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Digestive Disease Week, May 1-5, 2010

Digestive Disease Week's 2010 Annual Meeting

Digestive Disease Week's 2010 Annual Meeting took place May 1 to 5 in New Orleans and attracted approximately 15,000 attendees from around the world. The conference focused on the latest research in gastroenterology management, endoscopy and surgery, as well as hepatology.

Key highlights included advances in surgical and medical management of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, colorectal cancer, and liver disease. In addition, presentations focused on the incidence of pediatric hepatitis C virus, discovery of a targeted antibiotic for irritable bowel syndrome (IBS), and factors contributing to pediatric IBD.

In an update of the ongoing Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) registry, presented by Uma Mahadevan-Velayos, M.D., of the University of California in San Francisco, researchers found that women prescribed IBD medication during pregnancy may not experience adverse pregnancy outcomes.

The researchers evaluated the impact of IBD medication exposure in utero on newborn development in the first year of life. To date, they have enrolled 605 women, 417 of whom completed their pregnancy. They found that patients exposed to azathioprine or biologics (infliximab, adalimumab or certolizumab) did not have an increased risk of pregnancy-related adverse events; however, there seemed to be a trend toward increased neonatal intensive care unit stays, with a 2.3-fold increased risk among patients exposed to biologics. Mahadevan-Velayos said that, while this risk may be clinically significant, it is not statistically significant. There also appeared to be a trend toward preterm births in those exposed to biologics.

"This study is not only evaluating the safety of drug use in pregnancy in women with IBD, but will also be prospectively following women and offspring after birth for four years. At month nine from birth, we found that offspring whose mothers took azathioprine during pregnancy were at an increased risk of not reaching all developmental milestones. Therefore, pediatricians should understand that these children may be at an increased risk of developmental delay and monitor them closely," Mahadevan-Velayos said.

One author disclosed serving as a consultant and an advisory board member for multiple pharmaceutical companies, including manufacturers of drugs used in this study.

Abstract No. 764

In two separate trials designed by researchers at Cedars-Sinai Medical Center in Los Angeles, researchers demonstrated that rifaximin not only provides relief of IBS symptoms while patients are taking the drug but continues do so for an extended period after they stop taking it.

The researchers randomized more than 1,200 IBS patients with mild to moderate diarrhea and bloating to 550 mg of rifaximin or placebo three times a day for two weeks, and then followed them for an additional 10 weeks. Rifaximin provided relief of IBS symptoms including bloating and abdominal pain while patients were taking the drug and over the 10-week follow-up period. The results of the study provided further evidence suggesting IBS may be caused by an overgrowth of bacteria in the gut.

The study was funded by Salix Pharmaceuticals Inc., the company that markets rifaximin. One author disclosed financial ties to the company. The same author discovered the use of rifaximin for IBS, and Cedars-Sinai Medical Center holds the patent rights to this discovery, which it has licensed to Salix.

Abstract No. 475i

In a study presented by Souradet Y. Shaw, M.D., of the University of Manitoba in Winnipeg, Canada, researchers found that infants prescribed antibiotics in the first year of life may be more likely to develop pediatric IBD than those not exposed to antibiotics.

The researchers identified children younger than 11 years of age diagnosed with IBD between fiscal year 1996/97 and 2006/07 using the University of Manitoba IBD Epidemiological Database. They found an association between antibiotic prescriptions in the first year of life and pediatric IBD, with the association only statistically significant in male patients. In addition, the most common reason for physician visits for those receiving antibiotics was otitis media.

"Much more work needs to be done by our research group, and others, to make a convincing case that: first, the link between antibiotic use and pediatric IBD is not a spurious one. Secondly, if this link were proven to be robust, other types of studies need to be conducted to prove causality, if it exists," Shaw said.

Abstract No. 95

In another study, Gregory W. Munson, M.D., and Dawn L. Francis, M.D., of the Mayo Clinic in Rochester, Minn., found that the polyp detection rate does not decrease throughout the day among endoscopists who work a shorter daily work shift schedule.

Scheduling for outpatient colonoscopies among endoscopists at the Mayo Clinic includes three three-hour shifts per day. The researchers showed that, during the early shift, the polyp detection rate was 39.1 percent, with the rate at 44.6 percent during the midday shift, and 38.9 percent during the late shift.

"Our endoscopists usually work only one three-hour shift per day rather than a half or full day of endoscopy," Francis said in a statement. "With shorter shifts throughout the day, we don't see the drop in polyp detection rate later in the day that has previously been reported. Other health care facilities might also want to consider a model that breaks up the day into three-hour shifts."

Abstract No. M1063

Andrew Hart, M.D., of the University of East Anglia's School of Medicine in Norwich, U.K., and colleagues showed that a diet high in foods such as olive and grape seed oils, which contain oleic acid, may protect against the development of ulcerative colitis.

The researchers evaluated 25,639 individuals, aged 40 to 74 years, recruited between 1993 and 1997. At the start of the study, none of the participants presented with ulcerative colitis; however, after a median follow-up of 3.9 years, 22 had developed the disease (45 percent women). The researchers found that individuals with the highest intake of oleic acid were 90 percent less likely to develop ulcerative colitis.

"Oleic acid seems to help prevent the development of ulcerative colitis by blocking chemicals in the bowel that aggravate the inflammation found in the illness," Hart said in a statement. "We estimate that around half the cases of ulcerative colitis could be prevented if larger amounts of oleic acid were consumed. Two-to-three tablespoons of olive oil per day would have a protective effect."

Abstract No. 100

DDW: Regular Aspirin Use May Up Crohn's Disease Risk

TUESDAY, May 4 (HealthDay News) -- People who take aspirin regularly for at least a year may have a substantially increased risk of developing Crohn's disease, according to research presented at Digestive Disease Week 2010, held from May 1 to 5 in New Orleans.

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DDW: Anti-Reflux Drugs Linked to Cardiac Birth Defects

TUESDAY, May 4 (HealthDay News) -- The use of proton pump inhibitors (PPIs) for gastroesophageal reflux disease during pregnancy may be associated with cardiac birth defects, according to research presented at Digestive Disease Week 2010, held from May 1 to 5 in New Orleans.

Abstract No. 475b
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DDW: Physicians Often Treat IBS With Narcotics

MONDAY, May 3 (HealthDay News) -- Practicing physicians often treat patients with irritable bowel syndrome (IBS) with narcotics despite the potential for harmful long-term effects, and use of narcotics in these patients is associated with several factors, according to research presented at Digestive Disease Week 2010, held from May 1 to 5 in New Orleans.

Abstract No. W1378
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DDW: Fewer Child Hepatitis C Cases ID'd Than Expected

MONDAY, May 3 (HealthDay News) -- The number of reported pediatric hepatitis C virus (HCV) cases in Florida is substantially lower than expected, pointing to inadequate identification and suggesting that the percentage of children receiving appropriate care for the condition is low, according to research presented at Digestive Disease Week 2010, held from May 1 to 5 in New Orleans.

Abstract No. 232
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