Australian gastroenterology clinical research featured prominently at the United European Gastroenterology virtual meeting (UEG 2021), held this year from 3-5 October. Here are some of the highlights of the oral presentation and posters presented at the meeting:

Clip closure reduces bleeding risk in EMR of large polyps

Prophylactic endoscopic clip closure should be performed following endoscopic mucosal resection (EMR) of large (≥ 20mm) non-pedunculated colorectal polyps (LNPCPs) to reduce bleeding in the in the right colon, an Australian study showed. A randomised controlled trial led by Dr Sunil Gupta of the Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, investigated the impact of prophylactic clip closure on rates of clinically significant post-EMR bleeding (CSPEB) in 231 patients referred for the EMR of LNPCPs in the right colon. The results showed that by intention-to-treat analysis, CSPEB was lower in the clip group vs control (3.4% vs. 10.6%, P=0.031). The absolute risk reduction was 7.2% and number needed to treat was 13.9. Dr Sunil and co-investigators noted that clips were most effective for LNPCPs 20-39mm (ARR 13.1%) and those within the caecum (ARR 14.7%).

Ustekinumab levels in pregnancy and offspring

The levels of ustekinumab in pregnant women with IBD and their infants were investigated in a study by Dr Emma Flanagan a gastroenterologist at St Vincent’s Hospital, Melbourne. The study, which included ten women with Crohn’s disease, found that levels of ustekinumab were stable in pregnancy, with trough levels of 2.3 µg/ml in trimester 1, 2.2 µg/ml in trimester 2 and 1.8 µg/ml  in trimester 3, with no significant difference over the course of pregnancy. With the final antenatal dose administered eight weeks prior to delivery (gestational week 25-33) the infant and non-trough maternal ustekinumab levels at delivery were 4.0 (µg/ml) and 1.4  (µg/ml) respectively. The infant:maternal ratio of 1.8 was similar to that seen with anti-TNFs, but higher than for vedolizumab. The median time of infant ustekinumab clearance was nine weeks, suggesting that infants exposed to ustekinumab in third trimester should avoid live vaccination before six months of age, the investigators said.

Weight gain after staring IFX

IBD patients newly started on infliximab may be subject to some weight gain over their first year of therapy, according to poster presentation by Adelaide researchers. In a retrospective study, a group from the Adelaide University and the Royal Adelaide Hospital gastroenterology department examined weight trajectories in 194 patients with Crohns disease or ulcerative colitis who received IFX for at least 12 months between 2008 and 2020. They found that 26% of patients had weight loss (mean -4.1kg ) 63% had modest weight gain (+3.9kg) and 11% had marked weight gain (+16.1kg). Older patients were less likely to have marked weight gain or net weight loss, while male patients had a decreased probability of weight loss and a 47% higher probability of being in the marked weight gain group.

Seattle biopsies unnecessary after Barrett’s epithelium resection

Seattle protocol sampling of the neosquamous epithelium is recommended in guidelines but is expensive, time consuming and has minimal clinical value, according to a poster presentation at UEG 2021 by  gastroenterologists at Princess Alexandra Hospital, Brisbane. The Queensland team’s investigation into the best surveillance strategy after complete endoscopic eradication of Barrett’s epithelium with dysplasia analysed data from 2892 biopsies performed during 119 endoscopies including 714 cardia, and 66 targeted biopsies. The degree of dysplasia prior to endoscopic  eradication was low grade dysplasia in 14% of patients, high grade dysplasia in 55% and T1a adenocarcinoma in 31% of patients. The study showed that targeted biopsies identified residual Barrett’s in 15% of cases, with dysplasia (low and high grade) in two of them (3%). Random cardia biopsies identified residual intestinal metaplasia without dysplasia in 17 cases (2,4%). However, Seattle biopsies of the unremarkable neosquamous epithelium added an average 4.4 minutes of procedure time but the yield was very low (0.47%) and it neither identified dysplasia nor led to any change in patient management. None of these cases showed dysplasia and ongoing management was not altered by this finding.

Eating disorder risk with low FODMAP diet

Patients with IBS who adopt selective eating approaches such as the low FODMAP diet to control their symptoms may be at risk of orthorexia nervosa, an obsessive eating disorder, according to Victorian researchers. A team from La Trobe University, Melbourne, found that orthorexic traits were present in more than half of patients with IBS they investigated with eating disorder questionnaires. Their study involved 45 patients with IBS and 52 healthy controls. They found significantly more orthorexic traits were exhibited in the IBS patients compared to healthy controls when measured by the SCOFF score (71% vs 37%, p<0.01) and EHQ score  (54 vs 45,  p<0.01). They also found no significant differences between IBS patient scores and those of 16 patients with eating disorders for either the SCOFF or EHQ. Older patients were less likely to have marked weight gain or net weight loss, while male patients had a decreased probability of weight loss and a 47% higher probability of being in the marked weight gain group. Patients with IBS had worse quality of life compared to controls, particularly related to  stress, but orthorexic traits were not associated with differences in dietary intake. “Clinicians should consider these results in their practice, especially when utilising dietary therapies,” the study investigator suggested