Charles N Bernstein

University of Manitoba, Winnipeg, Manitoba, Canada

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Publications (372)3243.59 Total impact

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    ABSTRACT: Mode of birth affects development of the intestinal microbiota, and microbial dysbiosis has been associated with inflammatory bowel diseases (IBD). We performed a population-based analysis to determine if mode of delivery (Cesarean section vs vaginal delivery) affects risk of IBD. We collected data from the University of Manitoba IBD Epidemiology Database, which contains records on all Manitobans diagnosed with IBD from 1984 through 2010. Starting in 1970, 6-digit family health registration numbers were used in Manitoba to link mothers with their offspring. Maternal health records, including dates and modes of delivery and siblings of individuals with IBD, were identified. We obtained data on 1671 individuals with IBD and 10488 controls (individuals without IBD, matched by age, sex, and area of residence at IBD diagnosis) linked to mothers' obstetrical records. Higher proportions of urban than rural residents were delivered by Cesarean section deliver for IBD cases (12.8% vs 9.7%, P=.05) and controls (13.3% vs 9.4%, P<.0001). A higher percentage of men with Crohn's disease than women with Crohn's disease were born via Cesarean section (13.5% vs 8.4%, P=.01). Overall, there was no difference in the percentage of IBD cases born by Cesarean section (11.6%) vs controls (11.7%, P=.93). In multivariate analysis, birth by Cesarean section was not associated with an increased risk of subsequent IBD, controlling for age, sex, urban residence, and income (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.89-1.23). Persons with IBD were no more likely to have been born by Cesarean section than their siblings without IBD (1740 siblings from 1615 families) (11.6% vs 11.3%; OR, 1.14; 95% CI, 0.72-1.80; P=.79). People with IBD were not more likely to have been born via Cesarean section than controls or siblings without IBD. These findings indicate that events of the immediate post-partum period that shape the developing intestinal microbiome do not affect risk for IBD. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 08/2015; DOI:10.1016/j.cgh.2015.08.005 · 7.90 Impact Factor
  • Peter Stepaniuk · Charles N Bernstein · Laura E Targownik · Harminder Singh
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    ABSTRACT: The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients. Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, increasing age at diagnosis has been associated with a lower likelihood of having any of a family history of IBD, perianal disease in CD and extraintestinal manifestations. Although response to drug therapies appears to be similar in elderly patients and younger individuals, the elderly are more likely to receive 5-aminosalicylic acid agents, and less likely to receive immunomodulators and biologics. Corticosteroid use in the elderly is comparable with use in younger individuals. The rates of surgical intervention appear to be lower for elderly CD patients but not elderly UC patients. Elderly individuals with UC are more likely to need urgent colectomy, which is associated with an increased mortality rate. Elective surgery is associated with similar outcomes among the elderly and young patients with IBD. Therefore, the use of immunomodulators and biologics, and earlier consideration of elective surgery for medically refractory disease in elderly patients with IBD, should be emphasized and further evaluated to prevent complications of chronic corticosteroid(s) use and to prevent emergency surgery.
    06/2015; 29(6).
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    ABSTRACT: The incidence of intensive care unit (ICU) admission is elevated in the multiple sclerosis (MS) population but the reasons for this are incompletely understood, as are outcomes post-ICU admission. Among MS patients we examined the association between ICU admission and health care utilization in the year preceding admission, and compared health care utilization following ICU admission among persons with MS and persons from the general population. We used population-based administrative data from Manitoba, Canada to identify 4237 MS cases of which 2547 were incident. We compared the incidence rates of ICU admission in the prevalent MS population according to health care utilization in the year before admission, adjusting for age, sex, comorbidity and socioeconomic status. Among incident cases of MS we compared rates of health care utilization after ICU admission to those in a matched general population cohort. We used generalized linear models adjusting for age, sex, socioeconomic status, region, comorbidity and utilization before admission. Of 4219 prevalent MS cases, 222 (5.3%) were admitted to the ICU. After adjustment, any hospitalization in the prior year conferred an 80% increased incidence, and physician visits in the highest tertile and prescription costs in the highest quartile in the prior year each conferred a more than two-fold increased incidence of admission. Among 2547 incident cases of MS, 109 (4.3%) were admitted to the ICU and 93 survived their admission. Thirty-eight percent of the MS population were re-hospitalized in the year following admission, similar to the matched population (33.8%). Seven percent of both populations were readmitted to the ICU. The MS population had more hospital days after ICU admission than the matched population (adjusted RR 3.11; 95% CI: 1.34-5.90). After adjustment the number of physician visits did not differ between populations. The incidence of ICU admission is higher among persons with MS who have higher prior health care utilization. Health care utilization remains high after ICU admission. Efforts to prevent ICU admission in this population are needed. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
    Multiple Sclerosis and Related Disorders 05/2015; 46(4). DOI:10.1016/j.msard.2015.05.010 · 0.88 Impact Factor
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    ABSTRACT: Although immune responses directed against antigens from the intestinal microbiota are observed in certain diseases, the normal human adaptive immune response to intestinal microbiota is poorly defined. Our goal was to assess the adaptive immune response to the intestinal microbiota present in 143 healthy adults and compare this response with the response observed in 52 children and their mothers at risk of having allergic disease. Human serum was collected from adults and children followed from birth to 7 years of age, and the serum IgG response to a panel of intestinal microbiota antigens was assessed by using a novel protein microarray. Nearly every subject tested, regardless of health status, had serum IgG that recognized a common set of antigens. Seroreactivity to the panel of antigens was significantly lower in atopic adults. Healthy infants expressed the highest level of IgG seroreactivity to intestinal microbiota antigens. This adaptive response developed between 6 and 12 months of age and peaked around 2 years of age. Low IgG responses to certain clusters of microbiota antigens during infancy were associated with allergy development during childhood. There is an observed perturbation of the adaptive response to antigens from the microbiota in allergic subjects. These perturbations are observable even in childhood, suggesting that optimal stimulation of the adaptive immune system by the microbiota might be needed to prevent certain immune-mediated diseases. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    The Journal of allergy and clinical immunology 05/2015; DOI:10.1016/j.jaci.2015.03.036 · 11.48 Impact Factor
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    Digestive Disease Week, Washington, DC; 05/2015
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    ABSTRACT: To evaluate patterns and predictors of long-term nonuse of inflammatory bowel disease (IBD)-specific medications among patients with IBD. All incident cases of IBD diagnosed between 1987 and 2012 were identified from the population-based University of Manitoba IBD Epidemiology Database. Point prevalence of long-term medication nonuse (defined as no receipt of IBD-specific medications for a year or longer) was determined over calendar time and the course of disease. Cox proportional hazard regression analysis was performed to identify factors associated with delayed initiation and with becoming a long-term nonuser. Among 6451 persons with IBD followed since 1987 (46.8% male, 47.8% with Crohn's disease), 11.7% were not dispensed an IBD-specific medication within the first year and 6.2% within 5 years after diagnosis. Factors associated with delayed initiation included having Crohn's disease (hazard ratio [HR] = 0.78, 95% confidence interval [CI], 0.73-0.83), lower socioeconomic status (HR = 0.91, 95% CI, 0.84-0.98), age more than 65 years (HR = 0.76, 95% CI, 0.67-0.86), and having any medical comorbidity. The prevalence of long-term nonuse consistently remained between 40% and 50% of persons with IBD across the study years. Patients with Crohn's disease (HR = 1.14, 95% CI, 1.04-1.25), lower socioeconomic status (HR = 1.14, 95% CI, 1.02-1.27), patients with IBD-associated surgery (HR = 1.72, 95% CI, 1.51-1.96), or delayed initiation of first IBD medication were more likely to become long-term nonusers after initiation. At any given time, roughly half of all patients with IBD have not used IBD-specific medications in the previous year. Further work is required to evaluate the clinical implications of long-term medication nonuse in IBD.
    Inflammatory Bowel Diseases 05/2015; 21(7). DOI:10.1097/MIB.0000000000000418 · 4.46 Impact Factor
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    Nancy E Mayo · Susan C Scott · Charles N Bernstein · Lisa M Lix
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    ABSTRACT: As individuals experience changes in their health, they may alter the way they evaluate health and quality of life. The purpose of this study is to estimate the extent to which individuals with IBD change their rating of health over time because of response shift (RS). This is a reanalysis of a population-based longitudinal study of IBD in Manitoba, Canada (n = 388). RS was examined using trajectories of the difference between observed and predicted health. Logistic regression and dual trajectories were used to identify predictors of RS. Disease activity, vitality, pain, somatization, and physical and social function explained 51% of the variation in general health over two years with no evidence of RS in 82% of the sample. Negative RS was found for 8%, who initially rated health better than predicted; positive RS was found for 6%. The positive RS group was younger and had better baseline scores on measures of general health, hostility, pain, mental health and social and role function; less pain and better social function scores at baseline were predictors of negative RS. In conclusion, the majority of people with IBD did not demonstrate a RS indicating that the health rating over time was stable in relation to that predicted by known time varying clinical variables. This adds to the evidence that the single question on self-rated health is useful for monitoring individuals over time.
    Health and Quality of Life Outcomes 05/2015; 13(1):52. DOI:10.1186/s12955-015-0232-6 · 2.12 Impact Factor
  • Dana C. Moffatt · B.Nancy Yu · Aruni Tennakoon · Charles N. Bernstein
    Gastrointestinal Endoscopy 05/2015; 81(5):AB354. DOI:10.1016/j.gie.2015.03.581 · 5.37 Impact Factor
  • Dana C. Moffatt · B. Nancy Yu · Aruni Tennakoon · Charles N. Bernstein
    Gastrointestinal Endoscopy 05/2015; 81(5):AB357-AB358. DOI:10.1016/j.gie.2015.03.589 · 5.37 Impact Factor
  • Peter Stepaniuk · Charles N Bernstein · Zoann Nugent · Harminder Singh
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    ABSTRACT: Objective: To determine differences in phenotype and treatment among hospitalized elderly and young patients with inflammatory bowel disease (IBD), and the utility of International Classification of Diseases, 10th Revision (ICD)-10 codes in hospital discharge abstracts in diagnosing IBD in elderly patients. Methods: A large Canadian health region hospitalization discharge database was used to identify elderly (>65 years of age) and young (19 to 50 years of age) patients with IBD admitted between April 1, 2007 and March 31, 2012, and a random sample of elderly patients with other colonic conditions. Medical records were reviewed to confirm IBD diagnosis and extract clinical information. The characteristics of elderly versus young hospitalized IBD patients and accuracy of ICD-10 IBD discharge codes in the elderly were assessed. Results: One hundred forty-three elderly and 82 young patients with an IBD discharge diagnosis, and 135 elderly patients with other gastrointestinal discharge diagnoses were included. Elderly IBD patients were less likely to have ileocolonic Crohn disease (21.4% versus 50.9%; P=0.001), more likely to be prescribed 5-aminosalicylates (61% versus 43%; P=0.04), and less likely to be prescribed biologics (6% versus 21%; P=0.016) or immunomodulators (21% versus 42%; P=0.01). The sensitivity, specificity and positive predictive value of a single ICD code for CD were 98%, 96% and 94%, respectively, and for ulcerative colitis (UC) were 98%, 92% and 70%, respectively. Conclusions: Treatment approaches in elderly patients were different than in younger IBD patients despite having disease sufficiently severe to require hospitalization. While less accurate in UC, a single ICD-10 IBD code was sufficient to identify elderly CD and UC hospitalized patients.
    04/2015; 148(4). DOI:10.1016/S0016-5085(15)31586-9
  • Charles N Bernstein
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 04/2015; 13(8). DOI:10.1016/j.cgh.2015.04.003 · 7.90 Impact Factor
  • Harminder Singh · Charles N Bernstein · Jewel N Samadder · Rashid Ahmed
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    ABSTRACT: Introduction: Implementation of population-based colorectal cancer (CRC) screening programs should reduce disparities in participation in CRC screening. We estimated CRC screening rates in 2012 in Canada and assessed predictors of screening in provinces with and without well-established population-based screening programs. Methods: We used data from the Canadian Community Health Survey for 2012 to calculate the prevalence of up-to-date CRC screening, defined as fecal occult blood testing (FOBT) within 2 years before the survey or flexible sigmoidoscopy or colonoscopy within 10 years before the survey, or both. Weighted proportions of individuals with up-to-date screening were calculated and logistic regression analysis performed to assess predictors of up-to-date CRC screening, including differences in participation by income level. Results: The prevalence of up-to-date CRC screening among people 50-74 years of age in 2012 was 55.2%, ranging from 41.3% in the territories to 67.2% in the province of Manitoba. The rate for sigmoidoscopy or colonoscopy was 37.2% (highest in Ontario, at 43.3%), and for FOBT it was 30.1% (highest in Manitoba, at 51.7%). About 41% of those who had an FOBT also had a sigmoidoscopy or colonoscopy. Individuals in the highest income group were more likely than those in lower-income groups to be up to date with CRC screening, even in provinces with well-established population-based screening programs. Interpretation: More than half of Canadians were up to date with CRC screening in 2012, but there were large differences among provinces. Differences by income group in provinces with population-based screening programs need particular attention.
    04/2015; 3(2):E149-E157. DOI:10.9778/cmajo.20140073
  • Harminder Singh · Zoann Nugent · Lisa Lix · Laura Targownik · Charles N. Bernstein
    Gastroenterology 04/2015; 148(4):S-464-S-465. DOI:10.1016/S0016-5085(15)31566-3 · 16.72 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-24. DOI:10.1016/S0016-5085(15)30082-2 · 16.72 Impact Factor
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    ABSTRACT: To determine predictors of intensive care unit (ICU) admission and to assess health care utilization (HCU) post-ICU admission among persons with inflammatory bowel disease (IBD). We matched a population-based database of Manitobans with IBD to a general population cohort on age, sex, and region of residence and linked these cohorts to a population-based ICU database. We compared the incidence rates of ICU admission among prevalent IBD cases according to HCU in the year before admission using generalized linear models adjusting for age, sex, socioeconomic status, region, and comorbidity. Among incident cases of IBD who survived their first ICU admission, we compared HCU with matched controls who survived ICU admission. Risk factors for ICU admission from the year before admission included cumulative corticosteroid use (incidence rate ratio, 1.006 per 100 mg of prednisone; 95% confidence interval, 1.004-1.008) and IBD-related surgery (incidence rate ratio, 2.79; 95% confidence interval, 1.99-3.92). Use of immunomodulatory therapies within 1 year, or surgery for IBD beyond 1 year prior, were not associated with ICU admission. In those who used corticosteroids and immunomodulatory medications in the year before ICU admission, the use of immunomodulatory medications conferred a 30% risk reduction in ICU admission (incidence rate ratio, 0.70; 95% confidence interval, 0.50-0.97). Persons with IBD who survived ICU admission had higher HCU in the year following ICU discharge than controls. Corticosteroid use and surgery within the year are associated with ICU admission in IBD while immunomodulatory therapy is not. Surviving ICU admission is associated with high HCU in the year post-ICU discharge.
    Inflammatory Bowel Diseases 04/2015; 21(6). DOI:10.1097/MIB.0000000000000363 · 4.46 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-465. DOI:10.1016/S0016-5085(15)31568-7 · 16.72 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-467-S-468. DOI:10.1016/S0016-5085(15)31575-4 · 16.72 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-688-S-689. DOI:10.1016/S0016-5085(15)32329-5 · 16.72 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-480-S-481. DOI:10.1016/S0016-5085(15)31615-2 · 16.72 Impact Factor

Publication Stats

15k Citations
3,243.59 Total Impact Points


  • 1996–2015
    • University of Manitoba
      • Department of Internal Medicine
      Winnipeg, Manitoba, Canada
  • 2011
    • Hôpital St-Boniface Hospital
      Winnipeg, Manitoba, Canada
  • 2009
    • University College Cork
      • School of Medicine
      Cork, M, Ireland
  • 2007
    • Johns Hopkins University
      • Department of Medicine
      Baltimore, Maryland, United States
    • Government of Manitoba, Canada
      Winnipeg, Manitoba, Canada
  • 2002–2003
    • The University of Winnipeg
      Winnipeg, Manitoba, Canada
  • 2001
    • Emory University
      Atlanta, Georgia, United States
  • 1994–1995
    • University of California, Los Angeles
      • Department of Medicine
      Los Angeles, CA, United States