Grigorios I Leontiadis

• M.D., Ph.D.
• McMaster University

Introduction Colonoscopy quality can vary depending on endoscopist-related factors. Quality indicators, such as adenoma detection rate (ADR), have been adopted to reduce variations in care. Several interventions aim to improve ADR, but these fall into several domains that have traditionally been difficult to compare. We will conduct a systematic re...

Background: Cannulation techniques have been recognized as being important in causing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, considerable controversy exists about the usefulness of the guidewire-assisted cannulation technique for the prevention of PEP. Objectives: To assess the effectiveness and s...

We conducted systematic reviews of predefined clinical questions and used the GRADE approach to develop recommendations for the periendoscopic management of anticoagulant and antiplatelet drugs during acute gastrointestinal (GI) bleeding and the elective endoscopic setting. The following recommendations target patients presenting with acute GI blee...

We conducted systematic reviews of predefined clinical questions and used the Grading of Recommendations, Assessment, Development and Evaluations approach to develop recommendations for the periendoscopic management of anticoagulant and antiplatelet drugs during acute gastrointestinal (GI) bleeding and the elective endoscopic setting. The following...

Objective Functional dyspepsia (FD) is a chronic disorder that is difficult to treat. Helicobacter pylori may contribute to its pathophysiology. A Cochrane review from 2006 suggested that eradication therapy was beneficial, but there have been numerous randomised controlled trials (RCTs) published since. We evaluated impact of eradication therapy o...

Background: Upper gastrointestinal (GI) bleeding is a common reason for emergency hospital admission. Proton pump inhibitors (PPIs) reduce gastric acid production and are used to manage upper GI bleeding. However, there is conflicting evidence regarding the clinical efficacy of proton pump inhibitors initiated before endoscopy in people with upper...

Hyoscine butylbromide, also known as hyoscyamine or scopolamine, and sold under the trade name Buscopan, is an antimuscarinic agent commonly used to induce smooth muscle relaxation and reduce spasmodic activity of the gastrointestinal (GI) tract during endoscopic procedures. However, the balance between desirable and undesirable (adverse) effects i...

Background Corticosteroids (CS) have been used extensively to induce remission in Crohn’s disease (CD); however, they are associated with severe side effects. We hypothesized that the administration of an exclusive enteral nutrition (EEN) formula to CS would lead to increased CD remission rates and to decreased CS-related adverse events. We propose...

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is performed to diagnose and manage conditions of the biliary and pancreatic ducts. Though effective, it is associated with common adverse events (AEs). The purpose of this study is to systematically review ERCP AE rates and report up-to-date pooled estimates. Methods and analysis...

We performed systematic reviews addressing predefined clinical questions to develop recommendations with the GRADE approach regarding management of patients with overt upper gastrointestinal bleeding. We suggest risk assessment in the emergency department to identify very-low-risk patients (e.g., Glasgow-Blatchford score = 0-1) who may be discharge...

Background: Skin lesions in patients with Inflammatory Bowel Disease (IBD) may develop as an adverse effect of anti-TNF therapy or other immunomodulatory agents (IA), such as azathioprine or methotrexate. Skin lesions may also represent incidental findings or extra-intestinal manifestations of IBD. Aim of the study: To investigate and describe ski...

Background and Aims Chronic diarrhea affects about 5% of the population overall. Altered bile acid metabolism is a common but frequently undiagnosed cause. Methods We performed a systematic search of publication databases for studies of assessment and management of bile acid diarrhea (BAD). The certainty (quality) of evidence and strength of recom...

Background & aims: Altering the intestinal microbiota has been proposed as a treatment for inflammatory bowel diseases (IBD), but there are no established associations between specific microbes and IBD. We performed a systematic review to identify frequent associations. Methods: We searched the MEDLINE, EMBASE, Cochrane CDSR, and CENTRAL databas...

Objective: To review and summarize the recently developed Canadian Association of Gastroenterology screening recommendations for patients with a family history of colorectal cancer (CRC) or adenoma from a family medicine perspective. Quality of evidence: A systematic review and meta-analysis was performed to synthesize knowledge regarding family...

Description: This update of the 2010 International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding (UGIB) refines previous important statements and presents new clinically relevant recommendations. Methods: An international multidisciplinary group of experts developed the recommendations....

Background & aims: Chronic diarrhea affects about 5% of the population overall. Altered bile acid metabolism is a common but frequently undiagnosed cause. Methods: We performed a systematic search of publication databases for studies of assessment and management of bile acid diarrhea (BAD). The certainty (quality) of evidence and strength of rec...

Background & Aims Crohn’s disease (CD) is a lifelong illness with substantial morbidity, although new therapies and treatment paradigms have been developed. We provide guidance for treatment of ambulatory patients with mild to severe active luminal CD. Methods We performed a systematic review to identify published studies of the management of CD....

Background & Aims Crohn’s disease (CD) is a lifelong illness with substantial morbidity, although new therapies and treatment paradigms have been developed. We provide guidance for treatment of ambulatory patients with mild to severe active luminal CD. Methods We performed a systematic review to identify published studies of the management of CD....

Background & Aims Irritable bowel syndrome (IBS) is common but difficult to treat. Altering the gut microbiota has been proposed as a strategy for treatment of IBS, but the association between the gut microbiome and IBS symptoms has not been well established. We performed a systematic review to explore evidence for this association. Methods We sea...

Linked Content This article is linked to Sey et al paper. To view this article, visit https://doi.org/10.1111/apt.15092.

Background: Fistulas occur in about 25% of patients with Crohn's disease (CD) and can be difficult to treat. The aim of this consensus was to provide guidance for the management of patients with perianal fistulizing CD. Methods: A systematic literature search identified studies on the management of fistulizing CD. The quality of evidence and str...

Background: Dyspepsia is a common condition associated with gastrointestinal (GI) disease. Prokinetics are the treatment of choice for functional dyspepsia (FD). However, the role of prokinetics in FD treatment is still controversial. Objectives: We conducted a systematic review and meta-analysis of randomised control trials (RCTs) examining the...

Objectives: Prokinetics are recommended for the treatment of functional dyspepsia (FD) but systematic reviews give conflicting results on the efficacy of these agents. We have therefore conducted an updated systematic review to support the 2017 joint ACG/CAG dyspepsia guidelines. Methods: Electronic databases, including MEDLINE, EMBASE, and CENT...

Background Fistulas occur in about 25% of patients with Crohn’s disease (CD) and can be difficult to treat. The aim of this consensus was to provide guidance for the management of patients with perianal fistulizing CD. Methods A systematic literature search identified studies on the management of fistulizing CD. The quality of evidence and strengt...

Background and aims: A family history (FH) of colorectal cancer (CRC) increases the risk of developing CRC. These consensus recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on screening these high-risk individuals. Methods: Multiple par...

A recent paper by Cheung et al. reported that long-term use of proton pump inhibitors (PPIs) was associated with an increased risk of gastric cancer "even after" Helicobacter pylori (H. pylori) eradication. This has created significant concerns among physicians and patients. The Canadian Association of Gastroenterology (CAG) has serious reservation...

Since the publication of this manuscript it was realised that reference 14 was provided incorrectly. The correct reference is provided here.

en Linked Content This article is linked to Zamani et al papers. To view these articles visit https://doi.org/10.1111/apt.14561 and https://doi.org/10.1111/apt.14618.

Background Existing guidelines on colorectal cancer (CRC) screening for individuals with a family history (FH) of CRC or adenoma have not been based on systematic reviews or comprehensive assessment of the quality (=trustworthiness) of evidence (QoE). Aims To systematically review the literature to inform the ongoing development of a Canadian Asso...

Background Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Rectal Indomethacin and prophylactic pancreatic stent placement have been shown to be effective for the prevention of post-ERCP pancreatitis. However, there remains considerable controversy regarding the usefulness of protease inh...

Background and aims: Our aim is to review the literature and provide guidelines for the assessment of uninvestigated dysphagia. Methods: A systematic literature search identified studies on dysphagia. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluat...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: By meta-analysis and systematic review of randomized controlled trials (RCTs), to evaluate the role of prokinetics in the treatment of functional dyspepsia (FD) as reflected by improvement of either individual or global dyspepsia symptom scores and quality of li...

The American Journal of Gastroenterology is published by Springer Nature on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological...

Colorectal cancer (CRC) is a common cancer for which effective screening strategies are available; CRC screening strategies aim for both primary prevention (diagnosis and resection of adenomas, the precursors of the majority of CRCs) and secondary prevention (diagnosis and treatment of early-stage, asymptomatic CRC). There are 2 possible approaches...

Background: Observational studies have consistently shown an increased risk of upper gastrointestinal bleeding in users of selective serotonin receptor inhibitors (SSRIs), probably explained by their inhibition of platelet aggregation. Therefore, treatment with SSRIs is often temporarily withheld in patients with peptic ulcer bleeding. However, ab...

Helicobacter pylori (H. pylori) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-inflammatory medication, unexplained...

Background & aims: Video capsule endoscopy (CE) provides a noninvasive option to assess the small intestine, but its use with respect to endoscopic procedures and cross-sectional imaging varies widely. The aim of this consensus was to provide guidance on the appropriate use of CE in clinical practice. Methods: A systematic literature search iden...

Background and study aims Difficult cannulation is a risk factor for pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). The double-guidewire technique (DGT) may improve cannulation success and reduce the risk of post-ERCP pancreatitis (PEP) in patients with difficult cannulation. This systematic review compared the DGT wi...

The negative issue of AJG is an inspired initiative that will hopefully raise awareness on negative studies and put a small dent in the publication bias caused by the difficulty in getting such studies written up and published.The term negative study originates from the hypothesis testing statistics with P values and statistical significance.

Background and aims: The optimal timing of endoscopy in patients with peptic ulcer bleeding (PUB) remains unclear. The aim of this study was to examine the association between timing of endoscopy and mortality in PUB. Methods: A nationwide cohort study based on a database of consecutive patients admitted to hospital with PUB in Denmark. Patients...

Background: Difficult cannulation is a risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). It has been postulated that the pancreatic duct guidewire (PGW) technique may improve biliary cannulation success and reduce the risk of PEP in people with difficult cannulation. Objectives: To systematically revi...

Background & aims: Helicobacter pylori infection is increasingly difficult to treat. The purpose of these consensus statements is to review the literature and provide specific, updated recommendations for eradication therapy in adults. Methods: A systematic literature search identified studies on H. pylori treatment. The quality of evidence and...

Objectives: Acute severe steroid-refractory ulcerative colitis (UC) carries a poor prognosis and requires optimal management. A systematic review and meta-analysis were conducted to assess cyclosporine and infliximab (IFX) as rescue agents in patients with steroid-refractory UC. Methods: A literature search identified studies that investigated I...

Introduction: The principal effect of Helicobacter pylori infection is lifelong chronic gastritis, affecting up to 20% of younger adults but 50% to 80% of adults born in resource-rich countries before 1950. Methods and outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of H pylori...

Background & aims: The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy since the health of both the mother and the fetus must be considered. Methods: A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations wer...

To the Editor We read with interest the systematic review and meta-analysis by Köhler and colleagues.¹ In their study, they found that anti-inflammatory medications, particularly the nonsteroidal anti-inflammatory drug (NSAID) celecoxib, decreased depressive symptoms without increased risk for adverse effects. This study could potentially lead to t...

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...

The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastr...

An important mandate of the Canadian Association of Gastroenterology (CAG), as documented in the Association’s governance policies, is to optimize the care of patients with digestive disorders. Clinical practice guidelines are one means of achieving this goal. The benefits of timely, high-quality and evidenced-based recommendations include: Enhanci...

This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective: To investigate the H. pylori eradication rate obtained by each second-line regimen, stratifying these results by the first-line treatment previously used. Secondary objectives: To study the effect on the eradication success rate of differen...

Opinion statement: There are 34 studies in almost 2 million participants that have reported on the association between proton pump inhibitor (PPI) therapy and risk of fracture. There is substantial variation between the results of each study but systematic reviews of the data suggest overall there is an association between PPI therapy and risk of...

Objectives: There is emerging concern that selective serotonin reuptake inhibitors (SSRIs) may be associated with an increased risk of upper gastrointestinal (GI) bleeding, and that this risk may be further increased by concurrent use of nonsteroidal anti-inflammatory (NSAID) medications. Previous reviews of a relatively small number of studies ha...

The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastr...

& Aims: Guidelines for the management of venous thromboembolism (VTE) from the American College of Chest Physicians do not address patients with inflammatory bowel disease (IBD), a group with a high risk of both VTE and gastrointestinal bleeding. We present recommendations for the prevention and treatment of VTE in patients with IBD. A systematic l...

Distributions, trends and risk factors for Helicobacter pylori infection, peptic ulcer and gastric adenocarcinoma are reviewed. Persistent H. pylori infection, affecting approximately half of the world's population, may lead to peptic ulcer, gastric adenocarcinoma, or MALT lymphoma. H. pylori prevalence in each birth cohort (generation) reflects th...

Background: The optimal duration for Helicobacter pylori (H. pylori) eradication therapy is controversial, with recommendations ranging from 7 to 14 days. Several systematic reviews have attempted to address this issue but have given conflicting results and limited their analysis to proton pump inhibitor (PPI), two antibiotics (PPI triple) therapy...

A rigorously conducted cohort study published in this edition of the American Journal of Gastroenterology shows that the use of a proton-pump inhibitor is not associated with recurrent Clostridium difficile infection among hospitalized patients. This contradicts the findings of previous studies that, however, were at a high risk of bias. Where does...

There have been numerous studies investigating the risk of fracture with PPI therapy since the CAG position statement in 2008. These data, however, do not change the conclusions of the original position statement. Current data would not support particular care in prescribing PPI therapy due to concerns about risk of fracture. The risk is extremely...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of baclofen, valproic acid and various experimental compounds in development (such as, but not limited to, AZD3355, AZD9343, XP19986) in comparison to each other as well as PPI therapy and placebo in the treatment of GERD. To compa...

The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastr...

Background and study aims: Cannulation techniques are recognized to be important in causing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, considerable controversy exists about the usefulness of the guide wire-assisted cannulation technique for the prevention of PEP. This systematic review of randomized con...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of high dose PPIs versus standard dose PPIs in healing oesophagitis and curing reflux symptoms in patients with erosive reflux oesophagitis. To also compare the adverse effects of high dose PPIs versus standard dose PPIs.

Background: Treatment with proton pump inhibitors (PPIs) improves clinical outcomes in patients with peptic ulcer bleeding. However, the optimal dose and route of administration of PPIs remains controversial. Objectives: To evaluate the efficacy of different regimens of PPIs in the management of acute peptic ulcer bleeding using evidence from di...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the clinical effectiveness of the pancreatic duct guidewire (PGW) technique in difficult CBD cannulation for the prevention of PEP by systematic review and meta-analysis of RCTs. The objectives of this review are two-fold: • to assess whether the P...