Pessimism, optimism and the benefits of a late night snack – BSG 2013

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SECC, Glasgow

Optimism might have seemed to be in short supply at the 2013 British Society of Gastroenterology conference in Glasgow on June 24th-27th, attended by practising clinicians and basic scientists from across the discipline, as well as by BMC Gastroenterology. Giving his plenary lecture, President of the Royal College of Physicians Sir Richard Thompson spoke of a ‘tidal wave’ in acute care which, combined with a lack of doctors, nurses, beds and funding could produce a ‘train crash’ in gastroenterological care. Strong sentiments, seconded by many of the attendees, with plenty of talk of increasing strain on time and resources for practising gastroenterologists.

 

Lack of research funding was another complaint at a symposium on clinical trials, where it was noted that gastroenterology receives just 2% of UK clinical research funding despite a much larger proportion of the disease burden. Perhaps, it was suggested, gastroenterological diseases just aren’t as visibly in the public eye as other diseases like breast cancer, which typically get a larger proportion of the research budget. Newspaper reports of high-profile celebrities that have suffered from these diseases, such as Kylie Minogue and Angelina Jolie, or those who have been involved in health-awareness campaigns, may influence policy decisions when budgets are being set.

 

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Pessimism aplenty then, but there was some optimism as well. The UK government’s new framework to encourage clinical research was widely praised and, perhaps reflecting this, plenty of exciting new research was presented at the conference. Some presented potential new treatments, while others focused on preventing the need for treatment at all. Examples of the latter were reviewed by Andy Burroughs of UCL, in a review of the current status of treatments for liver cirrhosis. As Burroughs explained, given the inevitable shortage of liver donors prevention is key in this disease. Reducing alcohol intake is of course vital, but new research suggests that drinking coffee, eating dark chocolate and eating a late night carbohydrate meal could all be beneficial in preventing cirrhosis. There is also the possibility for drugs like propranolol (which reduces portal hypertension) to be more widely prescribed to those at risk, much like statins are used to prevent heart disease.

 

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Prevention was also on the agenda at the symposium on inflammatory bowel disease (IBD). Andrew Hart of the University of East Anglia discussed the strong evidence linking smoking and Crohn’s disease (potentially one quarter of cases could be prevented if no one smoked) and the, currently weaker, evidence suggesting that eating less meat and more oily fish could reduce your chance of developing IBD. However, the main debate revolved around the extent to which research should focus on developing new drugs. New evidence for the efficacy of anti-TNF drugs was discussed, as were concerns about potential side effects. In two separate talks however, Simon Travis of the University of Oxford and Andrew Robinson, consultant at Spire Manchester Hospital, both made pleas for an increased focus on the patient experience. Surveys have shown that the biggest concerns of IBD sufferers are lack of access to services and poor communication from doctors. Robinson and Travis argued that, rather than focus on new drugs that will benefit only a small subset of IBD sufferers, care should be reorganised to focus on quality of life and continuity of care, benefiting all patients. A controversial point of view; as some questioners from the audience noted, what patients most want is a cure and drug development offers the best hope of this.

 

These were a few highlights of the conference, but in truth there was far too much interesting research presented in talks and poster presentations than there is space to discuss here. One poster that did catch the eye was from David Sanders and colleagues showing that over the last 15 years the proportion of abstracts presented at BSG conferences that were eventually published in the literature has fallen substantially. It is suggested that busy doctors find the peer review process too difficult and time consuming to publish all but the best of their research. It would certainly be a shame if much of the interesting research presented at BSG 2013 was lost to the wider literature; with our various initiatives to attempt to ease the pressures of peer review, perhaps BMC Gastroenterology can help?