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Action Against Heartburn

NICE Guidance Issued on Biologic Treatments for Ulcerative Colitis

This week (26.2.15), the National Institute for Health and Care Excellence (NICE) has issued final guidance recommending the use of biologic therapies for the treatment of moderately to severely active ulcerative colitis (UC) in adult patients. REMICADE®(infliximab), SIMPONI® (golimumab) and HUMIRA®(adalimumab) are recommended, within their marketing authorisations, as options for treating moderately to severely active ulcerative colitis in adults whose disease has responded inadequately to conventional therapy including corticosteroids and mercaptopurine or azathioprine, or who cannot tolerate, or have medical contraindications for such therapies.

The guidance comes as new data from MSD’s pan-European Ulcerative Colitis Condition, Attitude, Resources and Educational Study (UC CARES) presented at the ECCO congress this week show that 91% of biologic-naïve patients with moderate-to-severe ulcerative colitis (UC) across 11 European countries believe their UC to be disruptive when experiencing a flare-up, whereas 40% of patients reported disruption when they were in remission. The data also show that although the majority of patients consider themselves to be ‘somewhat to very knowledgeable’ about their disease, not all patients were well controlled and maintaining remission, suggesting that a disconnect can occur between patients’ perceived disease control, and that measured objectively.

Latest NICE IBD quality Standard published

The Inflammatory bowel disease quality standard has been published on the NICE website today (26.2.15). You can view the quality standard by following this link: http://www.nice.org.uk/guidance/qs81

Action Against Heartburn

Action Against Heartburn is a group of charities that have an interest in promoting the earlier diagnosis of oesophageal cancer, and concentrate on communicating the message about the relationship between persistent heartburn, Barrett’s Oesophagus and oesophageal adenocarcinoma (OAC) to medical practitioners, pharmacists and the general public, particularly in view of the rise in OAC cases in the UK and the UK’s position of having the highest incidence of OAC in the world.   www.actionagainstheartburn.org.uk    We support awareness campaigns such as Be Clear on Cancer and carry out our own campaigns as funds allow, we also produce information sheets.

Public Health England’s Be Clear on Cancer campaigns have progressively dealt with various types of cancer.   The oesophagogastric campaign started with seven pilots that resulted in a 20%  increase in number of oesophageal cancers being diagnosed (177 to 212), and then became a regional campaign in the North East in early 2014.   This resulted in a 50% increase of referrals by GP for endoscopy, typically an additional weekly list for endoscopies per NHS trust, and a shift in diagnosis of oesophageal cancer towards the two week wait referral system rather than on presentation in A & E.   The detailed figures for whether diagnosis is being made at an earlier stage are not yet to hand, but the campaign addressed a significant lack of public awareness of the risks involved with persistent heartburn.    The emphasis on persistent heartburn has been made partly because of the changing epidemiology and shift from squamous cell to adenocarcinoma in oesophageal cancer over the last 30 years (as pointed out by Tony Watson and John Galloway in their article for British Journal of General Practice in March 2014) and partly because difficulty in swallowing, the classic symptom for oesophageal cancer,  invariably occurs when a tumour has reached round most of the circumference of the oesophagus and is therefore likely to be either stage 3 or beyond curative treatment.     Barrett’s Oesophagus is greatly under-diagnosed, and does present an opportunity for monitoring and indeed treatment with radio frequency ablation, so it is an opportunity to make inroads into the patients with a precursor condition.    The national OG campaign will run from 26 January to 28 February 2015, with information available from Cancer Research UK’s website

http://www.cancerresearchuk.org/health-professional/early-diagnosis-activities/be-clear-on-cancer/oesophago-gastric-cancers-campaign

 

The key messages of the Action Against Heartburn campaign are:

  • –  Consult your GP if you have:
    • persistent heartburn (acid reflux, often at night) – ie for three weeks or more
    • – persistent indigestion, for three weeks or more
    • – persistent hiccups or an unpleasant taste in your mouth
    • – difficulty or pain in swallowing food
    • – unexplained weight loss
  • – Do not keep taking over-the-counter indigestion remedies week after week without seeing your GP to investigate underlying causes (which most frequently will be less serious than cancer)
  • – GPs should consider a review of patients taking prescription remedies for reducing stomach acid after an appropriate period
  • – An endoscopic examination is the only sure way of detecting Barrett’s Oesophagus or oesophageal cancer.   This should be available for people of any age with worrying symptoms
  • – Diet, obesity, stress, tobacco and alcohol may contribute to acid reflux, and there are good reasons for us to address these issues even if they do not contribute to us developing cancer.

The other charities involved in Action Against Heartburn are:

  1. – AUGIS   – Association of Upper GI Surgeons
  2. – Barrett’s Oesophagus Campaign
  3. – Barrett’s Wessex
  4. – Cancer Research UK
  5. – CARD – Campaign Against Reflux Disease
  6. – CORE charity – Fighting Gut and Liver Disease
  7. – FORT – Fighting Oesophageal Reflux Together
  8. – Gutsy Group
  9. – Heartburn Cancer UK (formerly HCAS – Heartburn Cancer Awareness and Support)
  10. – Humberside Oesophageal Support Group
  11. – Michael Blake Foundation
  12. – OCHRE charity (Scotland)
  13. – Oesophagoose – National Oesophago-Gastric Awareness
  14. – OPA – Oesophageal Patients Association
  15. – OOSO – Oxfordshire Oesophageal and Stomach Organisation
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