12^th Global Gastroenterologists Meeting March 15-16, 2018 Barcelona, Spain

The gastrointestinal tracts of children are quite different from those of adults. Various treatments that are prescribed to adults cannot be prescribed to kids; hence the sub-specialty of pediatric gastroenterology was created, to overlook the kids suffering from various abdominal issues. Pediatric gastroenterologists, pediatric hepatologists, and dietitians together help children with biliary atresia, celiac disease, chronic abdominal pain, constipation,  gastrointestinal conditions, hepatitis, inflammatory bowel disease, nausea, obesity, reflux, short bowel syndrome, and vomiting. Kids often suffer from chronic diarrhea and mal-absorption or cystic fibrosis. Neonates/ Newborns with congenital gastrointestinal anomalies make up one of the largest percentage of patients in the pediatric wards. The specialists needed to treat neonates comprises of the multidisciplinary team including neonatologists, pediatric gastroenterologist surgeons, and radiologists who provide care to the infants showing regurgitation, constipation, and diarrhea symptoms. 

Inaccessibility of pancreas makes it harder to evaluate the course of pancreatic diseases. Even blood tests are often misleading; hence the specialists depend on radiographic and imaging tests like CT, MRCP, ERCP, EUS to detect pancreatic diseases. But sometimes, surgical exploration is the only way to evaluate the course of pancreatic diseases. Pancreatic diseases include pancreatitis, cystic fibrosis, exocrine pancreatic insufficiency, diabetes mellitus, pseudocysts, neoplasms, annular pancreas and pancreatic cancer. Hepato-pancreato-biliary disease affects the liver, bile ducts, pancreas, and gallbladder, thereby having a common symptom viz., jaundice, dark urine, and light stools. Hepato-bilary diseases include Liver cirrhosis, viral hepatitis, inflammation, cystic, vascular and metabolic disorders, gall stones, and gall bladder cancer. 

The cancers of the gastrointestinal tract and accessory organs which show the symptoms of internal bleeding, acute pains, swelling, inability to digest, difficulty in swallowing or chronic constipation or acute diarrhea. Gastrointestinal cancers are categorized into 2 types- upper gastrointestinal cancers and lower gastrointestinal tract cancers. Diagnosis requires endoscopy followed by biopsy, if there is a suspicion or a cyst. Upper digestive tract cancers include cancers of Esophagus, Stomach, Pancreas, liver, Gall bladder, and MALT. Lower digestive tract cancers include colorectal cancer, anal cancer, large and small intestine cancers, retroperitoneum and carcinoid tumor. Cancers of pancreas, gall bladder and liver are lethal with prolonged hepatitis and liver cancer being the second most common cancers with pancreatic cancer being the 5^th common and gastric cancer being the 4^th common cancer that claims lives.

Inflammatory Bowel Diseases (IBD) is a group of chronic inflammatory disorders of colon and intestines. Out of the various types of inflammatory diseases, the most common ones are ulcerative colitis and Crohn’s disease. Crohn’s disease affects mouth, esophagus, stomach, small intestine, colon, and anus while ulcerative colitis affects colon and rectum. Symptoms involve swelling, sudden weight loss, exhaustion, vomiting, anaemia, arthritis, and abdominal pains. Although, there is no known cure for ulcerative colitis and crohn’s disease, the treatments aims to relieve the symptoms currently experienced by the patient. Although causes of IBD are unknown, they are generally attributed to genetics, diet, microbes, and as a side-effect of other intestinal infections. Treatment includes surgery; medical therapies like, antibiotics, immune-suppressants, aminosalicylates, among others; nutritional and diet therapy, microbes, through the use of fecal transplants and stem cell therapies, if available. 

Hepatitis is the inflammation of the liver, caused mainly by virus. But, there are other possible causes of hepatitis that include autoimmune hepatitis and hepatitis caused due to excessive medications, drugs, due to excessive alcohol consumption and also autoimmune hepatitis. Viral hepatitis is the most common type of hepatitis infection and is caused by hepatitis virus, and is categorized into 5 types- Hepatitis A, B, C, D and E. Hepatitis B and Hepatitis C are the most common with Hepatitis B present in about 400 million people globally. Hepatitis C is the chronic form of hepatitis and is seen in about 200 million people globally. Hepatitis A and Hepatitis E are spread through contaminated food and water. Alcohol, toxins, drugs are the main causes of non-viral hepatitis. Formation of a large scar tissue leads to fibrosis mainly caused when liver attempts to repair and replace the damaged cells. This scar tissue obstructs blood flow through liver, thereby limiting the blood supply which in turn forms more scar tissue causing portal hypertension.  Although fibrosis produces no symptoms, prolonged presence of fibrosis progresses to cirrhosis which shows symptoms. Fibrosis can be detected using blood tests and imaging, but sometimes liver biopsy is also required. People having chronic hepatitis, or patients having HIV-Hepatitis Co-infection, fatty liver, and those prone to insulin resistance are at risk of having fibrosis. 

Hepatocellular carcinoma (HCC) also known as Liver cancer is a primary malignancy disorder of the liver occurring primarily in patients with chronic hepatitis and other liver diseases. Hepatocellular carcinoma is the 3^rd major leading cause of cancer-related deaths globally. The common symptoms are yellowish skin, severe abdominal swelling and pain, loss of appetite, weight loss, nausea, vomiting, and fatigue. People with chronic Hepatitis B and/ hepatitis C, patients with history of alcohol abuse, presence of aflatoxins, people with hemochromatosis, or with non-alcoholic steatohepatitis, type 2 diabetes, Wilson’s diseases, and Hemophilia, are at high risk of liver cancer. Treatment methods include surgical re-section, where surgeons remove the part of the liver having tumor while trying to preserve the healthy liver tissue. This method is not always desirable because only about 15% people globally are eligible for resection. Other most common treatment method is liver transplant. But, owing to the shortage of the organ with increasing list of patients for transplant, this option is not always recommended. The most common therapies prescribed by doctors are the Ablative therapies, viz., radiofrequency ablation (RFA), Cryo-ablation, Per-cutaneous ethanol injection, portal vein embolization, and potentially novel chemotherapeutic agents. These therapies help the patients in relieving the symptoms and provide relief. 

Gastrointestinal radiology is a small field of diagnostic radiology, which aids in the imaging of any discrepancies and obstructions during any gastro-intestinal and abdominal disorders. Abdominal radiology includes imaging of the gastrointestinal and genito-urinary systems through CT, Fluoroscopy, MRI, Nuclear Medicine Techniques, Ultrasound, and X-Rays to evaluate organ transplants, presence of malignancies in the abdomen, IBD, and other pelvic disorders. Although, X-rays and CT initially were used in imaging, the advancements in the field of imaging and radiology have made it possible for a clearer and mode high defined imaging techniques through the use of MRI, Nuclear Imaging and endoscopy. Abdominal ultrasounds are commonly used to investigate problems in the gastrointestinal tract, genito-urinary tract and pelvic region. However, of all the developed radiation tests, ultrasound is considered the safest as it uses sound waves to create the imaging of organs on the screen. Abdominal Ultrasound is used in explorative investigation of abdominal pain, and deduces the presence of complications in the upper abdominal organs. It helps in identifying appendicitis, gallstones, inflammatory diseases, kidney stones, and liver diseases. Color Doppler is another type of imaging modality used to measure arterial and venous blood flow in the organs. Accurate imaging is crucial to address various abnormalities in the organs and after transplants. Endoscopic Ultrasound along with positron emission tomography (PET) scans is commonly used over CT and MRI as they are considered safer and are cost-effective.

Endoscopy helps in diagnosing and identification of malignancies and gastrointestinal infections without the need of the explorative surgeries. An endoscope is inserted either through natural openings of the body, like mouth, nose, anus, urethra or vagina, or through the incision near the organ to be examined. The endoscope is a long flexible tube like instrument with attached cameras on the edge of the scope. Endoscopy has progressed beyond the gastrointestinal viewing. They are categorized into Arthroscopy, Bronchoscopy, Colonoscopy, Ureteroscopy, Laparoscopy, and Upper gastrointestinal endoscopy/ esophagogastroduodenoscopy. Endoscopy is one of the safest procedures but it does involve minimal rare complications like bleeding due to intestinal wall tear and minor infections. Endoscopy is used to evaluate unexplained abdominal pains, bleeding, gallstones, gastritis, polyps, ulcerative colitis, pancreatic cancer, Ulcers, gastric, oesophageal, hepatobiliary, hepatopancreatic, and intestinal diseases. Endoscopic ultrasound (EUS), is the most commonly used imaging modalities in the screening of pancreatic cancer. In ERCP, the endoscope guides a catheter through the bile duct to insert dye into the organ, which helps create the images showing blockages, tumors or other obstructions. ERCP is also used to place a stent into the duct. Endoscopy is not only a diagnostic tool, but has also been turned into a therapeutic tool due to the advancements in the field of imaging.

Gastrointestinal bleeding is one of the common complaints of the patients which could be chronic, mild or lethal. Most of the times, GI bleeding is contained by itself, but they are however evaluated to avoid a recurrence and to avoid further progression of infection, if any. Upper GI endoscopy is the first step during a GI bleed, if the result rules out any upper GI bleeding, then a colonoscopy is performed to ascertain that the bleeding is in the lower GI tract. Upper GI bleed is usually caused due to peptic ulcers, gastritis, esophageal varices, upper GI cancers or inflammation of the GI.  While the common cause of bleed in the lower GI tract is diverticulosis, colon cancers or colon polyps, IBD, hemorrhoids, or anal fissures. Symptoms include abdominal pain, breathlessness, pale skin, or passing out. 

Bariatric surgery is recommended for obese people whose BMI is greater than 40. Weight loss through bariatric surgery is achieved through reducing the size of the stomach with the use of a gastric band or removal of a portion of the stomach or by re-routing the small intestine to a small section in the upper stomach creating a pouch. Bariatric surgery is categorized into 3 categories based on the requirements of the surgery-: blocking, restricting, and mixed procedures. Blocking procedures include Biliopancreatic diversion, Endoluminal sleeve and Jejunoileal bypass. Restrictive procedures include Adjustable gastric band, Intragastric balloon, Sleeve gastrectomy, Stomach folding and Vertical banded gastroplasty. While, mixed procedures include Gastric bypass surgery, Implantable gastric stimulation and Sleeve gastrectomy with duodenal switch. As with any surgery, even bariatric surgery has its own set of risks. Deep vein thrombosis (blood clots in the lower leg) or pulmonary embolism (clots in lungs), post-surgical infections, slipping of gastric band, a gut leak, or a blocked gut, gall stones, and excessive malnutrition are the common side effects of a bariatric surgery. But in rare cases, viz., due to unexplained complications, there are risks of patient dying as well.

Diseases or infections of the gastrointestinal tract are referred to as digestive diseases or gastrointestinal infections. These are further categorized into oral, esophageal, gastric, intestinal, hepatic, pancreatic, and biliary tract diseases. The diseases of the digestive tract can range from the common everyday problems to critical and high-risk infections. The diseases include gingivitis, GERD, Gardner's syndrome, ulcers, Barrett's esophagus, IBD, Zenker's diverticulum, gastroenteritis, indigestion, enterocolitis, fecal impaction, enteritis, appendicitis, celiac disease, crohn’s disease, ulcerative colitis, hemorrhoids, pruritus ani, liver diseases, pancreatitis, and gall stones among others. The symptoms of the presence of a digestive disease are bloody stool, constipation or diarrhea, abdominal cramps, weight loss, heartburn, pale skin or yellowish skin. Digestive diseases can be diagnosed through endoscopic therapies or through biochemical or hematological tests. Although, an explorative surgery is also done to diagnose abdominal infections and discomfort sometimes.

Organ transplantation is a boon to the mankind whose internal organs have started to deteriorate and is no longer functioning. Although, with the regular lifestyle changes and the disease progression, the patients requiring transplant is ever increasing while the organ donors are lesser in number. Transplantation is recommended only when the organ has stopped responding to the treatments and is almost failing. Most of the organs in the gastrointestinal tract can be transplanted. For being eligible to be able to receive a transplanted organ, one should be able to satisfy all the required regulations set by the transplantation committee. The major gastrointestinal transplantations are liver, pancreas, esophagus, small intestine, and colon. The transplantation is a major surgery, and so the patient has to be under observatory before and after the transplantation. Most of the times, the complications arise after the operation, where the body starts rejecting the graft or the organ. The complications if any can be diagnosed through hematological or imaging tests. 

Gastrointestinal disorders and diseases are at an all-time high. According to various studies, 1 in 4 people is suffering from at least one of the gastrointestinal infections at any given point in time. The gastrointestinal diseases require treatment and the pharmacological treatment are divided into 2 categories- the prescription drugs and Over the Counter (OTC) drugs. Gastrointestinal drugs are prescribed based on the diagnostic results yielded during the hematological or imaging tests. The most common diagnosis is done through endoscopy. The therapies are recommended based on gastrointestinal tract disorders, gastrointestinal tract walls disorders, gastrointestinal motility disorders, gastrointestinal cancers.

Helicobacter pylori, a gram-negative, microaerophilic bacterium has co-existed within human stomach for thousands of years. They are accustomed to the harsh acidic environment of our stomach. The presence of H. pylori may go undetected as they hardly show any symptoms. But if there is an infection, it may cause acute gastritis with abdominal pain and nausea. While in its chronic stage, it causes non-ulcer dyspepsia, with symptoms like abdominal pains, nausea, bloating, and belching. H. pylori are also responsible for colorectal polyps and colorectal cancer. Cramps occur when the stomach is empty especially in the early morning and between meals. H. pylori use chemotaxis movements to avoid the highly acidic environment of the stomach by moving towards less acidic regions by burrowing in the mucous lining. H. pylori affects the linings of the stomach and duodenum by producing ammonia to regulate pH, which is toxic to the epithelial cells of the stomach and duodenum, besides, the proteases produce vacuolating cytotoxin A (VacA) which damages epithelial cells followed by disrupting the tight junctions thereby causing apoptosis, The colonization of the H. pylori in the stomach causes chronic gastritis. H. pylori invade the stomach during childhood due to contaminated water or food. Symptoms associated with H. pylori infections are anorexia, bloating, excessive burping, fever, heartburn, nausea and weight loss.

Neuro-gastroenterology is the study of the complex relationship between the gastrointestinal tract and the nervous system, with reference to the interactions and management of gastrointestinal motility. Neuro-gastroenterology helps in the understanding of the functions of the parasympathetic, sympathetic, and enteric divisions of the gastrointestinal tract. Neurons are present on every surface of our body. It is due to these neurons that we feel, and are able to carry out of the voluntary and involuntary actions. Similarly, neurons are also found on the gastrointestinal surfaces. It is due to these neurons that we can swallow the food, and which is then taken to the different organs for their functioning, which in turn is again coordinated by the brain. The peristalsis, which is the symmetrical contractions and relaxations of the muscles found in the smooth muscles throughout the digestive tract, helps to propel the food contents throughout the digestive system. The segmentation is the contraction in the smooth muscles that helps in the churning of the intestinal juices to produce chime for absorption is also coordinated by the nerve impulses. The secretion of the intestinal juices and enzymes is regulated by the cholinergic neurons that are present in the digestive walls. 

Pregnant women are more vulnerable to infections, which often causes complications in their pregnancies. Febrile illness along with acute intestinal infections may in some cases cause miscarriage or premature labour. Certain infections have been reported to have caused miscarriage; however, there is no concrete evidence of common gastrointestinal disorders to cause miscarriage or premature labour. If the infection progresses to a critical stage, the fetus is at high risk from both the infection and also the subsequent treatment and antibiotics. Listeriosis is one such infection that can directly harm the fetus, as the organism can directly cross the placenta due to its intracellular lifecycle and is fatal to the neonate. Although salmonella spp. can cause neonatal infection in the newborns, it is not fatal.  There are such infections that can cause severe illness to the mothers, viz., E. coli, Shigellosis, Clostridium difficile, Cholera, Cryptosporidium spp., Giardia lamblia, and Entamoeba spp. In general, pregnant women are susceptible to constipation, diarrhea, fecal incontinence, and hemorrhoids due to various structural, hormonal and lifestyle changes during pregnancy. Hyperemesis Gravidarum or morning sickness affects about 90% of all pregnant women and can be controlled through proper hydration and nutrition. However, if the condition is severe, hospitalization may be required as women are at risk of getting dehydrated and malnourished

Animals also get infected with various microorganisms that make them ill. Apart from the regular bout of veterinary gastrointestinal infections, they also get infected with the regular infections which in turn harm humans, especially their owners and kids. The diseases that are passed on from animals to humans are called zoonotic diseases, which often cause an outbreak. Out of numerous types of zoonotic diseases, enteric zoonotic diseases affect the gastrointestinal tract of both animals and humans. Common microorganisms that cause gastric infections include Salmonella, E. coli, and Campylobacter.