Inaugural BMJ Open Gastroenterology Blog

Welcome to the inaugural blog from BMJ Open Gastroenterology, in this concise monthly summary we will highlight 2-3 articles published in the journal and describe important manuscripts from the wider literature. We also intend to cover some specific topics throughout the year, including the importance of open access publishing, statistical reviews and calls for specific manuscripts. The blogs will primarily be written by myself, Dr James Ashton- social media editor, alongside our trainee editors, Dr Tarun Gupta and Dr John Ong.

In this first blog I want to highlight three articles published over the last two months in BMJOG, alongside an important paediatric article from the wider literature.

COVID-19 has dominated all of our lives in 2020 and will continue to be a challenge for society for the foreseeable future. In their article Harris et al describe the experiences of patients with IBD during COVID-19 lockdown. The team from Southampton received 685 responses to a survey designed to capture the impact of COVID on IBD healthcare, well-being and quality of life. The majority of patients reported a negative psychological impact from the lockdown, although around 80% of routine medical care continued. The study highlights that over 90% of patients would accept virtual follow-up whilst they were in remission, with impacts for care beyond the pandemic.

Published in December 2020, Rahman et al detail the prevalence, risk factors and metabolic profile of non-obese and obese patients with non-alcoholic fatty liver disease (NAFLD) in over 1300 from a rural Bangladeshi community. The authors report a high rate of NAFLD in the cohort, comprising 4.4% of non-obese patients and 14.2% of obese patients. Independent risk factors for NAFLD were age >40 years, male gender, metabolic syndrome (MS), diabetes mellitus (DM), abdominal obesity, hypertension, dyslipidaemia and obesity. The authors call for public health measures to be introduced to present subsequent adverse health consequences.

In the third article from BMJOG, Bragde et al describing the gene expression in blood from children with coeliac disease. This study, performed on 30 patients (10 with active coeliac disease, 10 with controlled coeliac disease and 10 non-coeliac disease) demonstrated no differentially expressed genes between sample groups, and concluded that RNA sequencing of whole blood was not feasible for aiding with diagnosis of coeliac disease. The authors report an important negative finding but do identify differentially expressed pathways in active coeliac disease, including negative regulation of viral replication. Further work is required on increased sample sizes.

Finally, I want to highlight an article published in Gut by a group from the Netherlands. In this article Jongsma et al report a multicentre randomised controlled trial comparing first-line treatment with infliximab versus conventional treatment in newly diagnosed paediatric moderate-to-severe Crohn’s disease on 100 patients (50 in each treatment arm). Interestingly, top-down treatment with infliximab was superior to conventional treatment in achieving short-term remission (at week 10), but there was no significant difference in remission rates between the two groups at 52 weeks. Subgroup analysis revealed 41% patients in the first-line infliximab group were in clinical remission on azathioprine monotherapy at 52 weeks, without need for treatment escalation compared to only 15% in the conventional group (p=0.004). Further studies are required to ascertain the long-term effectiveness of top-down vs bottom-up therapy in children.

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