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Three in 10 Diabetic Patients May Have Liver Fibrosis Many Drugs in The VOL. 12 NO. 3 MARCH 2018 ® Many drugs in the INSIDE IBD AND INTESTINAL pipeline for IBD DISORDERS High BMI linked to problems in IBD treatment Obesity related to EWS N increased rate of BY DOUG BRUNK sentation by highlighting ICAL hospitalization. • 23 ED Frontline Medical News anti-integrin therapies M for inflammatory bowel LIVER DISEASE LAS VEGAS – A wide disease (IBD) treatment. Obesity affects the RONTLINE /F variety of drugs are in These leukocyte membrane ability to diagnose the pipeline for both ul- glycoproteins target beta1 RUNK B cerative colitis (UC) and and beta7 subunits. They liver fibrosis OUG As BMI increases, so does D Crohn’s disease patients interact with endothelial li- Dr. Kenneth Cusi said, “Patients with diabetes [type 2] face the who are failing currently gands VCAM-1, fibronectin, discordance between greatest risk of fatty liver and of fibrosis.” available therapies. and MadCAM-1, and medi- imaging techniques. • 32 “The challenge for all ate leukocyte adhesion and GI ONCOLOGY of us is to integrate the trafficking. Approved an- Circulating tumor cell Three in 10 diabetic right drugs for the right ti-integrin therapies to date patients,” William J. Sand- include natalizumab and assay for CRC born, MD, AGAF, said at vedolizumab, while inves- High sensitivity and patients may have the annual congress of the tigational therapies include specificity reported. • 38 Crohn’s & Colitis Founda- etrolizumab, PF-00547659, tion, a partnership of the abrilumab, and AJM 300. AGA GUIDELINE liver fibrosis Crohn’s & Colitis Foun- In a phase 2 study of Use goal-directed dation and the American etrolizumab as induction fluid therapy, early BY DOUG BRUNK to treat it,” he said at the Gastroenterological Asso- therapy for moderate to se- refeeding in acute Frontline Medical News World Congress on Insulin ciation. vere UC, Séverine Vermeire, pancreatitis Resistance, Diabetes & Car- Dr. Sandborn, professor MD, AGAF, Dr. Sandborn, Recommendations for LOS ANGELES – For every diovascular Disease. and chief of the division and associates randomized the first 2 weeks of 10 adult patients with type Dr. Cusi, chief of the di- of gastroenterology at the 124 patients to one of two treatment. • 39 2 diabetes, three are likely vision of endocrinology, University of California, dose levels of subcutane- to have moderate to severe diabetes, and metabolism San Diego, began his pre- See Pipeline · page 22 liver fibrosis, according to at the University of Florida, Kenneth Cusi, MD, FACP, Gainesville, predicted that FACE. obesity will become the No. New multi-analyte blood test shows “The question is, How 1 cause of liver transplan- are we going to tackle this tation. “It’s a real epidemic; problem? My academic you’re not seeing it because promise screening for several cancers goal is that we incorporate the inflexion of obesity hap- screening for NASH [non- pened just 2 decades ago,” BY SHANNON AYMES cancer types. 99% in a cohort of 1,005 alcoholic steatohepatitis], he said. “Patients with dia- Frontline Medical News It’s early days for the patients with stage I-III or for fibrosis more spe- betes face the greatest risk technology, called Cancer- cancers and 850 healthy cifically, in the same way of fatty liver and of fibrosis. magine a single blood SEEK, but the test had a controls, wrote Joshua D. we do for retinopathy or Untreated, it’s the equiva- I test that would cost sensitivity of 69%-98%, Cohen of the Ludwig Cen- nephropathy [in diabetes], lent of having macroalbu- less than $500 and could depending on the cancer ter for Cancer Genetics and because we do have a way See Fibrosis · page 25 screen for at least eight type, and a specificity of See Blood test · page 34 June 2–5, 2018 Exhibit Dates: June 3–5 Walter E. Washington Convention Center Washington, DC www.ddw.org Monumental Developments in Science & Medicine Washington, DC REGISTER BY APRIL 18 AND SAVE AT LEAST $80. Plainview, NY 11803-1709 NY Plainview, Lebanon Jct. KY Jct. Lebanon AASLD, AGA, ASGE and SSAT Suite 2, 2, Suite Permit No. 384 No. Permit Jan. 17, 2018 members-only registration opens. PAID 151 Fairchild Ave., Ave., Fairchild 151 U.S. Postage U.S. Presorted Standard Presorted General registration opens. CHANGE SERVICE REQUESTED SERVICE CHANGE Jan. 24, 2018 GI & Hepatology News Hepatology & GI 6 NEWS MARCH 2018 • GI & HEPATOLOGY NEWS LETTER FROM THE EDITOR: IBD drugs, ‘liquid biopsies,’ and DDW he coming months will provide us welcome sponses. We are entering at concentrations that are vanishingly low. These relief from health care politics as we turn an era of precision medi- methodologies may allow screening for digestive T our attention to the science of medicine. Di- cine never before seen in cancers using blood and stool testing at accuracy gestive Disease Week® (DDW) will be in Washing- our specialty. Most of these rates that rival endoscopy – and at reduced cost. ton, D.C. from June 2 to 5. Major themes already biological medications can Other themes that we will see emphasized at are emerging and implications for our clinical be given orally or subcu- DDW® include the microbiome, telehealth, pre- practices are exciting. In this month’s issue of GI taneously, precluding the cision health, and use of “big data” for predictive & Hepatology News we summarize a presenta- need for infusion centers. analysis and risk stratification of patients. tion about the IBD medication pipeline given by I anticipate an enormous The Board of Editors appreciates the feedback Dr. Bill Sandborn (UCSD) at the Crohn’s & Colitis offering of IBD-related sci- that many of you sent us in our latest readership CongressTM (a partnership between the Crohn’s ence at DDW®. survey. Each month, we try hard to collect articles & Colitis Foundation and AGA in Las Vegas). The DR. ALLEN Two other articles this of clinical interest to the wide variety of clinicians number of medications that will enter clinical month should be read and researchers that read GI & Hepatology News. practice is impressive. Over the last several de- carefully. “Liquid biopsies” are coming. We know We will continue to improve our offerings based on cades, we have defined multiple inflammatory that solid cancers shed DNA into the circulation. your valuable opinions. pathways that can lead to IBD and developed We now have molecular tools to identify circulat- John I. Allen, MD, MBA, AGAF medications that modify abnormal immune re- ing tumor-related epigenetic and DNA changes Editor in Chief Quick Quiz Q2. A 68-year-old woman with further options to treat her pain. alcoholic chronic pancreatitis epigastrum, but otherwise it is un- has constant, disabling pain. She Which intervention will most likely Q1. A 37-year-old man with no remarkable. A complete blood count has previously tried gabapentin, improve her pain and quality of life significant past medical history reveals a white blood cell count of 6, celecoxib, and antioxidants with over the next 5 years? presents with a dull, nonradiating hemoglobin 10 g/dL, MCV 72 fL, and some improvement. She currently A. Continued medical therapy and in- epigastric pain for 3 months. The platelet count of 200 x 103/mcL. takes nonenteric coated pancre- creased dose of pancreatic enzymes pain is not associated with eating or alipase (90,000 IU per meal) and B. Lateral pancreaticojejunostomy positional changes. He denies any What is the most important next controlled-release oxycontin. CT (Peustow procedure) heartburn, regurgitation, chest pain, step of management? of the abdomen shows a few small C. ERCP with lithotripsy and stent nausea, vomiting, dysphagia, odyno- A. Schedule an abdominal ultra- punctate calcifications in the head placement phagia, or weight loss. He currently sound of the pancreas, a 1-cm calculus in D. EUS-guided celiac plexus block does not take any medications. Fam- B. Send an H. pylori stool antigen the genu with a markedly dilated E. Total pancreatectomy with islet ily history is not significant. Phys- C. Schedule an upper endoscopy pancreatic duct in the body and tail, autotransplantation ical examination reveals minimal D. Empiric antisecretory therapy and moderate distal atrophy. There tenderness to deep palpation in the E. Start amitriptyline 25 mg daily are no pseudocysts. She discusses The answers are on page 32. EDITOR IN CHIEF GI & HEPATOLOGY NEWS is the official newspaper of the American FRONTLINE MEDICAL COMMUNICATIONS SOCIETY PARTNERS John I. Allen, MD, MBA, AGAF Gastroenterological Association (AGA) Institute and provides the VP/Group Publisher; Director, FMC Society Partners Mark Branca ASSOCIATE EDITORS gastroenterologist with timely and relevant news and commentary about Editor in Chief Mary Jo M. Dales clinical developments and about the impact of health care policy. Content for Megan A. Adams, MD, JD, MSc Executive Editors Denise Fulton, Kathy Scarbeck GI & HEPATOLOGY NEWS is developed through a partnership of the newspaper’s Editor Lora T. McGlade Ziad Gellad, MD, MPH, AGAF medical board of editors (Editor in Chief and Associate Editors), Frontline Kim L. Isaacs, MD, PhD, AGAF Creative Director Louise A. Koenig Medical Communications Inc. and the AGA Institute Staff. “News from the Bryson Katona, MD, PhD AGA” is provided exclusively by the AGA, AGA Institute, and AGA Research Director, Production/Manufacturing Rebecca Slebodnik Gyanprakash A. Ketwaroo, MD, MSc Foundation. All content is reviewed by the medical board of editors for National Account Manager Artie Krivopal, 973-206-2326, Larry R. Kosinski, MD, MBA, AGAF accuracy, timeliness, and pertinence. To add clarity and context to important cell 973-202-5402, [email protected] Sonia S. Kupfer, MD developments in the field, select content is reviewed by and commented on by Digital Account Manager Rey Valdivia, 973-206-8094, Wajahat Mehal, MD, PhD external experts selected by the board of editors.
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