Journal of the Canadian Association of Gastroenterology, Nov 5, 2021
Persons with inflammatory bowel disease (IBD) make up more than 0.75% of the Canadian population ... more Persons with inflammatory bowel disease (IBD) make up more than 0.75% of the Canadian population in 2021. Early in the COVID-19 pandemic, individuals with IBD, particularly those on immunosuppressive therapies, were concerned that their health status may place them at higher risk of contracting COVID-19 or experiencing more severe disease course if infected with SARS-CoV-2. In response, Crohn's and Colitis Canada developed the COVID-19 and IBD Taskforce in March 2020 to rapidly synthesize the evolving knowledge of COVID-19 as relevant to Canadians with IBD. The Taskforce communicated expert information directly to the Canadian IBD community through online tools and a webinar series. In order to understand the full impact of COVID-19 on the IBD community, Crohn's and Colitis Canada commissioned a policy report that was informed through a systematic literature review and synthesized across working groups along the following domains: Epidemiology, Children and Expectant Mothers with IBD, Seniors with IBD, Mental Health, Risk Factors and Medications, Vaccines, and Healthcare Delivery during the Pandemic and the Future Model of IBD Care. This report from Canadian physicians, researchers, and IBD community representatives highlights the physical, mental, and health systems impact of COVID-19 on the entire spectrum of the IBD community, including children, adolescents, adults, seniors, and pregnant people with IBD. This executive summary provides an overview of the crucial information from each of the chapters of the policy report, supplemented with additional information made available through Crohn's and Colitis Canada's webinar-based knowledge translation platform.
Journal of the Canadian Association of Gastroenterology, 2020
Background Celiac disease (CD) has an estimated prevalence of 1% worldwide, including North Ameri... more Background Celiac disease (CD) has an estimated prevalence of 1% worldwide, including North America. Barrett’s esophagus (BE) is a complication of chronic gastroesophageal reflux disease (GERD), which predisposes to development of dysplasia, which can transition to esophageal adenocarcinoma (EAC). GERD is commonly found in patients with CD and there is evidence that reflux symptoms improve after starting the gluten-free diet. However, the prevalence of CD in patients with BE, and its impact on progression to EAC have not been studied. Aims To assess the prevalence of CD in patients with BE and its impact on development of dysplasia and EAC. Methods We performed a retrospective review of medical records of patients attending the Digestive Diseases Clinic and the specialized Barrett’s Clinic at McMaster University Medical Centre. We collected information related to demographics, esophageal and duodenal biopsies, as well as CD serological markers. CD diagnosis was based on the presence...
Journal of the Canadian Association of Gastroenterology, 2021
The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in C... more The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in Canada, is over 0.75% in 2021. Many individuals with IBD are immunocompromised. Consequently, the World Health Organization’s declaration of a global pandemic uniquely impacted those with IBD. Crohn’s and Colitis Canada (CCC) formed the COVID-19 and IBD Taskforce to provide evidence-based guidance during the pandemic to individuals with IBD and their families. The Taskforce met regularly through the course of the pandemic, synthesizing available information on the impact of COVID-19 on IBD. At first, the information was extrapolated from expert consensus guidelines, but eventually, recommendations were adapted for an international registry of worldwide cases of COVID-19 in people with IBD. The task force launched a knowledge translation initiative consisting of a webinar series and online resources to communicate information directly to the IBD community. Taskforce recommendations were po...
IntroductionUlcerative colitis (UC) is a chronic, relapsing condition characterised by colonic in... more IntroductionUlcerative colitis (UC) is a chronic, relapsing condition characterised by colonic inflammation. Increasing prevalence in early-age diagnosis provides opportunities for additional complications in later life as a result of prolonged exposure to inflammatory and therapeutic insults, necessitating novel avenues for therapeutics which may result in fewer side effects. Faecal microbiota transplantation (FMT) has previously demonstrated potential therapeutic benefit in an adult randomised-controlled trial and several recurrentClostridium difficileinfection studies. This phase Ib pilot will be the first randomised, single-blinded, placebo-controlled trial to assess feasibility and patient outcomes in a paediatric inflammatory bowel disease (IBD) population.Methods and analysisFifty patients will be randomised 1:1 to receive normal saline control or active sample. Enema administrations will be performed two times per week for 6 weeks, followed at a 6-month follow-up period. Fea...
Background: Little is known of the patients' perspective on fecal microbiota transplantation (FMT... more Background: Little is known of the patients' perspective on fecal microbiota transplantation (FMT) for ulcerative colitis (UC). Aim: To examine the satisfaction of UC patients on FMT and whether it was associated with the efficacy and safety of FMT, as well as to evaluate the treatment outcomes in patients with different compliances. Methods:Two clinical trials for UC were performed at our center from November 2012 to November 2018. The maximum follow-up was 72 months. After the first FMT, patients' satisfaction, compliance, treatment outcomes, and long-term adverse events (AEs) were evaluated. Patients' satisfaction to FMT was assigned a score from 0 (negative) to 10 (positive). Clinical remission was defined as partial Mayo score (PMS) ≤1 and recurrence was defined as PMS ≥ 2. Clinical response was defined as PMS drop ≥ 3. Kaplan-Meier survival curves were used to estimate the time to recurrence or lose response. The log-rank test was used in the univariate analysis to compare the time to lose response across 2 groups. Results:Totally 202 patients were recruited into this study, and among which 178 patients completed the survey. The follow-up period ranged from 3 months to 72 months. The median (IQR) satisfaction score of patients was 7.0 (5-9). 68% (121/178) of patients were willing to accept a second FMT. AEs were observed in 24.7%(44/178) of patients. The efficacy of patients with high satisfaction was significantly different from that with low satisfaction (P=0.002). Compared to subjects with poor compliance, patients with good compliance who accepted the scheduled second course of FMT (3-4 months after first FMT or during the time maintaining clinical response) attained a better long-term treatment outcome (P<0.0001). Compared with patients without second course of FMT, patients with second course of received better outcomes, respectively (P<0.05). Conclusion: FMT was safe and effective for UC. Patients' satisfaction was significantly affected by FMT efficacy but not AEs. Patients with good compliance of following the scheduled second course of FMT contributed to good outcomes.
Purpose Inflammatory bowel disease (IBD) significantly impacts patients’ quality of life and impo... more Purpose Inflammatory bowel disease (IBD) significantly impacts patients’ quality of life and imposes a considerable psychological, social, and financial burden. While the relationship between disease activity and quality of life is well established, the subjective challenges of living with IBD are more difficult to assess, and suggestions for improving patient experiences are lacking. The aim of this paper was to explore the various challenges patients encounter in living with IBD and to propose suggestions for overcoming them. Patients and Methods This study utilized a qualitative descriptive design with thematic content analysis. Patients were recruited from the Gastroenterology Clinic at McMaster University Medical Centre from December 2014 to April 2015. Data were collected over the course of 5 focus group interviews using a semi-structured interview guide. Results Seventeen patients aged 25 to 77 years old (mean age 43 years, SD 17 years) were interviewed. Fifteen patients were...
Journal of the Canadian Association of Gastroenterology, 2021
Background The aim of this study was to examine the associations among depression, anxiety and he... more Background The aim of this study was to examine the associations among depression, anxiety and health-related quality of life and predictors of improvement of quality of life in patients with inflammatory bowel disease. Methods This was a prospective cohort study conducted in the gastroenterology clinic at McMaster University Medical Center in Hamilton, Ontario, Canada from May 2014 to March 2015. We included 60 adult patients above the age of 18 years old with a diagnosis of inflammatory bowel disease. We assessed anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and Health Related Quality of Life (HRQoL) using the Short Inflammatory Bowel Disease questionnaire (SIBDQ) at baseline and after 6 months. Linear regression was performed to estimate the associations among depression, anxiety and predictors of improvement in health-related quality of life. Results The anxiety scores decreased over the span of 6 months (median HADS-A baseline 9.00 [interquartile...
Journal of the Canadian Association of Gastroenterology, 2021
Background Inflammatory bowel disease (IBD) can impact the quality of life and increase health ca... more Background Inflammatory bowel disease (IBD) can impact the quality of life and increase health care resource utilization. Nurses play an integral role in ensuring ease of access to care between scheduled office visits. Aims This study aimed to capture the utilization of Canadian IBD nursing telephone and e-mail services. Methods A descriptive cross-sectional study with an eight-item online survey was completed by nurses to assess the use of nurse-led telephone and e-mail services for IBD patients. Results Twenty-one IBD nurses participated, and 572 patients nurse encounters were reported. Patients with ulcerative (UC) contacted with disease flare when compared to Crohn’s disease (CD) (40% versus 24%, P < 0.001). Nursing services were primarily utilized for queries regarding medication (39.3%), disease exacerbations (29.6%), investigations (26%), and scheduling appointments (17.6%). Patients with CD had more telephone conversations (62.7%) and required more follow-up telephone cal...
Journal of the Canadian Association of Gastroenterology, 2021
The SARS-CoV-2 pandemic has had a profound impact on inflammatory bowel disease (IBD) health care... more The SARS-CoV-2 pandemic has had a profound impact on inflammatory bowel disease (IBD) health care delivery. The implementation of necessary public health restrictions has restricted access to medications, procedures and surgeries throughout the pandemic, catalyzing widespread change in how IBD care is delivered. Rapid large-scale implementation of virtual care modalities has been shown to be feasible and acceptable for the majority of individuals with IBD and health care providers. The SARS-CoV-2 pandemic has exacerbated pre-existing barriers to accessing high-quality, multidisciplinary IBD care that addresses health care needs holistically. Continued implementation and evaluation of both synchronous and asynchronous eHealthcare modalities are required now and in the future in order to determine how best to incorporate these modalities into patient-centred, collaborative care models. Resources must be dedicated to studies that evaluate the feasibility, acceptability and effectivenes...
Journal of the Canadian Association of Gastroenterology, 2020
Background Fecal microbiota transplantation (FMT) is under active investigation as a popular trea... more Background Fecal microbiota transplantation (FMT) is under active investigation as a popular treatment option for a variety of diseases, including ulcerative colitis (UC). Despite increasing evidence for its therapeutic role, the current literature is limited in its scope to assess firsthand patient experiences. Aims To exlore perceptions, attitudes, and experiences of patients who chose to pursue FMT and patients who declined FMT in favor of conventional medications. Methods Using qualitative descriptive design, eligible patients were invited to participate in face-to-face semi-structured interviews before and after FMT treatment. Interviews were audiotaped, transcribed, and analyzed using thematic analysis. Results Main baseline themes across the FMT (n=9) and non-FMT (n=8) groups included: (i) knowledge of FMT, (ii) attitudes around FMT, and (iii) factors contributing to the decision to pursue FMT. Post-FMT themes included: (i) experiences with FMT, and (ii) perceived response to...
BACKGROUND Several guidelines recommend influenza vaccination for high-risk patients, including t... more BACKGROUND Several guidelines recommend influenza vaccination for high-risk patients, including those on immune-suppressing medications (IS).OBJECTIVE: To assess the vaccination status and immunization history of an outpatient inflammatory bowel disease (IBD) population for H1N1 and seasonal influenza.RESULTS: Among 250 patients, 104 (41.6%) had been immunized against H1N1 and 62 (24.8%) against seasonal influenza, and 158 (63.2%) were taking IS (azathioprine, 6-mercaptopurine, infliximab, adalimumab, methotrexate, cyclosporine or prednisone). Among subjects on IS, the presence of comorbidities warranting vaccination was associated with higher likelihood of H1N1 immunization (62.5% versus 35.8%; P=0.022) but not of seasonal influenza vaccination (25.0% versus 17.2%; P=0.392). Among patients without comorbidities warranting vaccination, IS was associated with a decreased likelihood of vaccination against seasonal influenza (17.2% versus 30.7%; P=0.036) but not H1N1 (35.8% versus 41.3...
BACKGROUND: Capsule endoscopy is a common diagnostic procedure used in the evaluation of patients... more BACKGROUND: Capsule endoscopy is a common diagnostic procedure used in the evaluation of patients with known or suspected IBD. It is a non-invasive, endoscopic technique used to visualize the small bowel, an area not reached through endoscopy or colonoscopy. Traditionally GI nurses and practitioners prepare these patients, set up the sensor leads, administer the capsule, and very often do the preliminary read of the study. METHODS: A retrospective chart review was conducted to evaluate the diagnostic yield of capsule endoscopy in patients with suspected or known IBD and its effect on diagnosis and subsequent patient management. Nineteen patients with known or suspected IBD had CE performed in the outpatient setting at the division of Pediatric Gastroenterology and Nutrition, Stony Brook Long Children's Hospital and were included in the study. Fourteen subjects were males age 7-17: 10 had Crohn's Disease (CD), 2 had Ulcerative Colitis (UC) and 1 with Indeterminate Colitis (IC). Five were females ages 10 to 17 all with CD. Data collection included IBD serology, previous radiology studies, initial diagnosis and assessment of small bowel disease location prior to and after CE. Diagnosis and disease location on completion of CE were determined. RESULTS: In this study CE resulted in a change in the extent of disease location in 8 patients. Two patients underwent CE to assess small bowel involvement prior to surgery. One had Crohn's ileitis and underwent an ileal resection after the extent of the disease was confirmed on CE. The other had UC unresponsive to medical management. The study was nondiagnostic due to poor prep quality. Despite this he subsequently underwent a colectomy. Earlier pediatric reports have demonstrated the extent of small bowel disease is better delineated by CE than by upper gastrointestinal series with small bowel follow through. Prior to the advent of CE small bowel follow through had traditionally been the diagnostic modality for the assessing the extent of small bowel involvement. CONCLUSIONS: In this study CE did not change the diagnosis; however the extent of the disease was further refined in 8 patients and resulted in stepping up therapy in 6 of 7 patients and 1 patient was referred for surgery. It was also useful as adjunctive testing prior to surgery to assess small bowel involvement. Ideal IBD candidates for CE include: patients in whom terminal ileum intubation is not feasible during colonoscopy and those with ileal disease on biopsy unresponsive to medical management. Patients with previously diagnosed Crohn's disease may be found to more extensive involvement of the small bowel. This may result in targeting and developing more effective therapies leading to improved patient outcomes. The use of GI nurses and practitioners to prescreen CE videos may be a cost effective approach to study interpretation and provides opportunity for professional growth of the scope of practice of GI nurses.
Of the 66 IBS patients with positive antibodies, there were 14 cases of CD (11/12 EMA positive, 1... more Of the 66 IBS patients with positive antibodies, there were 14 cases of CD (11/12 EMA positive, 1 EMA positive patient declined biopsy). 3 patients with CD were EMA negative. Of the remaining patients, 9 were lost to follow-up/declined biopsy and 43 had normal duodenal mucosa. There were 2 EMA positive cases of CD from the controls (p=O.O04, OR =7.3 95% CI 1.6-32.4, chi-squared test for independence). Conclusion This is first study to assess the prevalence of CD in patients with IBS (4.7%). Patients with IBS should be routinely screened for CD.Using only EMA 20% of cases would have been missed.-ve ab. IgG IgA IgA/IgG. EMA. EMAJ EMA/ All 3 abs.
Journal of the Canadian Association of Gastroenterology, 2020
Background Corticosteroids (CS) have been used extensively to induce remission in Crohn’s disease... more Background Corticosteroids (CS) have been used extensively to induce remission in Crohn’s disease (CD); however, they are associated with severe side effects. We hypothesized that the administration of an exclusive enteral nutrition (EEN) formula to CS would lead to increased CD remission rates and to decreased CS-related adverse events. We proposed to undertake a pilot study comparing EEN and CS therapy to CS alone to assess decrease symptoms and inflammatory markers over 6 weeks. Aim The overall aim was to assess study feasibility based on recruitment rates and acceptability of treatment in arms involving EEN Methods The pilot study intended to recruit 100 adult patients with active CD who had been prescribed CS to induce remission as part of their care. The patients were randomized to one of three arms: (i) standard-dose CS; (ii) standard-dose CS plus EEN (Modulen 1.5 kcal); or (iii) short-course CS plus EEN. Results A total of 2009 CD patients attending gastroenterology clinics ...
Journal of the Canadian Association of Gastroenterology
Background This study aimed to compare fecal calprotectin (FC) levels with other commonly used pa... more Background This study aimed to compare fecal calprotectin (FC) levels with other commonly used parameters as part of patient care during evaluation for inflammatory bowel disease (IBD). Methods We recruited adult IBD patients with ulcerative colitis (UC) and Crohn’s disease (CD) and compared the results of the patient’s biopsy results (i.e., inflamed versus noninflamed) for six sites (i.e., ileum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum) with concentrations of C-reactive protein (CRP), total leucocytes and fecal calprotectin (FC). Results We found that FC was significantly elevated in a concentration-dependent manner that correlated with the number of active inflammation sites reported in biopsy. Although CRP and leucocyte measurements trended upwards in line with inflammation reported from biopsy, the results were highly variable and highlighted poor reliability of these biomarkers for indicating IBD inflammation. Conclusions These results strongl...
Journal of the Canadian Association of Gastroenterology
Background Tryptophan hydroxylase (TPH)1 catalyzes the biosynthesis of serotonin (5-hydroxytrptam... more Background Tryptophan hydroxylase (TPH)1 catalyzes the biosynthesis of serotonin (5-hydroxytrptamine; 5-HT) in enterochromaffin (EC) cells, the predominant source of gut 5-HT. Secreted 5-HT regulates various gut functions through diverse 5-HT receptor (5-HTR) families, and 5-HT transporter (5-HTT) sequesters its activity via uptake into surrounding cells. In inflammatory bowel disease (IBD) mucosal 5-HT signaling is altered, including upregulated EC cell numbers and 5-HT levels. We examined key mucosal 5-HT signaling components and blood 5-HT levels and, as part of a pilot study, investigated the association between 5-HTT gene-linked polymorphic region (5HTTLPR) and Crohn’s disease (CD). Methods In the context of inflammation, colonic expressions of TPH1, 5-HTT and 5-HTRs were studied in CD patients (n=15) and healthy controls (HC; n=10) using quantitative polymerase chain reaction (qPCR). We also investigated 5HTTLPR in 40 CD patients and HC utilizing PCR and measured platelet-poor...
Journal of the Canadian Association of Gastroenterology, Nov 5, 2021
Persons with inflammatory bowel disease (IBD) make up more than 0.75% of the Canadian population ... more Persons with inflammatory bowel disease (IBD) make up more than 0.75% of the Canadian population in 2021. Early in the COVID-19 pandemic, individuals with IBD, particularly those on immunosuppressive therapies, were concerned that their health status may place them at higher risk of contracting COVID-19 or experiencing more severe disease course if infected with SARS-CoV-2. In response, Crohn's and Colitis Canada developed the COVID-19 and IBD Taskforce in March 2020 to rapidly synthesize the evolving knowledge of COVID-19 as relevant to Canadians with IBD. The Taskforce communicated expert information directly to the Canadian IBD community through online tools and a webinar series. In order to understand the full impact of COVID-19 on the IBD community, Crohn's and Colitis Canada commissioned a policy report that was informed through a systematic literature review and synthesized across working groups along the following domains: Epidemiology, Children and Expectant Mothers with IBD, Seniors with IBD, Mental Health, Risk Factors and Medications, Vaccines, and Healthcare Delivery during the Pandemic and the Future Model of IBD Care. This report from Canadian physicians, researchers, and IBD community representatives highlights the physical, mental, and health systems impact of COVID-19 on the entire spectrum of the IBD community, including children, adolescents, adults, seniors, and pregnant people with IBD. This executive summary provides an overview of the crucial information from each of the chapters of the policy report, supplemented with additional information made available through Crohn's and Colitis Canada's webinar-based knowledge translation platform.
Journal of the Canadian Association of Gastroenterology, 2020
Background Celiac disease (CD) has an estimated prevalence of 1% worldwide, including North Ameri... more Background Celiac disease (CD) has an estimated prevalence of 1% worldwide, including North America. Barrett’s esophagus (BE) is a complication of chronic gastroesophageal reflux disease (GERD), which predisposes to development of dysplasia, which can transition to esophageal adenocarcinoma (EAC). GERD is commonly found in patients with CD and there is evidence that reflux symptoms improve after starting the gluten-free diet. However, the prevalence of CD in patients with BE, and its impact on progression to EAC have not been studied. Aims To assess the prevalence of CD in patients with BE and its impact on development of dysplasia and EAC. Methods We performed a retrospective review of medical records of patients attending the Digestive Diseases Clinic and the specialized Barrett’s Clinic at McMaster University Medical Centre. We collected information related to demographics, esophageal and duodenal biopsies, as well as CD serological markers. CD diagnosis was based on the presence...
Journal of the Canadian Association of Gastroenterology, 2021
The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in C... more The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in Canada, is over 0.75% in 2021. Many individuals with IBD are immunocompromised. Consequently, the World Health Organization’s declaration of a global pandemic uniquely impacted those with IBD. Crohn’s and Colitis Canada (CCC) formed the COVID-19 and IBD Taskforce to provide evidence-based guidance during the pandemic to individuals with IBD and their families. The Taskforce met regularly through the course of the pandemic, synthesizing available information on the impact of COVID-19 on IBD. At first, the information was extrapolated from expert consensus guidelines, but eventually, recommendations were adapted for an international registry of worldwide cases of COVID-19 in people with IBD. The task force launched a knowledge translation initiative consisting of a webinar series and online resources to communicate information directly to the IBD community. Taskforce recommendations were po...
IntroductionUlcerative colitis (UC) is a chronic, relapsing condition characterised by colonic in... more IntroductionUlcerative colitis (UC) is a chronic, relapsing condition characterised by colonic inflammation. Increasing prevalence in early-age diagnosis provides opportunities for additional complications in later life as a result of prolonged exposure to inflammatory and therapeutic insults, necessitating novel avenues for therapeutics which may result in fewer side effects. Faecal microbiota transplantation (FMT) has previously demonstrated potential therapeutic benefit in an adult randomised-controlled trial and several recurrentClostridium difficileinfection studies. This phase Ib pilot will be the first randomised, single-blinded, placebo-controlled trial to assess feasibility and patient outcomes in a paediatric inflammatory bowel disease (IBD) population.Methods and analysisFifty patients will be randomised 1:1 to receive normal saline control or active sample. Enema administrations will be performed two times per week for 6 weeks, followed at a 6-month follow-up period. Fea...
Background: Little is known of the patients' perspective on fecal microbiota transplantation (FMT... more Background: Little is known of the patients' perspective on fecal microbiota transplantation (FMT) for ulcerative colitis (UC). Aim: To examine the satisfaction of UC patients on FMT and whether it was associated with the efficacy and safety of FMT, as well as to evaluate the treatment outcomes in patients with different compliances. Methods:Two clinical trials for UC were performed at our center from November 2012 to November 2018. The maximum follow-up was 72 months. After the first FMT, patients' satisfaction, compliance, treatment outcomes, and long-term adverse events (AEs) were evaluated. Patients' satisfaction to FMT was assigned a score from 0 (negative) to 10 (positive). Clinical remission was defined as partial Mayo score (PMS) ≤1 and recurrence was defined as PMS ≥ 2. Clinical response was defined as PMS drop ≥ 3. Kaplan-Meier survival curves were used to estimate the time to recurrence or lose response. The log-rank test was used in the univariate analysis to compare the time to lose response across 2 groups. Results:Totally 202 patients were recruited into this study, and among which 178 patients completed the survey. The follow-up period ranged from 3 months to 72 months. The median (IQR) satisfaction score of patients was 7.0 (5-9). 68% (121/178) of patients were willing to accept a second FMT. AEs were observed in 24.7%(44/178) of patients. The efficacy of patients with high satisfaction was significantly different from that with low satisfaction (P=0.002). Compared to subjects with poor compliance, patients with good compliance who accepted the scheduled second course of FMT (3-4 months after first FMT or during the time maintaining clinical response) attained a better long-term treatment outcome (P<0.0001). Compared with patients without second course of FMT, patients with second course of received better outcomes, respectively (P<0.05). Conclusion: FMT was safe and effective for UC. Patients' satisfaction was significantly affected by FMT efficacy but not AEs. Patients with good compliance of following the scheduled second course of FMT contributed to good outcomes.
Purpose Inflammatory bowel disease (IBD) significantly impacts patients’ quality of life and impo... more Purpose Inflammatory bowel disease (IBD) significantly impacts patients’ quality of life and imposes a considerable psychological, social, and financial burden. While the relationship between disease activity and quality of life is well established, the subjective challenges of living with IBD are more difficult to assess, and suggestions for improving patient experiences are lacking. The aim of this paper was to explore the various challenges patients encounter in living with IBD and to propose suggestions for overcoming them. Patients and Methods This study utilized a qualitative descriptive design with thematic content analysis. Patients were recruited from the Gastroenterology Clinic at McMaster University Medical Centre from December 2014 to April 2015. Data were collected over the course of 5 focus group interviews using a semi-structured interview guide. Results Seventeen patients aged 25 to 77 years old (mean age 43 years, SD 17 years) were interviewed. Fifteen patients were...
Journal of the Canadian Association of Gastroenterology, 2021
Background The aim of this study was to examine the associations among depression, anxiety and he... more Background The aim of this study was to examine the associations among depression, anxiety and health-related quality of life and predictors of improvement of quality of life in patients with inflammatory bowel disease. Methods This was a prospective cohort study conducted in the gastroenterology clinic at McMaster University Medical Center in Hamilton, Ontario, Canada from May 2014 to March 2015. We included 60 adult patients above the age of 18 years old with a diagnosis of inflammatory bowel disease. We assessed anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and Health Related Quality of Life (HRQoL) using the Short Inflammatory Bowel Disease questionnaire (SIBDQ) at baseline and after 6 months. Linear regression was performed to estimate the associations among depression, anxiety and predictors of improvement in health-related quality of life. Results The anxiety scores decreased over the span of 6 months (median HADS-A baseline 9.00 [interquartile...
Journal of the Canadian Association of Gastroenterology, 2021
Background Inflammatory bowel disease (IBD) can impact the quality of life and increase health ca... more Background Inflammatory bowel disease (IBD) can impact the quality of life and increase health care resource utilization. Nurses play an integral role in ensuring ease of access to care between scheduled office visits. Aims This study aimed to capture the utilization of Canadian IBD nursing telephone and e-mail services. Methods A descriptive cross-sectional study with an eight-item online survey was completed by nurses to assess the use of nurse-led telephone and e-mail services for IBD patients. Results Twenty-one IBD nurses participated, and 572 patients nurse encounters were reported. Patients with ulcerative (UC) contacted with disease flare when compared to Crohn’s disease (CD) (40% versus 24%, P < 0.001). Nursing services were primarily utilized for queries regarding medication (39.3%), disease exacerbations (29.6%), investigations (26%), and scheduling appointments (17.6%). Patients with CD had more telephone conversations (62.7%) and required more follow-up telephone cal...
Journal of the Canadian Association of Gastroenterology, 2021
The SARS-CoV-2 pandemic has had a profound impact on inflammatory bowel disease (IBD) health care... more The SARS-CoV-2 pandemic has had a profound impact on inflammatory bowel disease (IBD) health care delivery. The implementation of necessary public health restrictions has restricted access to medications, procedures and surgeries throughout the pandemic, catalyzing widespread change in how IBD care is delivered. Rapid large-scale implementation of virtual care modalities has been shown to be feasible and acceptable for the majority of individuals with IBD and health care providers. The SARS-CoV-2 pandemic has exacerbated pre-existing barriers to accessing high-quality, multidisciplinary IBD care that addresses health care needs holistically. Continued implementation and evaluation of both synchronous and asynchronous eHealthcare modalities are required now and in the future in order to determine how best to incorporate these modalities into patient-centred, collaborative care models. Resources must be dedicated to studies that evaluate the feasibility, acceptability and effectivenes...
Journal of the Canadian Association of Gastroenterology, 2020
Background Fecal microbiota transplantation (FMT) is under active investigation as a popular trea... more Background Fecal microbiota transplantation (FMT) is under active investigation as a popular treatment option for a variety of diseases, including ulcerative colitis (UC). Despite increasing evidence for its therapeutic role, the current literature is limited in its scope to assess firsthand patient experiences. Aims To exlore perceptions, attitudes, and experiences of patients who chose to pursue FMT and patients who declined FMT in favor of conventional medications. Methods Using qualitative descriptive design, eligible patients were invited to participate in face-to-face semi-structured interviews before and after FMT treatment. Interviews were audiotaped, transcribed, and analyzed using thematic analysis. Results Main baseline themes across the FMT (n=9) and non-FMT (n=8) groups included: (i) knowledge of FMT, (ii) attitudes around FMT, and (iii) factors contributing to the decision to pursue FMT. Post-FMT themes included: (i) experiences with FMT, and (ii) perceived response to...
BACKGROUND Several guidelines recommend influenza vaccination for high-risk patients, including t... more BACKGROUND Several guidelines recommend influenza vaccination for high-risk patients, including those on immune-suppressing medications (IS).OBJECTIVE: To assess the vaccination status and immunization history of an outpatient inflammatory bowel disease (IBD) population for H1N1 and seasonal influenza.RESULTS: Among 250 patients, 104 (41.6%) had been immunized against H1N1 and 62 (24.8%) against seasonal influenza, and 158 (63.2%) were taking IS (azathioprine, 6-mercaptopurine, infliximab, adalimumab, methotrexate, cyclosporine or prednisone). Among subjects on IS, the presence of comorbidities warranting vaccination was associated with higher likelihood of H1N1 immunization (62.5% versus 35.8%; P=0.022) but not of seasonal influenza vaccination (25.0% versus 17.2%; P=0.392). Among patients without comorbidities warranting vaccination, IS was associated with a decreased likelihood of vaccination against seasonal influenza (17.2% versus 30.7%; P=0.036) but not H1N1 (35.8% versus 41.3...
BACKGROUND: Capsule endoscopy is a common diagnostic procedure used in the evaluation of patients... more BACKGROUND: Capsule endoscopy is a common diagnostic procedure used in the evaluation of patients with known or suspected IBD. It is a non-invasive, endoscopic technique used to visualize the small bowel, an area not reached through endoscopy or colonoscopy. Traditionally GI nurses and practitioners prepare these patients, set up the sensor leads, administer the capsule, and very often do the preliminary read of the study. METHODS: A retrospective chart review was conducted to evaluate the diagnostic yield of capsule endoscopy in patients with suspected or known IBD and its effect on diagnosis and subsequent patient management. Nineteen patients with known or suspected IBD had CE performed in the outpatient setting at the division of Pediatric Gastroenterology and Nutrition, Stony Brook Long Children's Hospital and were included in the study. Fourteen subjects were males age 7-17: 10 had Crohn's Disease (CD), 2 had Ulcerative Colitis (UC) and 1 with Indeterminate Colitis (IC). Five were females ages 10 to 17 all with CD. Data collection included IBD serology, previous radiology studies, initial diagnosis and assessment of small bowel disease location prior to and after CE. Diagnosis and disease location on completion of CE were determined. RESULTS: In this study CE resulted in a change in the extent of disease location in 8 patients. Two patients underwent CE to assess small bowel involvement prior to surgery. One had Crohn's ileitis and underwent an ileal resection after the extent of the disease was confirmed on CE. The other had UC unresponsive to medical management. The study was nondiagnostic due to poor prep quality. Despite this he subsequently underwent a colectomy. Earlier pediatric reports have demonstrated the extent of small bowel disease is better delineated by CE than by upper gastrointestinal series with small bowel follow through. Prior to the advent of CE small bowel follow through had traditionally been the diagnostic modality for the assessing the extent of small bowel involvement. CONCLUSIONS: In this study CE did not change the diagnosis; however the extent of the disease was further refined in 8 patients and resulted in stepping up therapy in 6 of 7 patients and 1 patient was referred for surgery. It was also useful as adjunctive testing prior to surgery to assess small bowel involvement. Ideal IBD candidates for CE include: patients in whom terminal ileum intubation is not feasible during colonoscopy and those with ileal disease on biopsy unresponsive to medical management. Patients with previously diagnosed Crohn's disease may be found to more extensive involvement of the small bowel. This may result in targeting and developing more effective therapies leading to improved patient outcomes. The use of GI nurses and practitioners to prescreen CE videos may be a cost effective approach to study interpretation and provides opportunity for professional growth of the scope of practice of GI nurses.
Of the 66 IBS patients with positive antibodies, there were 14 cases of CD (11/12 EMA positive, 1... more Of the 66 IBS patients with positive antibodies, there were 14 cases of CD (11/12 EMA positive, 1 EMA positive patient declined biopsy). 3 patients with CD were EMA negative. Of the remaining patients, 9 were lost to follow-up/declined biopsy and 43 had normal duodenal mucosa. There were 2 EMA positive cases of CD from the controls (p=O.O04, OR =7.3 95% CI 1.6-32.4, chi-squared test for independence). Conclusion This is first study to assess the prevalence of CD in patients with IBS (4.7%). Patients with IBS should be routinely screened for CD.Using only EMA 20% of cases would have been missed.-ve ab. IgG IgA IgA/IgG. EMA. EMAJ EMA/ All 3 abs.
Journal of the Canadian Association of Gastroenterology, 2020
Background Corticosteroids (CS) have been used extensively to induce remission in Crohn’s disease... more Background Corticosteroids (CS) have been used extensively to induce remission in Crohn’s disease (CD); however, they are associated with severe side effects. We hypothesized that the administration of an exclusive enteral nutrition (EEN) formula to CS would lead to increased CD remission rates and to decreased CS-related adverse events. We proposed to undertake a pilot study comparing EEN and CS therapy to CS alone to assess decrease symptoms and inflammatory markers over 6 weeks. Aim The overall aim was to assess study feasibility based on recruitment rates and acceptability of treatment in arms involving EEN Methods The pilot study intended to recruit 100 adult patients with active CD who had been prescribed CS to induce remission as part of their care. The patients were randomized to one of three arms: (i) standard-dose CS; (ii) standard-dose CS plus EEN (Modulen 1.5 kcal); or (iii) short-course CS plus EEN. Results A total of 2009 CD patients attending gastroenterology clinics ...
Journal of the Canadian Association of Gastroenterology
Background This study aimed to compare fecal calprotectin (FC) levels with other commonly used pa... more Background This study aimed to compare fecal calprotectin (FC) levels with other commonly used parameters as part of patient care during evaluation for inflammatory bowel disease (IBD). Methods We recruited adult IBD patients with ulcerative colitis (UC) and Crohn’s disease (CD) and compared the results of the patient’s biopsy results (i.e., inflamed versus noninflamed) for six sites (i.e., ileum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum) with concentrations of C-reactive protein (CRP), total leucocytes and fecal calprotectin (FC). Results We found that FC was significantly elevated in a concentration-dependent manner that correlated with the number of active inflammation sites reported in biopsy. Although CRP and leucocyte measurements trended upwards in line with inflammation reported from biopsy, the results were highly variable and highlighted poor reliability of these biomarkers for indicating IBD inflammation. Conclusions These results strongl...
Journal of the Canadian Association of Gastroenterology
Background Tryptophan hydroxylase (TPH)1 catalyzes the biosynthesis of serotonin (5-hydroxytrptam... more Background Tryptophan hydroxylase (TPH)1 catalyzes the biosynthesis of serotonin (5-hydroxytrptamine; 5-HT) in enterochromaffin (EC) cells, the predominant source of gut 5-HT. Secreted 5-HT regulates various gut functions through diverse 5-HT receptor (5-HTR) families, and 5-HT transporter (5-HTT) sequesters its activity via uptake into surrounding cells. In inflammatory bowel disease (IBD) mucosal 5-HT signaling is altered, including upregulated EC cell numbers and 5-HT levels. We examined key mucosal 5-HT signaling components and blood 5-HT levels and, as part of a pilot study, investigated the association between 5-HTT gene-linked polymorphic region (5HTTLPR) and Crohn’s disease (CD). Methods In the context of inflammation, colonic expressions of TPH1, 5-HTT and 5-HTRs were studied in CD patients (n=15) and healthy controls (HC; n=10) using quantitative polymerase chain reaction (qPCR). We also investigated 5HTTLPR in 40 CD patients and HC utilizing PCR and measured platelet-poor...
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Papers by Usha Chauhan