Rapid Rounds: Gastroenterology

Kerri Novak MD MSc FRCPCUniversity of Calgary, Division of Gastroenterology & Hepatology

Learning Objectives1. Briefly review ‘hot topics’ in gastroenterology reflected by calls

to Specialist Link, including new challenges, new drugs & new patient driven queries

2. Outline resources available to physicians and their teams in the Health Home for common, GI conditions

3. Review current access and challenges to GI care in the Calgary Zone

Access: Where are we?

505

512

293

140

Other 450

Access in the Calgary Zone: Where are we?

48%120$

32%

Most Important Wait List Indications

Appropriateness

CannabinoidsGI tract exhibits extensive Cannabinoid receptors:

The ‘endocannabinoid system’ important in modulatingboth sensory and motility function

Due to their effects on motility and secretion, CB1 agonists may be useful to treat IBS?

1. Uranga et al. Biochem Pharmacol 2018;157: 134

Chronic Diarrhea

• Functional diarrhea is common – prevalence of IBS ~12%1

• There is no perfect screening test (e.g. CRP, ESR, FC)

1. Carrasco-Labra et al. Gastro 2019; Sept 157(3): 859

Normal sigmoidcolon

Microscopic Colitis• Natural history reports vary:

symptomatic remission ranges from 60-93%1

• NO increased risk of adenomas & colon cancer?2

1. Pardi. Am J Gastro 2017; 112(2): 782. Levy et al. BMC Gastroenterol 2019; 19(1):

Motility: Loperamide/ Lomotil

Bismuth 262mg tabs TID

Confirm the Diagnosis

Corticosteroids – Budesonide (Entorcort)1

1. Sebastian et a. Scan J Gastro 2019; Aug 31(8):919

Psyllium*

Bile acid Sequestrant*

NAFLD

Rectal bleeding1

Change in bowel habit (<12mo)

Abdominal pain

Iron deficiency anemia – FERRITIN2

1. Rasmussen et al. Br J Ca 2019; 120(6):5952. Renzi et al. Eur J Cancer Care 2019; ;28:e13000.

What about IRON ??Iron deficiency

Clostridoides difficile: old bug, new challenges?

Vancomycin moving to first line1

Fidaxomicin (Dificid®) – lower recurrence rates1,2 $$

Fecal microbiota transplant (FMT)

1. Geury et al. BMJ 2019; 366: 146092. Rajasingham et al Clin Inf Dis 2019; April 17

Inflammatory Bowel Disease

New drugs

Immunizations: flu, pneumonia, varicella

Colorectal cancer screening

Thank you