Desmond Leddin

Royal College Grants MOC Accreditor Status to the CAG

An important goal for the surgeon after performing proctocolectomy  for ulcerative colitis is the preservation of continence,  with the formation of a pelvic ileal pouch. In most  patients who have required this procedure, clinical results  have been satisfactory. In recent years, it has become appreciated  that many patients with a satisfactory surgical result  are still at risk for pouchitis and pouch neoplasia. This is not  surprising because creation of a pouch leads to an environment  characterized by stasis, with associated mucosal adaptive  changes. In some patients, the ileal mucosa in the pouch  may assume the appearance of colonic mucosa.

Hugh J Freeman

Dysplasia Risk in Ileal Pouches after Reconstructive Surgery for Ulcerative Colitis

Osteonecrosis is a feared complication of corticosteroid use. However, a direct association between corticosteroid use and osteonecrosis has never been proven. The present report examines the case of a patient with longstanding Crohn's disease who had never been treated with corticosteroids and who developed osteonecrosis of the talus. The association of systemic inflammatory disorders with osteonecrosis and the possible association with vascular thrombosis are discussed.

Ali Khan

Gerald Illiffe

Donald S Houston

Charles N Bernstein

Osteonecrosis in a Patient with Crohn's Disease Unrelated to Corticosteroid Use

The familial occurrence of lymphocytic colitis in a female parent and her two female children is reported. No other genetically based disorder, including celiac disease, was evident. For both children, the age of diagnosis was more than two decades younger than the age of recognition of disease in the parent, and some clinical features, including the requirement for pharmacological agents in both children, suggested that their disease severity was more significant than that of the involved parent. These characteristics of a familial disease have been previously reported and labelled 'genetic anticipation' in some monogenetic forms of neurological disease, as well as in other types of inflammatory bowel diseases, including Crohn's disease. Alternatively, a common cohort effect related to a pathological environmental factor may have played a role in the pathogenesis of this disorder.

Familial Occurrence of Lymphocytic Colitis

Fistulas are common in patients with Crohn's disease and, when associated with inflammatory disease and established for several weeks, tend to be chronic. Perianal fistulas are the most frequent complication of, and are most often associated with, colonic disease. Perianal fistulas commonly require surgical resection and permanent ileostomy. Antibiotics, cyclosporine, methotrexate and thalidomide have been used in uncontrolled trials; only azathioprine, 6-mercaptopurine and infliximab have been assessed in double-blind, placebo controlled studies. Relapse of the fistula occurs with all drugs, unless treatment is continued long term. Each drug differs in its onset of action and long term tolerability. An approach to fistulizing disease in Crohn's disease is suggested.

Pierre Par&#xe9;

Management of Fistulas in Patients with Crohn'S Disease: Antibiotic to Antibody

Iron-deficiency anemia is a common reason for referral to a gastroenterologist. In adult men and postmenopausal women, gastrointestinal tract pathology is often the cause of iron-deficiency anemia, so patients are frequently referred for endoscopic evaluation. Endoscopy may be costly and at times difficult for the patient. Therefore, physicians need to know what lesions can be identified reliably and, more importantly, the importance of ruling out life-threatening conditions such as occult malignancy. Over the past decade, a number of prospective studies have been completed that examined the yield of endoscopy in the investigation of iron-deficiency anemia. The present article provides a broad overview of iron-deficiency anemia, with particular emphasis on hematological diagnosis, etiology, the use of endoscopy in identifying lesions and iron-repletion therapy. Other clinical scenarios, including assessment of patients on anti-inflammatory or anticoagulation therapy and patients with bleeding of obscure origin, are also addressed. The present article provides a diagnostic algorithm to iron-deficiency anemia, which describes a more systematic manner in which to approach iron-deficiency anemia.

Imran Rasul

Gabor P Kandel

An Approach to Iron-Deficiency Anemia

The widespread recognition of the success of liver transplantation as a treatment for most types of acute and chronic liver failure has led to increased referrals for transplantation in the setting of a relatively fixed supply of cadaver donor organs. These events have led to a marked lengthening of the waiting time for liver transplantation, resulting in increased deaths of those on the waiting list and sicker patients undergoing transplantation. Nearly 5000 liver transplantations were performed in the United States in 2000, while the waiting list grew to over 17,000 patients. The mounting disparity between the number of liver transplant candidates and the limited supply of donor organs has led to reassessment of the selection and listing criteria for liver transplantation, as well as revision of organ allocation and distribution policies for cadaver livers. The development of minimal listing criteria for patients with chronic liver disease based on a specific definition for decompensation of cirrhosis has facilitated the more uniform listing of patients at individual centres across the United States. The United Network for Organ Sharing, under pressure from transplant professionals, patient advocacy groups and the federal government, has continuously revised allocation and distribution policies based on the ethical principles of justice for the individual patient versus optimal utility of the limited organ supply available annually. Beginning in 2002, it is likely that the Model for End-stage Liver Disease (MELD) score will be implemented to determine disease severity and direct donor organs to the sickest patients rather than to those with the longest waiting times.

Andy S Yu

Aijaz Ahmed

Emmet B Keeffe

Liver Transplantation: Evolving Patient Selection Criteria

An international working party at the World Congress of   Gastroenterology held in Vienna, Austria from September   6 to 11, 1998 defined a classification for Crohn's disease   based on patient age at diagnosis (eg, less than 40   years of age, 40 years of age or older), disease location   (eg, terminal ileum, colon, ileocolon or upper gastrointestinal   tract) and behaviour (eg, stricturing, penetrating).   Disease location in the upper gastrointestinal tract   was defined by disease being present proximal to the   terminal ileum, regardless of terminal ileal or colon   involvement. A 20-year, single clinician database of   877 patients from a university campus hospital was used,   and comprised 492 women (56.1&#x25;) and 385 men (43.9&#x25;).   Of these patients, 740 (84.4&#x25;) were diagnosed before   age 40 years and 137 (15.6&#x25;) were diagnosed by 40 years   of age or older. Disease was located in the terminal   ileum alone in 222 patients (25.3&#x25;), colon alone in   238 patients (27.2&#x25;) and ileocolon in 304 patients (34.6&#x25;).   Another 113 patients (13.1&#x25;) had disease in the upper   gastrointestinal tract, usually with disease also in   the terminal ileum (23 patients), colon (12 patients)   or ileocolon (71 patients). Only seven of 877 patients   had disease located in the upper gastrointestinal tract   alone with no distal disease. Disease behaviour could   be classified as nonstricturing and nonpenetrating in   256 patients (29.2&#x25;), stricturing in 294 patients (33.6&#x25;)   and penetrating in 327 patients (37.2&#x25;). Of the 877   patients with Crohn's disease, 837 were white, 38 were   Asian and two were black. In this tertiary care setting   of a single clinician practice in a Canadian teaching   hospital at the University of British Columbia, Crohn's   disease predominantly affects women, and young adults   with a high rate of stricturing and penetrating complications.

Hugh James Freeman

Application of the Vienna Classificaton for Crohn's Disease to a Single Clinician Database of 877 Patients

Honorarium: fee, especially for professional services normally rendered without payment (Oxford English Dictionary) One of the main activities of the Canadian Association of Gastroenterology (CAG) is the organizing of professional education events, and the largest of these events is Canadian Digestive Diseases Week (CDDW). The CDDW is organized by members of the CAG for members of the CAG. The funds needed to run this meeting are generated from a number of sources - membership dues, sponsorship from pharmaceutical companies, sale of exhibit space, etc. These funds are used to pay for the convention facilities, for the audiovisual services, for the coffee breaks and lunches, and for the cost of bringing to our meetings the many experts who are on the program.

John L Wallace

A Question of Honor(aria)

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Canadian Journal of Gastroenterology and Hepatology publishes studies of areas related to medical, surgical, pathological, biochemical and physiological aspects of gastroenterology and hepatology.

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Canadian Journal of Gastroenterology and Hepatology - Table of contents 2001

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Canadian Journal of Gastroenterology and Hepatology publishes studies of areas related to medical, surgical, pathological, biochemical and physiological aspects of gastroenterology and hepatology.

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Canadian Journal of Gastroenterology and Hepatology

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Canadian Journal of Gastroenterology and Hepatology