Australian research featured at DDW 2020

One of the world’s largest gastroenterology meetings, Digestive Disease Week (DDW), should have been taking place in Chicago this week but the cancellation due to the COVID-19 pandemic has not prevented the presentations and posters being delivered online.

With many Australian gastroenterologists usually attending and presenting at the meeting we present some of the top abstracts to be featured by the DDW 2020 organisers:

Real world treatment persistence rates suggest best therapies for Crohn’s and colitis

A study of treatment persistence rates supports the use of ustekinumab over anti-TNF agents in Crohn’s disease and vedolizumab in ulcerative colitis, according to NSW researchers.

Their analysis of PBS data for 886 patients enrolled in a population-based registry from 2005 and 2019 showed that ustekinumab had the highest overall persistence rate in Crohns disease (median > 74.6%) followed by vedolizumab, infliximab and adalimumab. Ustekinumab had highest persistence as first, second and third-line therapies (p<0.05).

In ulcerative colitis, vedolizumab had the highest overall persistence rate (median >50.3%) followed by infliximab and adalimumab. Vedolizumab had the highest persistence rates as first line therapy and there were no significant differences for second and third-line therapies between the biological agents.

Higher treatment persistence with biologics seemed to be secondary to immunogenicity, since rates correlated with immunomodulator co-therapy in both Crohn’s disease and ulcerative colitis. The study was led by Dr Yanna Ko of Concord Hospital, Sydney.

Delayed colonoscopy after LRA may increase risk of advanced neoplasia

Australian data presented at DDW 2020 has called into doubt recent recommendations that colonoscopy surveillance interval may be increased from five to 10 years following a low risk adenoma (LRA).

This advice on low risk adenoma (1-2 tubular adenomas <10mm in size)  is brought into question by South Australian data showing that delayed surveillance colonoscopy beyond six years after a finding of LRA increases the risk of advanced neoplasia.

A retrospective review was conducted on outcome data from 960 follow-up colonoscopies of patients at elevated risk for colorectal performed after LRA. There were 30.7% colonoscopies that were delayed beyond six years, among which the incidence of advanced neoplasia was significantly greater (72/295, 24.4%) compared to on time colonoscopy (123/664, 18.5%).

The advanced neoplasia incidence increased over time with delays and the time since removal of LRA was a significant predictor for advanced neoplasia (Odds Ratio 1.24).

“The potential outcomes of extending surveillance to 10 years are unclear and further studies are necessary to determine the effects of such a recommendation,” concluded the study investigators led by Dr Zaki Hamarneh.

Cannabis use linked to better symptom control in patients with IBS

With cannabinoid receptors being viewed as potential therapeutic targets for the gastrointestinal tract disorders, US researchers reviewed the impact of cannabis use on control of irritable bowel syndrome (IBS) as measured by readmission rates.

In a retrospective of 6,798 patients treated for IBS of whom 357 used cannabis, Dr Catherine Choi and colleagues at  Rutgers New Jersey Medical School, Newark, found that all cause 30-day readmission rates were 8.1% and 12.7% for patients with and without cannabis use, respectively. After adjusting for confounders, the odds of 30-day readmission were almost 50% lower among patients who used cannabis compared with those who did not (adjusted OR: 0.53).

The most common reasons for readmission in patients who do not use cannabis were enterocolitis due to C. difficile, IBS without diarrhoea, and sepsis.

For cannabis users the most common reasons for readmission were cyclical vomiting, IBS with diarrhoea, and endometriosis.

Cannabis use was also associated with shorter length of stay of almost half a day (- 0.44 days) and lower hospitalisation charges: (-$3,473).

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