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Digestive Disease Week 2009, May 30-June 4, 2009

Digestive Disease Week 2009

Digestive Disease Week 2009 took place May 30 to June 4 in Chicago and attracted more than 15,000 gastroenterology professionals from around the world. Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract, the meeting presented about 5,000 abstracts and hundreds of lectures on the latest advances in gastroenterology research, medicine and technology.

"I saw a lot of practice-changing research at DDW this year," said Mark H. DeLegge, M.D., director of the Digestive Disease Center at the Medical University of South Carolina in Charleston, and chair-elect for the DDW's Practice Management and Economics Committee. "Some of it was technology based. But a lot of it was based on advances in diagnosis, treatment, and the pathophysiology of diseases."

Multiple sessions addressed new endoscopic treatments for obesity which are less invasive than standard gastric bypass surgery. "I was amazed at the number of people across the United States and internationally who are starting to focus on these procedures, which haven't been widely discussed until now," DeLegge said. "Because most of these devices are still in FDA trials or animal studies, it's still early. But this is an area I can see growing."

In one study, Roberto Fogel, M.D., of Hospital de Clinicas in Caracas, Venezuela, and colleagues performed trans-oral endoluminal vertical gastroplasty on 21 obese adolescents ages 13 to 17 years. The 40-minute procedure reduces stomach volume with suturing to connect the anterior and posterior gastric walls. After one year, the researchers found that all 21 patients had significantly decreased their body mass index.

Fogel reported a financial relationship with Davol Inc.

In a second study, Christopher C. Thompson, M.D., of Brigham and Women's Hospital in Boston, and colleagues performed trans-oral gastric volume reduction -- during which the sides of the stomach are sewn together to create a greater sense of satiety after patients eat small amounts of food -- on 18 adults with body mass index scores of 30 to 45. They reported a mean weight loss of 36.5 pounds and a mean waist circumference reduction of 5.6 inches in six patients who were evaluated after nine months. They also reported a mean weight loss of 27.9 pounds and a mean waist circumference reduction of 4.7 inches in 12 patients who were evaluated after six months.

"This procedure is safe and allows patients to resume their normal activities almost immediately," Thompson said in a statement. "It offers great potential for patients in lower BMI categories or for those who are not candidates for gastric bypass."

Thompson reported financial relationships with a variety of pharmaceutical and medical device companies.

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Related research addressed advances in Natural Orifice Translumenal Endoscopic Surgery (NOTES). "Most of the posters were animal studies that used NOTES to do such things as remove ovaries or fix a bleeding vessel in the abdominal cavity," DeLegge said. "But several surgeons reported on their experiences in using NOTES on patients."

In one study, Santiago Horgan, M.D., of the University of California in San Diego, and colleagues performed NOTES transvaginal appendectomy on two women. The procedure requires only two small incisions -- one on the vagina and one in the abdomen. Similar to results reported in other NOTES studies, the researchers found that it was associated with less pain, scarring, infection and hernia, and with faster recovery than conventional laparoscopic surgery.

Horgan reported financial relationships with a variety of industry companies, including Apollo Endosurgery Inc., Ethicon Endo-Surgery, and Novare.

In a second study, Oscar M. Laudanno, M.D., of Hospital Bocalandro at the University of Buenos Aires in Argentina, and colleagues performed NOTES transvaginal cholecystectomy on 22 patients, one of whom was unable to complete the procedure because of pelvic adhesions. They found that all of the patients rated the procedure as either "excellent" or "very good," and that two of the women had achieved pregnancy.

"Gallbladder removal using the NOTES procedure is remarkably safe and effective," Laudanno said in a statement. "We can eliminate the pain and recovery time of traditional surgery without introducing complications, either gynecological or sexual, for the patient."

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"One of the meeting's key themes is that we now have better treatments for inflammatory bowel disease," DeLegge said. "A lot of research focused on biological agents and identifying which patients are good candidates for these agents."

William J. Sandborn, M.D., of the Mayo Clinic in Rochester, Minn., presented one-year data from the SONIC study in which 508 Crohn's disease patients were randomly assigned to receive either infliximab plus azathioprine, infliximab alone, or azathioprine alone for 30 weeks. All patients had an option to continue in a blinded study extension for another 20 weeks. After 50 weeks, the researchers found that steroid-free remission rates in study extension participants were significantly higher in the combination therapy group (72.2 percent) than in the infliximab alone or azathioprine alone groups (60.8 and 54.7 percent, respectively). They also found no significant group differences in the incidence of serious infections.

"Results of this study will provide practitioners and their patients with more clinical data on how to use these drugs most appropriately to most effectively treat Crohn's disease," Sandborn said in a statement. "For the first time, we have longer term outcome data on the advantages of combination therapy that will help guide our treatment of patients with Crohn's disease."

Sandborn reported financial relationships with a variety of pharmaceutical and medical device companies.

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Other research addressed the use of biological agents in patients with hepatitis B or C. "Only one-third to one-half of patients with these diseases respond to current medications," DeLegge said. "A number of studies looked at either newer medications or combinations of medications."

David Oldach, M.D., of Gilead Sciences Inc., and colleagues studied 105 hepatitis B patients who had failed to respond to adefovir, randomly assigning them to either tenofovir alone or tenofovir plus emtricitabine. After 96 weeks, they found that tenofovir alone was associated with a higher rate of viral suppression than combination therapy (89 versus 83 percent).

"Tenofovir disoproxil fumarate has demonstrated consistent efficacy across a broad range of chronic hepatitis B patients, including patients with pre-existing resistance mutations or prior suboptimal response to adefovir dipivoxil, patients with cirrhosis, and patients with any of the major HBV genotypes," Oldach said in a statement. "An additional very promising finding in the registrational trial among HBeAg-positive patients has been hepatitis B surface antigen loss, occurring in 3 percent of tenofovir disoproxil fumarate recipients in one year and 6 percent in two years' time."

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Physician's Briefing