Ian Leonard Phillip Beales

Ian Leonard Phillip Beales
Norfolk and Norwich University Hospitals NHS Foundation Trust · Department of Gastroenterology

42.24
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MD

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149
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Publications

Publications (149)
Article
Full-text available
Objectives: Direct observation of procedural skills (DOPS) are competence-assessment tools in endoscopy. Formative paediatric gastroscopy DOPS were implemented into the UK curriculum in 2016 but lack validity evidence; we aimed to assess validity evidence using a recognised contemporary validity framework. Methods: We performed a prospective UK-...
Article
Objectives: This study aimed to examine changes to the microbiota composition and metabolic profiles of seven patients with recurrent Clostridium difficile infection (rCDI), following treatment with faecal microbiota transplant (FMT). Methods: 16S rDNA sequencing and 1H NMR were performed on faecal samples from the patients (pre-, post-FMT, and...
Article
Background: Direct Observation of Procedural Skills (DOPS) is an established competence assessment tool in endoscopy. In July 2016, the DOPS scoring format changed from a performance-based scale to a supervision-based scale. We aimed to evaluate the impact of changes to the DOPS scale format on the distribution of scores in novice trainees and on...
Article
Full-text available
Fecal microbiota transplant (FMT) has emerged as a highly efficacious treatment for difficult cases of refractory and/or recurrent Clostridium difficile infection (CDI). There have been many well-conducted randomized controlled trials and thousands of patients reported in case series that describe success rates of approximately 90% following one or...
Article
Full-text available
Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been pub...
Article
Full-text available
Purpose: Laboratory studies have suggested that statins may have useful anti-cancer effects against Barrett's epithelial cancer lines. A variety of effects have been reported in clinical studies. Methods: We performed a systematic review and meta-analysis of the association between statin use and the development of oesophageal cancer. Multiple d...
Conference Paper
Introduction DOPS are validated tools for assessing competence in endoscopy. Previously, DOPS were scored on a 4-point competence-based scale, with scores of 3 and 4 signifying competence. In July 2016, the DOPS rating scale changed to a supervision-based scale that has been shown to be more reliable, [1] with 4 ratings from maximal supervision, up...
Article
Staerk and colleagues’ paper provides support for the important, perhaps underused, practice of reintroducing anticoagulation after a gastrointestinal haemorrhage.1 Some aspects of the paper need to be put into context. The data on antiplatelet agents for atrial fibrillation have little relevance to current practice because the management and epide...
Article
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All post-graduate training programmes in the United Kingdom follow relevant competency-based curricula. Whilst much of trainees learning occurs during the day-day activities of their training posts, all training programmes support their trainees with a formal taught educational programme, usually based on full or half-days of education for all trai...
Article
It seems outrageous that the question of whether GPs should be paid to reduce unnecessary referrals is even being debated.1 Surely paying doctors not to refer is the same as doctors referring patients to a diagnostic or clinical facility in which they have a financial stake? This is morally and ethically wrong and at …
Article
Background Use of statins has been associated with a reduced incidence of esophageal adenocarcinoma in population-based studies. However there are few studies examining statin use and the development of Barrett’s esophagus. Aim The purpose of this study was to examine the association between statin use and the presence of Barrett’s esophagus in pat...
Article
Full-text available
Patients with inflammatory bowel disease (IBD) often have associated conditions, for which anti-inflammatory medication with cyclo-oxygenase (COX) inhibitors may be helpful. The current evidence is conflicting regarding the role of COX-inhibitors in causing relapse in IBD. This case-control study examined the association between the use of COX inhi...
Article
Full-text available
Background: Patients with inflammatory bowel disease (IBD) often have associated conditions which may benefit from treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or selective cyclo-oxygenase-2 (COX-2) inhibitors. However, evidence has suggested there may be an association between COX-inhibition and relapse in IBD, which leads to clin...
Article
Full-text available
In recent decades there has been a dramatic rise in the incidence of esophageal adenocarcinoma (EAC) in the developed world. Over approximately the same period there has also been an increase in the prevalence of obesity. Obesity, especially visceral obesity, is an important independent risk factor for the development of gastro-esophageal reflux di...
Article
Full-text available
Barrett's esophagus (BE) increases risk for esophageal adenocarcinoma (EAC). Increased risk for BE has been associated with single nucleotide polymorphisms (SNPs) on chromosome 6p21 (within the HLA region) and on 16q23, where the closest protein-coding gene is FOXF1. The Barrett's and esophageal adenocarcinoma consortium (BEACON) identified risk lo...
Article
The incidence of oesophageal adenocarcinoma has increased dramatically in the developed world in the last half century. Over approximately the same period there has been an increase in the prevalence of obesity. Multiple epidemiological studies and meta-analyses have confirmed that obesity, especially abdominal, visceral obesity, is a risk factor f...
Article
Full-text available
Background & Aims: Barrett's esophagus (BE) increases the risk of esophageal adenocarcinoma (EAC). We found the risk to be BE has been associated with single nucleotide polymorphisms (SNPs) on chromosome 6p21 (within the HLA region) and on 16q23, where the closest protein-coding gene is FOXF1. Subsequently, the Barrett's and Esophageal Adenocarcino...
Article
Full-text available
Objective: Polyp detection rate (PDR) is an accepted measure of colonoscopy quality. Several factors may influence PDR including time of procedure and order of colonoscopy within a session. Our unit provides evening colonoscopy lists (6-9 pm). We examined whether colonoscopy performance declines in the evening. Design: Data for all National Health...
Article
Full-text available
Objective: Polyp detection rate (PDR) is an accepted measure of colonoscopy quality. Several factors may influence PDR including time of procedure and order of colonoscopy within a session. Our unit provides evening colonoscopy lists (6-9 pm). We examined whether colonoscopy performance declines in the evening. Design: Data for all National Health...
Article
Acute upper gastrointestinal (GI) bleeding is a common medical emergency and associated with significant morbidly and mortality. The risk of bleeding from peptic ulceration and oesophagogastric varices can be reduced by appropriate primary and secondary preventative strategies. Helicobacter pylori eradication and risk stratification with appropriat...
Article
To examine the association between statin use and the development of esophageal cancer We performed a systematic review and meta-analysis. Multiple databases (Pubmed, EMBASE, Cochrane Library, Web of Science, Wiley Interscience and Google Scholar) were systematically searched for studies reporting the association of statin use and the development o...
Article
Full-text available
Introduction Polyp detection rate (PDR) is an accepted measure of quality of colonoscopy. Several factors may influence PDR including time of procedure and rank of colonoscopy within a session. Our unit provides evening colonoscopy lists (6–9 pm) to meet high demand and improve patient convenience, but it is unknown if colonoscopy performance decli...
Article
Full-text available
Background: Probiotic preparations are heavily promoted in the United Kingdom and are widely available to purchase. Probiotics have multiple effects on gastrointestinal functions and may have beneficial or even harmful effects in inflammatory bowel disease (IBD). Various complementary and alternative medicines are commonly used by IBD patients but...
Article
Ford and colleagues’ summary of the current management of ulcerative colitis highlights the major failings of chronic disease management in the current purchaser-provider split NHS; this will only get worse with the upcoming changes.1 They rightly highlight the importance of preventing opportunistic infections with immunisations. …
Article
Full-text available
Background: Reports have suggested that academic medicine may be in decline within the UK. Further evidence suggests that rates of subsequent full publication of abstracts presented at major scientific meetings are low and may be declining. We have compared the publication rates of abstracts presented at meetings of the British Society of Gastroent...
Article
Full-text available
The role of the peptide hormone gastrin in stimulating gastric acid secretion is well established. Mature amidated gastrin is processed from larger peptide precursor forms. Increasingly these processing intermediates, such as glycine-extended gastrin (G-Gly) and progastrin, have been shown to have biological activities of their own, often separate...
Article
Background Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) have been shown to have potentially useful anticancer effects against colorectal cancers in experimental studies, but clinical studies have shown inconsistent results on colorectal cancer incidence. Most colorectal cancers are believed to develop through the polyp-cancer seq...
Article
The incidence of esophageal adenocarcinoma (EAC) is increasing significantly throughout the developed world. As yet, there are no proven chemopreventive strategies. In laboratory studies, aspirin, non-steroidal anti-inflammatory drugs and statins have promising chemopreventive actions. Several observational studies support a protective effect of as...
Article
Oesophageal adenocarcinoma (OAC) has a poor prognosis, and chemoprevention is an attractive option to reduce the burden of the disease. Hydroxyl-methyl-CoA reductase inhibitors (statins) have been shown to exert potentially useful anticancer effects against OAC cell lines, but there are only limited clinical data examining the effects of statins on...
Article
Full-text available
The aetiology of colorectal cancer (CRC) remains elusive in the majority of cases. There is experimental evidence to show that HMG-CoA reductase inhibitors (statins) may inhibit proliferation and induce cause apoptosis in CRC cells and although some clinical studies have suggested that statins may protect against the development of CRC, this has no...
Article
Reasons for the rising annual incidence of esophageal adenocarcinoma (EAC) remain uncertain. Previous studies have given conflicting results, but some have suggested that drugs which relax the lower esophageal sphincter (LES) may increase the risk of EAC. This study is to determine systematically the risk of EAC associated with individual medicatio...
Article
The following on progression to adenocarcinoma and markers of Barrett's esophagus includes commentariess on the expression of claudin 4 in Barrett's adenocarcinoma; the role of acid and bile salts; the role of insulin-like growth factor; the value of reactive oxygen species; the importance of abnormal methylation; genetic alterations in stromal cel...
Article
Full-text available
Introduction Colorectal cancer (CRC) remains a major clinical problem: advances in screening and therapies have improved the prognosis, but effective and safe chemopreventative strategies would likely be beneficial. HMG-CoA reductase inhibitors (statins) have been shown to have anti-CRC effects in vitro, inhibiting growth and inducing apoptosis, bu...
Article
Full-text available
Peptic ulcer bleeding remains a common cause of hospital admission, morbidity and mortality. Data published since 2006 illustrate that assessment, endoscopic and pharmacological management, and follow-up strategies can be refined to improve the overall prognosis of peptic ulcer bleeding.
Article
Full-text available
Barrett's oesophagus (BO) and oesophageal adenocarcinoma (OAC) are regarded as complications of gastro-oesophageal reflux disease, although all the factors that contribute to the development of these lesions are unknown. Acid suppressive drugs are widely used for symptomatic therapy of reflux disease but may induce hypersecretion of gastrin peptide...
Article
Prostaglandins are important in the progression of various gastrointestinal cancers including oesophageal adenocarcinoma (OAC). Cyclo-oxygenase (COX)-2 inhibitors reduce OAC prostaglandin production but also have potentially detrimental effects on vascular endothelial function by reducing prostacyclin production and increasing the risk of cardiovas...
Article
Glycine-extended gastrin (G-Gly) is a mitogen for several gastrointestinal tissues although the mechanisms responsible are ill-defined and it is unknown if G-Gly can influence signalling in Barrett's oesophagus. G-Gly stimulated proliferation in OE19 and OE33 cells in a dose-dependant manner. This was unaffected by a CCK2 receptor antagonist but ab...
Article
The incidence and mortality rates from esophageal adenocarcinoma (EAC) are rapidly increasing in the western world. Chemoprevention is being advocated to reduce the burden of disease. Statins are used clinically to treat hypercholesterolemia, and have an excellent safety profile. Statins reduce the intracellular availability of several biosynthetic...
Article
Obesity increases the risk of developing several cancers including oesophageal adenocarcinoma (OAC). Obesity is characterised by hyperleptinaemia and hypoadiponectinaemia: we have hypothesised that these hormonal factors may contribute to the progression of OAC. We have examined the effects of leptin and adiponectin on proliferation of OAC cells. L...
Article
Full-text available
Obesity increases the risk of developing oesophageal adenocarcinoma (OAC) as well as several other cancers. Leptin is secreted by adipocytes and serum leptin levels rise with body mass index. Leptin stimulates proliferation and inhibits apoptosis in OAC cells but the mechanisms are not fully elucidated, Transactivation of the epidermal growth facto...
Article
Systemic corticosteroids are effective in ulcerative colitis but commonly cause side effects. To compare the safety and efficacy of a sparingly absorbed formulation of prednisolone metasulfobenzoate (Predocol) with a conventional tapering course of oral prednisolone. In a double-blind randomized study, 59 active ulcerative colitis patients received...
Article
Obesity and gastro-oesophageal reflux are the main predisposing factors for oesophageal adenocarcinoma. We have examined the effects of transient acid exposure and leptin on OE33 oesophageal adenocarcinoma cells. Leptin and acid individually stimulated proliferation and inhibited apoptosis and the combination was synergistic. Leptin receptor protei...
Article
Full-text available
Obesity increases the risk of colon cancer. Hyperleptinemia is characteristic of obesity and leptin has been reported to be a colonic growth factor. We have examined the involvement of the cyclo-oxygenase (COX) pathways in the proliferation and anti-apoptotic effects of leptin. Leptin stimulated proliferation in HT-29 colon cancer cells: this was u...
Article
Full-text available
Obesity is a major risk factor for the development of colon cancer. Secretion of the hormone leptin from adipocytes is increased in obesity, and serum levels are proportional to body fat mass. Serum leptin levels are an independent risk factor for colon cancer. Leptin receptors are expressed in normal, premalignant and malignant colonic epithelia....
Article
Full-text available
The incidence of oesophageal adenocarcinoma is increasing rapidly in the developed world. The serine-threonine protein kinase and proto-oncogene Akt has been reported to regulate proliferation and apoptosis in several tissues but there are no data on the involvement of Akt in oesophageal carcinogenesis. Therefore we have examined the activation of...
Article
Full-text available
Obesity is an important risk factor for esophageal adenocarcinoma (EAC), and elevated serum leptin is characteristic of obesity. We hypothesized that leptin may have biological effects in promoting esophageal adenocarcinoma and examined the effects of leptin on the OE33 Barrett's-derived EAC line. Proliferation was assessed by dimethylthiazoldiphen...
Article
Adiponectin is a recently described mediator secreted by adipose tissue. Here we report the growth promoting and pro-inflammatory actions of adiponectin on colonic epithelial cancer cells. Full-length and globular adiponectin produced an identical stimulation of HT-29 cell growth that was blocked by inhibition of adenylate cyclase and protein kinas...
Article
Glycine-extended gastrin (G-Gly) is produced by colon cancers and has growth promoting and anti-apoptotic effects in the colonic epithelium. We have examined the anti-apoptotic effects of G-Gly and the signal transduction pathways involved. G-Gly stimulated HT-29 cell proliferation in a concentration dependent manner and inhibited serum-starvation...
Article
Glycine-extended gastrin (G-Gly) is an end product of processing of the progastrin precursor peptide that has a different spectrum of activity to amidated gastrin. G-Gly promotes cell proliferation in normal and malignant colonic epithelium but the mechanisms responsible are poorly understood. Prostaglandins produced by the cyclo-oxygenase (COX) en...
Conference Paper
Glycine-extended gastrin (G-Gly) is an end product of processing of the progastrin precursor peptide that has a different spectrum of activity to amidated gastrin. G-Gly promotes cell proliferation in normal and malignant colonic epithelium but the mechanisms responsible are poorly understood. Prostaglandins produced by the cyclo-oxygenase (COX) en...
Article
The hormone gastrin stimulates proliferation of the gastric mucosa. Inflammation of the stomach is also associated with increased proliferation. The proliferative response is important in the reparative response to injury but can be deleterious by predisposing to the development of cancer. Parietal cells, but not the cells in the proliferative zone...
Article
Full-text available
EDITOR—The paper by Harvey at al shows several inconsistencies.1 The first line contains an error: most patients with Helicobacter pylori actually have a mild pangastritis with normal or decreased intragastric acidity; the antral inflammation stimulates hypergastrinaemia but is balanced by a relative suppression of acid secretion by the oxyntic bod...
Article
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EDITOR—Hearnshaw and Glasziou and Chalmers highlight the inconsistencies and arbitrary decision making of UK research ethics committees and show that this may delay and suppress clinical research in the United Kingdom.1 2 I recently submitted a study that required six months, countless emails, and submission of 1443 sheets of A4 paper to gain appro...
Article
Full-text available
Amylin (islet amyloid polypeptide) is a hormone with suggested roles in the regulation of glucose homeostasis, gastric motor and secretory function and gastroprotection. In the gastric mucosa amylin is found co-localised with somatostatin in D-cells. The factors regulating gastric amylin release are unknown. In this study we have investigated the r...
Article
Full-text available
I enjoyed reading the guidelines on non-variceal upper gastrointestinal haemorrhage ( Gut 2002; 51 (suppl 4):V1–6) and would like to congratulate the British Society of Gastroenterology (BSG) on their production, and hope they will form the basis for continued improvements in the management of this condition. However, several areas of the guideline...
Article
Full-text available
I enjoyed reading Kyne and Kelly's therapy update concerning treatments for recurrent Clostridium difficile diarrhoea ( Gut 2001; 49 :152–3). Recurrence after a single episode of diarrhoea can occur in up to 50% of cases1 and following recurrent bouts further relapse is even more likely. The authors have demonstrated that a serum antibody response...
Article
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N-alpha-methyl-histamine, which is produced in the gastric mucosa by Helicobacter pylori, is a potent H-2 receptor agonist as well as a H-3 receptor agonist.
Article
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Helicobacter pylori is the main risk factor for the development of non-cardia gastric cancer. Increased proliferation of the gastric mucosa is a feature of H. pylori infection. Mucosal interkeukin-1beta production is increased in H. pylori infection and IL-1beta genotypes associated with increased pro-inflammatory activity are risk factors for the...
Article
EDITOR—Harris and Misiewicz in their review of managing Helicobacter pylori infection take a balanced view of the contentious issues surrounding treatment in patients without ulcers.1 But several inconsistencies are apparent in their approach to patients with ulcers, for whom solid evidence for treatment is available. Harris and Misiewicz advocate...
Article
The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastr...
Article
Full-text available
Interleukin 1beta (IL-1beta) is a potent inhibitor of gastric acid secretion. Regulatory actions at several levels have previously been demonstrated, including direct inhibition of parietal cell acid secretion. Although IL-1beta may activate several intracellular signalling pathways, the mechanisms responsible for inhibition of carbachol stimulated...
Article
Gastric infection with Helicobacter pylori is associated with hypergastrinemia. Platelet activating factor (PAF) is produced in H. pylori-infected mucosa. The effects of PAF on gastrin release from cultured antral rabbit G cells were examined. Rabbit antral G-cells were obtained by collagenase-EDTA digestion and enriched by centrifugal elutriation....

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