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Pancreatic Neoplasms: HELP
Articles by Andreas I. Koulouris
Based on 3 articles published since 2010
(Why 3 articles?)

Between 2010 and 2020, Andreas Koulouris wrote the following 3 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
1 Review Bridging clinic: The initial medical management of patients with newly diagnosed pancreatic cancer. 2019

Sreedharan, Loveena / Kumar, Bhaskar / Jewell, Anna / Banim, Paul / Koulouris, Andreas / Hart, Andrew R. ·ST Upper GI Surgery, East of England Deanery, UK. · Upper GI Surgery, Norfolk and Norwich Hospital, Norwich, UK. · Pancreatic Cancer UK, London, UK. · James Paget University Hospitals, Great Yarmouth, Norfolk, UK. · Academic Clinical Fellow in Gastroenterology, Norfolk and Norwich Hospital, Norwich, UK. · Gastroenterology, Norfolk and Norwich Hospital, Norwich, UK. ·Frontline Gastroenterol · Pubmed #31288251.

ABSTRACT: Pancreatic cancer is the 11th most common cancer in the UK and has the worst prognosis of any tumour with minimal improvements in survival over recent decades. As most patients are either ineligible for surgery or may decline chemotherapy, the emphasis is on control of symptoms and management of complications such as poor nutritional status. The time period between informing the patient of their diagnosis and commencing cancer treatments presents a valuable opportunity to proactively identify and treat symptoms to optimise patients' overall well-being. The 'bridging clinic', delivered by a range of healthcare professionals from gastroenterologists to nurse practitioners, can provide this interface where patients are first informed of their diagnosis and second supportive therapies offered. In this article, we provide a structure for instituting such supportive therapies at the bridging clinic. The components of the clinic are summarised using the mnemonic INDASH (Information/Nutrition/Diabetes and Depression/Analgesia/Stenting/Hereditary) and each is discussed in detail below.

2 Review Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments. 2017

Koulouris, Andreas I / Banim, Paul / Hart, Andrew R. ·Norwich Medical School, University of East Anglia, Bob Champion Research Center, Norwich Research Park, Norfolk, NR4 7TJ, UK. a.koulouris@uea.ac.uk. · Norfolk and Norwich University Hospital, Gastroenterology, Colney Lane, Norwich, NR4 7UY, UK. a.koulouris@uea.ac.uk. · Norwich Medical School, University of East Anglia, Bob Champion Research Center, Norwich Research Park, Norfolk, NR4 7TJ, UK. · James Paget University Hospital, Lowestoft Rd, Gorleston-on-Sea, Great Yarmouth, NR31 6LA, UK. · Norfolk and Norwich University Hospital, Gastroenterology, Colney Lane, Norwich, NR4 7UY, UK. ·Dig Dis Sci · Pubmed #28229252.

ABSTRACT: Pain affects approximately 80% of patients with pancreatic cancer, with half requiring strong opioid analgesia, namely: morphine-based drugs on step three of the WHO analgesic ladder (as opposed to the weak opioids: codeine and tramadol). The presence of pain is associated with reduced survival. This article reviews the literature regarding pain: prevalence, mechanisms, pharmacological, and endoscopic treatments and identifies areas for research to develop individualized patient pain management pathways. The online literature review was conducted through: PubMed, Clinical Key, Uptodate, and NICE Evidence. There are two principal mechanisms for pain: pancreatic duct obstruction and pancreatic neuropathy which, respectively, activate mechanical and chemical nociceptors. In pancreatic neuropathy, several histological, molecular, and immunological changes occur which correlate with pain including: transient receptor potential cation channel activation and mast cell infiltration. Current pain management is empirical rather etiology-based and is informed by the WHO analgesic ladder for first-line therapies, and then endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with resistant pain. For EUS-CPN, there is only one clinical trial reporting a benefit, which has limited generalizability. Case series report pancreatic duct stenting gives effective analgesia, but there are no clinical trials. Progress in understanding the mechanisms for pain and when this occurs in the natural history, together with assessing new therapies both pharmacological and endoscopic, will enable individualized care and may improve patients' quality of life and survival.

3 Article Dietary Fiber and the Risk of Pancreatic Cancer. 2019

Koulouris, Andreas I / Luben, Robert / Banim, Paul / Hart, Andrew R. ·Institute of Public Health, University of Cambridge, Cambridge. · Department of Gastroenterology, James Paget University Hospital, Great Yarmouth, United Kingdom. ·Pancreas · Pubmed #30489447.

ABSTRACT: OBJECTIVES: High dietary fiber may protect against pancreatic ductal adenocarcinoma (PDAC). We investigated associations between fiber intake and the risk of PDAC using for the first time 7-day food diaries. METHODS: Participants in the European Prospective Investigation Into Cancer-Norfolk completed the 7-day food diaries at recruitment. The cohort was followed up for 17 years to identify those who developed PDAC. Participants were divided into quintiles of fiber intake, and hazard ratios (HR) were estimated with their 95% confidence intervals (CIs). Fiber was tested for effect modification of high red and processed meat intake and smoking and the risk of PDAC. RESULTS: No significant associations for any quintiles of intake (HR Q5 vs Q1, 1.08; 95% CI, 0.56-2.08) were detected with no trend across quintiles. A high-fiber diet modified positive associations between red and processed meats with the development of PDAC (HR trends, 0.89 [95% CI, 0.47-1.69] and 1.02 [95% CI, 0.55-1.88], respectively) but not those with lower fiber intake. Fiber intake did not modify the risk of PDAC in past and current smokers. CONCLUSION: The findings do not suggest that fiber protects against PDAC, although it may decrease potential deleterious effects of meats.