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12 Top Updates in Gastroenterology, Hepatology From 2014
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The top 12 updates in gastroenterology and hepatology featured the most important data from 2014 on topics such as esophageal diseases, pancreatic disease, colorectal cancer, inflammatory bowel disease, liver disease and more.
The selected studies were excerpted in the Annals of Internal Medicine as part of its Summaries of the Year’s Most Important Studies Pertaining to the Practice of Internal Medicine. This special issue of the journal, which is the flagship publication of the American College of Physicians (ACP), also features summaries of key medical studies in various other specialties. The issue was timed to coincide with the 100th annual ACP Internal Medicine Meeting.
The following are the top 12 updates in gastroenterology and hepatology published in 2014, according to the ACP.
1. In both children and adults, eosinophilic esophagitis has become increasingly prevalent.
In this database study, researchers found that eosinophilic esophagitis affects up to 400,000 adults and children in the US, and is linked to significant GI morbidity and atopic symptoms.
2. In some patients with low-grade dysplasia, radiofrequency ablation of Barrett’s esophagus may significantly decrease the likelihood of progression to neoplasia.
This trial of 140 patients found that while ablation treatment appears to be the preferred therapy for Barrett’s esophagus with high-grade dysplasia, the value of endoscopic ablation in low-grade dysplasia is not well understood. Radiofrequency ablation for patients with Barrett’s esophagus with low-grade dysplasia showed significantly decreased neoplastic progression.
3. Chronic pancreatitis is a serious, prevalent medical problem, and confers increased risk of cancer, diabetes, comorbidities and mortality.
This retrospective cohort study from Denmark found that patients with chronic pancreatitis face significantly higher rates of mortality and morbidity from cancer and other diseases vs. control patients.
4. The value of colonoscopy performance quality for screening is underscored by the incidence of invasive colorectal cancers between colonoscopies.
In this retrospective study of 9,176 patients, researchers found that patients face a small chance of interval cancers, which highlights the importance of quality baseline screening colonoscopies.
5. Of colonoscopy quality parameters, adenoma detection rate is most highly correlated with a decreased risk of interval colorectal cancer.
In a retrospective study, researchers found that the most reliable marker of colonoscopy quality is the rate of adenoma detection.
6. Mutations can be detected in DNA shed into stool by colorectal cancer and other types of gastrointestinal cancer, and these mutations may offer a potential new screening method for GI cancer.
This study of 12,766 patients found that for patients who prefer not to undergo colonoscopy as their primary screening test, multi-targeted DNA testing of stool may be an alternative in the detection of colorectal cancer.
7. Although the risk for colorectal cancer has been reduced among patients with long-term inflammatory bowel disease, the increased risk associated with IBD and other types of cancer remains steady.
This population-based study of Dutch patients with IBD found that the risk for GI cancer in this patient population has reduced over time, while non-GI cancer rates in IBD patients have remained consistent.
8. Through more aggressive screening and therapeutic advances, hepatitis C could become rare in the U.S. within the next two decades.
In this study, model-based predictions were used to determine that more aggressive screening and therapeutic innovations could significantly decrease the prevalence of hepatitis C in the United States over the next 20 years.
9. Simpler regimens may yield sustained viral response in the treatment of hepatitis C virus.
In this multicenter trial of 647 patients, researchers found that oral medications may provide a significant and cost-effective advance in the treatment of hepatitis C, and may hold promise in eradicating this common disease.
10. In clinical practice, drug-induced liver damage is common, and may involve common drugs, such as statins.
This retrospective study reported that statins commonly play a role in hepatotoxic drug reactions and because chronic liver injury due to statins is rare, universal monitoring is not required.
11. Diverticulitis treatment has become less aggressive.
In this systematic database review, researchers found a clear shift toward less aggressive antibiotic and surgical interventions in diverticular disease.
12. Concerns about increased risk of community acquired pneumonia in connection with proton pump inhibitors are not substantiated.
This retrospective database study found that while proton pump inhibitors are overused, they do not appear to contribute to elevated risk of community-acquired pneumonia.