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Crohn Disease: HELP
Articles by John Kenneth Marshall
Based on 21 articles published since 2010
(Why 21 articles?)
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Between 2010 and 2020, John Marshall wrote the following 21 articles about Crohn Disease.
 
+ Citations + Abstracts
1 Guideline Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn's Disease. 2019

Mack, David R / Benchimol, Eric I / Critch, Jeff / deBruyn, Jennifer / Tse, Frances / Moayyedi, Paul / Church, Peter / Deslandres, Colette / El-Matary, Wael / Huynh, Hien / Jantchou, Prévost / Lawrence, Sally / Otley, Anthony / Sherlock, Mary / Walters, Thomas / Kappelman, Michael D / Sadowski, Dan / Marshall, John K / Griffiths, Anne. ·Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada. · Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Section of Pediatric Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada. · Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; IBD Centre, Department of Paediatrics, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire, Sainte-Justine, Montréal, Quebec, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Section of Pediatric Gastroenterology, Department of Pediatrics, Health Sciences Centre, Winnipeg, Manitoba, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Department of Pediatrics (Gastroenterology), Stollery Children's Hospital, Edmonton, Alberta, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Division of Gastroenterology and Nutrition, IWK Health Centre, Halifax, Nova Scotia, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Division of Pediatric Gastroenterology, McMaster University, Hamilton, Ontario, Canada. · Division of Pediatric Gastroenterology, University of North Carolina, Hospital-Children's Specialty Clinic, Chapel Hill, North Carolina. · Division of Gastroenterology, Royal Alexandra Hospital, Edmonton, Alberta, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; IBD Centre, Department of Paediatrics, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: anne.griffiths@sickkids.ca. ·Gastroenterology · Pubmed #31320109.

ABSTRACT: BACKGROUND & AIMS: We aim to provide guidance for medical treatment of luminal Crohn's disease in children. METHODS: We performed a systematic search of publication databases to identify studies of medical management of pediatric Crohn's disease. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. We developed statements through an iterative online platform and then finalized and voted on them. RESULTS: The consensus includes 25 statements focused on medical treatment options. Consensus was not reached, and no recommendations were made, for 14 additional statements, largely due to lack of evidence. The group suggested corticosteroid therapies (including budesonide for mild to moderate disease). The group suggested exclusive enteral nutrition for induction therapy and biologic tumor necrosis factor antagonists for induction and maintenance therapy at diagnosis or at early stages of severe disease, and for patients failed by steroid and immunosuppressant induction therapies. The group recommended against the use of oral 5-aminosalicylate for induction or maintenance therapy in patients with moderate disease, and recommended against thiopurines for induction therapy, corticosteroids for maintenance therapy, and cannabis in any role. The group was unable to clearly define the role of concomitant immunosuppressants during initiation therapy with a biologic agent, although thiopurine combinations are not recommended for male patients. No consensus was reached on the role of aminosalicylates in treatment of patients with mild disease, antibiotics or vedolizumab for induction or maintenance therapy, or methotrexate for induction therapy. Patients in clinical remission who are receiving immunomodulators should be assessed for mucosal healing within 1 year of treatment initiation. CONCLUSIONS: Evidence-based medical treatment of Crohn's disease in children is recommended, with thorough ongoing assessments to define treatment success.

2 Review New Applications for Traditional Drugs in Inflammatory Bowel Disease: What Do Cochrane Reviews Tell Us? 2015

Chande, Nilesh / Marshall, John K / Seow, Cynthia H / Sandborn, William J / Parker, Claire E / Nelson, Sigrid / Feagan, Brian G. ·*Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, CA; †Division of Gastroenterology, McMaster University, Hamilton, Ontario, CA; ‡Division of Gastroenterology, Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, CA; §Division of Gastroenterology, University of California San Diego, La Jolla, CA; ‖Robarts Clinical Trials, Inc, Robarts Research Institute, Western University, London, Ontario, CA; Departments of ¶Medicine, and **Epidemiology and Statistics, Western University, London, Ontario, CA. ·Inflamm Bowel Dis · Pubmed #26540276.

ABSTRACT: Although multiple innovative treatments of inflammatory bowel disease have become available, research continues to refine the value of existing drug therapies for Crohn's disease and ulcerative colitis. What can Cochrane reviews tell us about evolving applications for traditional agents in inflammatory bowel disease? A Cochrane Collaboration symposium held at the 2014 Digestive Diseases Week annual meeting addressed this question. This article reviews the data presented at that session.

3 Review Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology. 2014

Nguyen, Geoffrey C / Bernstein, Charles N / Bitton, Alain / Chan, Anthony K / Griffiths, Anne M / Leontiadis, Grigorios I / Geerts, William / Bressler, Brian / Butzner, J Decker / Carrier, Marc / Chande, Nilesh / Marshall, John K / Williams, Chadwick / Kearon, Clive. ·Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: geoff.nguyen@utoronto.ca. · IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. · Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. · Division of Gastroenterology, Hepatology, and Nutrition, Sick Kids Hospital, Toronto, Ontario, Canada. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Thromboembolism Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Department of Medicine, Division of Gastroenterology, St Paul's Hospital, Vancouver, British Columbia, Canada. · Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. · Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario, Canada. · Division of Gastroenterology, Western University, London, Ontario, Canada. · Hamilton Health Sciences Centre, Hamilton, Ontario, Canada. · Dalhousie University, Halifax, Nova Scotia; Memorial University, St John's, Newfoundland, Canada. ·Gastroenterology · Pubmed #24462530.

ABSTRACT: BACKGROUND & AIMS: Guidelines for the management of venous thromboembolism (VTE) from the American College of Chest Physicians do not address patients with inflammatory bowel disease (IBD), a group with a high risk of both VTE and gastrointestinal bleeding. We present recommendations for the prevention and treatment of VTE in patients with IBD. METHODS: A systematic literature search was performed to identify studies on VTE in IBD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were developed through an iterative online platform, then finalized and voted on by a working group of adult and pediatric gastroenterologists and thrombosis specialists. RESULTS: IBD patients have an approximately 3-fold higher risk of VTE compared with individuals without IBD, and disease flares further increase this risk. Anticoagulant thromboprophylaxis is recommended for IBD patients who are hospitalized with IBD flares without active bleeding and is suggested when bleeding is nonsevere. Anticoagulant thromboprophylaxis is suggested during moderate-severe IBD flares in outpatients with a history of VTE provoked by an IBD flare or an unprovoked VTE, but not otherwise. The recommended duration of anticoagulation after a first VTE is based on the presence of provoking factors. Specific suggestions are made for the prevention and treatment of VTE in pediatric and pregnant IBD patients. CONCLUSIONS: Using the American College of Chest Physicians' guidelines as a foundation, we have integrated evidence from IBD studies to develop specific recommendations for the management of VTE in this high-risk population.

4 Review Efficacy of 5-aminosalicylates in Crohn's disease: systematic review and meta-analysis. 2011

Ford, Alexander C / Kane, Sunanda V / Khan, Khurram J / Achkar, Jean-Paul / Talley, Nicholas J / Marshall, John K / Moayyedi, Paul. ·Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK. alexf12399@yahoo.com ·Am J Gastroenterol · Pubmed #21407190.

ABSTRACT: OBJECTIVES: Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract. Evidence for treatment with 5-aminosalicylic acid (5-ASA) drugs is conflicting. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine this issue. METHODS: MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched (through December 2010). Authors of studies were contacted to provide additional information on trials where required, and experts in the field were contacted to identify unpublished studies. Eligible trials recruited adults with active or quiescent CD and compared 5-ASAs with placebo, or no treatment. Dichotomous data were pooled to obtain relative risk (RR) of failure to achieve remission in active CD, and RR of relapse of disease activity in quiescent CD, with a 95% confidence interval (CI). The number needed to treat (NNT) was calculated from the reciprocal of the risk difference. RESULTS: The search identified 3,061 citations. Twenty-two RCTs were eligible. Six RCTs compared 5-ASA with placebo in active CD remission. There was a trend towards a benefit with sulfasalazine over placebo (two RCTs, RR of failure to achieve remission=0.83; 95% CI=0.69-1.00), but no definite benefit of mesalamine over placebo (four RCTs, RR=0.91; 95% CI=0.77-1.06). Neither sulfasalazine nor mesalamine were effective in preventing quiescent CD relapse, but in a per protocol analysis mesalamine appeared to reduce risk of relapse (RR=0.79; 95% CI=0.66-0.95, NNT=13). CONCLUSIONS: The role of 5-ASAs in inducing remission of active CD and preventing relapse of quiescent CD remains uncertain, and more RCTs are required.

5 Review Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. 2011

Khan, Khurram J / Ullman, Thomas A / Ford, Alexander C / Abreu, Maria T / Abadir, Amir / Marshall, John K / Talley, Nicholas J / Moayyedi, Paul. ·McMaster University Medical Centre, Hamilton, Ontario, Canada. ·Am J Gastroenterol · Pubmed #21407187.

ABSTRACT: The etiology of inflammatory bowel disease (IBD) is unknown but may relate to an unidentified bacterial pathogen or an immunological reaction to gut microbiota. Antibiotics have therefore been proposed as a therapy for Crohn's disease (CD) and ulcerative colitis (UC) to induce remission in active disease to prevent relapse. Current data are conflicting and we therefore conducted a systematic review of randomized controlled trials (RCTs) evaluating antibiotics in IBD. Only parallel group RCTs were considered eligible. Studies with adult patients receiving any dose of therapy for at least 7 days and up to 16 weeks for active disease, or at least 6 months of follow-up for preventing relapse in quiescent disease were analyzed. We included any antibiotics alone or in combination using predefined definitions of remission and relapse. Two reviewers independently assessed eligibility and extracted data. The primary outcome was remission or relapse using an intention-to-treat methodology. The data were summarized using relative risk (RR) and pooled using a random effects model. For active CD, there were 10 RCTs involving 1,160 patients. There was a statistically significant effect of antibiotics being superior to placebo (RR of active CD not in remission=0.85; 95% confidence interval (CI)=0.73-0.99, P=0.03). There was moderate heterogeneity between results (I(2)=48%) and a diverse number of antibiotics were tested (anti-tuberculosis therapy, macrolides, fluroquinolones, 5-nitroimidazoles, and rifaximin) either alone or in combination. Rifamycin derivatives either alone or in combination with other antibiotics appeared to have a significant effect at inducing remission in active CD. In perianal CD fistula there were three trials evaluating 123 patients using either ciprofloxacin or metronidazole. There was a statistically significant effect in reducing fistula drainage (RR=0.8; 95% CI=0.66-0.98) with no heterogeneity (I(2)=0%) and an number needed to treat 5 (95% CI=3-20). For quiescent CD, there were 3 RCTs involving 186 patients treated with different antibiotics combinations (all including antimycobacterials) vs. placebo. There was a statistically significant effect in favor of antibiotics vs. placebo (RR of relapse=0.62; 95% CI=0.46-0.84), with no heterogeneity (I(2)=0%). In active UC, there were 9 RCTs with 662 patients and there was a statistically significant benefit for antibiotics inducing remission (RR of UC not in remission=0.64; 95% CI=0.43-0.96). There was moderate heterogeneity (I(2)=69%) and antibiotics used were all different single or combination drugs. Antibiotic therapy may induce remission in active CD and UC, although the diverse number of antibiotics tested means the data are difficult to interpret. This systematic review is a mandate for further trials of antibiotic therapy in IBD.

6 Review Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. 2011

Ford, Alexander C / Bernstein, Charles N / Khan, Khurram J / Abreu, Maria T / Marshall, John K / Talley, Nicholas J / Moayyedi, Paul. ·Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK. alexf12399@yahoo.com ·Am J Gastroenterol · Pubmed #21407179.

ABSTRACT: OBJECTIVES: The use of glucocorticosteroids to treat both Crohn's disease (CD) and ulcerative colitis (UC) is widespread, but no systematic review and meta-analysis has examined the issue of efficacy of these agents in its entirety. METHODS: MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched (through December 2010). Randomized controlled trials (RCTs) recruiting adults with active or quiescent CD comparing standard glucocorticosteroids or budesonide with placebo or each other, or comparing standard glucocorticosteroids with placebo in active UC, were eligible. Dichotomous data were extracted to obtain relative risk (RR) of failure to achieve remission in active disease, and RR of relapse of activity in quiescent disease, with a 95% confidence interval (CI). Adverse events data were extracted where reported. RESULTS: The search identified 3,061 citations, and 20 trials were eligible. Only one trial was at low risk of bias. Standard glucocorticosteroids were superior to placebo for UC remission (RR of no remission=0.65; 95% CI 0.45-0.93). Both trials of standard glucocorticosteroids in CD remission reported a statistically significant effect, but because of heterogeneity between studies, the overall effect was not significant (RR=0.46; 95% CI 0.17-1.28). Budesonide was superior to placebo for CD remission (RR=0.73; 95% CI 0.63-0.84), but not in preventing CD relapse (RR=0.93; 95% CI 0.83-1.04). Standard glucocorticosteroids were superior to budesonide for CD remission (RR=0.82; 95% CI 0.68-0.98), but glucocorticosteroid-related adverse events were commoner (RR=1.64; 95% CI 1.34-2.00). CONCLUSIONS: Standard glucocorticosteroids are probably effective in inducing remission in UC, and may be of benefit in CD. Budesonide induces remission in active CD, but is less effective than standard glucocorticosteroids, and is of no benefit in preventing CD relapse.

7 Review IgG₄-related sclerosing disease: a novel mimic of inflammatory bowel disease. 2010

Narula, Neeraj / Vasudev, Monica / Marshall, John K. ·Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada. ·Dig Dis Sci · Pubmed #20521111.

ABSTRACT: High levels of IgG₄-positive plasma cells are commonly seen in autoimmune pancreatitis. It has recently become evident that autoimmune pancreatitis is one component of a larger multi-system disease. IgG₄-positive plasma cells have been identified in many extrapancreatic tissues, including the colon, biliary tract, liver, and lungs, and thus the term "IgG₄-related sclerosing disease" has been proposed. Awareness of IgG₄-related sclerosing disease is important, as it has been shown to mimic other conditions like malignancy. This review discusses IgG₄-related colitis and its potential for mimicking inflammatory bowel disease.

8 Review Patient outcomes after anti TNF-alpha drugs for Crohn's disease. 2010

Assasi, Nazila / Blackhouse, Gord / Xie, Feng / Marshall, John K / Irvine, E Jan / Gaebel, Kathryn / Robertson, Diana / Campbell, Kaitryn / Hopkins, Rob / Goeree, Ron. ·Programs for Assessment of Technology in Health Research Institute, St Joseph's Healthcare, Hamilton, 25 Main Street West, Suite 2000 ON, Canada. assasin@mcmaster.ca ·Expert Rev Pharmacoecon Outcomes Res · Pubmed #20384563.

ABSTRACT: Crohn's disease (CD) is a chronic inflammatory bowel disease with a relatively high prevalence rate in North America. More than 50% of CD patients require surgery at some stage of their disease. Anti-TNF-alpha drugs are increasingly being used in patients with CD who have had an inadequate response to conventional therapy. Treatment with anti-TNF-alpha agents aims at improving symptom control and reducing the need for hospitalization and surgery. This review examines the clinical effectiveness of three anti-TNF-alpha agents (infliximab, adalimumab and etanercept) in moderate and severe CD. The review further considers the evidence for the harms and benefits associated with switching from one anti-TNF-alpha agent to another and strategies to optimize the timing of therapy.

9 Review Should my patient with inflammatory bowel disease on immunosuppressive therapy be vaccinated against influenza virus? 2010

Narula, Neerja / Yamamura, Deborah L R / Marshall, John K. ·Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. ·Can J Gastroenterol · Pubmed #20151071.

ABSTRACT: Crohn's disease and ulcerative colitis are variants of inflammatory bowel disease (IBD) for which immunosuppressive therapy is often required. Immunosuppressed patients are at increased risk for infections, including vaccine-preventable diseases such as influenza. Although several guidelines recommend routine influenza immunization for such patients, recent literature suggests that this patient population may be inadequately immunized. Current research suggests that inactivated influenza vaccines are effective, well tolerated and can be administered safely in most IBD patients. Studies in other immunosuppressed populations have also demonstrated the safety of inactivated vaccines. The present article reviews the literature regarding the safety and efficacy of influenza vaccination in IBD patients receiving immunosuppressive therapy.

10 Article ECCO Guidelines on Therapeutics in Crohn's Disease: Surgical Treatment. 2019

Adamina, Michel / Bonovas, Stefanos / Raine, Tim / Spinelli, Antonino / Warusavitarne, Janindra / Armuzzi, Alessandro / Bachmann, Oliver / Bager, Palle / Biancone, Livia / Bokemeyer, Bernd / Bossuyt, Peter / Burisch, Johan / Collins, Paul / Doherty, Glen / El-Hussuna, Alaa / Ellul, Pierre / Fiorino, Gionata / Frei-Lanter, Cornelia / Furfaro, Federica / Gingert, Christian / Gionchetti, Paolo / Gisbert, Javier P / Gomollon, Fernando / Lorenzo, Marien González / Gordon, Hannah / Hlavaty, Tibor / Juillerat, Pascal / Katsanos, Konstantinos / Kopylov, Uri / Krustins, Eduards / Kucharzik, Torsten / Lytras, Theodore / Maaser, Christian / Magro, Fernando / Marshall, John Kenneth / Myrelid, Pär / Pellino, Gianluca / Rosa, Isadora / Sabino, Joao / Savarino, Edoardo / Stassen, Laurents / Torres, Joana / Uzzan, Mathieu / Vavricka, Stephan / Verstockt, Bram / Zmora, Oded. ·Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland. · University of Basel, Basel, Switzerland. · Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. · IBD Center, Humanitas Clinical and Research Center, Milan, Italy. · Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. · Humanitas Clinical and Research Center, Division of Colon and Rectal Surgery, Humanitas University, Department of Biomedical Sciences, Milan, Italy. · Imperial College London, Department of Surgery and Cancer, St Mark's Hospital, Department of Gastroenterology, London, United Kingdom. · IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS - Universita' Cattolica del Sacro Cuore, Rome, Italy. · Department of Internal Medicine I, Siloah St. Trudpert Hospital, Pforzheim, Germany. · Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark. · Department of Systems Medicine, University "Tor Vergata" of Rome, Italy. · Gastroenterology Practice Minden, Germany. · Imelda GI Clinical Research Centre, Imelda General Hospital, Bonheiden, Belgium. · Gastrounit, medical division, Hvidovre Hospital, University of Copenhagen, Denmark. · Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom. · Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland. · Department of Surgery, Aalborg University Hospital, Aalborg, Denmark. · Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta. · Departement of Surgery, Hospital Zollikerberg, Zollikerberg Zürich, Switzerland. · Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland. · Department of Human Medicine, Faculty of Health, University of Witten/Herdecke, Witten, Germany. · IBD Unit, DIMEC, University of Bologna, Bologna, Italy. · Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. · Chief, IBD UNIT, Hospital Clíico Universitario "Lozano Blesa"; IIS Aragón, CIBEREHD, Zaragoza, Spain. · Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom. · 5th Department of Internal Medicine, Sub-department of gastroenterology and hepatology, University hospital Bratislava and Faculty of Medicine, Comenius University Bratislava, Slovakia. · Gastroenterology, Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland. · Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece. · Department of Gastroenterology, Tel-HaShomer Sheba Medical Center, Ramat Gan, and Sackler Medical School, Tel Aviv, Israel. · Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Department of Internal medicine, Riga Stradiņš university, Riga, Latvia. · Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany. · National Public Health Organization, Athens, Greece. · Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany. · Department of Pharmacology and Therapeutics; Institute for Molecular and Cell Biology, University of Porto, Faculty of Medicine, Porto, Portugal. · Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · Department of Surgery, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. · Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania "Luigi Vanvitelli", Naples, Italy. · Department of Gastroenterology, IPOLFG, Lisbon, Portugal. · Department of Gastroenterology and Hepatology, University Hospitals, KU Leuven, Leuven, Belgium. · Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy. · Department of General Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands. · Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal. · Department of Gastroenterology, IBD unit, Beaujon Hospital, APHP, Clichy, France. · Center for Gastroenterology and Hepatology, Zürich- Altstetten, Switzerland. · Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. · Department of Chronic Diseases, Metabolism and Ageing, TARGID - IBD, KU Leuven, Leuven, Belgium. · Department of Surgery, Shamir Medical Center (Assaf Harofe), Tel Aviv, Israel. ·J Crohns Colitis · Pubmed #31742338.

ABSTRACT: This article is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn's disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn's disease and an update of prior guidelines.

11 Article Novel Microbial-Based Immunotherapy Approach for Crohn's Disease. 2019

Sutcliffe, Simon / Kalyan, Shirin / Pankovich, Jim / Chen, Jenny M H / Gluck, Rashieda / Thompson, Darby / Bosiljcic, Momir / Bazett, Mark / Fedorak, Richard N / Panaccione, Remo / Axler, Jeffrey / Marshall, John K / Mullins, David W / Kabakchiev, Boyko / McGovern, Dermot P B / Jang, Julie / Coldman, Andrew / Vandermeirsch, Gillian / Bressler, Brian / Gunn, Hal. ·Qu Biologics Inc., Vancouver, BC, Canada. · Department of Medicine, University of British Columbia, Vancouver, BC, Canada. · Emmes Canada, Burnaby, BC, Canada. · Department of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, BC, Canada. · Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada. · Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada. · Toronto Digestive Disease Associates Inc., Vaughan, ON, Canada. · Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada. · Department of Microbiology, Immunology and Medical Education, Geisel School of Medicine at Dartmouth, Hanover, NH, United States. · Zane Cohen Centre for Digestive Diseases, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. · Cedars-Sinai Medical Center, Los Angeles, CA, United States. · Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada. · Gastrointestinal Research Institute, Vancouver, BC, Canada. ·Front Med (Lausanne) · Pubmed #31380382.

ABSTRACT:

12 Article Characterization of Serotonin Signaling Components in Patients with Inflammatory Bowel Disease. 2019

Shajib, Md Sharif / Chauhan, Usha / Adeeb, Salman / Chetty, Yeshale / Armstrong, David / Halder, Smita L S / Marshall, John K / Khan, Waliul I. ·Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. · Hamiltion Health Sciences, Hamilton, Ontario, Canada. · Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. ·J Can Assoc Gastroenterol · Pubmed #31294376.

ABSTRACT: 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 plasma (PPP) and plasma 5-HT concentrations. Results: Compared with HC, inflammation in CD patients was associated with elevated TPH1, 5-HTR3, 5-HTR4, 5-HTR7 and downregulated 5-HTT expressions. In our second cohort of participants, significantly higher PPP and plasma 5-HT levels and higher S-genotype (L/S+S/S) than L/L genotype were observed in CD patients compared with HC. Conclusion: Our results suggest that augmented mucosal 5-HT signaling and specific 5-HTTLPR genotype-associated decreased efficiency in 5-HT reuptake, the latter through increased 5-HT availability, may contribute to inflammation in CD patients. These findings revealed important information on various components of 5-HT signaling in intestinal inflammation which may ultimately lead to effective strategies targeting this pathway in IBD.

13 Article Higher adalimumab serum levels do not increase the risk of adverse events in patients with inflammatory bowel disease. 2019

Narula, Neeraj / Lauzon, Brian / Marshall, John K. ·Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University , Hamilton , Canada. ·Scand J Gastroenterol · Pubmed #31144993.

ABSTRACT:

14 Article Clinical Practice Guideline for the Medical Management of Perianal Fistulizing Crohn's Disease: The Toronto Consensus. 2019

Steinhart, A Hillary / Panaccione, Remo / Targownik, Laura / Bressler, Brian / Khanna, Reena / Marshall, John K / Afif, Waqqas / Bernstein, Charles N / Bitton, Alain / Borgaonkar, Mark / Chauhan, Usha / Halloran, Brendan / Jones, Jennifer / Kennedy, Erin / Leontiadis, Grigorios I / Loftus, Edward V / Meddings, Jonathan / Moayyedi, Paul / Murthy, Sanjay / Plamondon, Sophie / Rosenfeld, Greg / Schwartz, David / Seow, Cynthia H / Williams, Chadwick. ·Division of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada. · Department of Medicine, University of Calgary, Calgary, Alberta, Canada. · Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Medicine, Division of Gastroenterology, St Paul's Hospital, Vancouver, British Columbia, Canada. · Department of Medicine, University of Western Ontario, London, Ontario, Canada. · Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. · Faculty of Medicine, Memorial University, St John's, Newfoundland, Canada. · Hamilton Health Sciences, Hamilton, Ontario, Canada. · Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada. · Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. · Division of General Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada. · Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Division of Gastroenterology, University of Ottawa, Ottawa, Ontario, Canada. · Department of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada. · Division of Gastroenterology, Pacific Gastroenterology Associates, Vancouver, British Columbia, Canada. · Inflammatory Bowel Disease Center, Vanderbilt University, Nashville, Tennessee, USA. · Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. · Division of Digestive Care & Endoscopy, Department of Medicine, Dartmouth General Hospital, Halifax, Nova Scotia, Canada. ·Inflamm Bowel Dis · Pubmed #30099529.

ABSTRACT: Background: Fistulas occur in about 25% of patients with Crohn's disease (CD) and can be difficult to treat. The aim of this consensus was to provide guidance for the management of patients with perianal fistulizing CD. Methods: A systematic literature search identified studies on the management of fistulizing CD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform using a modified Delphi process, then finalized, and voted on by a group of specialists. Results: The quality of evidence for treatment of fistulizing CD was generally of very low quality, and because of the scarcity of good randomized controlled trials (RCTs), these consensus statements generally provide conditional suggestions (5 of 7 statements). Imaging and surgical consultations were recommended in the initial assessment of patients with active fistulizing CD, particularly those with complicated disease. Antibiotic therapy is useful for initial symptom control. Antitumor necrosis factor (anti-TNF) therapy was recommended to induce symptomatic response, and continued use was suggested to achieve and maintain complete remission. The use of concomitant immunosuppressant therapies may be useful to optimize pharmacokinetic parameters when initiating anti-TNF therapy. When there has been an inadequate symptomatic response to medical management strategies, surgical therapy may provide effective fistula healing for some patients. Conclusions: Optimal management of perianal fistulizing CD requires a collaborative effort between gastroenterologists and surgeons and may include the evidence-based use of existing therapies, as well as surgical assessments and interventions when needed. 10.1093/ibd/izy247_video1izy247.video15978518763001.

15 Article Impact of Adalimumab Patient Support Program's Care Coach Calls on Clinical Outcomes in Patients with Crohn's Disease in Canada: An Observational Retrospective Cohort Study. 2018

Narula, Neeraj / Millson, Brad / Charland, Katia / Donepudi, Krishna / Gaetano, Tania / McHugh, Kevin / Latour, Martin G / Gazel, Sandra / Laliberté, Marie-Claude / Marshall, John K. ·Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · IQVIA, Health Access and Outcomes Division, Kirkland, Quebec, Canada. · AbbVie Corporation, St. Laurent, Quebec, Canada. ·J Can Assoc Gastroenterol · Pubmed #31294360.

ABSTRACT: Background: Adalimumab is an antitumour necrosis factor (TNFα) biologic therapy indicated for the treatment of Crohn's disease (CD). Patients receiving adalimumab in Canada are eligible to enroll in the AbbVie Care™ patient support program (AC-PSP), which provides personalized services, including care coach calls (CCCs). The objective of this study was to compare the likelihood of achieving clinical remission in a cohort of CD patients treated with adalimumab who did and did not receive CCCs. Methods: A longitudinal analysis was performed using de-identified aggregate-level data collected through the AC-PSP. Patients were indexed on the date of their first injection of adalimumab between July 2010 and October 2014. The AC-PSP database included measurements of the Harvey-Bradshaw Index (HBI), a symptom-based measure of disease severity. Eligible patients had an initial HBI measurement performed between 90 days before and up to 30 days after the index date and a follow-up HBI measurement six to 18 months later. Adjusted relative risk (RR) of achieving remission (HBI ≤ 4) at the time of the follow-up was estimated comparing patients who received and did not receive CCCs. Results: There were 381 CD patients who met eligibility criteria; 224 (59%) received CCCs, and 157 (41%) did not receive CCCs. Multivariate regression analysis demonstrated that CD patients receiving CCCs had a 17% increased likelihood of achieving HBI remission when compared with patients who did not receive CCCs (RR = 1.17; 95% CI, 1.03-1.34; P = 0.0192). Conclusions: This study provides preliminary evidence that a phone call intervention, aiming to improve the overall patient experience with adalimumab treatment, may increase the likelihood of HBI remission in patients taking adalimumab to manage CD.

16 Article Impact of High-Dose Vitamin D3 Supplementation in Patients with Crohn's Disease in Remission: A Pilot Randomized Double-Blind Controlled Study. 2017

Narula, Neeraj / Cooray, Mohan / Anglin, Rebecca / Muqtadir, Zack / Narula, Alisha / Marshall, John K. ·Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, 1280 Main Street West, Unit 3V28, Hamilton, ON, L8S 4K1, Canada. Neeraj.narula@medportal.ca. · Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, 1280 Main Street West, Unit 3V28, Hamilton, ON, L8S 4K1, Canada. ·Dig Dis Sci · Pubmed #27975236.

ABSTRACT: AIM: To assess the tolerability and efficacy of high-dose vitamin D3 in patients with Crohn's disease (CD). METHODS: This was a randomized, double-blind placebo-controlled trial of high-dose vitamin D3 at 10,000 IU daily (n = 18) compared to 1000 IU daily (n = 16) for 12 months in patients with CD in remission. The primary outcome was change in serum 25-hydroxy-vitamin D levels. Secondary outcomes included clinical relapse rates and changes in mood scores. RESULTS: High-dose vitamin D3 at 10,000 IU daily significantly improved 25-hydroxy-vitamin D levels from a mean of 73.5 nmol/L [standard deviation (SD) 11.7 nmol/L] to 160.8 nmol/L (SD 43.2 nmol/L) (p = 0.02). On an intention-to-treat basis, the rate of relapse was not significantly different between patients receiving low- and high-dose vitamin D3 (68.8 vs 33.3%, p = 0.0844). In per-protocol analysis, clinical relapse of Crohn's disease was less frequently observed in patients receiving a high dose (0/12 or 0%) compared to those receiving a low dose of 1000 IU daily (3/8 or 37.5%) (p = 0.049). Improvement in anxiety and depression scores and a good safety profile were observed in both groups treated with vitamin D3. CONCLUSIONS: Oral supplementation with high-dose vitamin D3 at 10,000 IU daily significantly improved serum 25-hydroxy-vitamin D levels. Rates of clinical relapse were similar between both groups. Larger studies using high-dose vitamin D3 for treatment of inflammatory bowel diseases are warranted. CLINICALTRIALS. GOV REGISTRATION NO: NCT02615288.

17 Article The probiotic VSL#3 has anti-inflammatory effects and could reduce endoscopic recurrence after surgery for Crohn's disease. 2015

Fedorak, Richard N / Feagan, Brian G / Hotte, Naomi / Leddin, Des / Dieleman, Levinus A / Petrunia, Denis M / Enns, Robert / Bitton, Alain / Chiba, Naoki / Paré, Pierre / Rostom, Alaa / Marshall, John / Depew, William / Bernstein, Charles N / Panaccione, Remo / Aumais, Guy / Steinhart, A Hillary / Cockeram, Alan / Bailey, Robert J / Gionchetti, Paolo / Wong, Cindy / Madsen, Karen. ·Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: Richard.Fedorak@ualberta.ca. · Robarts Clinical Trials University of Western Ontario, London, Ontario, Canada. · Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada. · Dalhousie University, Halifax, Nova Scotia, Canada. · University of Victoria, Victoria, British Columbia, Canada. · University of British Columbia, Vancouver, British Columbia, Canada. · McGill University, Montreal, Quebec, Canada. · Guelph GI and Surgery Clinic, Guelph, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada. · Université Laval, CHA-Hopitâl du Saint-Sacrement, Quebec City, Quebec, Canada. · University of Ottawa, Ottawa, Ontario, Canada. · McMaster University, Hamilton, Ontario, Canada. · Queen's University, Kingston, Ontario, Canada. · University of Manitoba, Winnipeg, Manitoba, Canada. · University of Calgary, Calgary, Alberta, Canada. · University of Montreal, Montreal, Quebec, Canada. · University of Toronto, Toronto, Ontario, Canada. · St John, New Brunswick, Canada. · DIMEC University of Bologna, Bologna, Italy. ·Clin Gastroenterol Hepatol · Pubmed #25460016.

ABSTRACT: BACKGROUND & AIMS: Probiotic formulations of single species of bacteria have not been effective in preventing the recurrence of Crohn's disease after surgery. We investigated the ability of VSL#3, a mixture of 8 different bacterial probiotic species, to prevent Crohn's disease recurrence after surgery in a multicenter, randomized, double-blind, placebo-controlled trial. METHODS: Within 30 days of ileocolonic resection and re-anastomosis, patients with Crohn's disease were randomly assigned to groups given 1 sachet of VSL#3 (900 billion viable bacteria, comprising 4 strains of Lactobacillus, 3 strains of Bifidobacterium, and 1 strain of Streptococcus salivarius subspecies thermophilus) (n = 59) or matching placebo (n = 60). Colonoscopy was performed at days 90 and 365 to evaluate the neoterminal ileum for disease recurrence and obtain mucosal biopsies for cytokine analysis. Patients from both groups with either no or mild endoscopic recurrence at day 90 received VSL#3 until day 365. The primary outcome was the proportion of patients with severe endoscopic recurrence at day 90. RESULTS: At day 90, the proportion of patients with severe endoscopic lesions did not differ significantly between VSL#3 (9.3%) and placebo (15.7%, P = .19). The proportions of patients with non-severe lesions at day 90 who had severe endoscopic recurrence at day 365 were 10.0% in the early VSL#3 group (given VSL#3 for the entire 365 days) and 26.7% in the late VSL#3 group (given VSL#3 from days 90 through 365) (P = .09). Aggregate rates of severe recurrence (on days 90 and 365) were not statistically different, 20.5% of subjects in the early VSL#3 group and 42.1% in the late VSL#3 group. Patients receiving VSL#3 had reduced mucosal inflammatory cytokine levels compared with placebo at day 90 (P < .05). Crohn's disease activity index and inflammatory bowel disease quality of life scores were similar in the 2 groups. CONCLUSIONS: There were no statistical differences in endoscopic recurrence rates at day 90 between patients who received VSL#3 and patients who received placebo. Lower mucosal levels of inflammatory cytokines and a lower rate of recurrence among patients who received early VSL#3 (for the entire 365 days) indicate that this probiotic should be further investigated for prevention of Crohn's disease recurrence. Clinical trials.gov number: NCT00175292.

18 Article Validation of international algorithms to identify adults with inflammatory bowel disease in health administrative data from Ontario, Canada. 2014

Benchimol, Eric I / Guttmann, Astrid / Mack, David R / Nguyen, Geoffrey C / Marshall, John K / Gregor, James C / Wong, Jenna / Forster, Alan J / Manuel, Douglas G. ·Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5; CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1; Department of Pediatrics, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5; Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5. Electronic address: ebenchimol@cheo.on.ca. · Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5; Department of Paediatrics, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8; Institute of Health Policy, Management and Evaluation, 155 College Street, University of Toronto, Toronto, Ontario, Canada, M5T 3M7. · CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1; Department of Pediatrics, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5. · Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8; Centre for Inflammatory Bowel Disease, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada, M5G 1X5. · Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4K1. · Department of Medicine, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada, N6G 2V4. · Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5. · Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5; Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5; Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, Canada, K1Y 4E9. · Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5; Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5; Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, Canada, K1Y 4E9; Department of Family Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada, K1H 8M5. ·J Clin Epidemiol · Pubmed #24774473.

ABSTRACT: OBJECTIVE: Health administrative databases can be used to track disease incidence, outcomes, and care quality. Case validation is necessary to ensure accurate disease ascertainment using these databases. In this study, we aimed to validate adult-onset inflammatory bowel disease (IBD) identification algorithms. STUDY DESIGN AND SETTING: We used two large cohorts of incident patients from Ontario, Canada to validate algorithms. We linked information extracted from charts to health administrative data and compared the accuracy of various algorithms. In addition, we validated an algorithm to distinguish patients with Crohn's from those with ulcerative colitis and assessed the adequate look-back period to distinguish incident from prevalent cases. RESULTS: Over 5,000 algorithms were tested. The most accurate algorithm to identify patients 18 to 64 years at diagnosis was five physician contacts or hospitalizations within 4 years (sensitivity, 76.8%; specificity, 96.2%; positive predictive value (PPV), 81.4%; negative predictive value (NPV), 95.0%). In patients ≥65 years at diagnosis, adding a pharmacy claim for an IBD-related medication improved accuracy. CONCLUSION: Patients with adult-onset incident IBD can be accurately identified from within health administrative data. The validated algorithms will be applied to administrative data to expand the Ontario Crohn's and Colitis Cohort to all patients with IBD in the province of Ontario.

19 Article Resource utilization during pediatric to adult transfer of care in IBD. 2013

Bollegala, Natasha / Brill, Herbert / Marshall, John K. ·Internal Medicine, McMaster University, Canada. natasha.bollegala@medportal.ca ·J Crohns Colitis · Pubmed #22677118.

ABSTRACT: BACKGROUND: The transition from pediatric to adult care for inflammatory bowel disease (IBD) is poorly understood. AIMS: To characterize this transfer of care, health resource utilization was assessed. METHODS: Patients transferred between 1999 and 2008 were studied. Utilization of health resources one year before transfer and one year after transfer was compared. Resource units assessed included: i) emergency department (ED) visits; ii) hospitalizations; iii) clinic visits; iv) surgical procedures; and v) endoscopies. Secondary outcomes included: i) documentation of patient non-compliance; ii) reason(s) for ED visit; iii) diagnoses most responsible for hospital admission; iv) medications; v) indications for surgery; vi) endoscopic findings; vii) and disease activity. RESULTS: 95 subjects were identified (48 female), of whom 69 had Crohn's disease (CD) and 26 had ulcerative colitis (UC). The average age of diagnosis was 12.9 years. Over their adult care interval, subjects had fewer clinic visits (2.56 versus 3.05 (p = 0.01)) and more documented non-compliance (43% versus 29% (p = 0.01)). No differences in ED visits (0.15 versus 0.18 (p = 0.71)), hospitalizations (0.13 versus 0.13 (p = 0.23)), surgical intervention (0.03 versus 0.05 (p = 0.53)) or endoscopies (0.37 versus 0.25 (p = 0.11)) were observed. IBD was active 66.7% of endoscopies under pediatric care versus only 23.8% under adult care (p = 0.003). The average activity of CD was also higher during the last year of pediatric care. CONCLUSIONS: Understanding the transition process can help to develop strategies needed to support patients and their families.

20 Article Canadian cost-utility analysis of initiation and maintenance treatment with anti-TNF-α drugs for refractory Crohn's disease. 2012

Blackhouse, Gord / Assasi, Nazila / Xie, Feng / Marshall, John / Irvine, E Jan / Gaebel, Kathryn / Campbell, Kaitryn / Hopkins, Rob / O'Reilly, Daria / Tarride, Jean-Eric / Goeree, Ron. ·Programs for Assessment of Technology in Health Research Institute, McMaster University, Hamilton, ON, Canada. blackhou@mcmaster.ca ·J Crohns Colitis · Pubmed #22261531.

ABSTRACT: OBJECTIVES: Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. Symptoms include but are not limited to abdominal pain, nausea, emesis, and diarrhea. Anti-TNF-α drugs are increasingly being used in patients with CD who have inadequate response to conventional therapy. However, these medications are quite expensive. The objective of this study is to evaluate the cost-utility of two anti-TNF-α drugs (infliximab, adalimumab) for refractory CD. METHODS: A Markov model was used to estimate the costs and QALYs of three treatments (usual care, infliximab, adalimumab) over a 5 year time horizon. After initial treatment, patients achieve remission, achieve treatment response or remain in the drug refractory health state. Patients who achieve remission or treatment response are at risk of relapse each 3 month model cycle. Patients in the drug refractory health state either remain in the health state or have surgery in each cycle. Different costs and utility values were assigned to the various model health states. Model input parameters including initial response rates, relapse rates, utility values were derived from published literature. RESULTS: Usual care had both the lowest expected costs ($17,017) and QALYs (2.555), while infliximab had both the highest expected costs ($54,084) and QALYs (2.721). The incremental cost per QALY moving from usual care to adalimumab and from adalimumab to infliximab was estimated to be to be $193,305 and $451,165, respectively. CONCLUSIONS: Based on common willingness to pay thresholds, ant-TNF-α drugs would not be perceived as a cost effective treatment for refractory CD.

21 Minor Bell's palsy in a patient receiving adalimumab for Crohn's disease. 2013

Lu, Lucy Xi / Marshall, John Kenneth. · ·J Crohns Colitis · Pubmed #22868065.

ABSTRACT: -- No abstract --