Recently, the Digestive Disease Week Meeting took place virtually. This conference had many parallel strengths and drawbacks that we see in remote meetings. It was both efficient and convenient to review content on the Learner’s Timeline and avoid missing time with family and loved ones. On the other hand, the lack of networking that we love so much at face-to-face meetings and serendipity connections with friends and acquaintances were missing. There’s a clear trajectory to back to face-to-face meetings in the fall in the U.S., and it is certainly anticipated that the next DDW will, again, have a face-to-face option in combination with some of the digital technologies that are certainly here to stay.
There was a major focus on alcohol-associated liver disease at the DDW Meeting. This is appropriate given the increasing incidence and prevalence of this condition in both the U.S. populations and worldwide. Global cases are driven, especially in high-population countries such as India, China, and Russia. Furthermore, increases are especially notable in women and young people, further impacting the economic and societal burden of this condition. The COVID-19 pandemic has further exacerbated many of the socioeconomic variables that contribute to alcohol-associated liver disease, and again, case volumes are increasing this year.
While several approaches are implemented with varying rigor in different societies, we know that, at a population level, taxation and regulation of marketing and sales relating to alcohol can impact overall alcohol consumption. One of the unmet needs is an appropriate screening approach for alcohol-associated liver disease that also recognizes that there are two conditions here that need screening, including alcohol-use disorder as well as alcohol-associated liver injury. Some primary care and population-based algorithms are under evaluation, including non-invasive serologic testing questionnaires and likely in the future even input from wearables such as watches. These initial screenings can allow enrichment of target populations that may require more detailed diagnostic evaluations, including elastography by ultrasound or MR-based techniques and either pharmacologic or cognitive therapy for alcohol-use disorders.
A number of new therapy pathways are also under evaluation. One of the major foci for therapy has related to the inflammasome and neutrophil and other white blood cell infiltration into the liver that occurs in alcohol-associated liver disease, especially in alcoholic hepatitis. Trials of interleukin-1 receptor inhibitors are underway in the United Kingdom, where a trial was recently completed, as well as in the U.S., where a trial is being conducted by the NIAAA-sponsored AlcHepNet Consortium. Other therapies are being evaluated for other pathophysiologic targets, including intestinal dysbiosis and metabolic derangements that occur in alcohol-associated liver disease.
Several digital health approaches are also on the horizon to help us combat alcohol-associated liver disease. These approaches include remote interactions with patients that can allow health intervention at a scale that is not currently feasible with face-to-face visits, biomonitoring of alcohol consumption, and early liver injury are also on the horizon. Improvements in MR-elastography and other imaging technologies are also likely to make an impact in the future, and both digital and serum-based biomarkers are likely to play an important role in diagnosis and prognosis. Finally, clinical trial activity, using new and innovative trial designs, continues to grow in the area providing optimism that we will eventually find improved pharmacologic therapies for both alcohol-associated liver disease as well as alcohol-use disorder, which is the root cause.
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