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A BIG event in gastroenterology

The British and Irish Gastroenterology (BIG) meeting, which takes place this week in Belfast, will see a comprehensive programme of presentations and discussions relevant to the specialty.

This meeting represents the second time that the Ulster Society of Gastroenterology (USG), Irish Society of Gastroenterology (ISG) and British Society of Gastroenterology (BSG) have collaborated on a combined conference programme.

Speaking to the Medical Independent (MI) in advance of the meeting, ISG President Prof Padraic MacMathuna outlined the positives of the three societies coming together periodically in this fashion. “Since many of the people know each other, and have worked with each other, I think it is helpful in terms of identifying common clinical priorities… It also has a social aspect where trainees can meet individuals and cross-fertilise, and a lot of these international meetings are forums for people to have informal interviews and make contacts for further training.”

One of the most topical subjects for discussion will be the epidemic of liver disease, both alcohol- and non-alcohol-related. Northern Ireland Chief Medical Officer Dr Michael McBride will present on the issue, followed by a panel discussion involving Prof MacMathuna; BSG President Prof Martin Lombard; Dr Stephen Stewart, Consultant Hepatologist at the Mater University Misericordiae Hospital, Dublin; and RCPI President Prof Frank Murray. A vocal supporter of the Public Health (Alcohol) Bill, Prof Murray has prominently raised in the media the increasing incidence of alcohol-related liver disease, especially among women.

Unit pricing, health campaigns and rising presentations to acute services with alcohol-related end-organ damage across Britain and Ireland will be up for discussion.

In addition, the increasing incidence of non-alcoholic fatty liver disease, which is strongly associated with metabolic syndrome, will also come into sharp focus.

“[Non-alcoholic fatty liver disease] is probably the commonest cause of raised liver blood tests in people who are generally well and it can be the indication for referring people to hospital. The second thing is that it is very common because of what is called the metabolic syndrome… high cholesterol, hyperlipidaemia, type 2 diabetes, obesity — it is part of the obesity spectrum and therefore, because obesity has become a big public health issue, fatty liver is becoming more problematic.”

Non-alcoholic fatty liver disease does not commonly lead to cirrhosis and the predominant clinical problem is one of cardiovascular disease, noted Prof MacMathuna. “And then a percentage of individuals will go on to get more severe liver disease as the dominant problem, and in the States it is one of the major indications for transplantation now.”

Prof MacMathuna said that further fibroscanning in the community would help reduce referrals to hospital liver units that may not be necessary. “There is a specific pattern — that it is frequently associated with hyperlipidaemia, it is frequently associated with type 2 diabetes and people who are overweight, so in that context, referral to a liver centre would be unnecessary in the majority of individuals, and I think that is an educational process [that is required] within the medical community.”

Another key item on the meeting agenda will be an update on the five nations’ experience of bowel cancer screening. This presentation will be delivered by surgeon Prof Robert Steele, who is based at Ninewells Hospital and Medical School, Dundee, Scotland. Prof Steele is also Director of the Scottish Colorectal Cancer Screening Programme.

“Screening is up-and-running now in England, Wales, Scotland and in Ireland, north and south. We in the Republic were the last to take it up. We felt it was a good theme — to review the experience of Britain and Ireland in terms of its impact on colorectal cancer, and so, looking at the targets and how well it is functioning, and the uptake. Bob Steele is a surgeon in Scotland who is one of the major UK players and he is bringing the data together,” said Prof MacMathuna.

The HSE has acknowledged that the percentage of the eligible population (people aged 60-to-69 years) who participate in BowelScreen after receiving the letter of invitation is currently low, at 40.2 per cent. 

“I think there is a job of work to be done in terms of public relations and public health measures,” said Prof MacMathuna. “I think the data in terms of our KPIs, in terms of once people come to colonoscopy, are pretty good and meet international standards, but it is getting more people to be compliant with the system in the first place… ”

The target age group is meant to be the 55-to-74 years cohort. “Now, there wasn’t the facilities to deal with that, so that is why it has been a 60-to-69 window, which is maintained at the moment but the idea is to expand it further as the facilities increase. I think it was a wise decision, because if you started with a 20-year window, you would have too many patients coming for colonoscopy and the system wouldn’t be able to cope, because we have to deal with symptomatic patients as well.” More awareness-raising on BowelScreen is required among the 60-to-69 age group, as well as funding to meet the subsequent higher uptake of colonoscopy, advised Prof MacMathuna.

As always at gastroenterology meetings, treatment and management of inflammatory bowel disease (IBD) will be one of the major focus areas. Contributions will include ‘Accelerated dosing of infliximab for acute, severe UC’ (Dr David Kevans, St James’s Hospital, Dublin); ‘New drugs in IBD for the clinic’ (Prof Larry Egan, NUI Galway); and ‘How should we optimally manage postoperative Crohn’s disease?’ (Prof Jack Satsangi, Edinburgh, Scotland), among other IBD-related presentations.

“It is always a big topic in gastroenterology and I suppose the biggest innovation and advance has been the development of biologics treatments. So there are going to be critical reviews of that, because there is much more available now across the spectrum — there are more of these available and there is competition in terms of pricing… which is important, because they are expensive drugs. There is always an element of, where is it appropriate to start, what compound to use, what is the patient selection and how long do you use it for?”

Prof MacMathuna said that increasingly, with further experience, gastroenterologists are developing a more open mind to biosimilars.

Summarising, Prof MacMathuna said the programme is “interesting and topical”, with leading national and internationally-based speakers. He noted that former Professor of Medicine in University College Cork, Prof Eamonn Quigley, would be making a return to the island to present on testing for functional gut disorders. Prof Quigley, who is based in Houston, Texas, is a major name in the area of irritable bowel syndrome (IBS). Also of note is the return to these shores of BSG President Prof Lombard, an Irishman who trained in gastroenterology at the Mater Hospital in Dublin.

Prof MacMathuna also referenced the hard work of local organisers Dr Paddy Allen and Dr Jenny Addley. While the three societies have been involved in organising the meeting, “the ‘heavy lifting’ has been done by our Belfast colleagues, which I think needs to be acknowledged”.

#BIG2017

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