Clinical News

BSG supported STOPAH study shows a lack of evidence for drug treatments

Wednesday, 29 April 2015 08:22

The survival of patients with alcohol-related hepatitis is not being significantly improved by the main drugs currently widely used in treatment of this condition, according to a major new National Institute for Health Research sponsored study supported by members of the British Society of Gastroenterology.

Senior health professionals are highlighting an 'urgent need' for investment into research for the prevention and treatment of alcohol-related liver disease. Documented in the New England Journal of Medicine¸ a trial of over 1,000 patients using prednisolone and pentoxifylline did not achieve a statistically significant reduction in mortality after 28 days, 90 days, or a year.

The alarming findings come at a time when the incidence of alcohol-related liver disease is rapidly increasing, however the report does also show that the overall mortality has fallen compared to studies done in the past which suggests that specialist in hospital care of these very sick people can improve outcomes, and what could be achieved more widely contrasting with the 2013 NCEPOD report on the care of cirrhosis where care was often found to be lacking.

Commenting, British Society of Gastroenterology Vice President (Hepatology), Dr Stephen Ryder, said:

"STOPAH has answered some key questions in the treatment of alcohol-related hepatitis and highlighted the urgent need for research into the prevention and treatment of alcohol-related liver disease, which is on the rise.

Whilst the study does suggest that patients are receiving better care than reported in previous reviews, unfortunately it also shows that neither steroids or pentoxifylline are effective treatments and there is no real indication now for their use.

The stark finding in STOPAH remains the high late mortality related to resumption of alcohol intake and emphasises the need for universal implementation of the BSG recommendations on alcohol care teams, that seems likely to be a far more effective intervention than any medical therapy for the acute episode.

One of the great successes of this study was to show that UK hepatologists and gastroenterologists from over 50 UK centres can collaborate to deliver important large scale clinical studies aimed at improving outcomes for patients with liver disease."

 

Nice Quality Standards for IBD

Friday, 27 February 2015 10:42

Professor Chris Probert, Chair BSG IBD Section Committee

"The BSG welcomes the release of Quality Standards for IBD by NICE. The four statements are necessarily succinct and members should read the more detailed version on the NICE website. This document sets a standard that should be recognised by CCGs and Trusts and should enable us to raise the quality of our services. These standards should form the basis of the forthcoming IBD Accreditation, along with the IBD Audit and Registry."

Lancet liver recommendations must be implemented to address crisis

Tuesday, 25 November 2014 00:00

The British Society of Gastroenterology (BSG) has today urged for the Lancet Commission UK Liver Disease Publication recommendations to be pursued "without delay" to "address the UK liver disease crisis".

Liver Disease mortality rates have increased by 400% since 1970 and is the third most common form of premature death in the UK.

The most common form of liver disease is alcohol-related, followed by fatty liver disease caused by obesity. The steep rise in both alcohol consumption and obesity in recent decades has led to increases in both conditions.

Incidences of chronic viral hepatitis are also on the rise, with annual deaths from hepatitis C having quadrupled since 1996, and significant increases in hepatitis B infection.

The Lancet report calls for wide-reaching, joined-up action including:

  1. Better detection of early disease in primary care
  2. Improved support services in community settings
  3. The establishment of Liver Units in District General Hospitals
  4. A national review of liver transplantation services
  5. Strengthening of continuity of care for children with liver disease surviving into adult life
  6. A range of population-level measures such as a minimum unit price for alcohol
  7. Promotion of healthier lifestyles with clearer government messaging and new regulations on the food industry
  8. Eradication of chronic HBV and HCV infection from the country by 2020
  9. Greater provision of medical training in hepatology
  10. A national campaign led by NHS England to increase awareness of liver disease in the general population

NICE Evidence Update: Acute Upper Gastrointestinal Bleeding

August 2014

A summary of selected new evidence relevant to NICE clinical guideline 141 'Acute upper gastrointestinal bleeding: management' (2012)

This Evidence Update provides a summary of selected new evidence published since the literature search was last conducted for the following NICE guidance: Acute upper gastrointestinal bleeding. NICE clinical guideline 141 (2012) A search was conducted for new evidence from 23 September 2011 to 20 February 2014. A total of 6061 pieces of evidence were initially identified. After removal of duplicates, a series of automated and manual sifts were conducted to produce a list of the most relevant references.

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