The edition · Gastroenterology & Hepatology
Barrett's neoplasia: nine in ten Dutch patients had never had an endoscopy before diagnosis
A nationwide cohort shows surveillance finds only a sliver of Barrett-related cancer. Also: cardiovascular risk with IBD advanced therapies, the gut microbiome and cirrhosis admissions, a premixed IV pantoprazole recall, and IV PPI dosing after haemostasis.
The edition in brief
Of 8,914 patients treated with curative intent for Barrett-related dysplasia or oesophageal adenocarcinoma in the Netherlands from 2008 to 2018, 90% had no prior endoscopy showing Barrett's; they were far more often diagnosed at stage II or later (70% vs 11%). Even among those treated endoscopically, 65% presented without prior surveillance. A meta-analysis of 43 studies found no clear increase or decrease in major cardiovascular events with advanced IBD therapies; trial and observational estimates disagreed and were imprecise. In 679 outpatients with cirrhosis across seven countries, adding stool metagenomic features to clinical variables improved prediction of 90-day hospitalisation (AUC 0.84 vs 0.79). The FDA lists a Class II recall of Baxter's premixed pantoprazole 80 mg/100 mL bags for manufacturing-practice deviations.
Advanced IBD therapies: no clear signal of cardiovascular harm or benefit
Advanced IBD therapies show no clear cardiovascular signal; keep assessing risk before JAK inhibitors and treat modifiable factors.
Cirrhosis: the gut microbiome added to predicting who is admitted within 90 days
Microbiome testing is not ready for practice in cirrhosis, but avoiding needless antibiotics and PPIs is consistent with these findings.
Class II recall: Baxter premixed IV pantoprazole 80 mg/100 mL
Check stock for affected Baxter premixed pantoprazole bags and switch to reconstituted vials without changing the regimen.
IV PPI after endoscopic haemostasis: bolus-and-infusion or intermittent high dose
After haemostasis of a high-risk ulcer, give 72 hours of high-dose PPI by infusion or intermittent bolus, then switch to oral.
Barrett's surveillance finds few of the cancers: 90% presented without prior endoscopy
Most Barrett-related cancer arises in people never diagnosed with Barrett's; target screening at high-risk reflux patients rather than relying on surveillance.
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