Podcasts about clinical gastroenterology

El doctor Huerta, nos cuenta sobre un estudio publicado en Clinical Gastroenterology and Hepatology, el cual identifica tres condiciones que aumentan significativamente el riesgo de daño hepático en personas que consumen alcohol.

~~研究文獻解析~~ 你知道嗎？

In this episode, Sonal Kumar, MD, MPH, discusses key findings from primary biliary cholangitis (PBC) studies presented at AASLD 2024, including:ELATIVE, a phase III trial of elafibranor for PBCRESPONSE, a phase III trial of seladelpar for PBCASSURE, another phase III trial of seladelpar for PBCPresenter:Sonal Kumar, MD, MPHDirector, Clinical Gastroenterology and HepatologyAssistant Professor of MedicineWeill Cornell Medical CollegeNew York, New YorkLink to full program:https://bit.ly/41tvSDuGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In this episode, Sonal Kumar, MD, MPH, discusses key findings from primary biliary cholangitis (PBC) studies presented at AASLD 2024, including:ELATIVE, a phase III trial of elafibranor for PBCRESPONSE, a phase III trial of seladelpar for PBCASSURE, another phase III trial of seladelpar for PBCPresenter:Sonal Kumar, MD, MPHDirector, Clinical Gastroenterology and HepatologyAssistant Professor of MedicineWeill Cornell Medical CollegeNew York, New YorkLink to full program:https://bit.ly/41tvSDuGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

00:00:00 - Surf's Up: Season 5 Episode 25 On July 20, Clinical Gastroenterology and Hepatology released the paper, Expert Panel Recommendations: Practical Clinical Applications for Initiating and Monitoring Resmetirom in Patients with MASH/NASH and Moderate to non-cirrhotic Advanced Fibrosis. Corresponding author Maru Rinella joins the Surfers to share key points from the recommendations and offer her thoughts on what lay behind them.00:02:26 - Introduction and GroundbreakerThe highlight was Louise's groundbreaker: having become a full Fellow in the Roal College of Physicians.00:06:28 - Introducing the paperRoger starts by discussing the importance of this paper and listing the questions the panel will address during the episode. Maru provides a history of developing the paper. Jörn praises its timeliness. 00:08:59 - Treating the "Right" patients; Using the "Right" testsJörh asks why the authors changed the patient definition from a histological one to at-risk MASH patients confirmed by NITs. Maru said the authors sought to follow the FDA guidance on NITs and patient targets. They considered adding liver enzymes or confirmatory VCTE to the protocol, but demurred because not every clinical could execute such a recommendation. Jörn asks whether the authors considered requiring three metabolic risk factors. Roger notes that this question implies a need to prioritize patients, which is a factor in Europe but not the U.S. This paper takes a more U.S-based perspective, which is to set a threshold for use.  00:14:21 - The Decision Not to Discuss CostThe authors did not address costs because they anticipated steep reductions over time. The panel compares the MASH case to HCV. In HCV, the combination of high drug costs and large number of warehoused patients drove prioritization over time. 00:16:34 - Relative paucity of warehoused MASH patients Maru suggests relatively few MASH patients are warehoused. Louise asks whether many U.S. insurers are controlling access by requiring liver biopsy. Maru reports she has not encountered this personally and  estimates it might affect ~5% of cases so far. 00:19:05 - Rationale for Patient SelectionMaru explains the rationale for an F2 threshold for patient selection: patients with fibrosis >= F2 show a demonstrable decline in long-term survival. The rationale for excluding cirrhosis patients? Resmetirom is not yet proven to help patients with cirrhosis. Jörn notes, the MAESTRO-OUTCOMES trial is running and will generate consequential data on cirrhosis. 00:22:11 - Value of Stabilizing Disease without ImprovementMaru notes that the paper focused strongly on how to stabilize patients because the drug is safe and stabilization has real-world benefits.. She points out that patient advocates strongly recommend this focus. All this led to the paper's recommendation to discontinue only upon progression.  00:25:12 - The importance of incremental learningThe group agrees that these recommendations comprise a base that will be strengthened over time as individual providers gain experience with the drug. 00:30:06 - Wrapping upPanelists touch briefly on the value of loose discontinuation rules, how patients feel about starting therapy, how to handle drug interactions, and how the paper is used in the US vs. other countries. In closing, the group remembers Stephen Harrison's unique contributions one more time.00:37:55 - Question of the WeekWhich of the paper's two striking recommendations -- using multiple NITs to qualify patients and continuing therapy unless and until a patient shows signs of disease progression -- will have greater impact on how physicians treat patients?00:38:44 - Business ReportSummer schedules, value of the business report, the vault discussion.

In his weekly clinical update, Dr. Griffin discusses RSV vaccination recommendations and revisions to guidelines before reviewing the recent statistics on SARS-CoV-2 infection, data suggesting that individuals with high HLA-DQA2 expression (MHC class II) are better at preventing the onset of a sustained viral infection, how moderate coffee intake can reduce risk of COVID-19 severity but cannabis use resulted in more severe disease but reduced risk of mortality, where to find PEMGARDA, if statin use prevented severe COVID-19, the benefit of administering nirmatrelvir and ritonavir after 5 days, convalescent plasma, what do when healthcare workers succumb to SARS-CoV-2 infection, if fecal microbiota transplants aid in recovery from COVID-19, and the definition of characteristics and clinical patterns for the diagnosis of long COVID. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode CDC ACIP for RSV (CDC) This respiratory virus season everyone age 75 and older receive the RSV vaccine (CDC Newsroom) Revised RSV vaccine recommendations (CIDRAP) COVID-19 national trend (CDC) COVID-19 deaths (CDC) Local and systemic response dynamics to SARS-CoV-2 infection (Nature) Drink more coffee, reduces risk for SARS-C0V-2 infection (Cell & Bioscience) Cannabis, tobacco…smoking in general NOT good for preventing COVID-19 (JAMA Network OPEN) Do older versions of the COVID-19 vaccine still provide any protection (JAMA Internal Medicine) Where to get pemgarda (Pemgarda) CDC Quarantine guidelines (CDC) Early phase of SARs-CoV-2 infection (COVID.gov) NIH COVID-19 treatment guidelines (NIH) Infectious Disease Society guidelines for treatment and management (ID Society) Adjuvant statin therapy reduces SARS-CoV-2 mortality (American Journal of Medicine) Nirmatrelvir and ritonavir beyond 5 days of symptom onset improved the multiple organ dysfunction in severe COVID-19 patient (BMC Infectious Disease) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What do when your heathcare provider is infected with SARS-CoV-2 (CDC) Managing healthcare staffing shortages (CDC) Steroids, dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Faecal microbtiota transplantation cures sleep disturbance in post-acute COVID-19 syndrome (Clinical Gastroenterology and Hepatology) Long COVID defined by patient phenotype (CIDRAP) Three distinct symptom-based post-COVID condition phenotypes (JID) Contribute to our Floating Doctors fundraiser Letters read on TWiV 1126 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, have a conversation about artificial intelligence (AI) and patient education, with guest Dr. Corey Ketchem, a third-year Gastroenterology Fellow at the University of Pennsylvania.   In this episode, Ryan, Holly, and Dr. Ketchem discuss Dr. Ketchem's interests, and his research into using an AI chatbot to provide patient education on eosinophilic gastrointestinal diseases. He shares, in broad terms, the methodology and conclusion of the research and what current and future research he is pursuing about using artificial intelligence to improve patient education and care.   Listen to this episode to learn about the current limitations and potential future benefits of using AI to help patients. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [1:17] Ryan Piansky and co-host Holly Knotowicz introduce the topic, artificial intelligence and patient education, and their guest, Dr. Corey Ketchem, a third-year Gastroenterology Fellow at the University of Pennsylvania.   [1:30] Dr. Corey Ketchem has an interest in allergic inflammation of the gastrointestinal tract, particularly eosinophilic gastrointestinal diseases (EGIDs), as well as artificial intelligence and epidemiologic studies.   [2:01] Dr. Ketchem did his residency at the University of Pennsylvania following medical school. There he met Dr. Evan Dellon, a world expert in EoE. Dr. Dellon became a mentor to Dr. Ketchem.   [2:24] As Dr. Ketchem learned more about EoE, he was fascinated by the many unknowns and opportunities for discovery within the eosinophilic GI field. He wanted to make an impact on patient care.   [2:51] Under Dr. Dellon's mentorship, he did epidemiologic studies. Seeking specialized training, he ended up at the University of Pennsylvania where he is getting rigorous training in epidemiology to study EGIDs.   [3:18] As ChatGPT was gaining its buzz, Dr. Ketchem saw a lot of clinical applicability. He views AI as an asset in epidemiology and hopes to use it to accelerate his research.   [4:30] AI usually references using computers to mimic human abilities, estimate decisions, or predict outcomes. An example is Natural Language Processing (NLP), to analyze and understand human language. Large Language Models (LLM) use NLP.   [5:08] ChatGPT is based on a LLM. LLMs use NLP techniques to understand vast amounts of text that they are trained on and generate responses in a chat format.   [5:25] Machine learning is another subset of AI that uses statistical techniques to give computers the ability to learn with the data and predict outcomes.   [5:50] The hope is to use these AI techniques to speed up discovery and also minimize human expense or labor.   [6:28] Dr. Ketchem co-authored a paper in Clinical Gastroenterology and Hepatology about an AI chatbot and EoE. He had been inspired by a cardiology paper on whether ChatGPT would create accurate, appropriate answers about cardiology disease health.   [7:19] Dr. Ketchem wondered if ChatGPT could be applied to EoE education. He discussed it with Dr. Dellon and Dr. Krystle Lynch, Dr. Ketchem's mentor at the University of Pennsylvania, and with Dr. Joy Chang, at the University of Michigan. They came up with a study design.   [8:06] The study asked ChatGPT questions about EoE, focusing on patient education and the therapeutics, and seeing if it gave accurate responses or not.   [8:45] The four doctors developed 40 questions that they gave ChatGPT as prompts and evaluated the responses. They proposed the questions in two ways: each question in an individual chat and 40 questions in a single chat.   [9:41] Analyzing the responses, the study demonstrated that ChatGPT responded with multiple inaccuracies to questions about EoE on general topics, complications, and management. Over half of the responses mixed correct and incorrect information.   [10:09] To evaluate the readability of the responses, the doctors used the Flesch-Kincaid reading ease tool. To understand the output from ChatGPT one would need high school and two years of college. That poses a potential health literacy barrier.   [11:40] The questions ranged from general: “What is eosinophilic esophagitis?”, to complications: “What is a food impaction?”, “What is a stricture?”, to therapeutics: “What are steroids for eosinophilic esophagitis?”, “Can I use a proton pump inhibitor for EoE?”   [12:15] It was not clear where ChatGPT pulled data from to respond to the questions. The data it was trained on was known to be in texts over a year old. Newer data may not have been accessible to ChatGPT.   [13:29] The doctors asked about things that were common knowledge in the eosinophilic GI realm, like dupilumab, and ChatGPT didn't know much about it because it was a newer treatment option for EoE at the time of the study. [13:42] The doctors scored the answers on their scientific accuracy and patient educational value. Simple questions got good responses. For questions about therapies and complications, “it wasn't doing well.” They identified limitations to the study. [14:14] The doctors asked ChatGPT if EoE is associated with cancer. From their best epidemiologic knowledge, the doctors don't think that it is. ChatGPT falsely associated EoE with esophageal adenocarcinoma.   [14:34] ChatGPT also associated EoE with Barrett's esophagus. To the doctors' best epidemiologic data, they are not sure that there's a connection.   [15:02] When the doctors asked the questions in individual chats, they asked ChatGPT for medical literature references for the information. It didn't provide accurate references. Titles and authors were often incorrect and links often didn't work.   [15:36] The incorrect references were a signal that ChatGPT wasn't ready to answer complex medical questions. In the more updated versions of ChatGPT, instead of giving references, it says you should consult your doctor, which is the right thing to do.   [15:56] The researchers concluded that implementing this technology requires clinical oversight; it's a tool that should be used with caution for patients in educating themselves and also from the perspective of a physician who is not an expert in EoE.   [16:29] Dr. Ketchem had been surprised by how long the responses were. He was expecting paragraphs but got pages and pages. He was also surprised by how quickly people were starting to use ChatGPT in other aspects of gastroenterology.   [16:57] While Dr. Ketchem and his team were writing the paper, another study came out about gastroesophageal reflux (GERD) that was somewhat similar to what Dr. Ketchem proposed for EoE. There is rapidly much being published about ChatGPT.   [17:14] Although the results were imperfect, there is potential applicability in patient-facing chats in the future for patient education but not yet there “for prime time.”   [18:33] These chats need to be transparent about where they're getting data, especially in the medical field.   [18:41] There will always be a role for people in medicine. You can't replace a face-to-face connection with a nurse or a physician with a chat bot.   [19:11] Dr. Ketchem says everyone needs to be careful about using AI tools. He advises patients to always discuss any medical questions with their physician. AI tools are not yet able to provide accurate medical information all the time.   [19:50] Ryan reminds listeners that this podcast is for educational purposes. Always consult your physician before making any changes to your healthcare. If you ask ChatGPT, also consult with your doctor before making any changes to your healthcare.   [20:31] One of the problems with large language models is the potential for inaccuracy. Dr. Ketchem's gold standard is the medical literature and you don't know where the large language models are getting their information.   [21:04] Future benefits may include helping patients get answers quicker and becoming more educated. Dr. Ketchem hopes we will get to a point where we can trust these technologies and implement them safely.   [21:37] Government organizations like the National Institutes of Health (NIH) and the U.S. Food & Drug Administration (FDA) are bringing together experts to think about large language models and create regulatory frameworks for their use in healthcare. Dr. Ketchem tells how HIPAA (Health Insurance Portability and Accountability Act) rules are followed to protect patients.   [23:29] Dr. Ketchem sees potential in machine learning to predict which therapies an EoE patient will respond to. AI is also used in colonoscopies to identify hard-to-see polyps. It might be useful in endoscopies to see changes in the esophagus from EoE.   [24:35] AI image recognition could also be applied in pathology. Dr. Ketchem is interested in trying to apply it to work he wants to do in the long term. People are working with pathology specimens to automate the counting of eosinophils. Dr. Ketchem discusses the potential use of AI for epidemiology in pathology.   [25:43] Dr. Ketchem and Holly discuss the potential for using AI chatbots in medical screening questionnaires. There will always need to be a human element.   [27:57] Dr Ketchem speaks to the potential future development of educational videos prepared by AI. It is a complex scenario that would require a lot of training. If a camera is added, AI could analyze where patients are having problems in taking medications.   [29:55] Dr. Ketchem says there are many moving parts in healthcare and many stakeholders, making it difficult to implement AI. It could be used in many aspects, but its use must be safe. Dr. Ketchem thinks it will soon be useful in medical imaging.   [30:57] In the next decade, AI may be used in drug discovery, clinical decision-making, and healthcare administrative operations. The goal is to improve the care for the patient. Personalized care would be an aspirational goal of using artificial intelligence.   [31:29] Dr. Ketchem heard of a computer scientist at a government meeting suggesting a far-future scenario of doctors having digital versions of patients to test the patient's reaction to a specific medication, based on comorbidities and other medications in use.   [32:30] Holly thanks Dr. Ketchem for sharing his research findings to help others.   [32:40] Dr. Ketchem's last words: “The future is bright. There are many open avenues to apply these technologies to eosinophilic GI diseases – in diagnostic support, personalizing treatment, and predictive modeling – to make patient care better.”   [33:10] Dr Ketchem is building a research program to use epidemiologic training with artificial intelligence. He hopes to find how to take text from histology or pathology and apply epidemiologic methods, to build a cohort of patients to study diseases faster.   [34:03] Dr. Ketchem hopes to use AI to help predict patient outcomes, regarding who will respond to what therapy and who will have more complications from their disease; those are things he is interested in. There are so many unanswered questions.   [34:30] After Dr. Ketchem finishes his fellowship, he hopes to be an independent investigator, being curious and answering these questions somewhere. If you know of such a job, please let Dr. Ketchem know!   [34:53] To learn more about Dr. Ketchem's research, please check out the links in the show notes. To learn more about eosinophilic gastrointestinal disorders, visit apfed.org/egids. If you're looking for a specialist who treats eosinophilic disorders, use APFED's Specialist Finder at apfed.org/specialist. [35:17] To connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [35:26] Ryan thanks Dr. Corey Ketchem for joining us today. Holly thanks APFED's Education Partners, GSK, Sanofi, and Regeneron, linked below, for supporting this episode.   Mentioned in This Episode: Corey Ketchem, M.D., M.S. Penn Medicine Abstract of paper in Clinical Gastroenterology and Hepatology: “Artificial Intelligence Chatbot Shows Multiple Inaccuracies When Responding to Questions About Eosinophilic Esophagitis”Medscape article about the paper in Clinical Gastroenterology and Hepatology: “ChatGPT Gives Incorrect Answers About Eosinophilic Esophagitis”, by Carolyn Crist American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/egids apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of GSK, Sanofi, and Regeneron.   Tweetables:   “We ultimately came to the conclusion that implementing this technology requires clinical oversight and it's a tool that should be used with caution.” — Corey Ketchem, M.D., M.S.   “There will always be a role for people in medicine. You can't replace a face-to-face connection with a chat. That's just not going to work.” — Corey Ketchem, M.D., M.S.   “There will always need to be a human element to it. The goal is to make [AI for healthcare] as good as it can be. We're certainly not there yet, but it's probably closer to being here than we think.” — Corey Ketchem, M.D., M.S.   Bio: Dr. Corey J. Ketchem, MD is a rising third-year gastroenterology fellow at the University of Pennsylvania, driven by a profound interest in allergic inflammation of the gastrointestinal tract, particularly eosinophilic gastrointestinal diseases (EGIDs). He has acquired a unique skillset in clinical epidemiology and biostatistics that equip him with the necessary tools to conduct rigorous research studies, culminating in a Master of Science in Clinical Epidemiology (MSCE) upon fellowship completion. Dr. Ketchem's passion for EGIDs has spurred a series of epidemiologic investigations focusing on both eosinophilic esophagitis (EoE) and non-esophageal EGIDs, yielding numerous publications in high-quality gastroenterology journals and earning him recognition through various research awards. Moreover, his academic path has included the incorporation of artificial intelligence into his research endeavors, aiming to enhance patient care and facilitate epidemiologic studies. Dr. Ketchem's trajectory is set toward becoming an independent researcher, dedicated to employing high-quality epidemiologic approaches to uncover pivotal insights into EGIDs, advance clinical knowledge, and optimize therapeutic strategies for patients.   Bio: Penn Medicine Division of Gastroenterology and Hepatology Fellows  

Rapha, Leticia e Lucca discutem 7 armadilhas na doença do refluxo gastroesofageana (DRGE)! Referências: 1. Fass, Ronnie. “Gastroesophageal Reflux Disease.” The New England journal of medicine vol. 387,13 (2022): 1207-1216. 2. Parmar, Malvinder S. “Gastroesophageal Reflux Disease.” The New England journal of medicine vol. 388,9 (2023): 863. 3. Jenkins, Danny, and Ines Modolell. “Proton pump inhibitors.” BMJ (Clinical research ed.) vol. 383 e070752. 13 Nov. 2023. 4. Katzka, David A, and Peter J Kahrilas. “Advances in the diagnosis and management of gastroesophageal reflux disease.” BMJ (Clinical research ed.) vol. 371 m3786. 23 Nov. 2020, 5. Barr J, Gulrajani NB, Hurst A, Pappas TN. Bottoms Up: A History of Rectal Nutrition From 1870 to 1920. Ann Surg Open. 2021;2(1):e039. Published 2021 Feb 10. 6.Fass, R et al. “Clinical trial: the effects of the proton pump inhibitor dexlansoprazole MR on daytime and nighttime heartburn in patients with non-erosive reflux disease.” Alimentary pharmacology & therapeutics vol. 29,12 (2009): 1261-72. 7. Lee, R. D., et al. "Clinical trial: the effect and timing of food on the pharmacokinetics and pharmacodynamics of dexlansoprazole MR, a novel dual delayed release formulation of a proton pump inhibitor–evidence for dosing flexibility." Alimentary pharmacology & therapeutics 29.8 (2009): 824-833. 8.Metz, D C et al. “Clinical trial: dexlansoprazole MR, a proton pump inhibitor with dual delayed-release technology, effectively controls symptoms and prevents relapse in patients with healed erosive oesophagitis.” Alimentary pharmacology & therapeutics vol. 29,7 (2009): 742-54. 9. Ip, Stanley, et al. Comparative Effectiveness of Management Strategies For Gastroesophageal Reflux Disease. Agency for Healthcare Research and Quality (US), December 2005. 10. Zhuang, Qianjun, et al. "Comparative efficacy of P-CABs versus proton pump inhibitors for Grade C/D esophagitis: A systematic review and network meta-analysis." Official journal of the American College of Gastroenterology| ACG (2022): 10-14309. 11. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020839s078lbl.pdf 12. Iwakiri, Katsuhiko, et al. "Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021." Journal of gastroenterology 57.4 (2022): 267-285. 13. Graham, David Y., and Aylin Tansel. "Interchangeable use of proton pump inhibitors based on relative potency." Clinical Gastroenterology and Hepatology 16.6 (2018): 800-808. 14. Hatlebakk, J G et al. “Nocturnal gastric acidity and acid breakthrough on different regimens of omeprazole 40 mg daily.” Alimentary pharmacology & therapeutics vol. 12,12 (1998): 1235-40. 15. Chen, Joan W., et al. "AGA clinical practice update on the diagnosis and management of extraesophageal gastroesophageal reflux disease: expert review." Clinical Gastroenterology and Hepatology (2023). 16. Gyawali, C. Prakash, et al. "Updates to the modern diagnosis of GERD: Lyon consensus 2.0." Gut 73.2 (2024): 361-371. 17. Katz, Philip O., et al. "ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease." Official journal of the American College of Gastroenterology| ACG 117.1 (2022): 27-56. 18. Hicks, Douglas M., et al. "The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers." Journal of Voice 16.4 (2002): 564-579. 19. Blondeau, Kathleen, et al. "Improved diagnosis of gastro‐oesophageal reflux in patients with unexplained chronic cough." Alimentary pharmacology & therapeutics 25.6 (2007): 723-732.

Welcome to our four-episode series: Raising Awareness of Hepatorenal Syndrome Acute Kidney Injury (HRS-AKI). In episode three, our host Muhamad Nadeem Yousaf, MD, speaks with Nikhilesh Mazumder, MD, MPH, Shilpa Junna, MD, and Pratima Sharma, MD, MBBS, MS, to discuss initial management of patients with HRS-AKI. They'll explore topics such as the efficacy of non-selective beta-blockers, the recommended plasma expander for those with decompensated cirrhosis, the roles of renal replacement therapy (RRT), TIPS, and extracorporeal liver support system (ELSS), and the significance of liver transplant in the context of HRS-AKI. Each episode of this series corresponds to a journal article from a September 2023 supplement of Clinical Gastroenterology and Hepatology (CGH), the official clinical practice journal of the American Gastroenterological Association, focusing on addressing knowledge gaps in HRS-AKI. To read the related journal articles and claim CME for listening, visit agau.gastro.org. This series is supported by an independent educational grant from Mallinckrodt

Welcome to our four-episode series: Raising Awareness of Hepatorenal Syndrome Acute Kidney Injury (HRS-AKI). In episode two, our host Muhamad Nadeem Yousaf, MD, speaks with Nikki Duong, MD, to discuss the nomenclature, pharmacological options, and care recommendations for HRS-AKI patients. Each episode of this series corresponds to a journal article from a September 2023 supplement of Clinical Gastroenterology and Hepatology (CGH), the official clinical practice journal of the American Gastroenterological Association, focusing on addressing knowledge gaps in HRS-AKI. To read the related journal articles and claim CME for listening, visit agau.gastro.org. This series is supported by an independent educational grant from Mallinckrodt

Welcome to our four-episode series: Raising Awareness of Hepatorenal Syndrome Acute Kidney Injury (HRS-AKI). In episode one, our host Muhamad Nadeem Yousaf, MD, speaks with Danielle Adebayo, MD, and Florence Wong, MD, MBBS, FRCPC, to analyze the pathophysiology of HRS-AKI. They cover peripheral vasodilatation hypothesis shortcomings in HRS-AKI, vasoconstrictor systems, bacterial translocation, inflammation, renal dysfunction, and contributory factors like cholemic nephropathy and adrenal insufficiency, while also suggesting the potential of metabolomic studies for future insights. Each episode of this series corresponds to a journal article from a September 2023 supplement of Clinical Gastroenterology and Hepatology (CGH), the official clinical practice journal of the American Gastroenterological Association, focusing on addressing knowledge gaps in HRS-AKI. To read the related journal articles and claim CME for listening, visit agau.gastro.org. This series is supported by an independent educational grant from Mallinckrodt

Welcome to our four-episode series: Raising Awareness of Hepatorenal Syndrome Acute Kidney Injury (HRS-AKI). In our final episode, our host Muhamad Nadeem Yousaf, MD, speaks with Vivian Ortiz, MD, and Neil Shah, MD, to delve into critical aspects of HRS-AKI. They cover the prognosis after initial management, the significance of reversing renal impairment for liver transplant candidates, the predictive role of MELD score in HRS-AKI, treatment's impact on liver transplant waiting lists, decision-making between liver transplant alone or simultaneous liver-kidney transplant, timing considerations for kidney transplant post-liver transplant, and factors affecting post-transplant prognosis. Each episode of this series corresponds to a journal article from a September 2023 supplement of Clinical Gastroenterology and Hepatology (CGH), the official clinical practice journal of the American Gastroenterological Association, focusing on addressing knowledge gaps in HRS-AKI. To read the related journal articles and claim CME for listening, visit agau.gastro.org. This series is supported by an independent educational grant from Mallinckrodt

Description: Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Mary Jo Strobel, APFED's Executive Director, speak with Dr. Kathryn Peterson, MD, MSCI, a Professor of Gastroenterology at the University of Utah Health. In this episode, Ryan and Mary Jo interview Dr. Peterson about the family risk of eosinophilic gastrointestinal diseases, discussing the studies she has done, future work she is planning, and other studies of related topics. She shares that she is a parent to a patient living with an eosinophilic disorder. She hints at future research that may lead to easier diagnosis of EGIDs.   Listen in for more information on Dr. Peterson's work. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Ryan Piansky welcomes co-host Mary Jo Strobel. Mary Jo introduces Dr. Kathryn Peterson, a Professor of Gastroenterology at the University of Utah Health. Dr. Peterson specializes in diagnosing and treating diseases of the digestive system including eosinophilic esophagitis (EoE), Barrett's esophagus, and inflammatory bowel disease.   [2:00] Dr. Peterson works at the University of Utah in Salt Lake City. She co-directs an eosinophilic gastrointestinal disease clinic with Dr. Amiko Uchida. They also work closely with allergy, nutrition, and pharmacy in the clinic and are looking for additional ancillary services to come into the clinic.   [2:27] Dr. Peterson takes care of all sorts of eosinophilic gastrointestinal diseases. She works closely with Dr. Gerald Gleich, as well. Dr. Peterson is a mother of a boy living with eosinophilic disease for 10 years, so she experiences both sides of eosinophilic diseases. She loves her job.   [3:23] Familial risk refers to the risk of the disease in a patient when a family member is affected, compared to the general population. Looking at a proband (patient), is a first-degree family member (parent, sibling, or child) also affected with eosinophilic disease? Is a second-degree family member (grandparent) affected? Are cousins?   [3:58] Dr. Peterson's is trying to see if and how far out the risk for the disease goes within a family. Based on that, you can get an idea if some shared genes are involved, vs. shared environmental influence of the disease within family members. That's the idea of doing family risk studies in complex diseases; eosinophilic diseases are very complex.   [4:44] Dr. Peterson explains how she conducts a family risk study in Utah. The Utah Population Database is very helpful. The University of Utah has partnered with The Church of Jesus Christ of Latter-day Saints for large genealogical pedigrees that allow tracking disease through expanded pedigrees, with privacy and security limitations.   [5:24] It's necessary to clarify physician coding to make sure it's realistic and coded appropriately so that results are believable. It's very hard to recruit family members. Dr. Peterson feels extremely blessed to live in that area. The families are generous and giving. She also believes all eosinophilic families are generous.   [6:34] The farther out you can identify the risk for disease, the more likely you will find a common gene that could be implicated in disease risk or onset. If the disease is tracked in extended relatives, it implies a shared gene more than a shared environmental risk. If the disease is isolated within nuclear families, it may indicate an environmental risk.   [7:39] In doing familial research, Dr. Peterson is trying to develop a risk score. People are getting pretty good at diagnosing EoE, but Dr. Peterson would not say that the non-EoE EGIDs are well-established or well-diagnosed. They are missed commonly and often. To have a risk score from the extent of the disease in a family is helpful.    [8:12] Dr. Peterson notes that studies of cancer risk in extended families have established cancer risk scores and related screening that is needed.   [8:43] Dr. Peterson coauthored a paper in November 2020 about the familial risk of EoE, published in the Clinical Gastroenterology and Hepatology Journal. She and her colleagues looked at nuclear families. They were looking for how many members of the nuclear family of an EoE patient have esophageal eosinophilia. [9:28] They used a questionnaire on allergies, food allergies, and symptoms. They pulled in around 70 first-degree family members and scoped them for eosinophilia, pulled the records on the rest of the family members if they had been scoped, and assessed the risk for eosinophilia.   [9:51] Including the records, and assuming that everyone who hadn't had an endoscopy was negative, they found the risk for esophageal eosinophilia in first-degree family members was 14%, bordering on the familial risk for celiac disease. It's probably higher since they assumed anyone who hadn't been scoped didn't have eosinophilia.   [10:19] They called it esophageal eosinophilia, because the guidelines for diagnosing EoE suggest that the patient must complain of symptoms, and these family members did not have symptoms. It was interesting to find this high prevalence of eosinophilia in the nuclear family members of EoE patients. They had a higher risk of allergy, as well.   [11:14] Dr. Peterson explains the differences between esophageal eosinophilia and eosinophilic esophagitis (EoE). Esophageal eosinophilia means eosinophils are in the esophagus, >15 per high-power field in a biopsy. That could qualify as EoE when you go through the criteria of symptoms.   [12:19] We call it esophageal eosinophilia while we rule out everything else that could cause that cell to get recruited into the esophagus. It could be an allergic reaction to a medication, larger eosinophilic disorders, or parasitic infections. Esophageal eosinophilia means you had that initial biopsy that puts you at risk for EoE.   [13:06] You have to go down the diagnostic steps: Do I have symptoms? Do I have anything else that explains it? If you have nothing else that explains the eosinophils, and you have esophageal dysfunction, then you can call it EoE.   [13:33] Dr. Peterson, speaking personally, believes that educating doctors to ask patients about EoE symptoms would be useful in diagnosing EoE. People cope. You don't want to focus on your symptoms because you want to be able to focus on your life. If symptoms aren't brought to a doctor's attention, a diagnosis can get missed.   [16:47] Dr. Peterson discusses risks for EoE in families where allergies are present. Dr. Peterson is involved currently in another familial study to find more information about the risk of EoE where there are allergies in a family. In the preliminary data, it looks like there is a link with asthma. Asthma and EoE in a family seem to track together.   [17:31] The risk of EoE seems to be higher with additional allergies within a family. Dr. Peterson says they are cleaning up the data to get a better answer. It appears that allergies in general go along with some of the genes that have been identified in EoE. Watch for Dr. Peterson's papers going forward!   [19:05] They looked at around 300 eosinophilic gastroenteritis (EGE) patients and about 170 eosinophilic colitis (EoC) patients. If you have a proband with EoE, is there a higher family risk of having EGE or EoC? It looks like EoE puts you at higher risk of these other conditions. But with such low numbers in the study, the jury is still out.   [20:37] They looked at EGE codes because there is a subset of patients who have eosinophilic disease in their stomach and small bowel who don't have EoE. They found that in patients who have eosinophilic disease in the stomach or the small bowel, EoE is still commonly seen throughout families. EoE seems to be a common theme.   [21:54] Down the road, Dr. Peterson hopes to be able to identify enough families that they might be able to start looking at genes that might put people at risk for more extensive disease.   [23:07] Dr. Peterson discusses the difficulty in diagnosing eosinophilic colitis, inflammatory bowel disorder, and other disorders. Having eosinophils does not categorize you as an EGID patient. There are other disorders where eosinophils are present. We need a better understanding of eosinophilic colitis.   [25:21] Eosinophilic asthma and eosinophilic fasciitis are disorders that Dr. Peterson has not studied but are in the Institutional Review Board approved documentation for future study.   [26:18] Dr. Peterson addresses whether your degree of risk for an EGID increases if you have an immediate family member with an EGID, vs. a second cousin with an EGID. She would say yes, based on the hazard ratios in the data and knowing that eosinophilic disorders are complex and twin studies show an environmental influence.   [27:28] Dr. Peterson asks patients about their family history, especially when they have other symptoms besides EoE. It makes her more aware of what to test.   [29:10] A paper Dr. Peterson is about to submit studied family members who weren't affected, who were siblings of probands. Their mucosa wasn't entirely normal. They may be pre-diagnostic. These are patients who need to be followed. There may be things that set people up for the development of this disease, in the right environment.   [31:04] Something fascinating from the familial study is the challenge of diagnosing EGIDs. Fifty percent of the people they brought in hadn't had an endoscopy. We need to be proactive in identifying diseases in patients. In the study, there are a lot of general GI symptoms coded that Dr. Peterson wonders if they may be missed EGIDs.   [32:34] The NIH gave Dr. Peterson's team funding and they were able to do linkage analysis on several de-identified families that were at high risk for EGIDs. It looks like multiple genes have the potential to be involved. Personalizing medicine would be applicable if there were just one specific gene involved.   [33:23] Down the road, we may find some genes that portend higher risk and other genes that portend risk where we can do preventative environmental care. We can develop risk scores to identify risks and point to interventions.   [34:10] Mary Jo thanks Dr. Peterson for joining us today to share her expertise and help us learn and understand.   [34:36] Future research needs to be done where we are able to recruit patients and do more work looking at genetic linkage and get to the point where we can diagnose and identify non-EoE EGIDs well enough to explore them more, including eosinophilic colitis. Defining those diseases is necessary and needed.   [35:16] A lot of what Dr. Peterson is trying to do is to look further into combined diseases and hypereosinophilic states to determine if there is some gene within families that may help her to develop other therapies not focusing only on the GI tract but on a global approach to health for these patients.   [35:48] There is current research being done to find less invasive ways of identifying disease, such as imaging, so people don't have to undergo endoscopy. That research is being done on the commercial side.   [36:44] Dr. Peterson has been looking at food-specific antibodies. Also, research by other doctors is being done to identify other markers of the foods that often trigger the disease. There has been some interesting preliminary data. This can help patients to eliminate fewer foods.   [37:27] Dr. Peterson has been looking at less invasive ways to identify non-EoE EGIDs in ways that can avoid biopsy.   [38:04] What's being done to study Barrett's esophagus? Dr. Peterson speaks of past and planned research, using the Utah population database. They looked at the risk for Barrett's esophagus in patients with EoE and it was eight times higher than the normal population. Dr. Peterson correlates risks with reflux for Barrett's and EoE.   [39:26] There are still questions about which comes first, EoE, Barret's esophagus, or reflux. She also talks about the relationship between achalasia, allergic diseases, and EoE.   [41:05] To learn more about Dr. Peterson's research, please see the links in the show notes. To learn more about eosinophilic gastrointestinal disorders, please visit apfed.org/egids.   [41:29] To find a specialist, visit apfed.org/specialists. To connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [41:48] Ryan and Mary Jo thank Dr. Kathryn Peterson again for joining them. Mary Jo thanks APFED's education partners, linked below, for supporting this episode.   Mentioned in This Episode: Kathryn A. Peterson, M.D. Pubmed.ncbi.nlm.nih.gov/36148824/ (to release February 2024) Pubmed.ncbi.nlm.nih.gov/33221551/ (published November 2020) University of Utah Health American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, Sanofi, and Regeneron.   Tweetables:   “When we study familial risk, we're looking at the risk of the disease in a patient when a family member is affected, compared to the general population.” — Dr. Kathryn Peterson   “I think allergies, in general, kind of go along with some of the genes that have been identified in EoE.” — Dr. Kathryn Peterson   “Fifty percent of the people we brought in [to this familial risk study] hadn't had an endoscopy. We need to be proactive in identifying diseases in patients.” — Dr. Kathryn Peterson   About Dr. Kathryn Peterson Kathryn Peterson, MD is a Professor of Gastroenterology at the University of Utah Health. She is certified by the American Board of Internal Medicine.   Dr. Peterson specializes in diagnosing and treating diseases of the digestive system including eosinophilic esophagitis, Barrett's esophagus, and inflammatory bowel disease. She completed her medical degree at the University of Texas Southwestern, followed by residency and a fellowship at the University of Utah and a master's program in Epidemiology at Harvard University.   Bio: Healthcare.utah.edu/find-a-doctor/kathryn-peterson    .  

Videos : Proof Government Lab Created COVID, Says Escaped Chinese Virologist Dr. Li-Meng Yan – Ask Dr. Drew   Fewer cases of melanoma among people taking vitamin D supplements University of Eastern Finland, January 10, 2023 Fewer cases of melanoma were observed among regular users of vitamin D supplements than among non-users, a new study finds. People taking vitamin D supplements regularly also had a considerably lower risk of skin cancer, according to estimates by experienced dermatologists. The study, conducted in collaboration between the University of Eastern Finland and Kuopio University Hospital and published in Melanoma Research, included nearly 500 people with an increased risk of skin cancer. 498 adult patients estimated to have an increased risk of a skin cancer, such as basal cell carcinoma, squamous cell carcinoma or melanoma, were recruited at the dermatological outpatient clinic of Kuopio University Hospital. Experienced dermatologists at the University of Eastern Finland carefully analysed the patients' background information and medical history and examined their skin. The dermatologists also classified the patients into different skin cancer risk classes, namely low risk, moderate risk and high risk. Based on their use of oral vitamin D supplements, the patients were divided into three groups: non-users, occasional users and regular users. Serum calcidiol levels were analysed in half of the patients and found to correspond to their self-reported use of vitamin D. A key finding of the study is that there were considerably fewer cases of melanoma among regular users of vitamin D than among non-users, and that the skin cancer risk classification of regular users was considerably better than non-users'. Logistic regression analysis showed that the risk for melanoma among regular users was considerably reduced, more than halved, compared to non-users. The findings suggest that even occasional users of vitamin D may have a lower risk for melanoma than non-users. Other relatively recent studies, too, have provided evidence of the benefits of vitamin D in melanoma, such as of the association of vitamin D with a less aggressive melanoma. (NEXT) Diabetics should pay attention to vitamin C University of Otago (New Zealand), January 9 2023. Research reported in Nutrients suggests that low intake and serum levels of vitamin C may be particularly risky for adults with diabetes. The study analyzed data from 25,206 men and 26,944 women who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. Four hundred twenty-eight individuals had type 1 diabetes and 6,807 had type 2 diabetes. At the beginning of the study, 38% of the people had an intake of vitamin C that was below the estimated average requirement (EAR), which worsened to 46.5% by 2017-2018. Individuals whose intake of vitamin C was lower than the EAR had a 20% higher risk of type 2 diabetes compared with an intake above the EAR, and those who did not use vitamin C supplements had a 28% greater risk than vitamin C supplement users. Low and deficient serum vitamin C levels were associated with fewer years of life in comparison with normal vitamin levels. Compared with an adequate intake of vitamin C, the risk of mortality through 2019 among type 2 diabetics was 25% greater for those with a very low intake of the vitamin. Deficient serum levels of the vitamin were associated with an 84% greater mortality risk compared with adequate levels. Not supplementing with vitamin C was associated with a 25% greater mortality risk among people with type 1 diabetes, a 20% greater risk among those with type 2 diabetes and a 24% greater risk among nondiabetics compared with supplementation. “Observation of declining vitamin C intake and deleterious consequences of low serum vitamin C in US adults with diabetes suggests encouragement of vitamin C intake, including vitamin C supplementation of 500–1000 mg/day, may be beneficial for pre-diabetic and diabetic US adults,” the authors concluded. (NEXT) Feeling depressed? Performing acts of kindness may help Ohio State University, January 10, 2023 People suffering from symptoms of depression or anxiety may help heal themselves by doing good deeds for others, new research shows. The study found that performing acts of kindness led to improvements not seen in two other therapeutic techniques used to treat depression or anxiety. Most importantly, the acts of kindness technique was the only intervention tested that helped people feel more connected to others, said study co-author David Cregg at The Ohio State University. “Social connection is one of the ingredients of life most strongly associated with well-being. Performing acts of kindness seems to be one of the best ways to promote those connections,” Cregg said. The research also revealed why performing acts of kindness worked so well: It helped people take their minds off their own depression and anxiety symptoms. This finding suggests that one intuition many people have about people with depression may be wrong, Cheavens said. “We often think that people with depression have enough to deal with, so we don't want to burden them by asking them to help others. But these results run counter to that,” she said. “Doing nice things for people and focusing on the needs of others may actually help people with depression and anxiety feel better about themselves.” The study involved 122 people in central Ohio who had moderate to severe symptoms of depression, anxiety, and stress. After an introductory session, the participants were split into three groups. Two of the groups were assigned to techniques often used in cognitive behavioral therapy (CBT) for depression: planning social activities or cognitive reappraisal. Members of the third group were instructed to perform three acts of kindness a day for two days out of the week. Acts of kindness were defined as “big or small acts that benefit others or make others happy, typically at some cost to you in terms of time or resources.” Some of the acts of kindness that participants later said they did included baking cookies for friends, offering to give a friend a ride, and leaving sticky notes for roommates with words of encouragement. Participants followed their instructions for five weeks, after which they were evaluated again. The researchers then checked with the participants after another five weeks to see if the interventions were still effective. The findings showed that participants in all three groups showed an increase in life satisfaction and a reduction of depression and anxiety symptoms after the 10 weeks of the study. “But acts of kindness still showed an advantage over both social activities and cognitive reappraisal by making people feel more connected to other people, which is an important part of well-being,” he said. In addition, the acts of kindness group showed greater improvements than the cognitive reappraisal group for life satisfaction and symptoms of depression and anxiety, results showed. Cheavens noted that just participating in social activities did not improve feelings of social connection in this study. “There's something specific about performing acts of kindness that makes people feel connected to others. It's not enough to just be around other people, participating in social activities,” she said. (NEXT) Selenium protects a specific type of interneurons in the brain Helmholtz Zentrum München (Germany) December 29, 2022 Exactly 200 years ago, the Swedish scientist Jöns Jacob Berzelius discovered the trace element selenium, which he named after the goddess of the moon, Selene. Selenium is an essential trace element and indispensable for humans, many animals and some bacteria. A team led by Dr. Marcus Conrad, research group leader at the Institute of Developmental Genetics (IDG) at Helmholtz Zentrum München, showed for the first time why selenium is a limiting factor for mammals. The scientists have been investigating for years the processes of a novel type of cell death, known as ferroptosis. In this context, the enzyme GPX4, which normally contains selenium in the form of the amino acid selenocysteine, plays an important role. In order to better understand the role of GPX4 in this death process, we established and studied mouse models in which the enzyme was modified,” said study leader Conrad. “In one of these models, we observed that mice with a replacement of selenium to sulfur in GPX4 did not survive for longer than three weeks due to neurological complications.” In their search for the underlying reasons, the researchers identified a distinct subpopulation of specialized neurons in the brain, which were absent when selenium-containing GPX4 was lacking. “In further studies, we were able to show that these neurons were lost during postnatal development, when sulfur- instead of selenium-containing GPX4 was present,” stated first author of the study, Irina Ingold. Furthermore, the scientists were able to show that ferroptosis is triggered by oxidative stress, which is known to occur for instance during high metabolic activity of cells and high neuronal activity. “Our study demonstrates for the first time that selenium is an essential factor for the postnatal development of a specific type of interneurons,” said Dr. José Pedro Friedmann Angeli, a scientist at the IDG, describing the results. “Selenium-containing GPX4 protects these specialized neurons from oxidative stress and from ferroptotic cell death.” (NEXT) Association of Dietary α-Carotene and β-Carotene Intake with Low Cognitive Performance in Older Adults Sun Yat-sen University (China), January 3, 2023 With the increased life expectancy around the world, the number of elderly people with cognitive decline has been escalating, causing a burden for their families and governments. The decline in cognitive function is associated with various factors, including normal aging processes and neurological diseases. However, without any prevention measures to delay cognitive function decline, the decline in cognitive function will gradually develop into mild cognitive impairment (MCI) and Alzheimer's disease. The process of Alzheimer's disease is irreversible, and medical treatment for this disease is still limited. The underlying mechanism of vitamin B12 on cognitive function is related to the activation of methylation reactions in the brain. According to previous studies, vitamin A, an antioxidant in the central nervous system, also participates in cognitive function decline in older people. Both α-carotene and β-carotene can be transformed into retinol, which will be converted into a long-chain fatty acid ester that is the main precursor of vitamin A in the human body. Thus, α-carotene and β-carotene may have similar effects on neurocognitive decline. Some previous studies showed that higher levels of α-carotene and β-carotene in the plasma were associated with better cognitive function. In this study, our results reflected that dietary α-carotene and β-carotene intake might have inverse effects on cognitive function decline in older people. However, the excessive intake of dietary α-carotene and β-carotene may be a problem that needs special attention. (NEXT) Consumption of fast food linked to liver disease University of Southern California, January 10, 2023 The new year has begun, and with it, resolutions for change. A study from Keck Medicine of USC published in Clinical Gastroenterology and Hepatology gives people extra motivation to reduce fast-food consumption. The study found that eating fast food is associated with nonalcoholic fatty liver disease, a potentially life-threatening condition in which fat builds up in the liver. Researchers discovered that people with obesity or diabetes who consume 20% or more of their daily calories from fast food have severely elevated levels of fat in their liver compared to those who consume less or no fast food. And the general population has moderate increases of liver fat when one-fifth or more of their diet is fast food. “Healthy livers contain a small amount of fat, usually less than 5%, and even a moderate increase in fat can lead to nonalcoholic fatty liver disease,” said Ani Kardashian, MD, a hepatologist with Keck Medicine and lead author of the study. “The severe rise in liver fat in those with obesity or diabetes is especially striking, and probably due to the fact that these conditions cause a greater susceptibility for fat to build up in the liver.” The findings also reveal that a relatively modest amount of fast food, which is high in carbohydrates and fat, can hurt the liver. “If people eat one meal a day at a fast-food restaurant, they may think they aren't doing harm,” said Kardashian. “However, if that one meal equals at least one-fifth of their daily calories, they are putting their livers at risk.” Nonalcoholic fatty liver disease, also known as liver steatosis, can lead to cirrhosis, or scarring of the liver, which can cause liver cancer or failure. Liver steatosis affects over 30% of the U.S. population. The study characterized fast food as meals, including pizza, from either a drive-through restaurant or one without wait staff. The researchers evaluated the fatty liver measurement of approximately 4,000 adults whose fatty liver measurements were included in the survey and compared these measurements to their fast-food consumption. Of those surveyed, 52% consumed some fast food. Of these, 29% consumed one-fifth or more daily calories from fast food. Only this 29% of survey subjects experienced a rise in liver fat levels. The association between liver steatosis and a 20% diet of fast food held steady for both the general population and those with obesity or diabetes even after data was adjusted for multiple other factors such as age, sex, race, ethnicity, alcohol use and physical activity.

Today we are discussing the recent guidelines on gastroparesis with Dr. Brian Lacy from the Mayo Clinic in Jacksonville. The expert review entitled, “AGA Clinical Practice Update on the Management of Medically Refractory Gastroparesis” was published in Clinical Gastroenterology and Hepatology. Our guest Dr. Brian Lacy is a world renowned expert in gastrointestinal motility disorders. He is a current Professor of Medicine at Mayo Clinic Jacksonville. He is the author of over 215 peer-reviewed articles on gastrointestinal motility disorders and functional bowel disorders, in addition to multiple textbook chapters. Dr. Lacy recently finished a 6-year tenure as co-Editor in Chief of the American Journal of Gastroenterology. He is the former Editor in Chief of Clinical and Translational Gastroenterology and was the co-Chairman for the Rome IV Committee on Functional Bowel Disorders.    Host: Dr. Chuma Obineme (GI Fellow) –  https://twitter.com/TypicallySilent  Co-Host: Dr. Jason Brown - https://med.emory.edu/directory/profile/?u=JMBROW2  Guest: Dr. Brian Lacy - https://www.mayoclinic.org/biographies/lacy-brian-e-m-d-ph-d/bio-20392407 Link to Review: https://gastro.org/clinical-guidance/management-of-medically-refractory-gastroparesis/ Link to Emorid Digest visual Summary: https://twitter.com/emorygastrohep/status/1521122087825461249?s=21&t=6J1Bco7gE-4y0ITwo6Im9A Link to Emoroid Digest Website: https://med.emory.edu/departments/medicine/divisions/digestive-diseases/education/emoroid-digest.html  

Resumo da semana: - Descoberta ligação entre distúrbios hipertensivos na gravidez e demência mais tarde na vida (Conferência Internacional da Associação de Alzheimer) - Recém-nascidos de mães deficientes enfrentam riscos ao nascer, com bebês menores e mais partos prematuros observados (Pediatrics) - Prostasina, uma proteína do sangue, pode ajudar a prever diabetes e morte por câncer (Diabetologia) - A remoção de pequenos cálculos renais assintomáticos reduz significativamente a recorrência (The New England Journal of Medicine) - Mulheres vegetarianas têm risco 33% maior de fraturar o quadril (BMC Medicine) - Dois adoçantes artificiais, sacarina e sucralose, podem aumentar o açúcar no sangue (Cell) - Córneas feitas por bioengenharia usando pele de porco podem ajudar pessoas cegas com ceratocone avançado a ver novamente (Nature Biotechnology) - Vírus Epstein-Barr foi associado ao câncer de estômago, com uma prevalência de 7,5% do vírus em células tumorais (Clinical Gastroenterology and Hepatology) Veja mais notícias em news.med.br Este podcast é oferecido por HiDoctor – o software médico mais usado em consultórios e clínicas no país

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Reena Chokshi, MD Gastric emptying tests may be used for patients with gastroparesis and functional dyspepsia. But when it comes to assessing patients with symptoms, is it time to discard these tests? Find out with Dr. Peter Buch as he speaks with Dr. Reena Chokshi, Assistant Professor at Baylor College of Medicine and author of an editorial on this topic, titled Is It Time to Abandon Gastric Emptying in Patients With Symptoms of Gastroparesis and Functional Dyspepsia?, which was published in the Clinical Gastroenterology and Hepatology journal in May 2021.

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Reena Chokshi, MD Gastric emptying tests may be used for patients with gastroparesis and functional dyspepsia. But when it comes to assessing patients with symptoms, is it time to discard these tests? Find out with Dr. Peter Buch as he speaks with Dr. Reena Chokshi, Assistant Professor at Baylor College of Medicine and author of an editorial on this topic, titled Is It Time to Abandon Gastric Emptying in Patients With Symptoms of Gastroparesis and Functional Dyspepsia?, which was published in the Clinical Gastroenterology and Hepatology journal in May 2021.

Sarah finally discusses The Terrible Diet tm.  Otherwise known as the Autoimmune Protocol or AIP, Sarah covers how this radical approach to food has changed the course of her health, disease, and life.  Learn how the AIP process works, what a food coach is, and why vegan is not the answer for everyone.  Stay for why Sarah had to take a "sabbatical" to save her friendships. Join us on The Unchosen Fork.ReferencesMills, E.N.C., Sancho, A.I., Rigby, N.M., Jenkins, J.A. and Mackie, A.R. (2009), Impact of food processing on the structural and allergenic properties of food allergens. Mol. Nutr. Food Res., 53: 963-969. https://doi.org/10.1002/mnfr.200800236M.D., Wahls Terry. The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles. Illustrated, Avery, 2014. terrywahls.comM.D., Myers Amy. The Autoimmune Solution: Prevent and Reverse the Full Spectrum of Inflammatory Symptoms and Diseases. Reprint, HarperOne, 2017.  amymyersmd.comTam, Michelle, and Henry Fong. Nom Nom Paleo: Food for Humans (Volume 1). 1st Edition, Andrews McMeel Publishing, 2013. nomnompaleo.comAhmed, Serge H.a,b; Guillem, Karinea,b; Vandaele, Younaa,b Sugar addiction, Current Opinion in Clinical Nutrition and Metabolic Care: July 2013 - Volume 16 - Issue 4 - p 434-439 doi: 10.1097/MCO.0b013e328361c8b8 COSNES, J., et al. “Incidence of Autoimmune Diseases in Celiac Disease: Protective Effect of the Gluten-Free Diet.” Clinical Gastroenterology and Hepatology, vol. 6, no. 7, 2008, pp. 753–58. Crossref, https://doi.org/10.1016/j.cgh.2007.12.022.Follow the Unchosen Fork:FacebookInstagramDisclaimer: The contents of this podcast, including text, graphics, images, and other materials created and/or disseminated by The Unchosen Fork are for informational purposes only. The Contents are NOT intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition, before beginning a nutritional plan and/or taking nutritional supplements. Reliance on any information provided by this podcast, others content appearing on this podcast, or other visitors to the Site is solely at your own risk. None of the contents of this podcast are intended to be relied upon for medical treatment or diagnosis. The Unchosen Fork, their affiliates, nor any of the host family members assumes any liability or responsibility for damage or injury to person or property arising from any use of any product, service, information, or instruction contained on this Podcast.Support the show (https://www.patreon.com/theunchosenfork)

In this episode, I review an article on alternatives to Ibuprofen. This episode is sponsored by McNeese Construction. You can also read this episode on our blog at https://yopistudio.blogspot.com/2022/03/natural-alternatives-for-ibuprofen.html To keep this podcast going please feel free to donate at www.paypal.me/yopistudio If you would like to read more on this topic or any other previous topics, you can do so by checking out our blog at https://yopistudio.blogspot.com/ Feel free to see what we are up to by following us at:  https://twitter.com/Dauricee https://parler.com/profile/Daurice/ https://www.facebook.com/yopistudio/ https://www.facebook.com/LouisianaEntertainmentAssociation/ To listen to the podcast, watch creative videos and skits go to https://www.youtube.com/channel/UCvn6tns6wKUwz9xZw11_vAQ/videos Interested in projects Daurice has worked on in the movie industry you can check it out at www.IMDb.com under Daurice Cummings. Please add us to your RSS Feed, & iTunes, iHeart, Spotify, Stitcher, Google Pod, Sound Cloud, and our favorite Podbean! For comments or questions, you can reach us at yopi@post.com To read more about today's topic check out the references below. References: https://www.forbes.com/2004/12/13/cx_mh_1213faceoftheyear.html?sh=7432b7776d57 https://www.reuters.com/article/us-painkillers-risks/high-doses-of-common-painkillers-increase-heart-attack-risks-idUSBRE94S1FV20130529?feedType=RSS&feedName=healthNews https://www.greenmedinfo.com/blog/ibuprofen-kills-more-pain-so-what-alternatives https://www.greenmedinfo.com/blog/ibuprofen-can-stop-your-heart-31-increase-cardiac-arrest-risk https://www.greenmedinfo.com/blog/ibuprofen-deadly-vioxx https://www.greenmedinfo.com/toxic-ingredient/ibuprofen https://www.greenmedinfo.com/substance/arnica https://www.greenmedinfo.com/article/topical-treatment-arnica-effective-ibuprofen-hand-osteoarthritis https://www.greenmedinfo.com/substance/ginger https://www.greenmedinfo.com/article/ginger-effective-mefenamic-acid-and-ibuprofen-relieving-pain-women-primary-dys https://www.greenmedinfo.com/substance/turmeric https://www.greenmedinfo.com/article/efficacy-and-safety-curcuma-domestica-extracts-compared-ibuprofen-patients-kne https://www.greenmedinfo.com/substance/thyme https://www.greenmedinfo.com/article/thymus-vulgaris-least-effective-ibuprofen-reducing-severity-pain-and-spasm-pri https://www.greenmedinfo.com/substance/omega-3-fatty-acids https://www.greenmedinfo.com/article/omega-3-fatty-acids-are-effective-alternative-ibuprofen-reducing-arthritic-pai https://www.greenmedinfo.com/substance/cinnamon https://www.greenmedinfo.com/blog/cinnamon-beats-ibuprofen-pain-study-reveals-2 https://www.greenmedinfo.com/pharmacological-action/anti-inflammatory-agents https://www.greenmedinfo.com/pharmacological-action/analgesics https://www.greenmedinfo.com/blog/powerful-aspirin-alternative-grows-trees-1 https://www.greenmedinfo.com/toxic-ingredient/non-steroidal-anti-inflammatory-drugs-nsaids Fitzgerald, G.A. (2001). The coxibs, selective inhibitors of cyclooxygenase-2. New England Journal of Medicine, 345, 433-442. Fitzgerald, G.A. (2004). Coxibs and cardiovascular disease. The New England Journal of Medicine, 351(17), 1709-1711.  Coxib and traditional NSAID Trialists' (CNT) Collaboration et al. (2013). Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet, 382(9849), 769-779. doi: 10.1016/S0140-6736(13)60900-9 Mukherjee, D., Nissen, S.E., & Topol, E.J. (2001). Risk of Cardiovascular Events Associated With Selective COX-2 Inhibitors. Journal of the American Medical Association, 286(8), 954-959. doi:10.1001/jama.286.8.954doi:10.1001/jama.286.8.954 Singh, D. (2004). Merck withdraws arthritis drug worldwide. The British Medical Journal, 329. doi: link.  Berenson et al. (2004). Despite Warnings, Drug Giant Took Long Path to Vioxx Recall. The New York Times. 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Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole and placebo. Clinical Gastroenterology and Hepatology, 3(2), 133-141.  Shiotani et al. (2010). Randomized, double-blind pilot study of gnarly geranylacetone versus placebo in patients taking low dose enteric-coated aspirin: low-dose aspirin-induced small bowel damage. Scandinavian Journal of Gastroenterology, 45(3), 292-298.  Caunedo-Alvarez et al. (2010). Macroscopic small bowel mucosal injury caused by chronic non steroidal anti-inflammatory drugs (NSAIDs) use as assessed by capsule endoscopy. Rev Esp Enferm Dig, 102(2), 80-85. Kent, T.H., Cardelli, R.M., & Stamler, F.W. (1969). Small intestinal ulcers and intestinal flora in rats given indomethacin. American Journal of Pathology, 54(2), 237-249. Uejima et al. (1996). Role of intestinal bacteria in ileal ulcer formation in rats treated with a non steroidal anti-inflammatory drug. Microbiology and Immunology, 40(8), 553-560.  Watanbe et al. (2008). Non-steroidal anti-inflammatory drug-induced intestinal damage is Toll like 4 receptor dependent. Gut, 57(2), 181-187. Fasano, A. (2012). Leaky gut and autoimmune disease. Clinical Reviews in Allergy and Immunology, 42(1), 71-78.  Lanza, F.L., Chan, F.K., & Quigley, E.M. (2009). Practice parameters committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. American Journal of Gastroenterology, 104(2), 728-238.  Bhatt et al. (2008). ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of anti platelet therapy and NSAID use: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation, 118(18), 1894-1909.  American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis and Rheumatology, 46(2), 328-346.  Wallace et al. (2011). Proton pump inhibitors exacerbate NSAID-induced small intestinal injury by inducing dysbiosis. Gastroenterology, 141(4), 1314-1322.   Endo et al. (2011). Efficacy of Lactobacillus casei treatment on small bowel injury in chronic low-dose aspirin users: a pilot randomized controlled study. Journal of Gastroenterology, 46(7), 894-905.  Bhala et al. (2013). Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. The Lancet, 382(9894), 769-779.  Montenegro et al. (2014). Non steroidal anti-inflammatory drug induced damage on lower gastro-intestinal tract: is there an involvement of microbiota? Current Drug Safety, 9(3), 196-204. Ozgoli, G., Goli, M., & Moattar, F. (2009). Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. Journal of Alternative and Complementary Medicine, 15(2), 129-132. doi: 10.1089/acm.2008.0311. Salmalian et al. (2014). Comparative effect of thymus vulgaris and ibuprofen on primary dysmenorrhea: A triple-blind clinical study. Caspian Journal of Internal Medicine, 5(2), 82-88.  Levy et al. (2009). Flavocoxid is as effective as naproxen for managing the signs and symptoms of osteoarthritis of the knee in humans: a short-term randomized, double-blind pilot study. Nutrition Research, 29(5), 298-304. doi: 10.1016/j.nutres.2009.04.003. Conrozier et al. (2014). A Complex of Three Natural Anti-inflammatory Agents Provides Relief of Osteoarthritis Pain. Alternative Therapies in Health and Medicine, 20(Suppl 1), 32-37.  Chiu et al. (2016). Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis of Randomized Controlled Trials. Pain Physician, 19(1), E97-E112. Diener et al. (2005). Efficacy and safety of 6.25 mg tid feverfew CO2‐extract (MIG‐99) in migraine prevention—a randomized, double‐blind, multicentre, Placebo‐controlled study. Cephalalgia, 25(11), 1031–1041. Lipton et al. (2004). Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology, 63(12), 2240-2244.  Shara, M., & Stohs, S.J. (2015). Efficacy and Safety of White Willow Bark (Salix alba) Extracts. Physiotherapy Research, 29(8), 1112-1116. doi: 10.1002/ptr.5377. Vlachojannis, J.E., Cameron, M., & Chrubasik, S. (2009). A systematic review on the effectiveness of willow bark for musculoskeletal pain. Phytotherapy Research, 23(7), 897-900. doi: 10.1002/ptr.2747. Wesolowska et al. (2006). Analgesic and sedative activities of lactucin and some lactucin-like guaianolides in mice. Journal of Ethnopharmacology, 107, 254-258. Gupta, S.K., & Ansari, S.H. (2005). Review on phytochemical and pharmacological aspects of Cichorium intybus L. Asian Journal of Chemistry, 17, 33-36. Tall et al. (2004). Tart cherry anthocyanins suppress inflammation-induced pain behavior in rat. Brain and Behavior Research, 153(1), 181-188. Seeram et al. (2001). Cyclooxygenase inhibitory and antioxidant cyanidin glycosides in cherries and berries. Phytomedicine, 8(5), 362-369. Kuehl et al. (2010). Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial. Journal of International Society of Sports Nutrition, 7, 17. doi: 10.1186/1550-2783-7-17. Illich, I. (1974). Medical Nemesis: The Expropriation of Health. New York: Pantheon Books. Capone et al. (2004). Clinical pharmacology of platelet, monocyte, and vascular cyclooxygenase inhibition by naproxen and low-dose aspirin in healthy subjects.          

[Dr.Amp Podcast ตอนพิเศษ] เคล็ด(ไม่)ลับ เพื่อสุขภาพดีของหมอแอมป์ EP.1 การกินเพื่อสุขภาพของหมอแอมป์ ฟังเรื่องเล่า 9 เคล็ดลับการกินเพื่อสุขภาพของคุณหมอแอมป์ พร้อมที่มาของหลักการและวิธีคิดในการเลือกทานอาหารของคุณหมอ รวมถึงอาหารมื้อโปรดของคุณหมอว่ามีอะไรบ้างได้ที่ตอนนี้เลย แหล่งอ้างอิง 1. Kleinman RE, Hall S, Green H, Korzec-Ramirez D, Patton K, Pagano ME, Murphy JM. Diet, breakfast, and academic performance in children. Annals of Nutrition and Metabolism. 2002;46(Suppl. 1):24-30. 2. Shinohara M, Saitoh M, Nishizawa D, Ikeda K, Hirose S, Takanashi JI, Takita J, Kikuchi K, Kubota M, Yamanaka G, Shiihara T. ADORA2A polymorphism predisposes children to encephalopathy with febrile status epilepticus. Neurology. 2013 Apr 23;80(17):1571-6. 3. Cornelis MC, El-Sohemy A, Kabagambe EK, Campos H. Coffee, CYP1A2 genotype, and risk of myocardial infarction. Jama. 2006 Mar 8;295(10):1135-41. 4. Childs E, Hohoff C, Deckert J, Xu K, Badner J, De Wit H. Association between ADORA2A and DRD2 polymorphisms and caffeine-induced anxiety. Neuropsychopharmacology. 2008 Nov;33(12):2791-800. 5. Rétey JV, Adam M, Khatami R, Luhmann UF, Jung HH, Berger W, Landolt HP. A genetic variation in the adenosine A2A receptor gene (ADORA2A) contributes to individual sensitivity to caffeine effects on sleep. Clinical Pharmacology & Therapeutics. 2007 May;81(5):692-8. 6. Sachse C, Brockmöller J, Bauer S, Roots I. Functional significance of a C→ A polymorphism in intron 1 of the cytochrome P450 CYP1A2 gene tested with caffeine. British journal of clinical pharmacology. 1999 Apr;47(4):445-9. 7. Koskinen L, Romanos J, Kaukinen K, Mustalahti K, Korponay-Szabo I, Barisani D, Bardella MT, Ziberna F, Vatta S, Széles G, Pocsai Z. Cost-effective HLA typing with tagging SNPs predicts celiac disease risk haplotypes in the Finnish, Hungarian, and Italian populations. Immunogenetics. 2009 Apr;61(4):247-56. 8. Monsuur AJ, de Bakker PI, Zhernakova A, Pinto D, Verduijn W, Romanos J, Auricchio R, Lopez A, van Heel DA, Crusius JB, Wijmenga C. Effective detection of human leukocyte antigen risk alleles in celiac disease using tag single nucleotide polymorphisms. PloS one. 2008 May 28;3(5):e2270. 9. Pietzak MM, Schofield TC, McGinniss MJ, Nakamura RM. Stratifying risk for celiac disease in a large at-risk United States population by using HLA alleles. Clinical Gastroenterology and Hepatology. 2009 Sep 1;7(9):966-71. 10. Vatta S, Fabris A, Segat L, Not T, Crovella S. Tag–single nucleotide polymorphism–based human leukocyte antigen genotyping in celiac disease patients from northeastern Italy. Human immunology. 2011 Jun 1;72(6):499-502. แหล่งอ้างอิงเพิ่มเติม https://docs.google.com/document/d/1DGoUKC2JBkoIxoW6uLJqulYco_jkQKAPqmLNVS58qxE/edit?usp=sharing

Dr. Kanwal is currently on a mission to raise awareness and improve understanding among physicians and is here today to discuss an exciting new initiative, “Preparing for the NASH Epidemic: A Call to Action”, sponsored by AGA, that brings together leaders in gastroenterology, endocrinology and primary care to improve screening, diagnosis and management of Non-alcoholic steatohepatitis (NASH), an advanced form of non-alcoholic fatty liver disease (NAFLD). By Michael Tetreault and Fasiha Kanwal, MD, MSHS Today we are delighted to welcome and bring you Fasiha Kanwal, MD, MSHS, Professor of Medicine and Chief of Gastroenterology and Hepatology at Baylor College of Medicine. Dr. Kanwal is the Chair of the American Gastroenterological Association's initiative, “Preparing for the NASH Epidemic: A Call to Action!" and has helped develop a new clinical care pathway for PCPs to easily identify and manage patients at risk of NASH. Dr. Kanwal is currently on a mission to raise awareness and improve understanding among physicians and is here today to discuss with us exactly that. She is also the Editor-in-Chief of Clinical Gastroenterology and Hepatology (CGH) - clinical practice journal of the American Gastroenterological Association (AGA). Dr. Kanwal is also Chair of an exciting new initiative, “Preparing for the NASH Epidemic: A Call to Action”, sponsored by AGA, that brings together leaders in gastroenterology, endocrinology and primary care to improve screening, diagnosis and management of Non-alcoholic steatohepatitis (NASH), an advanced form of non-alcoholic fatty liver disease (NAFLD). These global experts have developed a clinical care pathway and an easy to use digital tool to help primary care practitioners, endocrinologists and gastroenterologists identify and manage patients at risk of NASH. SHOW NOTES & RESOURCES MENTIONED Preparing for NASH Epidemic ... (PDF) - https://wp.me/p2Y9ja-hZU Clinical Care Pathway | Gastroenterology ... (PDF)- https://wp.me/p2Y9ja-hZU Connect With Dr. Kanwal (Contact Info ...) - https://wp.me/p2Y9ja-hZU FULL EPISODE NOW AVAILABLE HERE: https://wp.me/p2Y9ja-hZU

Este podcast é oferecido por HiDoctor – o software médico mais usado em consultórios e clínicas no país O resumo da semana de 13/09 a 17/09 traz as seguintes publicações: Estudo estima que o gerenciamento ideal após um ataque cardíaco pode prolongar os anos saudáveis de vida de um paciente em mais de 7 anos (European Society of Cardiology) O uso de um substituto do sal pode reduzir o risco de derrame, eventos cardiovasculares e morte (The New England Journal of Medicine) Garcinia cambogia, um suplemento à base de ervas para emagrecer, foi associado a graves danos ao fígado (Clinical Gastroenterology and Hepatology) Proposta de redução voluntária de açúcar em alimentos embalados tem potencial de grande impacto na saúde (Circulation) Avanços recentes no tratamento do câncer de próstata metastático (JCO Oncology Practice) Um terço dos medicamentos contra o câncer sem benefício clínico comprovado continuam a ser recomendados para pacientes (The Bristish Medical Journal) Uso de um certo tipo de antipsicótico aumenta o risco de câncer de mama em mulheres com esquizofrenia (The Lancet Psychiatry) Limitar o tempo de tela para adultos jovens após uma concussão resulta em menor duração dos sintomas (JAMA Pediatrics) Veja mais notícias em news.med.br.

Alina Allen shares the results of her recent Clinical Gastroenterology and Hepatology paper on predictive value of MR Elastography in determining likelihood of progress for NASH patients exhibiting F1 - F3 disease and separately, those living with cirrhosis.Using a longitudinal data base of over 800 patients spanning 12 years, Dr. Allen and her colleagues published analysis demonstrated that  kPa readings based on MR Elastography produced highly significant results predicting likelihood of progression. Alina shares some of the thinking that drove the desire to do the study and presents some of the key results. Louise Campbell and Roger Green ask clarifying questions from their own very distinct perspectives.

Dr. David Suskind, Professor of Pediatrics at the University of Washington School of Medicine and Physician Lead of ImproveCareNow, returns to discuss the latest diet research in The Produce Study and Dine CD, including a comparison to The Specific Carbohydrate Diet.

Recently the American Gastroenterological Society updated their guidelines for treatment for a true medical emergency: gastric and esophageal bleeding. This episode reviews the guidelines and highlights the importance of several changes to management. Today's episode is sponsored by a special CEimpact FREE Law focused webinar: Make sure to save your spot for FREE LIVE LAW CE April 1st. 7PM. https://ceimpact.com/law  Reference: Henry Z, Patel K, Patton H, et al. AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review. Clinical Gastroenterology and Hepatology. 2021. https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S154235652100077X?returnurl=null&referrer=null  CPE details for GameChangers Podcast March 2021 Learning Objective: Identify appropriate therapy for individuals with variceal bleeds based on the new guidelines 0107-0000-21-097-H01-P 0.25 CEU/2.5 Hrs (Knowledge) Initial Release Date: 03/02/21 Expiration Date: 03/02/24 Additional CPE information is located at https://www.ceimpact.com/podcast  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Recently the American Gastroenterological Society updated their guidelines for treatment for a true medical emergency: gastric and esophageal bleeding. This episode reviews the guidelines and highlights the importance of several changes to management. Today's episode is sponsored by a special CEimpact FREE Law focused webinar: Make sure to save your spot for FREE LIVE LAW CE April 1st. 7PM. https://ceimpact.com/law  Reference: Henry Z, Patel K, Patton H, et al. AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review. Clinical Gastroenterology and Hepatology. 2021. https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S154235652100077X?returnurl=null&referrer=null  CPE details for GameChangers Podcast March 2021 Learning Objective: Identify appropriate therapy for individuals with variceal bleeds based on the new guidelines 0107-0000-21-097-H01-P 0.25 CEU/2.5 Hrs (Knowledge) Initial Release Date: 03/02/21 Expiration Date: 03/02/24 Additional CPE information is located at https://www.ceimpact.com/podcast  See omnystudio.com/listener for privacy information.

Recently the American Gastroenterological Society updated their guidelines for treatment for a true medical emergency: gastric and esophageal bleeding. This episode reviews the guidelines and highlights the importance of several changes to management. Today's episode is sponsored by a special CEimpact FREE Law focused webinar: Make sure to save your spot for FREE LIVE LAW CE April 1st. 7PM. https://ceimpact.com/law  Reference: Henry Z, Patel K, Patton H, et al. AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review. Clinical Gastroenterology and Hepatology. 2021. https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S154235652100077X?returnurl=null&referrer=null  CPE details for GameChangers Podcast March 2021 Learning Objective: Identify appropriate therapy for individuals with variceal bleeds based on the new guidelines 0107-0000-21-097-H01-P 0.25 CEU/2.5 Hrs (Knowledge) Initial Release Date: 03/02/21 Expiration Date: 03/02/24 Additional CPE information is located at https://www.ceimpact.com/podcast  See omnystudio.com/listener for privacy information.

Recently the American Gastroenterological Society updated their guidelines for treatment for a true medical emergency: gastric and esophageal bleeding. This episode reviews the guidelines and highlights the importance of several changes to management. Today's episode is sponsored by a special CEimpact FREE Law focused webinar:Make sure to save your spot for FREE LIVE LAW CE April 1st. 7PM. https://ceimpact.com/law Reference: Henry Z, Patel K, Patton H, et al. AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review. Clinical Gastroenterology and Hepatology. 2021. https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S154235652100077X?returnurl=null&referrer=null CPE details for GameChangers Podcast March 2021Learning Objective: Identify appropriate therapy for individuals with variceal bleeds based on the new guidelines0107-0000-21-097-H01-P0.25 CEU/2.5 Hrs (Knowledge)Initial Release Date: 03/02/21Expiration Date: 03/02/24Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information.

咖啡灌腸是通過肛門注射咖啡以清潔直腸和大腸的灌腸相關程序。沒有醫學和科學證據支持咖啡灌腸的任何積極健康聲明。該過程可導致敗血症，嚴重的電解質紊亂，結腸炎，直腸結腸炎，內部灼熱，直腸穿孔，甚至腦膿腫或心力衰竭。 咖啡灌腸的歷史 History 雖然直腸清潔的想法可以追溯到古埃及人，但咖啡作為灌腸相關物質的概念並不新鮮。它於1917年構思出來。1920年，德國科學家研究了咖啡因對膽管和小腸的影響。 Max Gerson提出咖啡灌腸對胃腸道有積極作用。 Gerson說咖啡灌腸具有積極的排毒作用，有助於恢復患者的健康。他聲稱，與鹽水灌腸不同，灌腸中的咖啡通過小腸的平滑肌進入肝臟。他說，這可以刺激自主神經系統，就像咖啡因口服時一樣，激活肝臟中膽汁的釋放，清除更多的胃腸道並排出比正常灌腸更多的毒素。他經常告訴他的病人，“咖啡灌腸不是為了腸道的功能，而是為了刺激肝臟。” 結腸清潔的實踐經歷了20世紀90年代的復興，此時，咖啡灌腸被用作替代癌症治療。 效用和風險 一些替代醫學的支持者聲稱咖啡灌腸通過“解毒”腫瘤的代謝產物而具有快速解毒作用。但是，目前沒有醫學科學證據支持咖啡灌腸的任何解毒或抗癌作用。咖啡灌腸可能引起嚴重的副作用（一些常見於其他類型的灌腸），包括感染，敗血症，嚴重的電解質紊亂，結腸炎，直腸結腸炎，沙門氏菌，腦膿腫和心力衰竭。 如果咖啡灌入太快或太熱 ，它可能導致內部燒傷或直腸穿孔。 每兩小時給藥一次，由於嚴重的電解質紊亂，低鈉血症，脫水和胸膜和心包積液，咖啡灌腸已經顯示與兩例死亡病例有關。美國食品和藥物管理局（FDA）已經裁定提供咖啡灌腸者必須警告使用者有關咖啡灌腸死亡的風險。 參考資料： Teekachunhatean S, Tosri N, Sangdee C, et al. Antioxidant effects after coffee enema or oral coffee consumption in healthy Thai male volunteers. Hum Exp Toxicol. 2012 Jul;31(7):643-51. Jones LE, Norris WE. Rectal burn induced by hot coffee enema. Endoscopy. 2010;42 Suppl 2:E26. Sashiyama H, Hamahata Y, Matsuo K, et al. Rectal burn caused by hot-water coffee enema. Gastrointest Endosc. 2008 Nov;68(5):1008; Ernst, E. "Colonic irrigation and the theory of autointoxication: a triumph of ignorance over science". Journal of Clinical Gastroenterology. 1997 Jun; 24 (4): 196–198. Lee C, Song S, Jeon J, et al. "Coffee enema induced acute colitis". The Korean Journal of Gastroenterology. 2008; 52 (4): 251–254. Shils ME, Hermann MG (April 1982). "Unproved dietary claims in the treatment of patients with cancer". Bull N y Acad Med. 1982 Apr; 58 (3): 323. Cassileth B. "Gerson regimen". Oncology 2010 Feb;24 (2): 201. Margolin, K.; Green, M. "Polymicrobial enteric septicemia from coffee enemas". The Western Journal of Medicine. 1984;140 (3): 460. Eisele J, Reay D. "Deaths related to coffee enemas". JAMA: The Journal of the American Medical Association. 1980; 244 (14): 1608–1609. Keum B, Jeen YT, Park SC, et al. "Proctocolitis Caused by Coffee Enemas". The American Journal of Gastroenterology. 2010; 105 (1): 229–230. Sashiyama H, Hamahata, Y, Matsuo K, et al.”Rectal burn caused by hot-water coffee enema". Gastrointestinal Endoscopy. 2008; 68 (5): 1008–1009. Paran H, Butnaru G, Neufeld D, et al. "Enema-induced perforation of the rectum in chronically constipated patients". Diseases of the Colon and Rectum. 1999; 42 (12): 1609–1612. Teekachunhatean S, Tosri N, Rojanasthien N, et al. Pharmacokinetics of Caffeine following a Single Administration of Coffee Enema versus Oral Coffee Consumption in Healthy Male Subjects. ISRN Pharmacol. 2013;2013:147238. 咖啡灌腸的風險： 1. 電解質不平衡 2. 腸粘膜燙傷 3. 腸穿孔 4. 腸炎、感染

Ronnie Fass MD is a Professor of Medicine at Case Western Reserve University. He is the Director of the Division of Gastroenterology and Hepatology, and Heads the Esophageal and Swallowing Center at MetroHealth Medical Center in Cleveland. Dr. Fass earned his medical degree from Ben-Gurion University Faculty of Medicine in Israel. He then moved to the United States and pursued a residency in Internal medicine at the University of Arizona Medical Center before completing his fellowship in Gastroenterology from UCLA Medical Center. Dr. Fass serves as the editor-in-chief of the Journal of Clinical Gastroenterology and The Journal of Neurogastroenterology and Motility. Dr. Fass has published more than 550 articles, editorials, commentaries, and abstracts in reputed journals. He is the recipient of various awards and honors including the American Gastroenterological Association/Janssen Award for Digestive Sciences in Clinical or Basic Research. When did you decide to study medicine? What about a specialty? These are big decisions which are likely to affect the rest of your life. How do you make the right decision? Today, Dr. Ronnie Fass shares the secret to his approach on making these decisions. He tells us that he made sure to lay the groundwork, he did his research, but most importantly he talked to people who had already taken the journey he was considering, and his mentors. So how did it turn out? Dr. Fass asserts, “Even now, 30, 40 years down the line, I still feel this was the proper path for me.” Pearls of Wisdom: 1. When you need to make an important decision, lay the groundwork: talk to people who know you and understand the subject that you're making a decision about, and consult with expert mentors. 2. When you reach out to mentors, show enthusiasm and seriousness. It's not just that a mentor feeds you and you eat. You have to have the ingredients and listen to them about how to prepare an amazing meal. 3. Listen to patients and give them time. Read their charts beforehand so that you have a background. Never skip the physical examination, which is critical to your role as a healer. Follow up in a timely manner and keep communication open.

Bile acid diarrhea is a common cause of diarrhea in patients with IBS and IBD. Currently, our diagnostic tools are unaccessible and often, therapeutic trials with bile acid sequestrants are used in the diagnosis. Dr Robert Battat shares his research with a new diagnostic marker, C4, in the diagnosis and management of B.A.D., leading to more targeted care for patients. Robert J. Battat, M.D. is an expert in inflammatory bowel disease specializing in Crohn's Disease and Ulcerative Colitis. He is an Assistant Attending Physician at the New York-Presbyterian Hospital/Weill Cornell Medicine and the Jill Roberts Center for Inflammatory Bowel Disease.     Dr. Battat obtained his medical degree and completed both his internal medicine residency training and clinical gastroenterology fellowship at McGill University in Montreal, Canada. He subsequently completed a clinical and research fellowship in inflammatory bowel disease at the University of California, San Diego and at Robarts Clinical Trials under Dr. William Sandborn and Dr. Brian Feagan.       He has a major interest in personalized medicine in inflammatory bowel disease and has extensively published scientific articles on this topic. This includes the development of a serum tess to diagnose bile acid malabsorption -which leads well into our topic today! Dr Battat and I discuss: What is bile acid diarrhea?  How does bile acid diarrhea develop? How is it diagnosed?  SEHCAT Test Therapeutic trial C4 Testing as a measurement for precursor to bile acids Is it a common cause of unexplained diarrhea in your practice? How is BAD managed?  Do you often see an overlap between BAD and IBS? IBD & BAD?  Where the research is going with BAD diagnosis and management and what can patients and health care providers expect? You can read Dr. Battat's research here: Battat, R., Duijvestein, M., Casteele, N. V., Singh, S., Dulai, P. S., Valasek, M. A., ... & Jain, A. (2019). Serum Concentrations of 7α-hydroxy-4-cholesten-3-one are Associated with Bile Acid Diarrhea in Patients with Crohn’s Disease. Clinical Gastroenterology and Hepatology, 17(13), 2722-2730.

David Suskind, MD, is a Professor of Pediatrics at the University of Washington School of Medicine and Physician Lead of ImproveCareNow, a collaborative of over 100 Pediatric IBD centers worldwide, at Seattle Children's Hospital. An expert in intestinal diseases, Dr. Suskind has focused much of his energy on clinical care and inflammatory bowel disease research. He is studying the fecal microbiome's effect in IBD, focusing on dietary therapy in inflammatory bowel disease. The IBD Center at Seattle Children's Hospital is one of the first academic centers to fully incorporate IBD dietary treatment. In addition to Dr. Suskind's research in dietary treatments for IBD, he has chaired the Nutrition Committee. He has been a member of the Medical Executive Committee at Seattle Children's Hospital. He believes in patient and family empowerment through medical education. In 2019, Dr. Suskind received the Catalyst for IBD research award from the Crohn's and Colitis Foundation for his work researching the effect of diet in IBD. For episode links and more, visit SCDforMe.com.

Scientists renamed human genes because of Microsoft Excel by Grant Currin Vincent, J. (2020, August 6). Scientists rename human genes to stop Microsoft Excel from misreading them as dates. The Verge; The Verge. https://www.theverge.com/2020/8/6/21355674/human-genes-rename-microsoft-excel-misreading-dates Ziemann, M., Eren, Y., & El-Osta, A. (2016). Gene name errors are widespread in the scientific literature. Genome Biology, 17(1). https://doi.org/10.1186/s13059-016-1044-7 Bruford, E. A., Braschi, B., Denny, P., Jones, T. E. M., Seal, R. L., & Tweedie, S. (2020). Guidelines for human gene nomenclature. Nature Genetics, 52(8), 754–758. https://doi.org/10.1038/s41588-020-0669-3  A new study finds that the person you choose isn't as important as the relationship you build by Kelsey Donk Betuel, E. (2020, July 27). Landmark study on 11,196 couples pinpoints what dating apps get so wrong. Inverse; Inverse. https://www.inverse.com/mind-body/dating-study-predicts-happy-relationships  Joel, S., Eastwick, P. W., Allison, C. J., Arriaga, X. B., Baker, Z. G., Bar-Kalifa, E., Bergeron, S., Birnbaum, G. E., Brock, R. L., Brumbaugh, C. C., Carmichael, C. L., Chen, S., Clarke, J., Cobb, R. J., Coolsen, M. K., Davis, J., de Jong, D. C., Debrot, A., DeHaas, E. C., … Wolf, S. (2020). Machine learning uncovers the most robust self-report predictors of relationship quality across 43 longitudinal couples studies. Proceedings of the National Academy of Sciences, 117(32), 19061–19071. https://doi.org/10.1073/pnas.1917036117  Why don't we sneeze or burp in our sleep?by Ashley Hamer (Listener question from Natalie) Shieh, M. (2017). Is it possible to sneeze while you are sleeping? Popular Science. https://www.popsci.com/sneeze-sleep/  Villazon, L. (2019). Can you sneeze in your sleep? BBC Science Focus Magazine; BBC Science Focus Magazine. https://www.sciencefocus.com/the-human-body/can-you-sneeze-in-your-sleep/  ‌Do people sneeze in their sleep without waking up? (2008, July 31). Mentalfloss.Com. https://www.mentalfloss.com/article/19227/do-people-sneeze-their-sleep-without-waking  ‌Repasky, D. (2019, January 3). Swallowing Air with CPAP (Aerophagia): Causes and Solutions | CPAP.com Blog. CPAP.Com Blog. https://www.cpap.com/blog/swallowing-air-with-cpap-aerophagia/  ‌Karamanolis, G., Triantafyllou, K., Tsiamoulos, Z., Polymeros, D., Kalli, T., Misailidis, N., Liakakos, T., & Ladas, S. D. (2009). Effect of Sleep on Excessive Belching. Journal of Clinical Gastroenterology, 1. https://doi.org/10.1097/mcg.0b013e3181bd885e  ‌Bredenoord, A. J. (2013). Management of Belching, Hiccups, and Aerophagia. Clinical Gastroenterology and Hepatology, 11(1), 6–12. https://doi.org/10.1016/j.cgh.2012.09.006 ‌Imran Khawaja, Spurling, B. C., & Shantanu Singh. (2020, July 19). REM Sleep Behavior Disorder. Nih.Gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534239/  ‌Brain Basics: Understanding Sleep | National Institute of Neurological Disorders and Stroke. (2020). Nih.Gov. https://www.ninds.nih.gov/Disorders/patient-caregiver-education/understanding-sleep#2  Subscribe to Curiosity Daily to learn something new every day with Ashley Hamer and Natalia Reagan (filling in for Cody Gough). You can also listen to our podcast as part of your Alexa Flash Briefing; Amazon smart speakers users, click/tap “enable” here: https://www.amazon.com/Curiosity-com-Curiosity-Daily-from/dp/B07CP17DJY See omnystudio.com/listener for privacy information.

El Dr. Alan Burguete-Torres, oncólogo médico junto con el Dr. Carlos Rodríguez Montalvo, cirujano hepatobiliar, ambos del Centro Médico Zambrano Hellion, TecSalud en Monterrey, Nuevo León, México, nos comentan sobre el manejo multidisciplinario del carcinoma hepatocelular. El carcinoma hepatocelular es la sexta enfermedad oncológica más frecuente a nivel mundial, se estima que en los próximos 20 años el número de casos aumente hasta casi duplicarse alrededor de un millón y medio de casos de forma anual. (1) Las guías internacionales de tratamiento sugieren que las recomendaciones terapéuticas sean propuestas por un equipo multidisciplinario local, basados en la experiencia individual de cada especialista en el equipo y las características del paciente. Las guías NCCN proponen la evaluación multidisciplinaria como el factor principal previo al algoritmo del diagnóstico. Además de resaltar la importancia para la toma de decisiones de nuevos esquemas de tratamiento como la combinación de inmunoterapia más antiangiogénicos como primera línea. (2-3) El Dr. Carlos Rodríguez Montalvo, comenta que en el 90% de los casos, el hepatocarcinoma está relacionado con una enfermedad hepática crónica, de tal manera que es fundamental contar con un equipo que colabore de manera integral con el paciente. El doctor destaca que hoy en día existen diversas herramientas de detección como los estudios de imagen y programas de detección temprana que hacen posible el identificar esta enfermedad de forma anticipada, incrementando la posibilidad de curación. (4) De acuerdo con su experiencia, el trasplante hepático es una indicación claramente establecida para el tratamiento con intención de curación, sin embargo, no todos los pacientes son aptos para este procedimiento, aunado a esto, la aplicación de terapias quirúrgicas como una alternativa, pueden ofrecer tratamientos con intención de recuperación y control a largo plazo de la enfermedad. Así mismo, la importancia de la biopsia es fundamental para tomar en cuenta la biología tumoral, ya que esto permitirá seleccionar de una mejor manera a los pacientes que recibirán tratamiento en cualquier etapa de su enfermedad. En conclusión, es fundamental el trabajo multidisciplinario para el manejo de pacientes con hepatocarcinoma ya que se puede llegar al mejor tratamiento dependiendo de la situación específica del paciente, incrementando la tasa de supervivencia y mejorando la calidad de vida. (4) Referencias: World Health Organization. Cancer today, global cancer observatory. 2018, International Agency for Research on Cancer. Vogel A., Cervantes A., Chau I., y cols. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. 2018. ESMO. iv238–iv255. National Comprehensive Cancer Network. NCCN Guidelines Hepatocellular Carcinoma Version 4.2020. 2020. NCCN. Agarwal P., Philips P., Hillman L., y cols. Multidisciplinary Management of Hepatocellular Carcinoma Improves Access to Therapy and Patient Survival. 2017. Clinical Gastroenterology. 10.1097/MCG.0000000000000825 Gracias al apoyo educativo de Roche México

Will Bulsiewicz, MD MSCI ("Dr. B") is a graduate of Georgetown University School of Medicine. He trained in internal medicine at Northwestern Memorial Hospital and gastroenterology at The University of North Carolina Hospitals. He also earned a Master of Science in Clinical Investigation (MSCI) from Northwestern University and a certificate in nutrition from Cornell University. Dr. Bulsiewicz is board-certified in both internal medicine and gastroenterology.Dr. B. is a respected clinician and the recipient of numerous awards. At Northwestern, he received the prestigious Rambach Award, was elected into the Alpha Omega Alpha honor society, and was Chief Medical Resident. At UNC, he once again received the highest clinical award given by the program and was Chief Gastroenterology Fellow. Dr. B also has an accomplished background in research, with more than 20 articles published in peer reviewed scientific journals including repeatedly publishing in the top American gastroenterology journals: Gastroenterology, The American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, and Gastrointestinal Endoscopy. He has given more than 40 presentations at national meetings. He also did an epidemiology fellowship at the world renowned UNC - Gillings School of Global Public Health and received a prestigious grant from the National Institutes of Health.Dr B started his @theguthealthmd Instagram page in 2016 and it has quickly become the Internet's most trusted source for gut health guidance. He has been featured in numerous national magazines, including Men's Health, Women's Health and Reader's Digest, has been profiled by The Post & Courier and Vanderbilt Magazine, and he regularly gives sold out lectures on gut health.He is in clinical practice at Lowcountry Gastroenterology in Charleston, SC.To learn more about Dr. B's work:Web: https://theplantfedgut.com/book/IG: https://www.instagram.com/theguthealthmd/FB: https://www.facebook.com/theguthealthmd/This podcast is brought to you by Emory Lifestyle Medicine & Wellness. To learn more about our work, please visithttps://bit.ly/EmoryLM

The "Gluten-Free" movement for those without Celiac Disease was one of the earliest health trends in recent years and remains a very popular dietary option today. Nearly every grocery store, restaurant, and recipe has gluten-free options. While a medical necessity for those with Celiac Disease, others voluntarily choose to maintain a gluten-free diet. There has been heavy debate on whether or not there is a health benefit to following a gluten-free diet if you don't have Celiac Disease, which has led to the emergence of the term "Non-Celiac Gluten (Wheat) Sensitivity". Since headlines and anecdotes muddy the waters on this issue, Andy and Aaron dive into the research to get some answers, as well as share their experience with gluten. Learn more on InstagramWatch us on YouTubeVisit our WebsiteResources:Jimmy Kimmel - What is Gluten?Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders [Nutrients 2013]Non-Celiac Wheat Sensitivity: Exploring a New Clinical Entity [American Journal of Gastroenterology 2012]Effect of Gliadin on Intestinal Permeability [Nutrients 2015]Markers of Non-Celiac Wheat Sensitivity in Patients with Chronic Fatigue Syndrome [Gut 2019]Intestinal Cell Damage in Individuals Reporting Sensitivity to Wheat in the Absence of Celiac Disease [Gut 2016]Serological Tests in Gluten Sensitivity (Nonceliac Gluten Intolerance) [Journal of Clinical Gastroenterology 2012]Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity [Psychiatric Quarterly 2012]Headache Associated with Celiac Disease: A Systematic Review and Meta-Analysis [Nutrients 2018]A survey on patients suspected of having non-celiac gluten sensitivity [BMC Medicine 2014]Migraine and Celiac Disease [Journal of Head and Face Pain 2003]Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm [World Journal of Gastroenterology 2018]Anxiety but Not Depression Decreases in Coeliac Patients After One-Year Gluten-Free Diet [Scandinavian Journal of Gastroenterology 2001]Dietary Gluten and the Development of Type 1 Diabetes [Diabetologia 2014]Gluten Sensitivity: From Gut to Brain [The Lancet Neurology 2010]Increased Prevalence and Mortality in Undiagnosed Celiac Disease [Gastroenterology 2009]Cyrex Laboratories: Array 3

Acute abdominal complications developing in critically ill patients in the ICU can be associated with significant morbidity and mortality. In this episode of Critical Matters, we discuss a variety of acute abdominal complications such as abdominal compartment syndrome, acalculous cholecystitis, toxic megacolon and ischemic bowel. Our guest is Dr. Samuel Tisherman. Dr. Tisherman is a surgical critical care physician at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center and a Professor of Surgery at the University of Maryland School of Medicine. Additional Resources: World Society of Abdominal Compartment Syndrome (WSACS) consensus definitions and recommendations: https://bit.ly/2l9m6EQ Acute Acalculous Cholecystitis: A Review. Huffman J, Schenker S. Clinical Gastroenterology and Hepatology: https://bit.ly/2nfssTL Ogilvie’s Syndrome: Management and Outcomes. Haj, M et al. Medicine: https://bit.ly/2mKLVM5 Books Mentioned in this Episode: Complications: A Surgeon’s Note on an Imperfect Science. By Atul Gawande: https://amzn.to/2laETzB

We're certain that many of our listeners have heard the debates about the merits and downfalls of having a gluten sensing device, like Nima. Do they actually provide peace of mind or make users even more anxious? And, do they really work? We're here today to discuss the results of a recent study that measures exactly that. To share more with our listeners about this controversial topic, I have Dr. Randi Wolf in the studio with me. Dr. Wolf is a faculty member and researcher at Teachers College at Columbia University. She was a leader of the Benefits and Barriers to Portable Gluten Detection study that was published in a recent issue of the journal Clinical Gastroenterology and Hepatology.  To learn more about the Celiac Disease Center at Columbia University Irving Medical Center and find information about various studies underway, please visit:  celiacdiseasecenter.columbia.edu. Thank you to the Walter and Jean Boek Global Autoimmune Institute for their ongoing support to make this podcast possible.  Photo Credit: NIMA Website: https://nimasensor.com/blog/ 

Will Bulsiewicz, MD MSCI ("Dr. B") is a graduate of Georgetown University School of Medicine. He trained in internal medicine at Northwestern Memorial Hospital and gastroenterology at The University of North Carolina Hospitals. He also earned a Master of Science in Clinical Investigation (MSCI) from Northwestern University and a certificate in nutrition from Cornell University. Dr. Bulsiewicz is board-certified in both internal medicine and gastroenterology. Dr. B. is a respected clinician and the recipient of numerous awards. At Northwestern, he received the prestigious Rambach Award, was elected into the Alpha Omega Alpha honor society, and was Chief Medical Resident. At UNC, he once again received the highest clinical award given by the program and was Chief Gastroenterology Fellow. Dr. B also has an accomplished background in research, with more than 20 articles published in peer reviewed scientific journals including repeatedly publishing in the top American gastroenterology journals: Gastroenterology, The American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, and Gastrointestinal Endoscopy. He has given more than 40 presentations at national meetings. He also did an epidemiology fellowship at the world renowned UNC - Gillings School of Global Public Health and received a prestigious grant from the National Institutes of Health. Dr B started his @theguthealthmd Instagram page in 2016 and it has quickly become the Internet's most trusted source for gut health guidance. He has been featured in numerous national magazines, including Men's Health, Women's Health and Reader's Digest, has been profiled by The Post & Courier and Vanderbilt Magazine, and he regularly gives sold out lectures on gut health. He is in clinical practice at Lowcountry Gastroenterology in Charleston, SC. Topics discussed in this conversation are: what is gut health, most recent research; how diet effects microbiome; effectiveness of probiotics and prebiotics, who should use them and when; importance of fiber, different kinds of fiber; effects of antibiotics on gut health. Sign up for Dr. B's newsletter on his website: theguthealthmd.com Instagram @theguthealthmd Facebook: @theguthealthmd

Your gastrointestinal tract is approximately 30 feet long, and it runs from your mouth all the way to the anus! We know that celiac disease can impact any part of the digestive tract. But there is another disease that wreaks havoc on the GI tract as well, a condition called eosinophilic esophagitis or EoE. The Gluten Free RN is explaining the fundamentals of eosinophilic esophagitis, from its characteristic inflammation of the esophagus and elevated eosinophils in the blood to the common symptoms of vomiting and upper abdominal pain. She walks us through the treatment for EoE, an elimination diet or steroid therapy. Nadine speaks to the research exploring a possible connection between eosinophilic esophagitis and celiac disease, citing a paper that found a higher prevalence of EoE in children with celiac disease than the general population as well as the case study of a woman with both celiac disease and elevated eosinophils in her blood. Listen in for the Gluten Free RN’s insight on the best EoE clinics and physicians in the country and learn why further study is needed around EoE and celiac disease! What’s Discussed:  The fundamentals of eosinophilic esophagitis Allergic response to dietary antigens Causes inflammation of esophagus, increased eosinophils in blood The benefits of unsedated transnasal endoscopy for children with EoE Monitors esophageal mucosa without sedation Safer, faster and less costly Some common symptoms of eosinophilic esophagitis Vomiting, difficulty swallowing, food stuck in throat Chest pain, heartburn, upper abdominal pain The condition of achalasia Muscles of esophagus don’t work appropriately Causes spasms or constriction The treatment for EoE Elimination diet (remove wheat, eggs, milk, soy, shellfish and seafood, peanuts and tree nuts) Topical or systemic steroids The potential increased prevalence of EoE in children with celiac disease 2015 paper found prevalence of 10.7% (much higher than general population) Other research articles argue no increased prevalence of EoE in CD The case study of a 30-year-old woman with celiac disease and elevated eosinophils Presented with abdominal pain and distension, vomiting and frequent bowel movement Treated with IV hydrocortisone, but developed steroid induced psychosis Nadine’s insight on the best specialty clinics for EoE in the US University of Colorado (Denver School of Medicine) Pennsylvania Dr. Glenn Furuta’s insight on the difficulty of diagnosing EoE Relatively new disease, tendency to diagnose based on pathology report alone Elevated eosinophils also found in GERD, inflammatory bowel disease and celiac disease Special considerations for pediatric patients with EoE Consultation with dietician Limited exposure to corticosteroids Attention to development of feeding skills Potential psychosocial, behavioral problems Resources: ‘Unsedated Transnasal Esophagoscopy for Monitoring Therapy in Pediatric Eosinophilic Esophagitis’ in Gastrointestinal Endoscopy ‘Eosinophilic Esophagitis Associated with Celiac Disease in Children’ in BMC Research Notes ‘Eosinophilic Gastrointestinal Disorder in Coeliac Disease: A Case Report and Review’ in Case Reports in Gastrointestinal Medicine ‘Eosinophilic Esophagitis in Children and Adults’ in Gastroenterology and Hepatology ‘The Association Between Celiac Disease and Eosinophilic Esophagitis in Children and Adults’ in BMC Gastroenterology ‘Eosinophils in Gastrointestinal Disorders’ in Immunology and Allergy Clinics of North America ‘2013 Update on Celiac Disease and Eosinophilic Esophagitis’ in Nutrients ‘Eosinophilic Esophagitis: New Insights in Pathogenesis and Therapy’  in the World Journal of Gastrointestinal Pharmacology and Therapeutics ‘Incidence and Prevalence of Eosinophilic Esophagitis in Children’ in the Journal of Pediatric Gastroenterology and Nutrition ‘Management of Eosinophilic Esophagitis and Celiac Disease’ in Current Opinion in Pharmacology ‘Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients with Active Celiac Disease on Biopsy’ in Clinical Gastroenterology and Hepatology ‘Individuals Affected by Eosinophilic Gastrointestinal Disorders Have Complex Unmet Needs and Frequently Experience Unique Barriers to Care’ in Clinics and Research in Hepatology and Gastroenterology ‘Eosinophilic Esophagitis and Celiac Disease: A True Association or Coincidence?’ in the Journal of Pediatric Gastroenterology and Nutrition Connect with Nadine: Instagram Facebook Contact via Email ‘Your Skin on Gluten’ on YouTube Melodies of the Danube Gluten-Free Cruise with Nadine Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Heal

The Irish are known for being lucky… But does that luck hold out when it comes to celiac disease? The prevalence of celiac disease among the Iris is 1:100, about the same as the rest of the world. And if you are a redhead of Irish descent, there is a good chance that you are an HLA-DQ2 or HLA-DQ8 gene carrier. Today, the Gluten Free RN explores Irish ancestry and celiac disease, discussing how the Potato Famine led to a change in diet for much of the surviving population. She walks us through a paper published by Irish College of General Practitioners explaining the clinical presentations and complications of celiac disease. Nadine shares her experience running the Dublin marathon and the health consequences she suffered after touring the Guinness brewery. Listen in to understand the work of the Coeliac Society of Ireland and learn about the trends in celiac disease among the Irish. What’s Discussed:  Why red hair is associated with celiac disease Tend to be HLA-DQ2 and/or HLA-DQ8 gene carriers The prevalence of celiac disease in Irish Setters Do much better on a gluten-free/Paleo diet The Irish Potato Famine Potato-based diet, little access to grains Famine from 1845-1849 One million died, many emigrated The myth that celiac disease is more prevalent in Europe than the US 30-50% of the population carries HLA-DQ2, HLA-DQ8 gene The myth that women are more susceptible to celiac disease Statistics don’t support this belief The Irish College of General Practitioners paper on celiac disease Clinical presentations, complications of celiac disease Conditions associated with increased prevalence The prevalence of celiac disease in Ireland 1:100 (matches rest of world) The appropriate testing for celiac disease and NCGS Blood test for total IgA/IgG, DGP and AGA Nadine’s experience running the Dublin marathon in 1998 Extreme edema in lower extremities The information provided by the Coeliac Society of Ireland Health ramifications of undiagnosed CD Average duration from symptoms to diagnosis (nine months) Resources: ‘Gluten-Sensitive Enteropathy in a Family of Irish Setters’ in The Canadian Veterinary Journal ‘Diagnosis and Management of Adult Coeliac Disease’ in ICGP Coeliac Society of Ireland ‘Prevalence and Incidence of Celiac Disease in Edinburgh and the Lothian Region of Scotland’ in Gastroenterology ‘Prevalence and Diagnosis’ by the Coeliac Society of Ireland ‘Coeliac Disease in Europe’ in Alimentary Pharmacology & Therapeutics ‘Escalation in the Amount of Adults Diagnosed with Coeliac Disease’ in Lifestyle Health ‘Gluten-Free Foods’ by the Food Safety Authority of Ireland ‘How Irish Diets of the Past Affect the Present’ in The Irish Times ‘Changes in Presentation of Celiac Disease in Ireland from the 1960s to 2015’ in Clinical Gastroenterology and Hepatology ‘Coeliac Disease: A Personal Perspective’ in Irish Health ‘Coeliac Disease: More Common Than You Think in Irish Health ‘Pathology and Management of Coeliac Disease’ by the Dublin Academic Medical Centre & UCD Connect with Nadine: Instagram Facebook Contact via Email ‘Your Skin on Gluten’ on YouTube Melodies of the Danube Gluten-Free Cruise with Nadine Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Health Activism

Dr. David Greenwald is currently the Director of Clinical Gastroenterology and Endoscopy at Mount Sinai Hospital in New York City. He is also a Professor of Clinical Medicine at the Icahn School of Medicine at Mount Sinai.  Previously, he was Fellowship Program Director in Gastroenterology at Montefiore Medical Center/Albert Einstein College of Medicine for nearly […] The post Latest Advances in Preparation, Screening and Recurrence Monitoring, With Dr. David Greenwald appeared first on The Colon Cancer Podcast.

A study in the December CGH finds that constipation and a low-fiber diet are not associated with diverticulosis. A related "Perspectives in Clinical Gastroenterology and Hepatology" article reconsiders conventional wisdom about diverticular disease.

A “Perspectives in Clinical Gastroenterology and Hepatology” article in the September issue of CGH provides condition-specific rationale for using probiotic therapy and literature-based recommendations. Dr. Kuemmerle speaks to author Dr. Matthew A. Ciorba