The May gray of San Diego failed to dampen the vibrant energy brought by over 10,000 attendees at the Digestive Disease Week 2022. The sessions represented a great mix of clinical case discussions, research updates, technological innovation, and addressing critical issues of equity, diversity, and inclusion. The live format highlighted the importance of personal interaction while sharing findings, asking a question, bouncing off ideas, and making future connections. We met our friends and colleagues and got to know how they are doing and what is new on professional and personal fronts for them. We realized how much we missed being with our scientific and professional community. We cherished our society's receptions, honored our esteemed colleagues and mentors, and congratulated junior colleagues for their accomplishments and awards.
As a clinician-scientist interested in enteric neurosciences, I hustled between varied clinical and research symposia. The meeting started with the Rome Foundation committees gathering to brainstorm advances in the field as it develops and validates the Rome V criteria for disorders of gut-brain interactions. It is an important process that brings together the brightest minds in the field and builds consensus around our definitions for these disorders, which affect close to 20% of the population in the U.S. and worldwide. I was particularly excited to learn about and get more involved with the Rome Foundation Research Institute, which is embarking on large, multi-national studies to understand the epidemiology and pathobiology of irritable bowel syndrome (IBS) and other disorders of the gut-brain interaction.
The clinical symposia in this space discussed challenging cases of IBS, dyspepsia, gastroparesis, and pelvic floor disorders. These sessions allowed our practicing gastroenterologists to interact with leading academic experts and ask their practice questions. There was a relative paucity of clinical trials presented for these disorders, which may be a reflection of the hiatus imposed by the pandemic on clinical trial activity. Emerging themes were the expanding role of machine learning and artificial intelligence (AI) for a host of indications, but with the most progress in the detection of colonic polyps and neoplasia. I was intrigued by the data presented on the use of AI in understanding disturbances seen in esophageal manometry. We are in the early days, and I am looking forward to seeing how these data can provide better diagnostics and treatments for our patients.
Intestinal microbiome, an area of significant interest of mine, continues to be a major emphasis at DDW. With a session dedicated to the role of microbiomes in neurodegenerative disorders, like Parkinson’s disease, amyotrophic lateral sclerosis, and autism, we saw the applications go beyond conventional luminal disorders of a gut, like IBS and inflammatory bowel disease. We learnt from session on microbiome in IBS how we need to quickly move from describing what bugs are there in the gut to what they are doing. We realized the importance of longitudinal assessment of microbiomes within our patients and considering the effect of circadian rhythm while collecting fecal samples. We realized that only 10-20% of gastrointestinal metabolome is annotated and how the use of publically available repositories like MASST can help us all in discovering and annotating the metabolites at much faster pace. We understood that intestinal proteases are regulated via commensal microbes and can serve as possible biomarker to predict the onset or relapse in inflammatory bowel disease.
From technological standpoint, a fascinating talk highlighted “Smart Toilet”, a novel system that images stool and applies convolutional neural network analyses to characterize its form and consistency. It also measures parameters like time to the start of defecation, time spent on the toilet, etc., which upon testing and validation, can be helpful for assessing and improving care of our patients with pelvic floor disorders. A presentation also showed similar paradigms being tested by mobile apps like Dieta. Digital behavioral interventions for IBS were also displayed.
The basic enteric neurobiology sessions demonstrated remarkable progress made in identifying types of intrinsic afferent and myenteric neurons and subsets of immune cells using single-cell sequencing. Work highlighted the progress in tissue clearing and three-dimensional imaging to better understand the distribution of enteric neurons and nerve fibers. Neuroimmune interactions stood out to be a progressively recognized driver of gastric and colonic dysmotility in humans and mice. Additionally, we learned about the critical role of mechanosensitivity in enteroendocrine cells towards epithelial secretion, as well as the role of interstitial cells in integrating inhibitory signals toward colonic motility.
I left the meeting proud of the accomplishments our scientific community continues to make towards offering better explanations and providing better treatments to the patients. I was uniquely proud of our division with over 100 presentations, plenary sessions driven by diverse topics, faculty at different career stages, and fellows. I was proud to see our division vice chair presenting on work-life balance debating if it's time to change that term to allow better reflection of the experience. I was proud to see our American Neurogastroenterology and Motility society do a first reception dedicated to and honoring women in neurogastroenterology.
In all, I left DDW excited and charged toward our future ahead, particularly as a neuro-gastroenterologist and a clinician-scientist. Now, we wait to gather again in the Windy City in 2023.
Dr. Grover has received grants from Takeda, Alexza, and Donga, as well as consulting fees from Alfasigma. He has also written for the Rome Foundation.
Image by Luciano Lozano / Getty
