Professional Practice Symposium 2008

Janssen-Cilag's Professional Practice Symposium 2008 was convened earlier this year. More than 100 gastroenterologists gathered in Sydney for a mix of professional and clinical topics of interest. Featuring international guest Professor Kenneth McColl, the program received glowing endorsements from attendees. The Professional Practice 08 newsletter has now been released (see below).

Gender the key to modifying GO junction cancer development

In his plenary address, Professor Kenneth McColl of the Gardiner Institute, Scotland, discussed the marked increase in gastro-oesophageal (GO) junction cancers. He talked about the possible roles of atrophic gastritis and H. pylori; nitrate as a pre-carcinogen; and environmental factors.

A gender phenomenon characterised by a marked male predominance in adenocarcinomas of the oesophagus and stomach was also discussed. A population study in the west of Scotland demonstrated that there was a 17-year delay in the development of cancers in females versus males. Professor McColl said his findings can offer insight into the carcinogenic process in males versus females. The high incidence of GO junction cancer warrants consideration of the gender phenomenon with respect to screening and disease modification options.

Should we measure azathioprine metabolites?

Dr Miles Sparrow of Box Hill Hospital, Melbourne, presented his views on the measurement of azathioprine metabolites, which offers an explanation for non-response in some patients, as well as a way to detect those at risk of leukopaenia, a rare but potentially fatal side effect of azathioprine. Dr Sparrow highlighted the value of azathioprine metabolite testing in the context of a new top-down approach to the management of inflammatory bowel disease (IBD). Metabolite testing offers a way of optimising the use of thiopurines, and this testing sits well with the increasing role of immunomodulators in managing IBD.

Workshop explores role of acid pocket in GO cancer

Professor McColl described his work on the "acid pocket" as the source of reflux disease. He theorised that an acid pocket sitting at the top of the stomach bathes the distal oesophagus in acid following a meal. He said the meal distorts the lower oesophageal sphincter, exposing the squamocolumnar junction to acid, thereby resulting in acid reflux.

It runs in the family

Clinical Associate Professor Judy Kirk of Westmead Hospital, Sydney, discussed the nature of family cancer clinics and identified some of the familial syndromes involved in gastrointestinal cancers. Genetic susceptibility to gastrointestinal cancers is rare, but in certain individuals genetic testing could aid risk reduction and influence cancer management. Among the genetic syndromes associated with bowel cancer discussed were Lynch syndrome (also known as hereditary non-polyposis colon cancer), familial adenomatous polyposis, Peutz-Jeghers syndrome, juvenile polyposis syndrome, and hereditary diffuse gastric cancer. Professor Kirk emphasised the importance of genetic counselling and testing where appropriate.

A new endoscopic paradigm for Barrett's oesophagus

Associate Professor Ian Norton of Royal North Shore Hospital, Sydney, outlined some new techniques for the management of Barrett's oesophagus. He discussed photodynamic therapy, band-ligation mucosectomy, and confluent radio frequency ablation of Barrett's mucosa ("Halo"). These new techniques provide more alternatives for high risk surgery patients, and an opportunity to reassess the management of Barrett's oesophagus in Australia.

Fiji program offers chance to help out

Professor Finlay Macrae of the Royal Melbourne Hospital and the Gastroenterological Society of Australia said that 42 Australian gastroenterologists have volunteered their services to assist the Fiji School of Medicine's GE training program via the GESA Fiji Training Team (GESAFiTT). He gave an overview of what the program involves, and urged more gastroenterologists to join the initiative.