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Taking gastroenterology to the next level

Prof Padraic MacMathuna, Consultant Gastroenterologist in the Mater Hospital, Dublin, became the President of the Irish Society of Gastroenterology (ISG) in June. The ISG Winter Scientific Meeting, which takes place on November 19 and 20 in the Killiney Castle in Dublin, is one Prof MacMathuna is very much anticipating, marking as it does the first meeting he has helped organise as President. Speaking to the Medical Independent, Prof MacMathuna says it is an honour to follow so many illustrious occupants of the role, including his direct predecessor Prof Humphrey O’Connor.

“Humphrey did a great job,” Prof MacMathuna says.

“During his term, the number of topics and international speakers significantly increased. The numbers of specialised teaching sessions also increased during his term. I think that was a positive innovation. The administration that supported Humphrey is very strong and robust so he has left the Society in good order and I am delighted to take over.”

The role of the President encompasses responsibility for helping organise meetings, such as this weekend’s Winter Meeting, as well as highlighting issues that are relevant to the profession with stakeholders such as the Department of Health, HSE and training bodies. For Prof MacMathuna, the responsibilities of the President in terms of advocacy can be broken into three main areas.

“One is highlighting the innovations and the new research that is going into patient care, and being an advocate for these new treatments,” he says.

“I think the second would be issues about training. There is training representation in the Society so that the training and liaising within the College of Physicians [RCPI] is promoted to the highest level. That dovetails with having an advocacy role for manpower in terms of promoting more gastroenterologists and GI specialists in the country. The training and the manpower issues are part and parcel of the same agenda. The other issue is, in terms of advocacy to the public, highlighting the importance of the colorectal cancer screening programme, for instance, and any other public health measures that are important in terms of disease control.”

Public component

Communication with the public will be improved with the unveiling of a new website for the Society, even if the site will primarily cater for members. The website, which is expected to be live by next spring, will cover areas such as registration and payment. There will be sections for abstract submissions, archives of meetings, links to appropriate medical and scientific meetings or journals, and general updates for the profession.

“It will have a public component,” Prof MacMathuna says.

“There will be specific drop-down menus and access for members and then there will be ones that will be highlighting health information for the public, something along the lines of dietary advice or new medications or cancer prevention. The preliminary designs are very attractive and it looks like a very user-friendly interface.”

Another issue, which Prof MacMathuna argues is important for gastroenterologists and the ISG to advocate on, is the area of nutrition. He points out that there is a nutritional structure within the overall operations of the ISG.

“That is obviously important in terms of promoting healthy eating, and also criticising and taking to task what we would regard as inappropriate advice about diets and food supplements that don’t have any evidence or scientific basis, and I think it is part of the role to be proactive that way.”

Clinical programme

The development of a HSE clinical programme for gastroenterology is also a central aim of the Society. Prof MacMathuna says it is hoped that the creation of an endoscopy clinical programme will eventually evolve into a clinical programme for the speciality as a whole.

“I think the HSE recognises the importance of it and the ISG is very keen to be proactive in promoting that in the coming year or so,” according to Prof MacMathuna.

“It will obviously address issues about endoscopy and colonoscopy standards in particular, in colorectal cancer pathways of treatment. And I think it will help standardise treatment and make the standards uniformly excellent throughout the country. There are several quality assurance programmes now that have been incorporated within the HSE, so the ISG is working closely with the HSE in that regard.”

‘Most people with colorectal cancer don’t have a gene so we can’t identify it. But gradually, the number of people we are finding with a genetic basis is increasing, so it is something to be aware of’  

A clinical lead for the endoscopy programme is currently being sought and Prof MacMathuna hopes the appointment will be made within the next six months.

“We are working closely with the HSE to identify a clinical lead in endoscopy and that in turn will translate into a more comprehensive gastroenterology programme. It has not been put on the long finger. I think funding is available, so it is question of identifying a good, experienced clinician who would be able to take this on and run with it.”

Recruitment of consultants in the HSE has proved a problem, not just for gastroenterology, but for the medical profession in general. Prof MacMathuna believes it is vital this problem is dealt with for the sake of the future of the specialty and for patients.

“There is the generic issue of recruitment, regardless of speciality, and that has become more challenging in the economic climate and many of the posts are more attractive abroad,” according to Prof MacMathuna.

“Within GI specifically, that is part of the general recruitment problem and that comes back to remuneration and terms and conditions that are maybe more attractive for people abroad. Obviously, the ISG does not set the pay rates but the Society would be in favour of recruiting more fully-trained gastroenterologists to provide the service, because the wait times for colonoscopy and other interventions are unacceptably long in many places, so you need more skilled people to do it. The Government initiative in terms of making jobs more attractive through changes in pay scales and conditions for gastroenterologists are the same for the other consultants, so it is not specific for GI doctors, but we would support anything that improves the recruitment in terms of pay and conditions for consultants within the Irish system.”

Winter Meeting

In terms of the upcoming Winter Meeting, Prof MacMathuna points to a packed and exciting programme.

“We are having more oral sessions for the local investigators and the trainee GIs and scientists. I think that is important,” he says.

“We are encouraging more presentations of clinical and laboratory research.”

Sessions will also be devoted to comprehensive presentations about acute colitis, endoscopy, obesity and digestive disease and colorectal cancer genetics.

The first session will be on controversies in the management of acute ulcerative colitis and will feature presentations from Dr David Kevans, Consultant Gastroenterologist, St James’s Hospital, Dublin, and Mr Sean Martin, Consultant Colorectal Surgeon, St Vincent’s University Hospital, Dublin.

Prof MacMathuna explains that the session promises to shed light on an interesting area.

“Part of the controversy is that when people are acutely ill, it is often unclear when surgery should be performed,” he says.

“There is also a whole new range of biologic treatments. They are expensive but they have transformed the treatment of inflammatory bowel disease, colitis and Crohn’s disease. The optimum use of those treatments in the acutely sick patient is a matter for discussion.”

The next session is entitled ‘endoscopy: management of complex screen-detected lesions — an emerging challenge’. Presentations on the subject will be delivered by Prof Ronan Cahill, Professor of Surgery, UCD, and Consultant Surgeon, the Mater Hospital, Dublin; Prof Kieran Sheahan, Consultant Histopathologist, St Vincent’s University Hospital, Dublin; and Prof Matt Rutter, Consultant Gastroenterologist, Durham University, UK.

“On the one hand, there are simple polyps that can taken out, but we are now seeing much larger ones,” according to Prof MacMathuna.

“And we are finding them now before they develop into cancer. Historically, they would have gone on to cancer and then the patient would have had surgery. But there are now more advanced colonoscopy techniques that can be used and there is more advanced minimally-invasive surgery, which will be discussed during the session.”

Prof Stephen O’Rahilly, Co-Director of the Institute of Metabolic Science, and Director, University of Cambridge Metabolic Research, UK, and Prof Chris Day, Pro Vice-Chancellor for the Faculty of Medical Sciences in Newcastle University, UK, and Consultant Hepatologist, will give presentations on ‘obesity and digestive disease’.

“Obesity is having an impact on mortality across the board,” Prof MacMathuna says.

“It causes cardiovascular issues, it increases your risk of cancer, including digestive disease cancers in the liver, it increases the rate of cirrhosis and it is one of indications for liver transplants. So it has direct bearing on our speciality.”

The final session is on colorectal cancer genetics and it will be delivered by Prof Gareth Evans, Professor of Medical Genetics and Cancer Epidemiology in the University of Manchester, UK.

“Most people with colorectal cancer don’t have a gene so we can’t identify it,” Prof MacMathuna explains.

“But, gradually, the number of people we are finding with a genetic basis is increasing, so it is something to be aware of. It is tightening the profile because you can do tests on people who apparently have sporadic cancer and a percentage of these people will be found to have a specific genetic mutation that may not influence how they are dealt with but could mean it is important to target their family members.”

Prof MacMathuna says it is important to recognise the support of the pharmaceutical industry to the Society’s meetings because they subsidise the travelling international speakers and provide prize money for the trainees. He also wanted to thank the administrators for their hard work in organising this weekend’s event.

“I am looking forward to it,” says  Prof MacMathuna.

“The feedback to date has been good. There have been a lot of abstract submissions, more than usual, which is encouraging.

“So we are looking forward to it having a good turnout and being successful.”

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