The American College of Gastroenterology's 75th Annual Scientific Meeting
The American College of Gastroenterology's 75th Annual Scientific Meeting took place Oct. 15 to 20 in San Antonio and attracted approximately 4,000 participants from around the world. The conference highlighted advances in the management of patients with gastrointestinal disorders, with presentations focusing on the diagnosis, prevention, and treatment of colorectal cancer, esophageal disorders, bowel disorders, liver disease, as well as pancreatic and biliary conditions.
In a prospective study, Bincy Abraham, M.D., and Hoda Malaty, M.D., of the Baylor College of Medicine in Houston, found that inflammatory bowel disease (IBD) and vitamin D deficiency was associated with abnormal bone density.
"We found a reduction in bone density with a diagnosis of either osteopenia or osteoporosis in 22 percent of patients, of whom 50 percent were below the age of 40. Of those with abnormal bone density, 40 percent had vitamin D deficiency versus only 1 percent that had normal vitamin D levels. This association persisted after adjusting for confounding factors such as age, gender, and corticosteroid use," Abraham said.
The investigators evaluated 161 patients aged 10 to 70 years, between 2008 and 2010, who were diagnosed with IBD based on clinical, radiologic, endoscopic, and histological data.
"IBD patients with vitamin D deficiency were nine times more likely to have abnormal bone density scans than those with normal levels of the vitamin," Abraham added. "Practicing clinicians should check vitamin D levels in IBD patients, as patients with vitamin D deficiency are more likely to have osteoporosis or osteopenia on bone density scan."
During the meeting, the American College of Gastroenterology held a press briefing highlighting a series of studies focusing on increasing rates of Clostridium difficile (C. difficile) infection as well as advances in the prevention and management of the infection. During the press briefing, Mark Mellow, M.D., of the INTEGRIS Digestive Health Center in Oklahoma City, discussed a new approach for the treatment of recurrent C. difficile infection and found that colonoscopic fecal bacteriotherapy was an effective treatment approach for patients with recurrent or refractory disease. The approach involved removing fecal matter from a healthy individual, liquefying it, and infusing it into the colon of an individual with recurrent or refractory C. difficile infection during colonoscopy.
The investigators treated 13 patients (six females and seven males), aged 32 to 87 years, with colonoscopic fecal bacteriotherapy between July 2009 and April 2010. During a follow-up of five months, the investigators found that nearly all patients experienced resolution of diarrhea, with a success rate of 92 percent.
"What impressed me was that most patients had experienced at least four episodes of the infection that lasted an average of 11.5 months and continuously relapsed and these patients did well with this approach," Mellow said.
During another presentation, Douglas A. Drossman, M.D., of the University of North Carolina at Chapel Hill, provided an overview of the role of abuse history in gastrointestinal disorders and symptom exacerbation and discussed the underlying mechanisms for this association. In addition, the presentation provided recommendations for clinical practice management. Overall, abuse history appears to be highly prevalent in patients with gastrointestinal symptoms, particularly in patients with functional gastrointestinal diagnoses experiencing severe symptoms; this history may impact clinical care approaches.
"It seems that there is an abnormality in the functioning of areas of the brain that modulate pain and emotion and this leads to more severe pain symptoms," Drossman said. "There is growing evidence that centrally-targeted interventions, including antidepressants and behavioral treatments, may have palliative effects on reducing symptoms, altering brain-gut dysregulation and structure and improving the clinical outcome among these patients."
Drossman concluded that practicing clinicians need to understand the association between the brain and gut and how to inquire about abuse history and how to provide directed care, particularly for patients with more severe gastrointestinal symptoms.
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