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Advances in COVID-19 and Hepatology

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The American College of Gastroenterology Scientific Meeting and Postgraduate Course (ACGSM/PGC) always provides a rich smorgasbord of educational activities from practice management, to topic reviews, hands-on workshops, and original scientific research. 

As a former President of the ACG, I know the challenges of putting on a “normal” meeting. The COVID-19 pandemic changed everything — for the organizers, attendees, and corporate sponsors of the 2020 ACGSM/PGC. Still, ACG President Mark Pochapin, his Board of Trustees, and ACG support staff led by Executive Director Brad Stillman created a tour de force like few others. 

The ACG is devoted to the art and science of clinical gastroenterology, endoscopy, and hepatology. It has always been, and remains, a welcoming venue for trainees and young clinicians, as well as those more established clinicians. Research tilts heavily towards clinical practice, rather than animal and lab-based studies. Devotion to confidence-building of the younger member is everywhere. 

So how did this year’s virtual meeting work out? Let’s hear first from some younger participants. 

ACG GI Jeopardy – The FINALS returned. The Saturday evening event was the culmination of a multi-tiered competition. Only the best four teams in the country were honored to participate in the Finals. I am pleased to report that Team Cleveland Clinic prevailed this year despite stiff competition. The value this activity brings to young gastroenterologists is summed up by the winning team: 

"Getting to participate in the ACG GI Jeopardy was a great achievement to our fellowship program and more importantly, all of my co-fellows who, through a superb team effort, made us qualify to participate in the online finals. It was an absolute honor for [us] to be selected to represent our program. We were thrilled and delighted to have won the contest and would also like to congratulate all of the other four fantastic participating teams from UCLA, UPenn, University of Iowa and Rutgers. We are proud to bring home the ACG GI Jeopardy 2020 trophy." (Carol Rouphael, GI Fellow)

"I was honored to be selected to represent our fellowship program at Cleveland Clinic with Carol Rouphael this year. We had the privilege of competing against impressive teams from UCLA, Iowa, Rutgers and UPenn and were very excited to win. I feel so lucky to work each day with incredible co-fellows while learning from talented faculty, and winning was especially meaningful because it meant we get to bring the cup home to them this year." (Katie Falloon, GI Fellow)

Aspiring gastroenterologists include internal medicine residents, many of whom made presentations at this year’s meeting. One of them told me: “Participating in the ACG 2020 conference was an enriching experience. It provided a platform to share my work on post-Nissen fundoplication dyspepsia and also to see similar work done in the field by others. Winning the Excellent Poster Presenter Award for our poster was a cherry on the cake and has motivated me to enthusiastically move forward with my research!) (Achintya “Archie” Singh, Internal Medicine Resident)

A dominant theme of ACGSM/PGC 2020 was, naturally, COVID 19, and in particular its GI manifestations, risks to patients, and to providers. Since my specialty area is hepatology, I paid close attention to learning about its liver manifestations.

I learned from Suraj Suresh (Henry Ford Hospital; P1987) that cirrhotics admitted with COVID-19 had a more than 2-fold increase in mortality, compared to those without cirrhosis (including those with non-cirrhotic liver disease). 

Ceena Chandrabos (Zucker School of Medicine at Hostra; P2038) reviewed more than 11,000 confirmed COVID 19 cases and found AST at admission predicted a higher inpatient mortality; those with very high levels (more than 10 times the upper limit of normal) were three times more likely to have a bad outcome. 

In a similar vein, Vohra et al (Cook County, Chicago; P1938) showed that hepatocellular liver injury in COVID 19-infected patients in a safety net hospital is associated with poor outcomes. 

Walker Redd (Brigham and Women’s Hospital – Boston; P2102) reported that 13% of 363 COVID-19 patients had pre-existing chronic liver disease and this was associated with more severe illness, including need for ICU admission and ventilator support. Only chronic liver disease patients with NAFLD cirrhosis had a higher mortality, however. 

From the Nassau University Medical Center, Jiten Desai (P2028) also reported worse outcomes for those with liver injury, and the effect in Hispanic patients was pronounced.

Let it be known, that ACGSM/PGC 2020 met the needs of every attendee by a blend of original research, smaller learning breakfasts and luncheons, and topic reviews. The unparalleled excellence for which the ACG is rightfully known and respected was on full display. While I pine for the personal touch of an in-person meeting, until the world is right again, the virtual platform in the hands of master-educators performs extremely well.

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