David S Sanders

The University of Sheffield, Sheffield, England, United Kingdom

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Publications (210)1372.72 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Coeliac disease (CD) has been linked to gastro-oesophageal reflux disease (GORD). Previous studies have demonstrated an increased prevalence of reflux in patients with CD. However data on the risk for CD in patients presenting with reflux are conflicting. The aim of this study was to establish the prevalence of CD in patients with GORD and to elucidate the mechanisms for reflux symptoms in newly diagnosed CD patients. Group A: patients who had undergone routine duodenal biopsy were prospectively recruited between 2004 and 2014. Diagnostic yield was compared with that of a screening cohort. Group B: 32 patients with newly diagnosed CD who had undergone oesophageal manometry and 24-h pH studies were prospectively recruited. Group A: 3368 patients (58.7% female, mean age 53.4 years) underwent routine duodenal biopsy. Of these patients, 850 (25.2%) presented with GORD. The prevalence of CD among GORD patients was 1.3% (0.7-2.4%), which was not significantly higher than that in the general population (P=0.53). Within the context of routine duodenal biopsy at endoscopy (when corrected for concurrent symptoms, age and sex), reflux was found to be negatively associated with CD [adjusted odds ratio 0.12 (0.07-0.23), P<0.0001]. In group B, 34% of patients complained of reflux. On manometry, 9% had a hypotensive lower oesophageal sphincter and 40.6% had oesophageal motor abnormalities, with 25% significantly hypocontractile. On pH studies, 33% demonstrated reflux episodes. The prevalence of undiagnosed CD among GORD patients is similar to that in the general population, and routine duodenal biopsy cannot be recommended. A significant number of patients with newly diagnosed CD were found to have reflux and/or oesophageal dysmotility on pH/manometry studies; this may explain the high prevalence of reflux symptoms in CD.
    European journal of gastroenterology & hepatology 06/2015; 27(6):692-7. DOI:10.1097/MEG.0000000000000359 · 2.15 Impact Factor
  • Medical Education 05/2015; 49(5):532-3. DOI:10.1111/medu.12705 · 3.62 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB583. DOI:10.1016/j.gie.2015.03.1891 · 4.90 Impact Factor
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    ABSTRACT: A gluten-free diet (GFD) is currently the only available therapy for coeliac disease (CD). We aim to review the literature on the GFD, the gluten content in naturally gluten-free (GF) and commercially available GF food, standards and legislation concerning the gluten content of foods, and the vitamins and mineral content of a GFD. We carried out a PubMed search for the following terms: Gluten, GFD and food, education, vitamins, minerals, calcium, Codex wheat starch and oats. Relevant papers were reviewed and for each topic a consensus among the authors was obtained. Patients with CD should avoid gluten and maintain a balanced diet to ensure an adequate intake of nutrients, vitamins, fibre and calcium. A GFD improves symptoms in most patients with CD. The practicalities of this however, are difficult, as (i) many processed foods are contaminated with gluten, (ii) staple GF foods are not widely available, and (iii) the GF substitutes are often expensive. Furthermore, (iv) the restrictions of the diet may adversely affect social interactions and quality of life. The inclusion of oats and wheat starch in the diet remains controversial.
    04/2015; 3(2):121-35. DOI:10.1177/2050640614559263
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    ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule prior to capsule endoscopy in these patients (strong recommendation, low quality evidence). In the presence of obstructive symptoms or known stenosis, ESGE recommends that dedicated small bowel cross-sectional imaging modalities such as magnetic resonance enterography/enteroclysis or computed tomography enterography/enteroclysis should be used first (strong recommendation, low quality evidence). 6 In patients with established Crohn's disease, based on ileocolonoscopy findings, ESGE recommends dedicated cross-sectional imaging for small-bowel evaluation since this has the potential to assess extent and location of any Crohn's disease lesions, to identify strictures, and to assess for extraluminal disease (strong recommendation, low quality evidence). In patients with unremarkable or nondiagnostic findings from such cross-sectional imaging of the small bowel, ESGE recommends small-bowel capsule endoscopy as a subsequent investigation, if deemed to influence patient management (strong recommendation, low quality evidence). When capsule endoscopy is indicated, ESGE recommends use of the PillCam patency capsule to confirm functional patency of the small bowel (strong recommendation, low quality evidence). 7 ESGE strongly recommends against the use of small-bowel capsule endoscopy for suspected coeliac disease but suggests that capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy (strong recommendation, low quality evidence). © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 04/2015; 47(4):352-386. DOI:10.1055/s-0034-1391855 · 5.20 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-169. DOI:10.1016/S0016-5085(15)30565-5 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-287. DOI:10.1016/S0016-5085(15)30946-X · 13.93 Impact Factor
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    ABSTRACT: Celiac disease has been linked to decreased quality of life and certain mood disorders. The effect of the gluten free diet on these psychological aspects of the disease is still unclear. The objective of this article is to review the literature on psychological morbidity of celiac disease. We performed a PubMed search for the time period from 1900 until June 1, 2014, to identify papers on psychological aspects of celiac disease looking specifically at quality of life, anxiety, depression and fatigue. Anxiety, depression and fatigue are common complaints in patients with untreated celiac disease and contribute to lower quality of life. While aspects of these conditions may improve within a few months after starting a gluten-free diet, some patients continue to suffer from significant psychological morbidity. Psychological symptoms may affect the quality of life and the dietary adherence. Health care professionals need to be aware of the ongoing psychological burden of celiac disease in order to support patients with this disease.
    04/2015; 3(2):136-45. DOI:10.1177/2050640614560786
  • Gastroenterology 04/2015; 148(4):S-287-S-288. DOI:10.1016/S0016-5085(15)30947-1 · 13.93 Impact Factor
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    ABSTRACT: Celiac disease (CD) occurs in approximately 1% of the Western population. It is a lifelong disorder that is associated with impaired quality of life (QOL) and an excessive risk of comorbidity and death. To review the literature on screening for CD in relation to the current World Health Organization (WHO) criteria for mass screening. We performed a PubMed search to identify indexed papers on CD screening with a publication date from 1900 until 1 June 2014. When we deemed an abstract relevant, we read the corresponding paper in detail. CD fulfills several WHO criteria for mass screening (high prevalence, available treatment and difficult clinical detection), but it has not yet been established that treatment of asymptomatic CD may reduce the excessive risk of severe complications, leading to higher QOL nor that it is cost-effective. Current evidence is not sufficient to support mass screening for CD, but active case-finding may be appropriate, as we recognize that most patients with CD will still be missed by this strategy. Although proof of benefit is still lacking, screening for CD may be appropriate in high-risk groups.
    04/2015; 3(2):106-20. DOI:10.1177/2050640614561668
  • Gastroenterology 04/2015; 148(4):S-287. DOI:10.1016/S0016-5085(15)30945-8 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-590-S-591. DOI:10.1016/S0016-5085(15)32001-1 · 13.93 Impact Factor
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    ABSTRACT: & Aims: Some studies have found that patients with idiopathic bile acid diarrhea (BAD) present with symptoms of diarrhea-predominant irritable bowel syndrome (D-IBS). However, these studies were either retrospective, did not define D-IBS according to current criteria, or included patients with chronic functional diarrhea. We performed a prospective study of the prevalence of idiopathic BAD in consecutive patients fulfilling the Rome III criteria for D-IBS. We analyzed data from 118 consecutive adult patients who fulfilled the Rome III criteria for D-IBS (mean age, 41.7 years; 72.9% female), seen at 2 gastroenterology clinics in the UK. We excluded patients with risk factors for BAD (previous history of cholecystectomy, terminal ileal Crohn's disease, terminal ileal resection or right hemicolectomy, pelvic or abdominal radiotherapy, celiac disease, or microscopic colitis). Participants completed questionnaires at baseline (on demographics, hospital anxiety, somatization, and depression, as well as the patient health questionnaire-12 and the short form-36 [SF-36]), and then received the (75)selenium homocholic acid taurine retention test. Retention of (75)selenium homocholic acid taurine 7 days after administration was used to identify patients with idiopathic BAD (mild BAD, 10%-14.9%; moderate BAD, 5.1%-9.9%; and severe BAD, ≤5%). Twenty-eight were found to have BAD (23.7% of total), with similar percentages at each study site (25.3% and 20%; P=.54). Eight patients had mild BAD (28.6%), 8 had moderate BAD (28.6%), and 12 had severe BAD (42.8%). There was no statistical difference in age or sex, or depression, patient health questionnaire-12, or SF-36 scores, between individuals with vs without BAD. However, patients with BAD had a higher mean body mass index than those without BAD (31.6 vs. 26.4; P=.003). Physical activity (based on the SF-36) was significantly lower in subjects with moderate (43.8) or severe BAD (41.7), compared to patients with mild BAD (87.5) (P=.046). Almost 25% of patients presenting with D-IBS have idiopathic BAD; most cases are moderate to severe. Guidelines should advocate testing to exclude BAD before patients are diagnosed with D-IBS. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    Clinical Gastroenterology and Hepatology 03/2015; DOI:10.1016/j.cgh.2015.03.002 · 6.53 Impact Factor
  • Journal of gastrointestinal and liver diseases: JGLD 03/2015; 24(1):125-126. · 1.85 Impact Factor
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    ABSTRACT: Non-celiac gluten sensitivity and the associated use of a gluten-free diet (GFD) are perceived to belong to the spectrum of irritable bowel syndrome (IBS). However, recent reports suggest substantial use of a GFD in inflammatory bowel disease (IBD). We assessed the bidirectional relationship between IBD and self-reported non-celiac gluten sensitivity (SR-NCGS). A cross-sectional questionnaire screened for SR-NCGS and the use of a GFD in 4 groups: ulcerative colitis (n = 75), Crohn's disease (n = 70), IBS (n = 59), and dyspeptic controls (n = 109). We also assessed diagnostic outcomes for IBD in 200 patients presenting with SR-NCGS. The prevalence of SR-NCGS was 42.4% (n = 25/59) for IBS, followed by 27.6% (n = 40/145) for IBD, and least among dyspeptic controls at 17.4% (n = 19/109); P = 0.015. The current use of a GFD was 11.9% (n = 7/59) for IBS, 6.2% (n = 9/145) for IBD, and 0.9% (1/109) for dyspeptic controls; P = 0.02. No differences were established between ulcerative colitis and Crohn's disease. However, Crohn's disease patients with SR-NCGS were significantly more likely to have stricturing disease (40.9% versus 18.9%, P = 0.046), and higher mean Crohn's Disease Activity Index score (228.1 versus 133.3, P = 0.002), than those without SR-NCGS. Analysis of 200 cases presenting with SR-NCGS suggested that 98.5% (n = 197) could be dietary-related IBS. However, 1.5% (n = 3) were found to have IBD; such patients had associated alarm symptoms, and/or abnormal blood parameters, prompting colonic investigations. SR-NCGS is not only exclusive to IBS but also associated with IBD, where its presence may be reflecting severe or stricturing disease. Randomized studies are required to further delineate the nature of this relationship and clarify whether a GFD is a valuable dietetic intervention in selected IBD patients.
    Inflammatory Bowel Diseases 02/2015; 21(4). DOI:10.1097/MIB.0000000000000335 · 5.48 Impact Factor
  • Imran Aziz, Federica Branchi, David S Sanders
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    ABSTRACT: Mankind has existed for 2·5 million years but only in the last 10 000 years have we been exposed to wheat. Wheat was first cultivated in the Fertile Crescent (South Western Asia) with a farming expansion that lasted from about 9000BC to 4000BC. Thus it could be considered that wheat (and gluten) is a novel introduction to man's diet! Prior to 1939 the rationing system had already been devised. This led to an imperative to try to increase agricultural production. Thus it was agreed in 1941 that there was a need to establish a Nutrition Society. The very roots of the society were geared towards necessarily increasing the production of wheat. This goal was achieved and by the end of the 20th century, global wheat output had expanded 5-fold. Perhaps as a result the epidemiology of coeliac disease (CD) or gluten sensitive enteropathy has changed. CD is a state of heightened immunological responsiveness to ingested gluten in genetically susceptible individuals. CD now affects 1 % or more of all adults, for which the treatment is a strict lifelong gluten-free diet. However, there is a growing body of evidence to show that a far greater proportion of individuals without coeliac disease are taking a gluten-free diet of their own volition. This clinical entity has been termed non-coeliac gluten sensitivity (NCGS), although the condition is fraught with complexities due to overlap with other gluten-based constituents that can also trigger similar clinical symptoms. This review will explore the relationship between gluten, the rising prevalence of modern coeliac disease, and the new entity of NCGS along with its associated uncertainties.
    Proceedings of The Nutrition Society 02/2015; DOI:10.1017/S0029665115000038 · 4.94 Impact Factor
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    DESCRIPTION: Microscopic enteritis (ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy. This work recognises a need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance. The consensus working party reviewed statements about the aetiology, diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment. Following the 5th International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME. A five-step agreement scale (from strong agreement to strong disagreement) was used to score 21 statements, independently. There was strong agreement on all statements about ME histology (95%-100%). Statements concerning diagnosis achieved 85% to 100% agreement. A statement on the management of ME elicited agreement from the lowest rate (60%) up to 100%. The remaining two categories showed general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of ME. There was strong agreement on the histological definition of ME. Weaker agreement on management indicates a need for further investigations, better definitions and clinical trials to produce quality guidelines for management. This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy
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    ABSTRACT: Celiac disease is under-diagnosed. Many patients are examined by endoscopy, but celiac disease is missed or not detected. We evaluated the accuracy of finger prick-based point of care tests in detection of celiac disease and developed an algorithm for diagnosis. We performed a prospective study of 2 groups of patients with celiac disease evaluated at the Royal Hallamshire Hospital in Sheffield UK from March 2013 through February 2014. In group 1, patients at high risk of celiac disease who tested positive for endomysial antibody (n=55) were evaluated using the Biocard test and Celiac Quick Test, which measure antibodies to tissue transglutaminase (anti-tTG), and the Simtomax test, which measures deamidated gliadin peptide antibodies (DGP). Patients in group 2 (508 consecutive patients who underwent endoscopy examinations for any indication) received the DGP test, and were also evaluated using a diagnostic algorithm that incorporated results from the DGP test and data on symptoms. In both groups point of care tests were taken at the time of endoscopy and results were compared with results from histologic analyses of duodenal biopsies from all patients. In Group 1, the DGP test identified patients with celiac disease with 94.4% sensitivity, the Celiac Quick Test with 77.8% sensitivity (P=.03 vs the DGP test), and the Biocard test with 72.2% sensitivity (P=.008 vs the DGP test). In Group 2, the DGP test identified patients with celiac disease with 92.7% sensitivity (95% confidence interval [CI], 83.0-97.3), 85.2% specificity (95% CI, 81.5-88.3), a positive predictive value of 49.2% (95% CI, 40.3-58.2), and a negative predictive value of 98.7% (95% CI, 96.8-99.5). Measurement of serum anti-tTG identified patients with celiac disease with 91.2% sensitivity (95% CI, 81.1-96.4), 87.5% specificity (95% CI, 84.0-90.4), a positive predictive value of 53.0% (43.6-62.2), and a negative predictive value of 98.5% (95% CI, 96.5-99.4). The algorithm identified patients with celiac disease with 98.5% sensitivity; its use could reduce duodenal biopsies by 35%. In a prospective study, a test for DGP identified patients with celiac disease with similar levels of sensitivity and specificity as standard serologic analysis of anti-tTG. Use of the DGP test before endoscopy could increase the accuracy of diagnosis of celiac disease. Further studies, in lower prevalence populations, are required to assess the impact of the test in clinical practice. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    Clinical Gastroenterology and Hepatology 01/2015; DOI:10.1016/j.cgh.2015.01.010 · 6.53 Impact Factor
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    ABSTRACT: Celiac disease (CD) is a lifelong disorder. Patients are at increased risk of complications and comorbidity. We conducted a review of the literature on patient support and information in CD and aim to issue recommendations about patient information with regards to CD. We searched PubMed for English-language articles published between 1900 and June 2014, containing terms related to costs, economics of CD, or education and CD. Papers deemed relevant by any of the participating authors were included in the study. No quantitative synthesis of data was performed. Instead we formulated a consensus view of the information that should be offered to all patients with CD. There are few randomized clinical trials examining the effect of patient support in CD. Patients and their families receive information from many sources. It is important that health care personnel guide the patient through the plethora of facts and comments on the Internet. An understanding of CD is likely to improve dietary adherence. Patients should be educated about current knowledge about risk factors for CD, as well as the increased risk of complications. Patients should also be advised to avoid other health hazards, such as smoking. Many patients are eager to learn about future non-dietary treatments of CD. This review also comments on novel therapies but it is important to stress that no such treatment is available at present. Based on mostly observational data, we suggest that patient support and information should be an integral part of the management of CD, and is likely to affect the outcome of CD.
    12/2014; 3(2). DOI:10.1177/2050640614562599
  • Gut 11/2014; 64(6). DOI:10.1136/gutjnl-2014-308568 · 13.32 Impact Factor

Publication Stats

3k Citations
1,372.72 Total Impact Points

Institutions

  • 2003–2015
    • The University of Sheffield
      • Academic Urology Unit
      Sheffield, England, United Kingdom
    • Sheffield Teaching Hospitals NHS Foundation Trust
      Sheffield, England, United Kingdom
  • 2014
    • University of Cincinnati
      • Department of Neurology
      Cincinnati, Ohio, United States
  • 2002–2014
    • Royal Berkshire NHS Foundation Trust
      Reading, England, United Kingdom
  • 2012
    • St. James University
      Сент-Джеймс, New York, United States
    • Imperial College London
      Londinium, England, United Kingdom
  • 2011
    • The British Society for Gastroenterology
      Londinium, England, United Kingdom
    • East Coast Community Healthcare CIC
      Beccles, England, United Kingdom
  • 2010
    • Chesterfield Royal Hospital NHS Foundation Trust
      Chesterfield, England, United Kingdom
  • 2009
    • Dalhousie University
      Halifax, Nova Scotia, Canada