Journal of the Canadian Association of Gastroenterology最新文献

Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory conditions of the gastrointestinal tract associated with impaired quality of life. The Communicating Needs and Features of IBD Experiences (CONFIDE) study aimed to assess the impact of CD/UC symptoms on the lives of people with IBD and elucidate any communication gaps between healthcare professionals (HCPs) and people with IBD. The current Canadian study replicates the CONFIDE study previously conducted in the United States, Europe, and Japan.

Methods: Online cross-sectional surveys were conducted between February and April 2023 among people with moderate-to-severe CD/UC and prescribing HCPs. Disease severity was defined using criteria based on previous treatment, steroid use, and/or hospitalization. Data were presented using descriptive analyses.

Results: Surveys were completed by 107 individuals with CD, 82 individuals with UC, and 53 HCPs. Bowel urgency was the second most common symptom reported by individuals, following diarrhoea, and it was the most frequently reported symptom leading to declining participation in work/school, social events, and physical exercise. HCP-perceived symptoms with the greatest impact on people with IBD and their treatment decisions were diarrhoea and blood in stool. While most HCPs reported proactive discussion of bowel urgency with their patients, more than a third of those experiencing this symptom reported discussing it infrequently during HCP appointments.

Conclusions: The results indicate that CD/UC symptoms have a substantial impact on the daily lives of people with IBD, even among those receiving advanced therapies. Although both HCPs and individuals with IBD reported a substantial symptom burden, their perceptions regarding the most impactful symptoms differed. Bowel urgency was identified as a common yet overlooked symptom and should be incorporated into regular IBD assessments.

Background: Gastroenterology may be a medical specialty with higher-than-average medico-legal risk. We evaluated the characteristics of medico-legal proceedings relating to the delivery of gastroenterology medical care in Canada during a five-year time period.

Methods: We used a repository of Canadian medico-legal cases to identify cases between 2017 and 2021 involving a gastroenterologist. We analyzed patient, provider, team, and system contributing factors using a previously published Contributing Factors Framework and patient harm using a previously published coding system.

Results: We identified 223 cases involving 229 gastroenterologists with no preponderance by years of experience. Gastroenterologists had a higher rate of civil legal actions than the average for all other physician specialties in the database. 59% involved patients older than 50 years of age, 10% with digestive tract malignancies, and 10% with IBD. 51% of involved patients had a healthcare-related harm that had a negative effect on their health or quality of life. 35% had avoidable harm. Patients most commonly reported a perception of deficient assessment (35%), communication breakdowns (27%), unprofessional manner (25%), diagnostic error (22%), and inadequate monitoring or follow-up (20%). 50% of cases were criticized by peer experts, of which they deemed 45% involved communication breakdown with patients, 38% involved clinical decision-making, 30% situational awareness, 25% documentation, and 15% communication among providers.

Conclusions: Communication issues remain a major contributing factor to medico-legal cases involving gastroenterologists. Integrated risk-reduction strategies may include enhancing diagnostic rigor through improved clinical protocols and decision support tools and strengthening communication at all levels of care.

Background: Music therapy is a low-cost and low-risk intervention that has been shown to improve patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in various areas of medicine including gastrointestinal (GI) endoscopy. A scoping review was performed to answer the following research question: What is known from the existing literature about the effect of music therapy used in adult GI endoscopy on PROMs (eg pain, anxiety) and PREMs (eg satisfaction, willingness to repeat procedure)?

Methods: Guided by the methodologic framework proposed by Arksey and O'Malley, 3 medical databases were queried for articles pertinent to the research question and published between January 2005 and December 2024. Studies were selected for inclusion based on established criteria and summarized in a comprehensive data table as well as accompanying figures.

Results: A total of 30 original research articles were selected for inclusion. The most reported outcomes were pain (N = 21), anxiety (N = 21), and satisfaction (N = 14). Significant improvements following music therapy were described most commonly for anxiety (N = 15, 71% of 21) and satisfaction (N = 10, 71% of 14) and less commonly for pain (N = 11, 52% of 21). Reductions in pain and anxiety were more consistent for music interventions performed in the pre-endoscopy period.

Conclusions: Music therapy appears to be an effective means of improving anxiety and satisfaction in patients undergoing GI endoscopy. Endoscopists should consider music therapy as a non-pharmacologic adjunct to improve the patient experience in endoscopy.

Background: Telemedicine offers a promising approach to reduce the carbon footprint of healthcare delivery by minimizing travel-related greenhouse gas emissions. In this study, we quantified the carbon emissions savings from shifting gastroenterology clinic visits from in-person to telemedicine in a single gastroenterologist's clinic in a major urban Canadian centre that serves a mixed urban and rural Canadian population.

Methods: A cross-sectional analysis was conducted on 5690 telemedicine encounters from March 2020 to March 2022 at a tertiary-care gastroenterology clinic in Winnipeg, Manitoba, for a single gastroenterologist. Carbon emissions related to travel from home to clinic were estimated. The values are presented as CO2e, a standardized measure used to compare and aggregate the impact of different greenhouse gases on global warming. Travel distances were estimated using driving routes or flights for non-drivable locations. Clinic operational emissions were also estimated to assess total potential savings.

Results: The total potential travel distance avoided was 880 336 km. Rural patients accounted for 92.7% of this distance. The average CO2e emissions saved per encounter was 42.9 kg, with rural encounters averaging 106.7 kg and urban encounters 4.6 kg. Clinic operational emissions were minimal at 0.06 kg of CO2e per encounter, compared to travel-related emissions. Over the 2 years, telemedicine visits saved approximately 244 079 kg of CO2e, underscoring the significant environmental benefit of virtual care.

Conclusion: Telemedicine reduces the carbon footprint of gastroenterology outpatient care by minimizing patient travel, especially for rural populations. Incorporating telemedicine into routine practice can promote environmental sustainability within healthcare systems.

Background and aims: This study explores the effectiveness of vedolizumab dose escalation among patients with ulcerative colitis or Crohn's disease who experienced a suboptimal or loss of clinical response in a Canadian real-world cohort.

Methods: Patients with moderately to severely active ulcerative colitis or Crohn's disease treated with vedolizumab were prospectively followed in a patient support program in Canada from 2015 to 2023. In patients who dose escalated to every 4 weeks from every 8 weeks intravenous maintenance dosing, Harvey-Bradshaw Index and Partial Mayo Scores were assessed 12 and 52 weeks after dose escalation. Clinical remission was defined as Harvey-Bradshaw Index < 5 or Partial Mayo Score < 3.

Results: This study included 924 patients with Crohn's disease (45% bio-naïve) and 1816 patients with ulcerative colitis (71% bio-naïve). Of patients with Crohn's disease, 39% bio-naïve and 54% bio-experienced dose-escalated within the first 2 years. Of patients with ulcerative colitis, 39% bio-naïve and 50% bio-experienced dose escalated within the first 2 years. For Crohn's disease patients receiving every 8 weekly intravenous maintenance dosing who were not in clinical remission, 50% bio-naïve and 23% bio-experienced patients were in clinical remission 12 weeks after dose escalation, while for ulcerative colitis, 43% bio-naïve and 35% bio-experienced patients were in clinical remission 12 weeks after dose escalation, which was sustained through 52 weeks.

Conclusions: For patients who experienced a suboptimal or loss of clinical response to vedolizumab, this study supports the real-world effectiveness of intravenous vedolizumab dose escalation in improving clinical response and clinical remission rates among patients with ulcerative colitis or Crohn's disease.

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: Evaluating small bowel Crohn's disease (SBCD) often relies on cross-sectional imaging (eg, computed tomography enterography [CTE]) and small bowel endoscopy (eg, balloon-assisted enteroscopy [BAE]). The accuracy of CTE for evaluating SBCD compared to BAE remains unclear and is assessed in this study.

Methods: This single-centre retrospective study included patients with SBCD who underwent both CTE and BAE within 6 months. Findings of active inflammation, long-segment disease, skip-segments, and presence of both strictures and high-grade strictures (HGS) were extracted from CTE and BAE reports and analyzed using BAE as the reference standard.

Results: Sixty-three CTE and BAE pairings were identified. CTE was sensitive for assessing active inflammation (80.0%) and all strictures (92.1%) and specific for long-segment inflammation (95.0%) and HGS (87.2%). Sensitivity was low for HGS (60.9%) and long-segment inflammation (50.0%), with poor specificity for all strictures (68.4%). In surgically naïve bowel, accuracy improved for active inflammation (sensitivity: 83.3%, specificity: 100%) and worsened for HGS (sensitivity: 42.9%, specificity: 84.2%). In postsurgical bowel, CTE sensitivity for HGS improved to 68.8%.

Conclusion: Computed tomography enterography accurately detected active inflammation and fibrostenotic disease but may not be sufficient to rule out clinically significant findings such as HGS. The accuracy of CTE varied between surgically naïve and postsurgical bowel. CTE remains an important modality for evaluation of SBCD and should be used in combination with BAE when clinical discrepancy arises.

Background: Access to inflammatory bowel diseases (IBD) specialist care is a predictor of health outcomes. We sought to characterize the impact of the pandemic on patterns of IBD healthcare delivery and whether it compromised overall access to care.

Methods: We identified adults with an IBD diagnosis residing in Ontario between 2016 and 2021 using administrative data at ICES. We determined quarterly rates of in-person and virtual IBD specialist visits and stratified that by regions with high and low access to IBD specialists. We stratified our analyses into 3 periods: pre-COVID, immediate COVID, and maintenance COVID. We performed interrupted time series analysis to assess for time trends.

Results: During the immediate COVID phase, there was a 69% relative quarterly decline in in-person IBD specialist visits with a concurrent 591% relative quarterly rise in rates of virtual visits. Entering the COVID maintenance phase, there was a 7% quarterly relative decline in the rate of in-person visits, and a 7% and 4% quarterly relative increases in the rates of virtual and total IBD specialist visits, respectively. Pre-pandemic, IBD patients residing in regions with high specialist access had a 16% higher rate of visits than those in low-access regions. During the COVID maintenance phase, the disparity was reduced to 12%.

Conclusions: During the COVID-19 pandemic, the rapid transition from in-person to virtual IBD specialist care led to a slight increase in overall IBD visits. There was also a small decrease in the gap in rates of IBD specialist visits between high- and low-access regions.

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.