Coeliac disease (CD) and noncoeliac wheat or gluten sensitivity (NCWS/NCGS) are common gluten‐related disorders. Both conditions can present with gastrointestinal and extraintestinal manifestations, ...which can be a challenge for physicians to discern between. Whilst coeliac serology and histological assessment are required for the diagnosis of CD, there are no clear biomarkers for the diagnosis of NCGS. The management of both conditions is with a gluten‐free diet (GFD), although the duration, as well as strictness of adherence to a GFD in NCGS, is unclear. Adherence to a GFD in CD can also be challenging, with recent developments of noninvasive assessments, although histological assessment via duodenal biopsies remains the gold standard. The management of refractory coeliac disease remains particularly challenging, often requiring specialist input. Whilst wheat is noted to be a trigger for symptom generation in NCGS, it is unclear which components of wheat are responsible for symptom generation in this group, with further research required to elucidate the pathophysiology.
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects approximately 10% of the population. Diet triggers symptoms in the vast majority of individuals with IBS. ...In view of this, there has been a focus on the role of diet in IBS. The diets currently being headlined for IBS include (i) traditional dietary advice, (ii) the low fermentable oligo‐, di‐, mono‐ saccharides and polyols (FODMAPs) diet and (iii) the gluten‐free diet (GFD). Although traditional dietary advice is considered as the first‐line dietary therapy, its evidence base is variable, with a few randomized controlled trials (RCTs) exploring the efficacy of this approach, other than for fibre. There are now a growing number of RCTs demonstrating the efficacy of the low FODMAP diet in the short‐term, with some emerging data on the long‐term ‘adapted’ low FODMAP diet. There are also several RCTs showing the benefits of a GFD in IBS; however, this concept is hampered with uncertainty as to the mechanism of action. Nevertheless, all of these dietary therapies are viable options for individuals with IBS, with the dietitian and patient engagement at the forefront of achieving success. However, future pragmatic studies are needed to clarify the comparative efficacy and convenience of implementing these various diets into routine life. Moreover, it is imperative to better delineate the concern that restrictive diets – such as the low FODMAP and GFD – may promote nutritional inadequacies, disordered eating behaviours, and lead to detrimental alterations to the gut microbiota.
There has been a renewed interest in the role of dietary therapies to manage irritable bowel syndrome (IBS), with diet high on the agenda for patients. Currently, interest has focussed on the use of ...traditional dietary advice (TDA), a gluten-free diet (GFD) and the low FODMAP diet (LFD). A consensus meeting was held to assess the role of these dietary therapies in IBS, in Sheffield, United Kingdom. Evidence for TDA is from case control studies and clinical experience. Randomised controlled trials (RCT) have demonstrated the benefit of soluble fibre in IBS. No studies have assessed TDA in comparison to a habitual or sham diet. There have been a number of RCTs demonstrating the efficacy of a GFD at short-term follow-up, with a lack of long-term outcomes. Whilst gluten may lead to symptom generation in IBS, other components of wheat may also play an important role, with recent interest in the role of fructans, wheat germ agglutinins, as well as alpha amylase trypsin inhibitors. There is good evidence for the use of a LFD at short-term follow-up, with emerging evidence demonstrating its efficacy at long-term follow-up. There is overlap between the LFD and GFD with IBS patients self-initiating gluten or wheat reduction as part of their LFD. Currently, there is a lack of evidence to suggest superiority of one diet over another, although TDA is more acceptable to patients. In view of this evidence, our consensus group recommends that dietary therapies for IBS should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Given the lack of dietetic services, novel approaches such as employing group clinics and online webinars may maximise capacity and accessibility for patients. Further research is also required to assess the comparative efficacy of dietary therapies to other management strategies available to manage IBS. Keywords: Irritable bowel syndrome, Low FODMAP diet, Gluten-free diet, Traditional dietary advice
What is the optimal FODMAP threshold in IBS? Rej, A; Sanders, DS; Buckle, RL ...
Journal of gastroenterology and hepatology,
June 2021, 2021-Jun, 2021-06-00, 20210601, Letnik:
36, Številka:
6
Journal Article
In recent years climate variability has threatened the sustainability of inland fisheries and dependent fishers in India. Systematic methodology to assess the vulnerability of the fisheries sector to ...climate variability is currently not available. Towards this end, the present work deals with the assessment of inland fisheries vulnerability to climate variations in 13 districts of West Bengal state in India. For this purpose, a composite vulnerability index (0.0–1.0) has been developed on the basis of functional relationships amongst sensitivity, exposure and adaptive capacity using 19 indicators related to inland fisheries. The data obtained reflected different spatial combinations of climate exposure, sensitivity and adaptive capacity among the districts. Five districts were highly vulnerable which was attributable to low adaptive capacity of the fishers which played an important role in altering the spatial pattern of vulnerability among the districts. Thus our research will provided an important basis for policy makers to develop appropriate adaptation strategies to minimize the risk of fisheries sector to climate variability.
Climate change is evident in India as manifested by increased air temperatures, regional variation in the monsoon, frequent occurrence of droughts, and a regional increase in severe storm incidence ...in coastal states of India. The impacts are evident for freshwater fisheries and fishers of the River Ganga and the water bodies in its plains and deltaic areas. Analysis of time series data for 32 years from published literature and from current investigations showed a 0.99°C increase in the minimum water temperature recorded in the upper stretch of River Ganga and 0.5 to 1.4°C increases in aquaculture water on the Gangetic Plains of West Bengal. The minimum air temperature showed a 15% shift upwards during the colder months of January–February. Rainfall showed a 1% increase in the post monsoon months of September–December. The impacts were manifest in a geographic shift of warm water fish species such as Glossogobius giuris , Xenentodon cancila into the colder stretch of the River Ganga. The breeding of the Indian Major Carps (IMC) has been affected and a consequent decline in fish spawn availability in River Ganga recorded. However a positive impact on breeding in fish farm hatcheries in the Gangetic Plains was evident in the advancement and extension of the breeding period for IMC by 45–60 days. Drought in West Bengal during 2009 was evident in rainfall deficits of 29% and 27% in the districts of North 24 Parganas and Bankura, respectively, in the fish breeding months of March–September and 92% of fish spawn hatcheries were affected. These districts recorded losses on average 61% to 73% of fish spawn during 2009 compared to the previous four years. A study of the potential impact of cyclones and storms on saline water inundation using a digital elevation model generated for coastal district of South 24 Parganas indicated the potential for 3% to 11% submergence of aquaculture areas in response to 1 to 2 meter rises due to sea water incursions. The inland fisheries sector in coming years will face stiff competition for water from the industrial, municipal and agricultural sectors and climate change will compound these problems. Under such a scenario implementation of integrated water resource management involving different stake holders of fresh water would be the most effective management approach.
IntroductionThe role of the ward round is crucial in managing inpatient care, and its importance is often neglected, as highlighted by the Royal College of Physicians (RCP)1. A daily consultant led ...approach was reviewed at the Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust.MethodFrom November 2015, a new method of working was implemented, with a consultant of the day to review new admissions to gastroenterology, twice during the day, at 8am and 3pm, as well as performing any new emergency inpatient endoscopy. In addition to this, ward based consultants were allocated (2 luminal and 2 hepatology) to cover ward rounds daily on the new system. This was done on a rotational basis. Prior to this, consultants would review patients on the ward approximately twice a week, with a consultant reviewing new patients at 8am only, without an allocated consultant for the day. Data was retrospectively compared from April-Oct 2015, prior to implementation, to November 2015-November 2016, after implementation.ResultsImplementation of consultant of the day and ward based consultants led to a reduction in daily bed occupancy (median 83 vs 77 beds), reduced length of non-elective stay (median 7.40 vs 6.79 days), reduction in number of outliers (median 24 vs 19 inpatients), reduced monthly re-admission rate (median 3.19% vs 3.08%), greater proportion of early discharges (median 65% vs 60% stay <1 week) and reduction in Datix complaints (median 11.0 vs 10.5 complaints).ConclusionThe data suggests that daily consultant ward rounds and reviews may result in reduced inpatient stay, early discharges, appropriate bed allocation and reduced complaints.Reference. Royal College of Physicians and Royal College of Nursing. Ward rounds in medicine: principles for best practice. London: RCP, 2012.Disclosure of InterestNone Declared
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