American College of Gastroenterology: 2011 Annual Scientific Meeting
Another Major Presence for Inform Diagnostics
Washington, D.C. – For the past four years, the conspicuous presence of researchers from Inform Diagnostics has become a tradition at the annual meeting of the American College of Gastroenterology. This year was no exception: Fifteen abstracts were selected for poster presentation, a number that compares favorably with the most prestigious academic gastroenterology and pathology departments in the United States. One of these posters (see below for details) was honored with the ACG Presidential Poster Award.
This year, Inform Diagnostics researchers focused their efforts on several areas: infections, neoplasia, diarrhea, gastritis, and eosinophilic esophagitis. In a highly innovative study and winner of the ACG Presidential Poster Award, Bedeir, Bhattacharya, and Ray discovered that young women (<40 years of age) with collagenous colitis are eight times more likely than the general population to have celiac disease. Therefore, these authors suggest that such patients should also have an EGD with duodenal biopsies to exclude concurrent celiac disease.
As part of an ongoing effort to determine the temporal and geographic trends of reactive gastropathy, a condition of the gastric mucosa related to bile reflux and possibly to the use of NSAIDs that appears to be increasing in prevalence, Genta (in collaboration with I Maguilnik of the University of Rio Grande do Sul in Porto Alegre, Brazil) examined the demographic and epidemiologic patterns of this condition and concluded that it has been increasing in frequency in the last few years, that it is emerging in children and young people, and that its prevalence is not as inversely related to the prevalence of H. pylori as previously believed. In collaboration with J Hurrell (University of Texas Southwestern) and A Sonnenberg (University of Oregon) Genta showed that, contrary to previous suggestions derived from smaller series, there was no evidence of monthly or seasonal variation even within regions with variable climates among 10,000 patients with eosinophilic esophagitis. While it has been shown that H. pylori gastritis is inversely correlated with Barrett’s esophagus, Trapasso took this concept one step further and showed that H. pylori infection seems to also protect from dysplasia occurring in Barrett’s mucosa. In contrast, there is a positive correlation with squamous cell carcinoma, possibly because of shared risk factors. McIntyre, who has a long-standing interest in the diagnosis of Barrett’s esophagus, presented a study on the controversial issue of focal intestinal metaplasia at the gastroesophageal junction. She concluded that, in order to meet AGA guidelines for the diagnosis of Barrett’s esophagus, the pathologist must be aware of the endoscopic impression at the time of biopsy.
In three separate studies, Saboorian and his colleagues (Lindberg, Morgan, and Kinsey) examined the prevalence of unexpected infections in gastrointestinal biopsy specimens and concluded that, although exceedingly rare, colonic amebiasis, spirochetosis, and herpes esophagitis occur in immunocompetent patients. Since these patients usually present with non-specific symptoms and minimal organism loads, the diagnosis rests on the pathologist’s ability to consider rare, often neglected entities, and to be perseverant in the search for an etiology that can elucidate the origin of otherwise unexplained inflammatory changes. Yang devoted two projects to the investigation of the distribution patterns of colorectal adenomas and carcinomas; he and his colleagues (SJ Tang and R Wu of the University of Mississippi; and J Yang, from the Medical College of Wisconsin) determined that the distribution of colonic adenocarcinoma shares similar patterns with its precursors, but that its left-sided predominance gradually diminishes and shifts to the right side with advancing age, particularly in women. Golembeski focused on unexpected signet ring carcinomas that may be found in biopsy specimens from otherwise benign-appearing areas of the stomach. Two studies were devoted to diarrheal diseases. After examining colonic biopsy sampling patterns in more than 100,000 patients with diarrhea, Golembeski and Genta concluded that representative, topographically defined mucosal sampling is paramount in helping pathologists reach etiology-specific diagnoses in these patients.
In addition to these systematic studies (some of which have already been submitted as full papers at the time of this writing) there were several case reports: “Gastric Clear Cell Carcinoid Tumor in a Patient with Von Hippel-Lindau Disease” and “Metastatic Breast Carcinoma to the Colon Mimicking Microscopic Colitis” (both by Bhattacharya and Bedeir) as well as a clinicopathologic study of four adults with autoimmune enteropathy (Kinsey, Malhotra, and Gates).
– Robert M. Genta, MD, Chief for Academic Affairs