Daily Recap, Monday, October 4

It’s Day 2 of UEG Week Virtual 2021! 

Monday marked the centre of the UEG Week Virtual 2021 programme and featured more breaking science from the digestive health community. The final event of the day saw Dirk Haller receive the UEG Research Prize 2021 for his research ‘Repurposing mitochondria-protective targets for adjuvant IBD therapy’. Scroll through today’s Daily Recap to catch up on all of the best action!

Scientific Highlights: Colorectal cancer diagnoses dropped more than 40% during COVID-19 pandemic

The number of colorectal cancer (CRC) cases diagnosed fell dramatically by 40% in a year during the COVID-19 pandemic, new research presented today has shown.

The research, which was conducted across multiple hospitals in Spain, compared data from the first year of the COVID-19 pandemic with data from the previous year. Of 1,385 cases of CRC diagnosed over the two-year period, almost two thirds (868 cases, 62.7%) were diagnosed in the pre-pandemic year from 24,860 colonoscopies. By contrast, only 517 cases (37.3%) were diagnosed during the pandemic, which also saw a 27% drop in the number of colonoscopies performed, to 17,337.

Those who were diagnosed with CRC between 15 March 2020 and 28 February 2021 were also older than in the pre-pandemic year, had more frequent symptoms, a greater number of complications and presented at a more advanced disease stage. Experts say the fall is a consequence of the suspension of screening programmes and the postponement of non-urgent colonoscopy investigations during the pandemic.

Dr María José Domper Arnal, who presented the study, commented “These are very worrying findings indeed – cases of colorectal cancer undoubtedly went undiagnosed during the pandemic. Not only were there fewer diagnoses, but those diagnosed tended to be at a later stage and suffering from more serious symptoms.”

There was a significant increase in the number of patients being diagnosed with serious complications – a sign of late-stage disease – with an increase in symptoms such as bowel perforation, abscesses, bowel obstruction and bleeding requiring hospital admission. These cases made up 10.6% pre-pandemic and 14.7% during the pandemic. The number of stage IV cancers being diagnosed rose during the pandemic year, with stage IV cases making up 19.9% of cases, in comparison to 15.9% in the previous year.

“Although these figures are across a population of 1.3 million in Spain, it’s highly likely that the same drop in diagnoses would have happened elsewhere across the globe where screening was stopped and surgeries postponed, especially in countries that were heavily impacted by COVID-19”, explained Dr María José Domper Arnal.

“Colorectal cancer is often curable if it’s caught at an early stage. Our concern is that we’re losing the opportunity to diagnose patients at this early stage, and this will have a knock-on effect on patient outcomes and survival. We are likely to see this fall out for years to come.”

Case closed? Live expert lunch

Today’s lunchtime session from the TV Studio saw a panel of leading experts discuss common situations from clinical life, with the pancreas as the day’s topic of choice. Torsten Beyna, who moderated the session, was joined by three fellow experts Paolo Giorgio Arcidiacono, Balint Eross and Jeanin E. van Hooft, and three cases were debated and explored within the hour-long session.

Be sure to check out yesterday’s session ‘Case Closed’ session on digestive oncology and stay tuned for tomorrow’s on IBD at 12:00 CEST!

Scientific Highlights: One in 10 people experience frequent meal-related abdominal pain 

Around 11% of the global population (13% of women and 9% of men) frequently experience abdominal pain when they eat meals, according to a survey on over 50,000 people. Pain associated with eating appears to be most common in young people aged 18 to 28, with 15% affected, the research found.

Those who experienced frequent abdominal meal-related pain were also more likely to suffer from bloating, a swollen tummy, feeling too full after eating or feeling full up too quickly, constipation and diarrhoea. The same group also had more severe psychological distress and somatic symptoms.

A total of 36% of the people with frequent meal-related pain reported suffered from anxiety compared with 25% in the occasional symptoms group and 18 % in those who never experienced meal-related pain. Those with frequent attacks also reported higher rates of depression (35%) compared to 24% in the occasional symptom group and 17% in the group that never had meal-related pain.

Based on the Rome Foundation Global Epidemiology study, the findings were a result of surveying 54,127 people across 26 countries online.

Esther Colomier, who presented the study today, explained, “The take home message from this study is that people who experience meal-related abdominal pain more frequently experience other gastrointestinal symptoms and more regularly fulfil criteria for disorders of the gut brain interactions (DGBIs, formerly known as functional gut disorders), including common conditions such as irritable bowel syndrome (IBS), bloating and abdominal distension.”

Best Abstract Prize: Xyloglucan and pea protein improve markers of gut function in animal model of abdominal pain

A plant-based preparation containing xyloglucan (derived from tamarind tree seeds) and pea protein (XP) significantly decreased intestinal permeability and improved markers of gut barrier integrity in a murine model of abdominal pain and distention. Researchers used Sprague-Dawley rats that were subjected to partial restraint stress to assess viscerosomatic responses after colonic distention.

Gut barrier function was assessed using a lactulose/mannitol test. The aim of the study was to investigate whether XP could potentially restore intestinal barrier function to prevent stress-induced abdominal distention and visceral hypersensitivity–key factors involved in the etiology of functional gastrointestinal disorders such as functional abdominal bloating and distension (FABD).

Pretreatment with XP twice-daily for 5 days prevented stress-induced visceral hypersensitivity, significantly reducing the number of stress-induced abdominal contractions in response to colonic distention compared with vehicle. XP also restored the expression of multiple tight junction proteins, including claudin-1, occludin, and E-cadherin, in both the small and large intestine, thereby potentially stabilising or improving intestinal barrier integrity. The lactulose/mannitol ratio was significantly reduced after XP treatment compared with vehicle, suggesting restoration of normal intestinal permeability in the stressed rats.

“This compound represents a novel therapeutic strategy for FABD that should be further explored in patients to improve the quality of life,” concluded Michela Campolo, who presented the study findings and received a Best Abstract Prize at the congress.

UEG Rising Stars Awards

The UEG Rising Star Awards are presented each year to the most promising, emerging scientists. The award provides a durable platform for young researchers to further evolve their professional career. Awardees are jointly selected by the National Societies Committee and the Scientific Committee based on a track record of international quality research and developing scientific independence.

Congratulations to this year’s UEG Rising Stars:

Javier Ampuero, Spain

Imran Aziz, United Kingdom

Marco Carbone, Italy

Joep Grootjans, The Netherlands

Daniel Keszthelyi, The Netherlands

Sabela Lens, Spain

Giovanni Marchegiani, Italy (pictured)

David James Pinato, United Kingdom

Ville Sallinen, Finland

Xavier Verhelst, Belgium

Best Abstract Prize: Givosiran provides sustained and continuous benefit in acute hepatic porphyria patients

A 24-month analysis of the Phase 3 ENVISION study has provided evidence that the aminolevulinate synthase 1-directed small interfering RNA, givosiran, provides sustained and continuous benefit over 2 years in patients with acute hepatic porphyria (AHP). Patients who continued with givosiran treatment in the open-label extension (OLE) of the ENVISION study continued to benefit from the near-normal levels of urinary disease markers, low acute attack rates and hemin use, and improved quality of life achieved after 6 months of double-blind treatment.

The ENVISON study randomised 94 patients aged ≥12 years with AHP who had an elevated level of urinary aminolevulinic acid (ALA) or porphyobilinogen (PBG) (≥4 times the upper limit of normal), and who had experienced at least two composite porphyria attacks during the 6 months before baseline. Patients were randomised to receive monthly subcutaneous givosiran 2.5 mg/kg (n=48) or placebo (n=46) for 6 months, with the option to continue givosiran 2.5 or 1.25 mg/kg in the OLE. Among the 89 patients with acute intermittent porphyria (the most common form of AHP) who took part in the study, the median annualised attack rate (AAR) (the primary endpoint) was 1.0 (IQR: 0.0–6.2) in the givosiran group and 10.7% (IQR: 2.2–26.1) in the placebo group – a relative difference of 90%.1 Attack rates remained low during long-term treatment with givosiran. Among patients who received continuous givosiran over 24 months (n=47), the median AAR was 0.46 and the proportion of patients with zero attacks per 3-month intervals improved over the OLE period, with 82.6% of patients attack free at months >21–24 compared with 66.7% of patients attack free at months >3–6.

Continuous givosiran treatment led to a sustained lowering of median urinary ALA levels to near normal and lowering of PGB levels by >75% through Month 24. The percentage of patients with zero days of hemin use increased from 54.2% during double-blind treatment to 68.1% during open-label treatment, with median annualised days of hemin use of 0.0 and 0.2, respectively. Patients experienced continued improvements in quality of life and other patient-reported outcomes during open label treatment.

The most common treatment-related adverse events reported with givosiran treatment were injection site reactions (29%), nausea (20%), and fatigue (13%). Serious adverse events, which included increased blood homocysteine, chronic kidney disease, device breakage, pyrexia, and urinary tract infections, were reported in 28 patients (30%).

The research, which has been awarded with a Best Abstract Prize, was presented by Herbert Bonkovsky.

Gut talk: Lessons learned – a focus on endoscopy

Back in the TV Studio this afternoon, Marianna Arvanitakis and Joost P.H. Drenth chaired an interactive ‘Gut talk: Lessons learned’ session, offering clinicians the opportunity to receive a crash course in distinct clinical topics. Today’s session looked at endoscopy and surgery, featuring clinical presentation and diagnostic work ups (Fredrik Swahn), endoscopic management (Daniel Blero) and when surgeons should be called into settings (Valerio Lucidi).

Each speaker presented a case, before moving onto exploration and debate with the wider group on how to manage the situation and provided best-practice examples for future use. The majority of the session was dedicated to open discussion in the TV Studio, allowing each of the cases to be fully examined in-depth with interactive from online delegates.

Tomorrow’s programme will also feature another ‘Gut talk: Lessons learned’ session, with the focus on oesophageal emergencies. You can also catch up on yesterday’s session – on Fistulising Crohn’s disease – via the on-demand section of the virtual platform!

UEG Research Prize 2021: Dirk Haller

In the final session of today’s packed programme, Dirk Haller was awarded the distinguished UEG Research Prize 2021 for his research ‘Repurposing mitochondria-protective targets for adjuvant IBD therapy’. Dirk Haller is the director of the ZIEL - Institute for Food & Health, Technical University of Munich, Germany and Full Professor at the Technical University of Munich, Germany in Nutrition and Immunology.

“I feel very privileged and honoured considering the fact that a nutrition scientist was able to make valuable contributions to clinically relevant questions”, commented Dirk Haller. “I am a basic scientist at the interface of different research fields (gastroenterology, microbiology, immunology and nutrition science), and to make sure that our approaches are relevant, the clinical translation of our work was and still is a central vision of my research.”

“I am proposing here that metabolic injury a novel concept for the underlying cause of unresolved tissue injury and the risk for recurrent disease behaviour of IBD phenotypes. This brings together more than 10 years of work suggesting that mitochondrial perturbations and metabolic impairment of the intestinal epithelium causes metabolic injury. If this is true than we can think about using other therapeutic approaches to generate clinical benefit. More specifically, my team and I will look at the impact of mitochondrial therapeutics and their impact on IBD-related tissue wounding. I think this is exciting and will complement our ongoing research looking at microbiome-related factors in the regulation of metabolic injury.”

“This award from the UEG clearly belongs to the short list of my personal highlights.”

That's all for today's recap! Tune in tomorrow for a final installment of highlights from the scientific and wider congress programme.