24 — Canadians from coast to coast are remarkably prone to inflammatory bowel disease, possibly the result of a climate that discourages bacterial activity and promotes sterile conditions in childhood. About 0.5% of Canadians have inflammatory bowel disease, which means ulcerative colitis and Crohn’s disease together strike about one in 350 persons, according to a study published in the July issue of the American Journal of Gastroenterology. “Canada has the highest incidence and prevalence of Crohn’s disease yet reported,” wrote Charles N. Bernstein, M.D., of the University of Manitoba here, and colleagues. The researchers found that ulcerative colitis, the inflammatory bowel disease that affects only the large intestine, strikes an average of 194 of every 100,000 Canadians, with 11.8 new cases per 100,000 each year. Crohn’s disease, which affects the large and small intestines, is even more common in Canada and affects about 234 per 100,000 people, with an incidence of 13.4 per 100,000 each year. By comparison, ulcerative colitis prevalence is 58 to 157 per 100,000 in Northern Europe and about 167 per 100,000 for an area of Minnesota. Crohn’s disease prevalence ranges from 27 to 48 per 100,000 in Northern Europe to 144 per 100,000 in an area of Minnesota. Some Third World nations and areas in tropical latitudes have still lower rates. Although the reasons for these differences remain unclear, the hygiene hypothesis may help explain the distribution in Canada, said Richard Fedorak, M.D., of the University of Alberta in Edmonton, a co-author. “If you live in an environment that’s too clean or too sterile as a child your intestines are not exposed to bacteria of the same types and numbers you would be exposed to in a tropical area,” he said. which is especially true for Canada because much of the country has cold winters with little bacterial activity in the soil. Then if the genetic triggers are present, “your intestine is not able to tolerate bacteria as you get older and starts to destroy itself,” he added.
Gastroenterologists release new safety guidelines
“If one looks at the sort of totality of endoscopy service delivery, particularly from a patient point of view — which is access to services, rapid access, high quality services, feedback, and an ability to respond to how they perceive endoscopy service delivery — then there really was nothing in place,” said Dr. David Armstrong, chair of the endoscopy committee and the consensus guideline committee. Endoscopy is used to detect or screen for a number of diseases and involves examining the colon or digestive tract using a long, thin tube with a light and camera attached. Last October, about 6,800 Ottawa residents were sent letters from public health officials after it was found that a non-hospital clinic wasn’t following some procedures involving cleaning and infection prevention. The letters indicated the patients might have been exposed to hepatitis B, hepatitis C or HIV. Armstrong said he likes to think the presence of these guidelines would have made a difference in the Ottawa situation. “That’s really because one of the challenges for endoscopy — and it’s in and out of hospitals — has been that if there isn’t a framework to say how things should be monitored and how they should be delivered, it’s difficult to know how much or how closely to monitor things, and what actually are the standards,” Armstrong said in an interview from Hamilton, where he’s an associate professor of medicine at McMaster University. “So I think guidelines that say what should be monitored and what processes have to be in place really from a patient point of view and knowledge that there are tools available to monitor the way that services are delivered and to use as a basis for quality improvement programs would have made a big difference.” Armstrong indicated that it used to be felt that washing the scope and then doing a manual cleaning was sufficient. “And the trouble is there are times when that isn’t sufficient. It’s also important to ensure that all of the endoscopy manufacturers’ instructions and the automatic cleaning equipment instructions are followed, that there’s regular checks of the equipment and the water supply and the filtration and everything else.” It’s something of an undertaking, he noted. “And so to know that those have to be checked regularly and incorporated into all the other quality processes, I think is going to be key as we go forward — particularly as volumes increase.” The new Consensus Guidelines on Safety and Quality Indicators in Endoscopy were developed by a group of 35 Canadian, European and U.S.-based participants, the association said. They reviewed more than two decades’ worth of research to develop their recommendations.