‘Gastro’ congress spotlights advances

Not every day is one presented with a chance to walk through an inflatable replica of the human colon showing various stages of colorectal cancer and other diseases of the large intestine. Taking advantage of the opportunity, at GASTRO 2009, was compelling for some. The presence of the replica gut was significant – for the event was designed to reach beyond the clinical community to the general population. The Inflatable Colon, from the Digestive Cancers Consultancy, can be used to break down taboos surrounding colorectal cancer, increase knowledge about this cancer and its prevention, and promote early diagnosis. Professor Chris Hawkey, president of the British Society of Gastroenterology, stressed to The Clinical Services Journal the importance of presenting scientific data publicly to patient groups, and drew attention to how GASTRO 2009’s patient symposium had provided information for, and involvement with, individuals with chronic gut conditions such as coeliac disease, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). About 350 people – patients and patients’ relatives – attended the event which involved UK patient organisations Coeliac UK, The Gut Trust and the National Association for Colitis and Crohn’s Disease.

 An information and discussion platform created for patients was “long overdue in GI meetings”, Prof. Hawkey said, adding that the initiative was to be followed up by the British Society of Gastroenterology at its next annual meeting which will be held in Liverpool in March and feature a professional and public symposium. Prof. Hawkey pointed to the strong growth in interest in stem cell transplantation, and to how some of the latest research results appeared extremely promising. Presented at the congress was a paper concerning a study into whether or not autologous stem cell transplantation improved the clinical course in patients with refractory coeliac disease type 2.2 Autologous haematopoietic stem cell transplantation (aSCT) is an increasingly accepted treatment for different refractory autoimmune diseases. Although it seems to be feasible and safe for refractory coeliac disease (RCD) type 2 based on short-term follow-up, it has not yet been evaluated properly. RCD is seen in the 2% to 5% of the adult-onset coeliac disease patients who fail to respond to a strict gluten-free diet. In contrast to RCD type 1, type 2 is characterised by an immunophenotypically aberrant intraepithelial T cell population, which might be causative in 60% to 80% for transition in enteropathy associated T cell lymphoma (EATL) having a very poor prognosis. For RCD type 2, no standardised treatment approach is yet available.

Between March 2004 and January 2009, 14 RCD type 2 patients unresponsive to cladribine treatment were evaluated for aSCT preceded by conditioning with fludarabine and melphalan. Patients were monitored for survival rate, EATL development, and change in clinical and histological course during follow up. It was concluded that aSCT, after conditioning with fludarabine and melphalan, appeared to be extremely promising for patients with RCD type 2. Shown for the patients given transplantation was a “tremendous” improvement in survival, less EATL development, and, in more than 50% of the cases, improvement in clinical and histological course. Prof. Hawkey said the bowel screening programme in the UK was, encouragingly, starting to deliver improvement in early diagnosis of bowel cancer, adding: “We have to develop less and less instrusive approaches to resection.” Involved in this would be advances in endoscopy, minimally invasive surgery and robotics that would facilitate the practising of “precise medicine”. New European guidelines have been formulated to assist with the standardisation of bowel cancer screening, and this will make it possible to detect the disease at an extremely early stage in many cases and to significantly improve prospects of recovery by initiating prompt treatment, Professor Colm O’Morain, of Tallaght Hospital/Trinity College, Dublin, said. The guidelines have been developed by a pan-European network of over 100 experts co-ordinated by the International Agency for Research on Cancer. After lung cancer, colorectal cancer is the second most common cancer in the EU. Nineteen EU member states already operate national programmes for bowel cancer screening. Faecal occult blood testing (FOBT) and colonoscopy were two methods of screening whose effectiveness has been scientifically proven, Prof. O’Morain said. Although the EU Council currently recommends only FOBT for widespread screening, several EU member states have already introduced programmes for countrywide colonoscopy. In Germany, for example, people with statutory medical insurance can take advantage of FOBT once a year from the age of 50, and have two colonoscopies at an interval of 10 years from the age of 55. Similar initiatives have been introduced, for example, in Italy, France and the Netherlands.