognise those developing or likely to develop severe pancreatitis, ensure accurate documentation of severity, expedite critical care review and/or admission, and help to encourage the timely management of those with a treatable underlying cause of their pancreatitis.
MeSH term(s)	Acute Disease ; Cholangiopancreatography, Endoscopic Retrograde ; Critical Care/utilization ; Critical Pathways/organization & administration ; England ; Gallstones/complications ; Gallstones/surgery ; Guideline Adherence/statistics & numerical data ; Humans ; Medical Audit ; Pancreatitis/diagnosis ; Pancreatitis/etiology ; Pancreatitis/therapy ; Patient Admission/statistics & numerical data ; Practice Guidelines as Topic ; Quality of Health Care ; Time Factors ; Tomography, X-Ray Computed/utilization
Language	English
Publishing date	2011-05
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/pgmj.2010.002113rep
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Article: A comparison of two methods of palliation of large bowel obstruction due to irremovable colon cancer.

Johnson, Richard / Marsh, Ralph / Corson, John / Seymour, Keith

Annals of the Royal College of Surgeons of England

2004 Volume 86, Issue 2, Page(s) 99–103

Abstract: Introduction: Untreated malignant large bowel obstruction is rapidly fatal. Short-term palliation of symptoms can be achieved by formation of a stoma in those patients for whom resection surgery is inappropriate. In the final months of life, a stoma ... ...

Abstract	Introduction: Untreated malignant large bowel obstruction is rapidly fatal. Short-term palliation of symptoms can be achieved by formation of a stoma in those patients for whom resection surgery is inappropriate. In the final months of life, a stoma represents a significant burden for both patients and carers. Palliative endoluminal stenting may therefore be an attractive alternative option for this poor prognostic group. Patients: Thirty-six patients were studied of whom 18 had obstructing left-sided colon cancer relieved by placement of endoluminal stents. These were compared with 18 historical controls with similar clinicopathological features that were treated more conventionally with palliative stoma formation in the same hospital. Results: Patients in the two groups had similar sex distribution (P = 0.5); however, patients undergoing palliative stoma formation were significantly younger than patients being stented (P = 0.0065). As well as being older, there was a trend towards greater co-morbidities, stent patients having higher ASA grades (P = 0.01). Both groups of patients gained relief of obstructive symptoms. There were no differences in survival (P = 0.5) or in hospital mortality (2 in each group). The median length of palliation is 92 days (42-infinity days) for stenting and 121 days (89-281 days) for palliative stoma formation. Formation of a stoma required a significantly longer stay in ITU (P = 0.003) but total hospital stay was similar. Conclusions: As an alternative to palliative surgery, selected patients benefit from colonic endoluminal stenting with relief of obstructive symptoms and no adverse effect on survival. They may be spared the potential problems associated with palliative stoma formation and the morbidity of surgery. Stenting can be offered to the very frail patient who would otherwise be managed conservatively.
MeSH term(s)	Aged ; Aged, 80 and over ; Colonic Neoplasms/complications ; Colonic Neoplasms/surgery ; Critical Care ; Female ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Length of Stay ; Male ; Middle Aged ; Palliative Care/methods ; Postoperative Complications/etiology ; Referral and Consultation ; Stents ; Survival Analysis
Language	English
Publishing date	2004-03
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/003588404322827473
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Article: Impact of a care pathway in acute pancreatitis.

McCallum, Iain J D / Hicks, Gareth J / Attwood, Stephen / Seymour, Keith

Frontline gastroenterology

2010 Volume 2, Issue 1, Page(s) 32–34

Abstract	Background: Previous studies have shown that accurate process of care predicts quality of care. Few examples currently exist for process of care for the acute surgical patient. A recent region wide audit had identified good outcomes for patients with acute pancreatitis at our institution but aspects of care that could be improved. Methods: For this re-audit, a simple written care pathway for the management of those presenting with acute pancreatitis was introduced in our institution from February to July 2009. The audit standards were set against the British Society of Gastroenterology (BSG) guidelines for management of acute pancreatitis and were compared with the previous region wide audit. Results: Marked improvements were noted in the rates of abdominal imaging achieved within 24 h of diagnosis (35.2% vs 47.7%), severity stratification within 48 h of diagnosis (28.7% vs 75%), critical care admission for those classified as severe (39.3% vs 63.6%) and definitive treatment during index admission (22.2% vs 38.5%). Survival rates were 100% for this audit cycle and 95% for all patients within the region wide audit. Despite these improvements, care still does not reach the standards set out by BSG. Conclusion: Predefined processes of care may help to recognise those developing or likely to develop severe pancreatitis, ensure accurate documentation of severity, expedite critical care review and/or admission, and help to encourage the timely management of those with a treatable underlying cause of their pancreatitis.
Language	English
Publishing date	2010-11-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2521857-8
ISSN	2041-4137
ISSN	2041-4137
DOI	10.1136/fg.2010.002113
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Zs.A 6880: Show issues

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Article: Referral pathways of patients with gallstones: a potential source of financial waste in the U.K. National Health Service?

Borowski, David / Knox, Margaret / Kanakala, Venkat / Richardson, Stuart / Seymour, Keith / Attwood, Stephen / Slater, Bary

International journal of health care quality assurance

2010 Volume 23, Issue 2, Page(s) 248–257

Abstract: Purpose: Gallstone-related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone-disease is by laparoscopic cholecystectomy, which can be safely ... ...

Abstract	Purpose: Gallstone-related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone-disease is by laparoscopic cholecystectomy, which can be safely and cost-effectively performed during a short hospital stay or as day-case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings. Design/methodology/approach: The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment. Findings: Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co-morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least pounds 16,194. Originality/value: A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.
MeSH term(s)	Aged ; Cholecystectomy/economics ; Cholecystectomy/utilization ; Clinical Audit ; Costs and Cost Analysis ; Emergency Service, Hospital/economics ; Female ; Gallstones/economics ; Gallstones/surgery ; Humans ; Male ; Middle Aged ; National Health Programs/economics ; Prospective Studies ; Referral and Consultation/economics ; Referral and Consultation/standards ; Surveys and Questionnaires ; United Kingdom
Language	English
Publishing date	2010
Publishing country	England
Document type	Journal Article
ZDB-ID	645125-1
ISSN	0952-6862 ; 1366-0756
ISSN	0952-6862 ; 1366-0756
DOI	10.1108/09526861011017139
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Article: Nutritional strategies in severe acute pancreatitis: a systematic review of the evidence.

Al Samaraee, Ahmad / McCallum, Iain J D / Coyne, Peter E / Seymour, Keith

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2010 Volume 8, Issue 2, Page(s) 105–110

Abstract: Nutrition in severe acute pancreatitis is a critical aspect in the management of this condition. This review aims to systematically review the evidence available to inform the use of nutritional support in severe acute pancreatitis. High quality (level 1) ...

Abstract	Nutrition in severe acute pancreatitis is a critical aspect in the management of this condition. This review aims to systematically review the evidence available to inform the use of nutritional support in severe acute pancreatitis. High quality (level 1) evidence supports naso-jejunal enteral nutrition (NJ-EN) over parenteral nutrition (PN) reducing infectious morbidity and showing a trend towards reduced organ failure although there is no detectable difference in mortality. Trial data may underestimate benefit as patients are often recruited with predicted rather than proven severe disease. NJ-EN is safe when started immediately (level 3 evidence). NJ-EN is often impractical and naso-gastric (NG) feeding seems to be equivalent in terms of safety and outcomes whilst being more practical (level 2 evidence). Regarding feed supplementation, probiotic feed supplementation is not beneficial (level 1 evidence) the and may cause harm with excess mortality (level 2 evidence). No evidence exists to confirm benefit of the addition of prokinetics in severe acute pancreatitis (SAP) although their use is proven in other critically ill patients. Level 2 evidence does not currently support the use of combination immuno-nutrition though further work on individual agents may provide differing results. Level 2 evidence does not support intravenous supplementation of anti-oxidants and has demonstrated that these too may cause harm.
MeSH term(s)	Acute Disease ; Enteral Nutrition ; Evidence-Based Medicine ; Humans ; Intubation, Gastrointestinal ; Pancreatitis/immunology ; Pancreatitis/therapy ; Pancreatitis, Acute Necrotizing/therapy ; Probiotics/therapeutic use
Language	English
Publishing date	2010-04
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2009.10.006
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