David S Sanders

The University of Sheffield, Sheffield, England, United Kingdom

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Publications (328)2322.51 Total impact

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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; · 5.12 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.
    The Proceedings of the Nutrition Society. 02/2015;
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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.
    01/2015;
  • M Kurien, P D Mooney, D S Sanders
    Alimentary Pharmacology & Therapeutics 01/2015; 41(1):146-7. · 4.55 Impact Factor
  • Gut 11/2014; · 13.32 Impact Factor
  • Matthew Kurien, Hugo Penny, David S Sanders
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    ABSTRACT: Introduction: Gastric access devices such as nasogastric tubes and gastrostomy tubes are increasingly being used in clinical practice to provide both short- and long-term nutrition support therapy. Increasingly these devices are being utilized to help deliver oral medications, where swallowing is impaired. This concomitant administration of medications and enteral formulas could derive potential benefits in regard to time and cost; however, uncertainty exists regarding potential drug and nutrient interactions and the influence this may have on both safety and efficacy. Areas covered: This article provides an overview of the differing gastric access devices used in clinical practice and evaluates the evidence base for using oral medications via these routes. Alternative methods of drug administration are discussed, alongside common drug nutrient interactions and potential complications. Expert opinion: Delivering medications via gastric access devices can be performed safely; however, careful consideration needs to be made regarding tube and patient influences, alongside drug-nutrient interactions. Improving practice in this area in the future necessitates enhancement of an evidence base to substantiate the safety of drug delivery via gastric access devices and improvement in education among healthcare professionals about the potential problems.
    Expert Opinion on Drug Delivery 10/2014; · 4.12 Impact Factor
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    ABSTRACT: Introduction: Coeliac disease is an autoimmune gluten sensitive enteropathy and is now known to affect 1% of the adult population. A gluten-free diet (GFD) should be curative; however, up to 30% of patients have persistent symptoms and many patients find the diet difficult to fully adhere to. Currently, there are no licensed therapeutic options for patients with coeliac disease outside of a GFD.Areas covered: This review will outline the case for alternative treatments and discuss the potential therapeutic targets. The products in the most advanced stage of development will be discussed in detail.Expert opinion: There is clearly an unmet need for alternatives to a GFD for the treatment of coeliac disease. Oral glutenase supplements to improve the degradation of gluten into non-toxic peptides appear to be the most likely to provide a breakthrough in the treatment of coeliac disease; however, other modalities such as a therapeutic vaccine or zonulin inhibitors to reduce intestinal permeability have shown promising results.
    Expert Opinion on Emerging Drugs 09/2014; · 2.48 Impact Factor
  • Imran Aziz, Marios Hadjivassiliou, David S Sanders
    The American Journal of Gastroenterology 09/2014; 109(9):1498-9. · 9.21 Impact Factor
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    ABSTRACT: Background Celiac disease (CD) is a common but underdiagnosed condition. A rapid point-of-care test (POCT) could reduce lead times and missed diagnoses. Objective To assess the utility of an immunoglobulin (Ig) A tissue transglutaminase (TTG) antibody POCT in an endoscopic setting. Design Prospective observational study. Setting A single UK university hospital. Patients Patients presenting with suspected CD, known CD, and routine endoscopy for upper GI symptoms. Interventions All patients were tested with POCT, serum TTG, endomysial antibody (EMA), and upper GI endoscopy with duodenal biopsies at the same visit. Main Outcome Measurements Comparison was made with histology in all cases, with villous atrophy regarded as diagnostic of CD. Results A total of 576 patients (63.5% female, mean [± standard deviation] age 49.7 years [± 17.6 years]) were recruited. A total of 523 patients had no prior diagnosis of CD, and 53 patients had known CD coming for reassessment. A total of 117 patients were newly diagnosed with CD, and 82 were positively identified by the POCT. Sensitivity, specificity, positive predictive value, and negative predictive value were 70.1%, 96.6%, 85.4%, and 91.8%, respectively. In comparison, TTG and EMA both performed significantly better than the POCT. Sensitivity and specificity of TTG were 91.0% and 83.5%, respectively, and EMA were 83.8% and 97.5%, respectively. Of patients with known CD coming for reassessment, 26 had villous atrophy, and POCT results were positive in 16 (61.5%). There was poor agreement between POCT and standard serology. Limitations High pre-test probability of CD. Conclusion The performance of this POCT was disappointing compared with standard serology and cannot at present be recommended within the context of an endoscopy unit.
    Gastrointestinal endoscopy 09/2014; · 4.90 Impact Factor
  • Peter D Mooney, David S Sanders
    Journal of gastrointestinal and liver diseases: JGLD 09/2014; 23(3):241. · 1.85 Impact Factor
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    ABSTRACT: In view of the increasing popularity of a gluten-free diet, we sought to determine whether there has been a change in awareness of gluten-related disorders (GRD) among the general public and chefs.
    European Journal of Gastroenterology & Hepatology 08/2014; · 2.15 Impact Factor
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    ABSTRACT: There has been increasing interest in subclassifying irritable bowel syndrome (IBS) to make a positive diagnosis.
    European Journal of Gastroenterology & Hepatology 07/2014; · 2.15 Impact Factor
  • Imran Aziz, Tim Key, John G Goodwin, David S Sanders
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    ABSTRACT: Duodenal intraepithelial lymphocytosis (D-IEL) is an early marker for celiac disease (CD). However, the majority of cases are due to non-CD-related conditions.
    Journal of Clinical Gastroenterology 07/2014; · 3.19 Impact Factor
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    I. Aziz, M. Hadjivassiliou, D. S. Sanders
    Alimentary Pharmacology & Therapeutics 07/2014; 40(1). · 5.48 Impact Factor
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    Alimentary Pharmacology & Therapeutics 07/2014; 40(2):215. · 4.55 Impact Factor
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    ABSTRACT: A multidisciplinary panel of 18 physicians and 3 non-physicians from eight countries (Sweden, UK, Argentina, Australia, Italy, Finland, Norway and the USA) reviewed the literature on diagnosis and management of adult coeliac disease (CD). This paper presents the recommendations of the British Society of Gastroenterology. Areas of controversies were explored through phone meetings and web surveys. Nine working groups examined the following areas of CD diagnosis and management: classification of CD; genetics and immunology; diagnostics; serology and endoscopy; follow-up; gluten-free diet; refractory CD and malignancies; quality of life; novel treatments; patient support; and screening for CD.
    Gut 06/2014; · 13.32 Impact Factor
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    ABSTRACT: Introduction The pinnacle for SPRs who undertake research is to initially present in abstract form at national and international meetings and ultimately publish in peer-reviewed journals. We have previously shown that full publication rate from the BSG has ranged from 20.4–55.9%, furthermore the trend over a 15 year period suggests a reduction in full publication rates. There has been no study which assesses the publication rate or utility of regional research meetings in the UK. Our study prospectively presents 10 years of abstract publications rates and qualitative data from the South Yorkshire Regional Gastroenterology meeting (the Bardhan Fellowship).Methods 112 abstracts were presented at the meeting between 2003 and 2012. Abstracts were ranked at each meeting by peer review and the winner awarded a monetary prize. Subsequent full publication rates were determined using Medline searches of peer-reviewed journals. Searches were made firstly by the author’s name, subsidiary authors’, keywords from the abstract titles and personal communication with presenters.Qualitative data collected at each meeting in the form of an evaluation form was also available to provide subjective feedback from attendees on the relevance of the event.Results Overall, 37 (33%) abstracts went on to be published in peer-reviewed journals. Of the 112 abstracts presented, 32 were ranked in the top 3 of their respective meetings, of whom 24 went on to be published in peer-reviewed journals (75%), compared with 13 of the 80 not ranked (16.25%) (p < 0.0001).Ranking within the top 3 resulted in a higher impact factor (median 4.06) publication, compared with those ranked outside the top 3 (2.87) (p < 0.05), and to more rapid publication (12.8 vs. 19.3 months).Qualitative feedback indicated that >95% attendees felt the meeting was educationally beneficial, relevant to their professional development and had encouraged them to participate in research for themselves.Conclusion This is the first study to assess the value of regional SPR meetings. In terms of overall abstract publication rate, the data shows that the Bardhan fellowship is comparable with the BSG. Peer review appears to reliably predict subsequent publication success. Trainees ranked ‘top three’ at the meeting are significantly more likely to publish their work in peer-reviewed journals. Regional meetings can promote research and are a ‘friendly’ environment in which SPR’s can improve their presentation skills and may stimulate them to consider a formal period of research. We would encourage Deanery support for such initiatives.Disclosure of Interest None Declared.
    Gut 06/2014; 63(Suppl 1):A41. · 13.32 Impact Factor
  • PD Mooney, S Wong, A Johnston, DS Sanders
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    ABSTRACT: Introduction Coeliac disease (CD) remains underdiagnosed. Previous studies have shown that up to 13% of patients with CD have undergone a previous gastroscopy where the opportunity to take duodenal biopsies and make a diagnosis had been missed. Clinicians may rely on the presence of endoscopic markers of CD to guide biopsy however these have been shown to lack the required sensitivity. A routine duodenal biopsy approach may solve this problem but this is time consuming and expensive. Methods to improve the macroscopic detection of CD at endoscopy to guide biopsy would seem advantageous. A single trial on I-Scan, a commercially available digital enhancement technique, has shown promising results in identifying markers of villous atrophy. However this was an uncontrolled, unblinded trial in high prevalence population (35% CD). We aimed to assess the utility of I-Scan in a lower prevalence population in a randomised controlled trial.Methods Patients on a single coeliac enriched endoscopy list were randomised into 2 groups. Group 1 standard HD white light endoscopy (WLE) and group 2 WLE plus I-Scan. The presence of endoscopic markers of CD, scalloping, mosaic pattern, nodularity, loss of duodenal folds or increased vascularity was noted throughout the duodenum. All patients received 4 biopsies from the second part of the duodenum and at least 1 biopsy from the bulb. Coeliac serology was taken at the time of endoscopy. Macroscopic markers of CD are compared to the presence of villous atrophy on histology as the gold standard. 3, 10-point likert scales for pain, discomfort and distress were used to assess tolerability.Results 116 patients (66 female, mean age 54.9 SD 17.5) have been recruited to date (55 into group 1 and 61 in group 2). In total 14 (12.1%) new diagnoses of CD have been made. I-Scan appears to enhance the appearance of markers for CD and in a single patient in group 2 CD markers that were not noted to be seen on WLE became apparent. Preliminary results show that endoscopic markers of CD across both groups currently have a sensitivity of 78.6% (48.8 – 94.3), specificity 82.4% (73.3 – 88.9), positive and negative predictive values of 37.9% (21.3 – 57.6) and 96.6 (89.5 – 99.1). Median tolerability scores were good in both groups but better in the I-Scan group than WLE alone (4/30 vs. 8/30 p 0.005).Conclusion The addition of I-Scan to standard endoscopy to aid the diagnosis of CD is well tolerated and is feasible. I-Scan appears to enhance the markings of coeliac disease, however a larger study is required to truly evaluate the effectiveness of I-Scan as an adjunct to standard endoscopy to increase CD diagnosis.Disclosure of Interest None Declared.
    Gut 06/2014; 63(Suppl 1):A263-A264. · 13.32 Impact Factor
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    ABSTRACT: Introduction Endoscopic markers of coeliac disease (CD) lack sensitivity; therefore many centres take routine duodenal biopsies or have a low threshold for biopsy, ensuring high detection rates. Newly available, point of care tests (POCT) provide rapid findings unlike conventional serological markers, potentially reducing the need for duodenal biopsies. This study evaluates a new POCT (Simtomax) which detects IgA and IgG deamidated gliadin peptide (DGP) with comparisons made to conventional serological markers and histology.Methods Patients referred for a gastroscopy to a specialist CD list were prospectively recruited between March and November 2013. Patients were excluded if they were on a gluten free diet at the time of the test or if they had previously been diagnosed with seronegative villous atrophy. All patients had a duodenal biopsy as the gold standard for detecting CD. Concurrently serological testing for IgA tissue transglutaminase (TTG), endomysial antibody (EMA), total immunoglobulin A level and the DGP based rapid test was performed. Sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV) were calculated.Results 354 patients met the inclusion criteria (45.8% male mean age 53.3 +18.5). Of these, 52 (14.7% 11.2 – 18.9) had newly diagnosed CD and 302 were controls with a normal duodenal biopsy. The sensitivity, specificity, PPV and NPV for the POCT were 94, 83, 49 and 99% respectively. This compares with results for TTG of 92, 88, 57, 99 and EMA of 88, 97, 85, and 98% respectively. In a second cohort, 43 patients with known CD for re-assessment were recruited (20.9% male, mean age 49.4 +16.6). 16 (37% 23 -53) of these 16 patients (37%) had persistent villous atrophy despite a gluten free diet. POCT compared to histology showed sensitivity of 88% and specificity 41%. tTG showed sensitivity and specificity of 63 and 70% respectively and EMA 56 and 78% respectively. However agreement between histology and POCT was poor with concordance between results in only 60% (κ=0.274). tTG and EMA were marginally better with κ=0.321 and κ=0.345 respectively.Conclusion This is the first study to prospectively demonstrate the value of a novel POCT for adult CD in endoscopy compared to the gold standard of histology. The sensitivity and specificity of the POCT is comparable to conventional serology. Simtomax could be used to appropriately identify patients requiring a duodenal biopsy within the endoscopic setting. This strategy may be cost effective by reducing the number of routine duodenal biopsies taken. Further work is required to clarify the role of POCT for the assessment of histological remission in patients with known CD.Disclosure of Interest None Declared.
    Gut 06/2014; 63(Suppl 1):A262. · 13.32 Impact Factor

Publication Stats

5k Citations
2,322.51 Total Impact Points

Institutions

  • 2004–2014
    • The University of Sheffield
      • Academic Urology Unit
      Sheffield, England, United Kingdom
  • 2003–2014
    • Sheffield Teaching Hospitals NHS Foundation Trust
      Sheffield, England, United Kingdom
  • 2002–2014
    • Royal Berkshire NHS Foundation Trust
      Reading, England, United Kingdom
  • 2011
    • East Coast Community Healthcare CIC
      Beccles, England, United Kingdom
  • 2010
    • Imperial College Healthcare NHS Trust
      Londinium, England, United Kingdom
    • Chesterfield Royal Hospital NHS Foundation Trust
      Chesterfield, England, United Kingdom
  • 2005
    • University of Nottingham
      Nottigham, England, United Kingdom