Journal of the Canadian Association of Gastroenterology最新文献

{"title":"Endoscopic Retrograde Cholangiopancreatography Under General Anesthesia Compared to Conscious Sedation Study","authors":"Grant Greaves, Kaitlyn G Harding, Brent Parker, Vu C Nguyen, Azim Ahmed, Belinda Yee, Joël Perren, Mathew Norman, Morgan Grey, Rafael Perini, Fahd Jowhari, Adrian Bak","doi":"10.1093/jcag/gwad037","DOIUrl":"https://doi.org/10.1093/jcag/gwad037","url":null,"abstract":"Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat pancreatic and biliary disease. The current standard is to conduct ERCP under conscious sedation (CS). Patient movement and agitation during ERCP under CS can result in procedure failure and complications. Aiming to reduce procedure failure rates and complications, Kelowna General Hospital (KGH) in British Columbia, Canada transitioned to performing ERCP under general anesthesia (GA) as the practice standard. Objective To determine if conducting ERCP under GA compared to CS decreases procedure complications, particularly post-ERCP pancreatitis (PEP). Methods The charts of 2,198 patients who underwent ERCP at KGH between 2015 and 2020 were reviewed. Before September 17, 2017, ERCP was performed under CS (n = 1,316). Afterwards, ERCP was conducted under GA (n = 882). Demographic, clinical, and procedural data were extracted. The data were analyzed using univariate and multivariate statistical analysis. Results Procedure failure rates (CS = 9 percent, GA = 3 percent, P < 0.001) decreased in the GA cohort after adjusting for age, sex, and co-morbidities. Thirty-day mortality, intensive care unit (ICU) transfer, returns post-discharge, PEP, and cholangitis rates were similar between cohorts. Conclusion Performing ERCP under GA compared to CS resulted in an increase in procedural success rates. Other complication rates were similar between groups.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135738897","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":"Assessing Frequency and Appropriateness of Proton Pump Inhibitor Deprescription in Patients Requiring Endoscopic Therapy for Esophageal Strictures","authors":"Kevin L Kecskemeti, Mark Borgaonkar, Jerry McGrath","doi":"10.1093/jcag/gwad036","DOIUrl":"https://doi.org/10.1093/jcag/gwad036","url":null,"abstract":"Abstract Objective There have been concerns about the widespread usage of proton pump inhibitors (PPIs), leading to recommendations to deprescribe PPIs in certain patients. This study aims to determine if PPI deprescription in patients with symptomatic esophageal strictures was consistent with published guidelines and to compare the rate of PPI deprescription between two-time points. Methods All patients from two gastroenterology practices who received endoscopic dilation to treat symptomatic strictures between the years of 2015–2017 and 2019–2021 were identified using physician billing codes. We defined inappropriate PPI deprescription as: a patient who was deprescribed their PPI with a past medical history of esophageal stricture, Barrett’s esophagus, grade C/D esophagitis, or who had experienced symptom recurrence after PPI deprescription. Furthermore, we analyzed the rate of PPI deprescription between two time periods 2015–2017 (group 1) and 2019–2021 (group 2). Results Two hundred twenty-three esophageal dilations were analyzed. Twenty-six patients in the sample were deprescribed their PPI, with the majority (57 percent) meeting the criteria for inappropriate PPI deprescription. There was a trend towards more inappropriate deprescription in the second time period. (71 percent vs. 33 percent; P = 0.06). Patients in group 2 had a higher rate of PPI deprescription (23.9 percent) than group 1 (6.0 percent; P < 0.001). Conclusions PPI deprescription in patients treated for symptomatic esophageal strictures appears to be more common in the second time period. Most patients were defined as inappropriate deprescription. Physicians must apply guidelines carefully when considering deprescribing PPIs.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136341873","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":"Irritable Bowel Syndrome Patient Experience: A Survey of Patient-Reported Symptoms by Irritable Bowel Syndrome Subtype and Impact on Quality of Life","authors":"Ganive Bhinder, Javier M Meza-Cardona, Alan Low, Guy Aumais, Gail P Attara, James R Gray","doi":"10.1093/jcag/gwad028","DOIUrl":"https://doi.org/10.1093/jcag/gwad028","url":null,"abstract":"Abstract Objectives Irritable bowel syndrome (IBS) is a chronic, debilitating, functional gastrointestinal disorder with symptoms of abdominal pain, bloating, and altered bowel behaviours of constipation (IBS-C), diarrhea (IBS-D), or a mixture of both (IBS-M). There is limited information published on the impact of symptoms on everyday life in the Canadian population. Methods An online survey was conducted with individuals diagnosed with IBS to capture the severity and frequency of patient-reported symptoms, including impact on productivity, quality of life, healthcare utilization, treatment access, and corresponding symptom relief. Responses from the three subtypes of IBS were categorized to illustrate differences among these. Results There were 2,470 qualified respondents (filtered from 2,981, which included nonspecific IBS). IBS-M was the most common subtype, at 44 percent. Most individuals from all three IBS subtypes reported experiencing moderate to severe abdominal pain (63–70 percent) and bloating (59–75 percent) over the previous 3 months. Persons living with IBS-C reported severe bloating (32 percent), straining (72 percent), and tenesmus (78 percent) whereas those with IBS-D experienced severe urgency (63 percent) and incontinence (29 percent). Symptoms interfered in daily life, sometimes in 46 percent and often in 23 percent of respondents. Patients reported mood and anxiety disorders as common comorbidities with IBS (mood disorders: 30–34 percent; anxiety disorders: 25–30 percent). Conclusions This study focuses on the differences among the IBS subtypes. IBS impacts productivity and healthcare utilization, which requires further investigation on approaches to improve treatment. The frequency and severity of symptoms in IBS are high and only a few respondents reported that their symptoms are under control.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135132987","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":"Gastroscopy for dyspepsia: Understanding primary care and gastroenterologist mental models of practice: A cognitive task analysis approach","authors":"Tanya Barber, Katelynn Crick, Lynn Toon, Jordan Tate, Karen Kelm, Kerri Novak, Rose O Yeung, Puneeta Tandon, Daniel C Sadowski, Sander Veldhuyzen van Zanten, Denise Campbell-Scherer","doi":"10.1093/jcag/gwad035","DOIUrl":"https://doi.org/10.1093/jcag/gwad035","url":null,"abstract":"Abstract Background Gastroscopy to investigate dyspepsia without alarm symptoms rarely results in clinically actionable findings or sustained health-related quality-of-life improvements among patients aged 18–60 years and is, therefore, not recommended. Despite this, referrals for and performance of gastroscopy among this patient population remain high. The purpose of this study was to understand family physicians’ and gastroenterologists’ mental models of dyspepsia and the drivers behind referring or performing gastroscopy. Methods Cognitive task analysis routine critical decision method interviews with family physicians (n = 8) and gastroenterologists (n = 4). Results Family physicians and gastroenterologists hold rich mental models of dyspepsia that rely on sensemaking; however, gaps in information continuity affect their ability to plan and coordinate patient care. Drivers behind decisions to refer or perform gastroscopy were: eliminating risk for serious pathology, providing reassurance, perceived preference by patients to receive information and reassurance from gastroenterologists, maintaining relationships with patients, and saving costs to the health system. Conclusions Family physicians refer for dyspepsia when they are seeking support from gastroenterologists, they believe that alternative factors may be impacting the patient’s health or view it as a cost-saving measure. Likewise, gastroenterologists perform gastroscopy for dyspepsia when they perceive it as a cost-saving measure, they want to support their primary care colleagues and provide their colleagues and patients with reassurance. An improved degree of communication between speciality and primary care could allow for continuity in the transfer of information about patients and reduce referrals for dyspepsia.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477850","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":"Current Evidence for Combined Targeted Therapy for the Treatment of Inflammatory Bowel Disease","authors":"Panu Wetwittayakhlang, Peter L Lakatos","doi":"10.1093/jcag/gwad032","DOIUrl":"https://doi.org/10.1093/jcag/gwad032","url":null,"abstract":"Abstract Biologicals and small molecules have revolutionized the medical management of inflammatory bowel diseases (IBD), yet they are only effective in a proportion of patients, and their impact on changing the natural history of the disease is still debatable. Recently, the concept of combining targeted biologics and small-molecule therapies has been introduced to the treatment of IBD. Dual-targeted therapy (sequential and combined), which is the combination of two targeted therapies, might be a reasonable choice for patients to break through the therapeutic ceiling. A recent randomized clinical trial (VEGA) provided the first controlled evidence that the short-term combination of two biological agents may lead to superior disease control than either of the agents alone in patients with ulcerative colitis (UC) without jeopardizing safety. Multiple studies are underway in both Crohn’s disease and UC. Additionally, real-world evidence is accumulating in IBD patients receiving combination therapies with concomitant IBD and extraintestinal manifestations or in patients with medically refractory IBD. Of note, the majority of these patients were exposed to multiple biological agents earlier and lost response to at least one of the agents in the combination. This review summarizes current knowledge regarding this attractive novel therapeutic option in IBD. Clearly, more controlled data are needed to evaluate optimal timing, efficacy, and mitigation of safety concerns.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134960554","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":"Managing ulcerative colitis and Crohn’s disease: should the target be endoscopy, histology, or both?","authors":"Fernando Magro, Maria Manuela Estevinho, André Valois","doi":"10.1093/jcag/gwad034","DOIUrl":"https://doi.org/10.1093/jcag/gwad034","url":null,"abstract":"Abstract In inflammatory bowel disease (IBD), mucosal healing is the primary long-term treatment goal, encompassing both endoscopic and histological outcomes. This paper aims to overview the ability of new treatment options to promote endoscopic and histological healing and to discuss the prognostic significance of endoscopic and histological outcomes. The analysis included randomized-controlled trials (published since 2020) focused on the impact of pharmacological interventions on endoscopic and histological remission in IBD. Even though the Mayo endoscopic subscore is routinely used, the application of validated scoring systems for ulcerative colitis is uncommon. In Crohn’s disease (CD), the application of endoscopic scores remains limited to clinical studies. The standardized evaluation of histological features has been performed in several recent ulcerative colitis trials, resorting mostly to the Geboes score and the Nancy histological index. Still, the use of histological scores for CD remains elusive. Current evidence underscores that histological remission conveys the best long-term prognosis, supporting the inclusion of histology as a treatment guide in ulcerative colitis. In CD, data are promising but originated from a few retrospective studies. Further efforts are warranted to: (1) use validated histological indexes for ulcerative colitis, aiming their adoption as treatment targets; (2) promote the validation and utilization of histological scores for CD, at least in clinical studies; (3) confirm the prognostic impact of histological remission in CD; (4) integrate artificial intelligence assets to support grading, particularly in the setting of histology; (5) prospectively define the monitoring frequency of IBD patients who achieved histological remission.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959923","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":"Choosing Therapy for Moderate to Severe Crohn’s Disease","authors":"Malcolm Irani, Bincy Abraham","doi":"10.1093/jcag/gwad023","DOIUrl":"https://doi.org/10.1093/jcag/gwad023","url":null,"abstract":"Abstract The availability of approved therapies for Crohn’s disease has significantly increased over the past decade. To choose the appropriate therapy for the patient, ideally head to head studies, and data on positioning could help the provider individualize the decision. Due to the paucity of head-to-head trial data, we turn to network meta-analysis and real-world studies to help guide our treatment choices. Ultimately, the best approach is to consider each patient on an individual basis, taking into consideration the characteristics of their disease, individual risk factors, extra-intestinal manifestations, co-morbid conditions, patient age, cost, and personal preferences. In this review, we summarize the evidence comparing biologic as well as small molecule therapies for the treatment of moderate-to-severe Crohn’s disease. We have summarized the evidence in relation to factors such as efficacy, fistulizing disease, pregnancy, infection risk, and co-existing conditions.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136062334","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":"Identification and Evaluation of Mobile Applications for Self-Management of Diet and Lifestyle for Patients with Inflammatory Bowel Disease.","authors":"Stephanie L Gold, Brandon A Chiew, Vidya Rajagopalan, Celeste M Lavallee","doi":"10.1093/jcag/gwad029","DOIUrl":"10.1093/jcag/gwad029","url":null,"abstract":"<p><strong>Background: </strong>Mobile health applications (apps) providing diet and lifestyle self-management programs to patients with inflammatory bowel disease (IBD) are emerging. The objective of this study was to evaluate current apps available in the US and Canada based on app quality, perceived impact on diet and mental health and comprehensiveness to support self-management.</p><p><strong>Methods: </strong>The Apple iOS and Google Play app stores were searched for terms related to IBD. Apps were included if they targeted diet and lifestyle behaviours for patients living with IBD and were available to the general public. Apps were excluded if they were not specific to IBD, not available in English, did not target diet or lifestyle therapy, were not available in the US and Canada, or did not offer stand-alone self-management programs. The Mobile App Rating Scale was used to assess mobile app quality.</p><p><strong>Results: </strong>A total of 1,512 apps were identified through the app stores. Six apps met inclusion criteria. <i>My IBD Care: Crohn's and Colitis</i> received the highest quality rating and <i>Lyfe</i>^<i>MD</i> received the highest overall app rating. Only these two apps provided behaviour tracking over time, and three (50 percent) apps provided good-quality information.</p><p><strong>Conclusions: </strong>While many IBD-related apps exist, few support self-management of diet and lifestyle behaviours. The My IBD Care and Lyfe^MD apps had the highest ratings and can be used to track lifestyle behaviours. The effectiveness of these apps to improve behaviours, and subsequently impact the disease course and quality of life, should be explored in future studies.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 5","pages":"186-195"},"PeriodicalIF":0.0,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10558196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136581","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 Association Between Increased Maladaptive Health Behaviours and Elevated Mental Health Symptoms Among Persons with IBD During the COVID-19 Pandemic.","authors":"Casandra L Dolovich,&nbsp;Seth R Shaffer,&nbsp;Lesley A Graff,&nbsp;Harminder Singh,&nbsp;Renée El-Gabalawy,&nbsp;Souradet Shaw,&nbsp;Charles N Bernstein","doi":"10.1093/jcag/gwad030","DOIUrl":"10.1093/jcag/gwad030","url":null,"abstract":"<p><strong>Aim: </strong>To assess the association between maladaptive health behaviours and elevated mental health (MH) symptoms during the COVID-19 pandemic among persons with inflammatory bowel disease (IBD).</p><p><strong>Methods: </strong>Participants of the population-based University of Manitoba IBD Research Registry (<i>n</i> = 2,942) were invited to participate in a survey in November 2020, regarding their experiences during the COVID-19 pandemic. Maladaptive health behaviours included increased use of alcohol, marijuana, and cigarettes, and reduced exercise relative to pre-pandemic levels. Clinically significant MH symptoms were defined by the presence of elevated anxiety, depression, and/or post-traumatic stress. Adjusted logistic regression assessed the odds of elevated MH symptoms predicted by maladaptive health behaviours, stratified by gender.</p><p><strong>Results: </strong>Of 1,363 (46%) respondents, 319 (23%) had elevated MH symptoms. Those with elevated MH symptoms were older (mean age 54) and predominantly females (70%). The odds of any elevated MH symptoms were approximately two to four times greater among those who experienced maladaptive health behaviours during the pandemic including: increased alcohol use [aOR 2.14, 95% CI (1.50-3.05)], males who increased marijuana use [aOR 4.18, 95% CI (1.18-14.74)], females who increased smoking cigarettes [aOR 3.68 95% CI (1.15-11.86)] and any maladaptive health behaviour [aOR 1.93 95% CI (1.44-2.60)].</p><p><strong>Conclusion: </strong>During the COVID-19 pandemic, persons with IBD who experienced any maladaptive health behaviour was associated with double the likelihood of experiencing clinically significant MH symptoms. For persons with elevated MH symptoms, it is important for health care providers to recognize the association of increased maladaptive behaviours. Alternatively, if it is determined that MH symptoms predated maladaptive health behaviours then, inquiries into MH and providing appropriate referrals should be pursued.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 5","pages":"179-185"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10558191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41119105","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":"Obliterated Appendiceal Orifice with Sessile Serrated Lesion","authors":"Nabeel Ahmed, Christine Orr, Sunil Patel, Robert Bechara","doi":"10.1093/jcag/gwad031","DOIUrl":"https://doi.org/10.1093/jcag/gwad031","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136298797","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}