Connolly Hospital

This is the second of two articles presenting the European Crohn's and Colitis Organisation [ECCO] evidence‑based consensus guidelines on the management of adult patients with ulcerative colitis [UC]. The first article covers the medical management of UC, including acute severe colitis. The present article addresses the surgical management of medically refractory UC, including the general surgical approach and perioperative optimisation, surgical strategies and techniques, and recommended levels of centre expertise and surgical specialisation. Together, these two articles aim to inform shared decision‑making and to guide clinicians and healthcare professionals involved in the care of patients with UC, drawing on the best available evidence.

BackgroundHelicobacter pylori (H. pylori) is a gram-negative bacterium infecting over 40% of the global population, with highest prevalence in low- and middle-income regions. Chronic infection leads to persistent gastritis and can result in peptic ulcer disease, dyspepsia and gastric adenocarcinoma. Despite its high pathogenic potential, population-based screening and eradication programmes remain limited, particularly in Europe.MethodsThis narrative review summarisescurrent evidence on the epidemiology, clinical burden and eradication strategies for H. pylori. A literature search of PubMed, Embase and the Cochrane Database was performed to identify recent publications relating to H. pylori infection, consequences and screening approaches.ResultsH. pylori has been classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen and is the leading cause of infection-attributable cancer worldwide, accounting for approximately 850,000 gastric cancer cases annually. Robust evidence demonstrates that eradication of H. pylori reduces the risk of peptic ulcer recurrence, dyspepsia, and gastric cancer incidence, with recent meta-analyses reporting a pooled relative risk reduction of up to 44%. Population-based eradication initiatives, such as the Matsu Islands study, have shown dramatic declines in H. pylori prevalence, peptic ulceration, and gastric cancer incidence. Current international guidelines, including the Maastricht VI/Florence and 2025 Taipei Global Consensus reports, now recommend universal eradication of confirmed infections and support population-level or family-based screening in high-risk regions. Ongoing European pilot studies, including the TOGAS initiative, aim to inform the implementation of gastric cancer screening programs. Concerns regarding antibiotic resistance remain, though recent evidence suggests that the risks are manageable with appropriate antibiotic stewardship.ConclusionPopulation-based H. pylori screen-and-treat strategies represent a cost-effective and evidence-based approach to preventing gastric cancer. Further large-scale European studies are warranted to guide optimal implementation, timing, and cost-effectiveness of such programs.

Background:Small bowel capsule endoscopy (SBCE) enables non-invasive mucosal assessment of the small bowel, while double-balloon enteroscopy (DBE) allows histological confirmation and therapeutic intervention. Appropriate patient selection is essential to maximise diagnostic yield and minimise unnecessary invasive procedures. Methods:We performed a retrospective analysis of patients referred for investigation of suspected small bowel Crohn's disease over a two-year period at a tertiary referral centre. Demographic data, prior investigations, SBCE findings, and subsequent DBE decisions were recorded. The primary outcome was the decision to proceed to DBE. Secondary outcomes included the diagnostic yields of SBCE and DBE. Multivariate logistic regression was used to identify factors associated with DBE referral. Results:Ninety-eight patients with complete data were included. SBCE was performed as the initial investigation in 90.8%, while 5.5% proceeded directly to DBE for therapeutic or histological indications. The SBCE-to-DBE conversion rate was 30.4%. SBCE alone established or excluded inflammatory bowel disease in 70% of patients. Among those undergoing DBE, Crohn's disease was confirmed in 21% and excluded in 79%. Increasing age (OR 1.04 per year; 95% CI 1.01-1.07) and diagnostic uncertainty on SBCE (OR 2.0; 95% CI 1.8-3.5) independently predicted DBE referral. Conclusion:SBCE is diagnostic in the majority of patients with suspected small bowel Crohn's disease and functions effectively as a triage tool. DBE should be reserved for cases requiring histological confirmation, clarification of indeterminate findings, assessment of proximal disease, or therapeutic intervention.

The Objective Structured Clinical Examination (OSCE) first appeared as a title and as an acronym in 1979. It has now become a worldwide phenomenon with almost 3,200 related publications reported in PubMed to date. Prior to its introduction, there were very real concerns regarding Objectivity, Validity and Reliability of prior clinical assessment methods and the overall fairness to students on their assessment of clinical competence. Variations and applications in other allied clinical sub-specialties and non-allied, have now emerged on the method. In addition, numerous psychometric papers have resulted. However, very little in reference to its precise origin has been accurately reported. What has been reported thus far, in some otherwise excellent publications, has been significantly incorrect. A combination of the Steeplechase Examination method, a joint paper from the University of Dundee and the University of Glasgow, and a dissertation for a Diploma in Educational Technology by the author, has resulted in what has now become the globally recognised term: OSCE. The detailed evidence-based narrative of its true origins and its Irish connections to The Royal College of Surgeons in Ireland (RCSI) in this paper summarises the preceding two years of academic endeavour in Dundee prior to its publication debut in January 1979.

BACKGROUND:Cardiopulmonary exercise testing (CPET) assesses physiological responses to incremental exercise and identifies potential causes of exercise limitation. There have been several population-specific reference equations published, but none that span the human age range. It would be advantageous to have all-age global reference ranges. This task force aimed to derive Global Lung Function Initiative reference equations for peak oxygen uptake (V̇ O2 peak) and peak work rate (Wpeak) in healthy individuals. METHODS:CPET data were collected retrospectively. Generalised additive models of location, shape and scale were used to develop reference ranges, including age, sex, height and weight as explanatory variables. The influence of geographic region, equipment, testing protocols and averaging methods for peak exercise data were also examined. RESULTS:Data from 5956 healthy individuals aged between 6 and 83 years across 17 sites in Europe, North and South America and Asia were analysed. There was substantial between-subject variability in both V̇ O2 peak and Wpeak, with wide confidence intervals across age groups. Heterogeneity in V̇ O2 peak was related to geographic region, metabolic cart type, and averaging methods for peak exercise values. Controlling for these variables improved model fit, but not sufficiently to be reliable predictors for reference ranges. CONCLUSION:Significant heterogeneity in CPET testing methodology and outcomes between sites precluded the development of reference ranges for V̇ O2 peak and Wpeak. This task force has developed a framework for prospective data collection with strictly standardised protocols and centralised data analysis to reduce variability and establish robust, clinically meaningful reference ranges for CPET outcomes.