Sander Veldhuyzen van Zanten

• University of Alberta

Background Most treatment failures of Helicobacter pylori are attributed to antibiotic resistance or patient nonadherence. Commonly used 1st-line treatment regimens include 14 day concomitant [proton pump inhibitor(P), amoxicillin(A), metronidazole(M), and clarithromycin(C):PAMC], or bismuth-based quadruple therapy [P, Bismuth(B), M, and tetracycli...

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 kno...

Objective: To evaluate health system use, health outcomes, and avoided costs when patients with chronic gastrointestinal (GI) conditions are managed in the medical home. Design: A retrospective, observational cohort study was conducted through a single-point-of-entry referral system. Setting: Calgary, Alta. Participants: Patients with referr...

Background Computed tomography of the head (CT head) is frequently used for patients with cirrhosis presenting with suspected hepatic encephalopathy (HE). Aims The primary aims of this study were to assess the frequency of CT head usage in this patient population and to determine whether these scans yielded significant findings. Our secondary aims...

Background Dyspepsia is a common, generally low-risk gastrointestinal condition. The American College of Gastroenterology and Canadian Association of Gastroenterology recommend avoiding gastroscopy in healthy patients <60 years old. Many dyspeptic patients can be effectively managed in primary care. This study aimed to determine: (1) the proportion...

Background Pancreaticobiliary (PB) cancer is associated with a poor prognosis. A timely diagnosis and a coordinated, multidisciplinary effort may improve outcomes as patients navigate the healthcare system for investigations and treatment. Aims To establish and pilot a multidisciplinary (gastroenterology [GI], hepatopancreatic biliary [HPB] surger...

Background Updated 2016 Helicobacter pylori consensus guidelines recommend treatment for 14 days with concomitant therapy (proton-pump inhibitor (PPI)-amoxicillin-metronidazole-clarithromycin (PAMC) or bismuth-based quadruple therapy (PPI-bismuth-metronidazole-tetracycline, PBMT)) as first line, PBMT or PPI-amoxicillin-levofloxacin (PAL) as second...

Background Gastroscopy to investigate dyspepsia without alarm symptoms rarely results in clinically actionable findings or sustained health-related quality-of-life improvements among patients aged 18–60 years and is, therefore, not recommended. Despite this, referrals for and performance of gastroscopy among this patient population remain high. The...

Simple Summary Community-driven projects have characterized health impacts of Helicobacter pylori (Hp) infection in Indigenous communities in the Northwest Territories (NT) and Yukon (YT), Canada. These projects address concerns expressed by community leaders about the frequent diagnosis of Hp infection and its relation to gastric cancer deaths, pe...

Background & Aims The incidence of biopsy-confirmed celiac disease has increased. However, few studies have explored the incidence of celiac autoimmunity based on positive serology results. Methods A population-based cohort study assessed testing of tissue transglutaminase antibodies (tTG-IgA) in Alberta from 2012 to 2020. After excluding prevalen...

Background Management of pancreaticobiliary malignancy is complex and multi-disciplinary. Decompression of malignant biliary obstruction (MBO) is preferentially achieved with endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent placement. This may improve the quality of life for patients with unresectable disease and improve outc...

Background & Aims Incidence of biopsy-confirmed celiac disease has increased. However, few studies have explored incidence of celiac autoimmunity based on positive serology. Methods A population-based cohort study assessed testing of tissue transglutaminase antibodies (tTG-IgA) in Alberta from 2012 to 2020. After excluding prevalent cases, inciden...

Background Canada has the highest global age-adjusted incidence and prevalence rates of inflammatory bowel disease (IBD). Due to IBD patient volumes and limited resources, challenges to timely access to specialty care have emerged. To address this gap, the aim of this paper was to understand the experiences and perspectives of persons living with I...

A relationship between ulcerative colitis (UC) and diet has been shown in epidemiological and experimental studies. In a 6-month, open-label, randomized, placebo-controlled trial, adult UC patients in clinical remission were randomized to either an “Anti-inflammatory Diet (AID)” or “Canada’s Food Guide (CFG)”. Menu plans in the AID were designed to...

Background and Aims Corticosteroid-free remission is a primary treatment goal in IBD which may be achieved with greater use of anti-TNF therapy. We defined temporal trends of corticosteroid use, anti-TNF use, hospitalization and surgery in a prevalent IBD cohort within the province of Alberta, Canada. Methods Health administrative data were used t...

Background Ulcerative colitis (UC) is associated with altered intestinal microbiome (‘dysbiosis’), most significantly, reduced strict butyrate-producing anaerobes and increased facultative anaerobes. Inulin-type prebiotics appear to reduce and prevent colitis in preclinical studies and small clinical trials. However, these results need to be valida...

Background Our community-driven projects address concerns of Canadian Arctic Indigenous communities about Helicobacter pylori (Hp) infection, responsible for elevated gastric cancer mortality in the region. A key concern is poor effectiveness of anti-Hp treatment. We aimed to describe antibiotic resistance patterns in Hp isolated from project parti...

Background Our community-driven projects address concerns of Canadian Arctic Indigenous communities about Helicobacter pylori (Hp) infection, responsible for elevated gastric cancer mortality in the region. Community research partners wished to learn whether bacterial characteristics determine severity of Hp-related disease in their communities. We...

Background Severe or fulminant Clostridioides difficile infection (SFCDI) is associated with significant morbidity and mortality. Emerging evidence suggests fecal microbiota transplant (FMT) may be a promising therapy for SFCDI. Aim This systematic review determines the safety and efficacy of FMT in medically refractory SFCDI. Methods A systemati...

Background Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in Canada. They are effective for several upper GI-disorders, have a very favorable safety profile and therefore there are few barriers to prescribing. Concern about overuse of PPIs has been growing. Many patients do not need long term treatment. Patients starting...

Background The demand for gastroenterology (GI) care in Canada outstrips the supply. In the Calgary Zone, a Central Access and Triage (CAT) model is used as a single point of entry for most GI referrals. In collaboration with primary care, clinical care pathways (CCP) were co-developed and implemented in CAT to support care for common GI referrals...

Background The Canada-Global Rating Scale (C-GRS) is a web-based, patient centered endoscopy quality improvement tool. It assesses the quality of the services an endoscopy unit provides in two dimensions: clinical quality and the quality of the patient experience. It also allows each endoscopy unit to choose priority areas for future QI activities....

Background There is little literature related to access to inflammatory bowel disease (IBD) care that incorporates the perspective of key system stakeholders, such as primary healthcare providers (PHCP), despite their clear and integral role in facilitating access. Objective This study aimed to identify barriers to referring patients to speciality...

LINKED CONTENT This article is linked to Barberio et al papers. To view these articles, visit https://doi.org/10.1111/apt.16184 and https://doi.org/10.1111/apt.16247

Objectives: To determine the impact of transitioning from guaiac-based fecal occult blood testing (gFOBT) to fecal immunochemical testing (FIT) on the detection rate of adenomas, advanced adenomas (AA) and colorectal cancer (CRC). Background: Recently, the health region in Edmonton, Alberta switched from gFOBT to FIT for CRC screening. Study:...

Adverse childhood experiences (ACEs) have been found to be associated with various health conditions; however, there is dearth of evidence on the relationship between ACEs and prenatal depression. This study was conducted to determine the association between overall ACE score and prenatal depression symptoms, assess the moderating effect of social...

Background: Gastroesophageal reflux disease (GERD), dyspepsia and irritable bowel syndrome (IBS) are common gastrointestinal disorders accounting for a significant demand for specialty care. The aim of this study was to evaluate safety, access and outcomes of patients assessed by a nurse-led, shared medical appointment. Methods: This prospective...

Background Lack of access to gastroenterologists may influence outcomes for upper gastrointestinal bleeding (UGIB). Aims To evaluate admission and re-admissions for patients with UGIB across the five health zones in Alberta that vary by access to local gastroenterologists. Methods Administrative databases identified all patients presenting to an...

Background Canada has the highest global age-adjusted incidence and prevalence rates of Inflammatory Bowel Disease (IBD). Resulting from compounding prevalence and limited resources, timely access to specialty care is a challenge faced by patients and healthcare providers. Despite this issue, there has been no published research elucidating the pat...

Background Hospitalization rates for patients with inflammatory bowel disease (IBD) are decreasing throughout Canada; however, this may vary across Canadian jurisdictions. Access to gastroenterologists is limited in many parts of Canada, resulting in care by non-gastroenterologists, and variation in outcomes. Aims To assess trends of hospitalizati...

Objectives: To conduct a systematic review and meta-analysis that defines the worldwide incidence of celiac disease (CD) and examines temporal trends. Methods: MEDLINE and EMBASE were searched for population-based studies reporting the incidence of CD in the overall population, children, or adults. No limits were placed on year or language of pu...

Background Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disease which affects nearly two million North Americans, with Canada demonstrating the highest age-adjusted incidence and prevalence rates globally. Resulting from compounding prevalence rates, the IBD clinical burden continues to grow. With high demand and limited resources,...

Background Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disease which affects nearly two million North Americans, with Canada demonstrating the highest age-adjusted incidence and prevalence rates globally. Resulting from compounding prevalence and limited resources, timely access to IBD care continues to be a widespread issue for p...

Background: Psychological distress, defined as depression, anxiety and perceived stress, during pregnancy is common, with 15-25% of women experiencing clinically significant levels of such distress. Despite the far-reaching impact of prenatal psychological distress on mothers and their children, and that women are receptive to screening, few provi...

Background: Indigenous communities across the circumpolar north have elevated H. pylori (Hp) prevalence and stomach cancer incidence. We aimed to describe the Hp-associated disease burden among western Canadian Arctic participants in community-driven projects that address concerns about health risks from Hp infection. Methods: During 2008-2013,...

Introduction : Acute upper gastrointestinal bleeding (UGIB) is a common presentation to emergency departments (ED). Of these patients, 35-45% receive a blood transfusion. Guidelines for blood transfusion in UGIB have been well established, and recommend a hemoglobin (Hb) level below 70 g/L as the transfusion target in a stable patient. There is no...

Introduction : Upper gastrointestinal bleeding (UGIB) is a common presentation to the emergency department (ED). Early endoscopy within 24 hours has been shown to reduce re-bleeding rates and lower mortality. However, low-risk patients can often be managed through outpatient follow-up. The aim of this study was to compare the timing and appropriate...

Background Canada has the highest age-adjusted incidence and prevalence rates of Inflammatory Bowel Disease (IBD) globally. Given its cumulative prevalence, the IBD clinical burden continues to grow. Limitations in accessing specialty healthcare services is not a new issue facing patients and healthcare providers. Despite this persistent problem, n...

Background Acute upper gastrointestinal bleeding (UGIB) is a common presentation to emergency departments (ED). Of these patients, 35–45% receive a blood transfusion. Guidelines for blood transfusion in stable UGIB have been well established, and recommend a hemoglobin (Hb) level of 70 g/L as the transfusion target. There is no consensus on a trans...

Background The prevalence of celiac disease is estimated to be approximately 1%. However, the rate at which diagnoses have changed over time remains unknown. Aims To analyze the incidence of celiac disease across time. Methods We performed a systematic review in MEDLINE and EMBASE up to 2018, to identify all population-based studies reporting the...

Background Upper gastrointestinal bleeding (UGIB) is a common presentation to the emergency department (ED) and is associated with significant morbidity and mortality. Early endoscopic intervention within 24 hours has been shown to reduce re-bleeding rates and lower morbidity and mortality. However, low-risk patients can often be managed through ou...

Background Helicobacter pylori (Hp) infection is a health concern in Arctic Canada, where prevalence of Hp and gastric cancer rates are high. The Canadian North Helicobacter pylori (CANHelp) Working Group conducts community projects to address public concerns, describe the disease burden, and inform regional health policy. Projects were launched pr...

Background Physicians use therapeutic drug monitoring of adalimumab (ADA) as an optimization tool to guide patient therapy with inflammatory bowel disease (IBD). IBD consists primarily of Crohn’s disease (CD) and ulcerative colitis (UC). Presently, the literature on ADA therapeutic boundaries recommend a broad 5–20μg/mL range. Due to limited treatm...

This chapter provides definition of functional dyspepsia (FD), evaluation, and diagnostic tests, methodology of clinical treatment trials with a focus on outcome measures used to determine the efficacy of treatments, and treatments including antacids, H2‐receptor antagonists (H2‐RAs), proton pump inhibitors (PPIs), prokinetic agents, anti‐Helicobac...

Background inflammatory bowel disease (IBD) is a chronic, immune-mediated disease that affects approximately two million North Americans. Canada has the highest age-adjusted incidence and prevalence rates of IBD globally. Given its cumulative prevalence, the IBD clinical burden in North America continues to grow. Limitations in accessing specialty...

Background: Common bile duct (CBD) stones are extracted with a basket or balloon during ERCP with sphincterotomy. However, some stones are difficult to extract by conventional means. Cholangioscopy with lithotripsy is a modality to treat these difficult stones. We describe the clinical efficacy of single-operator per oral cholangioscopy (SOPOC) fo...

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...

BACKGROUND: Fecal calprotectin (FCP) is a useful biomarker for monitoring inflammatory bowel disease activity, showing good correlation to endoscopic disease activity. The currently used lab tests take 2-4 weeks to return a result, limiting their usefulness. Recently, lateral flow-based rapid tests have been combined with smartphone applications to...

Introduction: Upper gastrointestinal bleeding (UGIB) is a common Emergency Department (ED) presentation. Early endoscopic intervention, supported by Glasgow Blatchford Score (GBS) severity, has been shown to reduce re-bleeding rates and lower morbidity and mortality. However, emergent endoscopy is not necessary for all patients. Low-risk patients c...

Introduction: Upper gastrointestinal bleeding (UGIB) is a common medical condition presenting to emergency departments (ED) and associated with substantial morbidity, mortality, and healthcare expenditures. Our aim was to evaluate the incidence of patients presenting to ED with UGIB in a large population-based surveillance cohort. Methods: The Nati...

Background The recently developed GRS-Canada is a validated instrument whose implementation leads to improved quality and patient experience of colonoscopy. The GRS-C has two dimensions dealing with clinical quality and quality of the patient experience. Both have ratings for 6 different categories resulting in a total of 12 dimensions for the “tot...

Background Fecal calprotectin (FCP) is a useful biomarker for monitoring inflammatory bowel disease, showing good correlation to endoscopic disease activity. Currently used lab tests take 2–4 weeks to return a result, limiting their usefulness. Recently, lateral flow-based rapid tests have been combined with smartphone applications to allow patient...

Background Endoscopy services in the Edmonton Zone (EZ) are provided by 8 endoscopy units. Implementation of the Global Rating Scale (GRS) as a measure of endoscopy unit quality in the EZ was previously based at individual sites, with no coordination across the EZ. This led to poor uptake of the GRS. In September 2015, Alberta Health Services leade...

Background Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disease with significant societal burden. The highest age and sex-adjusted standardized incidence and prevalence estimates of IBD have been observed in Canada, with Nova Scotia exhibiting the highest rates in the country. Despite this burden, Canadians living with IBD often fa...

Background Upper gastrointestinal bleeding (UGIB) is a common Emergency Department (ED) presentation. Early endoscopic intervention, supported by Glasgow Blatchford Score (GBS) severity, has been shown to reduce re-bleeding rates and lower the morbidity and mortality. However, emergent endoscopy is not necessary for all patients. Low-risk patients...

Background Non-alcoholic steatohepatitis is a recognized cause of cirrhosis affecting 12% of word population. The proportion of orthotopic liver transplants (OLT) for NASH cirrhosis increased 8-fold (1.2 to 9.7%) between 2001–2009 and is anticipated to become the leading indication for OLT in the next 20 years. Surprisingly, disease-specific indica...

Background A relationship between ulcerative colitis and diet has been shown in epidemiological and experimental studies. Aims To investigate the effectiveness of an anti-inflammatory diet for maintenance of remission in UC patients. Methods In this 6-month randomized control trial, adult UC patients in clinical remission (partial Mayo score<3) w...

Background The incidence and prevalence rates of Inflammatory Bowel Disease (IBD) in Canada have been observed to be amongst the highest globally, with the highest observed estimates in Nova Scotia (NS). Excessive wait times for outpatient consultations is a well-documented problem. As increased wait times lead to negative outcomes for IBD patients...

Background Individuals with inflammatory bowel diseases (IBD) often live remote to specialized tertiary care centers. In traditional practices, this impedes the close surveillance of symptoms, objective markers of disease (C-reactive protein (CRP), fecal calprotectin (FCP), and optimization of therapies recommended to achieve the best health outcom...

Background Fecal calprotectin (FCP) has been demonstrated to be a noninvasive marker of mucosal inflammation and when elevated, correlates with endoscopic mucosal disease activity in patients with Ulcerative Colitis (UC) and Crohn’s Disease (CD). Endoscopic mucosal healing and normalization of FCP represents desired therapeutic results in these pat...

Background Body Mass Index [BMI: weight(kg)/height(m)2] has been previously identified a key predictor of mortality in orthotopic liver transplant (OLT) recipients. However, the interpretation of BMI in subjects with cirrhosis is rather controversial due to ascites/anasarca-induced errors. Albumin modified BMI (amBMI= BMI*albumin/40) is an alternat...

Canada has one of the highest prevalence estimates of inflammatory bowel disease (IBD) in the world. Like other chronic illnesses, access to specialist care is required for disease management. Traditionally, access to care is evaluated through wait times (actual access); however, new patient-oriented definitions of access (perceived access) highlig...

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...

We report here the complete genome sequences of two Amerind Helicobacter pylori strains from Aklavik, Northwest Territories, Canada. One strain contains extra iron-cofactored urease genes and ~140 rearrangements in its chromosome relative to other described strains (typically differing from one another by <10 rearrangements), suggesting that it rep...

Objectives Helicobacter pylori infection, linked to gastric cancer, is responsible for a large worldwide disease burden. H pylori prevalence and gastric cancer rates are elevated among indigenous Arctic communities, but implementation of prevention strategies is hampered by insufficient information. Some communities in northern Canada have advocate...