This past week, more than 14,000 attendees attended educational sessions spanning the range of gastroenterology and hepatology at Digestive Disease Week in San Diego. From Barrett's esophagus to inflammatory bowel disease (IBD) to proton-pump inhibitors (PPIs), the conference covered new research and presented evidence-based clinical takeaways.
The optimal surveillance interval for patients with nondysplastic Barrett's esophagus ranges from three years for men to five years for women, said John Inadomi, MD, during a session on questions and controversies about the disease. Patients who have had endoscopic eradication therapy for low-grade dysplasia confirmed after high-dose PPI therapy should also undergo surveillance, he added.
In terms of when to stop surveillance of nondysplastic Barrett's esophagus patients, new research presented at the meeting showed that comorbidity is a better predictor of surveillance benefit than age of diagnosis, said Dr. Inadomi, professor of medicine and head of the division of gastroenterology at the University of Washington School of Medicine in Seattle. In U.S. men, stop surveillance in those with no or mild comorbidities at age 82 years, with moderate comorbidities at age 79 years, and with severe comorbidities at age 74 years, the results suggested.
The conference, which coincided with World IBD Day on May 19, also reviewed the role of diet and environment in the management of patients with IBD. In clinical practice, physicians can help mitigate the impact of environment on their patients with IBD by encouraging smoking cessation, minimizing NSAID use, encouraging moderate-intensity physical activity, and possibly supporting stress-targeted interventions (although further evidence is needed to show a benefit on disease activity), recommended Ashwin N. Ananthakrishnan, MD, MPH.
In terms of modifying diet, he noted that there is no evidence to support efficacy of the following popular diets in treating active Crohn's disease or ulcerative colitis: low-FODMAP diet, Paleo diet, lactose-free diet, or gluten-free diet. The best evidence supports an elemental diet, Crohn's disease exclusion diet, or the CD-TREAT diet, said Dr. Ananthakrishnan, a gastroenterologist and associate professor of medicine at Massachusetts General Hospital and Harvard Medical School in Boston.
“It's important as physicians when they see patients with IBD that we do acknowledge the role of diet but [also] that there's also a heterogeneity of benefit,” he said, adding that minimizing processed foods is a good overall dietary strategy.
Finally, a research forum, “PPI Uses and Misuses,” featured results from several brand-new studies about the controversial drugs.
Patients often hear about numerous adverse outcomes with PPIs, which are not always supported by evidence, said moderator Colin W. Howden, MD, professor of medicine at the University of Tennessee Health Science Center in Memphis. He was senior author of a meta-analysis of 11 studies that found no good evidence for an association between PPI use and dementia. “The results are pretty straightforward,” he said. “I think that we don't know what's causing the uptick in dementia, but I really think it's ridiculous that people are suggesting that PPIs are playing any role.”
Other research in the session found that PPIs are more effective than placebo or famotidine in preventing upper GI bleeding in patients receiving clopidogrel-based antithrombotic therapy and that the rate of PPI prescribing in ambulatory care continues to increase, though at a slower rate in recent years than in the past.
Finally, an educational intervention, along with an electronic health record-based tool that assisted in tapering PPI use, helped reduce the proportion of inappropriate PPI prescriptions from 77% to 52% at a resident-run primary care clinic at Baylor College of Medicine in Houston, said lead author Chiemeziem Eke, MD.