ORCID Profile
0000-0002-9149-3589
Current Organisations
Monash University
,
Northern Health
,
Melbourne Health
,
Eastern Health
,
University of Melbourne
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Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.CLNU.2017.06.011
Abstract: Vitamin D at serum 25(OH)D concentrations above 100 nmol/L is associated with disease remission in patients with IBD, suggesting targeted dosing might be anti-inflammatory. This study aimed to assess the effectiveness, safety and predictors of a 12-week regimen of vitamin D supplementation to achieve such a target in patients with active disease. In a pilot study, patients with active colitis and a serum 25(OH)D concentration <75 nmol/L were prescribed oral liquid vitamin D supplementation over 12 weeks using a specific protocol with dose adjusted 4-weekly to aim for a target level of 100-125 nmol/L. Five patients each with Crohn's colitis or ulcerative colitis (UC) had mean 25(OH)D concentration 52 (range 27-73 nmol/L). Five reached the targeted level and four 89-95 nmol/L. One withdrew after 4 weeks (88 nmol/L). Target dose was met only in those with BMI <30 kg/m A specified oral vitamin D regimen successfully and safely achieved target or near-target levels, improved symptom-based activity scores, but did not alter objective measures of intestinal or systemic inflammation. A modified version of this dose-escalating regimen would be suitable for a randomised placebo-controlled trial, but does require regular safety monitoring.
Publisher: Wiley
Date: 07-2022
DOI: 10.1111/IMJ.15840
Abstract: Inflammatory bowel disease is a chronic gastrointestinal condition that necessitates life‐long healthcare engagement and management. Empowering patients with knowledge is fundamental to enhance health literacy, improve health outcomes and facilitate complex decision‐making regarding medication and potential surgery. A working group was formed to develop concise, comprehensive patient information sheets to meet this unmet need in the Australian setting.
Publisher: Wiley
Date: 26-05-2020
DOI: 10.1111/APT.15779
Publisher: Wiley
Date: 10-2019
DOI: 10.1111/APT.15470
Publisher: SAGE Publications
Date: 2019
Abstract: The intestinal vitamin D receptor (VDR) remains poorly characterized in patients with inflammatory bowel disease (IBD). Colonoscopic biopsies and intestinal resection specimens from the terminal ileum, ascending and sigmoid colon, from patients with and without IBD, were analyzed for VDR mRNA quantification by polymerase chain reaction, and protein localization and semi-quantification by immunohistochemistry. The relationship between VDR and intestinal inflammation, serum 25(OH)D and oral vitamin D intake was elicited. A total of 725 biopsies from 20 patients with Crohn’s disease (CD), 15 with ulcerative colitis (UC) and 14 non-IBD controls who underwent colonoscopy were studied. VDR gene expression and protein staining intensity was similar across all three groups, and across the intestinal segments. Sigmoid colon VDR mRNA expression inversely correlated with faecal calprotectin ( r = −0.64, p = 0.026) and histological score ( r = −0.67, p = 0.006) in UC, and histological score ( r = −0.58, p = 0.019) in patients with CD. VDR staining intensity was higher in quiescent than diseased segments. No relationship with serum 25(OH)D or oral vitamin D intake was noted. Immunohistochemical staining of 28 intestinal resection specimens from 15 patients (5 each with CD, UC and non-IBD controls) showed diffuse VDR staining in the mucosa, submucosa and circular muscle. VDR transcript expression and protein staining intensity are inversely related to inflammation in IBD, but unrelated to serum 25(OH)D, and similar to non-IBD controls. Strategies to upregulate intestinal VDR, potentially translating to modulation of disease activity, require investigation.
Publisher: Wiley
Date: 2021
DOI: 10.1111/IMJ.15162
Publisher: Wiley
Date: 28-03-2019
DOI: 10.1111/APT.15199
Publisher: Wiley
Date: 27-12-2018
DOI: 10.1111/APT.15079
Abstract: Despite the efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) for patients with irritable bowel syndrome, many questions remain unanswered with respect to its clinical implementation. To review literature to identify, synthesise, and provide direction for future research in the implementation and evaluation of the low FODMAP diet. Bibliographical searches were performed in Ovid Medline, CINAHL, Scopus and PubMed from database commencement until September 2018, with search terms focused on the population (irritable bowel syndrome) and intervention of interest (FODMAP). Predictors of response to a low FODMAP diet remain under investigation, with preliminary data supporting faecal microbiota or faecal volatile organic compound profiling. Training of clinicians, and standards for the education of patients about the phases of a low FODMAP diet, as well as the role of Apps, require formal evaluation. There are limited data on the longer term efficacy and safety of the low FODMAP diet with respect to sustained symptom control, effect on quality of life and healthcare utilisation, nutritional adequacy, precipitation of disordered eating behaviours, effects on faecal microbiota and metabolomic markers, and subsequent translation to clinical effects. Many gaps in implementation of the low FODMAP diet in clinical practice, as well as long-term safety and efficacy, remain for further investigation.
Publisher: Wiley
Date: 12-05-2020
DOI: 10.1111/APT.15796
Publisher: Wiley
Date: 11-08-2021
DOI: 10.1111/APT.16521
Abstract: This article is linked to Gordon et al paper. To view this article, visit 0.1111/apt.16155
Publisher: BMJ
Date: 19-01-2022
Publisher: Wiley
Date: 28-11-2018
DOI: 10.1111/APT.15027
Publisher: Wiley
Date: 10-06-2022
DOI: 10.1111/APT.16954
Abstract: This article is linked to Quinn et al papers. To view these articles, visit 0.1111/apt.16859 and 0.1111/apt.16988
Publisher: Wiley
Date: 31-07-2021
DOI: 10.1111/APT.16519
Abstract: This article is linked to Frazzoni et al paper. To view this article, visit 0.1111/apt.16371
Publisher: Wiley
Date: 27-03-2019
DOI: 10.1002/JGH3.12150
Publisher: Wiley
Date: 31-07-2021
DOI: 10.1111/APT.16450
Abstract: This article is linked to Almradi et al paper. To view this article, visit 0.1111/apt.16248
Publisher: Wiley
Date: 14-02-2023
DOI: 10.1111/APT.17341
Abstract: This article is linked to Hocking et al paper. To view this article, visit 0.1111/apt.17309
Publisher: BMJ
Date: 16-05-2023
Publisher: BMJ
Date: 13-08-2019
DOI: 10.1136/GUTJNL-2019-318512
Abstract: We evaluated the influence of the renin–angiotensin system (RAS) on intestinal inflammation and fibrosis. Cultured human colonic myofibroblast proliferation and collagen secretion were assessed following treatment with angiotensin (Ang) II and Ang (1–7), their receptor antagonists candesartan and A779, and the ACE inhibitor captopril. Circulating and intestinal RAS components were evaluated in patients with and without IBD. Disease outcomes in patients with IBD treated with ACE inhibitors and angiotensin receptor blockers (ARBs) were assessed in retrospective studies. Human colonic myofibroblast proliferation was reduced by Ang (1–7) in a dose-dependent manner (p .05). Ang II marginally but not significantly increased proliferation, an effect reversed by candesartan (p .001). Colonic myofibroblast collagen secretion was reduced by Ang (1–7) (p .05) and captopril (p .001), and was increased by Ang II (p .001). Patients with IBD had higher circulating renin (mean 25.4 vs 18.6 mIU/L, p=0.026) and ACE2:ACE ratio (mean 0.92 vs 0.69, p=0.015) than controls without IBD. RAS gene transcripts and peptides were identified in healthy and diseased bowels. Colonic mucosal Masson’s trichrome staining correlated with Ang II (r=0.346, p=0.010) and inversely with ACE2 activity (r=−0.373, p=0.006). Patients with IBD who required surgery (1/37 vs 12/75, p=0.034) and hospitalisation (0/34 vs 8/68, p=0.049) over 2 years were less often treated with ACE inhibitors and ARBs than patients not requiring surgery or hospitalisation. The RAS mediates fibrosis in human cell cultures, is expressed in the intestine and perturbed in intestinal inflammation, and agents targeting this system are associated with improved disease outcomes.
Publisher: Wiley
Date: 25-07-2023
DOI: 10.1111/IMJ.16184
Abstract: Iron deficiency is the most common nutritional deficiency worldwide, with significant adverse health consequences in the presence or absence of anaemia. Total dose intravenous iron replacement is recommended for replacement of iron in patients with severe iron deficiency, especially in the presence of anaemia, intolerance or inefficacy following oral iron, or states of inflammation where upregulation of hepcidin may impair gastrointestinal absorption of iron. Currently, available intravenous iron formulations have been demonstrated to have an excellent overall safety profile, but potential adverse effects, including skin staining, infusion‐related reactions and hypophosphataemia, have been described. Knowledge of differences in administration and safety profiles of currently available iron formulations will allow appropriate prescription, counselling, as well as recognition and management of adverse events in patients requiring intravenous iron.
Publisher: Wiley
Date: 27-05-2023
DOI: 10.1111/APT.17521
Abstract: This article is linked to Jayasooriya et al papers. To view these articles, visit 0.1111/apt.17370 and 0.1111/apt.17548
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/IMJ.15231
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 07-2023
DOI: 10.1002/JGH3.12933
Abstract: Acute severe ulcerative colitis (ASUC) remains a significant cause of morbidity and healthcare utilization. This study aimed to characterize the total healthcare costs of ASUC, explore factors associated with significant cost over the 12 months following an index admission, and document outcomes including corticosteroid exposure. Patients admitted from January 2016 until January 2021 for ASUC to a tertiary inflammatory bowel disease (IBD) center in Australia were identified via retrospective chart review. Costs were calculated over a 12‐month period following index admission. Seventy‐two patients (30 [42%] female, median age 39 [IQR 27–54] years) were included. The median length of stay of index admission was 6 days (IQR 5–10 days). The median cost of index admission was 7829 AUD, which was driven by the initial length of stay ( P 0.01) and requirement for colectomy ( P 0.01). Median total healthcare cost over the first 12 months was 13 873 AUD (IQR 9684–19 936 AUD), again predominately driven by the length of stay ( P 0.01) and requirement for colectomy ( P 0.01). Median cumulative corticosteroid use over 12 months inclusive of index hospitalization was 1760 mg (IQR 1560–2350 mg). Requirement for inpatient medical salvage therapy with infliximab was associated with increased corticosteroid requirement ( P = 0.01). Healthcare expense related to ASUC remains high, driven predominantly by the length of stay during initial hospitalization and need for colectomy. From a healthcare cost perspective, novel methods to reduce inpatient hospital stay as well as need for colectomy may help reduce the economic and steroid burden of ASUC.
Publisher: Wiley
Date: 20-09-2020
DOI: 10.1111/APT.16063
Publisher: Elsevier BV
Date: 07-2017
No related grants have been discovered for Mayur Garg.