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Toronto Notes 2019 Landmark Gastroenterology Trials Gastroenterology G51 Landmark Gastroenterology Trials
Trial
MELD score as a predictor of death in chronic liver disease
Infliximab, azathioprine, or combination for Crohn’s disease
Enteral versus parenteral nutrition for acute pancreatitis
Rifaximin treatment in hepatic encephalopathy
Adenoma detection rate and risk of colorectal cancer and death
Prednisolone or pentoxifylline for alcoholic hepatitis
Reference
Gastroenterology
2003;124:91-6
NEJM 2010;362:1383-95
Cochrane DB Syst Rev
2010;1:CD002837
NEJM 2010;362:1071-81
NEJM 2014;370:1298- 1306
NEJM 2015;372:1619-28
Results
MELD score can be applied for allocation of donor livers as it accurately predicts 3 mo mortality in patients with chronic liver failure
In moderate-severe Crohn’s disease, infliximab + azathioprine was more likely to result in corticosteroid-free remission than infliximab monotherapy. Infliximab monotherapy was more effective than azathioprine monotherapy. Similar results have been reported for ulcerative colitis (Gastroenterology 2014; 146:392-400)
For acute pancreatitis, no trial was convincing alone, but in aggregate, enteral feeds via nasogastric tube is preferable to either no feeding or parenteral nutrition
The most convincing of several articles establishing this non-absorbable antibiotic as the treatment of choice for hepatic encephalopathy for maintaining remission from hepatic encephalopathy and reducing hospitalization associated with the disease
A high miss rate for colorectal cancers has been suggested, chiefly in the right colon. This study demonstrates a method of assessing the competence of endoscopists in detecting cancers using adenoma detection rate (the proportion of colonoscopic exams in which a physician detects one or more adenomas) as a surrogate marker. Adenoma detection rate was associated with lower risk of interval colorectal cancer and has launched quality assurance programs for screening colonoscopies
For alcoholic hepatitis, prednisolone improved survival when the Maddrey’s discriminant function >32, but the benefit did not reach statistical significance and pentoxifylline was of no advantage at all. Other studies had shown some benefit with pentoxifylline, but this study was the most definitive