Journal of the Canadian Association of Gastroenterology最新文献

{"title":"The 2023 Impact of Inflammatory Bowel Disease in Canada: Epidemiology of IBD.","authors":"Stephanie Coward, Eric I Benchimol, M Ellen Kuenzig, Joseph W Windsor, Charles N Bernstein, Alain Bitton, Jennifer L Jones, Kate Lee, Sanjay K Murthy, Laura E Targownik, Juan-Nicolás Peña-Sánchez, Noelle Rohatinsky, Sara Ghandeharian, James H B Im, Tal Davis, Jake Weinstein, Quinn Goddard, Jennifer Bennett, Léa Caplan, Maxime Bergevin, Xin Yu Yang, Kate Mason, Rhonda Sanderson, Colten Brass, Gilaad G Kaplan","doi":"10.1093/jcag/gwad004","DOIUrl":"10.1093/jcag/gwad004","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD), consisting of Crohn's disease and ulcerative colitis, is recognized across the world, though Canada has among the highest burdens of IBD in the world. The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) led a six-province study that demonstrated the compounding prevalence of IBD in Canada from 400 per 100,000 in 2002 to 636 per 100,000 in 2014. The prevalence in 2023 is estimated at 825 per 100,000, meaning that over 320,000 people in Canada are living with IBD. Prevalence is forecasted to rise by 2.44% per year such that 1.1% of the population, 470,000 Canadians, will live with IBD by 2035. The overall incidence of IBD in 2023 is 30 per 100,000 person-years, indicating that over 11,000 Canadians will be newly diagnosed with IBD in 2023. Incidence is forecasted to rise by 0.58% per year up to 32.1 per 100,000 by 2035. The rising incidence of IBD is propelled by pediatric-onset IBD, which is rising by 1.23% per year from 15.6 per 100,000 in 2023 to 18.0 per 100,000 in 2035. In contrast, incidence rates among adults and seniors are relatively stable. Understanding the determinates of IBD has expanded through prospective cohort studies such as the Crohn's and Colitis Canada Genetic, Environmental, Microbial (CCC-GEM) project. Consensus recommendations towards diet, lifestyle, behavioural and environmental modifications have been proposed by international organizations with the goal of optimizing disease control and ultimately preventing the development of IBD. Despite these efforts, Canadian healthcare systems will need to prepare for the rising number of people living with IBD.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 Suppl 2","pages":"S9-S15"},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10181338","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 2023 Impact of Inflammatory Bowel Disease in Canada: The Influence of Sex and Gender on Canadians Living With Inflammatory Bowel Disease.","authors":"Laura E Targownik, Natasha Bollegala, Vivian H Huang, Joseph W Windsor, M Ellen Kuenzig, Eric I Benchimol, Gilaad G Kaplan, Sanjay K Murthy, Alain Bitton, Charles N Bernstein, Jennifer L Jones, Kate Lee, Juan-Nicolás Peña-Sánchez, Noelle Rohatinsky, Sara Ghandeharian, Tal Davis, Jake Weinstein, James H B Im, Nazanin Jannati, Rabia Khan, Priscilla Matthews, Tyrel Jones May, Sahar Tabatabavakili, Rohit Jogendran, Elias Hazan, Mira Browne, Saketh Meka, Sonya Vukovic, Manisha Jogendran, Malini Hu, Jessica Amankwah Osei, Grace Y Wang, Tasbeen Akhtar Sheekha, Ghaida Dahlwi, Quinn Goddard, Julia Gorospe, Cyanne Nisbett, Shira Gertsman, James Sousa, Taylor Morganstein, Taylor Stocks, Ann Weber, Cynthia H Seow","doi":"10.1093/jcag/gwad011","DOIUrl":"10.1093/jcag/gwad011","url":null,"abstract":"<p><p>Sex (the physical and physiologic effects resulting from having specific combinations of sex chromosomes) and gender (sex-associated behaviours, expectations, identities, and roles) significantly affect the course of inflammatory bowel disease (IBD) and the experience of living with IBD. Sex-influenced physiologic states, like puberty, the menstrual cycle, pregnancy, and andropause/menopause may also impact and be impacted by IBD. While neither Crohn's disease nor ulcerative colitis is commonly considered sex-determined illnesses, the relative incidence of Crohn's disease and ulcerative colitis between males and females varies over the life cycle. In terms of gender, women tend to use healthcare resources at slightly higher rates than men and are more likely to have fragmented care. Women are more commonly prescribed opioid medications and are less likely than men to undergo colectomy. Women tend to report lower quality of life and have higher indirect costs due to higher rates of disability. Women are also more likely to take on caregiver roles for children with IBD. Women with IBD are more commonly burdened with adverse mental health concerns and having poor mental health has a more profound impact on women than men. Pregnant people with active IBD have higher rates of adverse outcomes in pregnancy, made worse in regions with poor access to IBD specialist care. The majority of individuals with IBD in Canada do not have access to a pregnancy-in-IBD specialist; access to this type of care has been shown to allay fears and increase knowledge among pregnant people with IBD.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 Suppl 2","pages":"S55-S63"},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10183279","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":"Time for a Gut Check: A Qualitative Study of Proposed Interventions to Address Gender Inequality in Gastroenterology.","authors":"Sowmya Sharma,&nbsp;Holly Mathias,&nbsp;Emma Jones,&nbsp;Courtney Heisler,&nbsp;Noelle Rohatinsky,&nbsp;Kerri Novak,&nbsp;Yvette Leung,&nbsp;Sharyle Fowler,&nbsp;Melaine Kaczur,&nbsp;Laura Targownik,&nbsp;Jennifer L Jones","doi":"10.1093/jcag/gwad022","DOIUrl":"10.1093/jcag/gwad022","url":null,"abstract":"<p><strong>Background: </strong>Gender inequalities persist in medicine, particularly in some speciality fields where fewer women are employed. Although previous research has suggested potential interventions to broadly address gender inequality in medicine, no research has focused on interventions in the field of gastroenterology. The purpose of this research was to engage women in the field of gastroenterology in Canada, to identify interventions with potential to be effective in addressing gender inequality.</p><p><strong>Methods: </strong>A World Café was hosted in 2019 to discuss gender inequality and interventions in gastroenterology. Twelve women employed in the field of gastroenterology (i.e. physicians, nurses, research staff, and trainees) were purposively recruited and participated in the event. The discussion rounds were audio-recorded, transcribed, and thematic analyses was conducted using Braun and Clarke's principles.</p><p><strong>Results: </strong>Three key themes identifying potential interventions to address gender inequality in gastroenterology were generated: (1) Education; (2) Addressing institutional structures and polices; and 3) Role modelling and mentorship. Participants indicated that interventions should target various stakeholders, including both women and men in gastroenterology, young girls, patients, and administrators.</p><p><strong>Conclusion: </strong>Many of the interventions identified by participants correspond with existing research on interventions in general medicine, suggesting that institutional changes can be made for maximum effectiveness. Some novel interventions were also identified, including publicizing instances of gender parity and supporting interventions across the educational and professional lifecourse. Moving forward, institutions must assess their readiness for change and evaluate existing policies, programs, and practices for areas of improvement.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 5","pages":"155-161"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10558195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41137253","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":"Choosing Therapies in Ulcerative Colitis","authors":"Ronit Das, A Hillary Steinhart","doi":"10.1093/jcag/gwad025","DOIUrl":"https://doi.org/10.1093/jcag/gwad025","url":null,"abstract":"Abstract Those managing ulcerative colitis (UC) must be aware of new treatments. Mesalamine (5-ASA) is the first treatment for mild UC. Steroids have been the first therapy for patients with more severe UC but these are not effective or safe long term. This means that other medicines are needed. Newer advanced therapies are now frequently used. There are several types of advanced therapies. These are the anti-TNF, anti-integrin and anti-IL12/23 agents as well as the JAK inhibitors and sphingosine1-phosphate receptor modulators. All of these are effective in treating UC. Choosing among treatments is complicated. There are multiple factors to think about when choosing a treatment for UC. Without research studies that directly compare the different treatments, the use of any one treatment should be based on effectiveness and safety. Other considerations include specific disease features, patient factors and the preference of patients.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135402739","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":"Biomarkers That Predict Crohn’s Disease Outcomes","authors":"Pablo A Olivera, Mark S Silverberg","doi":"10.1093/jcag/gwad024","DOIUrl":"https://doi.org/10.1093/jcag/gwad024","url":null,"abstract":"Abstract Crohn’s disease (CD), a chronic inflammatory condition of the digestive tract, poses significant challenges in terms of disease prognosis and treatment selection. Biomarkers have the potential to predict CD outcomes and guide clinical decision-making. This review aims to summarize the current literature on promising biomarkers associated with CD outcomes and their potential clinical implications. The identification of reliable biomarkers for CD outcomes is of paramount importance in tailoring treatment strategies, monitoring disease activity, and predicting the risk of complications. Clinical prognostic factors traditionally used to assess disease severity, and the likelihood of complications have limitations in accuracy and predictive value. Thus, there is a need for more precise biomarkers, particularly in newly diagnosed and treatment-naive patients. Pharmacogenomic markers, such as TPMT and NUDT15 polymorphisms, have been utilized to identify patients at risk of adverse events with thiopurine therapy. Several biomarkers, including HLA haplotypes, oncostatin M expression, and transcriptomic profiles, have shown associations with response to anti-TNF therapy. Confocal laser endomicroscopy and single-cell analyses hold promise in predicting treatment response to specific therapies. The identification of biomarkers associated with post-operative recurrence in CD is crucial, as it could lead to changes in management algorithms. Several promising microbiome signatures and proteomic profiles have been identified. In conclusion, biomarkers have the potential to revolutionize the management of CD by providing valuable prognostic information and guiding treatment decisions. However, further research and validation are necessary to establish their clinical utility and integration into routine practice.","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134949095","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":"The 2023 Impact of Inflammatory Bowel Disease in Canada: Cancer and IBD.","authors":"Sanjay K Murthy,&nbsp;M Ellen Kuenzig,&nbsp;Joseph W Windsor,&nbsp;Priscilla Matthews,&nbsp;Parul Tandon,&nbsp;Eric I Benchimol,&nbsp;Charles N Bernstein,&nbsp;Alain Bitton,&nbsp;Stephanie Coward,&nbsp;Jennifer L Jones,&nbsp;Gilaad G Kaplan,&nbsp;Kate Lee,&nbsp;Laura E Targownik,&nbsp;Juan-Nicolás Peña-Sánchez,&nbsp;Noelle Rohatinsky,&nbsp;Sara Ghandeharian,&nbsp;Saketh Meka,&nbsp;Roxana S Chis,&nbsp;Sarang Gupta,&nbsp;Eric Cheah,&nbsp;Tal Davis,&nbsp;Jake Weinstein,&nbsp;James H B Im,&nbsp;Quinn Goddard,&nbsp;Julia Gorospe,&nbsp;Jennifer Loschiavo,&nbsp;Kaitlyn McQuaid,&nbsp;Joseph D'Addario,&nbsp;Ken Silver,&nbsp;Robyn Oppenheim,&nbsp;Harminder Singh","doi":"10.1093/jcag/gwad006","DOIUrl":"https://doi.org/10.1093/jcag/gwad006","url":null,"abstract":"<p><p>Cancer is a major cause of morbidity and mortality among people with inflammatory bowel disease (IBD). Intestinal cancers may arise as a complication of IBD itself, while extra-intestinal cancers may arise due to some of the immunosuppressive therapies used to treat IBD. Colorectal cancer (CRC) and small bowel cancer risks remain elevated among persons with IBD as compared to age-and sex-matched members of the general population, and the lifetime risk of these cancers is strongly correlated to cumulative intestinal inflammatory burden. However, the cumulative risk of cancer, even among those with IBD is still low. Some studies suggest that IBD-CRC incidence has declined over the years, possibly owing to improved treatment standards and improved detection and management of early neoplastic lesions. Across studies of extra-intestinal cancers, there are generally higher incidences of melanoma, hepatobiliary cancer, and lung cancer and no higher incidences of breast cancer or prostate cancer, with equivocal risk of cervical cancer, among persons with IBD. While the relative risks of some extra-intestinal cancers are increased with treatment, the absolute risks of these cancers remain low and the decision to forego treatment in light of these risks should be carefully weighed against the increased risks of intestinal cancers and other disease-related complications with undertreated inflammatory disease. Quality improvement efforts should focus on optimized surveillance of cancers for which surveillance strategies exist (colorectal cancer, hepatobiliary cancer, cervical cancers, and skin cancers) and the development of cost-effective surveillance strategies for less common cancers associated with IBD.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 Suppl 2","pages":"S83-S96"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171057","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 2023 Impact of Inflammatory Bowel Disease in Canada: COVID-19 and IBD.","authors":"Gilaad G Kaplan,&nbsp;M Ellen Kuenzig,&nbsp;Joseph W Windsor,&nbsp;Charles N Bernstein,&nbsp;Alain Bitton,&nbsp;Stephanie Coward,&nbsp;Jennifer L Jones,&nbsp;Kate Lee,&nbsp;Sanjay K Murthy,&nbsp;Laura E Targownik,&nbsp;Juan-Nicolás Peña-Sánchez,&nbsp;Sara Ghandeharian,&nbsp;Noelle Rohatinsky,&nbsp;Jake Weinstein,&nbsp;Tyrel Jones May,&nbsp;Mira Browne,&nbsp;Nazanin Jannati,&nbsp;Sahar Tabatabavakili,&nbsp;James H B Im,&nbsp;Saketh Meka,&nbsp;Sonya Vukovic,&nbsp;Tal Davis,&nbsp;Quinn Goddard,&nbsp;Julia Gorospe,&nbsp;Taylor Stocks,&nbsp;Léa Caplan,&nbsp;Najla Kanaan,&nbsp;Daniel Stuart,&nbsp;Tesa Ramsay,&nbsp;Kelly J Robinson,&nbsp;Diane Charron-Bishop,&nbsp;Eric I Benchimol","doi":"10.1093/jcag/gwad019","DOIUrl":"https://doi.org/10.1093/jcag/gwad019","url":null,"abstract":"<p><p>The COVID-19 pandemic had a monumental impact on the inflammatory bowel disease (IBD) community. At the beginning of the pandemic, knowledge on the effect of SARS-CoV-2 on IBD was lacking, especially in those with medication-suppressed immune systems. Throughout the pandemic, scientific literature exponentially expanded, resulting in clinical guidance and vaccine recommendations for individuals with IBD. Crohn's and Colitis Canada established the COVID-19 and IBD Taskforce to process and communicate rapidly transforming knowledge into guidance for individuals with IBD and their caregivers, healthcare providers, and policy makers. Recommendations at the onset of the pandemic were based on conjecture from experience of prior viruses, with a precautionary principle in mind. We now know that the risk of acquiring COVID-19 in those with IBD is the same as the general population. As with healthy populations, advanced age and comorbidities increase the risk for severe COVID-19. Individuals with IBD who are actively flaring and/or who require high doses of prednisone are susceptible to severe COVID-19 outcomes. Consequently, sustaining maintenance therapies (e.g., biologics) is recommended. A three-dose mRNA COVID-19 vaccine regimen in those with IBD produces a robust antibody response with a similar adverse event profile as the general population. Breakthrough infections following vaccine have been observed, particularly as the virus continues to evolve, which supports receiving a bivalent vaccine booster. Limited data exist on the impact of IBD and its therapies on long-term outcomes following COVID-19. Ongoing research is necessary to address new concerns manifesting in those with IBD throughout the evolving pandemic.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 Suppl 2","pages":"S76-S82"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10181336","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 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease.","authors":"Lesley A Graff,&nbsp;Rose Geist,&nbsp;M Ellen Kuenzig,&nbsp;Eric I Benchimol,&nbsp;Gilaad G Kaplan,&nbsp;Joseph W Windsor,&nbsp;Alain Bitton,&nbsp;Stephanie Coward,&nbsp;Jennifer L Jones,&nbsp;Kate Lee,&nbsp;Sanjay K Murthy,&nbsp;Juan-Nicolás Peña-Sánchez,&nbsp;Laura E Targownik,&nbsp;Nazanin Jannati,&nbsp;Tyrel Jones May,&nbsp;Tasbeen Akhtar Sheekha,&nbsp;Tal Davis,&nbsp;Jake Weinstein,&nbsp;Ghaida Dahlwi,&nbsp;James H B Im,&nbsp;Jessica Amankwah Osei,&nbsp;Noelle Rohatinsky,&nbsp;Sara Ghandeharian,&nbsp;Quinn Goddard,&nbsp;Julia Gorospe,&nbsp;Shira Gertsman,&nbsp;Michelle Louis,&nbsp;Richelle Wagner,&nbsp;Colten Brass,&nbsp;Rhonda Sanderson,&nbsp;Charles N Bernstein","doi":"10.1093/jcag/gwad012","DOIUrl":"https://doi.org/10.1093/jcag/gwad012","url":null,"abstract":"<p><p>Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn's disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 Suppl 2","pages":"S64-S75"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10183286","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 2023 Impact of Inflammatory Bowel Disease in Canada: Special Populations-Children and Adolescents with IBD.","authors":"Wael El-Matary,&nbsp;Matthew W Carroll,&nbsp;Colette Deslandres,&nbsp;Anne M Griffiths,&nbsp;M Ellen Kuenzig,&nbsp;David R Mack,&nbsp;Eytan Wine,&nbsp;Jake Weinstein,&nbsp;Rose Geist,&nbsp;Tal Davis,&nbsp;Justin Chan,&nbsp;Rabia Khan,&nbsp;Priscilla Matthews,&nbsp;Gilaad G Kaplan,&nbsp;Joseph W Windsor,&nbsp;Charles N Bernstein,&nbsp;Alain Bitton,&nbsp;Stephanie Coward,&nbsp;Jennifer L Jones,&nbsp;Kate Lee,&nbsp;Sanjay K Murthy,&nbsp;Laura E Targownik,&nbsp;Juan-Nicolás Peña-Sánchez,&nbsp;Noelle Rohatinsky,&nbsp;Sara Ghandeharian,&nbsp;James H B Im,&nbsp;Quinn Goddard,&nbsp;Julia Gorospe,&nbsp;Jules Verdugo,&nbsp;Samantha A Morin,&nbsp;Taylor Morganstein,&nbsp;Lisa Banning,&nbsp;Eric I Benchimol","doi":"10.1093/jcag/gwad016","DOIUrl":"https://doi.org/10.1093/jcag/gwad016","url":null,"abstract":"<p><p>Rates of inflammatory bowel disease (IBD) in Canadian children and adolescents are among the highest in the world, and the incidence is rising most rapidly in children under five years of age. These young children may have either a typical form of IBD with multi-factorial aetiology, or they may have a monogenic form. Despite the growing number of children in Canada living with this important chronic disease, there are few available medical therapies approved by Health Canada due to the omission of children from most clinical trials of newly developed biologics. As a result, off-label use of medications is common, and physicians have learned to use existing therapies more effectively. In addition, most Canadian children are treated in multidisciplinary, specialty clinics by physicians with extra training or experience in IBD, as well as specialist nurses, dietitians, mental health care providers and other allied health professionals. This specialized clinic approach has facilitated cutting edge research, led by Canadian clinicians and scientists, to understand the causes of IBD, the optimal use of therapies, and the best ways to treat children from a biopsychosocial perspective. Canadians are engaged in work to understand the monogenic causes of IBD; the interaction between genes, the environment, and the microbiome; and how to address the mental health concerns and medical needs of adolescents and young adults transitioning from paediatric to adult care.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 Suppl 2","pages":"S35-S44"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177839","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 2023 Impact of Inflammatory Bowel Disease in Canada: Special Populations-IBD in Seniors.","authors":"Seth R Shaffer,&nbsp;M Ellen Kuenzig,&nbsp;Joseph W Windsor,&nbsp;Alain Bitton,&nbsp;Jennifer L Jones,&nbsp;Kate Lee,&nbsp;Sanjay K Murthy,&nbsp;Laura E Targownik,&nbsp;Juan-Nicolás Peña-Sánchez,&nbsp;Noelle Rohatinsky,&nbsp;Sara Ghandeharian,&nbsp;Parul Tandon,&nbsp;Joëlle St-Pierre,&nbsp;Navneet Natt,&nbsp;Tal Davis,&nbsp;Jake Weinstein,&nbsp;James H B Im,&nbsp;Eric I Benchimol,&nbsp;Gilaad G Kaplan,&nbsp;Quinn Goddard,&nbsp;Julia Gorospe,&nbsp;Maxime Bergevin,&nbsp;Ken Silver,&nbsp;Dawna Bowles,&nbsp;Margaret Stewart,&nbsp;Marsha Pearlstein,&nbsp;Elizabeth H Dawson,&nbsp;Charles N Bernstein","doi":"10.1093/jcag/gwad013","DOIUrl":"https://doi.org/10.1093/jcag/gwad013","url":null,"abstract":"<p><p>Approximately one out of every 88 seniors has inflammatory bowel disease (IBD), and this is expected to increase in the future. They are more likely to have left-sided disease in ulcerative colitis, and isolated colonic disease in Crohn's disease; perianal disease is less common. Other common diagnoses in the elderly must also be considered when they initially present to a healthcare provider. Treatment of the elderly is similar to younger persons with IBD, though considerations of the increased risk of infections and malignancy must be considered when using immune modulating drugs. Whether anti-TNF therapies increase the risk of infections is not definitive, though newer biologics, including vedolizumab and ustekinumab, are thought to be safer with lower risk of adverse events. Polypharmacy and frailty are other considerations in the elderly when choosing a treatment, as frailty is associated with worse outcomes. Costs for IBD-related hospitalizations are higher in the elderly compared with younger persons. When elderly persons with IBD are cared for by a gastroenterologist, their outcomes tend to be better. However, as elderly persons with IBD continue to age, they may not have access to the same care as younger people with IBD due to deficiencies in their ability to use or access technology.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"6 Suppl 2","pages":"S45-S54"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177833","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}