Abstract
The 164th Falk Symposium was organized in Budapest, Hungary for May 2–3, 2008. The symposium was entitled ‘Intestinal Disorders’ , which reflected the wide range of topics discussed in plenary sessions. The scientific poster session and the live endoscopic demonstration enriched the program of the symposium. Lectures and posters were presented at the Budapest Congress and World Trade Centre, while endoscopic examinations were performed in the Endoscopic Unit of the scientific organizer, the 2nd Department of Medicine, Semmelweis University, Faculty of Medicine. The international organizing committee (President: Zsolt Tulassay, Budapest, Hungary; Members: Petr Dite, Brno, Czech Republic; Guenter J Kreis, Graz, Austria; Jurgen Schö lmerich, Regensburg, Germany; and Hans-Joachim Schulz, Berlin, Germany) invited 43 experts from 16 different countries.
The program of the meeting consisted of nine main sessions. The first session gave information on the recent diagnostic and therapeutic approaches of the most frequent diseases of the rectum: anal outlet obstruction syndrome, piles and anal fissures and fistulas. Ferenc Jakab (Budapest, Hungary) demonstrated the importance of proper diagnostic workup in these cases, which determines the success of the therapy. A multidisciplinary approach is needed to treat these patients successfully. The lecturer surgeon advised careful consideration of surgical treatment.
The main diagnostic and therapeutic challenges concerning the hemorrhoidal diseases was presented by Per-Olof Nyström (Karolinska University, Stockholm, Sweden). This kind of disease is a very rare topic for international conferences, so it received a great amount of interest from the audience. Many questions arose concerning the classification of and therapeutic approaches to this disease as well.
The second session focused on diverticular disease and irritable bowel syndrome. Diagnostic and therapeutic approaches of diverticular disease were presented. Exact classification of diverticulitis, whether acute or chronic, and complicated versus uncomplicated categories helps the selection of the best therapeutic options. The use of 5-aminosalicylates in the therapy of mild cases and prevention of forthcoming attacks with 5-aminosalicylatesis is controversial. Alastair Forbes (London, UK) highlighted the difficulties regarding diverticular bleeding. Colonoscopy has the highest overall efficacy in diagnosis and therapy; however, preparing the patient for an acute colonoscopy is not easy. Robin Spiller (Nottingham, UK) presented a very useful lecture on the therapeutic possibilities for different types of irritable bowel syndrome. He focused on management approaches dependent on the most prominent symptoms. Recent data were also presented on medicines of the very near future.
Further presentations gave some new information concerning the recent policy of therapy on Crohn’ s disease and ulcerative colitis. Research on the pathogenesis of inflammatory bowel disease is one of the most frequent areas of gastroenterology. Lectures were presented on the significance of epithelial barrier function of the gut and the immune system as a therapeutic target. Gerhard Rogler (Zü rich, Switzerland) showed the high importance of the defensins in barrier function. The relationship between altered defensin production and the genetic variation of proteins of the naive immune system was demonstrated in this lecture. This information bridged to the next presentation, where Elke Cario (Essen, Germany) highlighted the importance of the Toll-like receptors as a pattern recognition receptor family in the pathogenesis of inflammatory bowel diseases. Potential strategies for activation, inhibition or a combination of both on the different stages of the process of inflammation were discussed.
Two lectures were held on the partition of Crohn’ s disease based on the clinical manifestations and serological/genetic results. Christoph Gasche (Vienna, Austria) demonstrated the efficacy of the Vienna and Montreal classification of the disease in the prediction of prognosis. Só verine Vermeire (Leuven, Belgium) gave a very interesting lecture concerning the importance of the serological markers and genetic alterations. From the viewpoint of the everyday practice, the examination of thiopurine methyltransferase activity and the genetic background of the alteration seem to be the most important factors; however, the cost–effectiveness of this examination is controversial.
At the end of the first day interesting case reports of inflammatory bowel disease were presented. Experts in the specific topics focused on surgical and conservative therapeutic approaches regarding the presented cases. Both typical and rare clinical situations were presented in this session. The discussion was based on evidence or personal experiences in the latter cases (e.g., Crohns’ s disease causing duodenal stenosis).
The morning of the second day began with a live endoscopic demonstration. Procedures were performed in the Endoscopic Unit of the organizer, the 2nd Department of Medicine, Semmelweis University, Faculty of Medicine. Invited professors Horst Neuhaus, Nib Soehendra, Christoph Dietrich, Hans-Joachim Schulz and Já nos Papp performed the examinations. In total, 12 interventions were performed, including metallic stent implantation, mucosectomy, papillotomy, use of intraductal mother–baby scope, small bowel enteroscopy, endosonography and transnasal upper endoscopy. Professional communication engineering support was provided by the Lux AV Corporation from Berlin. Many questions arose from the large audience in the lecture hall, which provided interaction between the experts and the participants. This communication became more active in a case of a bleeding as a complication of a mucosectomy in the esophagus. Very neat solutions were presented by the experts in the most complicated and also the most simple cases.
Different tumors of the small bowel were the main topic of the afternoon session. Fabio Farrinati (Padua, Italy) and Marcis Leja (Riga, Latvia) chaired this session with a high competence. The new WHO classification of the gastrointestinal lymphomas was presented in the first lecture by Wolfgang Fischbach from Germany. He highlighted the importance of the so-called mapping biopsy to achieve the proper diagnosis. Choosing an adequate chemotherapeutic protocol and deciding whether the patient needs a supplemental therapy (e.g., antibody or radiological) is very difficult and requires special preparedness. An excellent presentation was given by Farrinati on gastrointestinal stromal tumors . He presented their own multicenter Italian study including 172 cases of GI stromal tumors. Their observations enhanced the significance of genetic alterations and the clinical behavior of this type of tumor. Recent data on conservative and surgical therapy of neuroendocrine tumors were presented in this session. The role of conservative therapy cannot be overemphasized in these cases because metastases can be observed at the time of the diagnosis in 50% of cases.
In the afternoon session, Meinhard Classen presented the results from the efforts of the European Medical Society in terms of the screening for colorectal cancer. Importance of this screening program is demonstrated by the contribution of the EU. Exciting results from the screening programs have recently become available in Poland, Slovakia and the Czech Republic. Classen also underlined the most problematic point of the screening program. Both speakers gave lectures that could be very useful in the everyday practice. Alastair Watson (Liverpool, UK) gave a clear guideline of how achieve the optimal surveillance of colonic adenomas and Karel Geobes from Belgium highlighted new aspects in the management of metastatic colorectal cancer.
The last presentation was given by the Past President of the American Gastroenterological Association and Editor of Gastroenterology, Daniel Podolsky from the Medical Faculty of the Harvard University (MA, USA). He spoke on the prospectives of gastroenterology, potential research fields and challenges of the near future.
A total of 131 posters were presented from 19 different countries at the poster session; with the traditional awards. Posters focusing on basic science results as well as clinical observations were presented.
In total, 1200 participants registered for the 164th Falk Symposium in Budapest. The high attendance made this meeting the largest Falk Symposium organized outside of Germany to date.
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.