The Impact of Climate Change, Pollution, and Biodiversity Loss on Digestive Health and Disease.

The environment is changing rapidly under pressure from 3 related drivers: climate change, pollution, and biodiversity loss. These environmental changes are affecting digestive health and disease in multiple ways. Heat extremes can cause intestinal and hepatic dysfunction. Access to adequate amounts of food of high nutritional content and to clean water is under threat. Extreme weather is associated with flooding and enteric infections and affects the delivery of care through infrastructure loss. Air, water, and soil pollution from chemicals and plastics are emerging as risk factors for a variety of intestinal diseases including eosinophilic esophagitis, metabolic dysfunction associated fatty liver disease, digestive tract cancers, inflammatory bowel disease, and functional bowel disease. Migration of populations to cities and between countries poses a special challenge to the delivery of digestive care. The response to the threat of environmental change is well underway in the global digestive health community, especially with regard to understanding and reducing the environmental impact of endoscopy. Individuals, and peer societies, are becoming more engaged, and have an important role to play in meeting the challenge.

Assessment of endoscope reprocessing at World Gastroenterology Organisation training centers using adenosine triphosphate testing.

Background and study aims Adequacy of endoscope disinfection in resource-limited settings is unknown. Adenosine triphosphate (ATP) testing is useful for evaluation of endoscope reprocessing, and ATP <200 relative light units (RLUs) after manual endoscope cleaning has been associated with adequacy of endoscope disinfection. Methods Consecutive endoscopes undergoing reprocessing at five World Gastroenterology Organisation (WGO) training centers underwent ATP testing before and after an on-site educational intervention designed to optimize reprocessing practices. Results A total of 343 reprocessing cycles of 65 endoscopes were studied. Mean endoscope age was 5.3 years (range 1-13 years). Educational interventions, based on direct observation of endoscope reprocessing practices at each site, included refinements in pre-cleaning, manual cleaning, high-level disinfection, and endoscope drying and storage. The percentage of reprocessing cycles with post-manual cleaning ATP ≧200 decreased from 21.4% prior to educational intervention to 14.8% post-intervention ( P =0.11). In multivariable logistic modelling, gastroscopes were significantly less likely (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.01-0.19; P <0.001) than colonoscopes to achieve post-manual cleaning ATP < 200. No other factor (educational intervention, study site, endoscope age) was significantly associated with improved outcomes. Endoscope ID was not significantly associated with ATP values, and sites that performed manual versus automated HLD did not have significantly different likelihood of post-manual cleaning ATP <200 (OR 1.18, 95% CI 0.56-2.50; P =0.67). Conclusions In resource-limited settings, approximately 20% of endoscope reprocessing cycles may result in inadequate disinfection. This was not significantly improved by a comprehensive educational intervention. Alternative approaches to endoscope reprocessing are needed.