Journal of the Canadian Association of Gastroenterology最新文献

{"title":"Practical guidance for managing patients with moderate-to-severe ulcerative colitis using small molecule therapies.","authors":"Vipul Jairath, Waqqas Afif, Brian Bressler, Janet E Pope, Daniel Selchen, Laura E Targownik, Remo Panaccione","doi":"10.1093/jcag/gwae013","DOIUrl":"10.1093/jcag/gwae013","url":null,"abstract":"<p><p>Ulcerative colitis (UC) is a severe and debilitating illness that affects the quality of life and physical health of many Canadians. Given the dynamic and progressive nature of the disease, advanced therapies are required to support its long-term management. The emergence of small molecule therapies offers novel treatment options that target mechanisms central to the immunopathology of UC. Sphingosine-1-phosphate (S1P) receptor modulators and Janus-activated kinase inhibitors are 2 classes of therapies that target unique pathways to attenuate inflammation and modulate the immune response characteristic of UC. This review aims to provide practical guidance on how these therapeutic options can best be used to optimize treatment management and highlight the emerging role of small molecule therapies as a treatment strategy for UC.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 4","pages":"282-289"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975969","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":"Indication for endoscopic retrograde cholangiopancreatography and development of hemorrhage: a systematic review and meta-analysis.","authors":"Michael K Parvizian, Mitchell V Edwards, Prem Bhoey, Melanie C Zhang, Lawrence C Hookey, David M Rodrigues","doi":"10.1093/jcag/gwae014","DOIUrl":"https://doi.org/10.1093/jcag/gwae014","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage is a common complication associated with endoscopic retrograde cholangiopancreatography (ERCP), usually following sphincterotomy. Studies investigating risk factors for hemorrhage including ERCP indication have been conflicting. Therefore, we conducted a systematic review and meta-analysis to characterize the association between the ERCP indication and hemorrhage.</p><p><strong>Methods: </strong>Database searches of MEDLINE, EMBASE, and CENTRAL were conducted to identify articles up to December 12, 2022. Randomized trials or observational studies of adult patients undergoing ERCP were included. Quality assessment using the Cochrane Risk of Bias 2.0 and Newcastle-Ottawa Scales for randomized trials and observational studies respectively was conducted. A random effects meta-analysis generating pooled odds ratios with 95% confidence intervals was conducted.</p><p><strong>Results: </strong>A total of 1323 articles were identified of which 26 were included with up to 25 121 subjects in each meta-analysis. Rates of sphincterotomy (median 96.1%; IQR 60.5-100), biliary stent placement (median 17.2%; IQR 10.6-34.4), antiplatelet use (median 6.0%; IQR 0-10.1), and anticoagulant use (median 1.9%; IQR 0%-3.2%) varied among included studies. No specific indication was associated with hemorrhage in the meta-analyses including cholangitis (OR 1.50; 95% CI 0.97-2.32), choledocholithiasis/biliary stone (OR 1.28; 95% CI 0.95-1.73), malignancy (OR 0.97; 95% CI 0.66-1.42), sphincter of Oddi dysfunction (OR 1.32; 95% CI 0.72-2.40), and acute pancreatitis (OR 0.81; 95% CI 0.44-1.49).</p><p><strong>Conclusions: </strong>Overall, no indication was significantly associated with increased hemorrhage following ERCP. However, given limitations in the included studies (ie, significant heterogeneity between studies), additional research to better characterize these associations is needed.</p><p><strong>Protocol registration number: </strong>PROSPERO (CRD42021283978).</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 5","pages":"352-367"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468652","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":"The relationship among vedolizumab drug concentrations, biomarkers of inflammation, and clinical outcomes in a Canadian real-world study","authors":"C. H. Seow, J. K. Marshall, Stewart Erin, Christopher Pettengell, Ryan Ward, W. Afif","doi":"10.1093/jcag/gwae010","DOIUrl":"https://doi.org/10.1093/jcag/gwae010","url":null,"abstract":"\u0000 \u0000 \u0000 Therapeutic drug monitoring is used to optimize anti-tumour necrosis factor biologic effectiveness in inflammatory bowel disease, but its role with other biological classes is unclear. This study explores relationships between post-induction vedolizumab trough concentrations and biochemical outcomes in a real-world study of individuals with inflammatory bowel disease.\u0000 \u0000 \u0000 \u0000 This retrospective analysis of data from a national patient support program between 2018 and 2020, included 436 individuals with Crohn’s disease or ulcerative colitis receiving vedolizumab. Optimal vedolizumab concentration thresholds (at weeks 6 and 14) were determined based on their ability to predict biochemical normalization (week 30 faecal calprotectin [<250 µg/g], C-reactive protein [<5 mg/l]). Thresholds best associated with each outcome were evaluated in multivariate analyses.\u0000 \u0000 \u0000 \u0000 Among patients with Crohn’s disease, week 6 serum vedolizumab concentrations (>41.65 µg/ml) predicted normalization defined by C-reactive protein: Spearman correlation coefficient [ρ] = −0.26, P = 0.002 and multivariate analysis (MVA)—OR: 3.22, 95% CI: 1.32–7.87, P = 0.01, and at week 14 (>22.25 µg/ml): ρ = −0.38, P < 0.0001, and MVA—OR: 3.21, 95% CI: 1.26–8.17 but not faecal calprotectin. Similarly, among patients with ulcerative colitis, week 6 vedolizumab concentrations (>39.65 g/ml) predicted normalization defined by C-reactive protein: ρ = −0.26, P = 0.005 and MVA—OR: 4.03, 95% CI: 1.30–12.52, P = 0.016, and at week 14 (>17.35 µg/ml): ρ = −0.39, P = 0.0001 and MVA—OR: 6.95, 95% CI: 1.81–26.77, P = 0.005, but not faecal calprotectin.\u0000 \u0000 \u0000 \u0000 Induction and post-induction serum vedolizumab were not consistently associated with biochemical normalization. As such, proactive therapeutic drug monitoring for vedolizumab should not be routinely incorporated in a treat to target strategy for inflammatory bowel disease.\u0000 \u0000 \u0000 \u0000 NCT04567628.\u0000","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140385366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of a mandatory non-medical switch of infliximab to a biosimilar for inflammatory bowel disease in British Columbia, Canada","authors":"T. T. Hoang, J. Reid, C. Galorport, Brian Bressler, Y. Leung, G. Rosenfeld","doi":"10.1093/jcag/gwae011","DOIUrl":"https://doi.org/10.1093/jcag/gwae011","url":null,"abstract":"\u0000 \u0000 \u0000 Despite infliximab biosimilars becoming widely used in inflammatory bowel disease (IBD) patients, real-world non-medical switching is sparse. A biosimilar non-medical switch was launched in British Columbia in 2019, the first Canadian province to do so, from Remicade to an approved biosimilar (CT-P13 or SB2).\u0000 \u0000 \u0000 \u0000 This study aims to obtain real-world evidence evaluating the clinical outcomes of non-medical switching from Remicade to the infliximab biosimilars.\u0000 \u0000 \u0000 \u0000 This is a retrospective observational study of stable IBD patients from the IBD Centre of BC who underwent the non-medical infliximab switch. The primary outcome is treatment continuation at 12 ± 2 months post-switch. Secondary outcomes include frequency of loss of response, adverse events, and immunogenicity within the first 12 months post-switch. A control group of patients maintained on the originator served as a comparison.\u0000 \u0000 \u0000 \u0000 Patients in the biosimilar switch group (n = 264) and originator group (n = 99), show similar demographics and disease characteristics. There was no difference in infliximab continuation between the biosimilar group (94.9%) and the originator group (90.1%) (P = 0.18). Reasons for discontinuation of infliximab included loss of response (4.04% vs 4.91%), immunogenicity (1.01% vs 0.75%), or adverse effect (1.01% vs 2.3%) in the infliximab originator vs biosimilar switch group, respectively. Similarly, no differences in safety or efficacy were observed between patients switched to CT-P13 or SB2.\u0000 \u0000 \u0000 \u0000 Non-medical biosimilar switch of infliximab demonstrates similar clinical outcomes compared to originator molecule continuation for therapy of IBD. These data support the safety and efficacy of non-medical infliximab switching in IBD patients.\u0000","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":" 61","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-polypectomy surveillance: follow-up recommendations from the Alberta Colorectal Cancer Screening Program","authors":"Daniel C Sadowski, M. Kolber, Anthony Gomes, Linda Hickle, R. Hilsden, David Ross McLean, Dereck Mok, B. Moysey, Nicole Nemecek, John David Ryan, R. Sultanian, Jessica Wiseman, Huiming Yang","doi":"10.1093/jcag/gwae007","DOIUrl":"https://doi.org/10.1093/jcag/gwae007","url":null,"abstract":"\u0000 In 2013, the Alberta Colorectal Cancer Screening Program (ACRCSP) initially published recommendations for post-colonoscopy follow-up and polypectomy. Over time, emerging evidence and evolving surveillance guidelines from various expert groups necessitated a comprehensive review to align with the healthcare landscape in Alberta. To accomplish this, an expert panel was convened. Using the Agree II tool, we identified high-quality Clinical Practice Guidelines that were relevant to the Alberta medical context. Recommendations from these guidelines were adapted to fit the specific needs of Alberta. Recognizing inconsistencies and gaps within the existing guidelines, we conducted targeted literature reviews to ensure a comprehensive and evidence-based approach to our recommendations.\u0000 Our revised recommendations build upon the assumption that a high-quality index colonoscopy has been performed at baseline. They are intended to enhance the quality of care and reduce unnecessary procedures. As well, they align with the growing consensus in the scientific literature that individuals with low-risk tubular adenomas may not require aggressive colonoscopy surveillance.\u0000 The updated Alberta recommendations aim to provide clear recommendations for practicing endoscopists, referring physicians, and their patients. They address crucial questions such as determining which patients should commence surveillance via colonoscopy and which individuals should return to average-risk screening using the fecal immunochemical test (FIT). Additionally, our recommendations outline the appropriate surveillance intervals for those requiring continued monitoring.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":" 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140389744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of patients, parents, and health care providers on facilitators of and barriers to the transition from pediatric to adult care in inflammatory bowel disease: a qualitative descriptive study","authors":"A. Bihari, E. Wine, C. H. Seow, K. J. Goodman, K. Kroeker","doi":"10.1093/jcag/gwae002","DOIUrl":"https://doi.org/10.1093/jcag/gwae002","url":null,"abstract":"\u0000 \u0000 \u0000 The typical transition from pediatric to adult care in patients with inflammatory bowel disease occurs with an increase in health care utilization and a decrease in adherence to medications and scheduled appointments. An effective transition could reduce negative impacts but requires identifying opportunities to improve this process. This study aims to describe barriers and facilitators of transition according to patients, parents, and health care providers.\u0000 \u0000 \u0000 \u0000 This study used a qualitative description approach. The lead author conducted semi-structured interviews with 17 patients, 13 parents, and 15 providers recruited from Western Canada. Latent content analysis identified themes in interview transcripts.\u0000 \u0000 \u0000 \u0000 The theme of preparedness emerged across all groups as a transition facilitator. Other facilitators that emerged included patient characteristics, supportive parents, home environment, and supportive adult care team. Themes of barriers that emerged included patient factors, “hovering parents” and family factors, navigating a new health care system, and travel distance.\u0000 \u0000 \u0000 \u0000 This study describes facilitators and barriers according to each stakeholder involved in the transition process. Future studies should focus on designing and evaluating interventions aimed at promoting facilitators and addressing identified barriers in patients preparing to transition from pediatric to adult care.\u0000","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"12 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140241052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: The 2023 Impact of Inflammatory Bowel Disease in Canada: The Influence of Sex and Gender on Canadians Living With Inflammatory Bowel Disease.","authors":"","doi":"10.1093/jcag/gwae012","DOIUrl":"https://doi.org/10.1093/jcag/gwae012","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/jcag/gwad011.].</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 3","pages":"277"},"PeriodicalIF":0.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262037","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":"An image of portal hypertensive enteropathy in Roux-en-Y gastric bypass anatomy","authors":"Adnan Malik, Shahbaz Qureshi, Abdul Nadir","doi":"10.1093/jcag/gwae009","DOIUrl":"https://doi.org/10.1093/jcag/gwae009","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"9 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140258012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of oesophageal mucosal bridge.","authors":"Dain Raina Kim, Matthew Woo","doi":"10.1093/jcag/gwae008","DOIUrl":"10.1093/jcag/gwae008","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 6","pages":"395"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829183","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":"Gastroscopy for dyspeptic symptoms in patients <65 years has a low yield of clinically important findings: a retrospective study.","authors":"Brooke Maracle, Katelynn Crick, Kerri Novak, Denise Campbell-Scherer, Sander Veldhuyzen van Zanten, Daniel C Sadowski","doi":"10.1093/jcag/gwae003","DOIUrl":"10.1093/jcag/gwae003","url":null,"abstract":"<p><strong>Background: </strong>Dyspepsia is a common, generally low-risk gastrointestinal condition. The American College of Gastroenterology and Canadian Association of Gastroenterology recommend avoiding gastroscopy in healthy patients <60 years old. Many dyspeptic patients can be effectively managed in primary care. This study aimed to determine: (1) the proportion of gastroscopies performed for dyspepsia among patients <65 years old with no alarm symptoms or clinically appropriate indications and (2) to determine the frequency of clinically actionable findings and dyspepsia-related healthcare utilization in the year following gastroscopy.</p><p><strong>Methods: </strong>Outpatient endoscopy reports were sampled and reviewed retrospectively from 2019 to -2021 in Edmonton, Alberta to identify gastroscopies performed for the indication of dyspepsia. Gastroscopies were considered low-risk for significant endoscopic findings if age <65, no alarm symptoms or other concerning indications, and insufficient evidence that first-line treatments and diagnostic approaches had been tried prior to gastroscopy. Clinically important findings were defined as those impacting management, not otherwise identifiable non-invasively.</p><p><strong>Results: </strong>Of the 358 reviewed gastroscopies for dyspepsia, 293 (81.8%) had no alarm symptoms, and 130 (36.3%) had no alarm symptoms or other appropriate indications. Clinically important findings were identified in 9 (6.9%) of the 130 low-risk cases. In the year following, one patient (1/130) visited the emergency department 3 times for their symptoms and no patients required hospital admission. No malignancies were detected.</p><p><strong>Conclusions: </strong>Many gastroscopies are performed on patients <65 years old with dyspepsia, even when they lack alarm symptoms or other clinical indications, despite recommendations against this practice and low procedure yield. Strategies to improve the uptake of current guidelines may optimize endoscopy resource utilization.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 3","pages":"230-237"},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262038","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}