Australian Gastroenterology Week (AGW) 2007 & Developments in Ulcerative Colitis
Britains Andy Murray has often spoken of marathon sushi-eating sessions during training, downing huge bowls of pasta before matches and wolfing two entire baguettes stuffed with chicken afterwards. Djokovic, on the other hand, credits his ascent to world No 1 after years of being dogged by ill-health to a strict gluten-free diet. That means no bread, no pasta and nothing made with flour. As fad diets go, its almost as old-hat as The Atkins. So could it really be the key to his sporting success? Moreover, could it also give us mere mortals a dietary advantage? THE CELEBRITY INTOLERANCE Going gluten-free, usually shorthand for eradicating bread from the diet, has been linked to every skinny celebrity from Gwynnie to Minnie and even whippersnappers such as Miley Cyrus. Dieticians, ever sceptical, usually point out that cutting out gluten a protein found in grains that gives baked food its chewy texture is useful only if you have the debilitating medical condition coeliac disease, an incurable auto-immune disorder triggered by gluten which causes inflammation of the small bowel. So for most of us there should be no real benefit. Could this berry mean you can eat junk food guilt free? Lingonberries ‘halt the effects of high-fat diet’ Djokovic has never claimed to have coeliac disease but does speak of an intolerance to gluten, which leads to a crushing lack of energy and asthma-like symptoms. A few years ago, he hit a patch of bad form and was constantly dropping out of tournaments. It became a running joke with fellow competitors. Andy Roddick quipped in 2008: Two injured ankles, hip . . .
Specialist to help ease wait times
In disease limited to the rectum, the mainstay of therapy includes topical aminosalicyclate (5-ASA) suppositories (small masses of medication that are designed to melt when inserted into a body cavity). Topical therapy refers to local application of treatment directly onto the surface of a body part. In more extensive cases where disease affects larger parts of the bowels, combination therapy involving 5-ASA agents (both oral and topical), steroids and other immunosuppressive agents is recommended. In a recent study conducted by Barclay et al, an increased use of medications which act to alter the immune response (immunomodulators) was demonstrated. Out of 1421 patients with inflammatory bowel disease, the use of immunomodulators including azathioprine, 6 mercaptopurine and methotrexate was investigated. Oral 5-ASA treatments were used in 77% of ulcerative colitis patients. Use of these medications correlated with increasing disease extent. In conclusion, IM use was high in these patients, compared with previous studies. This was thought to be primarily due to changing clinical practice, rather than changes in disease severity. Response to Infliximab Therapy in Patients with Severe Ulcerative ColitisThe efficacy of Infliximab in outpatients with moderate – severe ulcerative colitis has been well demonstrated. Studies have been conducted in an attempt to further investigate the use of Infliximab as rescue therapy in a subset of severe hospitalised patients and also to try to reduce the numbers of people requiring surgery for removal of areas of bowel affected by ulcerative colitis. However, these studies only involved limited numbers of patients and were too small to identify patient factors which predict response.
September figures show priority-one gastroenterology patients waited an average 47 days to be seen at the outpatient clinic – 50 per cent longer than the recommended 30-day maximum – and category-two patients waited an average 16 weeks. But waiting times have improved since a year ago, when some children waited up to a year to be assessed because of an acute shortage of gastroenterologists. It prompted the State Government to launch an urgent recruitment drive for specialists. The hospital says progress has been made after finding a gastroenterologist to fill a vacant position but it will have to take on more staff. A spokeswoman said PMH expected waiting times to improve further with a new part-time gastroenterologist due to start this month. Another 0.5 full-time equivalent position was in the appointment process and PMH was optimistic about appointing someone early next year. The Australian Medical Association welcomed the recent addition of a specialist but said it was clear more were needed to keep up with demand in the highly specialised area. WA president Richard Choong said gastroenterology was historically a difficult specialty to staff, which led to long delays for patients to be assessed and treated. “The fact PMH has managed to find someone recently and is close to more appointments is good news and very encouraging,” he said. “This is an area of medicine that is very specific and there are many conditions that need to access its services, but it’s a classic example of where there just aren’t enough people to do the jobs required.” Dr Choong said as a result many children were waiting too long, often in pain and discomfort, to be diagnosed and treated. “What I really hope is that the hospital will be able to recruit the extra staff it needs so children can be seen even more quickly,” he said.