BACKGROUND: Peptic ulcer rebleeding (PUR) usually occurs within three days following endoscopic hemostasis. However, recent data have increasingly suggested delayed rebleeding.OBJECTIVE: To better characterize the timing of PUR (Forrest Ia to IIb) following initially successful endoscopic hemostasis.METHODS: An exhaustive literature search (1989 to 2013), with cross-referencing, was performed to identify pertinent randomized controlled trial (RCT) arms. Patients receiving high-dose proton pump inhibitor (PPI) infusion following successful modern-day endoscopic hemostasis were included. A sensitivity analysis included any patients receiving PPI doses &#x3e;40 mg daily. The main outcome measure was 30-day rebleeding, while weighted mean averages at t = three, seven, 14 and 28 to 30 days are also reported.RESULTS: Of 756 citations, six RCTs were included (561 patients; 58.5&#x25; to 89.5&#x25; male; 55.3 to 67.5 years of age). Among patients receiving high-dose PPI (five RCTs [393 patients]), 11.5&#x25; (95&#x25; CI 8.4&#x25; to 14.7&#x25;) experienced rebleeding, 55.6&#x25; (95&#x25; CI 41.1&#x25; to 70.1&#x25;) rebled within three days, 20&#x25; (95&#x25; CI 8.3&#x25; to 31.7&#x25;) between four and seven days, 17.8&#x25; (95&#x25; CI 6.6&#x25; to 28.9&#x25;) at eight to 14 days, and 6.7&#x25; (95&#x25; CI 0&#x25; to 14&#x25;) at 15 to 28 to 30 days. Using the relaxed lower PPI dosing threshold, similar respective rates were 14.4&#x25; (95&#x25; CI 11.5&#x25; to 17.3&#x25;) overall, with interval rates of 39.5&#x25; (95&#x25; CI 28.9&#x25; to 50.15&#x25;), 34.6&#x25; (95&#x25; CI 24.2&#x25; to 44.9&#x25;), 19.7&#x25; (95&#x25; CI 11&#x25; to 28.4&#x25;) and 6.2&#x25; (95&#x25; CI 0.95&#x25; to 11.5&#x25;). Qualitative review of patient characteristics, limited by small sample size, possible bias and study heterogeneity, suggested increased patient comorbidity and postendoscopic use of lower PPI dosing may predict delayed rebleeding.CONCLUSION: In patients with high-risk PUR undergoing successful endoscopic hemostasis, most rebled within three days, with many experiencing later rebleeding. Additional research is needed to better predict such an outcome.

Sara El Ouali

Alan N Barkun

Myriam Martel

Davide Maggio

Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

Patient-reported outcome measures (PROMs) are increasingly used in both research and clinical health settings. With the recent development of United States Food and Drug Administration guidance on PROMs, more attention is being devoted to their role and importance in health care. Several methodological challenges in the development, validation and implementation of PROMs must be resolved to ensure their appropriate utilization and interpretation. The present review discusses recent developments and updates in PROMs, with specific focus on the area of inflammatory bowel disease.

Wael El-Matary

Patient-Reported Outcome Measures in Inflammatory Bowel Disease

Subrata Ghosh

Are Patient-Reported Outcome Measures the Way to go in Inflammatory Bowel Disease?

Chronic hepatitis C virus (HCV) infection increases all-cause mortality, rates of cirrhosis, hepatocellular carcinoma, liver transplantation and overall health care utilization. Morbidity and mortality disproportionately affect individuals born between 1945 and 1975. The recent development of well-tolerated and highly effective therapies for chronic HCV infection represents a unique opportunity to dramatically reduce rates of HCV-related complications and their costs. Critical to the introduction of such therapies will be well-designed provincial programming to ensure immediate treatment access to individuals at highest risk for complication, and well-defined strategies to address the global treatment needs of traditionally high-risk and marginalized populations. HCV practitioners in New Brunswick created a provincial strategy that stratifies treatment according to those at highest need, measures clinical impact, and creates evaluation strategies to demonstrate the significant direct and indirect cost savings anticipated with curative treatments.

Daniel J Smyth

Duncan Webster

Lisa Barrett

Mark MacMillan

Lisa McKnight

Frank Schweiger

Transitioning to Highly Effective Therapies for the Treatment of Chronic Hepatitis C Virus Infection: A Policy Statement and Implementation Guideline

BACKGROUND: Perinatal transmission of hepatitis B virus (HBV) can occur despite postexposure prophylaxis (PEP). Recent literature suggests that antiviral treatment during pregnancy when maternal HBV DNA levels are elevated can further decrease vertical transmission. However, HBV DNA screening is not routinely performed antenatally.OBJECTIVE: To determine the rates of HBV prevalence and perinatal transmission in an antenatal cohort.METHODS: A retrospective review of public health records (December 2008 to December 2010) was performed for both mothers and newborns.RESULTS: A total of 725 mother-infant pairs were included. Of these, 574 of 715 (80&#x25;) women had antenatal hepatitis B e antigen (HBeAg) testing performed, and 127 of 574 (22&#x25;) were HBeAg positive (HBeAg+). Of babies born to hepatitis B surface antigen-positive (HBsAg+) mothers, only 573 of 725 (79&#x25;) received complete PEP. In addition, 172 of 725 (24&#x25;) infants did not receive post-PEP blood testing or were lost to follow-up. Of the 552 infants with results available, seven cases (1.3&#x25;) of mother-to-child HBV transmission were observed, six of which involved infants born to HBeAg+ women.CONCLUSIONS: Our findings suggest that routine HBeAg screening could identify a subset of mother-infant pairs among HBsAg+ pregnant women who are at higher risk for vertical HBV transmission. Determination of viral load in expectant HBeAg+ mothers may provide more precise insight into HBV transmission to their infants.

Julie van Schalkwyk

Melica Nourmoussavi

Andrea Massey

Reka Gustafson

Elizabeth Brodkin

Martin Petric

Mel Krajden

Simon Dobson

Jane Buxton

Mark Bigham

Neora Pick

Richard Schreiber

Christopher H Sherlock

Deborah Money

Eric M Yoshida

Missed Opportunities for Prevention of Perinatal Transmission of Hepatitis B: A Retrospective Cohort Study

Maria Jo&#xe3;o Magalh&#xe3;es

Marta Salgado

Isabel Pedroto

Anorectal Melanoma: An Uncommon and Aggressive Disease

Stephen Shafran

Telaprevir Activity is unaffected by the Q80K Polymorphism in Hepatitis C virus Genotype 1a

BACKGROUND: Serum tumour necrosis factor-alpha (TNF-&#x3b1;) levels correlate negatively with hepatitis C virus (HCV) antiviral response.OBJECTIVES: To test the hypothesis that a single infliximab induction dose would positively influence on-treatment virological response and sustained virological response (SVR).METHODS: The present study was a phase IIIB, randomized, prospective, open-label pilot trial conducted at eight Canadian sites. Treatment-naive HCV genotype 1-infected patients 18 to 65 years of age with high serum TNF-&#x3b1; values (&#x3e;300 pg/mL) were randomly assigned to receive a single pretreatment induction infliximab infusion (5 mg/kg) seven days before antiviral therapy (arm A) or no pretreatment (arm B). All patients received pegylated interferon &#x3b1;2b (1.5 &#x3bc;g/kg/week) plus weight-based ribavirin (800 mg/day to 1400 mg/day) for up to 48 weeks.RESULTS: Eighty-five patients (arm A [n=41], arm B [n=44]; 70&#x25; male) received pegylated interferon &#x3b1;2b. The mean age (48.1 years), race (81&#x25; white) and METAVIR fibrosis stage (F0&#x2013;2 = 79&#x25;, F3&#x2013;4 = 21&#x25;) were similar between groups. Infliximab was well tolerated without attributable severe adverse events; 56.5&#x25; completed the study (arm A [n=21], arm B [n=27]). Most discontinuations were due to virological failure at weeks 12 (n=20 [23.5&#x25;]) and 24 (n=7 [8.2&#x25;]) and did not differ according to group. Numerically lower proportions of infliximab recipients achieved rapid virological response (19.5&#x25; versus 36.4&#x25;), complete early virological response (43.9&#x25; versus 59.1&#x25;) and SVR (34.1&#x25; versus 52.3&#x25;). However, between-group differences did not reach statistical significance. No differences in adverse event profile or laboratory measures were noted.CONCLUSION: A single infliximab dose before pegylated-interferon &#x3b1;2b and ribavirin therapy did not result in greater viral decline during the first 12 weeks of HCV therapy or improved SVR.

Curtis Cooper

Susan Greenbloom

Robert Enns

John Farley

Nir Hilzenrat

Kurt Williams

Magdy Elkashab

Nabil Abadir

Manuela Neuman

Single-Dose Infliximab in Hepatitis C Genotype 1 Treatmentnaive Patients with High Serum Levels of Tumour Necrosis Factor-Alpha Does Not Influence the Efficacy of Pegylated Interferon Alpha-2B/Ribavirin Therapy

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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 2014

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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