Canadian Digestive Diseases Week Research Articles

Inflammatory Bowel Disease Increases the Risk of Venous Thromboembolism in Children: A Population-Based Matched Cohort Study.

Background and AimsAlthough venous thromboembolism [VTE] is a well-known complication of inflammatory bowel disease [IBD] in adults, limited data exist on the risk in children. We report the incidence of VTE among children with and without IBD.MethodsWe conducted a matched cohort study within a distributed network of population-based Canadian provincial health administrative databases. Children <16 years diagnosed with IBD were identified using validated algorithms from administrative data in Alberta, Manitoba, Nova Scotia, Ontario and Québec and compared to age- and sex-matched children without IBD. Hospitalizations for VTE within 5 years of IBD diagnosis were identified. Generalized linear mixed-effects models were used to pool province-specific incidence rates and incidence rate ratios [IRR] with 95% confidence intervals [CI]. Hazard ratios [HR] from Cox proportional hazards models were pooled with fixed-effects meta-analysis.ResultsThe 5-year incidence of VTE among 3593 children with IBD was 31.2 [95% CI 23.7–41.0] per 10 000 person-years [PY] compared to 0.8 [95% CI 0.4–1.7] per 10 000 PY among 16 289 children without IBD [unadjusted IRR 38.84, 95% CI 16.59–90.83; adjusted HR 22.91, 95% CI 11.50–45.63]. VTE was less common in Crohn’s disease than ulcerative colitis [unadjusted IRR 0.47, 95% CI 0.27–0.83; adjusted HR 0.52, 95% CI 0.29–0.94]. The findings were similar for deep vein thrombosis and pulmonary embolism when comparing children with and without IBD.ConclusionsThe risk of VTE is much higher in children with IBD than controls without IBD. While the absolute risk is low, we found a higher incidence rate than previously described in the pediatric literature.Conference Presentation: An abstract based on the data included in this paper was presented at Canadian Digestive Diseases Week [Montréal, Canada] in March 2020.

Novel Non-biologic Targets for Inflammatory Bowel Disease.

The biologic era revolutionized the medical management of inflammatory bowel disease (IBD) and allowed for a paradigm shift away from a therapeutic strategy that traditionally relied on corticosteroids and immunomodulators. IBD treatment has now further evolved to encompass novel non-biologic agents. An electronic database search, spanning up to September 2018, was conducted using PubMed, Web of Science, Google Scholar, and Scopus. Abstracts were also reviewed from Digestive Diseases Week, European Crohn's and Colitis Organization congress, Canadian Digestive Diseases Week, and United European Gastroenterology Week. The JAK1/3 inhibitor, tofacitinib, was shown to both induce and maintain clinical remission and mucosal healing in ulcerative colitis (UC). Also, the sphingosine-1-phosphate (SIP) S1P1/S1P5 receptor agonist ozanimod showed benefit with clinical remission and mucosal healing in UC. Anti-trafficking non-biologic therapies such as AJM300 and a phosphodiesterase (PDE) PDE4 inhibitor, apremilast, have shown benefit in terms of clinical response, clinical remission, and mucosal healing in UC. Upadacitinib and filgotinib have shown initial favorable outcomes in CD patients, with further ongoing trials. Non-biologic agents comprise a growing number of mechanisms of action with the promise of safe and effective oral therapy for patients with IBD.

The Benefit of Fentanyl in Effective Sedation and Quality of Upper Endoscopy: A Double-Blinded Randomized Trial of Fentanyl Added to Midazolam Versus Midazolam Alone for Sedation.

AimsOur goals were to compare the effect of adding fentanyl to midazolam in a double-blinded, randomized, placebo-controlled trial and determine if fentanyl enhances sedation, increases adverse events or effects time of the procedure or discharge.MethodsPatients 18 to 65 years scheduled for outpatient upper endoscopy were eligible for the study. Patients were randomized to receive either 100 mcg/2 mL of Fentanyl or 2 mL of placebo IV with a double-blinded protocol. All patients received 2 mg of intravenous midazolam initially. Additional midazolam could be given to achieve adequate sedation.ResultsThere were 68 patients randomized to the Fentanyl group and 69 patients to the placebo group. The mean dose of midazolam was 4.0 mg for the Fentanyl group and 5.2 mg for placebo group (P=0.003). Both endoscopist and nurse independently rated sedation to be better in the fentanyl group (P=0001). The patient did not perceive any difference in sedation (P=0.4). Procedure time was significantly shorter in the Fentanyl group (8.5 versus 11.1 minutes, P=0.001), with no difference in the discharge time. There was significantly less retching observed in patients in the fentanyl group (P<0.001). There were no major complications.ConclusionsEndoscopists and nurses found adding fentanyl significantly improved sedation, led to a shorter procedure time, and allowed for less midazolam to be used per case. It did not affect the patient experience of sedation and was safe. Fentanyl use for routine outpatient upper endoscopy should be considered as a safe option to improve procedural sedation.NCT:01514695 (www.clinicaltrials.gov)Accepted as an abstract for the Canadian Digestive Diseases Week meeting in February 2014.

Resident Survey on Gastroenterology Training in Canada.

BackgroundGastroenterology training in Canada is guided by the Royal College of Physicians and Surgeons of Canada. Resident perspectives on training and the degree of heterogeneity across training programs have not been previously surveyed.AimThis study aims to evaluate the current Canadian adult gastroenterology training experience from a resident perspective and provide insight into the heterogeneity among training programs.MethodA survey designed by three current gastroenterology residents was distributed to trainees attending the Gastroenterology Residents-in-Training course at Canadian Digestive Diseases Week 2018. Categorical data from the survey was analyzed in table format. Other continuous data was converted to dichotomous data and analyzed in groups of small and large programs, the large program defined as greater than six trainees.ResultsThe overall response rate was 45 of 56 (80%), representing 13 of 14 accredited training sites. Mandatory rotations and core procedures varied widely across respondents, with only inpatient training consistent across all sites. Small programs had a higher call burden (P=0.039), but staff were more likely to be available to cover call if the resident coverage was unavailable (P=0.002). There were nonsignificant trends in small programs in the inability to take a post-call day (P=0.07) and a resident perception of being well trained (P=0.07).ConclusionsThere is heterogeneity across programs in mandatory rotations and core procedures. With the upcoming shift to competency-based medical education, it is an opportune time to re-evaluate and perhaps standardize how gastroenterology training is delivered in Canada.

Canadian Association of Gastroenterology Awards Presented at Canadian Digestive Diseases Week 2015

Canadian Association of Gastroenterology Awards Presented at Canadian Digestive Diseases Week 2015

Probe based confocal laser endomicroscopy of the pancreatobiliary system.

To review applications of confocal laser endomicroscopy (CLE) in pancreatobiliary lesions and studies that assessed training and interpretation of images. A computerized literature search was performed using OVID MEDLINE, EMBASE, Cochrane library, and the ISI Web of Knowledge from 1980 to October 2014. We also searched abstracts from major meetings that included the Digestive Disease Week, Canadian Digestive Disease Week and the United European Gastroenterology Week using a combination of controlled vocabulary and text words related to pCLE, confocal, endomicroscopy, probe-based confocal laser endomicroscopy, and bile duct to identify reports of trials. In addition, recursive searches and cross-referencing was performed, and manual searches of articles identified after the initial search was also completed. We included fully published articles and those in abstract form. Given the relatively recent introduction of CLE we included randomized trials and cohort studies. In the evaluation of indeterminate pancreatobiliary strictures CLE with ERCP compared to ERCP alone can increase the detection of cancerous strictures with a sensitivity of (98% vs 45%) and has a negative predictive value (97% vs 69%), but decreased the specificity (67% vs 100%) and the positive predictive value (71% vs 100%) when compared to index pathology. Modifications in the classification systems in indeterminate biliary strictures have increased the specificity of pCLE from 67% to 73%. In pancreatic cystic lesions there is a need to develop similar systems to interpret and characterize lesions based on CLE images obtained. The presence of superficial vascular network predicts serous cystadenomas accurately. Also training in acquiring and interpretation of images is feasible in those without any prior knowledge in CLE in a relatively simple manner and computer-aided diagnosis software is a promising innovation. The role of pCLE in the evaluation of pancreatobiliary disorders might be better suited for those with an intermediate and low probability.

Canadian Digestive Diseases Week 2014 – Thank you Delegates!

Canadian Digestive Diseases Week 2014 – Thank you Delegates!

Canadian Association of Gastroenterology Awards Presented at Canadian Digestive Diseases Week 2014

Canadian Association of Gastroenterology Awards Presented at Canadian Digestive Diseases Week 2014

Canadian Association of Gastroenterology Awards presented at Canadian Digestive Diseases Week 2013

Canadian Association of Gastroenterology Awards presented at Canadian Digestive Diseases Week 2013

Canadian Association of Gastroenterology Awards Presented at Canadian Digestive Diseases Week 2012

Canadian Association of Gastroenterology Awards Presented at Canadian Digestive Diseases Week 2012

Canadian Journal of GastroenterologyAwards Presented at Canadian Digestive Diseases Week 2012

<i>Canadian Journal of Gastroenterology</i>Awards Presented at Canadian Digestive Diseases Week 2012

Research Topics in Gastrointestinal Disease: A Report on the 11th Symposium

The Canadian gastrointestinal (GI) research community is a world leader in advancing our understanding of many areas of physiology and pathophysiology relevant to GI disease. These highly successful research programs have created an excellent cohort of graduate and postgraduate research trainees involved in GI research at institutions across Canada. These trainees play an instrumental role in the discoveries and new knowledge that has emerged from their laboratories. Many of them are funded by the Canadian Association of Gastroenterology (CAG) in collaboration with the Canadian Institutes of Health Research (CIHR), the Crohn’s and Colitis Foundation of Canada (CCFC), and a number of industry partners. To recognize the value of the Canadian GI trainees’ outstanding research contributions, and to promote and encourage the continued efforts of the graduate and postgraduate research trainees in basic and clinical sciences, the CAG, CHIR and CCFC held the 11th Symposium on Research Topics in GI diseases on February 22 to 23, 2012 in Montreal, Quebec (in advance of Canadian Digestive Diseases Week [CDDW]). The goal of this meeting was to provide research trainees with an opportunity to informally present their original research from diverse disciplines, to their peers and to a selection of faculty from across Canada. In this forum, trainees actively participated in the discussions of papers in an open setting. This year’s program consisted of a series of superb presentations describing cutting-edge research with 39 podium scientific presentations of basic and clinical gastroenterology-related research, covering GI development, pathogenesis of esophagogastrointestinal inflammation and healing, enteric microbiota and pathogens, including bacteria that promote cancer, and gastric ulceration, enteric nerves, and epithelial transport and barrier function. The addition of a ‘reviewer role’ provided all participants with the opportunity to review another presenter’s abstract (as assigned by the program organizers) in advance of the presentation and to be prepared to ask a question related to the abstract presentation allowing the trainees to function in the ‘session chair role’. The keynote session ‘Developing a translational research program: Perspectives from a Clinician scientist’ was presented by Dr Paul Beck. This year’s career development toolbox session focused on ‘Writing a manuscript’. Dr Catharine Walsh presented a practical talk with key tips that was followed by small group breakout sessions in which trainees were able to begin to implement some of the key points reviewed. This year the program included a combined session and opportunity for interaction with the Scholars and Gastroenterology Residents-in-Training (GRIT) attendees: ‘GI Research: What’s in it for me?’ presented by CAG’s McKenna Lecturer, Dr Richard Hunt. Similar to previous years, a major success of the meeting was that it provided a venue in which trainees could meet their peers from across Canada, develop research skills and initiate collaborations, thus developing contacts for their future research career and the future of Canadian GI research. The majority of participants rated the program as good to excellent, and commented that attendance at the meeting offered great interaction with mentors and trainees. The Research Topics meeting provides a valuable opportunity for young researchers to exchange learning. The CAG is proud to acknowledge its Benefactor Corporate Sponsors: Abbott Canada AstraZeneca Canada Inc Olympus Canada Inc Pentax Canada Inc Janssen Inc Takeda Canada Inc

2011 Canadian Association of Gastroenterology Educational Needs Assessment Report

The annual survey of Canadian Association of Gastroenterology (CAG) members’ educational needs was conducted via an online survey during March and April. A total of 205 individuals completed the survey. Similar to previous years, inflammatory bowel disease (IBD) topics were most in demand for future educational events. Other highly rated areas were the following: celiac disease, endoscopic techniques and therapeutics, and live endoscopy. Of those who had an opinion on the subject, 58% preferred that Canadian Digestive Diseases Week (CDDW) be held at a resort over a major airport hub. More than two-thirds of respondents supported CAG providing speakers or content for regional/provincial gastroenterology society meetings. Approximately one-half were aware of the launch of CAG’s educational portal (ePortal) in 2009 and 31% had visited the site. Those familiar with the ePortal overwhelmingly agreed that it was valuable, easy to use and that they would visit again.

Research Topics in Gastrointestinal Disease: A Report on the 10th Meeting and an Announcement of the 11th Meeting

The Canadian gastrointestinal (GI) research community is a world leader in advancing our understanding of many areas of physiology and pathophysiology relevant to GI disease. These highly successful research programs have created an excellent cohort of graduate and postgraduate research trainees involved in GI research at institutions across Canada. These trainees play an instrumental role in the discoveries and new knowledge that has emerged from their laboratories. Many of them are funded by the Canadian Association of Gastroenterology (CAG) in collaboration with the Canadian Institutes of Health Research (CIHR), the Crohn’s and Colitis Foundation of Canada (CCFC) and a number of industry partners. In recognition of the value of the Canadian GI trainees’ outstanding research contributions, and to promote and encourage the continued efforts of the graduate and postgraduate research trainees in basic and clinical sciences, the CAG and CCFC held the 10th Symposium on Research Topics in GI diseases on February 24 to 25th, 2011, in Vancouver, British Columbia (in advance of Canadian Digestive Diseases Week [CDDW]). The goal of this meeting was to provide research trainees with an opportunity to informally present their original research from diverse disciplines to their peers and to a selection of faculty from across Canada. In this forum, trainees actively participated in the discussions of papers in an open setting. This year’s program consisted of a series of superb presentations describing cutting-edge research, with 30 podium scientific presentations of basic and clinical gastroenterology-related research, covering GI development, pathogenesis of esophago-GI inflammation and healing, enteric microbiota and pathogens including bacteria that promote cancer, and gastric ulceration, enteric nerves, and epithelial transport and barrier function. The keynote presentation by Dr Gil Kaplan was titled “Translational GI Research in the 21st Century: Statistical Considerations”. The program also included a research grant writing exercise, after which the groups of trainees developed their own proposals and presented them to the group. Similar to previous years, a major success of the meeting was that it provided a venue in which trainees could meet their peers from across Canada, develop research skills and initiate collaborations, thus developing contacts for their future research career and the future of Canadian GI research. Participants rated the program as good to excellent, and described the meeting as an amazing experience and a valuable opportunity for young researchers to exchange learning. The CAG is proud to acknowledge its Benefactor Corporate Sponsors: Abbott Canada AstraZeneca Canada Inc Olympus Canada Inc Pentax Canada Inc Merck & Co Inc Takeda Canada Inc

A Tribute to Grant Gall

A Tribute to Grant Gall

Canadian Digestive Diseases Week 2010 Including the Annual Canadian Association for the Study of the Liver Winter Meeting

Canadian Digestive Diseases Week 2010 Including the Annual Canadian Association for the Study of the Liver Winter Meeting

Message Delivered to the CAG Membership, from Dr William Paterson, CAG Past President, at the 2008 Annual General Meeting at CDDW 2008 in Montreal, Quebec

It is appropriate that my President’s end of term message comes on the heels of Richard Fedorak’s presentation, because it provides me with an opportunity to reinforce his message on the importance of our official foundation – the Canadian Digestive Health Foundation – to the future success of the Canadian Association of Gastroenterology (CAG). The CAG is a vibrant organization that has been highly successful in providing research and educational opportunities to its membership. The research fellowship program is unparalleled in Canada. Our educational programs, whether delivered at the Canadian Digestive Diseases Week, via regional meetings or on our Web site, are also outstanding. More recently, we have expanded our role into public advocacy and have taken the lead in providing timely public responses to highly newsworthy gastroenterology (GI) issues. Because of the human resource initiative started by Des Leddin, we have been able to join the Wait Time Alliance and have had our wait time benchmarks formally accepted by the Canadian Medical Association. Despite these successes, we have a number of current and future challenges that need to be addressed. Just because we have joined the rather exclusive Wait Time Alliance club does not mean that we can now claim victory on wait times. For instance, the Ontario Ministry of Health’s recent decision to freeze GI training positions in Ontario, despite us providing them with compelling data supporting the need to increase the number of gastroenterologists, shows that we still have a lot of work to do. In addition, the dramatic increase in demand for colonoscopy that is occurring as colorectal screening programs start up across the country will further challenge us to provide high-quality and timely care for patients with digestive illness. As professionals, we must avoid the urge to cherry pick in our practices, and remember that our primary role as gastroenterologists should be to help patients get better and not simply to rule out disease. The generous financial support of our many industry partners has been integral to the success of our organization, and I would like to take this opportunity to formally thank our industry partners, who have taken what I believe in many instances to be a very altruistic approach to funding GI research and education in Canada. However, times are changing and I think it is clear that, in the future, industry may be constrained in their ability to provide the financial support they would like to give us and that we have been accustomed to. In addition, the research mandate of the Canadian Institutes of Health Research has been expanded significantly in recent years without a comparable budget allocation, so basic and applied research in GI will continue to feel the pinch. Thus, it is critically important that we, the CAG membership, fully support the Canadian Digestive Health Foundation now. It is our foundation, which, if successful, will not only be able to provide sustained support for education and research in gastroenterology, but will serve as a public vehicle to promote the need for enhanced resources for digestive diseases in Canada. My past four years on the CAG Executive have been challenging but very rewarding, and I want to take this opportunity to thank all the members of the CAG who have contributed to the success of this organization. The many hardworking members of the CAG Executive and Board have greatly facilitated my term as President – in particular, Des Leddin, Ron Bridges and Phil Sherman. Of course, the real key behind the success of our organization has been the outstanding staff in the CAG office – Karen Moritz, Louise Hope, Sandra Daniels and our invaluable executive director, Paul Sinclair. I would like to thank them for their excellent support in guiding me through my Presidency. It is time to move to the last agenda item of our meeting, and I must say that although I have enjoyed my term as President immensely, I have been looking forward to this particular moment, when I get to pass the gavel into the extremely capable hands of Dr Ron Bridges. Please join me in welcoming the 42nd President of the CAG. The CAG is proud to acknowledge its Benefactor Corporate Sponsors: Abbott Canada AstraZeneca Canada Inc Axcan Pharma Inc Nycomed Canada Inc Olympus Canada Inc Pentax Canada Inc Procter & Gamble Pharmaceuticals Schering Canada Inc

Report from the Canadian Association of Gastroenterology Governing Board

To provide members with a continuing view to the directions of the Canadian Association of Gastroenterology (CAG) Governing Board and its committees, we are pleased to provide a short summary in the form of the present News Page. Decisions and key initiatives from board meetings – held twice annually, in the late autumn and in February, at Canadian Digestive Diseases Week (CDDW) – will be presented here. Here is a look at the major projects underway.

2008 Canadian Association of Gastroenterology Educational Needs Assessment Report

The annual survey of the Canadian Association of Gastroenterology (CAG) members’ educational needs was conducted via an on-line survey during March and April. Two hundred seventy-one individuals completed the survey. Similar to previous years, inflammatory bowel disease (IBD) topics – particularly difficult IBD cases, and Crohn’s disease and ulcerative colitis therapeutics – were most in demand for future educational events. Other highly rated areas were endoscopic techniques, live endoscopy, pancreatitis and pancreatic diseases, and celiac disease. Diagnosis and management of malabsorption and chronic diarrhea also remain popular, despite a focus on this at Canadian Digestive Diseases Week (CDDW) 2008. The two most popular educational formats were presentations ‘streamed’ to computers or delivered as podcasts, and a CAG educational portal to on-line presentations, self-assessments and Maintenance of Certification (MainCert) point tracking.

Follow-up of Past Participants of the Canadian Association of Gastroenterology Scholars’ Program (2001 to 2005) – Where are they Now?

Follow-up of Past Participants of the Canadian Association of Gastroenterology Scholars’ Program (2001 to 2005) – Where are they Now?