Inaugural Lecture by TCD Professor of Medicine Prof Colm Ó Moráin: Can Gastrointestinal Cancer be prevented?

Posted on: 01 February 2008

“Diseases of the gastrointestinal tract place a huge burden on the health economy. One third of all hospital admissions have a gastrointestinal complaint”, stated TCD Professor of Medicine, Professor Colm Ó Moráin based at the Adelaide & Meath Hospital, Incorporating the National Children’s Hospital (AMNCH) at Tallaght at his inaugural lecture as Chair of Medicine.

“Gastroenterology covers a wide range of diseases from benign to malignant and the variety and complexity of the diseases involved diffuse the focus of gastroenterologists compared to other specialists where only one organ is involved,” continued Professor Ó Moráin. “Gastroenterology is a relatively new speciality that was firmly established by the ability of endoscopy to visualise directly the internal organs of the body”.

“The cost of treatment of Inflammatory Bowel Disease in Ireland is the third highest in Europe. Inflammatory Bowel Disease, a term that is used to describe Ulcerative Colitis and Crohn’s Disease, can affect young people and has an onset between the ages of 20-40. Through Gastroenterology research carried out at TCD and AMNCH at Tallaght we have documented the precise incidence of this disease in Ireland where an estimated 45,000 patients now have Inflammatory Bowel Disease. These studies were carried out in collaboration with 21 centres throughout Europe from 1990 onwards. The collaborative research carried out through this network led to the discovery in 2002 that there is an inherited susceptibility to these conditions. The service at AMNCH at Tallaght has been accredited and is considered to be the benchmarker for outpatient service to patients with Inflammatory Bowel Disease”.

“There is no definite treatment for Inflammatory Bowel Disease and the cause remains unknown. Special diets that give the bowel a chance to rest and recover have been found to be successful, but its efficiency is limited as this form of diet is not very palatable. However, these special diets have given clues as to the possible cause of the disease. There have been significant gains in terms of treatment due to modern technology in the pharmaceutical industry developing drugs (monoclonal antibodies) based on a strategy of blocking specific proteins involved in inflammation. We have been involved in all of the pivotal studies to show that these drugs have a benefit for the patient. However, not all patients respond to this treatment and there is still a need to find better treatment”.

“Studies carried out in AMNCH in conjunction with St. James’s Hospital were the first to conclusively prove that Helicobacter pylori, a bacteria only found in the stomach, is the cause of duodenal ulcer. Getting rid of the bacteria cures the ulcer. Before this discovery in 1987 patients needed lifelong treatment with drugs or major surgery”.

“More recently this bacteria is listed as a Class I Carcinogen by the World Health Organisation. This has led to further collaboration with countries such as Japan and China which have a very high incidence of Helicobacter infection and gastric cancer. There are screening programmes in place to detect the bacteria and treat with the aim of reducing gastric cancer. Prevention is the best cure”.

“We have also been involved in all the pivotal clinical trials that improved the treatment of this condition. There are limitations to treatment due to antibiotic resistance. We are studying at a molecular level how the bacteria develops antibiotic resistance and are constantly evaluating new antibiotics to improve treatment”.

“Lessons learned from gastric cancer prevention can be applied to colon cancer. Colon cancer is the most common cancer in the European Union. There are 2,184 cases per annum and a predicted mortality rate of 2,020. Survival rates have not improved despite significant advances in diagnosis and treatment. The reason for this is the late presentation in patients. If patients present early or preferably at pre-cancer stage, survival rates are excellent. International data support population screening for colon cancer for patients over the age of 50. This is based on using an intermediate test of faecal occult blood to detect minute amounts of blood in the bowel motions”.

“Cancer can shed blood into the bowel without the patient being aware. If the test is positive the patient requires a colonoscopy to be performed by skilled personnel. The aim of this screening is to find cancer at an early stage. We have been involved in preliminary studies to validate this approach in AMNCH at Tallaght. At a laboratory level we are looking at the changes which occur at the benign and malignant stage of colon cancer. Cancer prevention is a major stakeholder in the Institute of Preventative Health which is a joint initiative, between AMNCH and Trinity College. This should be very apt as its completion date should coincide with the Tercentenary of the Medical School in 2011.”

Extracts from a presentation given by Professor of Medicine, Professor Colm Ó Moráin on the occasion of his inaugural lecture Chair of Medicine at TCD on 30 January 2008.