Highlights from the “First Annual” GI CME Event, 7/28/18

Though certainly not the first in the history of the division, Saturday’s Update in Gastroenterology, Hepatology and Endoscopy event was the first Continuing Medical Education event for the Division of Gastroenterology and Hepatology in more than a decade. That was more than enough time to merit the “First Annual” addition to the day-long conference’s title.

Course Directors Drs. Benjamin Alsop, Alan Gunderson, and Mariam Naveed grouped the day’s 12 presentations according to four different categories. They scheduled three half-hour presentations, followed by a fifteen-minute open-forum for questions to all three speakers and a brief break.

Session 1: General Gastrointestinal Disease

After an introduction from Dr. Gunderson, the day began with a presentation from Dr. Adrian Holm on questions surrounding the use of proton pump inhibitors (PPIs), which reduce stomach acid production, and what the current research has revealed, from their effects on the kidneys and on people with dementia to future avenues of research and the need for more clinical trials.

Dr. Holm was followed by Dr. Alsop, who focused on functional dyspepsia, describing the differences between epigastric pain and postprandial distress. Dr. Alsop detailed the current epidemiology and managing and treating the condition’s symptoms, including motility difficulty, an inflamed duodenum, and the psychosocial impacts.

Dr. Naveed, the first session’s moderator, explored issues surrounding recurrent C. difficile infections. She defined its difference from standard C. diff infections, the epidemiology (more than 500,000 cases per year in the United States), its mortality (above 9 percent), and its burden on the health care system with costs approaching $4.8B annually. She described the current therapeutic approaches, including fecal microbiota transplant, which reduces antibiotic use.

Session 2: Lumenal Immunologic Diseases

The second session of the morning, moderated by Division Director Dr. David Elliott, began with a presentation from Dr. Steven Polyak on IBD therapeutics, both an explanation of the different classes of biologics for inflammatory bowel disease, as well as the different approaches necessary for Crohn’s disease and ulcerative colitis. Dr. Polyak also defined the difference depending on whether one’s purpose is induction or maintenance therapy.

Sponsored by a gift from the estate of Sol Barnett, Dr. Sumona Saha, Associate Professor at the University of Wisconsin School of Medicine and Public Health, was one of two visiting lecturers that day. Dr. Saha detailed the impact that IBD can have on pregnancy. She explained why it was an important question since the first diagnosis of IBD comes for many women under the age of 30. Dr. Saha covered risk factors a provider should address with women diagnosed with IBD who are considering pregnancy as well as which medications are likely to produce the least complications in pregnancy and lactation.

Dr. Elliott closed the morning session with a deep dive on celiac disease, what it is and what it is not, the epidemiology, and the best methods for successfully arriving at a conclusive diagnosis. He described the underlying genetics and the mechanisms of the disease, which helped explain when serology and HLA testing would be more effective and when certain therapeutics should be implemented. One attendee told Dr. Elliott afterward, “I learned more about celiac disease in 30 minutes than I have in years.”

Session 3: Endoscopy

After a lunch and some time to socialize, chat with vendors, and explore the wetland area around the Coralville Marriott, the afternoon sessions got underway, moderated by Dr. Alsop. Dr. Henning Gerke demonstrated with videos and diagrams the per-oral endoscopic myotomy (POEM), which turns the submucosal area into a working space for dissection. Since 2013, Dr. Gerke and his colleagues have performed more than 125 POEMs, a relatively minimally invasive procedure, at UI Hospitals and Clinics.

Dr. Mahmoud Soubra was next with a presentation on bariatric endoscopy and the variety of weight reduction surgeries. Dr. Soubra first gave an overview of the health care crisis that obesity represents for the nation, with estimates of between 5 and 10 percent of all health-care dollars covering its impact. He then detailed the benefits and weaknesses of the available options and previewed some new directions for these interventional surgeries.

Another visiting lecturer, Dr. Ajay Bansal, Associate Professor at the University of Kansas Medical Center, was there to present on advances in Barrett’s esophagus, including some recent technological advances both in diagnosing and in treating low-grade dysplasia.

Session 4: Hepatology

The final trio of the day focused on the liver. Dr. Gunderson, who also moderated the session, presented updates on hepatitis C. First he detailed the burden both nationally and on Iowa that the virus represents (26,000 infections annually in Iowa, 3.5M in the United States) before moving on to the ways in which treatment has evolved. Dr. Gunderson described the different classes (and prices!) of drugs available, helping attendees sort through the dizzying array of options.

Dr. Michael Voigt presented next on liver transplantation, providing indications, when patients should be evaluated, and what constitutes urgency. Because about 20 percent of people in need of a liver die waiting for a donation, the stakes are high for ensuring proper assessments occur. Dr. Voigt also defined the absolute and relative contra-indications to liver transplant and how best to manage hepatocellular cancer and alcoholic hepatitis.

Which led neatly into the third and final presentation of the day from Dr. Antonio Sanchez, who presented on advances in non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH). Dr. Sanchez described the pathogenesis and how to confirm a diagnosis with non-invasive methods, presented on the spectrum of the disease, and focused on the importance of obtaining a comprehensive history in the evaluation. He also covered the ways in which NAFLD/NASH may intersect with other conditions, such as diabetes, and how to adapt treatment in those cases.

Congratulations to the Division of Gastroenterology and Hepatology on reviving its CME event and to this year’s presenters and organizers on a successful day. The baseline has been set high for future conferences.