Deaths from advanced chronic liver disease are increasing over the past 50 years1. Regardless of what type of gastroenterologist you are, you can probably think of a case of a patient with advanced chronic liver disease who has died. You may even have reflected on whether the circumstances could have been different if only we had the discussions earlier on the patient’s wishes (I know I have). This also adds a significant financial burden for recurrent admissions for these patients. This patient group is probably the most emotionally challenging as they are usually young and the trajectory is ..read more

We have just come to the end of our annual (friendly) competition, the #FGCup. We are very lucky to have had eight fantastic papers be included in a tournament and we thank our editor-in chief, Professor Mark Beattie, in helping to choose these. We also thank all our authors and reviewers for which this would not be possible without! The summary of #FGCup is shown below and here we will outline the papers that were involved and reveal the ultimate winner.     Colonoscopy training has developed over the year with varying standards in training. The consensus statements developed by Si ..read more

The importance of Patient Reported Outcome Measures (PROMs) in inflammatory bowel disease (IBD) is now widely appreciated. Despite this, only relatively recently were PROMs routinely incorporated into clinical trials as outcomes. Current tools available include the IBD questionnaire (IBDQ) for measuring health-related quality of life (HRQoL) and IBD-control for measuring patients’ perspective of disease control. The 2020 ICONIC study prospectively examined a variety of PROMs in an international cohort of 1804 patients with ulcerative colitis (UC); a 2022 subanalysis of UK patients in the trial ..read more

  As trainees progress through their career, they are encouraged or even expected to train and supervise junior colleagues. Traditionally, this has been reserved for inpatient management, basic procedures such as vascular access, and more advanced procedures such as chest drains or central venous access. Whilst surgical training in the UK often pair a junior and senior trainee oncall or in the operating theatre, this type of training has not yet reached the endoscopy department. Despite this, once a senior trainee becomes a consultant, they are expected to train junior colleagues in endos ..read more

Getting surveillance for Barrett’s oesophagus (BO) right is critical for early detection and prevention of oesophageal adenocarcinoma. When identified early, Barrett’s can be treated effectively with minimally invasive endoscopic techniques. Despite clear national guidelines on when and how to perform surveillance for BO, adherence to these guidelines is variable. In the most recent edition of Frontline Gastroenterology, Ratcliffe et al. present an impressive 5-year retrospective comparative cohort study to answer the question whether a dedicated BO surveillance service offers a higher dysplas ..read more

The “hub and spoke” model of liver transplant care that is used in some UK regions has been a concept over the past 10 years as described by John O’Grady in 20131.This sounds like a great idea on paper: you can see a patient as the hepatologist with chronic liver disease in clinic in a level 1 centre2; then one of the transplant hepatologists from the nearby liver transplant unit sees your patient in their peripheral clinic at your District General Hospital (DGH); assessment for liver transplantation then goes on from there. From the patient’s perspective, there is not this need to travel to t ..read more

  Colonoscopy is the gold standard technique to assess the lower gastrointestinal tract, allowing direct visualisation of the bowel mucosa, targeted biopsy, and appropriate therapy including resection of precancerous lesions. Although the quality of colonoscopy has improved, there is a still wide variation in quality of colonoscopies performed in the United Kingdom (UK).1, 2 With colonoscopy activities being at an all-time high in the UK,3, 4 it is crucial that we get the basics right in colonoscopy, as discussed in this previous paper in Frontline Gastroenterology (Figure 1),5 and t ..read more

As 2022 draws to a close we offer our thanks to our authors, reviewers and readers on another productive year! FG is delighted to publish pragmatic and useful advice from experts in the field, enabling practicing gastroenterologists to keep abreast of changing practice. Here we highlight the best of 2022’s papers selected by Editor-in-chief Professor Mark Beattie, which will go head-to-head in competition for our #FGCup readers’ choice award. The development of strictures in Crohn’s disease, unfortunately, remains a common complication of the disease, with almost 50% patients developing one in ..read more

It is well-established that UK endoscopy services are under pressure, with post-Covid waiting lists pushing demand to an all-time high.1 Whilst a no-biopsy approach has been advocated in the diagnosis of coeliac disease (CD) in children since 2012, British Society of Gastroenterology (BSG) guidelines issued in 2014 still advise four duodenal biopsies for the diagnosis of adult CD, including one biopsy from the duodenal bulb. Emergency guidance was issued by the BSG during the Covid-19 pandemic, suggesting that patients under the age of 55 with an anti-tissue transglutaminase antibody (TGA) gre ..read more

This time of year has always been an uneasy one. At school and university, it signified the end of frivolities and return to the classroom. In our professional career, it has usually signified the time for a change in workplace. Change is something that I, like many others, always struggle to adapt to. I enjoy the routine of knowing what I am going to do, where I am going to do it and who I am going to do it with. This year, many junior doctors may have greater anxiety as, finally, the almost mythical beast of ‘Shape of Training’ accompanies them to their next stage of training. The Shape of T ..read more