Gastroenterology Month in Review: October 2024

October was a busy month in gastroenterology, with excitement largely attributable to a plethora of news and research from the American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting, which took place in Philadelphia, Pennsylvania, from October 25-30. Prior to the meeting, the month began with a US Food and Drug Administration approval of another noninvasive colorectal cancer (CRC) screening option and also saw the publication of new research into the GI implications of GLP-1 RAs and ways to improve irritable bowel syndrome (IBS) care.

This gastroenterology month in review spotlights HCPLive’s top coverage from the ACG meeting, an important gastrointestinal pipeline development, and other news and research that helped characterize October in gastroenterology.

HCPLive at ACG 2024

Evan Dellon, MD, MPH: “Promising” Phase 3 Cendakimab Data for Eosinophilic Esophagitis

Phase 3 data presented during a late-breaking session at ACG 2024 highlight the durable efficacy and safety of cendakimab for the treatment of eosinophilic esophagitis (EoE) in adult and adolescent patients. Results showed statistically significant improvements in symptoms and esophageal eosinophils with cendakimab through 24 weeks that were durable through 48 weeks versus placebo.

Vitamin D Deficiency Linked to Worse IBD Hospital Outcomes

Findings from a trial presented at ACG suggest patients with inflammatory bowel disease (IBD) who are deficient in vitamin D may be at risk of worse outcomes, including more severe hospitalizations and risk of colectomy. The research expands upon the known association between IBD and vitamin D deficiency, asserting that patients with the latter are at significantly greater risk of severe outcomes with the former.

Bruce Sands, MD: Long-Term Data for Mirikizumab in Ulcerative Colitis, Crohn’s Disease

Findings from a pair of long-term phase 3 studies of mirikizumab were presented at ACG and reinforce the interleukin-23p19 (IL23p19) antagonist’s sustained safety and efficacy for both ulcerative colitis (UC) and Crohn’s disease (CD). Results from the LUCENT-3 study in UC and the phase 3 VIVID-2 long-term extension study in CD highlight stable, long-term remission among patients treated with mirikizumab.

Of note, these data make mirikizumab the first and only IL23p13 antagonist to report long-term, multi-year sustained safety and efficacy data for both UC and CD.

GI Pipeline News

FDA Approves Exact Sciences’ Cologuard Plus Test for Colorectal Cancer Screening

October began with the US Food and Drug Administration approval of Exact Sciences’ Cologuard Plus test, the company’s next-generation multitarget stool DNA test, for adults ≥ 45 years of age at average risk for CRC.

The approval was based on findings from the BLUE-C study, one of the largest prospective, head-to-head studies ever conducted in CRC screening, which showed the Cologuard Plus test demonstrated 95% overall cancer sensitivity and 43% sensitivity for advanced precancerous lesions at 94% specificity with no findings on colonoscopy among a subset of nearly 19,000 average-risk participants.

GLP-1 RAs and Endoscopic Procedures

GLP-1 RA Use Increases Risk of Food Retention, Poor Bowel Preparation in Endoscopy

Findings from this cross-sectional study suggest an increased risk of retained gastric contents and inadequate bowel preparation during single endoscopic procedures among patients who use GLP-1 RAs. Even when patients held GLP-1 RAs for 7 days prior to the procedure, the study found they were still more likely to show food retention during upper endoscopy than patients who were not taking these medications. Results also linked GLP-1 RA use to unsatisfactory bowel preparation for colonoscopies, potentially leading to missed lesions, patient dissatisfaction, and wasted resources.

GLP-1 RAs Increase Residual Gastric Content But Pose Low Medical Risk During Endoscopy

Although this study found a significant association between GLP-1RA use and increased rates of residual gastric content, results point to a minimal impact on upper endoscopy safety and completion, suggesting it may not be necessary to stop GLP-1 RA use in preparation for these procedures.

“There has been a lot of concern that these increased rates of gastric content material would precipitate a large number of negative outcomes, but our data suggests when you carefully case match the controls, the rate is actually very, very low,” Braden Kuo, MD, a neurogastroenterologist and director of the Center for Neurointestinal Health at Massachusetts General Hospital, explained to HCPLive.

Violeta Popov, MD, PhD: Do GLP-1 RAs Need to Be Held Before Endoscopy?

In line with findings from Kuo’s study, results from a systematic review and meta-analysis compiling all available evidence on the safety of GLP-1 RA use prior to endoscopy suggest patients may not need to stop taking the medication before upper endoscopic procedures. Although a higher rate of aborted endoscopies and retained gastric content was observed in patients receiving GLP-1RAs, a clear liquid diet and bowel preparation are likely to mitigate this risk without the need for GLP-1 RA discontinuation.

Improving IBS Care

Depression Symptoms May Impact Response to Dietary Intervention for IBS

Understanding the psychological profile of patients with IBS is essential for effective management, according to findings from this study, which highlights how symptoms of depression can impact response to dietary intervention for IBS. Results showed anxiety symptoms were common in patients with IBS but did not have a notable impact on disease severity or response to dietary therapies, whereas depression symptoms were less frequent but appeared to have a significant negative impact on response to dietary intervention.

Stress Triggers IBS Symptoms, Impacts Quality of Life More Than Diet, Study Finds

Recent research suggests a novel IBS classification system may be a valuable tool for tailoring management approaches based on the triggers most strongly affecting patients, especially psychological stress.