14^th International Conference on Clinical Gastroenterology and Hepatology August 29-30, 2018 Toronto, Ontario, Canada

 Innovation is a necessary function in healthcare. Clinical innovation and new technologies are two of the vitally important areas that gastroenterology leverages to provide optimal and cost-effective care to the patients. Innovation may encompass new devices and technologies, new practice patterns, novel methods of patient interaction, and new care delivery paradigms. The evidence threshold for new technologies to be approved continues to rise, and the regulatory and reimbursement pathways, at times, lack transparency and clear innovation. Understanding innovation and changes in clinical practice is a key to keep gastroenterology as a viable specialty. The main aim of the conference is to bridge the gap between innovation and practise in the field of gastroenterology.

Inflammatory bowel diseases (IBDs) are chronic inflammatory disorders characterized by chronic relapsing inflammation of the gastrointestinal tract that affect 0.1% of Western populations, comprising two major forms, Crohn's disease (CD) and ulcerative colitis (UC). Adjuvants to the traditional therapy of inflammatory bowel disease (IBD) have been studied to enhance the efficacy of the treatment and improve patients’ quality of life. Approximately 1.6 million Americans currently have IBD, a growth of about 200,000 since the last time CCFA reported in 2011. As many as 70,000 new cases of IBD are diagnosed in the United States each year. There may be as many as 80,000 children in the United States with IBD. 

Not all patients seen by an upper gastrointestinal surgeon will necessarily need an operation. A laparoscopic, or minimally invasive surgical procedure, is an alternative to traditional "open" surgery in which a large incision must be made. These small incisions create a passageway for special surgical instruments and a laparoscope. Surgery may be done in patients with continued lower GI bleeding but localization of the bleeding site is very important. If the bleeding site cannot be localized, subtotal colectomy is recommended the digestive system is an intricate system that can be disrupted by disease, diet and emotional stress. While some digestive problems can be remedied with medicine and lifestyle changes, others require surgery.

Gastrointestinal surgery covers two specialties of general surgery (upper gastrointestinal surgery and colorectal surgery. Gastrointestinal ultrasound provides more detailed images of the digestive system than other imaging studies. It allows physicians to examine your esophageal and stomach linings, as well as your upper and lower digestive tract. The surgical treatment of diseases of the gall bladder, liver and pancreas (hepatobiliary system) and oesophagus, stomach and small bowel (upper gastrointestinal tract) is performed under the care of the general surgeon who has a specialist interest in upper gastrointestinal surgery. The conditions treated are many and varied; they often require the assistance of physicians (gastroenterologists) and specialist nurses (cancer care and inflammatory bowel disease).

The burden to healthcare and the impact of disease to humans from luminal disorders of the gastrointestinal tract have driven the requirement for more efficient endoscopic visualization and instrumentation over the past decade. The push for greater diagnostic yield has driven advances in optical physics and bioengineering which are revolutionizing diagnostic and therapeutic endoscopy. Nowadays, Cholangioscopy is an established modality in diagnostic and treatment of pancreatic biliary diseases. The more widespread use and the recent development of new technologies and accessories had renewed the interest of endoscopic visualization of the biliary tract, increasing the range of indications and therapeutic procedures, such as diagnostic of indeterminate biliary strictures, lithotripsy of difficult bile duct stones, ablative techniques for intraductal malignancies, removal of foreign bodies and gallbladder drainage. These endoscopic interventions will probably be the last frontier in the near future.

Children are not just small adults. Their bodies are growing and have unique medical needs. They usually express their concerns differently  than adults. They cannot always answer medical questions and are not always able to be patient and cooperative. The aim of the study of pediatric gastroenterology is to reduce infant and child rate of deaths, control the spread of infectious disease, promote healthy lifestyles for a long disease-free life and help ease the problems of children and adolescents. It can be acknowledged that this can be reached by learning the major and primary subject on gastroenterology. It includes the treatments involved for the betterment of gastrointestinal health in children.

Gastric cancer is the second most common gastrointestinal cancer and the fourth most common cancer worldwide. Surgeons are continuing to improve their techniques for operating on colorectal cancers. They now have a better understanding of what makes colorectal surgery more likely to be successful, such as making sure enough lymph nodes are removed during the operation. Laparoscopic surgery is done through several small incisions in the abdomen instead of one large one, and it's becoming more widely used for some colon cancers. This approach usually allows patients to recover faster, with less pain after the operation. Gastroenterology have Laparoscopic surgery is also being studied for treating some rectal cancers, but more research is needed to see if it as effective as standard surgery. With robotic surgery, a surgeon sits at a control panel and operates very precise robotic arms to perform the surgery.

The gastrointestinal tract (GI tract) plays dual roles in human physiology: digestion and uptake of nutrients and the more daunting task of maintaining immune homeostasis (protecting the body from potentially harmful microbes, while inducing tolerogenic responses to innocuous food, commensals and self-antigens). The unique architecture of the GI tract and viral hepatitis facilitates both of these functions; multiple levels of infolding results in an immense overall surface area that allows maximal nutrient absorption while housing the largest number of immune cells in the body. As many pathogens enter the body via the intestinal mucosa, it is vital the gut-associated lymphoid tissues can provide effective immune responses when necessary

GI bleeding can originate anywhere from the mouth to the anus and can be overt or occult. The manifestations depend on the location and rate of bleeding.  Acute or chronic bleeding of internal haemorrhoids stops spontaneously in most cases. Patients with refractory bleeding are treated via anoscopy with rubber band ligation, injection, coagulation, or surgery. Massive GI bleeding is tolerated poorly by elderly patients. Diagnosis must be made quickly, and treatment must be started sooner than in younger patients, who can better tolerate repeated episodes of bleeding. Rectal bleeding may result from upper or lower GI bleeding. Orthostatic changes in vital signs are unreliable markers for serious bleeding. About 80% of patients stop bleeding spontaneously; various endoscopic techniques are usually the first choice for the remainder.

Hepatobiliary cancers refer to liver cancer and cancers of the biliary tract that arise in the bile ducts, the tubes that carry bile from the liver or gallbladder to the small gut. Biliary tract cancers, also referred to as cholangiocarcinomas, refer to those malignancies occurring in the organs of the biliary machine, inclusive of pancreatic most cancers, gallbladder cancer, and cancer of bile ducts. The occurrence of most cancers of the pancreas increases with age. Risk will increase after age 30 years, with most instances occurring among the ages of 65 and 79. But the disease has also been suggested in younger individuals, which include children. A variation in prevalence and mortality among distinct non secular agencies has additionally been found. The purpose of pancreatic carcinoma remains unsure; however numerous elements have been implicated. Cigarette smoking has been related to an increased hazard of pancreatic carcinoma.

Gastrointestinal disorders represent some of the most frequent complaints during pregnancy. Some women have GI disorders that are unique to pregnancy. Other pregnant patients present with chronic GI disorders that require special consideration during pregnancy. 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 foetus 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 foetus, 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 new-borns, it is not fatal. 

Endoscopes are minimally invasive and can be inserted into the openings of the body such as the mouth or anus. Because modern endoscopy has relatively few risks, delivers detailed images, and is quick to carry out, it has proven incredibly useful in many areas of medicine. Today, tens of millions of endoscopies are carried out each year. Sometimes, endoscopy will be combined with another procedure such as an ultrasound scan. Endoscopy can be used to place the ultrasound probe close to organs that can be difficult to image, such as the pancreas. Endoscopy has advanced in recent years, enabling some forms of surgery to be conducted using a modified endoscope; this makes the surgery less invasive. Current endoscopes are derived from a primitive system created in 1806-a tiny tube with a mirror and a wax candle. Although crude, this early instrument allowed a first view into a living body.

Neurogastroenterology is a subspecialty of gastroenterology that overlaps with neurology Neurogastroenterology encompasses the examine of the mind, the intestine, and their interactions with relevance to the understanding and control of gastrointestinal motility and functional gastrointestinal problems. Motility issues are the second classification of gastrointestinal disorder studied through neurogastroenterologists. Motility disorders are divided via what they affect, with 4 areas: The esophagus, the stomach, the small intestines, and the large intestines. Clinical studies in neurogastroenterology focuses particularly on the study of common motility disorders consisting of gastroesophageal reflux ailment, the damage of the mucosa of the esophagus caused by rising stomach acid through the lower esophageal sphincter.

Gastrointestinal and liver disease represents a significant global health problem, and cause approximately 8 million deaths per year worldwide. In developed countries, GI malignancies are among the leading causes of death.  In developing countries, diarrheal diseases and viral liver infections are highly prevalent and are responsible for significant mortality. These and other diseases are tracked by international and regional health organizations.  These tracking measures allow for some assessment of the global burden of GI diseases and may allow identification of important temporal trends. 

Although the future of hepatology promises to eradicate Hepatitis C  virus infection, a new challenge has taken its place. Obesity and metabolic syndrome and associated non-alcoholic fatty liver diseases are replacing hepatitis C virus as the most common cause of chronic liver diseases in Western countries.

Great progress in molecular biology, therapeutics, imaging and surgery has vastly improved the understanding and treatment of childhood liver disorders. In particular surgical advancements in liver transplantation currently allow for a lower age or weight limit for recipients. Furthermore the majority of children with liver diseases or with liver transplantation today survive well into adulthood.