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Biomedical subjects

G Holdstock

Publications and source records attributed to G Holdstock.

At least 19 recordsLinked to original sources
PubMed1997

Open access fundholding endoscopy in the private sector.

We conducted a comparative study of 150 patients referred for endoscopy to an NHS hospital and 150 patients referred to an open access scheme in the private sector for fundholding GPs. The concept of consultoscopy, whereby a consultant gastroenterologist gives an opinion at the same visit as the endoscopy is performed, is introduced. Results showed a similar number of normal studies (about 40%) were performed in each group, although the number of examinations showing serious pathology was significantly higher in the fundholding group (p < 0.01). Patients seen in the fundholding scheme had less sedation, required fewer outpatient appointments, and the GPs were given more advice on further management than those seen in the non-fundholding group. We conclude that open access endoscopy in the private sector is a workable option and may result in work being transferred from NHS hospitals to the private sector unless NHS hospitals review their working practices. The concept of consultoscopy is a useful development on traditional open access systems.

Adolescent↗
PubMed1996

Development of a sedation policy for upper GI endoscopy based on an audit of patients' perception of the procedure.

OBJECTIVE: To assess patients' perception of upper GI endoscopy, both with and without sedation, and based on this information to propose a sedation policy for the procedure. METHODS: A prospective audit of the experience of patients undergoing upper GI endoscopy both with and without sedation. RESULTS: Of the 500 patients in the study, 237 had endoscopy with sedation and 263 with local anaesthetic throat spray. Sedated patients found the procedure more tolerable, but most unsedated patients felt the extra discomfort was more than compensated for by other advantages. 87% of those patients sedated and 70% of those not sedated would choose to have the procedure repeated in the same way. CONCLUSION: Upper GI endoscopy using local anaesthetic throat spray alone is well tolerated by patients. We have developed a policy on sedation which we believe could result in many more patients electively choosing to have the procedure without sedation, resulting in potential savings on cost and manpower.

Administration, Topical↗
PubMed1989

Pulmonary permeability in coeliac disease and inflammatory bowel disease.

Respiratory disease and subclinical pulmonary abnormalities are recognised complications of both coeliac disease (CD) and inflammatory bowel disease (IBD) but the pathogenesis of the lung disease remains uncertain. We have studied lung function, including permeability measured by clearance of inhaled technetium-99m diethylene triamine pentaacetic acid in 25 patients with IBD, 18 patients with CD on a gluten-free diet, and in 20 normal controls, all without respiratory symptoms. In IBD there was evidence of obstruction to airflow (mean forced expiratory volume in 1 s/forced vital capacity equals 75.8%, control 81%; p less than 0.05) but no change in pulmonary permeability (half-time clearance equals 70.3 vs. 69.2 min). In CD airflow was not significantly different from control (forced expiratory volume in 1 s/forced vital capacity equals 80%) but there was an increase in pulmonary permeability (half-time clearance equals 48.9 min; p less than 0.01). These findings suggest that the mechanisms of lung disease in CD differs from that in IBD and supports the hypothesis of a common mucosal defect in lung and small intestine in CD allowing increased permeability.

Adult↗
PubMed1986

Prospective testing of a scoring system designed to improve case selection for upper gastrointestinal investigation.

A recently described scoring system designed to assess the individual risk of finding serious pathology in patients referred for upper gastrointestinal investigation has been prospectively tested in 1279 patients undergoing first-time endoscopy and 321 patients undergoing radiologic examination. The scoring system has been confirmed to give a reasonable prediction of the likelihood of finding serious pathology in two hospitals with differing endoscopic practice, and also to be applicable to patients attending for radiology. The system works best at defining a low-risk group (score less than 412, 26% of total) in which the incidence of serious pathology was 3%. All cases of malignancy (n = 55) occurred in patients scoring greater than 464 (50% of total). A simple table is described that allows for the easy calculation of score at a glance without the use of a computer. We believe that this scoring system, which can be implemented in seconds, is the simplest yet described and that it could prove to be a useful educational aid.

Age Factors↗
PubMed1986

Relationship between disease activity indices and colonoscopic findings in patients with colonic inflammatory bowel disease.

The Crohn's disease activity index, a similar index devised for patients with ulcerative colitis, and other commonly used laboratory indicators of disease activity have been studied in 50 patients with colonic inflammatory bowel disease undergoing routine colonoscopic assessment and compared with the histological extent and activity of disease. There was only poor correlation between the colonoscopic or histological findings and the indices of disease activity studied, showing that these are not reliable measures of disease activity or extent at the tissue level.

Blood Sedimentation↗
PubMed1986

Clinical importance of Campylobacter pyloridis and associated serum IgG and IgA antibody responses in patients undergoing upper gastrointestinal endoscopy.

Campylobacter pyloridis was isolated from 77% of 220 (35%) unselected adults undergoing gastroscopy. Isolation was significantly associated with histological gastritis (p less than 0.0001), duodenal ulcer (p less than 0.0001), and to a much lesser extent, with gastric ulcer (p less than 0.05). The relation between the isolation of C pyloridis and peptic ulcer seemed to be independent of coexisting gastritis. In those with no endoscopic or histological evidence of disease there was no relation between isolation and increasing age. Antibody responses to a whole cell sonicate of a strain of C pyloridis were measured by means of an enzyme linked immunosorbent assay (ELISA). Increased IgA (p less than 0.0001) and IgG (p less than 0.0001) antibody titres were found in patients with C pyloridis. Peptic ulceration or gastritis were present in 78% and 100% of patients with a high concentration of IgG and IgA, respectively, but in only 9% and 18% of those with low titres. These results provide further evidence for a possible pathogenic role of these organisms in gastric disease and suggest that immunological markers of their presence might be useful non-invasive indicators of disease.

Adult↗
PubMed1985

Potential of SeHCAT retention as an indicator of terminal ileal involvement in inflammatory bowel disease.

The absorption of 75Se-23-selena-25-homotaurocholate (SeHCAT) was compared with vitamin-B12 absorption and conventional radiography in 44 patients with inflammatory bowel disease. The retention of SeHCAT was normal in 11 patients with ulcerative colitis but was abnormally low in 9 patients with terminal-ileal resection, 9 out of 14 patients with small-bowel Crohn's disease and in 2 out of 10 patients with Crohn's colitis. The 5 patients with small-bowel Crohn's disease and normal retention had either inactive disease or no radiological evidence of terminal ileal involvement. Measurements of the absorption of vitamin B12 did not discriminate between these groups, and there was very poor correlation between B12 and SeHCAT absorption (r = 0.506, P less than 0.05). There was extremely good correlation of SeHCAT retention measured using a wholebody counter with that measured using an uncollimated gamma camera (r = 0.96, P less than 0.001). The results suggest that SeHCAT retention may prove complementary to conventional methods of assessing small-bowel disease in patients with inflammatory bowel disease. As measurement by gamma camera is feasible, this test can be used in most departments of nuclear medicine.

Colitis, Ulcerative↗
PubMed1985

The value of screening for autoantibodies in patients with non-specific symptoms.

An autoantibody screen is often requested in patients with non-specific symptoms such as pyrexia of unknown origin. However, in a survey of 100 consecutive requests for this investigation in such patients only one patient was encountered in whom the investigation led to a positive diagnosis at an estimated cost of pound 2500. These requests accounted for 5% of the total workload. These observations reaffirm that this should remain a second line investigation and should be deferred until more likely diagnoses have been excluded.

Adolescent↗
PubMed1985

An investigation into the validity of the present classification of inflammatory bowel disease.

To assess the validity of the present subdivision of patients with inflammatory bowel disease into those with Crohn's disease of the small bowel or of the colon and those with ulcerative colitis, 252 patients with inflammatory bowel disease have been studied by questionnaire and case note review. One hundred and seventy-two variables concerning the nature and frequency of symptoms in remission and relapse, the incidence of complications and results of investigation have been analysed by computer. As expected, there were many highly significant variables between patients with ulcerative colitis and those with Crohn's disease of the small bowel. The latter showed evidence of a more severe disease course with more complications. There were similar, although less marked, differences between patients with Crohn's disease of the colon and those with Crohn's disease of the small bowel. There were very few differences in disease course between patients with Crohn's disease of the colon and those with ulcerative colitis. The results suggest that while separate classification of patients with Crohn's disease of the small bowel is justified on clinical grounds, the present separation of patients with disease confined to the colon into groups labelled ulcerative colitis or Crohn's disease of the colon is not. Alternative methods of classification should therefore be investigated.

Colitis, Ulcerative↗
PubMed1984

Survey of the use of colonoscopy in inflammatory bowel disease.

In a survey of patients with inflammatory bowel disease (IBD), colonoscopy with multiple biopsies has been shown to be superior to either colonoscopy alone or barium studies in assessing disease extent. Thus, of a total of 149 patients, 23 (15%) were considered to have total colitis on barium enema, 51 (34%) on macroscopic colonoscopy appearance compared to 92 (62%) on biopsy. Furthermore, radiological assessment of "skip lesions" was shown to be unreliable. Although it remains to be seen whether the more accurate delineation of disease extent achieved by endoscopy is advantageous in terms of clinical management, it may have implications for our understanding of the disease.

Biopsy↗
PubMed1984

A comparison between the use of a shadow shield whole body counter and an uncollimated gamma camera ain the assessment of the seven-day retention of SeHCAT.

We have compared the 7-day retention of the radioisotope bile salt analogue SeHCAT (75Se-23-selena-25-homotaurocholate), by whole body counting and by uncollimated gamma camera measurement, in phantoms and in 25 patients with inflammatory bowel disease. The results correlate with a linear correlation coefficient of 0.96. An uncollimated gamma camera can be used to assess bile acid malabsorption when a whole body radioactivity monitor is not available.

Colitis, Ulcerative↗
PubMed1983

Scoring system to improve cost effectiveness of open access endoscopy.

The introduction of an open access general practitioner endoscopy service may result in many unnecessary examinations being performed. In an attempt to prevent this, 235 patients attending for endoscopy were interviewed and the results analysed to determine which factors best discriminated between those with major disease (ulcers, cancers, oesophageal strictures; n = 48) and those without (n = 187). The six characteristics which best discriminated between the two groups were increasing age, history of vomiting, male sex, smoking, and a past history of peptic ulcer or hiatus hernia. With the use of these six features a scoring system was devised, designed to give an indication of the likelihood of finding such disease in an individual patient. This was assessed prospectively in a further 356 patients. The results showed that by utilising this scoring system it would be possible to reduce the number of examinations performed by 30% yet still detect 98% of serious disease. If confirmed in further prospective studies, this scoring system (or a modification) could more accurately assess individual priority for endoscopy and enable optimum use to be made of limited resources.

Age Factors↗
PubMed1983

Different aetiology of chronic active hepatitis in U.K. and Iraq.

We have compared the clinical, biochemical and immunological features of patients with biopsy-proven chronic active hepatitis from Iraq and from the United Kingdom. Clear-cut differences emerge, which can mostly be attributed to the HBV status, as 91% of patients from Iraq were HBsAg-positive compared to only 6% from the U.K. Most patients from Iraq presented insidiously with established cirrhosis, while those from the U.K. presented more acutely and systemic symptoms were more common. Autoantibodies and associated autoimmune conditions were common in U.K. patients but extremely rare in Iraqis.

Adult↗
PubMed1983

Dupuytren's contracture, chronic liver disease and IgA immune complexes.

Contrary to previous reports, Dupuytren's contracture was found to be equally common in patients with alcoholic and non-alcoholic biopsy-proven liver disease (25% v 28%). Furthermore, in 69 patients with Dupuytren's contracture referred for surgical correction, there was no significant increase in either history of alcohol abuse or abnormality of liver function compared to a matched control group. Patients with Dupuytren's contracture were found to have increased levels of circulating IgA immune complexes compared to those without (p less than 0.05 for those with liver disease; p less than 0.001 for those awaiting surgical correction). Circulating immunoglobulins and immune complexes of other classes were similar between the groups with and without Dupuytren's contracture. These results suggest that the importance of alcohol has previously been exaggerated but that IgA immune complexes may be involved in the pathogenesis of the condition.

Adult↗
PubMed1983

Delay in diagnosis of adult coeliac disease.

The delay in diagnosis of 106 patients with adult coeliac disease, diagnosed between 1976 and 1980, was studied. Overall, delay in diagnosis was 11 +/- 10.6 years, being considerably greater in females (12.8 +/- 7.8 years) than in males (3.5 +/- 9.8 years). Most of this delay occurred prior to hospital referral, although that following referral to hospital clinics was still significant (1.8 +/- 4.8 years). The most common presenting complaints were lassitude (75%) anaemia (65%) and flatulence (50%). Typical gastro-intestinal symptoms were relatively uncommon and mild, but when present led to a more speedy diagnosis. It is concluded that, despite advances in modern diagnostic procedures, little progress has been made in hastening the diagnosis of coeliac disease.

Aged↗