Don’t overlook symptoms of IBD in pregnancy
Altered bowel habit and rectal bleeding in pregnancy should be fully investigated for new onset or previously undiagnosed ulcerative colitis, Victorian clinician say.
A series of three cases, published in the Internal Medicine Journal, has shown the potential for adverse outcomes including maternal anaemia requiring blood transfusions and foetal intrauterine growth restriction.
The Melbourne authors said stool MCS as well as C. difficile toxin to exclude infection should be part of the investigations.
“Faecal calprotectin retains high sensitivity and specificity for intestinal inflammation in pregnancy but does not help differentiate between IBD versus infection,” they said.
Flexible sigmoidoscopy was considered safe in pregnancy however bowel prep should be avoided. Intestinal ultrasound was also emerging as a safe modality for the exclusion of colonic disease activity.
They said early recognition of IBD and institution of therapies to achieve disease remission was essential to improve outcomes and minimise risks to both mother and foetus.
“Similarly, in patients with known IBD, preconception counselling, education and open discussion will allow shared therapeutic decision-making and optimisation of disease control.”
Genetic drivers for EAC explored
Loss of the tumour suppressor gene SMAD4 promotes progression of high-grade Barrett’s oesophagus towards oesophageal adenocarcinoma (EAC).
Melbourne-led research, published in Cellular and Molecular Gastroenterology and Hepatology, found up-regulation of oncogenes such as CDC6 and silencing of tumour suppressor genes following SMAD4 loss in a high-grade dysplastic Barrett’s oesophageal cell line.
The researchers said there is other evidence that SMAD4 loss is present in about 44% of patients with loco-regional and distant metastasis – suggesting an important role of SMAD4 loss in driving the invasive and metastatic potential of EAC.
“Given the replication stress and increased genomic instability, it may be possible to utilise vulnerabilities in cells with SMAD4 loss as a therapeutic advantage.”
They said incorporating SMAD4 loss as a clinically relevant biomarker of dysplastic Barrett’s progression towards EAC, might be of utmost benefit for early intervention and prevention.
Reassurance on endoscopy risk with new COVID-19 variant
Infection prevention and control measures put in place in the UK during the first phases of the COVID-19 pandemic appear to have been as effective in reducing endoscopy-related virus transmission since the emergence of a more infectious variant of SARS-CoV2.
Prospective data from before and after 2,440 diagnostic or therapeutic endoscopies performed at eight UK centres has shown just three cases (0.12%) of COVID-19 were likely related to the procedure. No other likely source of transmission was identified.
All cases recovered without the need for hospital admission and there were no cases of transmission to staff members.
“The risk of acquiring COVID-19 from endoscopy continues to remain very low. However, it is important to acknowledge that this rate is not zero,” the researchers said.
“This serves to emphasise the need for vigilance and strict adherence to the principle of a COVID-minimised pathway.”
More details in Gut.