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Preview: British Medical Bulletin - Advance Access

British Medical Bulletin Advance Access





Published: Thu, 16 Nov 2017 00:00:00 GMT

Last Build Date: Thu, 16 Nov 2017 05:43:49 GMT

 






Faecal transplantation for IBD management—pitfalls and promises

2017-11-13

Abstract
Background
Faecal microbiota transplantation (FMT) as a potential treatment for inflammatory bowel disease (IBD) is an area of active current research, having been stimulated by the remarkable efficacy of FMT in treatment of Clostridium difficile-associated colitis.
Sources of data
This review is based on data from numerous case series on FMT in IBD since 1989 and results of four RCTs in ulcerative colitis (UC); three fully published.
Areas of agreement
Early signals of short to medium-term efficacy of FMT for UC are promising
Areas of controversy
Methodology, underlying mechanisms and questions regarding safety of FMT remain controversial.
Growing points
Many trials of FMT in adults and children are currently recruiting.
Areas timely for developing research
Future trials of FMT will likely revisit Crohn’s disease and patients undergoing pouch surgery. Advances in microbial culture complementing genetic sequencing and investigations into the virome and mycobiome in IBD will be of great future interest.



Perioperative management of the obese surgical patient

2017-11-13

Abstract
Introduction
The escalation in the prevalence of obesity throughout the world has led to an upsurge in the number of obese surgical patients to whom perioperative care needs to be delivered.
Sources of data
After determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered.
Areas of agreement
There were no controversies regarding preoperative management and the intraoperative care of the obese surgical patient.
Areas of controversy
Is there a healthy obese state that gives rise to the obesity paradox regarding postoperative complications?
Growing points
This review considers how to prepare for and manage the obese surgical patient through the entire spectrum, from preoperative assessment to possible postoperative intensive care.
Areas timely for developing research
What results in an obese patient developing ‘unhealthy’ obesity?