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The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada. The current article presents the updated findings from the study concerning gastroesophageal reflux disease - a condition that develops when the reflux of stomach contents c...
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Citations
... Approximately 30,000 Canadians die from digestive disease annually [2]. Such disease burden has significant direct and indirect costs to the health care system [2][3][4][5][6][7] with direct healthcare costs for IBD estimated to exceed $28 billion by 2025 [5]. ...
... Approximately 30,000 Canadians die from digestive disease annually [2]. Such disease burden has significant direct and indirect costs to the health care system [2][3][4][5][6][7] with direct healthcare costs for IBD estimated to exceed $28 billion by 2025 [5]. ...
Background
Primary healthcare providers play a critical role in diagnosing and managing digestive disorders. Standardized clinical care guidelines have been developed, but with limited and inconsistent implementation. An evidence-based gastroenterology clinical care pathway (GUTLINK) has been proposed in one region of Canada; however, little is known in the medical literature about potential barriers to pathway implementation within primary care. We aimed to identify behavioral and environmental barriers and facilitators to implementation of evidence-based care pathways for undifferentiated lower gastrointestinal tract symptoms in primary care.
Methods
One-on-one semi-structured interviews were conducted with primary healthcare providers between September 2021 and May 2022. Interview script development was guided by the COM-B framework. Interviews were transcribed and data were analyzed using an inductive thematic analysis approach.
Results
A total of 15 primary healthcare provider interviews were conducted. Several key barriers to GUTLINK implementation were identified in all three domains of the COM-B framework. Key barriers included Capability (e.g., Physician Knowledge and Access to Allied Health), Opportunity (e.g., Access to diagnostic tools), and Motivation (e.g., Comfort with managing cases and optimism). Some of these barriers have not previously been identified in medical literature.
Conclusions
Evidence-based clinical care pathways have the potential to support access to quality gastroenterology care, yet primary healthcare providers in this study identified several barriers to implementation. Potential solutions exist at the individual and clinic levels (e.g., greater education, improved provider-specialist communication), but must be supported with systems-level changes (e.g., increased funding for gastrointestinal care and e-Health platforms) to support pathway implementation and improve quality of care.
... (5). The occurrence of potentially deadly consequences can be caused by GERD, even if the condition itself is not lethal (6). Based on the symptoms produced, it can be classified into two major types: erosive type, which is associated with esophageal mucosal damage, and non-erosive reflux disease, which encompasses symptoms lacking endoscopic indications of injury to the esophageal mucosa (7). ...
... Gastroesophageal reflux disease (GERD) is characterized by the reflux of abnormal stomach contents into the esophagus [1,2]. GERD symptoms are observed within 15-20% of adults residing in the United States; on the other hand, its prevalence ranges from 6.3% to 18.3% in Asian nations with roughly around 7.6-30% in the Indian population [3][4][5][6][7]. GERD encompasses erosive esophagitis (EO) and non-erosive reflux disease (NERD), with NERD accounting for the majority (70%) of GERD instances [8]. ...
Introduction: Proton pump inhibitors (PPIs) regulate gastric acid reflux. Dexlansoprazole's efficacy in prolonging acid suppression compared to conventional PPIs and placebo requires evaluation.
Methods: A prospective, randomized, placebo-controlled, five-way crossover pilot study was conducted on healthy volunteers comparing the potency of dexlansoprazole to conventional PPIs in which five patients were randomized into five treatment cohorts, including dexlansoprazole 60 mg, pantoprazole 40 mg, esomeprazole 40 mg, rabeprazole 20 mg, and placebo, assessing 24-hour intragastric pH using Z/pH Recorder (ZepHr®, Diversatek, Inc., Milwaukee, WI) and analyzing statistical differences via paired t-test.
Results: Dexlansoprazole showed significantly longer durations with pH > 4.0 compared to placebo (P < 0.001) and all other PPIs (P < 0.05) over 24 hours. Although not significant in the first 0-12-hour period, dexlansoprazole maintained significantly higher pH levels in the last 12-24-hour period compared to pantoprazole (P = 0.001) and esomeprazole (P = 0.044) but not with rabeprazole (P = 0.075). Additionally, during the 24-hour pH monitoring measured at 30-minute intervals, dexlansoprazole (mean pH = 3.98 ± 0.11) consistently showed higher values than pantoprazole (mean pH = 3.48 ± 0.12), rabeprazole (mean pH = 3.66 ± 0.05), esomeprazole (mean pH = 3.66 ± 0.05), and placebo (mean pH = 2.52 ± 0.12), indicating its superior potency.
Conclusion: Dexlansoprazole's dual-delayed release mechanism demonstrates superior acid suppression compared to traditional PPIs and placebo in this pilot study. Larger studies are needed to further evaluate its long-term efficacy and safety.
... (5). The occurrence of potentially deadly consequences can be caused by GERD, even if the condition itself is not lethal (6). Based on the symptoms produced, it can be classified into two major types: erosive type, which is associated with esophageal mucosal damage, and non-erosive reflux disease, which encompasses symptoms lacking endoscopic indications of injury to the esophageal mucosa (7). ...
Gastroesophageal reflux disease (GERD) is a prevalent chronic disorder characterized by the backflow of acidic gastric contents into the esophagus due to lower esophageal sphincter (LES) dysfunction. This condition causes esophageal mucosal damage, leading to symptoms such as heartburn and chest pain, and is associated with increased risks of severe complications, including esophageal adenocarcinoma. Aims: To review the current state of GERD management and assess the potential of photochemical plant-based treatments as alternatives to conventional therapies. Methods: A comprehensive literature review was performed to describe the status of GERD in detail while focusing on the emerging role of plant-based therapies in GERD management. Results: Traditional treatments for GERD are effective but often come with side effects and limitations. Plant-based treatments, particularly those with photochemical properties, are potential African journal of gastroenterology and hepatology Al-Sulivany B et al.2024 257 complementary therapies. Preliminary data suggest these alternatives may improve symptom management and patient outcomes. Conclusions: While standard treatments for GERD are widely used, their limitations necessitate exploring alternative options. Photochemical plant-based therapies offer a promising, supplementary approach, pending further validation through research and clinical trials.
... Particularly noteworthy is the occurrence of GERD symptoms on a weekly basis among 15-20% of individuals in the United States. [3][4][5][6] In Asian regions, GERD's occurrence varies from 6.3% to 18.3%, signifying an escalating tendency relative to earlier reports. 7 GERD can be stratified into two categories: erosive oesophagitis (EO) and non-erosive reflux disease (NERD), with NERD constituting 70% of instances and EO accounting for the remaining 30%. ...
Gastroesophageal reflux disease (GERD) remains prevalent in medical practice. Proton pump inhibitors (PPIs) are the primary treatment, yet limitations exist. Dexlansoprazole modified release (MR), an R-enantiomer of lansoprazole, offers high efficacy. Its dual release in the duodenum and small intestine yields two peak concentrations at different times (2- and 5-hours post-administration), ensuring the longest maintenance of drug concentration and proton pump inhibitory effect among all PPIs. Dexlansoprazole MR effectively heals erosive esophagitis, maintains healed esophageal mucosa, and controls NERD symptoms. It also improves nocturnal heartburn, GERD-related sleep disturbances, and bothersome regurgitation. Importantly, it maintains good plasma concentration regardless of food intake, enabling flexible dosing. Furthermore, it does not significantly affect clopidogrel metabolism or platelet inhibition, eliminating the need for dose adjustments when co-prescribed. This review highlights dexlansoprazole's unique attributes, pharmacokinetics, advantages, and safety in comparison to traditional PPIs.
... GI symptoms not only have an enormous impact on the quality of life, work, and daily activities of affected individuals, they 19:14 also impose substantial societal and economic costs [5]. These conditions are often under-recognized and remain untreated, which is concerning given their prevalence and the associated significant health and economic implications [6][7][8]. ...
Background
There is a paucity of studies reporting the presence of systemic symptoms and micronutrient deficiency in patients with chronic urticaria, and these data are lacking in a Canadian population.
Objective
To report the prevalence of gastrointestinal symptoms and vitamin B12 (cobalamin) deficiency in a Canadian patient population diagnosed with chronic urticaria.
Methods
A retrospective chart review of 100 adult patients with chronic urticaria was conducted. Demographic characteristics, medications, presence of gastrointestinal symptoms, and laboratory findings were abstracted from electronic medical records.
Results
Seventy percent of patients with chronic urticaria reported experiencing gastrointestinal symptoms. The most common symptom identified was gastroesophageal reflux (42%). Vitamin B12 (cobalamin) deficiency, defined as serum vitamin B12 level ≤ 250 pmol/L, was identified in 31.7% of the patients. Among those patients with urticaria and vitamin B12, 68% reported gastrointestinal symptoms.
Conclusions
This is the first study to provide data on the high prevalence of gastrointestinal symptoms and vitamin B12 (cobalamin) deficiency in a Canadian population diagnosed with chronic urticaria. Early recognition and management of systemic symptoms and micronutrient deficiency may lead to a more comprehensive approach to management of these patients.
Trial registration Not applicable
... A cross-sectional survey-based study in the United States revealed the need for population-specific educa-tional initiatives to improve awareness about the symptoms of GERD in populations with different cultural backgrounds [32]. Moreover, other studies were undertaken in industrialized nations, including Sweden, Canada, Switzerland, Norway, and the United Kingdom, to describe epidemiology, prevalence, risk factors, and the effect of public awareness of GERD and related lifestyle changes, these studies reported increasing rate of recently diagonosed patients with GERD year by year resulting in considerable burdens and costs [21,33,34]. ...
... In the United States, a crosssectional survey-based study highlighted the need for population-specific educational campaigns to raise awareness about the symptoms of GERD in communities with particular cultural background [12]. Furthermore, several studies were conducted to report epidemiology, prevalence, risk factors and the role of public awareness of GERD and associated lifestyle changes in developed countries, including Sweden, Canada, Switzerland, Norway, and United Kingdom [13][14][15]. ...
... Il faut distinguer le RGO de la dyspepsie, qui est un syndrome principalement caractérisé par une douleur épigastrique d'une durée d'au moins 1 mois 12 . En Amérique du Nord et en Europe, la prévalence du RGO (basée sur une manifestation hebdomadaire des symptômes) toucherait de 10 % à 20 % de la population selon les estimations 13,14 . ...
... De l'avis du Groupe d'étude canadien, les enjeux de faisabilité et de coûts sont importants, étant donné que le RGO chronique est une maladie très répandue (10 %-20 % de la population canadienne) 13,14 . Des rapports canadiens montrent que les temps d'attente pour les endoscopies sont considérés comme trop longs et excèdent les objectifs recommandés 53,54 . ...
... In the judgment of the task force, there are important feasibility and cost concerns, given that chronic GERD is a very common condition (10%-20% of Canadians). 13,14 Canadian reports show that endoscopy wait times are perceived as too long and exceed recommended targets. 53,54 Implementing screening would increase demand and could adversely affect health equity, as recent immigrant, rural or remote, Indigenous or lowincome populations may not have equal access. ...
