On March 18, 2020, the American Gastroenterology Association (AGA) canceled their annual meeting planned for Chicago during May 2–5, 2020, due to COVID-19. The announcement occurred only 10 months after a highly successful 50th-anniversary celebration at Digestive Disease Week 2019 in San Diego.
The leadership and staff involved in the planning of DDW 2021 should be congratulated for a highly successful conference. It was a well-organized virtual symposium that enhanced rather than detracted from the educational platforms to increase engagement and impact — all within reach of a personal computer, laptop, tablet device, or smartphone. There were 10,183 registrants for DDW 2021 as of May 17, 2021. Each session had an AGA staff member and technician present to ensure that the sessions were without a glitch. There were 152 lecture sessions (invited speaker-based and abstract-based sessions) with 1,330 AGA electronic-poster presentations and 85 featured industry sponsors for networking and additional satellite symposia and product theaters. All of it available at the convenience of your living room, office, or even on a laptop on the deck or balcony.
I have a unique perspective to share — as a presenter, planner, program chair, and participant. Although highly intuitive, the virtual platform provided challenges as less programming space was available when compared to a large convention center with neighboring hotels.
As a planner, this limitation demanded the prioritization of contemporary topics in 2020 and new ones in 2021, meriting attention. The sessions were diverse and covered a gambit of items for the practicing, training, and academic gastroenterologist. The impact of COVID-19 on digestive disease and hepatology was featured in 18 sessions at DDW 2021. Noteworthy sessions included: Gastrointestinal and hepatic manifestations and pathogenesis of SARS-CoV-2, the interaction of the gut microbiome, telemedicine and clinical workflows, endoscopic practice, hospital medicine, trainee education, cancer screening, and lessons learned from disaster management. COVID-19 was also represented in the AGA and two ASGE Presidential Plenary sessions, Clinical Science Plenary, and many research abstracts presented by video and electronic poster.
As a planner, presenter, and program chair — our AGA Institute Obesity, Metabolism, and Nutrition (OMN) Council was dedicated to vitamin D and the gut microbiome in the pathogenesis and treatment of COVID-19. I co-chaired the program with the vice-chair of our council, Dr. Andres Acosta of the Mayo Clinic School of Medicine in Rochester, MN. The session provided an overview of the pathophysiology of COVID-19, including gut microbiome-immune system dysregulation. Overall, this session elaborated on the growing evidence for the potential causative role of the microbiome-immune system in COVID-19 disease pathogenesis. The role of nutrition, malnutrition and possible disease modulation by vitamin D was also discussed. My co-presenters were Dr. Jun Sun, Professor of Medicine from the University of Illinois in Chicago, IL, and Dr. Suzanne Devkota from Cedars Sinai Hospital in Los Angeles, CA. Drs. Sun and Devkota are internationally recognized for their expertise in the gut microbiome.
Aside from COVID-19, there were many sessions, e-posters, and research abstracts on artificial intelligence (AI) in gastroenterology. The list of dedicated sessions included: AI in Endoscopy, Improving your GI Practice with Digital Technologies and AI, Advancing Technologies in Imaging for Pancreatitis and Pancreatic Cancer, New Technology and Innovations in Colorectal Cancer Screening/Surveillance, and Machine Learning and AI, and GI Genius Intelligent Endoscopy Module-Exploring AI in Gastrointestinal Endoscopy.
Another new and emerging theme at DDW 2021 across sessions was environmental factors in gastrointestinal disease pathogenesis. This includes evaluations of the “exposome” that can be defined as the measure of all the exposures of an individual in a lifetime and how those exposures relate to health. An individual's exposure begins before birth and includes insults from environmental and occupational sources. Sessions that explored this topic in-depth included the Role of Diet, Lifestyle, and Environment in Inflammatory Bowel Disease, which teased out several dietary and environmental exposures which were considered unlikely contributors. Dr. Andres Yaur from Medical College of Wisconsin demonstrated that patients with Crohn’s Disease (CD) with higher visceral adipose fat have a lower chance of achieving remission with certain biological-based therapies. Dr. Chun-Han Lo from Massachusetts General Hospital (MGH) shared an extensive cohort study from the Nurses’ Health study I, II, and the Health Professionals Follow-up Study. The results indicated that ultra-processed foods (UPFs), including carboxymethylcellulose, carrageenan, and polysorbate-80, were associated with an increased risk of CD.
Dr. Nidah Shabbir Khakoo, a medical resident from Jackson Memorial Hospital of Miami, FL, under the direction of her mentor Dr. Maria Abreu, developed a composite environmental score looking at previously described exposomes that were postulated as either protective or causative. Exposomes studied included bottle-feeding, mode of birth, exposure to farms, parasites, pets, NSAID use, unpasteurized milk, water or air pollution, smoking, water sources, crowding, antibiotic use, etc., age of onset, and outcomes in inflammatory bowel disease (IBD).
Dr. Simon Chan from Norwich University Hospital demonstrated that obesity, as measured by BMI, was associated with an increased risk of older-onset CD. Dr. Emily Walsh Lopes from MGH also studied IBD risk from environmental exposures. They found that the risk of disease increased with the number of exposomes, that these factors are modifiable, and contribute to a large proportion of cases. The session concluded with a presentation by Dr. Neeraj Narula from Hamilton Health Sciences. In a large cohort study of 136,384 adult participants from 21 countries, he demonstrated that higher intake of UPFs and exposure to food additives such as carboxymethylcellulose, carrageenan, and polysorbate-80, were associated with an increased risk of IBD.
An important theme that emerged from the contemporary issues in social justice awareness in 2020 was the meticulous attention of the DDW planners to incorporate programs that addressed gaps and disparities in our field. Sessions included: “Exploring Issues of Diversity & Disparity in Gastroenterology, Diversity, Equity, and Inclusion, Diversity, Equity, and Inclusion-DDW Diversity Symposium Networking, DDW Diversity Symposium: Unique Patient Populations with GI Disease Experience Barriers to Care, Diversity Equity, and Inclusion=Gastroenterology Women’s Coalition (GWC) Networking, /race in Science and Medicine, and Gastroenterology Women’s Coalition (GWC) Symposium: Take Charge of Your Career and Execute Your Strategic Plan. Stay tuned for more programming on equity and inclusion for DDW 2022.
Finally, I participated in the DDW Grand Rounds Networking session on Nutrition and GI on Sunday afternoon. Engagement for the grand rounds platform was robust at DDW 2021, with real-time interaction of attendees and speakers who presented cases on video using a few PowerPoint slides and fielded live questions from the audience via chat and video live using Zoom. Of interest, one speaker, Sonali Palchadhuri of the University of Pennsylvania, was on a laptop outdoors in a backdrop of a park studded with tall trees, which was quite enjoyable and didn’t detract from a high-level academic presentation. Dr. Palchadhuri presented data on the risk of unplanned 30-day readmission while on enteral nutrition under the direction of Dr. Octavia Pickett-Blakley.
In the end — DDW 2021 was an outstanding educational experience.
DDW 2022 will be in San Diego from May 21–22 — the same venue for the 50th Anniversary event, which included a big celebration with a live band (GI Distress) and extensive networking events. Be on the lookout for what I anticipate being a must-attend “we survived COVID-19” DDW event. There will be a virtual platform available.
Hope to see you all in San Diego in 2022!