Day 1 :
Keynote Forum
David H Van Thiel
Rush University Medical Center, USA
Keynote: Hepatitis C eradication: A promise unfulfilled
Time : 09:30-10:10
Biography:
David Van Thiel obtained his MD from the University of California at Los Angeles and completed his Internal Medicine residencies at Cornell University Hospitals and Boston University. He completed a Gastrointestinal/Hepatology fellowship at Boston University and the University of Pittsburgh. At the latter institution, he progressed from an Instructor of Medicine to Professor of Medicine and Director of the Gastroenterology & Hepatology Program and served as the medical Director of Liver transplantation. He has published more than 100 peer reviewed papers in a variety of journals and is on the Editorial Board of several journals as well as serves as a reviewer
Abstract:
Hepatitis non-A and non-B hepatitis was recognized as a unique form of viral hepatitis distinct from hepatitis A, hepatitis B, and other unusual types of a chronic hepatitis such as CMV, EBV as well other more uncommon types of viral hepatitis in the late 1970s. His clinical characteristics, biochemical manifestations as well as its chronicity from its initial presentation followed by increasing stages of chronic hepatitis and hepatic fibrosis ultimately resulting in cirrhosis and occasionally progressing to hepatic cancer and required an additional 15-30 years. A host of potentially antiviral agents were utilized initially to treat the disease process with minimal or no success. With the introduction of interferons (alfa 2a or alfa 2b) with or without additional ribavirin, a modicum of success defined as a reduction in transaminase levels was achieved with little or no retrospectively determined viral clearance. With the isolation and characterization of the hepatitis C virus genome and the various polypeptides it codes for, a new era of treatment directed at inhibiting viral replication as opposed to enhancing the immune response against the virus began. The initial direct acting antiviral agents increased viral clearance rates to 40%. Agents more recently developed have increased the rates of viral clearance to 95 to 100%. This initiated reports (a promise) that hepatitis C would be eliminated as a disease process by 2020 with a progressive decline in the rates of cirrhosis and hepatocellular carcinoma thereafter through at least 2030. Unfortunately this does not appear to be the case as multiple obstacles prevent the favourable outcome. The issues and remaining and prohibit the promises full film and include the following: Lack of knowledge of primary care physician's that the disease is a serious hepatic disease that slowly and quietly progresses to cirrhosis and potentially hepatic cancer and is treatable. As a result large numbers estimated to be three quarters of the infected population failed to be identified. Secondly the cost of the drugs is prohibitive to those individuals with no insurance and contributes to the effort by third party pears and cover mental agencies to limit treatment to selected groups with advanced liver disease. As a result only a minor fraction of the infected population is identified for treatment and receives treatment. In addition, individuals with non-hepatic manifestations of hepatitis C are not recognized this having the disease process and are excluded from treatment despite the fact that this population represents the largest group of individuals perpetuating the disease in the community as they do not know they have the disease. In order with a promise of the elimination of hepatitis C and a reduction in long-term consequences of the infection universal defecation of infected patient's to include all forms of hepatic dysfunction as well as non-hepatic manifestations of the disease need to be recognized in treated. To accomplish this, the cost of treatment will have to be dramatically reduced and includes not only the cost of the therapeutic agent but also through numerous tests required to justify
treatment. Some progress is being made by governmental agencies that are looking at the concept of micro-elimination as a potential means of reducing the prevalence of the disease in high prevalence groups such as men having sex with men, individuals enrolled in drug treatment programs, who said receive multiple transfusions as result of clotting disorders and/or hemolytic anemias. This is clearly a started but only if start.
Keynote Forum
Giovanni Gasbarrini
Catholic University of Rome, Italy
Keynote: Gut Microbiota: An epochal revolution
Time : 10:10-10:50
Biography:
Giovanni Gasbarrini was President of the Italian Society of Alcology and Member of the Board of Directors of the Italian Society of Gastroenterology, of the Italian Society of Internal Medicine, from which he was awarded the title of Member of Honor. He is the founder and President of the “Club del Tenue” and of the “FONCRE” (Operative Cancer Rectus-Colon), and currently the corporate framework for digestive diseases (Club del Tenue, FONCRE, Hp Italian Section, Intestinal Motility). He was Vice-President of the International Association of Surgeons & Gastroenterologists. He was President and is now a Member of the European Helicobacter Study Group (of which the Italian section is also the President); he was President of EAGEN (European Associate Gastroenterol, Nutrition) and is currently past-President of EAGEN. He is a member of over 15 Italian and International Scientific Societies (Italian Society of Internal Medicine -Italian Geriatrics Society -Italian Gastroenterology Society - Italian Electronic Microscopy Society -Italian Society of Alcology - European Society Liver Study - French Society of Gastroenterology.
Abstract:
Few data exist on differences in gut microbiota composition among principal gastrointestinal diseases. We evaluated the differences in gut microbiota composition among uncomplicated diverticular disease (DD), IBS and IBD patients. DD, IBS and IBD patients along with healthy controls (CT) were enrolled in our Italian GI outpatient clinic. Stool samples were collected. Microbiota composition was evaluated through a metagenomic gene-targeted approach. GI pathology represented a continuous spectrum of diseases where IBD displayed one extreme while healthy controls displayed the other. Among Phyla, Biplot PC2/PC3 and dendogram plot showed major differences in samples from IBS and IBD. DD resembled species CT composition, but not for Bacteroides fragilis. In IBS, Dialister spp and then Faecalibacterium prausnitzii were the most representative species. UC showed a reduced concentration of Clostridium difficile and an increase of Bacteroides fragilis. In CD, Parabacteroides distasonis was the most represented, while Faecalibacterium prausnitzii and Bacteroides fragilis were significantly reduced. Each disorder has its definite overall microbial signature, which produces a clear differentiation from the others. On the other side, shared alterations constitute the “core dysbiosis” of GI diseases. The assessment of these microbial markers represents a parameter that may complete the diagnostic assessment.
Keynote Forum
Fong-Fong Chu
The First Affiliated Hospital - HUST, P R China
Keynote: Reactive oxygen species generated by NADPH oxidase-1 and Dual oxidase-2 contribute to inflammatory bowel disease
Time : 11:10- 11:50
Biography:
Fong Fong Chu has her expertise in gastrointestinal diseases especially in inflammatory bowel disease (IBD). Her team has established a mouse model of IBD which is very-early onset. These mice are deficient in two isoenzymes which reduce hydrogen peroxide named GPx1/2-double knockout (DKO). This model is a better model than chemical-induced colitis models because it is not injury based and mimic closely to human IBD. She has built this model through 20 years of research and has identified new targets for IBD therapy. She joined Beckman Research Institute of the City of Hope, Duarte CA USA (1987). She is currently associated with the Department of Gastroenterology & Hepatology and the First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, P R China since 2016.
Abstract:
Statement of the Problem: Gut microbes play an essential role in pathogenesis of inflammatory bowel disease (IBD). Host cells respond to microbe colonization by releasing cytokines and chemokines. Some inflammatory cytokines such as IL-4 and IL-13 induce NADPH oxidase-1 (NOX1) and dual oxidase-2 (DUOX2) gene expression in the epithelial cells. Elevated NOX1 or DUOX2 can produce reactive oxygen species (ROS) to regulate various cellular functions including cell proliferation, migration and apoptosis. NOX1 and DUOX2 have been linked to very-early-onset IBD, beginning before 6 years old. But the exact role of NOX1 and DUOX2 in IBD is not known.
Methodology: Mice deficient in antioxidant enzymes, glutathione peroxidase (GPx)-1 and -2, so called GPx1/2-DKO mice, develop ileocolitis around weaning. The hall-mark of pathology includes high crypt apoptosis, Paneth cell depletion, exfoliation and crypt abscess. Germ-free DKO mice are disease-free. To explore the role of Nox1 and Duox2 in gut inflammation, we studied the pathology and phenotype of Nox1-GPx1/2-triple KO (TKO) and Duox GPx1/2-TKO mice at 35 days of age (comparable to human very-earlyonset IBD).
Findings: Nox1-Gpx1/2-TKO mice virtually do not have pathology. Duox-GPx1/2-TKO mice have intermediate pathology except crypt apoptosis remain as high as the DKO mice.
Conclusions & Significance: Both Nox1 and Duox2 contribute to inflammation, while Nox1 has a stronger impact than Duox2 probably because it is expressed in the crypt of the gland. Drugs that have been effective in treating IBD, such as dexamethasone and antibiotics, are likely mediated through suppression of NOX1 and DUOX2 gene expression.
- Gastrointestinal Disorders | Microbiota and diseases | Pancreatic diseases | Liver diseases | Helicobacter Pylori Treatment
Location: Holiday Inn Rome Aurelia
Chair
Fong-Fong Chu
The First Affiliated Hospital - HUST, China
Co-Chair
Silvia Melgar
APC Microbiome Ireland - University College of Cork, Ireland
Session Introduction
Qingjie Li
The University of Texas, USA
Title: Childhood colitis aggravates gut barrier impairment via miR-196 when exposed to another episode of inflammation in adult-life
Biography:
Qingjie Li, a Molecular Biologist, earned his MS Degree in Chemistry from the Department of Chemistry, Guangxi Normal University in 1991 and a PhD Degree in Biochemistry and Molecular Biology from the Central South University ( P R China) in 2000. He worked as a Faculty Member at the same university from 1991 to 2000 and as a Postdoctoral Fellow at the Linus Pauling Institute, Oregon State University from 2000 to 2006. In 2007, as an Assistant Professor he joined the University of Texas Medical Branch at Galveston. He was promoted to Associate Professor in 2018. He has several awards to his credit and has published more than 40 peer-reviewed research articles, a book chapter, and several gene sequences in GenBank. He has served as a Reviewer for NIH, American Gastroenterological Association, and numerous journals, including Gastroenterology, the most prominent journal in the field of gastrointestinal disease. His research interest include: pathogenesis, molecular mechanisms, and chemoprevention of inflammatory bowel diseases (IBD) and its comorbidities, including colitis-associated cancer and IBD-associated cardiovascular disorders.
Abstract:
Background & Aims: Mounting evidence suggests that adverse early-life events influence the perinatal programming and maturation of the immune system, predisposing the host to complex diseases including inflammatory bowel diseases (IBD). We hypothesized that neonatal colonic inflammation generates long range epigenetic memory that aggravates epithelial barrier impairment when exposed to another episode of inflammation in adult-life.
Methods: Neonatal inflammation (NI) was induced by intra rectal administration of trinitrobenzene sulfonic acid (TNBS, 130 mg/kg) on postnatal day 10. Another dose of TNBS (80 mg/kg) was applied to induce adult inflammation (AI) six weeks after NI. All 4 groups of rats (Veh+Veh, NI+Veh, Veh+AI, and NI+AI) were euthanized 7 days later.
Results: In NI+AI rats, we observed an aggravated epithelial damage, evidenced by exacerbated increase in colonic permeability, when compared with the other three groups of rats (p<0.01). We also tested the double-hit injury strategy in adult 6-week old rats given 130 mg/kg TNBS. After 6 weeks of remission, another episode of adult inflammation was induced with TNBS (AI+AI rats). There was no heightened tissue injury in AI+AI vs Veh+Veh, AI+Veh, and Veh+AI rats; noticeably less permeability was detected when compared to the NI model. Thus, aberrant epithelial damage occurs preferentially after colonic injury in the neonates. Molecular studies revealed a marginal decrease in Cdh1 mRNA and a significant reduction in E-cadherin protein in the colon mucosa of NI+AI rats, while Occludin, ZO-1, Claudin 1, Claudin 5, and Claudin 7 remained unchanged. To investigate the epigenetic mechanism underlying the loss of E-cadherin, we carried out miRNA arrays. miR-139, 196, 547, and 3596 were significantly upregulated whereas Let-7e, miR-19a, 96 and 101a were markedly repressed in NI+AI vs the other three groups of rats. Importantly, miR-196 is significantly elevated in patients with Crohn’s disease or colon cancer, indicating a human clinical correlation. Bioinformatics analysis predicted E-cadherin, a key adhesion molecule involved in gut epithelial integrity, as a target of miR-196. To determine its role in regulating E-cadherin, we overexpressed miR-196 in HT29 colorectal cancer cells and found a significant decrease in E-cadherin mRNA and protein (p<0.01). Thus, we postulated that a miR-196 inhibitor might decrease NI-induced disease susceptibility and might ameliorate epithelial barrier injury in NI+AI rats. Intervention study with miR-196 inhibitor is currently ongoing.
Conclusions: Severe neonatal colonic inflammation renders the host susceptible to aggravated epithelial damage in part by upregulating miR-196, which in turn downregulates E-cadherin, resulting in exacerbated increase in colonic permeability. miR-196 could serve as a therapeutic target in IBD and colitis-associated colon cancer.
Susan Joyce
APC Microbiome Ireland - University College of Cork, Ireland
Title: Gut bacteria and Metabolism: Examining host-microbe cross talk in the disease state
Biography:
Susan Joyce graduated with a B.Sc from NUI Maynooth in Biology and Mathematics and a research PhD in host-miocrobe interactions. She was awarded a Marie Curie Fellowship to examine cis and trans acting factors affecting mRNA synthesis and microbial gene expression at the Ecole Normal Superieure, Paris which included a stint at the Max Planck Institute, Berlin. Before returning to University College Cork, She was a postdoctoral scientist at Trinity College Dublin and the Univerity of Bath, UK. Her main interest is in microbial genetic and biochemical systems that alter eukaryotic host signalling. Susan is currently a Lecturer in the School of Biochemistry and Cell Biology and a funded Investigator in the APC Microbiome Institute as part of the Spoke 4 Host- Microbe Dialogue.
Abstract:
Our co-evolved gut microbiota confers beneficial mutualistic relationships both to the microbial residents and to human health. Microbes can alter human produced metabolites and indeed produce and excrete their own compounds to act locally or indeed systemically to elicit a response. In doing so, microbes can influence many different host processes including immune function and signalling to impact human health. Two examples of such processes include the catabolism of fatty acids and bile acid modification. The liver is the site for bile acid synthesis and conjugation, however, the gut microbiota is responsible for the range of diversity of bile moieties. Bile acids, released into the GI tract, are MI cellular components, emulsifiers of fat, liberators of fat soluble vitamins and they also influence microbial populations temporally and spatially depending on the gut region, the pH and oxygen levels. Here, we have examined the microbial, metabolic and gut hormonal hallmarks of an Irish cohort of IBD to include Crohn’s disease and ulcerative colitis (n=182). Our data indicate microbial and metabolic adjustments of different severity between disease states relative to healthy volunteers and also points to altered gut function and signalling.
Biljana Vuletić
University of Kragujevac, Serbia
Title: Acute pancreatitis in early childhood
Time : 12:40-13:05
Biography:
Biljana Vuletic received her Medical Degree from the Medical Faculty at the University of Belgrade. She is an Associate Professor of Pediatrics at the Faculty of Medical Sciences, University of Kragujevac and Chief of the Department of Gastroenterology of Pediatric Clinic and a full ESPGHAN Member. She started her residency in pediatrics at the University Children’s Hospital University of Belgrade. She was trained in Pediatric endoscopy and ultrasonography at the same university hospital. She completed two hands-on courses in UK, Sheffield Children’s Hospital. She has been accepted by OMI Foundation, Austria, for Observership Program at the Medical University of Graz, Univesitats Kinderklinik LKH Graz two times. Her mainly clinical interests include chronic intestinal failure, Celiac disease and clinical nutrition. She has summary of 168 publications including authored or co-authored papers in peer-reviewed journals and also chapters in the national monographs and textbooks published in Serbia.
Abstract:
Acute pancreatitis is an urgent pediatric problem which spontaneously disappears in most cases, although a severe form of the disease can develop in 10-30% of cases, known as severe acute pancreatitis (SAP). Publications from the last few decades have reported an increase in the incidence of pancreatitis among children. This can suggest a real increase in the incidence of pediatric pancreatitis or may indicate other issues such as increased attention to this disease which is, as previously thought, extremely rare in childhood. As the prevalence of pancreatitis in the adult population ranges between 6 and 45/100000 per year and two pediatric multi-institutional studies showed an incidence of 3.6 and 13.2 cases per 100,000 children, pancreatitis is no longer a rare disease in pediatric practice. In accordance with these relevant data and the fact that, unlike the extensive available literature on pancreatitis in adult population, the aetiology and history of pediatric pancreatitis is not clear enough and there are no evidence-based guidelines for the diagnosis and treatment of the disease or prognostic algorithms, the consortium named the International Study Group of Pediatric Pancreatitis: In Search for a Cure (INSPIRE) was established in 2010. The most important task of this group of pediatric gastroenterologists and associates was to define the occurrence of pancreatitis in childhood and then, through the analysis of demographic characteristics, clinical pictures and diagnostic procedures, to develop a therapeutic strategy in order to prevent the recurrence of acute pancreatitis and its progression in its chronic form.
Jaya Maheshwari
Jyoti Hospital, India
Title: Laser sphincterotomy: a minimally invasive treatment for severe anal spasm in cases of chronic anal fissures
Time : 14:15-14:40
Biography:
Jaya Maheshwari is a prominent dignified Surgeon and has pursued minimal access surgery moving further in her career. During her academic journey she has been awarded a couple of fellowships in laparoscopy from the top institutes. Ongoing with her pursuit for academic excellence she specialized and got certified in advance proctology and lasers. She is currently the Co-Convener for the FIAGES Board. She presently heads the Department of Advance Proctology and Department of Laparoscopic Surgery in Jyoti Hospital, Jaipur. Her rich clinical career in performing thousands of surgeries over a span of nearly one and half decade, and her vision for quality and excellence made her establish a first of its kind department, specifically in proctocare and minimal access surgeries. The department offers a plethora of surgeries and the most advance techniques, like the STARR for severe constipation, staplers and lasers for piles, fistula and fissures, and various types of mesh repairs for all hernias.
Abstract:
Statement of the Problem: A chronic anal fissure can be identified by the presence of hypertrophied anal papilla, visible internal sphincter fibres at the base of the fissure, a sentinel polyp at the distal end or a fibroepithelial polyp at the apex. The ischemia of the anal lining caused due to elevated sphincter pressures, may be responsible for the pain of anal fissures and their failure to heal. The present paper evaluates the treatment outcome of chronic anal fissures using laser sphincterotomy.
Methodology: 52 admitted and operated patients (30 males and 22 females) of anal fissure by laser sphincterotomy were examined retrospectively. The patients with chronic anal fissure and severe anal spasm with VAS scores 8-10 were selected. Data on duration of procedure, 6 months follow-up data of post-operative complications, resolution or persistency were collected. The diode laser of 1470 nm was used as the beam source. Follow up was scheduled in outpatient clinic at 1 week, 3 week, 2 months, 3 months and 6 months post-operatively.
Results: 46.7% males of the age group 41-50 years and 63.6% females of age group 31-40 years were most common. The preoperative average readings of patients with spasm in males were 120-140 mmHg and in females it was recorded to be 110-125 mmHg, which showed a decrease post-operatively and become almost normal after 3 months. No other post-operative complications were observed except mild bleeding in 20 patients (38.46%) in the first week, along with purities ani and anal discharge in 20 (38.46%) and 5 (9.6%) patients respectively upto 1 month.
Conclusions: The results showed that patients had reduced healing time with no scars following minimally invasive laser sphincterotomy when compared to conservative surgical procedures. There were nil post-operative complications at the follow-up period, with minimal bleeding in a few cases following the procedure.
Jelena Petkovic Dabic
University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
Title: Successful treatment of chronic Hepatitis C infection in Republic of Srpska
Biography:
Jelena Petkovic Dabic graduated from the Faculty of Medicine in University in Banja Luka Republic of Srpska, 2005. Experienced Head with a demonstrated history of working in the medical practice industry. She is skilled at Research Management, Medical Education, Healthcare, and Healthcare Management. Strong professional with a Doctor of Medicine (MD) master focused in Health/Health Care Administration/Management from School of Public Health Faculty of Medicine, University of Belgrade. She is currently employed as Head of the Health Sector in the Health Insurance Fund of the Republic of Serbia. She is currently planning the treatment for hepatitis C and all funded biological medicines. She is now Dermatovenerology Resident-University Clinical Center of the RS. She is mainly interested in new molecules and their
application in the treatment of very serious illness.
Abstract:
Introduction: Viral hepatitis C remains one of the major health and social problems related to infectious diseases. Today, interferon-free therapy using new direct-acting antivirals (DAA) has increased the cure rate across different HCV-infected patient populations. Nowdays, viral hepatitis C threatens to become a healing disease.
Methods: The methodolgy involved a retrospective study. We will present our experiences from the work carried out in 2016 and 2017. We have approved treatment with ombitsvir/paritaprevir/ritonavir + dasabuvir in a total of 55 patients' report.
Results: In 2016, we analyzed 25 patients, 17 (68%) males and 8 (32%) females with age of 26-66 years. In 2017, we analyzed 30 patients, 22 (73%) males and 8 (26,7%) females with age of 23-67 years. Sustained viral response (SVR) is 100%. Adverse events are typically mild, most commonly consisting of fatigue, headache, nausea, and diarrhea.
Discussion/Conclusions: The regimen consisting of ombitasvir/paritaprevir/ritonavir and dasabuvir is highly efficacious in the treatment of viral hepatits C. Today, viral hepatitis C is a curable disease, which reduces membrane damage, as well as the costs of treating patients.
Nany El Gayar
Alexandria University, Egypt
Title: Estimation of efficacy of hemodialysis in patients with Helicobacter pylori infection before and after eradication therapy
Biography:
Nany El Gayar pursued her Master’s Degree in Rheumatology and Doctor’s Degree in Geriatrics from Alexandria University. She is an Assistant Professor of Internal Medicine, Geriatrics Unit at the Alexandria University, Egypt. She has published more than 15 papers in reputed journals.
Abstract:
The aim of this work is to study gastric symptoms, efficacy of hemodialysis according to blood urea, serum creatinine levels and urea reduction ratio (URR), changes in mental functions according to serum ammonia level in hemodialysis patients with positive H. pylori antigen before and after eradication therapy. This study was carried out on 40 patients with end stage renal disease (ESRD) on chronic regular hemodialysis 3 times weekly, with gastric symptoms and positive stool H. pylori antigen were enrolled in this study. Blood urea, serum creatinine, urea reduction ratio, serum ammonia all were measured before and after eradication therapy. Stool H. pylori antigen was measured by ELISA before and one month after the end of therapy to confirm complete eradication of the organism. Eradication therapy was given (Amoxycillin 750 mg two times daily, Clarithromycin 500 mg two times daily and Pantazole 20 mg two times daily) for 10 days. Then after one month changes in gastric symptoms, stool H. pylori antigen, measure serum ammonia level again, H. pylori antigen, blood urea and serum creatinine were detect. The results of this study: gastrointestinal tract (GIT) symptoms pre-eradication therapy were 25% nausea, 21.5% epigastric pain, 16.1% heart burn, 12.5% early satiety, 12.5% postprandial fullness, 12.5% appetite loss. One month after eradication therapy 85% of the patients converted to H. pylori stool antigen negative. After eradication therapy, patients who converted to H. pylori negative antigen (GIT) symptoms had been relieved in 82.4% of cases and in 17.6%of cases (GIT) symptoms persist. There was significant difference in the mean blood ammonia level (p=0.001) as regards pre and post eradication therapy. In patients who still had H. pylori antigen (GIT) symptoms had been persisted in all cases and there was no significant difference in the mean blood ammonia level (p=0.463). There was significant negative correlation between H. pylori antigen with urea reduction ratio (URR) (r=0.402, p=0.010) and significant positive correlation between H. pylori antigen with ammonia level (r=0.452, p=0.003). This study showed that the prevalence of H. pylori infection increased with longer duration of hemodialysis, triple therapy was effective for eradication of H. pylori in hemodialysis patients, presence of H. pylori was associated with decreased efficacy of hemodialysis and blood ammonia level decreased with eradication of H. pylori infection.
Renata Tamburic
University Clinical Centre of the Republic of Srpska, Bosnia and Herzegovina
Title: Vedolizumab for Inflammatory Bowel Disease: for now only rescue therapy in the Republic of Srpska
Biography:
Renata Tamburic graduated from the Faculty of Medicine Banja Luka, in 2011. She have finished specialization in internal medicine, currently resident from gastroenterohepatology. She Works in the Clinic for Internal Diseases, Department of Gastroenterohepatology, University Clinical Centre of the Republic of Srpska since 2012. PhD student in clinical medicine at the Medical Faculty in Novi Sad. Her research interest in the success of treating patients with IBD is high. She hope that in the future we will witness the invention of new molecules in order to preserve our quality of life for our patients.
Abstract:
Introduction: Vedolizumab (VDZ) is a humanized monoclonal antibody α4β7 integrin-receptor antagonist indicated for the treatment of patients with moderately to severely active ulcerative colitis or Crohn's disease. We want to show our modest experience with the use of vedolizumab as a rescue therapy when other medical therapies have failed.
Methods: An observational study was carried out on patients with inflammatory bowel disease treated with VDZ for at one year. An evaluation was performed on the activity indices, faecal calprotectin and C-reactive protein levels.
Results: Our study included 7 patients (5 CD, 2 UC, mean age 40 years). Previous treatment failures with ≥ 2 anti-TNFs. At one year, in all patient maintained the clinical response and remission. The C-reactive protein and faecal calprotectin decreased significantly in both CD and UC patients..
Discussion / Conclusion: Our experience indicates that a long-term effect can be achieved, even beyond 1 year of treatment. Vedolizumab is generally well tolerated. Vedolizumab may be used as a rescue therapy in patients with medically refractory ulcerative colitis or Crohn's disease.
- Workshop
Location: Holiday Inn Rome Aurelia
Session Introduction
A S M A Raihan
Bangabandhu Sheikh Mujib Medical University, Bangladesh
Title: Genotype pattern of H. pylori in gastritis and peptic ulcer disease in relation to normal endoscopic findings
Biography:
A S M A Raihan has been working in the department of Gastroenterology, Banga bandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. His research interest is focused in Irritable bowel syndrome, inflammatory bowel disease, peptic ulcer disease and Helicobacter pylori infection. His important works are profile of ulcerative colitis in Bangladesh, presented in APDW, 2006, profile of patients of Crohn's disease in Bangladesh, Symptomatic overlap in patients with diarrhoea predominant irritable bowel syndrome and microscopic colitis in Bangladeshi population and histopathological alteration in post infectious irritable bowel syndrome. He developed a clinical scoring system to differentiate difficult to diagnose cases of intestinal tuberculosis and Crohn’s disease and presented his work in Asia Pacific Digestive Week, Kobe, Japan in 2016. He has got more than 50 publications and he supervised more than 50 theses.
Abstract:
Genotype pattern of H. pylori (Helicobacter pylori) in gastritis and peptic ulcer disease in relation to normal endoscopic findings was studied in 206 H. pylori positive dyspeptic patients (male 128, female 78). H. pylori were diagnosed by RUT (rapid urease test), culture and PCR (polymerase chain reaction). H. pylori positive was considered if any one of the test was positive. Multiplex PCR assay was done directly from biopsy specimens for genotyping. CagA and Vac A alleles were studied. CagA positive and CagA negative in three groups are shown in table 1. CagA gene was found to be significantly more frequent in gastritis and peptic ulcer patients as compared with patients with normal upper GI tract at endoscopy. Association of vac A alleles with gastritis and peptic ulcer was seen as shown in table 2.
Anisur Rahman
Sher -E - Bangla Medical College, Bangladesh
Title: Comparison of results of rapid urease test (RUT) and PCR after Helicobacter pylori (H. pylori) eradication therapy in peptic ulcer disease patients at a medical university hospital
Time : 17:25- 18:10
Biography:
Anisur Rahman is citizen of Bangladeshi. He passed HSC from Notre Dame College Dhaka. In 1999, He completed MBBS from Sir Salimullah Medical College and Mitford Hospital. He obtained MD (gastroenterology) degree from Bangabandhu Sheikh Mujib Medical University in 2012. He joined BCS (Health Cadre) under Ministry of health and family welfare of the people's republic of Bangladesh in 2006 and worked in different reputed hospitals in Bangladesh. He is a member of Bangladesh Gastroenterology Society. Now He is working as an Assistant Professor of Gastroenterology in Sher -E - Bangla Medical College, Barishal, Bangladesh. He was working in the field of Helicobacter Pylori since 2010 and he sshas special interest in the field of Helicobacter Pylori.
Abstract:
In this study 63 H. pylori positive patients with peptic ulcer disease were randomized for eradication therapy for two weeks. Four regimens were used : ECA consisting of Esemoprazole (20 mg bid), Clarithromycin (500mg bid) and Amoxicillin (1 gm bid), EALconsisting of Esemoprazole (20 mg bid), Amoxicillin (1gm bid), Levofloxaxin (500 mg once daily), EAT consisting of Esemoprazole (20 mg bid), Amoxicillin (1gm bid), Tetracycline (500 mg bid) and ETL consisting of Esemoprazole (20 mg bid), Tetracycline (500 mg bid) and Levofloxaxin (500 mg once daily). Out of 63 patients 13 dropped out. Six weeks after completion of therapy upper GI endoscopy was repeated to see endoscopic improvement and RUT and PCR for H. pylori was carried out. Conclusive result was obtained in 40 cases in RUT and PCR could be done in 37 cases. PCR positivity was considered when Vac A s1m1 or s1m2 or m2s1 were found to be positive. Eradication therapy showed no statistically significant difference in different regimens (p> 0.05). Thirty six patients were found to be RUT negative and 4 were found to be RUT positive. While RUT after eradication therapy showed 90% eradication rate PCR showed only 40.5% eradication rate. If PCR negativity is considered as successful eradication, this result is alarming. PCR positivity with negative RUT after eradication therapy in our patients may be explained by possible high percentage of the dead or coccoid form of H. pylori after antibiotic treatment.