Suchergebnisse

Abstract This paper reviews the epidemiology ofHelicobacter pylori(H. Pylori) in adults with intellectual disability (ID) including clinical presentation, risk factors for infection and diseases, and assesses the best options for testing and treatment. It was observed that particular groups of adults with ID have significantly higher rates ofH. pyloriinfection, and possibly disease consequences including peptic ulcer disease and gastric cancer, when compared to the general population, although the presentation with typical dyspepsia in people with ID is rare. Identified independent risk factors for infection include a history of institutionalization, lower ability, higher levels of behavior problems, and living with flatmates with oral hypersalivation or fecal incontinence. The presence of ID and the associated biopsychosocial factors necessitate development of adaptations to the usual testing and treatment methods as part of a preventive health strategy in order to relieve occult symptoms, and prevent disease development. Among the available tests, the fecal antigen or serology tests are equally acceptable to adults with ID regardless of their level of disability or behaviors, although only those who function more normally can perform the urea breath test. TheH. pylorieradication rate is lower, with treatment side‐effect and recurrence rates higher, compared to the general population; but, given the evidence that patients with ID carry the infection and associated pathology for long periods, testing and treating those with at‐risk is recommended. While not recommending screening all adults with ID forH. pyloriinfection, the authors provide an overall evidence‐based position statement on whom to test and treat, and how to diagnose and manage this infection, an important cause of preventable disease.

Introduction There are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT. A more selective approach to RT may be appropriate given the associated toxicity. Methods and analysis This trial will explore the feasibility of a definitive trial evaluating the omission of RT in resectable low rectal cancer requiring APER. It will test the feasibility of randomising patients to (1) standard care (neoadjuvant long course RT±chemotherapy and APER, or (2) APER surgery alone for cT2/T3ab N0/1 low rectal cancer with clear predicted resection margins on MRI. RT schedule will be 45 Gy over 5 weeks as current standard, with restaging and surgery after 8–12 weeks. Recruitment will be for 24 months with a minimum 12-month follow-up. Objectives Objectives include testing the ability to recruit, consent and retain patients, to quantify the number of patients eligible for a definitive trial and to test feasibility of outcomes measures. These include locoregional recurrence rates, distance to circumferential resection margin, toxicity and surgical complications including perineal wound healing, quality of life and economic analysis. The quality of MRI staging, RT delivery and surgical specimen quality will be closely monitored. Ethics and dissemination The trial is approved by the Regional Ethics Committee and Health Research Authority (HRA) or equivalent. Written informed consent will be obtained. Serious adverse events will be reported to Swansea Trials Unit (STU), the ethics committee and trial sites. Trial results will be submitted for peer review publication and to trial participants.