Journal of the Canadian Association of Gastroenterology最新文献

{"title":"Do the new ACG <i>Helicobacter pylori</i> treatment guidelines have implications for Canada?","authors":"Sander Veldhuyzen van Zanten, Thomas Krahn","doi":"10.1093/jcag/gwaf008","DOIUrl":"10.1093/jcag/gwaf008","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 3","pages":"85-88"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12201999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the role of ustekinumab dose escalation in Crohn's disease patients with loss of response: an observational study.","authors":"Davide De Marco, Valerie Heron, Alain Bitton, Talat Bessissow, Peter Lakatos, Gary Wild, Waqqas Afif","doi":"10.1093/jcag/gwaf001","DOIUrl":"10.1093/jcag/gwaf001","url":null,"abstract":"<p><strong>Background/aims: </strong>Among Crohn's disease patients with loss of response or non-response to ustekinumab (UST), there remains no clear strategy for dose escalation. Moreover, clinical associations and the role of therapeutic drug monitoring (TDM) are poorly understood. This study assessed response to escalation of UST therapy via increased dosing frequency or re-induction, as well as assessed associations of response.</p><p><strong>Methods: </strong>A single-centre retrospective cohort study was performed. Adults who underwent dose escalation to every 4 weeks or reinduction of UST were included. The primary outcome was clinical and biochemical remission which was defined as a Harvey Bradshaw Index (HBI) of <5 and a C-reactive protein (CRP) level within the normal limit or a Fecal Calprotectin (FCP) level <250 ug/g. Partial response to treatment was defined as a 50% decrease from baseline HBI, CRP, or FCP.</p><p><strong>Results: </strong>Thirty-nine patients were included. Clinical outcomes were assessed at a median of 17 weeks (IQR 12-21). Clinical and biochemical remission was achieved in 30.8% of patients (<i>n</i> = 12). Remission was found to be more likely among patients with lower baseline HBI (5.2 vs 9.0 <i>P</i> = .044) and younger patients (29.8 years vs 37.7 <i>P</i> = .046). No association was observed between baseline TDM values in the remission vs the non-remission group (3.32 ug/mL vs 2.91 ug/mL p=0.77). No severe adverse events were recorded.</p><p><strong>Conclusion: </strong>UST dose escalation, in the form of reinduction or increased frequency to every 4 weeks may be effective among patients with loss of response or partial response, though predictors of response and strategy of escalation remain unclear.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 3","pages":"97-102"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing colorectal cancer screening and outcomes among First Nations people in Alberta.","authors":"David Klassen, Winson Y Cheung, Angeline Letendre, Lea Bill, Bonnie A Healy, Chinmoy Roy Rahul, Karen A Kopciuk, Huiming Yang","doi":"10.1093/jcag/gwaf004","DOIUrl":"10.1093/jcag/gwaf004","url":null,"abstract":"<p><strong>Background: </strong>First Nations (FN) people in Canada are commonly diagnosed with colorectal cancers. Although Canada has treaty responsibilities to ensure FNs people have equitable access to quality health services, access to colorectal cancer screening in Canada by FNs people has not been fully assessed.</p><p><strong>Methods: </strong>The objectives of our retrospective population-level study that linked multiple administrative databases were to investigate differences in colorectal cancer screening rates: participation, retention, positivity, follow-up colonoscopy, and invasive colorectal cancer detection, as well as wait times to follow-up colonoscopy, and stages at diagnosis between FNs and non-FNs people in Alberta. All Alberta residents eligible for colorectal cancer screening (aged 50-74) between 2012 and 2018 were included. The study and descriptive methods adhered to FNs principles of ownership, control, access, and possession.</p><p><strong>Results: </strong>FNs people were less likely to participate in colorectal cancer screening (lower by 15.9% among women, <i>P</i> < 0.00001, and 17.0% among men; <i>P</i> = 0.0007), and less likely to be retained in the screening program (lower by 11.6%, <i>P</i> = 0.0013, among women and 9.9% %, <i>P</i> = 0.034, among men). They were more likely to screen positive (average difference of 7.0% among women and 7.3%, among men, both <i>P</i> < 0.0002). Invasive colorectal cancer detection rates were higher (3.2/1000) versus (2.3/1000) as were late-stage diagnoses (61% versus 43%, <i>P</i> = <i>P</i> = 0.004) among FNs people than non-FNs people, respectively.</p><p><strong>Conclusions: </strong>Higher invasive colorectal cancer detection rates and more late-stage diagnoses in FNs people can be due to lower participation and retention in colorectal cancer screening programs. Understanding and addressing the reasons for these inequities are needed to improve these outcomes for FNs people.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 3","pages":"103-111"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing proton-pump inhibitor therapy in paediatric eosinophilic esophagitis through <i>CYP2C19</i> pharmacogenetic testing.","authors":"Sierra Scodellaro, Kristen A Bortolin, Margaret A Marcon, Ruud H J Verstegen, Susana Da Silva, Shinya Ito, Tamorah Lewis, Nicola L Jones, Iris Cohn, Jessie M Hulst","doi":"10.1093/jcag/gwaf003","DOIUrl":"10.1093/jcag/gwaf003","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder which can respond to proton-pump inhibitors (PPIs). Genetic variation in the <i>CYP2C19</i> metabolism gene influences PPI efficacy and adverse effects. Pharmacogenetic testing (PGx) can predict PPI response by analyzing genetic variation, particularly identifying patients categorized as CYP2C19 rapid or ultra-rapid metabolizers who might benefit from PPI dosage increases or changes to pharmacotherapy. Although PGx clinical practice guidelines have been established for PPI use, routine clinical implementation has been slow.</p><p><strong>Methods: </strong>We conducted a non-interventional prospective cohort study of patients followed by a paediatric EoE clinic between 2020 and 2023. Eligible patients underwent <i>CYP2C19</i> PGx testing, with results correlated to PPI use and histological outcomes assessed via endoscopic biopsies.</p><p><strong>Results: </strong>Sixty-nine patients underwent PGx testing; 20 (29%) and 5 (7%) were determined to be rapid and ultra-rapid metabolizers, respectively. PGx-based management changes were made in 44 (64%) patients. Forty-three (62%) patients completed reassessment endoscopy, of which 21 (49%) demonstrated histological remission; 17 (40%) of these patients achieved remission after PGx-guided drug changes.</p><p><strong>Conclusions: </strong>This study demonstrates that PPI non-response in patients with EoE may partly be due to inadequate PPI dosing in those with rapid or ultra-rapid CYP2C19 metabolizer status. Identifying CYP2C19 metabolizer status in pediatric patients with EoE for first-generation PPIs leads to therapeutic management changes and can improve histological remission rates. Clinicians treating EoE patients should consider routine PGx testing in combination with monitoring clinical factors to guide individualized PPI therapy and optimize dosing.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 3","pages":"89-96"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Saint Paul's Endoscopy Comfort Scale (SPECS) for upper gastrointestinal endoscopy.","authors":"Aein Zarrin, Jennifer J Telford, Neal Shahidi, Natasha Harris, Cherry Galorport, Robert Enns","doi":"10.1093/jcag/gwaf002","DOIUrl":"10.1093/jcag/gwaf002","url":null,"abstract":"<p><strong>Introduction: </strong>Patient comfort is an important predictor of patient satisfaction and a quality indicator in endoscopy. The St. Paul's Endoscopy Comfort Score (SPECS), previously validated for colonoscopy, was assessed for measuring patient comfort during esophagogastroduodenoscopy (EGD).</p><p><strong>Methods: </strong>In this prospective cohort study, 3 groups of assessors (gastroenterologists, nurses, and observers) used SPECS and the modified Gloucester Comfort Scale (GS) to measure patients' comfort during outpatient EGD. Patient-reported outcomes were measured using a visual analogue scale (VAS) and satisfaction survey. Descriptive statistics and inter-rater reliability were calculated across the 3 groups for both tools. The correlation between SPECS, GS, and VAS was calculated.</p><p><strong>Results: </strong>Three hundred subjects were included. The mean age was 56.7 years (SD 14.7 years) and 160 (53.3%) were male. Overall, 89.0% (<i>N</i>=267) of subjects received conscious sedation with intravenous midazolam and fentanyl at a mean dose of 3.3 mg (SD 1.6 mg) and 51.4 mcg (SD 29.7 mcg), respectively. The mean total SPECS for physicians, nurses, and observers were 1.3 (SD 1.6), 1.4 (SD 1.7), and 1.7 (SD 1.9), respectively. Amongst the 3 assessors (9 physicians, 5 nurses, and 4 observers), SPECS and GS demonstrated good inter-rater reliability with an intraclass coefficient of 0.71 (95% CI, 0.66-0.76) and 0.64 (95% CI, 0.58-0.69), respectively. SPECS and GS had a mild correlation with VAS.</p><p><strong>Conclusions: </strong>SPECS is a reliable assessment tool to measure patient comfort during EGD. SPECS may be used to audit patient comfort at a facility and physician level.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 3","pages":"112-114"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in hepatology: a comparative analysis of ChatGPT-4, Bing, and Bard at answering clinical questions.","authors":"Sama Anvari, Yung Lee, David Shiqiang Jin, Sarah Malone, Matthew Collins","doi":"10.1093/jcag/gwae055","DOIUrl":"https://doi.org/10.1093/jcag/gwae055","url":null,"abstract":"<p><strong>Background and aims: </strong>The role of artificial intelligence (AI) in hepatology is rapidly expanding. However, the ability of AI chat models such as ChatGPT to accurately answer clinical questions remains unclear. This study aims to determine the ability of large language models (LLMs) to answer questions in hepatology, as well as compare the accuracy and quality of responses provided by different LLMs.</p><p><strong>Methods: </strong>Hepatology questions from the Digestive Diseases Self-Education Platform were entered into three LLMs (OpenAI's ChatGPT-4, Microsoft's Bing, and Google's Bard) between September 7 and 13, 2023. Questions were posed with and without multiple-choice answers. Generated responses were assessed based on accuracy and number of correct answers. Statistical analysis was performed to determine the number of correct responses per LLM per category.</p><p><strong>Results: </strong>A total of 144 questions were used to query the AI models. ChatGPT-4's accuracy was 62.3%, Bing's accuracy was 53.5%, and Bard's accuracy was 38.2% (<i>P</i> < .001) for multiple-choice questions. For open-ended questions, ChatGPT-4's accuracy was 44.4%, Bing's was 28.5%, and Bard's was 21.4% (<i>P</i> < .001). ChatGPT-4 and Bing attempted to answer 100% of the questions, whereas Bard was unable to answer 11.8% of the questions. All 3 LLMs provided a rationale in addition to an answer, as well as counselling where appropriate.</p><p><strong>Conclusions: </strong>LLMs demonstrate variable accuracy when answering clinical questions related to hepatology, though show comparable efficacy when presented with questions in an open-ended versus multiple choice (MCQ) format. Further research is required to investigate the optimal use of LLMs in clinical and educational contexts.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 2","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of GLP-1 receptor agonist therapy on resolution of steatohepatitis in non-alcoholic fatty liver disease: a systematic review and meta-analysis.","authors":"Kathryn J Potter, Jackie Phinney, Tasha Kulai, Vicki Munro","doi":"10.1093/jcag/gwae057","DOIUrl":"https://doi.org/10.1093/jcag/gwae057","url":null,"abstract":"<p><strong>Background: </strong>Non-alcoholic fatty liver disease (NAFLD) is common, can progress to cirrhosis and hepatic decompensation, and has no approved medical therapy in Canada.</p><p><strong>Objective: </strong>We conducted a systematic review on whether glucagon-like peptide-1 receptor agonists (GLP-1RA) improve non-alcoholic steatohepatitis (NASH) compared to standard care in NAFLD.</p><p><strong>Methods: </strong>We searched Medline Ovid, EMBASE(Elsevier), Cochrane CENTRAL, Clinical Trials.gov, and the World Health Organization International Clinical Trials Registry Platform in November 2023 for randomized controlled trials. Inclusion criteria included patients ≥13 years with NAFLD receiving GLP-1RA for ≥6 months compared to standard care/placebo. Cochrane risk-of-bias 2.0 tool was used for each outcome. After screening results in duplicate, we performed meta-analysis and reported odds ratios (OR) for dichotomous and mean difference of change score for continuous outcomes.</p><p><strong>Results: </strong>Six studies with 478 patients met inclusion criteria; 3 studies reported on the primary endpoint resolution of NASH. GLP-1RA likely leads to resolution of NASH (OR 4.45 (95% CI 1.92, 10.3)) and reduction in liver steatosis on imaging (-5.09% (95% CI -7.49, -2.69), but little to no reduction in liver stiffness on imaging (mean difference -0.17 kPa (95% CI -0.34, 0)).</p><p><strong>Interpretation: </strong>Treatment with GLP-1RA in NAFLD patients for ≥6 months can probably lead to improvement in NASH on liver biopsy and reduce liver steatosis on imaging. Whether improvements in steatosis on biopsy or imaging results in clinically significant outcomes need to be elucidated as the effects of GLP-1RA on liver fibrosis are unclear; larger ongoing trials may provide more definitive answers. <b>Protocol Registration:</b> PROSPERO-CRD42023472186.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 2","pages":"47-57"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multivariable prediction model to stratify risk of 90-day rehospitalization among adults with ulcerative colitis.","authors":"Claudia Dziegielewski, Sarang Gupta, Julia Lombardi, Erin Kelly, Jeffrey D McCurdy, Richmond Sy, Nav Saloojee, Tim Ramsay, Michael Pugliese, Jahanara Begum, Eric I Benchimol, Sanjay K Murthy","doi":"10.1093/jcag/gwae054","DOIUrl":"https://doi.org/10.1093/jcag/gwae054","url":null,"abstract":"<p><strong>Background: </strong>Individuals with ulcerative colitis (UC) are frequently re-hospitalized for persistent or recurrent severe disease flares. Accurate prediction of the risk of early re-hospitalization at the time of discharge could promote targeted outpatient interventions to reduce this risk.</p><p><strong>Methods: </strong>We conducted a retrospective study in adults with UC admitted to The Ottawa Hospital between 2009 and 2016 for an acute UC-related indication. We ascertained candidate demographic, clinical, and health services predictors through medical records and administrative health databases. We derived and bootstrap validated a multivariable logistic regression model of 90-day UC-related re-hospitalization risk. We chose a probability cut point that maximized Youden's index to differentiate high-risk from low-risk individuals and assessed model performance.</p><p><strong>Results: </strong>Among 248 UC-related hospitalizations, there were 27 (10.9%) re-hospitalizations within 90 days of discharge. Our multivariable model identified gastroenterologist consultation within the prior year (adjusted odds ratio [aOR] 0.11, 95% confidence interval [CI], 0.04-0.39), male sex (aOR 3.27, 95% CI, 1.33-8.05), length of stay (OR 0.94, 95% CI, 0.88-1.01), and narcotic prescription at discharge (OR 1.96, 95% CI, 0.73-5.27) as significant predictors of 90-day re-hospitalization. The optimism-corrected <i>c</i>-statistic value was 0.78, and the goodness-of-fit test <i>P</i>-value was .09. The chosen probability cut point produced a sensitivity of 77.8%, specificity of 80.9%, positive predictive value (PPV) of 33.0%, and negative predictive value (NPV) of 96.7% in the derivation cohort.</p><p><strong>Conclusions: </strong>A limited set of variables accessible at the point of hospital discharge can reasonably discriminate re-hospitalization risk among individuals with UC. Future studies are required to validate our findings.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 2","pages":"76-82"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse events, success, and tolerability of biliary endoscopic retrograde cholangiopancreatography with conscious sedation vs anaesthesia: a multi-centre prospective study.","authors":"Zachary L Smith, Ahmed Kayal, Yibing Ruan, Brendan Cord Lethebe, Peter D Siersema, Alejandra Tepox Padrón, Yousef Alshammari, Sunil Samnani, Hannah F Koury, Millie Chau, Megan Howarth, Shane Cartwright, Darren R Brenner, Anna Tavakkoli, Rajesh N Keswani, Badih Joseph Elmunzer, Sachin Wani, Nauzer Forbes","doi":"10.1093/jcag/gwae061","DOIUrl":"https://doi.org/10.1093/jcag/gwae061","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is performed using anaesthesia or conscious sedation, though the effectiveness, adverse events (AEs), and tolerability of each approach remain unclear. Thus, we compared these approaches prospectively.</p><p><strong>Methods: </strong>We performed a multi-centre prospective cohort study including patients with native papillae undergoing ERCP for biliary indications between 2018 and 2023. The primary outcome was sedation-related AEs, defined as sustained hypoxaemia or hypotension, unplanned mask ventilation or intubation, vasopressor or reversal agent use, cardiorespiratory arrest, or death. Secondary outcomes included other AEs, technical success measures, and patient-reported tolerability using a validated scale. Multivariable logistic regression was performed in addition to propensity score-matched analyses.</p><p><strong>Results: </strong>At 8 centres, a total of 3174 first-time biliary ERCPs were performed, 433 (13.6%) employing anaesthesia. Nine sedation-related AEs occurred with conscious sedation (0.3%), while 2 (0.5%) occurred with anaesthesia (odds ratio, OR, 0.35, 0.07-2.37). Only 25 (0.9%) conscious sedation-supported ERCPs were aborted due to the inability to appropriately sedate patients. There were no significant differences in other AE rates, cannulation success, time, or attempts, use of pre-cut or needle-knife access methods, or inadvertent pancreatic duct cannulation. Odds of significant patient-reported intra-procedural awareness and discomfort were both higher with conscious sedation (ORs 16.19, 4.81-54.53, and 21.25, 4.44-101.61, respectively). Propensity score-matched analyses yielded no differences in any outcome compared with primary analyses.</p><p><strong>Conclusions: </strong>Routine biliary ERCP is equally safe and effective with conscious sedation (vs anaesthesia). Given regional resource limitations, conscious sedation is justified as a primary option for routine biliary ERCP.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 2","pages":"63-70"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of sex bias in the referral letters for patients with inflammatory bowel disease: a mixed methods evaluation.","authors":"Sunil Samnani, Yasmin Nasser, Gurprit Girn, Huneza Nadeem, Laura Targownik, Shannon M Ruzycki","doi":"10.1093/jcag/gwae056","DOIUrl":"https://doi.org/10.1093/jcag/gwae056","url":null,"abstract":"<p><strong>Introduction: </strong>Women with inflammatory bowel disease (IBD) experience greater delays and misdiagnosis than men. Data from other conditions suggest that sex and/or gender bias in the process of referral to speciality care may contribute.</p><p><strong>Methods: </strong>We undertook a mixed methods analysis of 120 referral letters to gastroenterology for people ultimately diagnosed with IBD in Calgary, Alberta. Letters were masked for patient sex and gender prior to analysis. Gastroenterologists who were masked to the objective of the study rated the quality of referral letters and triaged letters for urgency. Two study team members performed a Framework analysis to identify agentic (masculine) and commensal (feminine) adjectives, mentions of caregiving and work roles, and psychosocial history. After analysis, letters were unmasked and findings were compared by patient sex.</p><p><strong>Results: </strong>There were 116 referral letters included in the analysis (<i>n</i> = 59, 50.9% for male patients). There were no differences in letter quality or triage urgency between male and female patients (median quality 4 [IQR 4-7] and 5 out of 10 [IQR 4-6], respectively, higher scores represent better quality; <i>P</i> = .37, and <i>P</i> = .44 for triage category). There was no difference in the use of adjectives and mention of caregiving or work roles, psychiatric history, or social history between letters for female and male patients.</p><p><strong>Conclusions: </strong>This mixed methods analysis identified no difference in referral letter language, contents, or quality for female and male patients with IBD. Masked letters were triaged similarly to unmasked letters, suggesting an absence of sex and/or gender bias in the gastroenterology triaging process in our setting.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 2","pages":"71-75"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}