Canadian Association of Gastroenterology

Creating an affirming care environment for young adults with IBD in the LGBTQ+ community is an essential part of inflammatory bowel disease (IBD) care. This article summarizes the discussions held during the Roundtable on Young Adults with IBD, which focused on essential information for adult-care providers to successfully navigate the complexities and intricacies of sexuality and gender identity for young adult IBD patients. The Roundtable on Young Adults with IBD is held through the Crohn’s and Colitis Young Adults Network. Key focus areas include establishing effective communication between providers and patients, maintaining patient safety and privacy, emphasizing trauma-informed practices, and building trust-based provider-patient relationships. Addressing these issues will allow providers to more fully and effectively treat LGBTQ+ young adults with IBD, ensuring a better, safer path into successful adult lives.

Although faecal microbiota transplantation (FMT) has a well-established role in the treatment of recurrent Clostridioides difficile infection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated centres, difficulties with donor recruitment and complexities related to regulation and safety monitoring. Given the considerable burden of CDI on global healthcare systems, FMT should be widely available to most centres.Stool banks may guarantee reliable, timely and equitable access to FMT for patients and a traceable workflow that ensures safety and quality of procedures. In this consensus project, FMT experts from Europe, North America and Australia gathered and released statements on the following issues related to the stool banking: general principles, objectives and organisation of the stool bank; selection and screening of donors; collection, preparation and storage of faeces; services and clients; registries, monitoring of outcomes and ethical issues; and the evolving role of FMT in clinical practice,Consensus on each statement was achieved through a Delphi process and then in a plenary face-to-face meeting. For each key issue, the best available evidence was assessed, with the aim of providing guidance for the development of stool banks in order to promote accessibility to FMT in clinical practice.

Several databases track gastroenterology (GI) human resource (HR) numbers in Canada. They differ in the data which they collect and, hence, in their estimates of GI HR. The two most likely to reflect current HR are the Canadian Institute of Health Research (CIHI) and Canadian Medical Association (CMA) databases. The estimates of GI’s generated by each of the databases correlate closely with each other. Approximately 50 trainees enter the adult GI workforce per year, and approximately five enter the pediatric group. We estimate that Canada as a whole has between 782 and 848 GIs or 2.14 GIs per 100,000 population in 2016. Six of the 10 provinces have fewer than two GIs per 100,000 population. National GI numbers are increasing by 6% per year. Validation studies are required.

A 2-year study explored metabolic and phenotypic plasticity of sun-acclimated Vitis vinifera cv. Pinot noir leaves collected from 12 locations across a 36.69-49.98°N latitudinal gradient. Leaf morphological and biochemical parameters were analysed in the context of meteorological parameters and the latitudinal gradient. We found that leaf fresh weight and area were negatively correlated with both global and ultraviolet (UV) radiation, cumulated global radiation being a stronger correlator. Cumulative UV radiation (sumUVR) was the strongest correlator with most leaf metabolites and pigments. Leaf UV-absorbing pigments, total antioxidant capacities, and phenolic compounds increased with increasing sumUVR, whereas total carotenoids and xanthophylls decreased. Despite of this reallocation of metabolic resources from carotenoids to phenolics, an increase in xanthophyll-cycle pigments (the sum of the amounts of three xanthophylls: violaxanthin, antheraxanthin, and zeaxanthin) with increasing sumUVR indicates active, dynamic protection for the photosynthetic apparatus. In addition, increased amounts of flavonoids (quercetin glycosides) and constitutive β-carotene and α-tocopherol pools provide antioxidant protection against reactive oxygen species. However, rather than a continuum of plant acclimation responses, principal component analysis indicates clusters of metabolic states across the explored 1,500-km-long latitudinal gradient. This study emphasizes the physiological component of plant responses to latitudinal gradients and reveals the physiological plasticity that may act to complement genetic adaptations.

The development and commercialization of drugs for rare diseases, termed 'orphan drugs', has historically been economically unattractive. However, because of the introduction of legislation that provides financial and regulatory incentives for the development of orphan drugs, new developments are making their way through the regulatory approval processes. Unfortunately, delays in availability of new drugs for treating rare disease continue to persist. This paper reviews the approach of several regulatory jurisdictions to orphan drugs in an effort to determine their relative effectiveness in providing patient access. Generally speaking, regulatory authorities across jurisdictions have recognized the need to enhance timely access to safe, effective treatment for patients with rare diseases and have been able to shift the approval timelines for access to new care. The greater impediment to orphan drug access appears to be funding, particularly in publicly sponsored health-care systems. Redundancies in federal and provincial reviews of orphan drugs can result in significant delays in access to new drugs. Clearly, more must be done to accelerate access to the treatments so desperately needed by patients. Public payers must be held accountable for their process and decisions--especially for rare disease therapies.

The Canadian Association of Gastroenterology (CAG) and the Canadian Association for the Study of the Liver (CASL) are seeking applicants for the position of Editor-in-Chief (EIC) of the Canadian Journal of Gastroenterology & Hepatology, effective January 1, 2015. Applications from both individual candidates and from two candidates jointly applying as Co-Editors-in-Chief (one luminal focused and one liver focused) will be welcomed. The successful candidate(s) will enter an overlap period with the current EIC, from January 1 to March 31, 2015. The EIC/Co-EICs will be appointed by the Boards of the CAG and CASL, and Pulsus Group on recommendation of a Search and Selection Committee. The EIC/Co-EICs will serve up to a five-year, non-renewable term. The EIC/Co-EICs will be a well-respected, recognized Canadian leader(s) in gastroenterology and/or hepatology. It is expected the successful candidate(s) will be effective communicator(s) as reflected by peer-reviewed publications, presentations at national and international conferences, and previous experience as journal reviewer(s)/member(s) of an editorial board. It is expected the successful candidate(s) will have administrative skills and a vision for the Journal, as well as a willingness to promote the Journal. The EIC/Co-EIC will have control over the scientific and editorial content of the Journal. He/she/they will appoint Associate Editors and Editorial Board members with the approval of the Communications Committee of the CAG and CASL Governing Boards. The EIC/Co-EICs and the Editorial Board will be responsible for maintaining the highest standards of the Journal, including selection of high-quality articles and reviews; developing long-term plans; and for preparing an annual report. The EIC/Co-EICs will report to the Chair of the Communications Committee of the CAG and CASL Governing Boards. An appropriate stipend will be paid to the EIC/Co-EICs as reimbursement for relevant time commitments and costs. Full applications (including a current curriculum vitae, vision statement and names of three referees) must be received in electronic format by e-mail to gro.gca-gac@eciffOGAC, no later than October 31, 2014. Expressions of interest, nominations or informal enquires may also be made by e-mail to Dr Borgaonkar: gro.gca-gac@eciffOGAC

An important mandate of the Canadian Association of Gastroenterology (CAG), as documented in the Association's governance policies, is to optimize the care of patients with digestive disorders. Clinical practice guidelines are one means of achieving this goal. The benefits of timely, high-quality and evidenced-based recommendations include: Enhancing the professional development of clinical members through education and dissemination of synthesized clinical research; Improving patient care provided by members by providing focus on quality and evidence; Creating legislative environments that favour effective clinical practice; Enhancing the clinical care provided to patients with digestive disease by nongastroenterologists; and Identifying areas that require further information or research to improve clinical care. The present document provides the foundation required to ensure that clinical practice guidelines produced by the CAG are necessary, appropriate, credible and applicable. These recommendations should be adhered to as closely as possible to obtain CAG endorsement.

To determine staffing and practice patterns for after-hours endoscopy service in Canada. A link to a web-based survey was sent by e-mail to all clinical members of the Canadian Association of Gastroenterology in February 2011. A priori, it was planned to compare variations in practice among gastroenterologists (GIs) performing endoscopy in different regions of Canada, between pediatric and adult GIs, and between university and community hospitals. Of 422 potential respondents, 168 (40%) responded. Of the 139 adult GIs, 61% performed after-hours endoscopy in the endoscopy suite where daytime procedures were performed, 62% had a trained endoscopy nurse available for all procedures, 38% had access to propofol sedation, 12% reprocessed the endoscopes themselves or with the help of a resident, 4% had out-of-hospital patients come directly to their endoscopy suite and 53% were highly satisfied. The adult endoscopists practising at community hospitals were more likely to have an anesthetist attend the procedure. Regional differences were noted, with more involvement of anesthetists (13%) and availability of propofol (50%) in Ontario, more frequent reprocessing of endoscopes in the central reprocessing units in British Columbia (78%) and almost universal availability of a trained endoscopy nurse (96%) with concomitant higher endoscopist satisfaction (84% highly satisfied) in Alberta. More than one-third of surveyed endoscopists across the country do not have a trained endoscopy nurse to assist in after-hours endoscopy - the time period when urgent patients often present and typically require therapeutic endoscopic interventions. There are significant regional differences in the practice of after-hours endoscopy in Canada.

Point-of-care practice audits allow documentation of procedural outcomes to support quality improvement in endoscopic practice. To evaluate a colonoscopists' practice audit tool that provides point-of-care data collection and peer-comparator feedback. A prospective, observational colonoscopy practice audit was conducted in academic and community endoscopy units for unselected patients undergoing colonoscopy. Anonymized colonoscopist, patient and practice data were collected using touchscreen smartphones with automated data upload for data analysis and review by participants. The main outcome measures were the following colonoscopy quality indicators: colonoscope insertion and withdrawal times, bowel preparation quality, sedation, immediate complications and polypectomy, and biopsy rates. Over a span of 16 months, 62 endoscopists reported on 1279 colonoscopy procedures. The mean cecal intubation rate was 94.9% (10th centile 84.2%). The mean withdrawal time was 8.8 min and, for nonpolypectomy colonoscopies, 41.9% of colonoscopists reported a mean withdrawal time of less than 6 min. Polypectomy was performed in 37% of colonoscopies. Independent predictors of polypectomy included the following: endoscopy unit type, patient age, interval since previous colonoscopy, bowel preparation quality, stable inflammatory bowel disease, previous colon polyps and withdrawal time. Withdrawal times of less than 6 min were associated with lower polyp removal rates (mean difference -11.3% [95% CI -2.8% to -19.9%]; P=0.01). Cecal intubation rates exceeded 90% and polypectomy rates exceeded 30%, but withdrawal times were frequently shorter than recommended. There are marked practice variations consistent with previous observations. Real-time, point-of-care practice audits with prompt, confidential access to outcome data provide a basis for targeted educational programs to improve quality in colonoscopy practice.

On behalf of the Canadian Association of Gastroenterology (CAG) Board, I am pleased to provide you with this report summarizing the activities and directions of the organization on behalf of its members. It is an honour to participate in the affairs of the organization and interact with groups and individuals from across the country dedicated to advancing science and care in the field of digestive health and disease. This is a challenging time in medicine, and the organization has been working hard to enhance the benefits, programs and services available to its members. The goal is to provide the highest level of services possible to meet your needs.