A Dickerson et al. Clin Gastroenterol Hepatol 2024; 22: 732-740. The Index of Severity for Eosinophilic Esophagitis (I-SEE) Reflects Longitudinal Clinicopathologic Changes in Children This was a retrospective analysis on a prospectively enrolled cohort of children at a single center who were treated as part of routine clinical care. I-SEE was calculated at the diagnostic and follow-up endoscopies over a mean of 6.6 years. Key findings: Of 67 children who met study criteria of at least 3 endoscopies over at least 2 years of follow-up time, 43%, 36%, and 21% had mild, moderate, and severe I-SEE ..read more

RJ Snijders et al. J Hepatol 2024; 80: 576-585. Open Access! An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis Methods: In this 24-week, prospective, randomised, open-label, multicentre superiority trial, 70 patients (mean age 57.9 years) with treatment-naive AIH received either MMF or azathioprine, both in combination with prednisolone. The primary endpoint was biochemical remission (BR) defined as normalisation of serum levels of alanine aminotransferase and IgG after 24 weeks o ..read more

JG Hashash et al. Clin Gastroenterol Hepatol 2024; 22: 705-707. Open Access! AGA Rapid Clinical Practice Update on the Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy: Communication “GLP-1 RAs (eg, semaglutide, tirzepatide, exenatide, liraglutide, albiglutide, dulaglutide, and lixisneatide) mimic incretins, which are hormones released after eating that prompt glucose-dependent insulin release from the pancreatic islets, stimulate satiety centers, inhibit glucagon release, and result in diminished gastric emptying.” Because GLP-1 RAs diminish gastric emptying, they can ..read more

WL Hasler et al. Clin Gastroenterol Hepatol 2024; 22: 867-877. Open Access! Benefits of Prokinetics, Gastroparesis Diet, or Neuromodulators Alone or in Combination for Symptoms of Gastroparesis Methods: In this prospective study of patients (n=129) with suspected gastroparesis, the authors examined longitudinal outcomes focusing on responses to prokinetics and other therapies. This included gastroparesis diets and neuromodulators. Patients underwent validated gastric emptying testing (wireless motility capsule and gastric emptying scan) before recommending new treatments. Prokinetics included ..read more

K Mullin, RM Rentea, M Appleby, PT Reeves. Pediatrics in Review 2024; 45: 210-224. Gastrointestinal Ostomies in Children: A Primer for the Pediatrician Like yesterday’s article on GTs, this is another terrific review with plenty of helpful images and advice regarding ostomy management. Background: “There are upwards of 1 million people living with ostomies (ostomates) in the United States.” “Approximately 75% of all ostomies in the pediatric population are created in the neonatal or infant patient.” Table 1 lists the purposes and types of ostomies including gastrostomy, jejunostomy, ileostomy ..read more

I Novak, NK Velazco. Pediatrics in Review; 2024: 45: 175-187. Gastrostomy Tubes: Indications, Types, and Care Thanks to Patrick Reeves for sharing this reference. While reading this article, I was reminded of Debbie Mason RN. She worked mainly for Colin Rudolph when I was a fellow at Cincinnati. She would teach the fellows the ‘ins and outs’ regarding gastrostomy tubes (GTs). Some of the points from this article: Background: In one large study, 25% of hospitalized pediatric patients in 63 U.S. hospitals required a temporary NG tube. GTs “preferred for longer-term access due to being less pron ..read more

Dr. Joel Rosh gave our group an excellent update on sequencing therapy for ulcerative colitis (UC).  My notes below may contain errors in transcription and in omission. Along with my notes, I have included many of his slides. There are only two FDA-approved biologics in pediatric Ulcerative Colitis. It typically takes 8-10 years for a medication with approval in adults to receive FDA approval in children The concept of IBD as two diseases, Crohn’s disease and UC, is flawed; there are more than 200 susceptibility genes for inflammatory bowel disease There has been an increasing incide ..read more

The pioneers of endoscopy are discussed in the following article: AR Schulman, JD Howell. Clin Gastroenterol Hepatol 2024; 22: 684-688.Open Access! From Hirschowitz to 2023: Modern Endoscopy and Beyond A few excerpts: “In 1868, the German physician Adolph Kussmaul looked inside the stomach of a human being. He chose to peruse the stomach of a professional sword-swallower, someone who was able to tolerate, although probably not to enjoy, a straight, 47-cm long metal tube with a diameter of 13 mm.1 This marked the beginning of the first era of endoscopy, the era of rigid endoscopy…encounte ..read more

AGA 4/10/24: New NHS Guidance on Informed Consent consent impacts GIs My take: This guidance likely was derived from patients having sensitive exams without permission while under anesthesia. While this guidance is directed at hospital settings and hospital-based outpatient clinics where written consent is now needed, practitioners in the outpatient setting likely will need to better document permission prior to rectal examination and assure appropriate use of chaperones. Resources: CMS Revisions and clarifications to Hospital Interpretive Guidelines for Informed Consent Based on increasing ..read more

SR Fernades et al. Inflammatory Bowel Diseases, izad272, https://doi.org/10.1093/ibd/izad272 Proactive Infliximab Monitoring Improves the Rates of Transmural Remission in Crohn’s Disease: A Propensity Score–Matched Analysis  Methods: Retrospective cohort study (n=195) including consecutive CD patients starting treatment with IFX. Rates of transmural remission were compared between patients with and without therapeutic drug monitoring (target level: 5-7 µg/mL). Key findings: The rates of transmural remission were higher in patients under proactive therapeutic drug monitoring (37.2% v ..read more