6 Cleveland Clinic Presentations You’ll Want to Catch at DDW 2019

A preview of research findings that could impact your GI practice

Physicians from Cleveland Clinic’s Digestive Disease & Surgery Institute are involved in dozens of oral and poster presentations of their research at this year’s Digestive Disease Week conference at the San Diego Convention Center May 18–21. Miguel Regueiro, MD, Chair of the Department of Gastroenterology, Hepatology and Nutrition, highlights six of special importance:

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1. Role of ESD in the Treatment of Esophageal Neoplasia. May 19, 2019, 10:22 – 10:44 a.m. Room 2.

ESD Hands On Workshop. May 21, 2019, 8 – 10:30 a.m. Hall H.  Amit Bhatt, MD.

“Dr. Bhatt is one of the pioneers in the field of endoscopic submucosal dissection of esophageal cancers. In the past, these patients often required major resection of the esophagus, which has high morbidity and even mortality. So the fact that Dr. Bhatt has been able to do this and show very good outcomes, clean margins and good recovery is noteworthy. Dr. Bhatt also will conduct a hands-on ESD teaching session, which should be a great opportunity to learn more about his technique.”

2. Impact of Endoscopic Surveillance in Patients with CDH1 Germline Mutations. May 20, 2019, 12 – 2 p.m., Halls C-E. Carol Burke, MD.

“Patients with a mutation of the CDH1 gene are at high risk for gastric cancer. Dr. Burke has one of the largest experiences looking at this specific mutation. In the past, before the association between CDH1 mutation and hereditary diffuse gastric cancer was identified, people would silently go without any screening and their first presentation would be with widely metastatic gastric cancer. Doing targeted biopsies with endoscopy actually picks up a high rate early and makes it possible to avoid metastatic cancer, which is really novel.”

3. Safety of Anti-Tumor Necrosis Agents in Patients with Cirrhosis. May 20, 2019, 9 – 9:15 a.m. Room 8. Jamak Modaresi Esfeh, MD.

“Biologic anti-tumor necrosis agents such as infliximab and adalimumab are commonly used to treat patients with inflammatory bowel disease. But opportunistic infections are a major safety concern in patients on anti-TNF therapy, and there’s limited knowledge about the safety of these agents in IBD patients with concomitant cirrhosis, which itself is an immunosuppressing condition. This retrospective study looks at the infection risk in cirrhosis patients receiving anti-TNF therapy. The findings could have important clinical implications.”

4. Increased Prevalence of Nonalcoholic Liver Disease in Crohn’s Disease: A Population-Based Study. May 18, 12 – 2 p.m., Halls C-E.

Nonalcoholic Liver Disease Significantly More Prevalent in Ulcerative Colitis: A Population-Based Study. May 18, 12 – 2 p.m., Halls C-E. Miguel Regueiro, MD.

“Inflammatory bowel disease is associated with many extra-intestinal manifestations. The traditional ones we think of are arthritis, erythema nodosum, iritis, even primary sclerosing cholangitis. Increasingly, we’re also identifying nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in IBD patients. With the increased gut permeability, altered microbiome and chronic inflammation of IBD, a predisposition to NAFLD and NASH independent of normal risk factors makes sense, but the prevalence of this IBD/NAFLD-NASH concomitance has not been extensively explored until recently. My colleagues and I analyzed a large multi-center database of electronic medical records for these two population-based studies. Our findings could have implications for liver-function testing and medication choices in IBD patients.”

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5. The Medical Intensive Liver Unit (MILU): A Novel Multi-Disciplinary Program for the Intensive Care of Patients with Advanced Liver Disease. May 20, 2019, 12– 2 p.m., Halls C-E. Christina Lindenmeyer, MD.

“Patients with advanced liver disease, especially those who require intensive care, are at high risk for in-hospital or short-term mortality. Less than half survive hospitalization, typically. Dr. Lindenmeyer and our hepatologists at Cleveland Clinic developed an innovative program, a subspecialty ICU focused on caring for critically ill patients with advanced liver disease. It’s one of the first in the United States. This presentation describes the structure of our medical intensive liver unit and examines early outcomes of patients admitted to the MILU compared to those who were treated in the conventional ICU prior to the MILU’s opening in 2018. The relevance of this is not just improving quality and reducing morbidity and mortality, but also having patients go into liver transplantation in healthier condition.”

6. Independent Validation of a Tissue Systems Pathology Test to Predict Progression in Barrett’s Esophagus Patients. May 21, 2019, 2:15 – 2:30 p.m. Room 33ABC. Prashanthi Thota, MD.

“We need better methods to predict the risk of progression in patients with non-dysplastic Barrett’s esophagus. Periodic endoscopic surveillance with biopsy is the current standard of care, but the randomness of tissue sampling and observers’ varying abilities to identify telltale morphologic changes make this approach less than ideal. Recently, researchers have developed a tissue systems pathology test meant to predict progression of BE to high-grade dysplasia or esophageal adenocarcinoma. Dr. Thota and her colleagues conducted a single-blinded case-control study to independently assess the pathology test’s predictive performance. The results could affect future BE patient management.”

More presentations of note

Other DDW 2019 sessions to watch for, Dr. Regueiro says, include:

  • Presentations on the development and implementation of the American Gastroenterological Association’s evidence-based clinical guidelines and care pathways. (Dr. Regueiro will discuss the ulcerative colitis care pathway, of which he was the senior author.)
  • Data from a Phase 3 study assessing the treatment efficacy of ustekinumab in moderate to severe ulcerative colitis.
  • Results from the first head-to-head comparison of adalimumab and vedolizumab to determine if either is superior for the treatment of moderate to severe ulcerative colitis.

A stellar CME opportunity

Dr. Regueiro and other staff members of the Digestive Disease & Surgery Institute will serve as faculty for a live educational satellite symposium that will take place during DDW 2019.

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The “Dr. Victor Fazio IBD Symposium in Medical and Surgical Treatment of Crohn’s Disease and Ulcerative Colitis: Positioning Medications and Surgery for IBD” will present in-depth clinical perspectives on new treatment options for patients with complex Crohn’s disease or ulcerative colitis. The symposium will highlight ways to optimize medical and surgical therapies for improved patient outcomes. For more information and to register, click here.

Follow Dr. Regueiro on Twitter @MRegueiroMD and live-tweet #DDW19 with Cleveland Clinic physicians.