APDW 2017 to examine key issues and outlook of digestive disease management
The Asian Pacific Digestive Week (APDW) 2017, to be held in Hong Kong on 23–26 September, will examine key issues in and the future of digestive disease management in the Asia-Pacific region. Professor Justin Wu of the Chinese University of Hong Kong (CUHK), Congress President of APDW 2017 and President of the Hong Kong Society of Gastroenterology, talks to MIMS Doctor about challenges the region is facing and shares highlights of the upcoming congress.
MD: What are the most remarkable achievements in Gastroenterology and Hepatology in the Asia-Pacific region in the last 5–10 years?
Wu: One remarkable achievement is incorporation of Fibroscan, a noninvasive technology that detects liver fibrosis, into clinical management of patients with chronic hepatitis B (CHB) infection and nonalcoholic fatty liver disease (NAFLD). This significantly reduces the need for invasive liver biopsies. Recent research has also shed light on associations between NAFLD and hepatocellular carcinoma (HCC), and between gut microbiota and metabolic syndrome. New therapies developed for treatment of hepatitis C have shown very high rates of cure.
More countries have implemented population-wide colorectal cancer (CRC) screening programmes following the development of Asia-Pacific guidelines on CRC screening. In addition to Korea, Japan and Taiwan, population-wide CRC screening has also become available in Hong Kong since October 2016.
With the prevalence of inflammatory bowel disease (IBD) increasing rapidly in Asia over the last 10 years, multinational working groups led by CUHK have conducted studies that shed light on the epidemiology, causes and mechanisms of IBD in the region.
MD: What challenges does the Asia-Pacific region face in the management of digestive diseases? How well are we positioned to overcome these challenges?
Wu: There is room for improvement in the general knowledge of community gastroenterologists. With the rising prevalence of IBD in our region, for example, early recognition of the disease is crucial for proper management. This relies on accurate and sensitive investigations performed early enough to differentiate patients with Crohn’s disease from those with ulcerative colitis, and to identify high-risk patients with Crohn’s disease for early treatment with immunosuppressive agents.
With the incidence of CRC increasing in the region, CRC screening has also become a very important topic. Endoscopy training needs to be optimized to support the implementation of population-wide CRC screening programmes. We also need to optimize endoscopic detection of premalignant lesions through improved bowel preparation, setting of endoscopy performance indicators, and development of standardized guidelines for all endoscopy centres in the region.
MD: The theme of APDW 2017 is “The Future in Digestive Diseases”. What future developments do you foresee in the management of digestive diseases in our region?
Wu: Research on IBD will lead to the development of new treatment options, while the availability of biologics and biosimilars will optimize standard of care of the disease in our region. As countries in the Asia-Pacific region continue to step up their efforts in understanding and controlling IBD, multinational collaborative research, such as the ENIGMA (Eastern Inflammatory Bowel Disease Gut Microbiota) project led by CUHK, will shed light on the mechanisms of the disease in our region. These research efforts, along with increased education, will ultimately improve clinical care of patients with IBD in Asia Pacific.
In terms of CRC screening, various screening modalities will be tested. These include image-enhanced endoscopy, which has emerged as a new paradigm for detection of premalignant lesions in recent years because of the high-contrast images they provide as compared with conventional endoscopy methods.
Early endoscopic intervention of digestive diseases, currently performed at expert centres only, will be more broadly applied in our region in the future. For example, endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are major endoscopic innovations that will become more widely used by endoscopists in the next 2 years. ESD is an advanced endoscopic technique that allows en-bloc resection of gastrointestinal tumours. POEM is expected to replace laparoscopic myotomy in the treatment of achalasia, with new data presented at the Digestive Disease Week 2017 in Washington, US, demonstrating its efficacy. As POEM requires good oesophageal motility testing, the demand for high-standard manometry is expected to increase.
The increasing prevalence of metabolic syndrome and NAFLD, along with the high prevalence of CHB infection, poses a threat to our region in terms of HCC risk. Researchers will continue to study the management of NAFLD and explore the value of newer diabetes drugs in NAFLD treatment.
MD: How will APDW 2017 be different this year? What will be the most exciting?
Wu: Highlights of APDW 2017 include new knowledge in IBD, state-of-the-art endoscopy workshops, advances in surgical treatment of digestive diseases, new approaches in the management of NAFLD, and the latest science and insights on the relationship between gut microbiota and health.
Stakeholders from across the Asia-Pacific region will convene in international consensus meetings and working groups to address the rising threats of digestive diseases in our region and share new discoveries. Abstracts submitted will be presented either in oral or e-poster format, while video presentations will also be available.
This year, we have increased the travel grant for clinicians and scientists in early stages of their career (up to 5 years following completion of training in Gastroenterology or Hepatology) to encourage participation in APDW, which broadens their education and experience in the field.