Research highlights from AGW 2023


By Mardi Chapman

14 Sep 2023

From the multitude of posters at AGW 2023, these five, along with the previously reported poster on ROTEM to predict bleeding in cirrhosis [link here], were judged as finalists in the Posters of Merit and invited to defend their research.

Here are the summaries:

Locked down and drinking

Hospital admissions due to alcoholic hepatitis increased dramatically at St Vincent’s Hospital Melbourne during the COVID-19 pandemic.

A retrospective cohort study compared hospital admissions for alcoholic hepatitis during the pandemic years (2020-2022) and in the preceding decade (2010 – 2019).

Pre-COVID, the number of alcoholic hepatitis admissions each year was less than 20, rising to more than 30 in 2020, and about 45 each year in 2021 and 2022.

The study identified a significant increase in alcoholic hepatitis admissions in both males and females from 2020 (p<0.001), with a greater relative increase in females than males.

A corresponding phenomenon was observed in the Victorian Admitted Episodes Dataset (p<0.05).

The study, led by Dr Timothy Phan, concluded there was an urgent need to prioritise public health strategies to address the harms of excessive alcohol consumption.

H. pylori genomics reveal clinical clues

A study of H. pylori isolates refractory to antimicrobial therapy from 135 patients across two Australian states has confirmed that most strains (58.5%) were multi-drug resistant.

The study, led by Dr Jonathon Schubert from the University of Adelaide and Queen Elizabeth Hospital, also found concordance between genetically determined resistance to clarithromycin and levofloxacin and phenotypic resistance as determined by culture and sensitivity testing.

“Given this high concordance our results support the potential role of polymerase chance reaction (PCR) testing for antimicrobial resistance to clarithromycin and levofloxacin, conferring regions of the genome as an alternative measure to detect antimicrobial resistance.”

The study said prior studies have suggested this may be attainable from stool samples, alleviating the need for endoscopy, biopsy and culture to determine antimicrobial resistance.

The study also found the majority of isolates contained virulence genes, including cagA found in 65% and the most virulent S1M1 VacA genotype in 24%.

“Risk factor stratification should be advocated in the individualised management of H. pylori, which should be modified not only according to the risk of antibiotic resistance, but also to risk of developing complications of H. pylori infection.”

Don’t skimp on quality dietetic advice

Generalised written dietary advice alone is insufficient to achieve dietary change in adults with mild to moderately active ulcerative colitis compared to comprehensive written and verbal dietary education delivered by a research dietitian.

The study, led by dietitian Laura Portmann from the Queen Elizabeth Hospital and the Basil Hetzel Institute for Translational Health Research in Adelaide, confirmed the importance of dietetic advice in microbial-modulating study designs.

The study found the dietitian-delivered intervention led to a 20% reduction in total protein, 34% reduction in animal protein, 64% increase in total fibre and 353% increase in resistant starch intake over 8 weeks.

The intervention included a set meal plan, diet manual with recipes, and verbal dietary counselling to help achieve the intended dietary change.

In contrast, a healthy eating pamphlet containing generalised ulcerative colitis diet recommendations with specific strategies to optimise their diet failed to have any significant impact on dietary intake.

Ultrasensitive PCR testing reveals mosaicism

A case presentation in a female with suspected Lynch syndrome has revealed an unusual mosaic pathogenic variant in the MMR genes.

The patient was diagnosed with endometrial cancer at 54 years of age and colorectal cancer at 58 years of age.

Her family history included members with young onset colorectal cancer, gastric cancer, non-melanoma skin cancers, breast cancer, kidney cancer and cancers of the cervix.

While Sanger sequencing was unable to detect any germline MMR pathogenic variant, the ultra-sensitive ddPCR testing confirmed a mosaic pathogenic variant in MSH6.

The variant was not found in DNA from the patient’s father or sister despite their cancers.

PhD candidate Romy Walker from the University of Melbourne, said the study highlights the importance of screening for mosaicism in patients with a diagnosis of suspected Lynch syndrome and somatic MMR mutations in their tumours.

Explanation for neuroinflammation in cirrhosis

Activation of the kynurenine pathway appears to underlie the neurodegeneration seen in patients with covert hepatic encephalopathy.

Dr Georgia Zeng, from St Vincent’s Hospital in Sydney, presented data comparing kynurenine pathway activity in patients with cirrhosis and covert hepatic encephalopathy, in those with cirrhosis alone, and in healthy controls.

The study found the kynurenine pathway was highly activated in patients with cirrhosis compared to controls as shown by elevated kynurenine/tryptophan ratios.

As well, patients with cirrhosis and covert hepatic encephalopathy had higher plasma levels of neurotoxic metabolites such as 3-hydroxykynurenine and quinolinic acid.

The study said patients with covert hepatic encephalopathy also had higher levels of the neuroprotective kynurenic acid which was possibly a compensatory mechanism.

It concluded that therapeutic agents which modulate the kynurenine pathway may be able to alleviate the symptoms of covert hepatic encephalopathy.

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