SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2021 | VOLUME 19 | ISSUE 2 | 47 Variceal Acute Upper Gastrointestinal Bleeding in Sudan: An Audit of Pharmacological Therapy and Endoscopy M Saad, L Mohamed, M Aburas, S Abdelrahman, AEG Eltaher, Z Omar, BAA Ibrahim, S Barakat National center for GI bleeding and Liver diseases, Ibn Sina Hospital Introduction: Terlipressin, antibiotic therapy and timely endoscopy are measures used to improve standard of care and patient outcome in suspected variceal acute upper gastrointestinal bleeding (AUGIB), as recommended by multi-society care bundle commissioned by the British society of gastroenterology. Patients with suspected variceal AUGIB should receive Terlipressin and antibiotics at presentation, and should undergo endoscopy within 24 hours from presentations. This audit aims to assess the use of antibiotics, Terlipressin, and endoscopy offered to patients presenting with suspected variceal AUGIB at a major Gastrointestinal (GI) bleeding centre in Khartoum, Sudan. Methods: This was a clinical audit on antibiotic and Terlipressin therapy, and endoscopy offered to patients with suspected variceal AUGIB in line with multi-society care bundle commissioned by British society of Gastroenterology.We collected retrospective data, on demographic characteristics, clinical presentation, pharmacological treatment and endoscopy reports of patients presenting with AUGIB at a major GI bleeding centre in October 2020. We have considered patient's AUGIB to be variceal in origin, if they had a history of variceal bleeding, schistosomiasis, and or chronic liver disease. Data was analysed using SPSS 23.0. Results of audit was presented at clinical governance meeting. Results: GI bleeding centre received 128 patients in October 2020, 75% of whom were male with an average age of 53. Most common presentation was haematemesis (44.5%), followed by haematemesis and melaena (37.5%), only a minority presented solely with melaena. 35% of patients with AUGIB had a past history of schistosomiasis, and 2.3% suffered from chronic liver disease. Therefore, Categorizing them as patients with suspected variceal bleeding. Antibiotic coverage for those patients was as high as 94%, while dual antibiotic and Terlipressin therapy was prescribed to 70% of those patients. 71.9% of all patients admitted underwent endoscopy within 24 hours of admission. 59.7% were found to have variceal bleeding. Conclusion: Antibiotic therapy standards arebeingmet satisfactorily.Wehighlighted to GI bleeding centre the importance of endoscopy within the first 24 hours.We recommend that teaching is held to encourage prescribing Terlipressin to patients with suspected variceal bleeding. Tandem use of anti-TNF agents in patients with IBD who fail first line anti-TNF therapy: real life lessons from a national database G Titus 1 , A Titus 1 , S Gabriel 2 , W de Villiers 3 , E Fredericks 2 Division of General Medicine, Department of Medicine, Faculty of Health Sciences, University of Stellenbosch and Tygerberg Hospital 1 , Division of Gastroenterology, Department of Medicine, Faculty of Health Sciences, University of Stellenbosch and Tygerberg Hospital 2 , University of Stellenbosch 3 Background: Inflammatory bowel disease (IBD) is a chronic relapsing and remitting inflammation of the bowel. Biologic therapy has been shown to be a safe and effective treatment for IBD. Anti-TNF agents were the first biologics introduced. As more anti-TNF agents joined the market, treating physicians started using anti-TNF agents consecutively when the first agent failed. Evidence-based data for this practice is extremely limited, therefore this study aims to scientifically evaluate tandem use of anti-TNF agents in IBD patients. Method: The South African Gastroenterology Society (SAGES) established a national database for all IBD patients commenced on biologic therapy. This registry was used to evaluate the data of all patients who received consecutive anti-TNF agents. Demographic and clinical details as well as treatment outcomes for all patients were documented. Results: Of the 1150 patients in the registry, 87 (8%) were treated with consecutive anti-TNF agents. 42 patients had Crohn’s disease (CD), 45 had ulcerative colitis (UC), and there were 45 male and 42 females.Analysis of the data failed to clearly identify any particular risk-factor for failure or success on a specific biologic treatment. The most important outcome of this study was the evidence that shows consecutive anti-TNF therapy has a statistically significant impact (p<0.001) on a patient’s likelihood to remain on therapy and achieve clinical remission. For a majority of patients (77%), this was achieved with their second anti-TNF, while 15% went on to a third/fourth/fifth biologic. With further investigation it was noted that patients treated with adalimumab as a second anti- TNF had a higher risk of dose escalation. Conclusion: This study has provided a valuable evidence-based dataset, showing that switching between different anti-TNF agents does indeed help patients maintain clinical remission and avoid surgery/hospitalisation. This is especially important in resource strained areas, where there previously has been no clear guideline. SAGES