The latest developments in gastroenterology

Irish Society of Gastroenterology, Summer Meeting, Virtual Meeting, 18 June 2021

Niamh Cahill speaks to President of the Irish Society of Gastroenterology Dr Tony Tham about the Society’s
upcoming virtual meeting, developments in the specialty, and the effect of Covid-19 on services

The Irish Society of Gastroenterology (ISG) Summer Meeting takes place virtually on 18 June with nine presentations by expert speakers on topics pertinent to the specialty of gastroenterology. The day-long meeting begins at 9.30am and will see Irish and international specialists deliver talks on subjects including haemochromatosis, cirrhosis and Crohn’s disease, among many other subjects of interest.

Speaking to the Medical Independent in advance of the meeting, ISG President Dr Tony Tham said that following the emergence of Covid-19 all face-to-face meetings planned by the Society were switched to a virtual format. Over the past 12 months the Society has hosted three webinars, which have highlighted some of the main areas within the specialty, such as endoscopy, inflammatory bowel disease, and liver disease, said Dr Tham. During this time the Society has continued its work in advancing service improvements in gastroenterology and hepatology in Ireland.

As Chairperson of the HSE National Clinical Programme for Gastroenterology and Hepatology Clinical Advisory Group, Dr Tham welcomed recent approval for six new consultant gastroenterologist posts in Ireland. The clinical advisory group, set up by the RCPI, oversees the work of the HSE Clinical Programme for Gastroenterology and Hepatology, which is led by Prof Colm O’Morain. Increasing the number of consultant gastroenterologists in Ireland was one of the group’s strategic objectives, explained Dr Tham.

A 2020 HSE report, ‘Demand for medical consultants and specialists to 2028 and the training pipeline to meet demand: A high-level stakeholder informed analysis’, showed that in 2018 there were 85 (69 public and 16 private only) consultants working in gastroenterology. Of this number, a fifth were over 55 years of age. In 2018 the number of higher specialist training trainees working in the specialty was 45. Ireland has 1.8 gastroenterologists per 100,000 of the population compared to 2.5 in England, 2.1 in Scotland, and 2.8 in Australia.

Specialist demand estimates show that the specialty requires a total head count of 152 gastroenterologists by 2028.
Dr Tham, who is Consultant Physician and Gastroenterologist based at Ulster Hospital, Belfast, said another objective of the group is to establish a hepatology hub and spoke network throughout the country to improve patient care.
“For example, a central hospital would have a network arrangement with a smaller hospital so that patient treatment could be transferred from the smaller hospital to the larger hospital if required. The expertise from the central hospitals could also go out to the smaller hospitals and deliver local care,” he explained.

The network would make hepatology care more accessible and create integrated care pathways for patients suffering from gastro-intestinal diseases to access care for complaints such as liver failure and inflammatory bowel disease, as well as nutrition, paediatrics, and some endoscopy services. The network is a “work in progress”. An agreed plan has yet to be devised before a business case is presented to the HSE for approval.

“We are making progress. A few years ago we started off with nothing and now we have a programme lead in Colm O’Morain who is bringing everyone together.”

New developments

Some very exciting developments have occurred within the specialty in recent times, said Dr Tham. The faecal immunochemical test (FIT) test, currently being rolled out in primary and secondary care services in Northern Ireland, is one such innovation. It is already in use by the HSE as part of the BowelScreen, the national bowel screening programme. Consultant Gastroenterologist at the University of Warwick in the UK, Prof Ramesh Arasaradnam will deliver a talk entitled “Using FIT in symptomatic disease” at the summer meeting.

FIT testing can be used to triage patients with lower gastrointestinal symptoms. It is a stool test used to detect a patients’ risk of serious underlying disease, said Dr Tham. Another promising development is the cytosponge, which is used to detect early or pre-cancerous lesions in Barret’s oesophageal cancer, said Dr Tham. This is a new test in development that has yet to be rolled out clinically, he added.

The topic of early gastric cancers and pre-cancer detection and management will be discussed in a
talk by Prof Mário Dinis-Ribeiro, a Consultant Gastroenterologist from the Institute of Porto, Portugal, at the
summer meeting. A colon capsule is another potentially significant and innovative test within the specialty that is currently under development, said Dr Tham.

“The colon capsule will go into the colon and take pictures of the colon, so it may be an alternative to colonoscopy.”

Agenda

According to Dr Tham: “It’s important to keep educated and our talks are aimed at the jobbing gastroenterologist and common diseases and how best to manage them for patients.” The meeting opens with Prof Dinis-Ribeiro’s talk, outlined above. He will be followed by Mr Paul Carroll, Oesophagogastric and General Surgeon, Galway University Hospital, who will give a talk on the future of gastric surgery.

Next up is a presentation on the gastrointestinal consequences of pelvic radiation disease by Prof Jervoise Andreyev, Consultant Gastroenterologist and Honorary Professor at the University of Nottingham, UK. He will be followed by Dr David Kevans, Consultant Gastroenterologist at St James’s Hospital, Dublin, who will look at preventing post-operative recurrence of Crohn’s disease. A talk on what’s new in haemochromatosis by Prof Susanne Norris, Consultant Hepatologist, St James’s Hospital, Dublin, begins after the lunch break.

Managing ascites in cirrhosis is the next topic under review by Prof Guru Aithal, Professor of Hepatology and Head of Division for Digestive Diseases at the University of Nottingham, UK. Dr Eamonn Quigley and past president of WGO, Chief of Gastroenterology and Hepatology at Houston Methodist Hospital, Texas, US, will then provide an overview of oesophageal dysmotility. Prof Arasaradnam’s talk on FIT testing, mentioned above, precedes the final presentation of the day, which will outline the latest approach to irritable bowel syndrome. The speaker will be Dr Kyle Staller, Director of Gastrointestinal Motility Laboratory, Harvard University, US.

Oral free papers and poster presentations are also included in the agenda and have increased this year, according to Dr Tham. “We’ve increased the number of oral and poster presentations this year to highlight original research from our young, talented Irish investigators because the trainees and young investigators are the future of our society.

“I would encourage people to attend virtually; take the study day off and immerse themselves in the education,” he added.

Society

As well as organising a packed agenda for the summer meeting, the Society has been active in engaging with its international counterparts, said Dr Tham, such as the European Society for Gastrointestinal Endoscopy.

“We’re looking beyond Ireland and collaborating with other societies in Europe.”

This will be Dr Tham’s last meeting as President of the Society before he hands over the reins to incoming President, Prof Deirdre McNamara, at the end of this meeting. 

“I would like to thank you and the Society for giving me the honour and privilege to be your President for the last two years. It has truly been the highlight of my career. It has been a most challenging time with the pandemic, but what we as a Society have learned is to be able to adapt to changes. I look back with pride on what the Society has achieved over the past two years with the ‘Es’: Engaging with other societies and clinical services, collaborating with Europe, and educating our members,” he said.

Covid-19

The pandemic has had a devastating impact on the healthcare service and continues to present challenges for clinicians. According to Dr Tham, the disease has resulted in a huge backlog of gastroenterology cases, both North and South of the border. In April, more than 14,000 patients were waiting on an outpatient gastrointestinal appointment, according to the National Treatment Purchase Fund, compared to about 12,000 in January 2020. The resulting treatment delays will result in more delayed diagnoses, he said.

“On the whole island of Ireland our waiting lists are pretty terrible. There will be delayed diagnosis of cancer and patients, with serious benign conditions being detected later. That’s the side-effect of Covid on our patients.
“We’ve seen an increase in the referral rate since Covid and so with the increased referrals we are detecting more cancers as well. It’s hard to know what the impact would be not for Covid, but you need a huge data set for that. I would anticipate that many years down the line, when they analyse the data, that cancer survival rates may dip. That’s speculation at the moment, but it makes sense if you detect cancers later that the prognosis would not be as good, but we don’t have the data yet to show that.”