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9th United European Gastroenterology Week

The idea for the United European Gastro­enterology Federation (UEGF), a federation that would combine the various European Associations and Societies active in gastroenterology and allied fields, surfaced in 1988. It was generally agreed that one joint annual scientific meeting would be much more productive than several competing meetings.

A coordinating council was set up with representatives of seven major societies. The purpose of this Council was to identify and establish the principal guidelines of such a meeting, which would be known as the United European Gastroenterology Week (UEGW). It was also generally agreed that at that stage Europe lacked a regular, genuinely scientifically oriented, multidisciplined gastroenterology meeting, which was forcing young European investigators to present their work abroad or at their national meetings. And so the UEGF was born.

The seven founding members of the Federation (the so-called “seven sisters”) are the following:

  • Association des Sociétés Nationales Européennes et Méditerranéennes de Gastroentérologie (ASNEMGE).
  • European Association for Gastroenterology and Endoscopy (EAGE).
  • European Association for Study of the Liver (EASL).
  • European Pancreatic Club (EPC).
  • European Society for Gastrointestinal Endoscopy (ESGE).
  • European Society for Paediatric Gastroenterology and Nutrition (ESPGAN).
  • International Society of Digestive Surgery (ISDS – European chapter).

The 2001 UEGW
This year’s meeting had several presentations of interest to hospital pharmacists. Some of them are described here.

Drug interaction studies of esomeprazole with amoxicillin and clarithromycin
A group from AstraZeneca presented the results of two studies designed to assess the potential for interaction of esomeprazole (E) with amoxicillin or clarithromycin. In an open-label, randomised, fourway crossover trial, 17 healthy volunteers were given E40 once daily, amoxicillin 1g twice daily, clarithromycin 500mg twice daily, or E plus amoxicillin plus clarithromycin. Assessments were made on day seven of each study period, with a two- to four-week washout between study periods. In a separate trial, 19 subjects received E20 twice daily; this trial was identical to the first in all other aspects. Their results showed that neither E40 once daily nor E20 twice daily affected the pharmacokinetic profiles of amoxicillin or of clarithromycin, demonstrating that E does not inhibit CYP3A4. They concluded from this that esomeprazole plus amoxicillin plus clarithromycin should be suitable for use in an Helicobacter pylori eradication regimen in patients with peptic ulcer disease.

Citation Gut 2001;49(Suppl III): abstract no. 2695.

Analysis of drugs prescription:pharmacists’ ­perspectives
Hospitalised patients receive on average 10 drugs, and 15% develop secondary effects. To decrease this risk, a group of pharmacists from Hôpital de la Croix-Rousse, Lyon, France, conducted a quality analysis of drug prescriptions, in agreement with their doctors, in the department of hepatogastroenterology. Once a week, pharmacists examined drug prescriptions at the patients’ bedsides, searching for possible drug interactions or similarly acting drugs, looking at controlling posology and routes of administration. For posology, renal function was estimated in patients over 60 years by the Cockroft and Gault formula. For drugs with high oral biodisponibility, oral administration was systematically proposed. Finally pharmacists answered questions directly from the patients. From May 1999 to September 2000, 1,751 prescriptions were analysed and 147 (8.4%) observations were made. Observations covered various issues, such as potentially hazardous interactions (n=31), preferential use of oral administration (n=52), change in posology (n=18), direct advice to the patient (n=15), and observations on the form of the prescription (n=31). Results showed that the analysis improved collaboration between doctors and pharmacists, decreased the risk of drugs interactions, and reduced costs significantly.

Citation Gut 2001;49(Suppl III): abstract no. 3054.
Helicobacter pylori infection and nonsteroidal anti- inflammatory drugs have an additive effect on peptic ulcer bleeding: a meta-analysis of case-control studies
It is unclear whether there is any interaction between Helicobacter pylori (HP) infection, nonselective anti-inflammatory drugs (NSAIDs) and peptic ulcer (PU) bleeding. A Canadian team presented the results of their study evaluating the prevalence of HP infection and NSAID use in patients with PU bleeding, the magnitude of any risk and any interactions between these two factors.

A comprehensive literature search was performed up to October 2000 with the keywords “NSAID, pylori, ulcer and bleeding”. It included age/gender-matched case-control studies of adult patients with ulcer bleeding confirmed endoscopically and clinically and NSAID use within four weeks before entry. It excluded duplicate publications, studies including patients with recent use of antibiotics/antiulcer drugs or receiving steroids/ anticoagulants or with a history of gastric surgery or non-ulcer gastrointestinal bleeding or gastric tumours. Six studies with 641 cases and 656 controls were found on Medline. The prevalence of HP infection and NSAID use was significantly higher in cases than controls: odds ratio (95% confidence interval) of 1.9 (1.5–2.4) and 4.9 (3.8–6.2), respectively. When both factors were present, the risk of PU bleeding increased to 6.1 (3.9–9.6).

The researchers concluded that HP infection and NSAIDs independently and significantly increase the risk of PU bleeding. These effects are additive, with NSAID use playing a major role.

Citation Gut 2001;49(Suppl III): abstract no. 1155.

Therapeutic drug monitoring in 6-mercaptopurine- treated patients with inflammatory bowel disease: is it worthwhile?
6-Mercaptopurine (6-MP) is metabolised to 6-thioguanine nucleotide (6-TG) and 6-methylmercaptopurine (6-MMP). 6-TG levels in erythrocytes correlate with drug efficacy and 6-MMP levels with toxicity (levels of >235 and >5,700pmol/8¥108 RBC [red blood cells] respectively). A group from Maasland Hospital, Sittard, the Netherlands, measured steady-state 6-TG and 6-MMP levels in 15 inflammatory bowel disease (IBD) outpatients. The mean age of patients was 40 years. All patients also received 5-ASA, and the 6-MP dose varied from 25mg to 100mg. In six patients metabolite levels were measured after 25mg dose-reduction. The mean steady- state 6-TG and 6-MMP levels were 365 and 2,878 respectively. Poor correlation was found between the 6-MP dose and the 6-TG or 6-MMP levels. 6-TG levels were therapeutic in 80% of patients, and the 6-MMP/6-TG ratio decreased for lower 6-MP doses, which is favourable. Investigation after 6-MP dose-reduction confirmed this latter observation. Thus 6-TG levels were less influenced by these dose reductions than 6-MMP levels.

These results confirmed that therapeutic drug monitoring is useful in IBD patients on 6-MP therapy to determine the optimal dose by measuring 6-MMP/6-TG ratios. The lowest possible ratio in combination with a therapeutic 6-TG level seems to be the optimal balance between efficacy and possible adverse effects.

Citation Gut 2001;49(Suppl III): abstract no. 3019.

United European Gastro-enterology Federation

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