The prevalence of IBD is rising in the Western world.

BackgroundPhysician training in the UK is undergoing considerable change due to the implementation of recommendations made in the Shape of Training Review. In particular, higher specialty training (HST), including gastroenterology, will be shortened from 5 to 4 years. This will also incorporate general internal medicine (GIM) training. There is concern among gastroenterologists regarding how high-quality gastroenterology training will be delivered in 4 years.MethodsThe 2018 British Society of Gastroenterology (BSG) trainees’ survey results were used to examine the potential impact of a 4-year HST period on achieving key competencies in gastroenterology.Results291 (49.4%) gastroenterology trainees responded. Satisfaction with gastroenterology training was high (79.6% respondents), and self-reported confidence in hepatology training was also high (84% senior respondents). However, only half (51.1%) of the respondents achieved complete colonoscopy certification by their final year of training. Comparison with the 2014 BSG trainees’ survey demonstrated that the number of endoscopy procedures achieved by trainees has reduced in sigmoidoscopy (p=0.006) and colonoscopy (p<0.001). The proportion of time spent in GIM training has increased since the last survey, with 81.8% of the respondents spending more than 25% of their time in GIM. GIM training was reported to be a key barrier to adequate gastroenterology and endoscopy training.ConclusionThese data indicate significant barriers to delivering gastroenterology and endoscopy training within the current 5-year programme. Novel strategies will be required to improve the rate of progression in endoscopy training, in particular if high-quality gastroenterology HST training is to be delivered in 4 years.

ObjectiveThe COVID-19 pandemic has placed increased strain on healthcare systems worldwide with enormous reorganisation undertaken to support ‘COVID-centric’ services. Non-COVID-19 admissions reduced secondary to public health measures to halt viral transmission. We aimed to understand the impact of the response to COVID-19 on the outcomes of upper gastrointestinal (UGI) bleeds.Design/methodsA retrospective observational multicentre study comparing outcomes following endoscopy for UGI bleeds from 24 March 2020 to 20 April 2020 to the corresponding dates in 2019. The primary outcome was in-hospital survival at 30 days with secondary outcomes of major rebleeding within 30 days postprocedure and intervention at the time of endoscopy.Results224 endoscopies for 203 patients with UGI bleeds were included within this study. 19 patients were diagnosed with COVID-19. There was a 44.4% reduction in the number of procedures performed between 2019 and 2020. Endoscopies performed for UGI bleeds in the COVID-19 era were associated with an adjusted reduced 30-day survival (OR 0.25, 95% CI 0.08–0.67). There was no increased risk of major rebleeding or interventions during this era. Patients with COVID-19 did not have reduced survival or increased complication rates.ConclusionEndoscopy for UGI bleeds in the COVID-19 era is associated with reduced survival. No clear cause has been identified but we suspect that this is a secondary effect of the response to the COVID-19 pandemic. Urgent work is required to encourage the public to seek medical help if required and to optimise patient pathways to ensure that the best possible care is provided.

P-450reductase-null mice show reduced transcriptional response to quercetin and reveal physiological homeostasis between jejunum and liver. Am J Physiol Gastrointest Liver Physiol 290: G63-G72, 2006. First published February 2, 2006 doi:10.1152/ajpgi.00565.2005.-Using mice deficient in hepatic cytochrome P-450 oxidoreductase (POR), which disables the liver cytochrome P-450 system, we examined the metabolism and biological response of the anticarcinogenic flavonoid, quercetin. Profiling circulating metabolites revealed similar profiles over 72 h in wild-type (WT) and POR-null (KO) mice, showing that hepatic P450 and reduced biliary secretion do not affect quercetin metabolism. Transcriptional profiling at 24 h revealed that two-to threefold more genes responded significantly to quercetin in WT compared with KO in the jejunum, ileum, colon, and liver, suggesting that hepatic P450s mediate many of the biological effects of quercetin, such as immune function, estrogen receptor signaling, and lipid, glutathione, purine, and amino acid metabolism, even though quercetin metabolism is not modified. The functional interpretation of expression data in response to quercetin (single dose of 7 mg/animal) revealed a molecular relationship between the liver and jejunum. In WT animals, amino acid and sterol metabolism was predominantly modulated in the liver, fatty acid metabolism response was shared between the liver and jejunum, and glutathione metabolism was modulated in the small intestine. In contrast, KO animals do not regulate amino acid metabolism in the liver or small intestine, they share the control of fatty acid metabolism between the liver and jejunum, and regulation of sterol metabolism is shifted from the liver to the jejunum and that of glutathione metabolism from the jejunum to the liver. This demonstrates that the quercetin-mediated regulation of these biological functions in extrahepatic tissues is dependent on the functionality of the liver POR. In conclusion, using a systems biology approach to explore the contribution of hepatic phase 1 detoxification on quercetin metabolism demonstrated the resiliency and adaptive capacity of a biological organism in dealing with a bioactive nutrient when faced with a tissue-specific molecular dysfunction.