American College of Gastroenterology, Oct. 25-30
The annual meeting of the American College of Gastroenterology was held from Oct. 25 to 30 in San Antonio and attracted approximately 5,000 participants from around the world, including gastroenterology and digestive specialists and other health care professionals. The conference featured presentations focusing on clinical updates in gastroenterology and hepatology as well as the latest advances in digestive health and gastrointestinal disorders.
In one study, Hamna Fahad, M.D., of the Cleveland Clinic Foundation, and colleagues found hyperbaric oxygen therapy to be safe and effective for use in patients with inflammatory diseases of the ileal pouch.
"Hyperbaric therapy is a viable adjunct therapy for patients with pouchitis who are refractory to conventional medical therapy," Fahad explained.
According to Fahad, hyperbaric oxygen therapy involves going to the hyperbaric oxygen chamber three to five times a week for a total of 30 sessions.
"This will be a great adjunct option for refractory cases. Some animal studies have demonstrated that it is as beneficial as steroids in patients with inflammatory bowel disease," Fahad said. "The ongoing research, including clinical trials, has made getting approval easier after an appeal."
In a phase 3 clinical trial, Ikuo Hirano, M.D., of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues found that a novel liquid formulation of budesonide designed specifically for eosinophilic esophagitis demonstrated significant improvement in symptoms of dysphagia as well as pathologic and endoscopic features of eosinophilic esophagitis.
"Eosinophilic esophagitis is a rapidly increasing disease that is now globally recognized as a leading cause of dysphagia and food impaction in adolescents and adults, and a variety of foregut symptoms in children. The absence of U.S. Food and Drug Administration-approved medical treatments for eosinophilic esophagitis is a huge unmet need for both patients and clinicians," Hirano said. "Currently, clinicians are confronting numerous obstacles in the off-label use of medications for the treatment of their patients suffering from symptoms due to eosinophilic esophagitis. The off-label use of topical corticosteroids designed for airway delivery (i.e., asthma) is clearly not an optimal solution for this increasing and progressive esophageal disease. The success of the phase 3 trial of budesonide oral suspension will hopefully lead to regulatory approval of the first pharmacologic therapy for eosinophilic esophagitis."
Li Jiao, M.D., of Baylor College of Medicine and the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center in Houston, and colleagues found that adult men who consume more caffeine daily had more diverse bacteria in their gut.
"Coffee consumption has several long-term health benefits, including decreased risk of various cancers, cardiovascular disease, liver diseases, and type 2 diabetes mellitus. However, the mechanisms of such beneficial effects are incompletely understood. We were interested in understanding whether phytochemicals contained in coffee could influence gut microbiome, which may then mediate some of the coffee-related effects," Jiao said. "We found that adult men who have more dietary consumption of caffeine, through drinking coffee and tea, had more diverse bacteria in their gut, which is generally a good thing. They also had relatively more abundant potentially beneficial bacteria, such as anti-inflammatory Faecalibacterium and less Erysipelatoclostridium, which has been related to metabolic abnormality previously. As a major source of caffeine, drinking more coffee may also be beneficial to the bacteria that are attached to the colon."
William J. Sandborn, M.D., of the University of California San Diego Health System in La Jolla, and colleagues found that the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients with ulcerative colitis treated with tofacitinib appears to be lower than that observed in older patients with rheumatoid arthritis and cardiovascular risk factors who were treated with tofacitinib.
"In the placebo-controlled portion of the induction and maintenance trials of tofacitinib in ulcerative colitis, all of the PE and DVT events occurred in patients receiving placebo," Sandborn said. "In the long-term, open-label, extension portion of the trial, there were five DVT and PE events that occurred. The rates for these events were lower than those observed in a recent study in rheumatoid arthritis patients over the age of 50 who had risk factors for cardiovascular disease. Virtually, all of the patients with ulcerative colitis who had DVT or PE had risk factors other than treatment with tofacitinib."
According to Sandborn, the FDA has given guidance on the use of tofacitinib in patients with ulcerative colitis, which should be restricted to patients who have failed antitumor necrosis factor drugs. In addition, the lowest effective dose (5 mg) should be used when possible. Tofacitinib should be avoided in patients with risk factors for DVT and PE.
"Given that the total experience with treating patients with ulcerative colitis with tofacitinib is still relatively small, continued surveillance of this issue is warranted," Sandborn said.
Muhammad Talal Sarmini, M.D., of the Cleveland Clinic Foundation, and colleagues conducted a meta-analysis to evaluate the impact of statin use on hepatocellular carcinoma (HCC) risk.
"We found that patients who were on statins had a 43 percent reduction in risk compared to patients who were not on statins. The reduction in risk was significant when we looked at studies grouped based on location (i.e., United States, Asia, and Europe)," Sarmini said. "Statins have favorable effects, besides the use for hyperlipidemia, including reducing the risk of HCC in the general population and patients who are at risk for HCC. It [is] reasonable to consider statins in patients who are at high risk for HCC."
Sarmini added that additional studies are needed to verify which statins are effective (lipophilic versus hydrophilic), especially in patients at high risk for HCC.