Journal of the Canadian Association of Gastroenterology最新文献

Background: Sexual dysfunction is common in individuals with inflammatory bowel disease (IBD). The aim of this study was to better characterize sexual dysfunction and associated factors among a Canadian cohort of IBD patients.

Methods: A cross-sectional survey study was conducted. The primary outcome was sexual dysfunction as measured by the Female Sexual Dysfunction Scale in females and the Male Sexual Dysfunction Scale in males. Analyses were stratified by sex and multiple linear regression was used to identify associations.

Results: In total, 351 respondents completed the survey. Both females and males were impacted by sexual dysfunction (IBD-FSDS 14.1 [± 13.8] and IBD-MSDS 7.2 [± 9.4, respectively]). Depression was common and strongly associated with sexual dysfunction (β coefficient 0.92 [0.13] for men and 0.84 [0.19] for women, P <.001).

Conclusions: Sexual dysfunction was common and more impactful in women. Depression was strongly associated with sexual dysfunction. This underscores the need for multidisciplinary care in addressing sexual health among individuals living with IBD.

Many patients with inflammatory bowel disease (IBD) show an inadequate response or experience a loss of response to advanced therapies. Guidelines recommend dose optimization and switching among therapies until an optimal treatment response is attained. With several advanced treatments available, we aimed to evaluate the persistence of different therapeutic sequences in IBD. The RECORDED study was a retrospective cohort study of Canadians with moderate-to-severely active ulcerative colitis (UC) or Crohn's disease (CD) who had been exposed to more than 1 advanced therapy between May 2015 and April 2021 for UC, and May 2016 and April 2021 for CD. The primary endpoint was time to permanent discontinuation of the first advanced treatment. Overall, 330 patients had CD and 344 had UC. The most common first-line treatments for CD and UC were adalimumab and infliximab, respectively. The median (95% CI) time to permanent discontinuation of first-line treatment was 12.3 (10.9, 13.6) months in patients with CD and 9.2 (8.2, 10.8) months for those with UC. The most common reason for treatment change across both diseases was lack of efficacy. First-line advanced treatments were optimized in 191 (58.1%) CD patients and 202 (59.1%) UC patients prior to permanent discontinuation. Second-line therapy was typically from a different class compared with the first-line treatment choice. The RECORDED study provides insights into the real-world sequencing and optimization patterns of advanced treatments in patients with moderate-to-severe IBD in Canada. Lack of efficacy was the most cited reason for switching to a different therapy.

Introduction: Eosinophilic esophagitis (EoE) is a chronic allergic, type 2, immune-mediated condition of the oesophagus, resulting in dysmotility and oesophageal stricturing. This study aims to identify practice variation among Canadian gastroenterologists treating adults with EoE.

Methods: A cross-sectional, web-based survey was distributed to Canadian gastroenterologists through the Canadian Association of Gastroenterology and administrations of Canadian universities.

Results: Seventy gastroenterologists completed the survey, with 59% working in academic practice or research. Overall, 90% of gastroenterologists require histological evidence of EoE to establish a diagnosis of EoE, while 50% require clinical symptoms of oesophageal dysfunction; 39% of gastroenterologists take less than 5 biopsies when assessing for EoE, with variability in biopsy location. Only 51% of respondents took biopsies in every case presenting with acute food bolus. Proton pump inhibitors were the initial therapy of 70% of gastroenterologists, with 11% using topical steroids. The preferred dietary approach was the 6-food elimination diet in 36%, followed by the 2-food elimination diet in 26%. Overall, 27% of participants did not use histologic improvement and 63% did not use endoscopic improvement to evaluate treatment response. Use of EoE Endoscopic Reference Score (EREFS) is low, with 56% being either unaware of what EREFS is or never using it. Most respondents feel Canadian guidelines would be helpful in their practice.

Conclusions: Eosinophilic esophagitis practice patterns among Canadian gastroenterologists are variable and differ from consensus guidelines. The development of Canadian guidelines and continuing medical education content can be considered to improve the management of EoE in Canada.

Background and aims: Delayed post-polypectomy bleeding (DPPB) can occur up to a month following the procedure but is typically seen within the first week. Tranexamic acid (TXA) is a member of a class of drugs called antifibrinolytic agents. It reduces fibrinolysis by slowing down the conversion of plasminogen to plasmin, which may prevent bleeding. The goal of this pilot study is to assess the feasibility of using tranexamic acid after endoscopic mucosal resection (EMR) of large (≥2 cm) non-pedunculated colorectal polyps (LNPCPs) to prevent DPPB.

Methods: This was a single centre feasibility study conducted at the Kingston Health Sciences Centre in 2021. After the polypectomy was completed, IV tranexamic acid was given [1 gram of TXA in 100 mL of normal saline] and infused over a 10-min interval. The participants received tranexamic acid 1 gram PO TID to be taken for 5 days.

Results: A total of 25 patients were enrolled with a mean polyp size of 3 cm. Intraprocedural bleeding occurred in 7 patients (28%) and all of these were treated with soft coagulation. Two patients had clipping for suspected muscle injury. All 25 patients received IV TXA post-procedure. Sixteen patients (64%) took every dose of the prescribed pills. One patient presented with post-polypectomy bleeding. All patients completed the day 30 follow-up phone call. There were no major adverse events.

Conclusions: TXA to prevent delayed post-polypectomy bleeding (DPPB) was feasible to use with no major adverse events reported. A randomized controlled study will be needed to see if TXA can significantly reduce DPPB.

Background: Button battery ingestions pose a serious threat to paediatric health and are on the rise worldwide. Little is known about Canadian data. This study described the type of button battery ingestions Canadian paediatric physicians have observed, including treatment and complications.

Methods: A Canadian Paediatric Surveillance Program (CPSP) survey was sent to paediatricians and paediatric subspecialists. The questions were developed through a literature review and consultation with 19 CPSP members, before piloting with 5 paediatric physicians. Descriptive analyses were conducted.

Results: The response rate was 39% (n = 1067/2716). Few were aware of treatment options with honey (n = 189/1067, 18%) and sucralfate (n = 118/1067, 11%). Two hundred and ninety-nine physicians (28%) had been involved in a case in the past 1 year (n = 132 case details). Children < 3 years were most affected (n = 67/132, 51%). In unwitnessed ingestions (n = 41/132, 31%), the most common symptoms were dysphagia (n = 14/41, 34%) and coughing (n = 10/41, 24%). When it was known where the child found the battery, it was most commonly loose in the environment (n = 34/132, 26%). Seventy per cent of patients (n = 92/132) presented within 6 h following the ingestion. Six per cent (n = 8/132) reported the battery eroding into important adjacent structures (eg, aorta and trachea).

Interpretation: A high degree of suspicion for button battery ingestion is needed in young children presenting with dysphagia and coughing. Prevention efforts should be aimed at battery disposal and security. There is a need for dissemination of guidelines to physicians caring for paediatric patients, since modifiable patient factors, such as honey and/or sucralfate administration while awaiting definitive treatment, can improve outcomes.