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American College of Gastroenterology, Oct. 3-8, 2008

American College of Gastroenterology 73rd Annual Scientific Meeting

The American College of Gastroenterology's 73rd Annual Scientific Meeting took place Oct. 3 to 8 in Orlando, Fla., and attracted attendees from its membership of 10,000 professionals in 80 countries. Highlights included an important advance in the treatment of Crohn's disease, a symposium on the management of irritable bowel syndrome, and multiple presentations on the association between obesity and gastrointestinal disorders.

"One of the most substantial pieces of news to come from the meeting was the SONIC trial (Phase 3b Study of Patients with Crohn's Disease Naive to Immunomodulators and Biologic Therapy)," said Amy Foxx-Orenstein, D.O., of the Mayo Clinic in Rochester, Minn., and immediate past president of the American College of Gastroenterology. "It's very exciting. The results have the potential to change the treatment paradigm for Crohn's disease."

Presented by William Sandborn, M.D., of the Mayo Clinic, and sponsored by Centacor, Inc., the trial randomly assigned 508 patients to receive either infliximab in combination with azathioprine, infliximab alone, or azathioprine alone. The researchers found that steroid-free remissions were achieved by 57 percent of the combination therapy group and 44 percent of those treated with infliximab alone compared to 30 percent of those treated with azathioprine alone. They also found that 61 percent of the combination therapy group achieved complete mucosal healing.

"Historically, patients with Crohn's disease have been treated sequentially with steroids, then azathioprine, then monoclonal antibodies such as infliximab," Sandborn said in a statement. "This study definitively demonstrates that infliximab-based strategies are more effective than azathioprine. Clinicians should consider a shift in practice to incorporate this new data."

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Another highlight included the symposium "Functional GI Disorders: Latest in Probiotics, Antibiotics, New Tests & ACGs Evidence-Based Approach to IBS," which featured William Chey, M.D., and Philip M. Schoenfeld, of the University of Michigan; and Nicholas Talley, M.D., of the Mayo Clinic in Jacksonville, Fla. The symposium addressed the American College of Gastroenterology's soon-to-be released systematic review of the management of irritable bowel syndrome, which will update a 2002 monograph based on data from North America with new data from worldwide research. "It will provide doctors and patients with a lot of information on useful therapies, including fiber, anti-spasmodics, antibiotics, probiotics and serotonin-modulating agents," Foxx-Orenstein said.

Several studies presented at the conference addressed the safety and efficacy of probiotics in the treatment of irritable bowel syndrome. Among them was a review of 19 randomized controlled trials involving 1,628 patients presented by Paul Moayyedi, M.D., of the Mayo Clinic. "Probiotics are effective in IBS, but we do not have enough information to be sure whether there is one probiotic that is particularly effective or whether combinations of probiotics are required," Moayyedi said in a statement.

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One of the over-arching themes of the conference was obesity and its association with gastrointestinal disorders. "We highlighted obesity because we recognized that gastroenterologists need to be involved in a big way," Foxx-Orenstein said. "New data shows that obesity significantly increases the risk of conditions such as GERD, esophageal cancer, precancerous polyps and colorectal cancer."

During her presidential address, Foxx-Orenstein talked about the College's "Obesity Initiative" and "Obesity Summit," which recommended changes in three areas: nutrition, physical activity, and to the health care system.

"The College saw a pressing need for physician leadership in the health crisis of obesity," Foxx-Orenstein said. "The magnitude of the obesity epidemic and an escalating awareness of obesity-related GI health risks along with our new understanding of the role of intestinal microorganisms in metabolism and the role of gut hormones in appetite regulation warranted a call to action."

Obesity-related lectures and symposia at the conference presented recent advances addressing the mechanisms of weight gain and offered strategies for managing obesity and its complications.

"The role of the GI specialist in managing obesity-related complications of GI disorders is expanding," Foxx-Orenstein said. "GI [specialists] must engage in efforts to refine existing approaches to care, improve management of associated complications and define new treatment options. Key to this is a new focus on research, keeping up on new discoveries in the field including rapid advances in endoscopic intervention. Gastroenterologists must take a lead role in managing this condition, including through an emphasis on prevention, as well as the related GI disorders."

Many of the new educational materials developed by the College's Task Force on Obesity were available at the conference, including a comprehensive physician resource guide.

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Physician's Briefing