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

TJ Woodruff. NEJM 2024; 390: 922-933. Health Effects of Fossil Fuel–Derived Endocrine Disruptors Initially, I was tempted to title this post ‘Burying the Evidence and the Bodies from Pollution.’ That sounded too alarmist, though. That said, this review article asserts that “chemical pollution is estimated to be responsible for at least 1.8 million deaths each year…This number is probably an underestimate, since less than 5% of approximately 350,000 chemicals registered for use globally have been adequately studied.1”  (90% of pollution-related deaths occurring in low- and middle-income co ..read more

K Marild et al. Clin Gastroenterol Hepatol 2024; Open Access (PDF)! Association Between Celiac Disease and Irritable Bowel Syndrome: A Nationwide Cohort Study Methods: Using Swedish histopathology and register-based data, we identified 27,262 patients with CD diagnosed in 2002–2017 and 132,922 age- and sex-matched general population comparators. Key Findings: During an average of 11.1 years of follow-up, 732 celiac patients (2.7%) were diagnosed with IBS vs 1131 matched general population comparators (0.9%). Compared with siblings (n= 32,010), celiac patients (n = 19,211) had >/= 2-fold ri ..read more

Jose Garza recently shared this lecture from one of our mentors, Mike Farrell. I really enjoyed being able to hear and see him. This lecture discusses the role of being a consultant and how many things have changed over the years. It is amazing that Mike has been at Cincinnati for 50 years and has instructed so many residents, clinicians as well as GI trainees. The main task is still providing assistance to our colleagues in a respectful manner. I’ve included some of his slides. Link: The Consultation: An Ancient and Venerable Process in the Modern Age Often, the person requesting the consult ..read more