Journal of the Canadian Association of Gastroenterology最新文献

{"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}

{"title":"Canada's changing climate: what does it mean for digestive health?","authors":"Desmond Leddin, Paul Sinclair, Harminder Singh, Rachael Sherman, Kelsey Cheyne","doi":"10.1093/jcag/gwae052","DOIUrl":"10.1093/jcag/gwae052","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189810","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":"Template of a climate sustainability plan for medical professional organizations: the Canadian Association of Gastroenterology example.","authors":"Desmond Leddin, Paul Sinclair, Harminder Singh, Rachael Sherman","doi":"10.1093/jcag/gwae051","DOIUrl":"10.1093/jcag/gwae051","url":null,"abstract":"<p><p>Environmental change is underway and has the potential to adversely affect digestive health. Professional medical organizations have an important role to play in addressing the challenge. An important initial response is the development of a sustainability plan for the medical organization. There are no standardized criteria as to what should be included in such a plan. We have proposed 12 key components that should be contained in sustainability plans for medical organizations. We describe how these were developed for the Canadian Association of Gastroenterology (CAG) and plans for future implementation. We hope that the CAG plan may serve as a template to assist peer medical organizations optimize their response to the climate crisis.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 1","pages":"4-6"},"PeriodicalIF":0.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189830","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":"Sustainable practice in gastroenterology: travel-related CO₂ emissions for gastroenterology clinic appointments in Canada.","authors":"Ciarán Galts, Sama Anvari, Amy Kim, Gregorios Leontiadis, David Armstrong","doi":"10.1093/jcag/gwae049","DOIUrl":"10.1093/jcag/gwae049","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine is increasingly common in gastroenterology and may represent an opportunity for improving sustainability in medical care. The purpose of this study was to determine the carbon emissions related to travel for in-person gastroenterology clinic appointments.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis evaluating carbon emissions associated with travel to gastroenterology appointments over a 2-week period. We determined the average number of appointments per day and used patient's postal codes to estimate travel distances. We estimated carbon emissions based on these travel distances and completed sensitivity analyses to model methods for emissions reductions.</p><p><strong>Results: </strong>We assessed 975 clinic appointments, of which 71 were excluded (eg, insufficient data, non-physician appointments), leaving 904 included appointments of which 75% were follow-up (678) and the remainder were new consultations (226). Sixteen different gastroenterologists had an average of 22.7 patients per clinic. The mean return distance travelled per appointment was 57.3 km which translates to 14.9 kg CO₂ per patient visit. An average day at our clinic was equal to burning 146.6 L of gasoline or the annual carbon capture of 15.5 trees. By changing follow-up appointments or those with a travel distance over 100 km to telehealth, emissions were reduced by 77%.</p><p><strong>Conclusions: </strong>We demonstrate that a relatively modest change in the number of in-person visits can save thousands of litres of gasoline emissions annually from each practicing clinician. While we cannot avoid emissions related to travel for procedure-based appointments, the use of telemedicine is one potential strategy to reduce healthcare-related emissions.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 1","pages":"7-12"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189827","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":"Associations with sexual dysfunction among a Canadian cohort with inflammatory bowel disease.","authors":"Adam V Weizman, Derek M Nguyen, Laura E Targownik, Jeff Mosko, Natasha Bollegala, Fred Saibil, Vivian Huang, Amanda Selk, Michael Bernstein","doi":"10.1093/jcag/gwae048","DOIUrl":"10.1093/jcag/gwae048","url":null,"abstract":"<p><strong>Background: </strong>Sexual dysfunction is common in individuals with inflammatory bowel disease (IBD). The aim of this study was to better characterize sexual dysfunction and associated factors among a Canadian cohort of IBD patients.</p><p><strong>Methods: </strong>A cross-sectional survey study was conducted. The primary outcome was sexual dysfunction as measured by the Female Sexual Dysfunction Scale in females and the Male Sexual Dysfunction Scale in males. Analyses were stratified by sex and multiple linear regression was used to identify associations.</p><p><strong>Results: </strong>In total, 351 respondents completed the survey. Both females and males were impacted by sexual dysfunction (IBD-FSDS 14.1 [± 13.8] and IBD-MSDS 7.2 [± 9.4, respectively]). Depression was common and strongly associated with sexual dysfunction (β coefficient 0.92 [0.13] for men and 0.84 [0.19] for women, <i>P</i> <.001).</p><p><strong>Conclusions: </strong>Sexual dysfunction was common and more impactful in women. Depression was strongly associated with sexual dysfunction. This underscores the need for multidisciplinary care in addressing sexual health among individuals living with IBD.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 1","pages":"31-38"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189805","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":"Treatment patterns for advanced therapies in Canadians with moderate-to-severe inflammatory bowel disease: a retrospective cohort analysis.","authors":"Laura Targownik, Waqqas Afif, Sunny Singh, Jesse Siffledeen, Christopher Ma, Kevin McHugh, Julie Charbonneau, Louis-Charles Rioux","doi":"10.1093/jcag/gwae040","DOIUrl":"10.1093/jcag/gwae040","url":null,"abstract":"<p><p>Many patients with inflammatory bowel disease (IBD) show an inadequate response or experience a loss of response to advanced therapies. Guidelines recommend dose optimization and switching among therapies until an optimal treatment response is attained. With several advanced treatments available, we aimed to evaluate the persistence of different therapeutic sequences in IBD. The RECORDED study was a retrospective cohort study of Canadians with moderate-to-severely active ulcerative colitis (UC) or Crohn's disease (CD) who had been exposed to more than 1 advanced therapy between May 2015 and April 2021 for UC, and May 2016 and April 2021 for CD. The primary endpoint was time to permanent discontinuation of the first advanced treatment. Overall, 330 patients had CD and 344 had UC. The most common first-line treatments for CD and UC were adalimumab and infliximab, respectively. The median (95% CI) time to permanent discontinuation of first-line treatment was 12.3 (10.9, 13.6) months in patients with CD and 9.2 (8.2, 10.8) months for those with UC. The most common reason for treatment change across both diseases was lack of efficacy. First-line advanced treatments were optimized in 191 (58.1%) CD patients and 202 (59.1%) UC patients prior to permanent discontinuation. Second-line therapy was typically from a different class compared with the first-line treatment choice. The RECORDED study provides insights into the real-world sequencing and optimization patterns of advanced treatments in patients with moderate-to-severe IBD in Canada. Lack of efficacy was the most cited reason for switching to a different therapy.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 1","pages":"21-30"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189844","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}