FG Podcast

Frontline Nutrition: The management of intestinal failure

Thank you for listening to this podcast, where Frontline Gastroenterology Trainee Editor Dr Philip Smith talks to Dr Simon Gabe, Consultant Gastroenterologist and Intestinal Failure Specialist at St. Mark’s Hospital, London.
The podcast is an accompaniment to the Frontline Gastroenterology Twitter Debate (#FGDebate) held on Tuesday 14th April 2015, 8-9pm GMT, entitled 'Frontline Nutrition: The management of Intestinal Failure'.
Prior to the debate Dr Gabe said:
“Intestinal failure is increasingly recognised as a clinical condition and is divided into different subtypes. There are a number of different causes and although it is still rare for patients to require long-term parenteral nutrition, it is high cost, very demanding and requires an experienced MDT to manage such patients. There has been a desire to set up an intestinal failure network (HIFNET) in order to develop the service and set standards. Unfortunately, patients in different countries and different regions are managed in very different ways and some are not always offered this life-saving treatment.
This #FGDebate aims to cover the different types of intestinal failure and its causes as well as issues related to the management of intestinal failure. Feeding patients using unused segments of intestine often present practical difficulties. The placement and selection of jejunal feeding tubes are often not straightforward. Parenteral nutrition formulation offers many challenges including different lipid types. New developments are also afoot with small bowel lengthening surgery, the introduction of intestinal growth factors and intestinal transplantation. These exciting areas will be addressed and relevant questions will be answered."
The purpose of the podcast is to 'fill any gaps' the #FGDebate may have left. Dr Gabe has also provided the slides he used in #FGDebate to help those interested understand the issues associated with Intestinal Failure. We hope you enjoy this and that it is informative.
View the slides: http://goo.gl/QosfR5
Don't miss the next Special DDW Twitter #FGDebate with Professor Edward Loftus, Professor of Gastroenterology and IBD at the Mayo Clinic, Rochester, Minnesota, USA on Monday 11th May 2015, at 9-10pm GMT and will discuss, 'Frontline IBD: Hot topics in IBD’.

Frontline Endoscopy: Polypectomy – tips, tricks and which polyps to remove endoscopically

Thank you for listening to this podcast, where Frontline Gastroenterology Trainee Editor Dr Philip Smith talks to Professor Brian Saunders, Consultant Gastroenterologist, St. Mark’s Hospital and Adjunct Professor of Endoscopy at Imperial College.
The podcast is an accompaniment to the Frontline Gastroenterology Special #EndoLive Twitter Debate (#FGDebate) held on Tuesday 3rd March 2015, 8-9pm GMT, entitled 'Frontline Endoscopy: Polypectomy – tips, tricks and which polyps to remove endoscopically'.
Prior to the debate Professor Saunders said:
“Colonoscopic polypectomy has become the most commonly performed therapeutic procedure in gastroenterology practice. Used correctly it is a powerful tool in cancer prevention and can significantly reduce the morbidity from traditional surgery. Training in polypectomy is highly variable and poor technique may lead to incomplete polyp resections and the risk of interval cancers. Complete and safe polyp resection requires an understanding of basic principles of anatomy, polyp pathology, the application of diathermy and the recognition and management of complications. Although most polyps are small and easily managed with tried and tested snare techniques, larger lesions can be more challenging and potentially hazardous to remove with the endoscope. In recent years patient-centred, multidisciplinary meetings (Polyp MDT’s) have been helpful in tailoring therapeutic strategy. Options for resection include piecemeal EMR, ESD or hybrid techniques such as laparoscopically assisted polypectomy or trans-anal submucosal endoscopic resection (TASER). This Twitter debate aims to share key guidance on the approach to lesion recognition, appropriate selection and delivery of polypectomy techniques and prevention and management of polypectomy complications. A unique feature will be the opportunity to upload polyp images for discussion and debate.”
The purpose of the podcast is to 'fill any gaps' the #FGDebate may have left. Professor Saunders has also provided the slides he used in #FGDebate to help those interested understand the issues associated with polypectomy and polyp management. We hope you enjoy this and that it is informative.
View the slides: http://goo.gl/hH0P10
Don't miss the next #FGDebate with Dr Simon Gabe, Consultant Gastroenterologist and Intestinal Failure Specialist at St Mark’s Hospital London on Tuesday 14th April 2015, at 8-9pm GMT and will discuss, 'Frontline Nutrition: The management of intestinal failure’.

Frontline Gastrointestinal NETs: The approach to diagnosis and initial management

Thank you for listening to this podcast, where Frontline Gastroenterology Trainee Editor Dr Philip Smith talks to Professor Mark Pritchard, Professor and Head of the Department of Gastroenterology and Honorary Consultant Gastroenterologist at the University of Liverpool, UK.
The podcast is an accompaniment to the Frontline Gastroenterology Twitter Debate (#FGDebate) held on Tuesday 10th February 2015, 8-9pm GMT, entitled, 'Frontline Gastrointestinal NETs: The approach to diagnosis and initial management'.
Prior to the debate Professor Pritchard said:
'Neuroendocrine tumours (NETs) are relatively rare, but because they are often associated with a good prognosis, they have a high prevalence. They are said to be more prevalent than stomach and exocrine pancreatic cancers combined. There is often a delay in initial diagnosis as NETs may cause similar symptoms to other more common conditions such as IBS. As many patients present with metastatic disease at the time of diagnosis, management usually requires the involvement of a multidisciplinary team of clinicians. A gastroenterologist is a crucial member of this team, as many NETs occur in the GI tract and pancreas where they are amenable to endoscopic detection, evaluation and removal.
In the #FGDebate we hope to cover the endoscopic evaluation of NETs, particularly how to determine the type of a gastric NET and whether it requires treatment. We will also discuss other tests, particularly how to interpret chromogranin A blood test results and the role of the new highly sensitive and specific PET scans. There have also been several recent advances in NET management, such as clinical trial evidence to support the use of long acting somatostatin analogues to delay disease progression as well as treat the symptoms of carcinoid syndrome, the more widespread use of targeted radionuclide therapies for metastatic NETs and the development of new drugs such as gastrin/CCK-2 receptor antagonists to treat specific tumour types. Finally we hope to consider how easy it is for patients to access specialist NET teams and therefore the various investigations and treatments that may be needed for optimal management’
The purpose of the podcast is to 'fill any gaps' the #FGDebate may have left. Professor Pritchard has also provided the slides he used in #FGDebate to help those interested understand the issues associated with Gastrointestinal NETs. We hope you enjoy this and that it is informative.
View the slides: http://goo.gl/x159bU
Don't miss the next #FGDebate with Professor Brian Saunders, Consultant Gastroenterologist at St Mark’s Hospital, London and Adjunct Professor of Endoscopy at Imperial College London on Tuesday 3rd March 2015, at 8-9pm GMT and will discuss, 'Frontline Endoscopy: Polypectomy – tips, tricks and which to remove endoscopically.’

Frontline Neurogastroenterology: Evidence based therapeutics in IBS

Thank you for listening to this podcast, where Frontline Gastroenterology Trainee Editor Dr Philip Smith talks to Dr Alex Ford, associate professor and honorary consultant in gastroenterologist, at Leeds University and St James's University Hospital, Leeds, UK.
The podcast is an accompaniment to the Frontline Gastroenterology Twitter Debate (#FGDebate) held on Tuesday 13th January 2015, 8-9pm GMT, entitled, 'Frontline Neurogastroenterology: Evidence based therapeutics in irritable bowel syndrome’.
Prior to the debate Dr Ford said:
'Over the last 10 years I have been involved in clinical research into functional gastrointestinal disorders. Gastrointestinal (GI) symptoms are highly prevalent, and possible aetiologies range from the benign to the life-threatening, but functional causes such as irritable bowel syndrome (IBS) are commonest. This condition affects up to 10% to 20% of the general population, and if individuals seek medical advice for these symptoms this group of patients comprises up to one in ten of those referred from primary care to gastroenterology clinics. Diagnostic symptom-based criteria for IBS exist, and a positive diagnosis is encouraged but, despite this, many individuals undergo investigation to exclude serious underlying pathology, and other management costs are substantial due to consultations and prescribed drugs. Inevitably, excessive expenditure in one disease area, such as this, has implications for the provision of resources in other, equally important, areas of health care. Greater knowledge of the natural history of IBS, why individuals consult with symptoms, whether to perform investigations to exclude potential underlying organic diseases, and which treatments are effective is needed, in order that clinicians can direct scarce resources more efficiently. Our debate will hopefully touch on some of these issues'
The purpose of the podcast is to 'fill any gaps' the #FGDebate may have left. Dr Ford has also provided the slides he used in #FGDebate to help those interested understand the issues associated with therapeutics in IBS. We hope you enjoy this and that it is informative.
View the slides: http://goo.gl/dmvMzR
Don't miss the next #FGDebate with Professor Mark Pritchard, professor and head of the Department of Gastroenterology and honorary consultant gastroenterologist at the University of Liverpool, on Tuesday 10th February 2015, at 8-9pm GMT. The topic is 'Frontline Gastrointestinal NETs: The approach to diagnosis and initial management'.

Frontline Research: the highs and lows of academic life

This is the podcast with Professor Barry Marshall and Professor Emad El-Omar to accompany the #FGDebate entitled 'Frontline Research: The highs and lows of academic life - the basics, the barriers and the breakthroughs' held on Sunday 21st December 2014.
Professor Barry Marshall is a an honorary Clinical Professor of Medicine and Pharmacology at Sir Charles Gairdner Hospital, University of Western Australia. Amongst his many international accolades, in 2005 Professor Marshall and Robin Warren were awarded the Nobel Prize for Physiology or Medicine in recognition of their 1982 discovery that a bacterium, Helicobacter pylori, causes one of the most common and important diseases of mankind, peptic ulcer disease. This discovery was the first step in developing more effective treatments for ulcers and in understanding the causative link between H. pylori and stomach cancer.
Professor Emad El-Omar is the Chair of Gastroenterology at Aberdeen University, Scotland. He is also an Honorary Consultant Physician with NHS Grampian. Amongst his many international accolades and Editorial board positions, he is the Editor in Chief of the journal Gut. His main research interests are in the role of microbially-induced inflammation in GI cancer and inflammatory bowel disease. His group has strong collaborations with national groups within the UK and international groups in the US, Europe, Asia and Australia.
We hope you enjoy it and wish you a Happy Christmas and New Year 2015 from all the Frontline Gastroenterology and Gut team.
View the accompanying slides: http://goo.gl/2N5NrH
Read the summary of the twitter debate: http://goo.gl/WWxlDC

Alcohol - our favourite drug and everyone’s problem

Thank you for listening to this podcast, where Frontline Gastroenterology Trainee Editor Dr Philip Smith talks to Professor Sir Ian Gilmore, honorary consultant physician at the Royal Liverpool University Hospital and honorary chair at the University of Liverpool.
The podcast is an accompaniment to the Frontline Gastroenterology Twitter Debate (#FGDebate) held on Tuesday 11th November 2014 at 8-9pm GMT, entitled, 'Frontline Hepatology: alcohol - our favourite drug and everyone's problem'.
Prior to the debate Sir Ian said:
'We are in the middle of an epidemic of alcohol-related diseases, of which alcoholic liver disease is a prime and crucial example. The burden of alcoholic liver disease and its complications is so great that all gastroenterologists, whatever their special interest, need to be competent to manage them. Furthermore, gastroenterologists and hepatologists seem to see, almost by default, the majority of patients in the UK admitted to hospital with alcohol-related conditions whether or not the GI tract or liver is affected, and so are the natural leaders not just in the clinical management but also in becoming advocates for evidence-based policies to reduce the burden. Public health may not be familiar territory for them, but it is an area where they can make as big a difference as on the wards. Also, by becoming champions for alcohol care teams in their hospital, they can not only make sure patients with alcohol dependence get a better outcome but also free up beds and save valuable resources. Finally, it is important that gastroenterologists have some knowledge of treatment options for alcohol dependence and the range of medications that they can prescribe. It is important to dispel the myth that treatment for alcohol dependence does not work – on the contrary it is highly cost-effective'
The purpose of the podcast is to 'fill any gaps' the #FGDebate may have left. Sir Ian has also provided the slides he used in #FGDebate to help those interested understand the issues associated with alcohol and its research. We hope you enjoy this and it is informative.
View the slides: http://goo.gl/XQCUk1
Don't miss the next #FGDebate which is our Christmas Special debate on Sunday 21st December 2014 at 12 noon GMT by Nobel Laureate Professor Barry Marshall and Editor in chief of GUT, Professor Emad El-Omar - "Frontline Research: The highs and lows of academic life - the basics, the barriers and the breakthroughs".

Finding the cause of IBD - genes, bugs or diet?

Thank you for listening to this podcast, where Frontline Gastroenterology Trainee Editor Dr Philip Smith talks to Dr Charlie Lees, Consultant Gastroenterologist at the Western General Hospital, Edinburgh and honorary senior lecturer at the University of Edinburgh, about Frontline IBD.
The podcast is an accompaniment to the Frontline Gastroenterology Twitter Debate (#FGDebate) held on Tuesday 14th October 2014 at 8-9pm GMT, entitled, 'Frontline IBD: Finding the cause of IBD – genes, bugs or diet?'.
A summary of this debate can be found at: https://storify.com/FrontGastro_BMJ/frontline-ibd-finding-the-cause-of-ibd-genes-bugs
Prior to the debate Dr Charlie Lees said:
'The inflammatory bowel diseases, Crohn’s disease and ulcerative colitis, are common in the Western world affecting about 1 in 200 individuals. In recent years incidence has increased dramatically in developing countries in parallel with the adoption of a Western lifestyle. Whilst the precise aetiology of IBD remains illusive the currently held paradigm is of dysregulated immune responses to commensal gut bacteria in genetically susceptible individuals. Gene discovery in IBD has seen unparalleled success in complex diseases. Nearly 200 disease genes have been identified. These findings have started to yield fruit with important insights into disease biology. However they also demonstrate the underlying complexity of disease pathogenesis. Furthermore, they only appear to explain around one quarter of phenotypic variance – ie why an individual develops disease. Much attention has now start to focus on the role of the gut microbiota in IBD. There is clearly reduced microbial diversity in IBD patients, but it remains unknown which critical aspects of the observed dysbiosis are potentially causal or simply the effect of underlying inflammation. Moreover, the interplay between environmental factors, notably antibiotic exposure and habitual diet, underlying genetic variation and the gut microbiota are only just starting to be explored.
In this Frontline Gastroenterology twitter debate we will explore these issues and discuss how present data, planned and future studies can / should address this critical question. How will we find out what causes IBD to develop? Will this knowledge help us prevent the disease from developing in high-risk individuals? Are the environmental triggers for disease onset the same as those for disease flare in patients with established disease? Will these findings bring us closer to a ‘cure’ or at least prolonged remission in those with established disease?.
The purpose of the podcast is to 'fill any gaps' the #FGDebate may have left. Dr Charlie Lees has also provided the slides he used in #FGDebate to help those interested understand the issues associated with IBD and IBD research. We hope you enjoy this and it is informative.
View the slides: http://goo.gl/ZjMpfU
Don't miss the next #FGDebate on Tuesday 11th November 2014 at 8-9pm by Prof Sir Ian Gilmore - "Frontline Hepatology: Alcohol - our favourite drug and everyone's problem".

Frontline Endoscopy: Colonic EMR vs ESD - which one and when?

Thank you for listening to this podcast, where Frontline Gastroenterology Trainee Editor Dr Philip Smith talks to Dr Bjorn Rembacken, Consultant Endoscopist Leeds Teaching Hospitals Trust, about frontline endoscopy.
The podcast is an accompaniment to the Frontline Gastroenterology Twitter Debate (#FGDebate) held on Tuesday 23rd September 2014 at 8-9pm GMT, entitled, 'Frontline Endoscopy: Colonic EMR vs ESD - which one and when?'.
A summary of this debate can be found at: https://storify.com/FrontGastro_BMJ/frontline-endoscopy-colonic-emr-vs-esd-which-one
Prior to the debate Dr Bjorn Rembacken said:
'It was about 10 years ago when Japanese endoscopists started to resect colonic lesions “en-bloc” by ESD. They were prompted by histopathologists who had difficulties interpreting margins. Not unlike the introduction of laparoscopic surgery, the technique has been criticised for being awkward, hazardous, expensive and time consuming. However, as it seems to be the correct direction of travel, many endoscopists outside of Japan are now beginning to have a go.
In the UK, patients expect to have “keyhole surgery” as it shortens recovery considerably. Has ESD now matured sufficiently to be regarded as the best standard?
In this Twitter debate, we will explore the issues, which are complicated, and has wide ranging implications for training, how histopathologists diagnose cancer and the surgical management of colorectal cancer'.
The purpose of the podcast is to 'fill any gaps' the #FGDebate may have left. Dr Bjorn Rembacken has also provided the slides he used in #FGDebate to help those interested understand the issues associated with these advanced endoscopy techniques. We hope you enjoy this and it is informative.
View the slides: http://goo.gl/ZPSCiy
Don't miss the next #FGDebate on Tuesday 14th October 2014 at 8-9pm by Dr Charlie Lees - Frontline IBD: Finding the cause of IBD - genes, bugs and diet?”

Frontline Gastroenterology’s first podcast

Frontline Gastroenterology (FG) aims to accelerate the adoption of best practice in the fields of gastroenterology and hepatology. It is multidisciplinary and focuses on the needs of patients and the professionals caring for them.In this podcast FG’s founding editor, Dr Roland Valori, explains how the journal came about. We also hear from 2 leading gastroenterologists who appeared at the international gastroenterology conference, Gastro 2009.