Simon Campbell | University of Birmingham (original) (raw)
Papers by Simon Campbell
Alimentary Pharmacology & Therapeutics, 2016
Background Ferric maltol was effective and well-tolerated in iron deficiency anaemia patients wit... more Background Ferric maltol was effective and well-tolerated in iron deficiency anaemia patients with inflammatory bowel disease during a 12-week placebo-controlled trial. Aim To perform a Phase 3 extension study evaluating long-term efficacy and safety with ferric maltol in inflammatory bowel disease patients in whom oral ferrous therapies had failed to correct iron deficiency anaemia. Methods After 12 weeks of randomised, double-blind treatment, patients with iron deficiency anaemia and mild-to-moderate ulcerative colitis or Crohn's disease received open-label ferric maltol 30 mg b.d. for 52 weeks. Results 111 patients completed randomised treatment and 97 entered the openlabel ferric maltol extension. In patients randomised to ferric maltol ('continued'; n = 50), mean AE s.d. haemoglobin increased by 3.07 AE 1.46 g/dL between baseline and Week 64. In patients randomised to placebo ('switch'; n = 47), haemoglobin increased by 2.19 AE 1.61 g/dL. Normal haemoglobin was achieved in high proportions of both continued and switch patients (89% and 83% at Week 64, respectively). Serum ferritin increased from 8.9 lg/L (baseline) to 26.0 lg/L (Week 12) in ferric maltol-treated patients, and to 57.4 lg/L amongst all patients at Week 64. In total, 80% of patients reported ≥1 adverse event by Week 64. Adverse events considered related to ferric maltol were recorded in 27/111 (24%) patients: 8/18 discontinuations due to adverse events were treatment-related. One patient was withdrawn due to increased ulcerative colitis activity. Conclusions Normal haemoglobin was observed in ≥80% of patients from weeks 20-64 of long-term ferric maltol treatment, with concomitant increases in iron storage parameters. Ferric maltol was well-tolerated throughout this 64-week study.
The Lancet Gastroenterology & Hepatology, 2016
Background Up to 60% of patients with Crohn's disease need intestinal resection within the fi rst... more Background Up to 60% of patients with Crohn's disease need intestinal resection within the fi rst 10 years of diagnosis, and postoperative recurrence is common. We investigated whether mercaptopurine can prevent or delay postoperative clinical recurrence of Crohn's disease. Methods We did a randomised, placebo-controlled, double-blind trial at 29 UK secondary and tertiary hospitals of patients (aged >16 years in Scotland or >18 years in England and Wales) who had a confi rmed diagnosis of Crohn's disease and had undergone intestinal resection. Patients were randomly assigned (1:1) by a computer-generated web-based randomisation system to oral daily mercaptopurine at a dose of 1 mg/kg bodyweight rounded to the nearest 25 mg or placebo; patients with low thiopurine methyltransferase activity received half the normal dose. Patients and their carers and physicians were masked to the treatment allocation. Patients were followed up for 3 years. The primary endpoint was clinical recurrence of Crohn's disease (Crohn's Disease Activity Index >150 plus 100-point increase in score) and the need for anti-infl ammatory rescue treatment or primary surgical intervention. Primary and safety analyses were by intention to treat. Subgroup analyses by smoking status, previous thiopurines, previous infl iximab or methotrexate, previous surgery, duration of disease, or age at diagnosis were also done. This trial is registered with the International Standard Randomised Controlled Trial Register (ISRCTN89489788) and the European Clinical Trials Database (EudraCT number 2006-005800-15).
Relevance of thiopurine methyltransferase activity in inflammatory bowel disease patients maintai... more Relevance of thiopurine methyltransferase activity in inflammatory bowel disease patients maintained on low-dose azathioprine
OBM Hepatology and Gastroenterology, 2019
Southern Medical Journal, 2011
Isolated abdominal pain is seen as a poor indication for colonic investigations. The yield of ser... more Isolated abdominal pain is seen as a poor indication for colonic investigations. The yield of serious pathology detected by optical colonoscopy (OC) has differed greatly in published series. This study aims to establish the yield of colonic investigations for isolated abdominal pain. A retrospective analysis of the endoscopy database was undertaken on all OCs performed from 2000 to 2008. The yield of OCs for detection of pathology (polyps, cancers, and inflammatory bowel disease) was compared for the symptoms of abdominal pain, chronic diarrhea, or anemia. Data on computed tomographic colonographies (CTC), performed for isolated abdominal pain in 2008, were used to compare the yield of CTCs and OCs. Of the 8564 OCs and 525 CTCs performed, 5.4% and 8.2% were undertaken for isolated abdominal pain, respectively. The yield of OCs for overall pathology detection was not significantly different for abdominal pain (23.87%), compared to other indications (20.34-24.85%). The yield of pathology detection was not significantly different for CTC (20.93%) and OC. Colonic polyps were the most common pathology (OC 16.05%, CTC 18.6%). Colonic investigations undertaken for isolated abdominal pain had a high yield of incidental colonic pathology. The detection of polyps could be beneficial, but it does not explain the symptoms. CTC offers a less invasive way of detecting colonic pathology in such patients, while maintaining the same yield. If CTC is used as a first line of investigation, it could spare 75% of patients the colonoscopy procedure.
Value in Health, 2013
A499 1.25 hospitalizations. Diagnostic tests were also more frequent (rectosigmoidoscopy: 49.3%; ... more A499 1.25 hospitalizations. Diagnostic tests were also more frequent (rectosigmoidoscopy: 49.3%; abdominal echography: 43.6%) except thyroid function (70.0%). The annual cost of second line was € 2,114 [1,509;2,819] versus € 2,920 [2,072;3,917] after second line failure. Hospitalizations accounted for about 75% of the costs. ConClusions: IBS with constipation leads to significant resource use and high costs certainly in case of second line treatment failure.
JOP : Journal of the pancreas, 2004
CONTEXT Intussusception in adults is rare, accounting for 0.1% of adult hospital admissions. In c... more CONTEXT Intussusception in adults is rare, accounting for 0.1% of adult hospital admissions. In contrast to this, it is the leading cause of obstruction in children. In up to 90% of adults a cause can usually be found, but in children this is rarely the case. CASE REPORT We report the case of a 27-year-old lady with a subacute bowel obstruction caused by a jejunal heterotopic pancreas and describe its successful surgical management. CONCLUSION The causes of intussusception in adults are discussed in the literature review.
Frontline Gastroenterology, 2014
Background Ulcerative colitis is a lifelong, chronic, relapsing-remitting disease. Objective To a... more Background Ulcerative colitis is a lifelong, chronic, relapsing-remitting disease. Objective To assess the relationship between ulcerative colitis disease status and patient quality of life, and to determine the impact of ulcerative colitis on healthcare costs and work productivity, in the UK. Methods Clinicians assessed 173 adult patients' current disease status at a single study visit using the partial Mayo (pMayo) instrument. Patients completed the Euro Quality of Life 5-dimension, 5-level (EQ-5D-5L) questionnaire, the Work Productivity and Activity Impairment (WPAI) questionnaire. Healthcare resource use was determined from questionnaires and from patients' medical charts. Results Patients in remission had a significantly higher EQ-5D-5L scores (mean (SD) 0.86 (0.15)) than patients with active disease (0.71 (0.20); p<0.001). Patients with mild disease had significantly higher mean (SD) EQ-5D-5L scores than patients with moderate/severe disease: 0.77 (0.11) and 0.66 (0.24), respectively (p<0.001). The mean percent productivity impairment was greater for patients with active disease than for patients in remission on all items of the WPAI questionnaire: 24.6% vs 1.8% for work time missed, 34.1% vs 12.9% for impairment while working, 40.8% vs 14.4% for overall work impairment and 42.7% vs 13.0% for activity impairment (p<0.001 for all comparisons). The mean (SD) total cost of healthcare for ulcerative colitis in the prior 3 months was £1211 (1588). Conclusions When compared with patients in remission, patients with active ulcerative colitis have significantly worse quality of life and significantly more work impairment. The healthcare costs of ulcerative colitis are considerable.
Journal of Crohn's and Colitis, 2009
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 22, 2015
Despite the significant impact of Crohn's disease (CD) on patients' physical and emotiona... more Despite the significant impact of Crohn's disease (CD) on patients' physical and emotional well-being, no CD-specific patient-reported outcome (PRO) measure is available for determining the efficacy of interventions. The objective of the study was to develop and validate the Crohn's Life Impact Scale (CLIQ), the first such measure. Questionnaire content was derived from qualitative interviews with CD patients and face and content validity assessed by cognitive debriefing interviews (CDIs) with patients. A postal survey was conducted to identify the final scale, confirm its unidimensionality and determine reproducibility and construct validity. A subset of the respondents was sent a second questionnaire package 2 weeks after the first. The survey included the CLIQ, Nottingham Health Profile (NHP) and Unidimensional Fatigue Impact Scale (U-FIS). Content analysis was conducted on the 30 interview transcripts and a draft scale produced. The CDIs indicated that the draft scal...
Gastrointestinal Endoscopy, 2010
Gastrointestinal Endoscopy, Volume 71, Issue 5, Pages AB337, April 2010, Authors:Christian P. Sel... more Gastrointestinal Endoscopy, Volume 71, Issue 5, Pages AB337, April 2010, Authors:Christian P. Selinger; Javaid Iqbal; Lolita Chan; Robert P. Willert; Simon Campbell. ...
Gastrointestinal …, 2010
Gastrointestinal Endoscopy, Volume 71, Issue 5, Pages AB337, April 2010, Authors:Christian P. Sel... more Gastrointestinal Endoscopy, Volume 71, Issue 5, Pages AB337, April 2010, Authors:Christian P. Selinger; Javaid Iqbal; Lolita Chan; Robert P. Willert; Simon Campbell. ...
Journal of Crohn's and Colitis, 2009
Background: In the Danish Crohn Colitis Database during the treatment era of 5-Aminosalicylic aci... more Background: In the Danish Crohn Colitis Database during the treatment era of 5-Aminosalicylic acid (5-ASA), steroids and surgery, it has been revealed that 8 years from diagnosis 44% of Crohn's disease (CD) patients were characterized with a mild disease course, 20% with an aggressive (relapse every year) and 36% with a moderate disease course (relapse every other year). Aim: The outcome of the first treatment course with 5-ASA monotherapy (1.5 4.8 g/day) was retrospectively studied in a consecutive cohort of 345 patients with CD diagnosed 1952 2007. The immediate and long-term outcome of 5-ASA treament was described. Methods: A phenotyped model was used to assess treatment response: Immediate outcome (30 days after the start of 5-ASA) was defined as Complete response: Total regression of symptoms. Partial response: Improvement of symptoms. No response: No regression of symptoms with a need to shift from 5-ASA to an immunomodulator or surgery. Longterm outcome (irrespective of the length of the treatment) was defined as: Prolonged response: Still in complete/partial remission 1 year after induction of remission (either maintained on or after cessation of 5-ASA). 5-ASA dependency: Relapse on stable/reduced dose of 5-ASA requiring dose increase to regain remission or relapse within 1 year after 5-ASA cessation regaining complete/partial response after 5-ASA reintroduction. Results: One hundred sixty-five (48%) out of 345 patients had monotherapy with 5ASA. In 50% of them 5-ASA was initiated within one year of diagnosis with a range 0 49 years. Complete or partial response was obtained in 75% and no response in 25% of patients within 30 days of treatment. Among initial responders (complete/partial response), prolonged 5-ASA response was obtained in 47% (59) of patients, 5-ASA dependency in 31% (38) and 18% (22) of patients lost initial response to 5-ASA and had to shift to surgery (73%) or immunomodulator (27%). Five patients (4%) were not assessed in long-term outcome due to short treatment couse. Female gender was associated with higher probability to develop prolonged response or 5-ASA dependency (OR 2.68, 95% CI: 1.06 6.77, p = 0.03). The median duration (range) of 5-ASA course was 34 months (1 304) in prolonged responders, 63 (6 336) in 5-ASA dependent and 5 (2 10) in non-responders. Conclusion: Patients with CD may profit from 5-ASA treatment. Seventy-eight percent of initial responders obtained long-term benefit with 31% becoming 5-ASA dependent, resulting in 5 up to 28 years of remission on 5-ASA in 50% of them. Prospective studies are warranted to assess the role of 5-ASA in CD.
Gut
Anti-Tumour Necrosis Factor alpha antibodies (anti-TNFs) are widely used for the treatment of sev... more Anti-Tumour Necrosis Factor alpha antibodies (anti-TNFs) are widely used for the treatment of severe and fistulising Crohn's Disease (CD). They are, however, associated with a number of adverse events (AEs) including infections, neutropenia, malignancy, demyelinating disease and infusion reactions. We aimed to evaluate the safety profiles Adalimumab (Al) and Infliximab (Ifx) amongst patients with CD at Central Manchester University Hospitals.
World Journal of Gastroenterology, 2008
We outline probable and possible developments with wireless capsule endoscopy. It seems likely th... more We outline probable and possible developments with wireless capsule endoscopy. It seems likely that capsule endoscopy will become increasingly effective in diagnostic gastrointestinal endoscopy. This will be attractive to patients especially for cancer or varices detection because capsule endoscopy is painless and is likely to have a higher take up rate compared to conventional colonoscopy and gastroscopy. Double imager capsules with increased frame rates have been used to image the esophagus for Barrett&amp;amp;amp;#39;s and esophageal varices. The image quality is not bad but needs to be improved if it is to become a realistic substitute for flexible upper and lower gastrointestinal endoscopy. An increase in the frame rate, angle of view, depth of field, image numbers, duration of the procedure and improvements in illumination seem likely. Colonic, esophageal and gastric capsules will improve in quality, eroding the supremacy of flexible endoscopy, and become embedded into screening programs. Therapeutic capsules will emerge with brushing, cytology, fluid aspiration, biopsy and drug delivery capabilities. Electrocautery may also become possible. Diagnostic capsules will integrate physiological measurements with imaging and optical biopsy, and immunologic cancer recognition. Remote control movement will improve with the use of magnets and/or electrostimulation and perhaps electromechanical methods. External wireless commands will influence capsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However, it should be noted that speculations about the future of technology in any detail are almost always wrong.
Nature Clinical Practice Gastroenterology & Hepatology, 2005
Well-designed studies that help guide physicians to apply the optimal therapeutic strategy for th... more Well-designed studies that help guide physicians to apply the optimal therapeutic strategy for the management of pyoderma gangrenosum are lacking in the literature. A multidisciplinary approach is paramount for the effective management of this condition, with close involvement of a wound-care specialist and a microbiologist. Treatment should be stepwise in nature. Local wound care, avoidance of trauma and the application of local steroid or tacrolimus ointment are the first-line treatments. Steroid therapy is the most widely published effective therapy for achieving resolution of pyoderma gangrenosum, although there is growing evidence for the efficacy of infliximab in refractory cases. Other therapies such as dapsone and clofazamine should be left as third-line agents for refractory pyoderma gangrenosum, while novel treatments such as granulocyte apheresis should only be used under trial conditions, to gain an objective evaluation of their efficacy. This article reviews the published treatment strategies in current use, and aims to guide the effective management of pyoderma gangrenosum.
The Lancet, 2004
CJDa case of mistaken identity. By - Dr Simon Campbell MRCP, Matthew Warner MB, Prof Margaret Es... more CJDa case of mistaken identity. By - Dr Simon Campbell MRCP, Matthew Warner MB, Prof Margaret Esiri FRCPath, Sandro Lanzon-Miller FRCP, Richard Butterworth FRCP.
Inflammatory Bowel Diseases, 2009
When surgery is necessary in patients with ulcerative colitis, total proctocolectomy with ileal p... more When surgery is necessary in patients with ulcerative colitis, total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice. Several inflammatory and noninflammatory complications can occur after IPAA. Pouchitis is the most common, occurring in 50% of patients. Whereas ''acute'' pouchitis can be treated rapidly and successfully in the majority of patients, ''refractory'' and ''chronic pouchitis'' remain therapeutic challenges to patients and physicians. This article reviews the literature and offers consensus guidelines on issues related to the epidemiology, diagnosis, pathogenesis, risk factors, and treatment of pouchitis.
Alimentary Pharmacology & Therapeutics, 2016
Background Ferric maltol was effective and well-tolerated in iron deficiency anaemia patients wit... more Background Ferric maltol was effective and well-tolerated in iron deficiency anaemia patients with inflammatory bowel disease during a 12-week placebo-controlled trial. Aim To perform a Phase 3 extension study evaluating long-term efficacy and safety with ferric maltol in inflammatory bowel disease patients in whom oral ferrous therapies had failed to correct iron deficiency anaemia. Methods After 12 weeks of randomised, double-blind treatment, patients with iron deficiency anaemia and mild-to-moderate ulcerative colitis or Crohn's disease received open-label ferric maltol 30 mg b.d. for 52 weeks. Results 111 patients completed randomised treatment and 97 entered the openlabel ferric maltol extension. In patients randomised to ferric maltol ('continued'; n = 50), mean AE s.d. haemoglobin increased by 3.07 AE 1.46 g/dL between baseline and Week 64. In patients randomised to placebo ('switch'; n = 47), haemoglobin increased by 2.19 AE 1.61 g/dL. Normal haemoglobin was achieved in high proportions of both continued and switch patients (89% and 83% at Week 64, respectively). Serum ferritin increased from 8.9 lg/L (baseline) to 26.0 lg/L (Week 12) in ferric maltol-treated patients, and to 57.4 lg/L amongst all patients at Week 64. In total, 80% of patients reported ≥1 adverse event by Week 64. Adverse events considered related to ferric maltol were recorded in 27/111 (24%) patients: 8/18 discontinuations due to adverse events were treatment-related. One patient was withdrawn due to increased ulcerative colitis activity. Conclusions Normal haemoglobin was observed in ≥80% of patients from weeks 20-64 of long-term ferric maltol treatment, with concomitant increases in iron storage parameters. Ferric maltol was well-tolerated throughout this 64-week study.
The Lancet Gastroenterology & Hepatology, 2016
Background Up to 60% of patients with Crohn's disease need intestinal resection within the fi rst... more Background Up to 60% of patients with Crohn's disease need intestinal resection within the fi rst 10 years of diagnosis, and postoperative recurrence is common. We investigated whether mercaptopurine can prevent or delay postoperative clinical recurrence of Crohn's disease. Methods We did a randomised, placebo-controlled, double-blind trial at 29 UK secondary and tertiary hospitals of patients (aged >16 years in Scotland or >18 years in England and Wales) who had a confi rmed diagnosis of Crohn's disease and had undergone intestinal resection. Patients were randomly assigned (1:1) by a computer-generated web-based randomisation system to oral daily mercaptopurine at a dose of 1 mg/kg bodyweight rounded to the nearest 25 mg or placebo; patients with low thiopurine methyltransferase activity received half the normal dose. Patients and their carers and physicians were masked to the treatment allocation. Patients were followed up for 3 years. The primary endpoint was clinical recurrence of Crohn's disease (Crohn's Disease Activity Index >150 plus 100-point increase in score) and the need for anti-infl ammatory rescue treatment or primary surgical intervention. Primary and safety analyses were by intention to treat. Subgroup analyses by smoking status, previous thiopurines, previous infl iximab or methotrexate, previous surgery, duration of disease, or age at diagnosis were also done. This trial is registered with the International Standard Randomised Controlled Trial Register (ISRCTN89489788) and the European Clinical Trials Database (EudraCT number 2006-005800-15).
Relevance of thiopurine methyltransferase activity in inflammatory bowel disease patients maintai... more Relevance of thiopurine methyltransferase activity in inflammatory bowel disease patients maintained on low-dose azathioprine
OBM Hepatology and Gastroenterology, 2019
Southern Medical Journal, 2011
Isolated abdominal pain is seen as a poor indication for colonic investigations. The yield of ser... more Isolated abdominal pain is seen as a poor indication for colonic investigations. The yield of serious pathology detected by optical colonoscopy (OC) has differed greatly in published series. This study aims to establish the yield of colonic investigations for isolated abdominal pain. A retrospective analysis of the endoscopy database was undertaken on all OCs performed from 2000 to 2008. The yield of OCs for detection of pathology (polyps, cancers, and inflammatory bowel disease) was compared for the symptoms of abdominal pain, chronic diarrhea, or anemia. Data on computed tomographic colonographies (CTC), performed for isolated abdominal pain in 2008, were used to compare the yield of CTCs and OCs. Of the 8564 OCs and 525 CTCs performed, 5.4% and 8.2% were undertaken for isolated abdominal pain, respectively. The yield of OCs for overall pathology detection was not significantly different for abdominal pain (23.87%), compared to other indications (20.34-24.85%). The yield of pathology detection was not significantly different for CTC (20.93%) and OC. Colonic polyps were the most common pathology (OC 16.05%, CTC 18.6%). Colonic investigations undertaken for isolated abdominal pain had a high yield of incidental colonic pathology. The detection of polyps could be beneficial, but it does not explain the symptoms. CTC offers a less invasive way of detecting colonic pathology in such patients, while maintaining the same yield. If CTC is used as a first line of investigation, it could spare 75% of patients the colonoscopy procedure.
Value in Health, 2013
A499 1.25 hospitalizations. Diagnostic tests were also more frequent (rectosigmoidoscopy: 49.3%; ... more A499 1.25 hospitalizations. Diagnostic tests were also more frequent (rectosigmoidoscopy: 49.3%; abdominal echography: 43.6%) except thyroid function (70.0%). The annual cost of second line was € 2,114 [1,509;2,819] versus € 2,920 [2,072;3,917] after second line failure. Hospitalizations accounted for about 75% of the costs. ConClusions: IBS with constipation leads to significant resource use and high costs certainly in case of second line treatment failure.
JOP : Journal of the pancreas, 2004
CONTEXT Intussusception in adults is rare, accounting for 0.1% of adult hospital admissions. In c... more CONTEXT Intussusception in adults is rare, accounting for 0.1% of adult hospital admissions. In contrast to this, it is the leading cause of obstruction in children. In up to 90% of adults a cause can usually be found, but in children this is rarely the case. CASE REPORT We report the case of a 27-year-old lady with a subacute bowel obstruction caused by a jejunal heterotopic pancreas and describe its successful surgical management. CONCLUSION The causes of intussusception in adults are discussed in the literature review.
Frontline Gastroenterology, 2014
Background Ulcerative colitis is a lifelong, chronic, relapsing-remitting disease. Objective To a... more Background Ulcerative colitis is a lifelong, chronic, relapsing-remitting disease. Objective To assess the relationship between ulcerative colitis disease status and patient quality of life, and to determine the impact of ulcerative colitis on healthcare costs and work productivity, in the UK. Methods Clinicians assessed 173 adult patients' current disease status at a single study visit using the partial Mayo (pMayo) instrument. Patients completed the Euro Quality of Life 5-dimension, 5-level (EQ-5D-5L) questionnaire, the Work Productivity and Activity Impairment (WPAI) questionnaire. Healthcare resource use was determined from questionnaires and from patients' medical charts. Results Patients in remission had a significantly higher EQ-5D-5L scores (mean (SD) 0.86 (0.15)) than patients with active disease (0.71 (0.20); p<0.001). Patients with mild disease had significantly higher mean (SD) EQ-5D-5L scores than patients with moderate/severe disease: 0.77 (0.11) and 0.66 (0.24), respectively (p<0.001). The mean percent productivity impairment was greater for patients with active disease than for patients in remission on all items of the WPAI questionnaire: 24.6% vs 1.8% for work time missed, 34.1% vs 12.9% for impairment while working, 40.8% vs 14.4% for overall work impairment and 42.7% vs 13.0% for activity impairment (p<0.001 for all comparisons). The mean (SD) total cost of healthcare for ulcerative colitis in the prior 3 months was £1211 (1588). Conclusions When compared with patients in remission, patients with active ulcerative colitis have significantly worse quality of life and significantly more work impairment. The healthcare costs of ulcerative colitis are considerable.
Journal of Crohn's and Colitis, 2009
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 22, 2015
Despite the significant impact of Crohn's disease (CD) on patients' physical and emotiona... more Despite the significant impact of Crohn's disease (CD) on patients' physical and emotional well-being, no CD-specific patient-reported outcome (PRO) measure is available for determining the efficacy of interventions. The objective of the study was to develop and validate the Crohn's Life Impact Scale (CLIQ), the first such measure. Questionnaire content was derived from qualitative interviews with CD patients and face and content validity assessed by cognitive debriefing interviews (CDIs) with patients. A postal survey was conducted to identify the final scale, confirm its unidimensionality and determine reproducibility and construct validity. A subset of the respondents was sent a second questionnaire package 2 weeks after the first. The survey included the CLIQ, Nottingham Health Profile (NHP) and Unidimensional Fatigue Impact Scale (U-FIS). Content analysis was conducted on the 30 interview transcripts and a draft scale produced. The CDIs indicated that the draft scal...
Gastrointestinal Endoscopy, 2010
Gastrointestinal Endoscopy, Volume 71, Issue 5, Pages AB337, April 2010, Authors:Christian P. Sel... more Gastrointestinal Endoscopy, Volume 71, Issue 5, Pages AB337, April 2010, Authors:Christian P. Selinger; Javaid Iqbal; Lolita Chan; Robert P. Willert; Simon Campbell. ...
Gastrointestinal …, 2010
Gastrointestinal Endoscopy, Volume 71, Issue 5, Pages AB337, April 2010, Authors:Christian P. Sel... more Gastrointestinal Endoscopy, Volume 71, Issue 5, Pages AB337, April 2010, Authors:Christian P. Selinger; Javaid Iqbal; Lolita Chan; Robert P. Willert; Simon Campbell. ...
Journal of Crohn's and Colitis, 2009
Background: In the Danish Crohn Colitis Database during the treatment era of 5-Aminosalicylic aci... more Background: In the Danish Crohn Colitis Database during the treatment era of 5-Aminosalicylic acid (5-ASA), steroids and surgery, it has been revealed that 8 years from diagnosis 44% of Crohn's disease (CD) patients were characterized with a mild disease course, 20% with an aggressive (relapse every year) and 36% with a moderate disease course (relapse every other year). Aim: The outcome of the first treatment course with 5-ASA monotherapy (1.5 4.8 g/day) was retrospectively studied in a consecutive cohort of 345 patients with CD diagnosed 1952 2007. The immediate and long-term outcome of 5-ASA treament was described. Methods: A phenotyped model was used to assess treatment response: Immediate outcome (30 days after the start of 5-ASA) was defined as Complete response: Total regression of symptoms. Partial response: Improvement of symptoms. No response: No regression of symptoms with a need to shift from 5-ASA to an immunomodulator or surgery. Longterm outcome (irrespective of the length of the treatment) was defined as: Prolonged response: Still in complete/partial remission 1 year after induction of remission (either maintained on or after cessation of 5-ASA). 5-ASA dependency: Relapse on stable/reduced dose of 5-ASA requiring dose increase to regain remission or relapse within 1 year after 5-ASA cessation regaining complete/partial response after 5-ASA reintroduction. Results: One hundred sixty-five (48%) out of 345 patients had monotherapy with 5ASA. In 50% of them 5-ASA was initiated within one year of diagnosis with a range 0 49 years. Complete or partial response was obtained in 75% and no response in 25% of patients within 30 days of treatment. Among initial responders (complete/partial response), prolonged 5-ASA response was obtained in 47% (59) of patients, 5-ASA dependency in 31% (38) and 18% (22) of patients lost initial response to 5-ASA and had to shift to surgery (73%) or immunomodulator (27%). Five patients (4%) were not assessed in long-term outcome due to short treatment couse. Female gender was associated with higher probability to develop prolonged response or 5-ASA dependency (OR 2.68, 95% CI: 1.06 6.77, p = 0.03). The median duration (range) of 5-ASA course was 34 months (1 304) in prolonged responders, 63 (6 336) in 5-ASA dependent and 5 (2 10) in non-responders. Conclusion: Patients with CD may profit from 5-ASA treatment. Seventy-eight percent of initial responders obtained long-term benefit with 31% becoming 5-ASA dependent, resulting in 5 up to 28 years of remission on 5-ASA in 50% of them. Prospective studies are warranted to assess the role of 5-ASA in CD.
Gut
Anti-Tumour Necrosis Factor alpha antibodies (anti-TNFs) are widely used for the treatment of sev... more Anti-Tumour Necrosis Factor alpha antibodies (anti-TNFs) are widely used for the treatment of severe and fistulising Crohn's Disease (CD). They are, however, associated with a number of adverse events (AEs) including infections, neutropenia, malignancy, demyelinating disease and infusion reactions. We aimed to evaluate the safety profiles Adalimumab (Al) and Infliximab (Ifx) amongst patients with CD at Central Manchester University Hospitals.
World Journal of Gastroenterology, 2008
We outline probable and possible developments with wireless capsule endoscopy. It seems likely th... more We outline probable and possible developments with wireless capsule endoscopy. It seems likely that capsule endoscopy will become increasingly effective in diagnostic gastrointestinal endoscopy. This will be attractive to patients especially for cancer or varices detection because capsule endoscopy is painless and is likely to have a higher take up rate compared to conventional colonoscopy and gastroscopy. Double imager capsules with increased frame rates have been used to image the esophagus for Barrett&amp;amp;amp;#39;s and esophageal varices. The image quality is not bad but needs to be improved if it is to become a realistic substitute for flexible upper and lower gastrointestinal endoscopy. An increase in the frame rate, angle of view, depth of field, image numbers, duration of the procedure and improvements in illumination seem likely. Colonic, esophageal and gastric capsules will improve in quality, eroding the supremacy of flexible endoscopy, and become embedded into screening programs. Therapeutic capsules will emerge with brushing, cytology, fluid aspiration, biopsy and drug delivery capabilities. Electrocautery may also become possible. Diagnostic capsules will integrate physiological measurements with imaging and optical biopsy, and immunologic cancer recognition. Remote control movement will improve with the use of magnets and/or electrostimulation and perhaps electromechanical methods. External wireless commands will influence capsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However, it should be noted that speculations about the future of technology in any detail are almost always wrong.
Nature Clinical Practice Gastroenterology & Hepatology, 2005
Well-designed studies that help guide physicians to apply the optimal therapeutic strategy for th... more Well-designed studies that help guide physicians to apply the optimal therapeutic strategy for the management of pyoderma gangrenosum are lacking in the literature. A multidisciplinary approach is paramount for the effective management of this condition, with close involvement of a wound-care specialist and a microbiologist. Treatment should be stepwise in nature. Local wound care, avoidance of trauma and the application of local steroid or tacrolimus ointment are the first-line treatments. Steroid therapy is the most widely published effective therapy for achieving resolution of pyoderma gangrenosum, although there is growing evidence for the efficacy of infliximab in refractory cases. Other therapies such as dapsone and clofazamine should be left as third-line agents for refractory pyoderma gangrenosum, while novel treatments such as granulocyte apheresis should only be used under trial conditions, to gain an objective evaluation of their efficacy. This article reviews the published treatment strategies in current use, and aims to guide the effective management of pyoderma gangrenosum.
The Lancet, 2004
CJDa case of mistaken identity. By - Dr Simon Campbell MRCP, Matthew Warner MB, Prof Margaret Es... more CJDa case of mistaken identity. By - Dr Simon Campbell MRCP, Matthew Warner MB, Prof Margaret Esiri FRCPath, Sandro Lanzon-Miller FRCP, Richard Butterworth FRCP.
Inflammatory Bowel Diseases, 2009
When surgery is necessary in patients with ulcerative colitis, total proctocolectomy with ileal p... more When surgery is necessary in patients with ulcerative colitis, total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice. Several inflammatory and noninflammatory complications can occur after IPAA. Pouchitis is the most common, occurring in 50% of patients. Whereas ''acute'' pouchitis can be treated rapidly and successfully in the majority of patients, ''refractory'' and ''chronic pouchitis'' remain therapeutic challenges to patients and physicians. This article reviews the literature and offers consensus guidelines on issues related to the epidemiology, diagnosis, pathogenesis, risk factors, and treatment of pouchitis.