Abstract
The World Gastroenterology Organization that, for decades, has organized a quadrennial world congress of gastroenterology in various parts of the world, recently collaborated, in conjunction with the Turkish Society of Gastroenterology, in its first regional meeting in Antalya, Turkey. This venture was embarked upon for several reasons: first, to collaborate with a major national gastroenterology organization; second, to address regional issues in digestive diseases; and third, to provide an accessible forum for education in the science and practice of gastroenterology to individuals from areas (e.g., Central Asia) where the specialty remains relatively under-developed. The success of the endeavor can be gauged, not only by an attendance of over 1000 individuals, but also by the level of interaction that took place between colleagues from Europe and North America, on the one hand, and Turkey and surrounding regions and the rest of the world, on the other. The emphasis was firmly on issues that are relevant to the area and on the development of education and training in gastroenterology in the region: approaches that must, ultimately, impact positively on the care of those afflicted by digestive disorders in these nations.
Gastro-Antalya 2011 was a truly unique gastroenterology meeting co-organized by the Turkish Society of Gastroenterology and the World Gastroenterology Organization (WGO). It represented the first regional meeting of WGO, an organization that had previously confined its major meeting activities to quadrennial World Congresses of Gastroenterology, the last being held in London (UK), in partnership with United European Gastroenterology Week, in 2009. Recognizing, however, the ever-growing closeness of the relationships between WGO and its 110 constituent national gastroenterology organizations, the stature of the Turkish Society and the geographical location of Turkey in proximity to a number of areas that have, in the past, rarely experienced international gastroenterology, WGO decided to embark on the first of what it hopes will be many such collaborations with prominent national societies throughout the world.
From the outset, this was a true partnership that, on the one hand, sought to preserve the unique features and personality of the annual Turkish Gastroenterology Week but, on the other hand, wished to add an additional, regional dimension highlighting issues in digestive disorders in the Middle and Near East, Central Asia, Russia, the former Soviet Republics and the Balkans.
In terms of its design, the meeting followed a fairly traditional format, consisting of a 1-day postgraduate course, followed by a 2.5-day core scientific meeting featuring the presentation of original work in the form of both oral and poster presentations, as well as 11 educational symposia covering all the major issues in clinical gastroenterology, gastrointestinal (GI) endoscopy and hepatology.
What was unique about Gastro-Antalya 2011?
First and foremost, the primary goal of the meeting – to jointly present a high-quality educational and research event that simultaneously preserved the unique characteristics of the partner organizations while developing a novel experience for attendees – was achieved to everybody’s obvious satisfaction. The very best of Turkish gastroenterology research was showcased for all to see and Turkish experts worked alongside their international colleagues to review the ‘hottest’ and most relevant clinical issues in gastroenterology. WGO’s presence was evident from the inclusion of symposia on two key aspects of WGO’s programmatic repertoire: ‘Gastrointestinal Infectious Diseases’, based on the 2011 theme for World Digestive Health Day, ‘Enteric Infections: Prevention and Management’; and the ‘WGO Symposium on Training and Education’, reflecting the key goals of this global organization. Most significantly, Gastro-Antalya 2011 marked the transition of the WGO presidency from Richard Kozarek, from the USA, to Henry Cohen, from Uruguay.
More unique still than the overall ‘look and feel’ of the program was the manner in which the postgraduate course was presented. The entire course was based on real-life cases selected to illustrate important clinical challenges and generate interactive discussions. In separate sessions, undoctored cases illustrative of diagnostic and/or therapeutic dilemmas in esophageal disease, inflammatory bowel disease (IBD), viral hepatitis, complications of cirrhosis and irritable bowel syndrome and functional GI disorders were presented ‘warts and all’ to panels comprising national, regional and international experts. Each case featured relevant laboratory, endoscopic, radiologic, pathologic or manometric findings and generated considerable debate and, understandably, some controversy. As the day progressed, audience participation grew and, by the end, was in full flow. As all of the cases were presented by either Turkish, Russian or Egyptian faculty, the panel and the audience had an opportunity to appreciate the spectrum of disease in the region (thus, the special focus on hepatitis and the inclusion of cases of delta hepatitis and hepatitis E), as well as how diagnostic and therapeutic strategies may vary according to local resources and expertise. This postgraduate course illustrated how one based on this format, if carefully prepared, skillfully presented and deftly chaired, can prove to be an outstanding and most memorable educational experience. Along the way, we were reminded of the challenges that adenocarcinoma in the context of achalasia, corrosive esophageal strictures, steroid-refractory ulcerative colitis (complicated by superimposed cytomegalovirus infection), acute hepatitis E, acute-on-chronic liver disease and ‘functional’ heartburn, to mention just some examples of the several excellent cases, may present and how they may be logically and optimally addressed.
Thirty invited international faculty participated in the symposia alongside Turkish and regional faculty that featured each day in the main meeting program. These topics were carefully selected to highlight issues considered to be of importance in the region: hepatocellular cancer, functional GI disorders, variceal bleeding, colon cancer, biliary tract disorders, regional trends in irritable bowel disease, GI infectious diseases, esophagus and reflux, obesity and nonalcohol fatty liver disease, nonvariceal bleeding, a WGO symposium on training and education, endoscopic ultrasonography and mesenchymal stem cells in gastroenterology. Sessions featuring the very best original work from Turkey, as well as the region and the rest of the world, were interspersed between these educational symposia.
Was the meeting a success?
How does one gauge the success of such a meeting? We would suggest that two primary measures can be examined; one simple, the other more complex. First, the easy one: the numbers speak for themselves. Over 1020 attendees were present from 38 different countries, ranging from Algeria to Indonesia and from Russia to Nigeria, who, between them, represented virtually all of the countries in the region. Given the economic turmoil that affects the globe and the political uncertainties that afflict so many nations in the region, this was a truly outstanding turnout. More complex and challenging is the second: the educational impact. Ultimately, this can be assessed only through the impact it has on an individual attendee’s practice and on patient care, measures that are beyond the compass of any major meeting, but if the quality of the lectures, the degree of interaction and the depth of questioning are anything to go by, then on this count also, the meeting was a great success. We would add one further and, perhaps, even more intangible measure: the opportunity for gastroenterologists from diverse geographical, economic and cultural backgrounds to share problems and solutions in a most conducive environment, facilitated by the warmth of the Turkish welcome and the generosity of Turkish fellowship.
Given the quality of all the presentations, it would be unfair to select some as better than others, but these authors wish to highlight areas where they went away with new information. It is evident, for example, that colon cancer is no longer the preserve of the West and is rapidly emerging as a leading cause of cancer and cancer-related mortality in Asia, the Near East and the Middle East. These shifts in prevalence can be, in some small part, explained by the emergence of IBD globally (the focus of another symposium), but may be, to a considerable extent, related to another even greater global epidemic: obesity. In a symposium on obesity and nonalcohol fatty liver disease, we were reminded of the dimensions of the phenomenon, on its toll on the individual and society, and of the disappointing results of dietary and pharmacological strategies to date. By contrast, surgical approaches, including less invasive techniques, such as the Lap-Band®, produce impressive results, not only in terms of sustained weight loss, but also in ameliorating the metabolic consequences of obesity. The tantalizing prospect that vagal nerve stimulation may represent an effective and even less invasive new approach to bariatric surgery was also discussed. In an era when we have been lulled into the belief that GI infectious diseases are a thing of the past, it was most appropriate that we should be reminded of the continuing burden of enteric pathogens and other GI infections. Indeed, not only are infectious diarrheas still the leading causes of infant mortality worldwide, but certain enteric pathogens are a source of considerable personal and societal distress in the developed world. Witness the impact of Clostridium difficile on hospitals and healthcare facilities in the West, compounded by the emergence of resistant and virulent strains and by the ability of this bacterium to precipitate relapse of IBD. The contrast between Western and non-Western experiences with a given disease entity was placed in sharp focus by a presentation on the global impact of Helicobacter pylori; a fading memory in the West, but an infection for which prevalence still exceeds 80% in many non-Western countries where gastric cancer is still a major issue. This issue of changes in the prevalence in causes of acid–peptic disease was further highlighted in a symposium on nonvariceal bleeding, where the ravages of NSAIDs were emphasized. This latter symposium also featured a vivid odyssey through the array of tools and techniques now at the disposal of the endoscopist in attempting to control acute GI hemorrhage, as well as critical reviews of the prevention of nonvariceal hemorrhage and how to address one of the most difficult clinical conundrums in gastroenterology: occult/obscure GI blood loss.
Education and training sit firmly at the core of WGO’s mission; a special symposium addressed core topics in this area: trial design, the use and abuse of evidence-based medicine, publication, guideline generation and the impact of a WGO training center. This turned out to be a tour de force in terms of touching on issues that confront those who attempt to advance training, education and research in gastroenterology worldwide, and offered realistic and reasoned solutions to developing a clinical research program, nurturing an English-language journal based in a non-English-speaking country, writing guidelines that can be globally implemented (utilizing the unique WGO cascades approach) and providing, as has been achieved at the WGO Rabat Training Center (Rabat, Morocco), training in gastroenterology to young doctors from nations, such as several in sub-Saharan Africa, where such training is not available.
Take-home message
Regional meetings provide a unique opportunity to explore what is similar and what is different in disease prevalence, diagnosis and management in various corners of our world; from such interactions we all have much to learn.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.