A welcome return to Cork for the ISG

Prof Orla Crosbie, President of the Irish Society of Gastroenterology, speaks to Catherine Reilly about the impressive programme for its upcoming Summer Meeting

The return of the Irish Society of Gastroenterology (ISG) to Cork after a long hiatus will be a proud moment for President Prof Orla Crosbie, a Consultant Hepatologist at Cork University Hospital (CUH).

Prof Crosbie believes the Summer Meeting on 23-24 May will be the first ISG national conference to be held on the Leeside in 30 years.

“In 1994 the late and great Prof Gerry O’Sullivan held it in Cork, and I believe this is the first time it has returned to Cork since then… it means so much to me,” the native Corkonian told the Medical Independent.

Talent

The meeting agenda includes presentations from an array of talented clinicians and scientists from home and abroad.

Prof Crosbie said there is a nice blend of traditional and emerging topics covered in the abstracts, such as the use of digital information to help improve patient care, and artificial intelligence in endoscopy.

An intern at CUH, Dr Lucy Mason, will present on social media misinformation in regard to diets for people with inflammatory bowel disease (IBD).

“She has an excellent oral abstract on that,” noted Prof Crosbie, who said it would be instructive to hear about these  newer trends and developments.

Simulation and patient safety; the microbiome; IBD; and the health consequences of alcohol misuse, will be the themes discussed by the distinguished speakers at the conference.

Dr Manmeet Matharoo, Consultant Gastroenterologist, St Mark’s Hospital and Academic Institute, London, UK, will present on patient safety in endoscopy.

Prof Crosbie said Dr Matharoo has widely published on patient safety in endoscopy and the use of simulation for team training and she looked forward to her insights.

“This will be followed very nicely by Prof Glen Doherty [Consultant Gastroenterologist, St Vincent’s University Hospital, Dublin], who is the national lead for endoscopy training in Ireland,” continued Prof Crosbie. “He will tell us about the simulation workshops that himself and his colleagues have done throughout the year and where we are in endoscopy with regards to simulation training, because I think this is something that is certainly going to evolve over the next number of years.”

Dr Vishal Patel, Consultant Hepatologist, King’s College Hospital, London, UK, will discuss ‘The role of the ‘oral-gut-liver axis’ in cirrhosis: Challenges of antimicrobial resistance and opportunities for novel therapeutics’.

Dr Patel will outline how the microbiome can influence liver disease. People with liver disease are prone to infections which are often associated with significant mortality. Dr Patel’s group in Kings College Hospital are looking at ways to improve patient care by means of new therapeutic interventions.

This will be followed by a presentation on ‘Faecal microbiota transplantation in different clinical conditions: Ecological and mechanistic considerations’ by Prof Jens Walter, Professor of Ecology, Food, and the Microbiome, School of Microbiology, University College Cork (UCC) and APC Microbiome Ireland.

“He is looking at how the microbiome has evolved, how that has influenced the gut, and the [work of APC] is to then look at how that can be translated into therapeutics and nutritional dietetic advice for both normal and disease states,” outlined Prof Crosbie.

IBD

The final presentation on the opening day will focus on IBD. Prof Subrata Ghosh, Chair and Head of the Department of Medicine, UCC, will discuss evolving concepts of mucosal healing as a target in IBD.

Prof Crosbie said Prof Ghosh is “a world expert on IBD”.  She noted that clinicians in IBD are looking for more accurate, more high-calibre markers for how a patient is doing. Mucosal healing on endoscopy is an important prognostic factor in the management of IBD and this area will be the focus of Prof Ghosh’s presentation.

IBD care will remain under the spotlight the following morning, when Prof Laurent Peyrin-Biroulet, Consultant Gastroenterologist, Lorraine University, France, will present on IL-23 antagonists in IBD.

IL-23 antagonists are a newer addition to the range of treatments used in IBD and Prof Peyrin-Biroulet will discuss their role in patient care.

Alcohol misuse

Thereafter, the conference will place special focus on alcohol misuse and its health consequences through a series of presentations and a panel discussion.

“It took a long time in Ireland for the Public Health (Alcohol) Act to get across the line and now we have achieved that,” noted Prof Crosbie.

“Scotland was a little bit ahead of us and that is why we invited Prof Alastair MacGilchrist [Chair, Scottish Health Action on Alcohol Problems] to talk about their experience – ie, have things like the minimum unit pricing and all the other parts of the [Scottish measures] had an influence on the number of alcohol-related problems and deaths… and I do believe they have seen a change in Scotland. We are hoping to get encouragement from him as to the effects they have seen. He is a consultant hepatologist and will be coming at it from a similar angle to ourselves.”

Preceding Prof MacGilchrist is an important presentation on ‘Liver transplant for alcohol-related liver disease (ARLD) in Ireland: What’s new in 2024’ from Dr Audrey Dillon, Consultant Hepatologist, St Vincent’s University Hospital, Dublin.

Prof Crosbie said Dr Dillon will discuss a potential change to the criteria for considering liver transplantation for people with acute alcohol-related hepatitis.

In Ireland, and at many centres internationally, a six-month period of abstinence from alcohol is part of the criteria for listing people with ARLD for transplant (as well as providing time for potential improvement in hepatic function, the six-month requirement is broadly used as a surrogate marker for predictability of alcohol relapse post-transplantation, although is not a reliable predictor of long-term abstinence).

However, patients who present to liver services due to acute alcohol-related hepatitis may not survive for six months without receiving a transplant. Some studies have demonstrated positive outcomes for carefully selected patients with acute alcohol-related hepatitis who are offered early liver transplantation. Internationally, some centres have changed their approach on the six-month abstinence requirement.

If such an approach is adopted, Prof Crosbie said a very careful selection process according to set criteria would be required.

During the oral abstract presentations on Thursday, Dr Matthew McKenna-Barry (St Vincent’s University Hospital) will present the results of a national point-in-time survey he conducted on management of alcohol-related hepatitis.

The results have indicated that the number of patients with alcohol-related hepatitis who may be  suitable for consideration for transplantation is very small.

Prof Crosbie said the number of people who may be transplanted for this condition per annum would be in single figures if the change is adopted. She said delegates will be keen to hear from Prof Michael Curry about the experience at Beth Israel Deaconess Medical Centre, Boston, US. Prof Curry, who is the hospital’s Director of Hepatology, will speak on ‘Dismantling the barriers to early transplantation for ARLD’.

Prof Crosbie said she expected this topic will generate “a lot of debate” among delegates. A panel discussion will be co-chaired by two experienced clinicians – Prof Garry Courtney, Consultant Gastroenterologist and Clinical Director, St Luke’s Hospital, Kilkenny; and Prof Anthony O’Connor, Consultant Gastroenterologist and Clinical Lead, Department of Gastroenterology, Tallaght University Hospital, Dublin. 

Prof Crosbie said she is greatly looking forward to the meeting and extended her thanks to all who have contributed to its organisation.

Hepatology services

Meanwhile, Prof Crosbie spoke enthusiastically about progress made in supporting the hepatology workforce in Ireland. Until recent years, for example, Prof Crosbie was the sole appointed consultant hepatologist at CUH, which is the only tertiary referral centre for liver disease outside of Dublin in the Munster area. She has since been joined by two consultant colleagues. Provision of funding for advanced nurse practitioners (ANPs) at hepatology units is another recent development. CUH will be appointing an ANP in hepatology shortly.

“We are as busy as ever, but we are now able to organise our services better,” said Prof Crosbie. “I do think it is a very exciting time for hepatology and an awful lot has happened that I never thought would happen. I mean, 10 years ago, if you’d asked me if we’d have [the role of] an advanced nurse practitioner in hepatology and that I would have two colleagues apart from myself… it is fantastic, it really is.”

The establishment of a hepatology training stream as part of general gastroenterology training is another positive recent development. Year-four trainees can now opt to train in hepatology as a pathway to specialising in the area.

Prof Crosbie said these developments are focused on ensuring the required skillsets are in place to meet current and future patient needs.

ISG Summer Meeting 2024 – Conference Programme