Brian Bressler

University of British Columbia - Vancouver, Vancouver, British Columbia, Canada

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Publications (91)721.3 Total impact

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    ABSTRACT: Conventional management of Crohn's disease features incremental use of therapies. However, early combined immunosuppression (ECI), with a TNF antagonist and antimetabolite might be a more effective strategy. We compared the efficacy of ECI with that of conventional management for treatment of Crohn's disease. In this open-label cluster randomised controlled trial (Randomised Evaluation of an Algorithm for Crohn's Treatment, REACT), we included community gastroenterology practices from Belgium and Canada that were willing to be assigned to either of the study groups, participate in all aspects of the study, and provide data on up to 60 patients with Crohn's disease. These practices were randomly assigned (1:1) to either ECI or conventional management. The computer-generated randomisation was minimised by country and practice size. Up to 60 consecutive adult patients were assessed within practices. Patients who were aged 18 years or older; documented to have Crohn's disease; able to speak or understand English, French, or Dutch; able to access a telephone; and able to provide written informed consent were followed up for 2 years. The primary outcome was the proportion of patients in corticosteroid-free remission (Harvey-Bradshaw Index score ≤4) at 12 months at the practice level. This trial is registered with, number NCT01030809. This study took place between March 15, 2010, and Oct 1, 2013. Of the 60 practices screened, 41 were randomly assigned to either ECI (n=22) or conventional management (n=19). Two practices (one in each group) discontinued because of insufficient resources. 921 (85%) of the 1084 patients at ECI practices and 806 (90%) of 898 patients at conventional management practices completed 12 months follow-up and were included in an intention-to-treat analysis. The 12 month practice-level remission rates were similar at ECI and conventional management practices (66·0% [SD 14·0] and 61·9% [16·9]; adjusted difference 2·5%, 95% CI -5·2% to 10·2%, p=0·5169). The 24 month patient-level composite rate of major adverse outcomes defined as occurrence of surgery, hospital admission, or serious disease-related complications was lower at ECI practices than at conventional management practices (27·7% and 35·1%, absolute difference [AD] 7·3%, hazard ratio [HR]: 0·73, 95% CI 0·62 to 0·86, p=0·0003). There were no differences in serious drug-related adverse events. Although ECI was not more effective than conventional management for controlling Crohn's disease symptoms, the risk of major adverse outcomes was lower. The latter finding should be considered hypothesis-generating for future trials. ECI was not associated with an increased risk of serious drug-related adverse events or mortality. AbbVie Pharmaceuticals. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet 09/2015; DOI:10.1016/S0140-6736(15)00068-9 · 45.22 Impact Factor
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    ABSTRACT: Background: Objective monitoring of the severity of inflammation in patients with inflammatory bowel disease (IBD) is an essential part of disease management. However, repeat endoscopy to define extent and severity of inflammation is not practical. Fecal calprotectin (FC) is a biomarker that can be used as a surrogate test to distinguish inflammatory from noninflammatory gastrointestinal disease. Methods: A targeted search of the literature regarding FC, focusing primarily on the past three years, was conducted to develop practical clinical guidance on the current utility of FC in the routine management of IBD patients. Results : It is recommended that samples for FC testing be obtained from the first bowel excretion of the day. FC testing should be used as standard of care to accurately confirm inflammation and 'real-time' disease activity when a clinician suspects an IBD flare. Although FC is a reliable marker of inflammation, its role in routine monitoring in improving long-term outcomes has not yet been fully assessed. Based on available evidence, the authors suggest the following cut-off values and management strategies: when FC levels are 50 g/g to 100 g/g, quiescent disease is likely and therapy should be continued; when FC levels are 100 g/g to 250 g/g, inflammation is possible and further testing (eg, colonoscopy) is required to confirm inflammation; and when FC levels are 250 g/g, active inflammation is likely and strategies to control inflammation should be initiated (eg, optimizing current therapies or switching to an alternative therapy). Discussion: FC is a useful biomarker to accurately assess the degree of inflammation and should be incorporated into the management of patients with IBD.
    06/2015; 29(7).
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    ABSTRACT: We investigated the mechanism of action, safety, and efficacy of the Site-Specific Immunomodulator (SSI) QBECO, a novel immunotherapy for Crohn’s disease (CD). Using human monocytic THP-1 cells, we demonstrate that SSI QBECO (derived from the common colon bacteria E. coli) activates macrophages to an M1 phenotype (associated with enhanced capacity to eliminate bacteria and activate innate immune responses). We assessed SSI QBECO in a compassionate use protocol of ten adult patients with active CD. Patients with moderate to severe clinical symptoms receiving conventional CD treatments and/or complementary therapies were included, except patients receiving anti-TNF medications. SSI QBECO was self-administered subcutaneously every second day, for a minimum of 2.5 months and a maximum of 11 months. All 10 patients reported improvement of symptoms while on the SSI QBECO treatment. Seven patients reported full resolution of clinical symptoms during a course of SSI QBECO of at least three months. Three patients have experienced ongoing sustained clinical remission after discontinuing all medications, including SSI treatment. The longest case of clinical remission is still ongoing (>4 years). No serious severe adverse clinical events were reported. Collectively, we conclude that treatment with the immunoactive SSI QBECO was well tolerated and effective for treatment of Crohn’s disease in this case series.
    Gastroenterology Research and Practice 06/2015; 2015:1-7. DOI:10.1155/2015/231243 · 1.75 Impact Factor
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    ABSTRACT: Computed tomography (CT) scans are commonly used to diagnose acute diverticulitis, but there are overlapping features between diverticulitis and colorectal cancer (CRC) on imaging studies. Hence, colonoscopy is typically recommended after an episode of acute diverticulitis to rule out underlying malignancy. Currently, 64-slice multidetector CT scanners are capable of providing higher-resolution images and may be able to distinguish malignancy from diverticular inflammation. We aimed to determine the prevalence of CRC among patients with CT-diagnosed acute diverticulitis. We performed a retrospective study of patients with acute diverticulitis diagnosed on CT scan between December 2005 and December 2010 at St. Paul's Hospital, Vancouver, BC. Nonresidents were excluded. We reviewed CT scan reports that included the term "diverticulitis," reports of follow-up colonic evaluation within 1 year of diagnosis and pathology results. We queried the provincial cancer registry to ensure no cases of CRC were missed. A total of 293 patients had acute diverticulitis diagnosed on CT scan, but 8 were nonresidents and were excluded. Of the 285 included in the analysis, the mean age was 59.4 ± 15.1 years, and 167 (58.6%) were men. Among the 114 patients who underwent follow-up evaluation, malignancy was diagnosed in 4 (3.5%). The overall prevalence of malignancy among patients with CT-diagnosed diverticulitis was 1.4%. Routine endoscopic evaluation after an episode of diverticulitis diagnosed with high-resolution CT scan does not appear to be necessary. Selective approach in patients with protracted clinical course or those with mass lesion/obstruction on CT scan may be of benefit.
    Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):014514-14514. DOI:10.1503/cjs.014514 · 1.51 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB221. DOI:10.1016/j.gie.2015.03.1288 · 5.37 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB319. DOI:10.1016/j.gie.2015.03.496 · 5.37 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB317. DOI:10.1016/j.gie.2015.03.491 · 5.37 Impact Factor

  • Gastroenterology 04/2015; 148(4):S-271-S-272. DOI:10.1016/S0016-5085(15)30896-9 · 16.72 Impact Factor

  • Gastroenterology 04/2015; 148(4):S-73-S-74. DOI:10.1016/S0016-5085(15)30255-9 · 16.72 Impact Factor

  • Gastroenterology 04/2015; 148(4):S-627. DOI:10.1016/S0016-5085(15)32115-6 · 16.72 Impact Factor
  • Brian Bressler ·

    Annals of internal medicine 03/2015; 162(6):JC12. DOI:10.7326/ACPJC-2015-162-6-012 · 17.81 Impact Factor
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    ABSTRACT: The medical management of ulcerative colitis (UC) has improved through the development of new therapies and novel approaches that optimize existing drugs. Previous Canadian consensus guidelines addressed the management of severe UC in the hospitalized patient. We now present consensus guidelines for the treatment of ambulatory patients with mild-to-severe active UC. A systematic literature search identified studies on the management of UC. 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 specialists. The participants concluded that the goal of therapy is complete remission defined as both symptomatic and endoscopic remission without corticosteroids. The consensus includes 34 statements focused on five main drug classes, 5-aminosalicylate (ASA), corticosteroids, immunosuppressants, anti-tumor necrosis factor-alpha (TNF) therapies, and other therapies. Oral and rectal 5-ASAs are recommended first-line therapy for mild-to-moderate UC, with corticosteroid therapy for those who fail to achieve remission. Patients with moderate-to-severe UC, should undergo a course of oral corticosteroids, with transition to 5-ASA, thiopurines, anti-TNF therapy (with or without thiopurines or methotrexate), or vedolizumab maintenance therapy in those who successfully achieve symptomatic remission. For patients with corticosteroid-resistant/dependent UC, anti-TNF therapies or vedolizumab are recommended. Timely assessments of response and remission are critical to ensuring optimal outcomes. Optimal management of UC requires careful patient assessment, evidence-based use of existing therapies, and thorough assessment to define treatment success. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    Gastroenterology 03/2015; 148(5). DOI:10.1053/j.gastro.2015.03.001 · 16.72 Impact Factor
  • Ashley Charlebois · Greg Rosenfeld · Brian Bressler ·
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    ABSTRACT: Abstract Diet may be a successful part of the treatment plan for improving outcome in patients with inflammatory bowel disease (IBD). This study aimed to systematically review all published clinical trials evaluating the effects of a regular diet on symptoms of IBD. Three medical databases were searched for clinical trials evaluating an intervention that involved dietary manipulation using a regular diet on adults with IBD whose symptoms were objectively measured before and after the intervention. The most common types of regular diet interventions that we observed in the literature fell into the following three categories: low residue/low fibre diets, exclusion diets, or other specific diets. Of all included studies, the few that were of higher quality and that observed a statistically significant improvement in symptoms in the diet group compared to the control group fell under the exclusion diet group or the other specific diet group. We were able to identify several high quality clinical trials evaluating dietary manipulations on symptoms of IBD. Exclusion diets and the low FODMAP diet are two areas identified in this review that show promise for having therapeutic benefits for patients with IBD.
    Critical Reviews in Food Science and Nutrition 01/2015; DOI:10.1080/10408398.2012.760515 · 5.18 Impact Factor
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    Barret Rush · Landon Berger · Greg Rosenfeld · Brian Bressler ·
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    ABSTRACT: Ulcerative colitis (UC)-associated pan-enteritis is a newly identified clinical entity that occurs almost exclusively after colectomy. Characterized by diffuse small bowel mucosal inflammation not compatible with Crohn's disease, the optimal treatment modality for this condition is unknown. Tacrolimus is a potent calcineurin inhibitor that has been successfully used in the treatment of UC. We describe a case of severe refractory pan-enteritis after colectomy for UC that was successfully treated with oral tacrolimus after failing intravenous corticosteroid treatment. Tacrolimus may be a safe and effective treatment modality for diffuse enteritis after colectomy in UC patients.
    10/2014; 2(1):33-5. DOI:10.14309/crj.2014.76
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    Yt Nancy Fu · Thomas Hong · Andrew Round · Brian Bressler ·
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    ABSTRACT: Aim: To evaluate the impact of medical therapy on Crohn's disease patients undergoing their first surgical resection. Methods: We retrospectively evaluated all patients with Crohn's disease undergoing their first surgical resection between years 1995 to 2000 and 2005 to 2010 at a tertiary academic hospital (St. Paul's Hospital, Vancouver, Canada). Patients were identified from hospital administrative database using the International Classification of Diseases 9 codes. Patients' hospital and available outpatient clinic records were independently reviewed and pertinent data were extracted. We explored relationships among time from disease diagnosis to surgery, patient phenotypes, medication usage, length of small bowel resected, surgical complications, and duration of hospital stay. Results: Total of 199 patients were included; 85 from years 1995 to 2000 (cohort A) and 114 from years 2005 to 2010 (cohort B). Compared to cohort A, cohort B had more patients on immunomodulators (cohort A vs cohort B: 21.4% vs 56.1%, P < 0.0001) and less patients on 5-aminosalysilic acid (53.6% vs 29.8%, P = 0.001). There was a shift from inflammatory to stricturing and penetrating phenotypes (B1/B2/B3 38.8% vs 12.3%, 31.8% vs 45.6%, 29.4% vs 42.1%, P < 0.0001). Both groups had similar median time to surgery. Within cohort B, 38 patients (33.3%) received anti-tumor necrosis factor (TNF) agent. No patient in cohort A was exposed to anti-TNF agent. Compared to patients not on anti-TNF agent, ones exposed were younger at diagnosis (anti-TNF vs without anti-TNF: A1/A2/A3 39.5% vs 11.8%, 50% vs 73.7%, 10.5% vs 14.5%, P = 0.003) and had longer median time to surgery (90 mo vs 48 mo, P = 0.02). Combination therapy further extended median time to surgery. Using time-dependent multivariate Cox proportional hazard model, patients who were treated with anti-TNF agents had a significantly higher risk to surgery (adjusted hazard ratio 3.57, 95%CI: 1.98-6.44, P < 0.0001) compared to those without while controlling for gender, disease phenotype, smoking status, and immunomodulator use. Conclusion: Significant changes in patient phenotypes and medication exposures were observed between the two surgical cohorts separated by a decade.
    09/2014; 20(33):11808-14. DOI:10.3748/wjg.v20.i33.11808

  • 09/2014; 28(8):454-453.
  • Mindy Cw Lam · Brian Bressler ·
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    ABSTRACT: Vedolizumab (VDZ) is a selective antibody against α4β7-integrin, which targets leukocyte trafficking in the gastrointestinal tract. The GEMINI studies are Phase 3, randomized, placebo-controlled trials to assess the efficacy of VDZ in induction and maintenance of moderately to severely active ulcerative colitis (GEMINI 1) and Crohn's disease (GEMINI 2). Included in these studies are patients who have failed TNF-α antagonist therapy. GEMINI 1 showed that VDZ is an effective agent in induction and maintenance of ulcerative colitis. GEMINI 2 met one of two primary end points in the induction phase showing that VDZ is more likely to induce clinical remission compared with placebo. VDZ is an effective agent in the maintenance of Crohn's disease. These studies pave the way to a new class of medications for treatment of inflammatory bowel disease.
    Immunotherapy 09/2014; 6(9):963-71. DOI:10.2217/imt.14.66 · 2.07 Impact Factor

  • 07/2014; 28(7):371-372.
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    ABSTRACT: Background: There is a paucity of published data regarding the quality of care of inflammatory bowel disease (IBD) in Canada. Clinical quality indicators are quantitative end points used to guide, monitor and improve the quality of patient care. In Canada, where universal health care can vary significantly among provinces, quality indicators can be used to identify potential gaps in the delivery of IBD care and standardize the approach to interprovincial management. Methods: The Emerging Practice in IBD Collaborative (EPIC) group generated a shortlist of IBD quality indicators based on a comprehensive literature review. An iterative voting process was used to select quality indicators to take forward. In a face-to-face meeting with the EPIC group, available evidence to support each quality indicator was presented by the EPIC member aligned to it, followed by group discussion to agree on the wording of the statements. The selected quality indicators were then ratified in a final vote by all EPIC members. Results: Eleven quality indicators for the management of IBD within the single-payer health care system of Canada were developed. These focus on accurate diagnosis, appropriate and timely management, disease monitoring, and prevention or treatment of complications of IBD or its therapy. Conclusions: These quality indicators are measurable, reflective of the evidence base and expert opinion, and define a standard of care that is at least a minimum that should be expected for IBD management in Canada. The next steps for the EPIC group involve conducting research to assess current practice across Canada as it pertains to these quality indicators and to measure the impact of each of these indicators on patient outcomes.
    05/2014; 28(5):275-85.
  • Nancy Fu · Kevan Jacobson · Andrew M. Round · Kathi Evans · Hong Qian · Brian Bressler ·

    Gastroenterology 05/2014; 146(5):S-780. DOI:10.1016/S0016-5085(14)62816-X · 16.72 Impact Factor

Publication Stats

1k Citations
721.30 Total Impact Points


  • 2007-2015
    • University of British Columbia - Vancouver
      • Division of Gastroenterology
      Vancouver, British Columbia, Canada
  • 2006-2015
    • St. Paul's Hospital
      Saskatoon, Saskatchewan, Canada
  • 2012
    • Keio University
      • Cancer Center
      Edo, Tōkyō, Japan
  • 2004-2007
    • University of Toronto
      • • Department of Medicine
      • • Division of Gastroenterology
      Toronto, Ontario, Canada