Pediatric and adult gastroenterologists have identified an important issue to be addressed which entails the process of transition of care for youth affected by chronic gastrointestinal disorders. The adolescent years are a time of change and development, and may be significantly affected by conditions such as Crohn's disease or ulcerative colitis. Health care providers need to advocate and provide comprehensive, developmentally appropriate care for youth and families to facilitate the transition from the pediatric to the adult setting. The present article will review important aspects of the transition from the pediatric to the adult care health system.

Jorge L Pinzon

Kevan Jacobson

John Reiss

Say Goodbye and Say Hello: The Transition from Pediatric to Adult Gastroenterology

Hypophosphatemia has been described in patients undergoing right hepatectomy for liver cancer and in living donors for liver transplantation who also received total parenteral nutrition. At the study centre, significant hypophosphatemia (0.36 mmol/L or less) requiring intravenous replacement was seen in two of the first nine living donors for adult-to-adult liver transplantation. To determine the frequency of hypophosphatemia in living donors, the authors obtained phosphate levels on stored serum samples from postoperative days 0, 1, 3 and 7 in all nine patients, none of whom were on total parenteral nutrition. Within the first week, hypophosphatemia developed in 55.6% of patients and phosphate levels returned to normal by day 7 in all nine patients. One patient had normal phosphate levels during the first week, but had profound hypophosphatemia (0.32 mmol/L) on day 14 when he presented with a Staphylococcus aureus infection of a bile collection and significant hypoxemia. The extent of hepatectomy and the rate of liver regeneration, estimated by baseline and postoperative day 7 volumetric computed tomography scans, did not correlate with the development of hypophosphatemia. In conclusion, hypophosphatemia is common in living donors undergoing right hepatectomy and may be associated with complications. All living donors should be monitored for the development of hypophosphatemia during the first two postoperative weeks.

Kelly W Burak

Charles B Rosen

Jeff L Fidler

Gina K Hesley

David Nagorney

Michael R Charlton

David J Brandhagen

Hypophosphatemia after Right Hepatectomy for Living Donor Liver Transplantation

Several government and nongovernment organizations held a consensus conference on the management of acute and chronic viral hepatitis to update previous management recommendations. The conference became necessary because of the introduction of new forms of therapy for both hepatitis B and hepatitis C. The conference issued recommendations on the investigation and management of chronic hepatitis B, including the use of lamivudine, adefovir and interferon. The treatment of hepatitis B in several special situations was also discussed. There were also recommendations on the investigation and treatment of chronic hepatitis C and hepatitis C-HIV coinfection. In addition, the document makes some recommendations about the provision of services by provincial governments to facilitate the delivery of care to patients with hepatitis virus infection. The present document is meant to be used by practitioners and other health care providers, including public health staff and others not directly involved in patient care.

Morris Sherman

Vincent Bain

Jean-Pierre Villeneuve

Robert P Myers

Curtis Cooper

Steven Martin

Catherine Lowe

The Management of Chronic Viral Hepatitis: A Canadian Consensus Conference 2004

Due to evidence that it reduces the frequency of cardiac  events and stroke, the use of daily low-dose aspirin has dramatically  increased over the past 20 years (1). The use of other  nonsteroidal anti-inflammatory drugs (NSAIDs) for the  relief of pain and inflammation has also increased (2).  Unfortunately, aspirin and conventional NSAIDs such as  diclofenac are notorious for causing significant damage to the  upper gastrointestinal tract because they suppress  prostaglandin (PG) synthesis (3).

Jennifer J Williams

Paul L Beck

There May Be a Way to Say 'NO' to Gastric Injury Associated with the Combined Use of Aspirin and Cyclooxygenase-2 Inhibitors

The Clinical Affairs portfolio reflects the most direct interests  of the majority of the membership and focuses on  issues related to patient care. It encompasses the Endoscopy,  Hepatobiliary/Transplant, Liaison, Pediatric, Practice Affairs  and Regional Representation Committees. The portfolio is  overseen by Dr Alan Barkun, Chair of Clinical Affairs. Its  committees have been very busy spearheading a number of  initiatives over the past six months, while contributing to a  number of projects undertaken by other committees of the  Canadian Association of Gastroenterology (CAG).

Alan Barkun

An Update from the Clinical Affairs Portfolio

There is controversy among pathologists when assessing the presence or absence of liver cell dysplasia in liver biopsies taken from cirrhotic patients. The objective of the present study was to determine the DNA ploidy pattern of hepatocytes of patients with liver cirrhosis and its relationship to liver cell dysplasia. A total of 48 male patients diagnosed with liver cirrhosis based on clinical, laboratory and histopathological criteria were included in the study. A liver biopsy was taken from each patient; one part of the biopsy was subjected to histopathology, and the other to flow cytometry. The histopathological examination revealed liver cell dysplasia in 60% of patients with liver cirrhosis (62% of them had large cell dysplasia [LCD] and 38% had small cell dysplasia [SCD]). Abnormal DNA content (aneuploidy) was found in 81.5% of positive liver cell dysplasia specimens and found only in 11.1% of negative liver cell dysplasia specimens, with a statistically significant difference (P&#x3c;0.001). Aneuploidy was found more commonly in LCD but without significant difference (P&#x3e;0.05) in comparison with SCD. In conclusion, SCD (similar to LCD) is also associated with aneuploidy and elevated DNA index, and may carry the same risk for progression to hepatocellular carcinoma.

Sayed S El-Sayed

Mohamed El-Sadany

Ashraf A Tabll

Ahmad Soltan

Ibrahim El-Dosoky

Abdelfattah M Attallah

DNA Ploidy and Liver Cell Dysplasia in Liver Biopsies from Patients with Liver Cirrhosis

OBJECTIVE: Pancreatic cancer is known to aggregate in some families and has been associated with a wide variety of cancer syndromes. The authors describe their experience with pancreatic cancer and the range of associated cancer syndromes. METHODS: The charts of all patients seen for concern of a hereditary cancer syndrome in the Cancer Genetics Clinic at the University of Alberta between 1995 and 2002 were reviewed. RESULTS: Forty families reported a personal or family history of pancreatic cancer in the context of a possible hereditary cancer syndrome. Three additional families reported a history of pancreatitis. Twenty-four (56%) of those families were suspected of having a hereditary breast and ovarian cancer syndrome. A further seven (16%) were suspected of having hereditary nonpolyposis colon cancer. Only three (7%) were believed to be at risk for a site-specific pancreatic cancer syndrome. Another three (7%) were suspicious for hereditary pancreatitis. The remaining family histories were suggestive of Li-Fraumeni syndrome, von Hippel-Lindau syndrome or a nonspecific cancer predisposition. CONCLUSIONS: With such a wide variety of hereditary cancer syndromes associated with pancreatic cancer, an accurate assessment of the family history is essential to determine the most appropriate cancer screening for at-risk family members and to guide any molecular testing that may be offered.

Margaret Lilley

Dawna Gilchrist

The Hereditary Spectrum of Pancreatic Cancer: The Edmonton Experience

About this journal

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 2004

Canadian Journal of Gastroenterology and Hepatology | Hindawi

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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