Journal of the Canadian Association of Gastroenterology最新文献

{"title":"Should we screen for colorectal cancer with biennial FIT beginning at age 45 in Canada?","authors":"Linda Rabeneck, Jill Tinmouth, John M Hutchinson, Yibing Ruan, Robert J Hilsden, Matthew T Warkentin, Jennifer J Telford, Harminder Singh, Mark J Dobrow, Alan N Barkun, Diego Llovet, Jerry McGrath, Amanda J Sheppard, Catherine Dubé, Henrik du Plessis, Clarence K W Wong, Sean P Cleary, Andrew J Coldman, Steven J Heitman, Laura C Senese, Darren R Brenner","doi":"10.1093/jcag/gwag008","DOIUrl":"https://doi.org/10.1093/jcag/gwag008","url":null,"abstract":"<p><strong>Background: </strong>Increasing incidence rates of colorectal cancer (CRC) diagnosed before age 50 have been reported in Canada and other Western countries. Several organizations have lowered their recommended starting age for CRC screening. We aimed to analyze CRC rates in Canada and model the impacts of lowering the age to start faecal immunochemical test (FIT)-based screening in Canada.</p><p><strong>Methods: </strong>We evaluated the differences in absolute and relative incidence rates between age groups over time using the Canadian Cancer Registry data. Additionally, we used the OncoSim-Colorectal microsimulation model to examine starting FIT screening at 45 years of age over a lifetime time horizon. We estimated changes in CRC cases, deaths, potential years of life gained, and costs.</p><p><strong>Results: </strong>Absolute CRC incidence increased among groups below 50 years of age, with recent birth cohorts experiencing the greatest relative increases. Microsimulation results suggest that screening at 45 would result in fewer CRC cases (15 070) and CRC deaths (6100) in Canada between 2025 and 2071. For every additional 100 colonoscopies, 3.5 fewer CRC cases and 1.4 fewer CRC deaths are expected. Modelling suggests this may lead to an overall cost savings of $233 million CAD over the lifespan of eligible cohorts.</p><p><strong>Conclusion: </strong>Our results indicate that as CRC incidence in younger age groups has continued to increase, lowering the age to start FIT screening to 45 would result in overall population benefit through reduced CRC incidence and mortality. However, given resource considerations, provincial decision makers must evaluate changes in their programs to ensure proper implementation.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 2","pages":"61-71"},"PeriodicalIF":2.7,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775190","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":"Factors associated with physical and mental health symptoms in pancreatic adenocarcinoma: a population-based cohort study.","authors":"Paul D James, Rishad Khan, Abdullah M Altheyabi, Misbah Salim, Peter Tanuseputro, Amy T Hsu, Natalie Coburn, Robert Talarico, Anastasia Gayowsky, Colleen Webber, Hsien Seow, Rinku Sutradhar","doi":"10.1093/jcag/gwaf040","DOIUrl":"https://doi.org/10.1093/jcag/gwaf040","url":null,"abstract":"<p><strong>Background: </strong>Patients with pancreatic ductal adenocarcinoma (PDAC) experience debilitating symptoms, yet factors associated with symptom burden and severity are not well described.</p><p><strong>Methods: </strong>This population-based cohort study included patients diagnosed with PDAC and who completed Edmonton Symptom Assessment System (ESAS) between 1 month before and 2 months after diagnosis between January 1, 2007 and December 31, 2020 in Ontario, Canada. The ESAS contains 9 symptoms on a scale from 0 to 10. The primary outcome was moderate to severe (ESAS scores ≥4) symptoms (pain, tiredness, nausea, depression, anxiety, drowsiness, loss of appetite, well-being, and shortness of breath) 2-6 months after diagnosis. We used multivariable logistic regression models to evaluate associations between the primary outcome and baseline demographic and clinical variables, cancer-specific factors, and baseline symptom scores.</p><p><strong>Results: </strong>We included 4918 patients (mean age 68 years, 52% male). Near the time of diagnosis, 13.8% (nausea) to 38.5% (well-being) of patients reported moderate to severe symptoms. At 2-6 months after diagnosis, 23.0% (dyspnea) to 57.5% (poor well-being) reported moderate to severe symptoms. A range of baseline demographic, clinical, and cancer-specific risk factors were identified for reporting of moderate to severe symptoms. The presence of baseline symptoms for each of the 9 included symptoms was associated with reporting of the same symptom with moderate to high severity 2-6 months after diagnosis.</p><p><strong>Conclusions: </strong>Patients with PDAC face a high symptom burden following diagnosis. Universal physician symptom screening for patients diagnosed with PDAC may enable improved symptom identification and management.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 2","pages":"100-109"},"PeriodicalIF":2.7,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775094","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":"Impact of COVID-19 pandemic on colonoscopy wait times by procedure indication.","authors":"Melina Thibault, Alan Barkun, Myriam Martel, Daniel von Renteln, Alton W Russell","doi":"10.1093/jcag/gwaf017","DOIUrl":"https://doi.org/10.1093/jcag/gwaf017","url":null,"abstract":"<p><strong>Background: </strong>Patients are referred for colonoscopy for symptom assessment, screening, and surveillance. Public health measures to mitigate the spread of the COVID-19 pandemic disrupted services and increased patient delays for colonoscopy services. The differential impact of these interruptions by colonoscopy indication is largely unknown. We aimed to understand the effects of the pandemic on colonoscopy services and patient wait times in Montreal, Canada.</p><p><strong>Study: </strong>Using 2018-2022 retrospective clinical data from 2 high-volume Montreal endoscopy centres and provincial administrative data, we characterized changes in colonoscopy wait times and the proportion of wait-listed patients who were delayed (wait time exceeded provincial guidelines) by procedure indication and demographics. We used regression to examine patient characteristics associated with delayed procedures during pre- and intraCOVID-19 periods. We used time series analysis to characterize trends in the proportion of wait-listed patients delayed.</p><p><strong>Results: </strong>The COVID-19-related public health measures resulted in record-high delays (median increase in wait times of 34%-159% across indications). While older patients experienced longer wait times pre-pandemic, intra-COVID-19 wait times increased disproportionately for patients younger than 50. The proportion of wait-listed patients delayed peaked in mid-2020 (56.9% for screening; 56.0% for symptom assessment patients). By early 2022, the proportion delayed had fallen to 37.3% for screening patients but remained at 53.8% for symptom assessment patients.</p><p><strong>Conclusions: </strong>Pandemic service disruptions disproportionately impacted symptom assessment procedures and younger patients, resulting in lasting effects. Systematic monitoring of procedures and wait times could facilitate timely detection and intervention to prevent disparities in patient access to care.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 2","pages":"118-130"},"PeriodicalIF":2.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775137","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":"Reducing endoscopic procedure backlog by improving efficiency: a predictive model and machine learning-based scheduling approach.","authors":"Tu-San Pham, Héloïse Gachet, Waleed Aljohani, Jeanne Archambault, Myriam Martel, Alan Barkun, Louis-Martin Rousseau","doi":"10.1093/jcag/gwaf006","DOIUrl":"https://doi.org/10.1093/jcag/gwaf006","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic led to a significant decrease in endoscopic procedure volumes, resulting in a backlog of patients awaiting investigation. Our study thus aimed to develop a machine learning-based scheduling tool to improve resource utilization, enhance system efficiency, and increase patient throughput, ultimately reducing procedural delays.</p><p><strong>Methods: </strong>In the first phase, machine learning methods were applied to historical data to predict procedure duration based on patient characteristics and environmental factors. In the second phase, a scheduling module was built using a greedy heuristic and a Mixed Integer Programming (MIP) model to optimize resource utilization.</p><p><strong>Results: </strong>We showed that among the tested models, an XGBoost regression model was selected with a mean absolute error of 5.67 minutes on the test set. The simulation results demonstrated that MIP increased the number of patients scheduled by 5.9% while reducing mean waiting time from 19.5 days to 17.3 days over a waiting list of 1,000 patients, evaluated within a 2-week period (10 working days). Simulations using real patient data showed that the MIP scheduled 8 more patients than the baseline. Numerical results confirmed higher resource utilization rates in adaptive schedules.</p><p><strong>Conclusions: </strong>Our study highlights the potential of a machine learning-based scheduling tool to enhance resource allocation, thus helping address backlogs in endoscopic procedures. Real-world clinical validation is now necessary to substantiate the tool's effectiveness. Future work should prioritize prospective data collection to refine the predictive model and seamlessly integrate the tool into clinical workflows, ensuring its practical utility and success.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 2","pages":"110-115"},"PeriodicalIF":2.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775143","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":"Family physicians' integration of palliative principles in cirrhosis care: a cognitive task analysis study of symptom management.","authors":"Tanya Barber, Lynn Toon, Puneeta Tandon, Lee A Green","doi":"10.1093/jcag/gwaf044","DOIUrl":"https://doi.org/10.1093/jcag/gwaf044","url":null,"abstract":"<p><strong>Background: </strong>Family physicians often hold reactive, case-by-case mental models for cirrhosis care due to systemic gaps in coordination, continuity, and transitions of care. Confusion may also exist between palliative and end-of-life care, with uncertainty around the timing of conversations with patients. Examining how family physicians approach symptom management with patients living with cirrhosis may provide insights into how they incorporate palliative principles of care. This study aims to elicit and explore family physicians' mental models of symptom management in cirrhosis care to reveal if palliative principles are integrated into primary care practice.</p><p><strong>Methods: </strong>A cross-sectional formal elicitation of mental models was conducted using Cognitive Task Analysis. We used purposive sampling of family physicians (<i>n</i> = 6) who saw small numbers, typical for unspecialized practice, of cirrhosis patients in Alberta, Canada.</p><p><strong>Results: </strong>Lack of continuity in cirrhosis care obliges physicians to hold reactive mental models of symptom management. This, with the confusion between palliative and end-of-life care, causes uncertainty around when and how to have conversations about advanced care planning and end-of-life care. Physicians expressed a desire for tools, processes, and education to fit palliative principles into their care.</p><p><strong>Conclusions: </strong>Without formal processes and structures in place, family physicians will continue to hold reactive mental models of cirrhosis management, often lacking fully integrated palliative principles. Family physicians and care teams require support to guide when and how to have conversations about advanced care planning with patients, family, and caregivers at the time of diagnosis, and throughout the trajectory of the illness.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 2","pages":"94-99"},"PeriodicalIF":2.7,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775106","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":"Colon cancer screening at age 45: the time is now.","authors":"Mark R Borgaonkar","doi":"10.1093/jcag/gwag001","DOIUrl":"https://doi.org/10.1093/jcag/gwag001","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 2","pages":"59-60"},"PeriodicalIF":2.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775081","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":"Improving the quality of paracentesis practices in people with advanced cirrhosis in an ambulatory care setting.","authors":"Mary Sedarous, Elizabeth Lee, Adam Bishara, Ina Cherepaha-Kantorovich, Amol Verma, Kieran Quinn, Gideon Hirschfield","doi":"10.1093/jcag/gwaf041","DOIUrl":"https://doi.org/10.1093/jcag/gwaf041","url":null,"abstract":"<p><strong>Background and aims: </strong>Spontaneous bacterial peritonitis (SBP) is a lethal complication of decompensated cirrhosis with a 90% mortality rate if untreated. Despite AASLD guidelines, a practice gap exists in fluid cell count (FCC) collection during paracentesis. We initiated a quality improvement (QI) project to increase FCC collection from 78% to 100% in an ambulatory setting between September 11, 2022, and April 17, 2023.</p><p><strong>Methods: </strong>We evaluated 233 ambulatory patient encounters for paracentesis procedures at a quaternary care centre in Toronto. A multidisciplinary QI initiative included focused groups, AASLD guideline education, a paracentesis bundle, and workflow streamlining. Descriptive statistics and statistical analyses using run charts and p-charts were conducted via QI Macros. Institutional QI Review Committee approval was obtained.</p><p><strong>Results: </strong>Baseline FCC adherence was 78%. Process mapping identified inconsistencies in documentation, label printing, and FCC collection. Bedside paracentesis bundles were introduced, increasing FCC collection marginally to 79.6% with no special cause variation. Subgroup analysis showed FCC collection rates of 100% among RNs/NPs, 97% among residents, and 92% among attending physicians. General hepatology had a 97% collection rate, while specialty hepatology had 40%. The SBP rate was 1.62% (<i>N</i> = 3).</p><p><strong>Discussion: </strong>This study highlights a persistent gap in FCC collection during ambulatory paracentesis. Understanding reasons for non-compliance and assessing the FCC collection's impact on morbidity and mortality in ambulatory settings are next crucial steps to optimize care for this high-risk population.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 2","pages":"86-93"},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775097","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":"Communicating Needs and Features of IBD Experiences study: Canadian individuals and healthcare professional perceptions of the experience and impact of symptoms of moderate-to-severe ulcerative colitis and Crohn's disease.","authors":"Vipul Jairath, Talat Bessissow, Jennifer Glass, Marta Braun, Theresa Hunter Gibble, Taline Movsessian, Christian Atkinson, Hilary Ellis, Thomas Dewar, Remo Panaccione","doi":"10.1093/jcag/gwaf036","DOIUrl":"10.1093/jcag/gwaf036","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory conditions of the gastrointestinal tract associated with impaired quality of life. The Communicating Needs and Features of IBD Experiences (CONFIDE) study aimed to assess the impact of CD/UC symptoms on the lives of people with IBD and elucidate any communication gaps between healthcare professionals (HCPs) and people with IBD. The current Canadian study replicates the CONFIDE study previously conducted in the United States, Europe, and Japan.</p><p><strong>Methods: </strong>Online cross-sectional surveys were conducted between February and April 2023 among people with moderate-to-severe CD/UC and prescribing HCPs. Disease severity was defined using criteria based on previous treatment, steroid use, and/or hospitalization. Data were presented using descriptive analyses.</p><p><strong>Results: </strong>Surveys were completed by 107 individuals with CD, 82 individuals with UC, and 53 HCPs. Bowel urgency was the second most common symptom reported by individuals, following diarrhoea, and it was the most frequently reported symptom leading to declining participation in work/school, social events, and physical exercise. HCP-perceived symptoms with the greatest impact on people with IBD and their treatment decisions were diarrhoea and blood in stool. While most HCPs reported proactive discussion of bowel urgency with their patients, more than a third of those experiencing this symptom reported discussing it infrequently during HCP appointments.</p><p><strong>Conclusions: </strong>The results indicate that CD/UC symptoms have a substantial impact on the daily lives of people with IBD, even among those receiving advanced therapies. Although both HCPs and individuals with IBD reported a substantial symptom burden, their perceptions regarding the most impactful symptoms differed. Bowel urgency was identified as a common yet overlooked symptom and should be incorporated into regular IBD assessments.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 1","pages":"38-48"},"PeriodicalIF":2.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157568","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":"Seeking gastroenterological services during a pandemic: lessons from a large, national, population-based survey during the COVID-19 pandemic.","authors":"Sachin Srinivasan, Sravanthi Parasa, Paul Sinclair, Kevin Kennedy, Gary Falk, David Armstrong, Prateek Sharma","doi":"10.1093/jcag/gwaf038","DOIUrl":"https://doi.org/10.1093/jcag/gwaf038","url":null,"abstract":"<p><strong>Background: </strong>The 2019 coronavirus pandemic (COVID-19) caused significant disruptions in people's lives, healthcare-seeking behavior, and willingness to undergo endoscopic procedures.</p><p><strong>Methods: </strong>This large national survey of adults used an online platform to collect participants' de-identified demographics, attitudes, and opinions regarding healthcare-seeking behavior and endoscopy during the COVID-19 pandemic. Data were analyzed using descriptive statistics and multivariate logistic regression.</p><p><strong>Results: </strong>There were 29 449 respondents; mean age 43.3 ± 17.3 years, 72% female. Among 3928 respondents who visited their doctor virtually during the COVID-19 pandemic, most were satisfied (76%). In a multivariate analysis, respondents who were satisfied or neutral toward a virtual visit were more likely to be married, African American, and have some college education. In contrast, those who were dissatisfied were more likely to be older or female. Only 26.3% (<i>n</i> = 7746) reported concerns about undergoing endoscopy during the pandemic. Among those respondents, preferences were to reschedule 3-4 months later (38%) after having had the vaccine (19%) or to forgo the procedure entirely (28%). In a multivariate analysis, having had a prior endoscopy was most strongly associated with concern, followed by African American race, female sex, being married, and older age.</p><p><strong>Conclusion: </strong>This large national survey suggested high satisfaction with virtual visits and low concern about undergoing endoscopy during the pandemic. Concern around endoscopy was increased among those who had a prior endoscopy, African Americans, women, and older age groups.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 2","pages":"129-133"},"PeriodicalIF":2.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775125","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":"Medico-legal cases involving gastroenterologists in Canada between 2017 and 2021.","authors":"Mehrnaz Mostafapour, Kate Barbosa, Jun Ji, Dov B Kagan, Natalie Gagne, Qian Yang, Gary E Garber, Harminder Singh","doi":"10.1093/jcag/gwaf035","DOIUrl":"10.1093/jcag/gwaf035","url":null,"abstract":"<p><strong>Background: </strong>Gastroenterology may be a medical specialty with higher-than-average medico-legal risk. We evaluated the characteristics of medico-legal proceedings relating to the delivery of gastroenterology medical care in Canada during a five-year time period.</p><p><strong>Methods: </strong>We used a repository of Canadian medico-legal cases to identify cases between 2017 and 2021 involving a gastroenterologist. We analyzed patient, provider, team, and system contributing factors using a previously published Contributing Factors Framework and patient harm using a previously published coding system.</p><p><strong>Results: </strong>We identified 223 cases involving 229 gastroenterologists with no preponderance by years of experience. Gastroenterologists had a higher rate of civil legal actions than the average for all other physician specialties in the database. 59% involved patients older than 50 years of age, 10% with digestive tract malignancies, and 10% with IBD. 51% of involved patients had a healthcare-related harm that had a negative effect on their health or quality of life. 35% had avoidable harm. Patients most commonly reported a perception of deficient assessment (35%), communication breakdowns (27%), unprofessional manner (25%), diagnostic error (22%), and inadequate monitoring or follow-up (20%). 50% of cases were criticized by peer experts, of which they deemed 45% involved communication breakdown with patients, 38% involved clinical decision-making, 30% situational awareness, 25% documentation, and 15% communication among providers.</p><p><strong>Conclusions: </strong>Communication issues remain a major contributing factor to medico-legal cases involving gastroenterologists. Integrated risk-reduction strategies may include enhancing diagnostic rigor through improved clinical protocols and decision support tools and strengthening communication at all levels of care.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 1","pages":"49-56"},"PeriodicalIF":2.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157627","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}