Dr. David Armstrong

Division of Gastroenterology

David Armstrong


Professor, Department of Medicine

Member, Farncombe Family Digestive Health Research

Administrative Assistant: Sarah Lawson
905.521.2100 X76404

Academic Interests

Dr. David Armstrong is an Associate Professor of Medicine at McMaster University and an active consultant gastroenterologist at Hamilton Health Sciences. David Armstrong graduated from Cambridge University (1974) and King’s College Hospital (1977). After 2 years (1980-92) as a Family Physician in Goose Bay, Labrador he trained in internal medicine (UK: 1982-85), gastroenterology research (Guy’s Hospital, London, UK: 1985-88; University of Lausanne, Switzerland: 1988-92) and clinical gastroenterology (McMaster University: 1992-95).

David Armstrong has research interests in upper gastrointestinal disease, nutrition, education and practice audit; he is principal investigator for a number of multicentre studies on dyspepsia and gastroesophageal reflux disease with over 120 peer-reviewed publications, 70 invited articles and 200 peer-reviewed presentations at learned societies.

He was Chief of Clinical Service for Gastroenterology (2000-2007) and is Past-President of the HHS Medical Staff Association (2005-7), a member of the International Working Group on the Classification of Oesophagitis (IWGCO; 1994-present), a member of the Organizing Committee for the Annual CAG/CASL Canadian Gastroenterology Fellows’ Postgraduate Training Courses (1996-2007), Chair of the CAG Endoscopy Committee and a participant in the Canadian Consensus Conferences on the Management of Gastroesophageal Reflux Disease (1996 and 2004), Helicobacter pylori-related diseases (1998) and Upper Gastrointestinal Bleeding (2002), the Latin-American consensus on gastro-oesophageal reflux disease (2005) and the Montreal Definition and Classification of GERD Working Group.

As Chair of the CAG Endoscopy Committee, he has overseen the recent series of Canadian credentialing guidelines for gastrointestinal endoscopy; he was also a member of the Cancer Care Ontario Colonoscopy Standards Expert Panel (2007).

Research Interests

Research interests relate predominantly to upper gastrointestinal diseases including gastroesophageal reflux disease (GERD), Helicobacter pylori-related disease and dyspepsia; recent work has included:

  • clinical studies in the treatment of symptomatic GERD,
  • clinical studies in the management of dyspepsia,
  • the clinical investigation of H. pylori infection using 13C Urea Breath Testing and its implications for the management H. pylori-related intestinal metaplasia and gastric cancer,
  • the endoscopic diagnosis of reflux esophagitis and other upper gastrointestinal disease, and
  • the assessment of upper gastrointestinal tract sensitivity using barostat techniques and monitoring of heart rate variability.
  • Related to the clinical management of parenteral nutrition, there are also research interests in economic aspects of home parenteral nutrition and the potential role of dietary supplements in nutritionally-compromised patients.
  • mydyspepsia.com - information and support for those with dyspepsia and other disorders affecting the upper gastrointestinal tract

Selected Publications 2006-2008

  1. Puhan MA, Guyatt GH, Armstrong D, Wiklund I, Fallone CA, Heels-Ansdells D, degli’Innocenti A, Veldhuyzen van Zanten SJO, Tanser L, Barkun AN, Chiba N, Austin P, El-Dika S, Schünemann HJ. Validation of a symptom diary for patients with gastroesophageal reflux disease. Aliment Pharmacol Ther 2006;23:531-541. 
  2. Veldhuyzen van Zanten SJO, Chiba N, Armstrong D, Barkun AN, Thomson ABR, Mann V, Escobedo S, Chakraborty B, Nevin K.  Validation of a 7-point Global Overall Symptom scale to measure the severity of dyspepsia symptoms in clinical trial.  Aliment Pharmacol Ther 2006;23:521-529.
  3. Veldhuyzen van Zanten SJO, Thomson ABR, Barkun AN, Armstrong D, Chiba N, White RJ, Escobedo S, Sinclair P.  The prevalence of Barrett’s oesophagus in a cohort of 1040 Canadian primary care patients with uninvestigated dyspepsia undergoing prompt endoscopy.  Aliment Pharmacol Ther 2006; 23: 595-599.
  4. Cohen H, Moraes-Filho JPP, Cafferata ML, Tomasso G, Salis G, Gonzàlez O, Valenzuela J, Sharma P, Malfertheiner P, Armstrong D, Lundell L, Corti R, Sakai P, Ceconello I, and the Latin-American GORD Consensus Group. An evidence-based, Latin-American consensus on gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol 2006;18:349–368.
  5. Armstrong D, Hollingworth R, Gardiner T, Klassen M, Smith W, Hunt RH, Leddin D. Practice audit in gastroenterology (PAGE) program: qualitative study of a novel approach to continuing professional development. Can J Gastroenterol 2006;20(6):405-410.
  6. Veldhuyzen van Zanten SJO, Armstrong D, Chiba N, Flook N, White RJ, Chakraborty B, Gasco A. Esomeprazole 40 gm once-a-day in patients with functional dyspepsia: the ENTER, randomized, placebo-controlled trial. Am J Gastroenterol 2006;101:2096-2106. (doi: 10.1111/j.1572-0241.2006.00751.x)
  7. Talley NJ, Armstrong D, Junghard O, Wiklund I. Predictors of treatment response in patients with non-erosive reflux disease. Aliment Pharmacol Ther 2006;24(2):371-376.
  8. Mauro M, Radovic V, Zhou P, Wolfe M, Kamath M, Bercik P, Croitoru K, Armstrong D. The 13C urea breath test for Helicobacter pylori: determination of the optimal cut-off point in a Canadian community population. Can J Gastroenterol 2006;20(12):770-774.
  9. Mauro M, Radovic V, Wolfe M, Kamath M, Bercik P, Armstrong D. The 13C urea breath test: evaluation of 10-min breath collection. Can J Gastroenterol 2006;20(12):775-778.
  10. Jones R, Armstrong D, Malfertheiner P, Ducrotté P. Does the treatment of gastroesophageal reflux disease (GERD) meet patients' needs? A survey-based study. Current Medical Research & Opinion 2006;22(4):657-62.
  11. Wilkinson SB, Kim PL, Armstrong D, Phillips SM. Addition of glutamine to essential amino acids and carbohydrate does not enhance anabolism in young human males following exercise. Appl Physiol Nutr Metab 2006;31(5):518-529.
  12. Sharma P, Dent J, Armstrong D, Bergman JJGHM, Gossner L, Hoshihara Y, Jankowski JA, Junghard O, Lundell L, Tytgat GNJ, Vieth M. The development and validation of an endoscopic grading system for Barrett’s esophagus – the Prague C and M criteria. Gastroenterology 2006; 131:1392-1399.
  13. Anvari M, Allen CJ, Marshall JK, Armstrong D, Goeree R, Ungar WJ, Goldsmith CH. A randomized controlled trial of laparoscopic Nissen fundoplication (LNF) versus proton pump inhibitors for treatment of patients with chronic gastro-esophageal reflux disease (GERD): One-year follow-up. Surgical Innovation 2006; 13: 238-249.
  14. Enns RA, Gagnon YM, Barkun A, Armstrong D, Gregor J, Fedorak RN and the RUGBE Investigators. Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting. World J Gastroenterol 2006; 12(48):7779-7785.
  15. Armstrong D, James C, Camacho F, Chen Y, Horbay GLA, Teixeira B, Husein-Bhabha FA. Oral rabeprazole vs. intravenous pantoprazole: A comparison of the effect on intragastric pH in healthy subjects. Aliment Pharmacol Therap 2007;25:185-196.
  16. Romagnuolo J, Barkun AN, Enns R, Armstrong D, Gregor J and the RUGBE Investigator Group. Simple clinical predictors obviate urgent endoscopy in selected patients with non-variceal upper gastrointestinal bleeding. Arch Intern Med. 2007;167:265-270.
  17. Comay D, Blackhouse G, Goeree R, Armstrong D, Marshall JK. Photodynamic therapy for Barrett’s esophagus with high-grade dysplasia: A cost-effectiveness analysis. Can J Gastroenterol 2007;21:217-222.
  18. Verdu E, Mauro M, Bourgeois J, Armstrong D. Clinical onset of celiac disease after an episode of Campylobacter jejuni gastroenteritis. Can J Gastroenterol 2007;21:453-455.
  19. Wilkinson SB, Tarnopolsky MA, MacDonald MJ, MacDonald JR, Armstrong D, Phillips SM. Milk protein consumption promotes greater muscle protein accretion following resistance exercise than soy protein. Am J Clin Nutr 2007;85:1031-1040.
  20. Modlin IM, Malfertheiner P, Hunt RH, Armstrong D, Holtmann G, Quigley EM, Spechler SJ. GERD evaluation: time for a new paradigm? J Clin Gastroenterol 2007;41(3):237-41.
  21. Mauro M, Armstrong D. Juvenile onset of Crohn's disease: a risk factor for reduced lumbar bone mass in premenopausal women. Bone 2007;40(5):1290-1293.
  22. Veldhuyzen van Zanten SJO, Barkun AN, Armstrong D, White R, Junghard O, Wiklund IK. Symptom overlap in patients with upper gastrointestinal complaints in the Canadian Confirmatory Acid Suppression Test (CAST) study. Further psychometric validation of the Reflux Disease Questionnaire (RDQ). Aliment Pharmacol Therap 2007;25(9):1087-1097.
  23. Wahlqvist P, Guyatt GH, Armstrong D, Degl’ Innocenti A, Heels-Ansdell D, El-Dika S, Wiklund I, Fallone CA, Tanser L, Veldhuyzen van Zanten SJO, Austin P, Barkun AN, Chiba N, Schünemann HJ. The Work Productivity and Activity Impairment Questionnaire for patients with Gastroesophageal Reflux Disease (WPAI-GERD): Responsiveness to change and English language validation. Pharmacoeconomics 2007;25(5):385-396.
  24. Mauro M, Armstrong D. Evaluation of densitometric bone-muscle relationships in Crohn's disease. Bone 2007;40(6):1610–1614.
  25. Moore DR, Del Bel NC, Nizi KI, Hartman JW, Tang JE, Armstrong D, Phillips SM. Resistance training reduces fasted- and fed-state leucine turnover and increases dietary nitrogen retention in previously untrained young men. J Nutr 2007;137(4):985-991.
  26. Mauro M, Radovic V, Armstrong D. Improvement of lumbar bone mass after infliximab therapy in Crohn’s disease patients. Can J Gastroenterol 2007;21(10):637-642.
  27. Kamath MV, Spaziani R, Ullal S, Tougas G, Guzman JC, Morillo CJ, Capogna J, Al-Bayati M,  Armstrong D.  The effect of sham feeding on neurocardiac regulation in healthy human volunteers.  Can J Gastroenterol 2007;21(11):721-726.
  28. Armstrong D, Enns R, Ponich T, Springer J, Romagnuolo J, Barkun AN. Canadian credentialing guidelines for endoscopic privileges: an overview. Can J Gastroenterol 2007; 21(12):797-801.
  29. Romagnuolo J, Enns R, Ponich T, Springer J, Armstrong D, Barkun AN. Canadian credentialing guidelines for colonoscopy. Can J Gastroenterol 2008;22(1):17-22.
  30. Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P. Endoscopic ultrasound: a meta-analysis of test performance in suspected cholelithiasis. Gastrointestinal Endoscopy 2008;67(2):235-244.
  31. Enns R, Romagnuolo J, Ponich T, Springer J, Armstrong D, Barkun AN. Canadian credentialing guidelines for flexible sigmoidoscopy. Can J Gastroenterol 2008;22(2):115-119.
  32. Armstrong D, Barkun ANG, Chen Y, Daniels S, Hollingworth R, Hunt RH, Leddin D. Access to specialist gastroenterology care in Canada: The Practice Audit in Gastroenterology (PAGE) Wait Times Program. Can J Gastroenterol 2008;22(2):155-160.
  33. Leddin D, Armstrong D, Barkun ANG, Chen Y, Daniels S, Hollingworth R, Hunt RH, Paterson WG. Access to specialist gastroenterology care in Canada: Comparison of wait times and consensus targets. Can J Gastroenterol 2008;22(2):161-167.
  34. Ponich T, Enns R, Romagnuolo J, Springer J, Armstrong D, Barkun AN. Canadian credentialing guidelines for esophagogastroduodenoscopy (EGD). Can J Gastroenterol 2008;22(4):349-354.
  35. Springer J, Enns R, Romagnuolo J, Ponich T, Barkun AN, Armstrong D. Canadian credentialing guidelines for endoscopic retrograde cholangiopancreatography (ERCP). Can J Gastroenterol 2008;22(6):547-551.
  36. Segal I, Otley A, Issenman R, Armstrong D, Espinosa V, Cawdron R, Morshed MG, Jacobson K. Prevalence of H. pylori infection in Canadian children: a cross-sectional analysis. Can J Gastroenterol 2008;22(5):485-489.
  37. Armstrong D, Pare P, Pericak D, Pyzyk M.  Symptom relief in gastroesophageal reflux disease: a randomized, controlled comparison of pantoprazole and nizatidine in a mixed patient population with erosive esophagitis or endoscopy-negative reflux disease. Am J Gastroenterol 2001; 96: 2849-2857.
  38. Armstrong D.  Long-term safety and efficacy of omeprazole in gastro-oesophageal reflux disease. Lancet 2000; 356: 610-612.
  39. Marshall JK, Armstrong D, O'Brien BJ. Test and treat strategies for helicobacter pylori in uninvestigated dyspepsia: A Canadian economic analysis. Can J Gastroenterol 2000; 14: 379-388.
  40. Armstrong D. Endoscopic evaluation of gastro-esophageal reflux disease. Yale J Biol Med 1999; 72: 93-100. Review.
  41. Lad R, Armstrong D. Management of nonsteroidal anti-inflammatory drug-induced gastroduodenal disease by acid suppression. Can J Gastroenterol 1999; 13: 135-142. 
  42. Viani F, Verdú EF, Idström JP, Cederberg C, Fraser R, Fried M, Blum AL, Armstrong D. Effect of omeprazole on regional and temporal variations in intragastric acidity. Digestion 2002; 65:2-10. 
  43. Armstrong D, Kazim F, Gervais M, Pyzyk M. Early relief of upper gastrointestinal dyspeptic symptoms: A survey of empirical therapy with pantoprazole in Canadian clinical practice. Can J Gastroenterol 2002;16(7):439-450.