-Autumn Meeting Parallel Session

The Special Interest Group in Gastroenterology and Clinical Nutrition ran a parallel session, chaired by Dr Stuart Bruce.

The meeting was very well attended - the lecture hall being full with more than 200 delegates present.

The first speaker was Prof Oliver James from Newcastle, who spoke on the topic of "Fatty Liver". In this superb lecture he highlighted the significance of non-alcoholic steato-hepatitis and its relation to obesity and to metabolic syndromes. He also expounded the significance of obesity and fatty liver in causing, not only hepatitis and fibrosis, but also leading to cirrhosis. He stated that in 10% of those patients, adenocarcinoma of the liver could also develop. The lecture was very stimulating and it triggered a lot of questions. Prof James also spoke about the effect of alcohol on the liver, in particular, its relation to the amount of units of alcohol that is consumed by men/women per week. NASH/NAFLD seems to be associated with 10% of the population in America and, to a lesser extent, in Europe. As obesity has recently become the number one epidemic, it has become important that non-alcoholic fatty liver is regarded as a problem carrying significant morbidity and mortality if not tackled at an early stage, particularly in children.

Refeeding Syndrome
The second speaker was Miss Sian Jones, senior gastroenterology dietitian from Newport. She gave an excellent account on an unusual topic, namely, "The Refeeding Syndrome". She highlighted the significance of the disorder, which is more common in elderly people. Sian defined it as severe electrolyte imbalance that might occur following re-introduction of carbohydrates to "somebody who has been starved". It carries a high mortality and morbidity rate; and it is more common than is thought.  However, it is also preventable. The electrolyte imbalance could be manifested as hypophosphataemia, hypomagnesaemia or hypokalaemia, as well as thiamine deficiency.  Miss Jones detailed the means of preventing the development of this syndrome, giving particular attention to those patients who are at risk, for example, people who have been starved for a few days, anorexia nervosa patients, patients who have undergone a duodenal switch operation for obesity, people with chronic alcoholism, diuretic abusers, hyperglycaemic patients, those subject to prolonged IV feeding, etc.

Non-Cardiac Chest Pain
The third talk was on "Non-Cardiac Chest Pain (NCCP)" given by Dr Nadim Haboubi, Secretary of the SIG. He defined the concept of non-cardiac chest pain as being chest pain with a normal cardiac test. Dr Haboubi concentrated on the oesophageal causes and the possible mechanism that could lead to non-cardiac chest pain. He highlighted the burden of NCCP on the patients, the health system and the doctors. He also gave an account on how to investigate these patients and treat them with minimal invasive procedures. Apart from gastro-oesophageal reflux, he discussed the concept of visceral hyperalgesia as one of the oesophageal mechanisms which could be the cause of non-GORD NCCP. The ease and practicality of using short PPI tests was also explained, along with various forms of available treatments. The concept of most recent therapeutic tests such as the use of pain modulators and SSRI drugs was also discussed, as were Botulinum toxin injections.

Nadim Y Haboubi
Secretary
SIG in Gastroenterology & Clinical Nutrition