Australian Gastroenterology Week (AGW) 2007 & Developments in Ulcerative Colitis

Between October 24th – 27th 2007, the Australian Gastroenterology Week (AGW) was hosted by the Gastroenterology Society of Australia. Gastroenterology refers to the field of medicine dealing with disorders affecting the stomach, intestines and other associated organs. The Perth Convention Exhibition Centre provided the ideal location for this event, attracting a wide range of guest speakers and specialists, including gastroenterologists (specialists dealing with gastroenterology), liver specialists, nutritional experts and interventional/procedural experts. The Australasian Society for Parenteral and Enteral Nutrition (AuSPEN) and Gastroenterological Nurses College of Australia (GENCA) are two prominent organizations that were involved in this meeting.

International speakers discussed important topics and treatment advances in areas such as inflammation of the intestines/gut (also known as inflammatory bowel disease or IBD), other functional disorders of the digestive system, liver diseases and transplantation, nutrition and pancreatitis (inflammation of the pancreas). The role of endoscopy / colonoscopy (these are tests in which a camera is attached to the end of a flexible tube and either inserted through the upper end (mouth) or lower end (rectum) of your digestive tract) in further investigation of problems and emergencies of the digestive tract was also covered. Topics involving treatment issues in children, such as chronic pain and medical therapies, were also discussed. Of particular clinical relevance is the addition of Infliximab onto the Pharmaceutical Benefits Scheme (PBS) from 1st October 2007, for treatment of patients with Crohn’s disease. This means that treatment costs will be subsidised, resulting in lower expenses and more affordable therapy for eligible patients.The focus of this article is on ulcerative colitis and its developments, particularly in relation to treatment regimes. Ulcerative colitis is a condition in which the lining of the colon (large intestine) becomes inflamed and irritated. It is one of the inflammatory bowel diseases, which also include Crohn’s disease. The condition may be limited to the rectum (proctitis) or extend upwards to involve all or part of the colon (colitis). If you have ulcerative colitis, you may experience acute attacks during which symptoms such as: abdominal pain, diarrhoea with blood and mucous, fever, generalised aches and weight loss can occur. These symptoms are related to ulceration and bleeding in the colon caused by the disease. The initial treatment depends upon how severe your disease is and also the length of colon involved. 5-ASA Compounds & A Simple Method for the Determination of its Levels in the Lining of the Large Bowel5-Aminosalicyclic acid (ASA) compounds are medications that act to reduce the amount of inflammation central to some disorders of the bowel, such as Crohn’s and ulcerative colitis. In patients with ulcerative colitis, they have been shown to be very effective in inducing and maintaining remission of disease. Levels of 5-ASA in the lining of the bowels have been shown to predict efficacy and possibly act as a marker for clinical endpoints in patients with disease. A clinical trial was performed by Haines et al, to try and determine a simple, yet sensitive and reproducible method for detection of 5-ASA in the lining of the bowel. Specific concentrations of 5-ASA were added to biopsies (tissue samples) of the lining of the colon. From the study, clear, reproducible peaks were achieved at certain wavelengths. These peaks were significantly sensitive for 5-ASA. What we need to do now is to apply these results in a clinical context. Genes Implicated in IBD – IL23R is an IBD Susceptibility Gene (confirmation in an Australian cohort) and GLI1 gene a Risk Factor for Ulcerative Colitis With advances in research and from results of clinical studies, additional insight into the causes and genetics behind ulcerative colitis has been obtained. For example, variations in particular receptors such as the IL 23 receptor has recently been shown to be associated with both Crohn’s and ulcerative colitis. Another gene called the GLI1 gene plays a significant role in the formation and maintenance of a healthy lining for our gut. Defects in the GLI1 gene have been implicated in patients with ulcerative colitis. Patterns of Medication use in Inflammatory Bowel Disease PatientsThere is a wide range of therapies for ulcerative colitis – depending on the location of disease, different combinations of treatments are employed. In disease limited to the rectum, the mainstay of therapy includes topical aminosalicyclate (5-ASA) suppositories (small masses of medication that are designed to melt when inserted into a body cavity). Topical therapy refers to local application of treatment directly onto the surface of a body part. In more extensive cases where disease affects larger parts of the bowels, combination therapy involving 5-ASA agents (both oral and topical), steroids and other immunosuppressive agents is recommended. In a recent study conducted by Barclay et al, an increased use of medications which act to alter the immune response (immunomodulators) was demonstrated. Out of 1421 patients with inflammatory bowel disease, the use of immunomodulators including azathioprine, 6 mercaptopurine and methotrexate was investigated. Oral 5-ASA treatments were used in 77% of ulcerative colitis patients. Use of these medications correlated with increasing disease extent. In conclusion, IM use was high in these patients, compared with previous studies. This was thought to be primarily due to changing clinical practice, rather than changes in disease severity. Response to Infliximab Therapy in Patients with Severe Ulcerative ColitisThe efficacy of Infliximab in outpatients with moderate – severe ulcerative colitis has been well demonstrated. Studies have been conducted in an attempt to further investigate the use of Infliximab as rescue therapy in a subset of severe hospitalised patients and also to try to reduce the numbers of people requiring surgery for removal of areas of bowel affected by ulcerative colitis. However, these studies only involved limited numbers of patients and were too small to identify patient factors which predict response. Ulcerative colitis is a chronic medical condition that can have significant effects on your quality of life and the way that you function. Although there is no cure, advances in medical treatments allow doctors to try and control the disease and remain on top of your symptoms. Multiple different treatments are available for treatment of ulcerative colitis, depending on the location and extent of disease. Combinations of 5-ASA agents and therapies that act on your immune system have been widely studied. Research findings regarding the causes and genetics surrounding ulcerative colitis help us understand the causes and associations related to the disease. Many patients will be able to live active and productive lifestyles, with regular medical treatment and close observation for disease progression and treatment complications. The next AGW meeting will be held in Brisbane, from 22 – 26th October, 2008. Many more delightful guest speakers and further research developments will be part of this upcoming event.