Journal of the Canadian Association of Gastroenterology最新文献

Background: As inflammatory bowel disease (IBD) becomes increasingly common worldwide, optimizing service delivery is critical to ensuring timely access to high-quality IBD care. We conducted a scoping review to understand the extent and type of evidence related to models of outpatient IBD care.

Methods: We searched MEDLINE, EMBASE, CINAHL, and PsycINFO from inception to April 29, 2025 to identify English-language studies describing or evaluating models of care delivery for individuals with IBD in outpatient settings. Eligible peer-reviewed articles included publications of any type (primary studies, reviews, perspectives) focusing on any age group, timepoints in care (eg, transition from pediatric to adult care), and context (eg, remote delivery).

Results: Of the 14,202 records searched, 243 met the inclusion criteria, including 89 studies evaluating models of care, 141 studies describing models of care without formal evaluation, and 13 consensus statements/guidelines. Models discussed included value-based multidisciplinary teams (with either biomedical or biopsychosocial approaches), care provided by nurses and other allied healthcare professionals (HCPs), remote monitoring and healthcare delivery, and rapid access clinics. Models increased patient satisfaction, enhanced collaboration between patients and HCPs, reduced health services utilization (eg, emergency department visits, hospitalizations), and improved patient outcomes (ie, disease activity, mental health, quality of life). Gastroenterologists, IBD nurses, and allied HCPs were consistently identified as key team members.

Conclusions: Innovative outpatient models of IBD care have been proposed and evaluated. These models of care can guide modifications to IBD care globally to help address the rising demand of IBD on healthcare systems, increasing the efficiency of care.

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that effects both pediatrics and adult patients in Canada and is increasing in prevalence. No Canadian focused best practice recommendations currently exist to guide clinical practice.

Methods: The study used a modified Delphi technique to develop evidence and expert opinion-based recommendations for providing care for patients with EoE. The Delphi process consisted of 3 rounds of quantitative surveys and qualitative consensus meetings. Experts were included in the Delphi if they had experience caring for EoE patients in Canada within one of the following professional groups: allergist, adult gastroenterologists, pathologists, pediatric gastroenterologists, and dieticians.

Results: Delphi rounds were completed between May 1, 2024, and June 30, 2024. A total of 31 experts in EoE care from across Canada were recruited to participate in the Delphi consensus process. All participants completed all 3 rounds of Delphi surveys. The final statement includes 38 recommendations for the care of patients with EoE organized into 3 sections: definition, diagnosis, and management. A table of research gaps is provided to stimulate further knowledge development on this topic.

Conclusion: This consensus statement includes actionable recommendations to support quality care of patients with EoE at any age across Canada. We encourage EoE centres in Canada to come together in a multidisciplinary form to not only provide clinical care but also do much needed research on Canadian specific topics and gaps in EoE care.

Background: Accurate and consistent documentation during colonoscopy is essential for optimal patient care and therapeutic decisions. Traditional manual documentation is time-consuming and subject to variability. Artificial intelligence (AI)-assisted tools offer potential improvements by standardizing report generation in real-time. We developed a novel AI-driven, voice-guided reporting platform that uses natural language processing (NLP) and real-time image capture for endoscopy documentation.

Methods: This prospective pilot study was conducted at the Centre Hospitalier de l'Université de Montréal between October 2023 and May 2024. A total of 95 patients undergoing elective endoscopy were recruited, with 57 procedures included in the final analysis. Endoscopists provided real-time verbal dictations during procedures, which the AI-assisted report generation tool transcribed and linked to captured images. The system's performance was evaluated based on documentation completeness, transcription accuracy, and user engagement.

Results: The AI-assisted report generation tool successfully documented key procedural parameters when verbal annotations were provided, achieving an 87.5% detection rate for ileocecal valve identification, and 100% detection rate for procedure indication, Boston Bowel Preparation Score, withdrawal time, and polyp characterization. However, the transcription word error was 10.07%, with errors primarily in medical terminology. User engagement varied, with some procedures lacking dictated annotations.

Conclusion: Our AI-assisted report generation tool demonstrates potential in standardizing colonoscopy documentation through AI-assisted, real-time NLP for generating reports. While effective, its performance depends on endoscopist engagement. Future improvements in NLP capabilities and structured reporting prompts can enhance completeness and usability, contributing to more efficient and accurate endoscopy documentation.

Background: Individuals with inflammatory bowel diseases (IBD) are at increased risk of repeated disease-related hospital admissions, some of which may be preventable with targeted outpatient interventions. We assessed population-level trends in the rates of IBD-specific hospital readmission within 30 and 90 days of index hospitalization among those with Crohn's disease (CD) and ulcerative colitis (UC) during a period marked by major changes to IBD management.

Methods: We accessed Ontario health administrative datasets to study CD (2002-2017) and UC (2004-2020) patients hospitalized for IBD-specific indications. We compared IBD-specific 30-day and 90-day hospital readmission rates across 4 (UC) and 5 (CD) year time periods using multivariable logistic regression, controlling for age, sex, comorbidities, residential setting, household income, hospital type, and clustering of admissions within patients.

Results: Among CD patients, 30-day readmission rates decreased from 9.7% to 7.4%, and 90-day rates decreased from 16.0% to 14.1% between 2002-2007 and 2012-2017 periods. There was a higher likelihood of 30-day readmission during 2002-2007 (adjusted odds ratio [aOR] 1.32; 95% CI, 1.16-1.50) and 2007-2012 (aOR 1.15; 95% CI, 1.01-1.32), and of 90-day readmission during 2002-2007 (aOR 1.14; 95% CI, 1.03-1.26), as compared to 2012-2017. Among UC patients, readmission rates remained stable across time periods.

Conclusion: Inflammatory bowel disease-related early rehospitalization risk has declined over time among individuals with CD but not among individuals with UC.

Background: Inflammatory bowel disease-related psychological distress (IBD-PD) refers to the emotional impact of IBD and has been shown to be associated with increased disease severity, comorbid mental health disorders, and increased mortality.

Aims: This study aims to identify the facilitators for accessing evidence-based interventions for IBD-PD to inform the design and implementation of patient-centred models for IBD mental health support in the future.

Methods: This was a qualitative research study in which a semistructured interview script was developed by a multidisciplinary team guided by the domains of the COM-B Behaviour Change Wheel framework. Using thematic analysis, codes were generated to identify themes using an inductive approach.

Results: Fourteen participants were successfully recruited (n = 14). Thematic analyses identified the following major themes: (1) mental health should be treated as an integrated component of specialty IBD care; (2) use of self-help strategies alongside existing supports is feasible, acceptable, and accessible; (3) accessing support for IBD-PD through virtual care is often acceptable; and (4) flexible, multifaceted delivery models for IBD-PD are needed. All participants felt that mental health should be discussed at IBD clinic visits. Preferences for hybrid formats for IBD-PD care were clear. Most participants felt that it was important for psychological support persons to also have IBD knowledge. Participants felt strongly that a more qualified psychologist, even in the absence of IBD knowledge, was their top priority.

Conclusions: Some key facilitators identified from this study include healthcare professionals discussing IBD-PD directly with their patients, offering hybrid formats for IBD-PD, and integrating self-help strategies into care.

Objective: Proton pump inhibitors (PPIs) are widely prescribed but inappropriate indications and concerns over long-term side effects have led to recommendations to deprescribe PPIs in certain patients. We previously found a 4-fold increase in PPI deprescription in patients with esophageal strictures. This study aims to assess the PPI deprescription rate in patients with upper gastrointestinal bleeding (UGIB).

Methods: All patients from 2 gastroenterology practices who received endoscopic treatment for UGIB during the years of 2015-2022 were identified using physician billing codes. We defined PPI deprescription as either a 50% dose reduction, frequency reduction, or complete medication discontinuation at the time of endoscopic intervention compared to the established PPI therapy from the 3 months prior. We compared the rate of PPI deprescription between 2 time periods 2015-2018 (group 1) and 2019-2022 (group 2).

Results: Three hundred one UGIB managed with endoscopy were analyzed. Patients in group 2 had a significantly higher rate of PPI deprescription than group 1 (15% vs 4%; P < .002). Patients with peptic ulcer disease (PUD) had a significantly higher PPI deprescription during the second time period (16% vs 0%; P = .028). Among patients with repeat UGIB, 10% had their PPI deprescribed.

Conclusions: Proton pump inhibitor deprescription in patients with UGIB treated with endoscopic intervention was more common in the second time period. This corresponds to when PPI deprescription guidelines were distributed. Physicians should ensure the appropriate application of PPI deprescription guidelines and continuation of PPI therapy for patients with strong indications.

Background: Literature from procedural specialties reveals gender differences amongst trainees regarding work-life balance, career goals, and workplace discrimination.

Purpose: To determine the impact of gender on gastroenterology resident experiences.

Methods: A 70-question cross-sectional survey was electronically disseminated to gastroenterology trainees across Canada. Survey questions addressed personal, professional, financial, and training characteristics. Comparisons were made between self-identified men and women. Wilcoxon test was used for continuous variables. Chi-squared test and Fisher's exact test were applied for categorical variables. Qualitative thematic analysis was applied for short answer responses with 2 independent reviewers.

Results: Forty-four trainees were surveyed, with 41% women. At work, women were more likely to have their clinical competency challenged than men (35% vs 8%, P = .024) and report difficult relationships with support staff (35% vs 0%, P = .001). Most trainees planned to complete further gastroenterology training (86%), but males were more likely to choose therapeutics (36% vs 0%, P = .033). Women more commonly were the predominant caregiver for children (67% vs 8%, P = .012) and felt that having children would slow their career advancement (77% vs 33%, P = .046). Men were more likely to prefer having children during residency (50% vs 7%, P = .036). No statistical difference was found between genders regarding desire for advanced subspecialty training, leadership aspirations, or academic pursuits.

Conclusion: Gender-related differences exist amongst Canadian gastroenterology trainees regarding work-life balance and career advancement. Women may benefit from supports to allow them to meet career goals which are similar to their male peers.

Purpose: Primary sclerosing cholangitis (PSC) is a cholestatic liver disease that frequently coexists with inflammatory bowel disease (IBD). The risk of infections in patients with concurrent PSC-IBD remains unclear. The aim of this study was to identify the event rate of infections and associated risk factors in PSC-IBD patients.

Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 12, 2024 for studies examining event rate or risk factors for infection in patients with PSC-IBD. The primary outcome was the event rate of all-cause and site-specific infections as well as infection-related mortality. The secondary outcome was risk factors for infection. Random-effects models were used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI) comparing the event rate of all-cause infections in PSC-IBD patients to those with just PSC and just IBD. I ² values more than 50% suggested substantial heterogeneity.

Results: Eighty-one studies were included. The pooled event rate of all-cause infections in patients with PSC-IBD was 25.1% (95% CI, 17.0%-33.2%, I ² = 99.2%). PSC-IBD patients had significantly increased odds of all-cause infection (OR 3.67, 95% CI, 2.07-6.52, I ² = 41.9%), sepsis (OR 3.35, 95% CI, 2.29-4.91, I ² = 9.1%), and infection-related mortality (OR 11.25, 95% CI, 2.03-62.37, I ² = 0) compared to those with IBD but not those with PSC.

Conclusion: Patients with PSC-IBD appear to be at increased risk of all-cause infection, sepsis, and mortality compared to those with IBD alone.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is valuable in management of primary sclerosing cholangitis (PSC). Herein, we characterize individuals with PSC who underwent ERCP on-demand at a high-volume quaternary centre, with evaluation of pathology results and short-term postprocedural outcomes.

Methods: This retrospective cohort study evaluated patients with PSC who underwent ERCP at St Michael's Hospital between April 2011 and July 2021. Chart review was conducted to collect clinical, procedural, and pathology data, and reported post-ERCP complications within 90 days. Logistic regression analyses were conducted to evaluate factors associated with post-ERCP complications and placement of a biliary stent.

Results: One hundred and sixty-seven patients with PSC underwent 464 ERCPs (69% males, median age 45 years). The median duration of PSC diagnosis prior to ERCP was 6.7 years and 42% of procedures were in patients with cirrhosis. Symptoms pre-ERCP included jaundice, abdominal pain, subjective fevers, and pruritus. Stent insertion at procedure was associated with presentations with jaundice or elevated bilirubin, prior stent insertion, and/or concern for malignancy. Stent insertion was also associated with post-ERCP complications within 90 days. Neoplastic pathology was identified in 20% of cytology samples and 27% of biliary biopsies. There were no significant differences in symptomology at presentation between patients with and without neoplastic pathology.

Conclusion: Primary sclerosing cholangitis patients undergoing ERCP have high symptom burden and rates of neoplastic pathology, with high rates of recurrent obstruction post-ERCP. Stent insertion is associated with a sicker PSC phenotype and higher risk of post-ERCP complications. Future studies are needed to further explore the role of ERCP in management of PSC.