Podcasts about Gastroenterology

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Play Episode Listen Later Nov 19, 2025 52:15 Transcription Available

Send us a textWelcome to episode 1 of our series- IBD Can Eat Me guest hosted by Stacey Collins, IBD RD. In this series, Stacey will interview other Dietitians who also specialize in IBD. This week we welcomed Venus Kalami- board-certified pediatric Dietitian Nutritionist! What if the strict diet you're told to follow does more harm than good? We sit down with pediatric dietitian Venus to unpack how nutrition in IBD can support health without sacrificing joy, culture, or family life. From Stanford Children's IBD and celiac center to medical affairs and public education, Venus brings a rare mix of clinical depth and human warmth—and she doesn't shy away from hard truths.We dig into the pressure families feel to “do everything,” the overuse of restrictive therapeutic diets, and the real risks that come with them: malnutrition, ARFID, pediatric feeding disorders, and lasting food trauma. Venus shares a clear way to tell the difference between a transient food reaction and an inflammatory flare, helping patients step off the rollercoaster of fear and over-correction. She also shows how to make care culturally inclusive with simple, powerful questions: What do you like? What do you cook? What feels doable at home? It's a move from generic handouts to plans that honor heritage foods and real life.You'll hear a vivid case study where a patient referred for low FODMAP improved dramatically without elimination—just lactase with dairy, spreading fruit across the day, and changing other patterns developed from past food trauma. We talk about involving mental health early, “asking around the ask” when supplements come up, and borrowing pediatric best practices for adults who shouldn't have to navigate IBD alone. The theme running through it all: patients deserve permission to dream beyond survival. Biomarkers matter, but so do birthdays, travel, and the comfort foods that make you feel at home.If this conversation resonates, follow the show, share it with someone who needs a gentler path, and leave a review to help more people find evidence-based, humane IBD care. Your feedback shapes future episodes—what question should we tackle next?Nutrition Pearls podcast with VenusVenus on XSolid Starts app"Offering Nutritional Therapies to Patients with IBD: Even If You're Not An Expert"- Video from Nutritional Therapy for IBDLet's get social!!Follow us on Instagram!Follow us on Facebook!Follow us on Twitter!

Predictors of not using medication for EoE

Real Talk: Eosinophilic Diseases

Play Episode Listen Later Nov 19, 2025 44:35

Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Evan S. Dellon, MD, and Elizabeth T. Jensen, PhD, about a paper they published on predictors of patients receiving no medication for treatment of eosinophilic esophagitis. Disclaimer: The information provided in this podcast is designed to support, not replace, the relationship 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: [:52] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz. [1:14] Holly introduces today's topic, predictors of not using medication for EoE, and today's guests, Dr. Evan Dellon and Dr. Elizabeth Jensen. [1:29] Dr. Dellon is an Adjunct Professor of Epidemiology at the University of North Carolina School of Medicine in Chapel Hill. He is also the Director of the UNC Center for Esophageal Diseases and Swallowing. [1:42] Dr. Dellon's main research interest is in the epidemiology, pathogenesis, diagnosis, treatment, and outcomes of eosinophilic esophagitis (EoE) and eosinophilic GI diseases (EGIDs). [1:55] Dr. Jensen is a Professor of Epidemiology with a specific expertise in reproductive, perinatal, and pediatric epidemiology. She has appointments at both Wake Forest University School of Medicine and the University of North Carolina at Chapel Hill. [2:07] Her research primarily focuses on etiologic factors in the development of pediatric immune-mediated chronic diseases, including understanding factors contributing to disparities in health outcomes. [2:19] Both Dr. Dellon and Dr. Jensen also serve on the Steering Committee for EGID Partners Registry. [2:24] Ryan thanks Dr. Dellon and Dr. Jensen for joining the podcast today. [2:29] Dr. Dellon was the first guest on this podcast. It is wonderful to have him back for the 50th episode! Dr. Dellon is one of Ryan's GI specialists. Ryan recently went to North Carolina to get a scope with him. [3:03] Dr. Dellon is an adult gastroenterologist at the University of North Carolina at Chapel Hill. He directs the Center for Esophageal Diseases and Swallowing. Clinically and research-wise, he is focused on EoE and other eosinophilic GI diseases. [3:19] His research interests span the entire field, from epidemiology, diagnosis, biomarkers, risk factors, outcomes, and a lot of work, more recently, on treatments. [3:33] Dr. Jensen has been on the podcast before, on Episode 27. Holly invites Dr. Jensen to tell the listeners more about herself and her work with eosinophilic diseases. [3:46] Dr. Jensen has been working on eosinophilic gastrointestinal diseases for about 15 years. She started some of the early work around understanding possible risk factors for the development of disease. [4:04] She has gone on to support lots of other research projects, including some with Dr. Dellon, where they're looking at gene-environment interactions in relation to developing EoE. [4:15] She is also looking at reproductive factors as they relate to EoE, disparities in diagnosis, and more. It's been an exciting research trajectory, starting with what we knew very little about and building to an increasing understanding of why EoE develops. [5:00] Dr. Dellon explains that EoE stands for eosinophilic esophagitis, a chronic allergic condition of the esophagus. [5:08] You can think of EoE as asthma of the esophagus or eczema of the esophagus, although in general, people don't grow out of EoE, like they might grow out of eczema or asthma. When people have EoE, it is a long-term condition. [5:24] Eosinophils are a type of white blood cell, specializing in allergy responses. Normally, they are not in the esophagus. When we see them there, we worry about an allergic process. When that happens, that's EoE. [5:40] Over time, the inflammation seen in EoE and other allergic cell activity causes swelling and irritation in the esophagus. Early on, this often leads to a range of upper GI symptoms — including poor growth or failure to thrive in young children, abdominal pain, nausea, and symptoms that can mimic reflux. [5:58] In older kids, symptoms are more about trouble swallowing. That's because the swelling that happens initially, over time, may turn into scar tissue. So the esophagus can narrow and cause swallowing symptoms like food impaction. [6:16] Ryan speaks of living with EoE for decades and trying the full range of treatment options: food elimination, PPIs, steroids, and, more recently, biologics. [6:36] Dr. Dellon says Ryan's history is a good overview of how EoE is treated. There are two general approaches to treating the underlying condition: using medicines and/or eliminating foods that we think may trigger EoE from the diet. [6:57] For a lot of people, EoE is a food-triggered allergic condition. [7:01] The other thing that has to happen in parallel is surveying for scar tissue in the esophagus. If that's present and people have trouble swallowing, sometimes stretching the esophagus is needed through esophageal dilation. [7:14] There are three categories of medicines used for treatment. Proton pump inhibitors are reflux meds, but they also have an anti-allergy effect in the esophagus. [7:29] Topical steroids are used to coat the esophagus and produce an anti-inflammatory effect. The FDA has approved a budesonide oral suspension for that. [7:39] Biologics, which are generally systemic medications, often injectable, can target different allergic factors. Dupilumab is approved now, and there are other biologics that are being researched as potential treatments. [7:51] Even though EoE is considered an allergic condition, we don't have a test to tell people what they are allergic to. If it's a food allergy, we do an empiric elimination diet because allergy tests aren't accurate enough to tell us what the EoE triggers are. [8:10] People will eliminate foods that we know are the most common triggers, like milk protein, dairy, wheat, egg, soy, and other top allergens. You can create a diet like that and then have a response to the diet elimination. [8:31] Dr. Jensen and Dr. Dellon recently published an abstract in the American Journal of Gastroenterology about people with EoE who are not taking any medicine for it. Dr. Jensen calls it a real-world data study, leveraging electronic health record patient data. [8:51] It gives you an impression of what is actually happening, in terms of treatments for patients, as opposed to a randomized control trial, which is a fairly selected patient population. This is everybody who has been diagnosed, and then what happens with them. [9:10] Because of that, it gives you a wide spectrum of patients. Some patients are going to be relatively asymptomatic. It may be that we arrived at their diagnosis while working them up for other potential diagnoses. [9:28] Other patients are going to have rather significant impacts from the disease. We wanted to get an idea of what is actually happening out there with the full breadth of the patient population that is getting diagnosed with EoE. [9:45] Dr. Jensen was not surprised to learn that there are patients who had no pharmacologic treatment. [9:58] Some patients are relatively asymptomatic, and others are not interested in pursuing medications initially or are early in their disease process and still exploring dietary treatment options. [10:28] Holly sees patients from infancy to geriatrics, and if they're not having symptoms, they wonder why bother treating it. [10:42] Dr. Jensen says it's a point of debate on the implications of somebody who has the disease and goes untreated. What does that look like long-term? Are they going to develop more of that fibrostenotic pattern in their esophagus without treatment? [11:07] This is a question we're still trying to answer. There is some suggestion that for some patients who don't manage their disease, we very well may be looking at a food impaction in the future. [11:19] Dr. Dellon says we know overall for the population of EoE patients, but it's hard to know for a specific patient. We have a bunch of studies now that look at how long people have symptoms before they're diagnosed. There's a wide range. [11:39] Some people get symptoms and get diagnosed right away. Others might have symptoms for 20 or 30 years that they ignore, or don't have access to healthcare, or the diagnosis is missed. [11:51] What we see consistently is that people who may be diagnosed within a year or two may only have a 10 or 20% chance of having that stricture and scar tissue in the esophagus, whereas people who go 20 years, it might be 80% or more. [12:06] It's not everybody who has EoE who might end up with that scar tissue, but certainly, it's suggested that it's a large majority. [12:16] That's before diagnosis. We have data that shows that after diagnosis, if people go a long time without treatment or without being seen in care, they also have an increasing rate of developing strictures. [12:29] In general, the idea is yes, you should treat EoE, because on average, people are going to develop scar tissue and more symptoms. For the patient in front of you with EoE but no symptoms, what are the chances it's going to get worse? You don't know. [13:04] There are two caveats with that. The first is what we mean by symptoms. Kids may have vomiting and growth problems. Adults can eat carefully, avoiding foods that hang up in the esophagus, like breads and overcooked meats, sticky rice, and other foods. [13:24] Adults can eat slowly, drink a lot of liquid, and not perceive they have symptoms. When someone tells Dr. Dellon they don't have symptoms, he will quiz them about that. He'll even ask about swallowing pills. [13:40] Often, you can pick up symptoms that maybe the person didn't even realize they were having. In that case, that can give you some impetus to treat. [13:48] If there really are no symptoms, Dr. Dellon thinks we're at a point where we don't really know what to do. [13:54] Dr. Dellon just saw a patient who had a lot of eosinophils in their small bowel with absolutely no GI symptoms. He said, "I can't diagnose you with eosinophilic enteritis, but you may develop symptoms." People like that, he will monitor in the clinic. [14:14] Dr. Dellon will discuss it with them each time they come back for a clinic visit. [14:19] Holly is a speech pathologist, but also sees people for feeding and swallowing. The local gastroenterologist refers patients who choose not to treat their EoE to her. Holly teaches them things they should be looking out for. [14:39] If your pills get stuck or if you're downing 18 ounces during a mealtime, maybe it's time to treat it. People don't see these coping mechanisms they use that are impacting their quality of life. They've normalized it. [15:30] Dr. Dellon says, of these people who aren't treated, there's probably a subset who appropriately are being observed and don't have a medicine treatment or are on a diet elimination. [15:43] There's also probably a subset who are inappropriately not on treatment. It especially can happen with students who were under good control with their pediatric provider, but moved away to college and didn't transfer to adult care. [16:08] They ultimately come back with a lot of symptoms that have progressed over six to eight years. [16:18] Ryan meets newly diagnosed adult patients at APFED's conferences, who say they have no symptoms, but chicken gets caught in their throat. They got diagnosed when they went to the ER with a food impaction. [16:38] Ryan says you have to wonder at what point that starts to get reflected in patient charts. Are those cases documented where someone is untreated and now has EoE? [16:49] Ryan asks in the study, "What is the target EGID Cohort and why was it selected to study EoE? What sort of patients were captured as part of that data set?" [16:58] Dr. Jensen said they identified patients with the ICD-10 code for a diagnosis of EoE. Then they looked to see if there was evidence of symptoms or complications in relation to EoE. This was hard; some of these are relatively non-specific symptoms. [17:23] These patients may have been seeking care and may have been experiencing some symptoms that may or may not have made it into the chart. That's one of the challenges with real-world data analyses. [17:38] Dr. Jensen says they are using data that was collected for documenting clinical care and for billing for clinical care, not for research, so it comes with some caveats when doing research with this data. [18:08] Research using electronic health records gives a real-world perspective on patients who are seeking care or have a diagnosis of EoE, as opposed to a study trying to enroll a patient population that potentially isn't representative of the breadth of individuals living with EoE. [18:39] Dr. Dellon says another advantage of real-world data is the number of patients. The largest randomized controlled trials in EoE might have 400 patients, and they are incredibly expensive to do. [18:52] A study of electronic health records (EHR) is reporting on the analysis of just under 1,000. The cohort, combined from three different centers, has more than 1,400 people, a more representative, larger population. [19:16] Dr. Dellon says when you read the results, understand the limitations and strengths of a study of health records, to help contextualize the information. [19:41] Dr. Dellon says it's always easier to recognize the typical presentations. Materials about EoE and studies he has done that led to medicine approvals have focused on trouble swallowing. That can be relatively easily measured. [20:01] Patients often come to receive care with a food impaction, which can be impactful on life, and somewhat public, if in a restaurant or at work. Typical symptoms are also the ones that get you diagnosed and may be easier to treat. [20:26] Dr. Dellon wonders if maybe people don't treat some of the atypical symptoms because it's not appreciated that they can be related to EoE. [20:42] Holly was diagnosed as an adult. Ryan was diagnosed as a toddler. Holly asks what are some of the challenges people face in getting an EoE diagnosis. [20:56] Dr. Jensen says symptoms can sometimes be fairly non-specific. There's some ongoing work by the CEGIR Consortium trying to understand what happens when patients come into the emergency department with a food bolus impaction. [21:28] Dr. Jensen explains that we see there's quite a bit of variation in how that gets managed, and if they get a biopsy. You have to have a biopsy of the esophagus to get a diagnosis of EoE. [21:45] If you think about the steps that need to happen to get a diagnosis of EoE, that can present barriers for some groups to ultimately get that diagnosis. [21:56] There's also been some literature around a potential assumption about which patients are more likely to be at risk. Some of that is still ongoing. We know that EoE occurs more commonly in males in roughly a two-to-one ratio. Not exclusively in males, obviously, but a little more often in males. [22:20] We don't know anything about other groups of patients that may be at higher risk. That's ongoing work that we're still trying to understand. That in itself can also be a barrier when there are assumptions about who is or isn't likely to have EoE. [23:02] Dr. Dellon says that in adolescents and adults, the typical symptoms are trouble swallowing and food sticking, which have many causes besides EoE, some of which are more common. [23:18] In that population, heartburn is common. Patients may report terrible reflux that, on questioning, sounds more like trouble swallowing than GERD. Sometimes, with EoE, you may have reflux that doesn't improve. Is it EoE, reflux, or both? [24:05] Some people will have chest discomfort. There are some reports of worsening symptoms with exercise, which brings up cardiac questions that have to be ruled out first. [24:19] Dr. Dellon mentions some more atypical symptoms. An adult having pain in the upper abdomen could have EoE. In children, the symptoms could be anything in the GI tract. Some women might have atypical symptoms with less trouble swallowing. [24:58] Some racial minorities may have those kinds of symptoms, as well. If you're not thinking of the condition, it's hard to make the diagnosis. [25:08] Dr. Jensen notes that there are different cultural norms around expressing symptoms and dietary patterns, which may make it difficult to parse out a diagnosis. [25:27] Ryan cites a past episode where access to a GI specialist played a role in diagnosing patients with EoE. Do white males have more EoE, or are their concerns just listened to more seriously? [25:57] Ryan's parents were told when he was two that he was throwing up for attention. He believes that these days, he'd have a much easier time convincing a doctor to listen to him. From speaking to physicians, Ryan believes access is a wide issue in the field. [26:23] Dr. Dellon tells of working with researchers at Mayo in Arizona and the Children's Hospital of Phoenix. They have a large population of Hispanic children with EoE, much larger than has been reported elsewhere. They're working on characterizing that. [26:49] Dr. Dellon describes an experience with a visiting trainee from Mexico City, where there was not a lot of EoE reported. The trainee went back and looked at the biopsies there, and it turned out they were not performing biopsies on patients with dysphagia in Mexico City. [27:13] When he looked at the patients who ended up getting biopsies, they found EoE in 10% of patients. That's similar to what's reported out of centers in the developed world. As people are thinking about it more, we will see more detection of it. [27:30] Dr. Dellon believes those kinds of papers will be out in the next couple of months, to a year. [27:36] Holly has had licensure in Arizona for about 11 years. She has had nine referrals recently of children with EoE from Arizona. Normally, it's been one or two that she met at a conference. [28:00] Ryan asks about the research on patients not having their EoE treated pharmacologically. Some treat it with food avoidance and dietary therapy. Ryan notes that he can't have applesauce, as it is a trigger for his EoE. [28:54] Dr. Jensen says that's one of the challenges in using the EHR data. That kind of information is only available to the researchers through free text. That's a limitation of the study, assessing the use of dietary elimination approaches. [29:11] Holly says some of her patients have things listed as allergies that are food sensitivities. Ryan says it's helpful for the patients to have their food sensitivities listed along with their food allergies, but it makes records more difficult to parse for research. [30:14] Dr. Dellon says they identify EoE by billing code, but the codes are not always used accurately. Natural Language Processing can train a computer system to find important phrases. Their collaborators working on the real-world data are using it. [30:59] Dr. Dellon hopes that this will be a future direction for this research to find anything in the text related to diet elimination. [31:32] Dr. Jensen says that older patients were less likely to seek medication therapy. She says it's probably for a couple of reasons. First, older patients may have been living with the disease for a long time and have had compensatory mechanisms in place. [32:03] The other reason may be senescence or burnout of the disease, long-term. Patients may be less symptomatic as they get older. That's a question that remains to be answered for EoE. It has been seen in some other disease processes. [32:32] Dr. Dellon says there's not much data specifically looking at EoE in the older population. Dr. Dellon did work years ago with another doctor, and they found that older patients had a better response to some treatments, particularly topical steroids. [32:54] It wasn't clear whether it was a milder aspect of the disease, easier to treat, or because they were older and more responsible, taking their medicines as prescribed, and having a better response rate. It's the flip side of work in the pediatric population. [33:16] There is an increasingly aging population with EoE. Young EoE patients will someday be over 65. Dr. Dellon hopes there will be a cure by that point, but it's an expanding population now. [33:38] Dr. Jensen says only a few sites are contributing data, so they hope to add additional sites to the study. For some of the less common outcomes, they need a pretty large patient sample to ask some of those kinds of questions. [33:55] They will continue to follow up on some of the work that this abstract touched on and try to understand some of these issues more deeply. [34:06] Dr. Dellon mentions other work within the cohort. Using Natural Language Processing, they are looking at characterizing endoscopy information and reporting it without a manual review of reports and codes. You can't get that from billing data. [34:29] Similarly, they are trying to classify patient severity by the Index of Severity with EoE, and layer that on looking at treatments and outcomes based on disease severity. Those are a couple of other directions where this cohort is going. [34:43] Holly mentions that this is one of many research projects Dr. Jensen and Dr. Dellon have collaborated on together. They also collaborate through EGID Partners. Holly asks them to share a little bit about that. [34:53] Dr. Jensen says EGID Partners is an online registry where individuals, caregivers, and parents of children affected with EGIDs can join. [35:07] EGID Partners also needs people who don't live with an EGID to join, as controls. That gives the ability to compare those who are experiencing an EGID relative to those who aren't. [35:22] When you join EGID Partners, they provide you with a set of questionnaires to complete. Periodically, they push out a few more questionnaires. [35:33] EGID Partners has provided some really great information about patient experience and answered questions that patients want to know about, like joint pain and symptoms outside the GI tract. [36:04] To date, there are close to 900 participants in the registry from all over the world. As it continues to grow, it will give the ability to look at the patient experience in different geographical areas. [36:26] Dr. Dellon says we try to have it be interactive, because it is a collaboration with patients. The Steering Committee works with APFED and other patient advocacy groups from around the world. [36:41] The EGID Partners website shows general patient locations anonymously. It shows the breakdown of adults with the condition and caregivers of children with the condition, the symptom distribution, and the treatment distribution. [37:03] As papers get published and abstracts are presented, EGID Partners puts them on the website. Once someone joins, they can suggest a research idea. Many of the studies they have done have come from patient suggestions. [37:20] If there's an interesting idea for a survey, EGID Partners can push out a survey to everybody in the group and answer questions relatively quickly. [37:57] Dr. Dellon says a paper came out recently about telehealth. EoE care, in particular, is a good model for telehealth because it can expand access for patients who don't have providers in their area. [38:22] EoE is a condition where care involves a lot of discussion but not a lot of need for physical exams and direct contact, so telehealth can make things very efficient. [38:52] EGID Partners surveyed patients about telehealth. They thought it was efficient and saved time, and they had the same kind of interactions as in person. In general, in-state insurance covered it. Patients were happy to do those kinds of visits again. [39:27] Holly says Dr. Furuta, herself, and others were published in the Gastroenterology journal in 2019 about starting to do telehealth because patients coming to the Children's Hospital of Colorado from out of state had no local access to feeding therapy. [39:50] Holly went to the board, and they allowed her to get licensure in different states. She started with some of the most impacted patients in Texas and Florida in 2011 and 2012. They collected data. They published in 2019 about telehealth's positive impact. [40:13] When 2020 rolled around, Holly had trained a bunch of people on how to do feeding therapy via telehealth. You have to do all kinds of things, like make yourself disappear, to keep the kids engaged and in their chairs! [40:25] Now it is Holly's primary practice. She has licenses in nine states. She sees people all over the country. With her diagnosis, her physicians at Mass General have telehealth licensure in Maine. She gets to do telehealth with them instead of driving two hours. [40:53] Dr. Jensen tells of two of the things they hope to do at EGID Partners. One is trying to understand more about reproductive health for patients with an EGID diagnosis. Only a few studies have looked at this question, and with very small samples. [41:15] As more people register for EGID Partners, Dr. Jensen is hoping to be able to ask some questions related to reproductive health outcomes. [41:27] The second goal is a survey suggested by the Student Advisory Committee, asking questions related to the burden of disease specific to the teen population. [41:48] This diagnosis can hit that population particularly hard, at a time when they are trying to build and sustain friendships and are transitioning to adult care and moving away from home. This patient population has a unique perspective we wanted to hear. [42:11] Dr. Jensen and Dr. Dellon work on all kinds of other projects, too. [42:22] Dr. Dellon says they have done a lot of work on the early-life factors that may predispose to EoE. They are working on a large epidemiologic study to get some insight into early-life factors, including factors that can be measured in baby teeth. [42:42] That's outside of EGID Partners. It's been ongoing, and they're getting close, maybe over the next couple of years, to having some results. [43:03] Ryan says all of those projects sound so interesting. We need to have you guys back to dive into those results when you have something finalized. [43:15] For our listeners who want to learn more about eosinophilic disorders, we encourage you to visit apfed.org and check out the links in the show notes below. [43:22] If you're looking to find specialists who treat eosinophilic disorders, we encourage you to use APFED's Specialist Finder at apfed.org/specialist. [43:31] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections. [43:41] Ryan thanks Dr. Dellon and Dr. Jensen for joining us today. This was a fantastic conversation. Holly also thanks APFED's Education Partners GSK, Sanofi, Regeneron, and Takeda for supporting this episode. Mentioned in This Episode: Evan S. Dellon, MD, MPH, Academic Gastroenterologist, University of North Carolina School of Medicine Elizabeth T. Jensen, MPH, PhD, Epidemiologist, Wake Forest University School of Medicine, University of North Carolina at Chapel Hill Predictors of Patients Receiving No Medication for Treatment of Eosinophilic Esophagitis in the United States: Data from the TARGET-EGIDS Cohort Episode 15: Access to Specialty Care for Eosinophilic Esophagitis (EoE) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections apfed.org/research/clinical-trials Education Partners: This episode of APFED's podcast is brought to you thanks to the support of GSK, Sanofi, Regeneron, and Takeda. Tweetables: "I've been working on eosinophilic gastrointestinal diseases for about 15 years. I started some of the early work around understanding possible risk factors for the development of disease. I've gone on to support lots of other research projects." — Elizabeth T. Jensen, MPH, PhD "You can think of EoE as asthma of the esophagus or eczema of the esophagus, although in general, people don't grow out of EoE, like they might grow out of eczema or asthma. When people have it, it really is a long-term condition." — Evan S. Dellon, MD, MPH "There are two general approaches to treating the underlying condition, … using medicines and/or eliminating foods from the diet that we think may trigger EoE. I should say, for a lot of people, EoE is a food-triggered allergic condition." — Evan S. Dellon, MD, MPH "I didn't find it that surprising [that there are patients who had no treatment]. Some patients are relatively asymptomatic, and others are not interested in pursuing medications initially or are … still exploring dietary treatment options." — Elizabeth T. Jensen, MPH, PhD "We have a bunch of studies now that look at how long people have symptoms before they're diagnosed. There's a wide range. Some people get symptoms and are diagnosed right away. Other people might have symptoms for 20 or 30 years." — Evan S. Dellon, MD, MPH "EGID Partners is an online registry where individuals, caregivers, and parents of children affected with EGIDs can join. EGID Partners also needs people who don't live with an EGID to join, as controls." — Elizabeth T. Jensen, MPH, PhD

#126 – What's the Microbiome Gut to Do with It

Breakpoints

Play Episode Listen Later Nov 14, 2025 68:15

Dr. Julie Ann Justo is joined by experts Drs. Krista Gens and Javier A. Villafuerte Gálvez as they dive deep into the gut microbiome and explore the latest therapeutic frontier for C. difficile infections. From bacteria battles to breakthrough treatments, this one's a must-listen! You can also review the helpful infographic on our website (https://breakpoints-sidp.org/infographics/). This podcast was supported by an unrestricted grant from Nestlé Health Science. References: Helpful review from one of our guest experts: Gens KD, et al. Fecal microbiota transplantation and emerging treatments for Clostridium difficile infection. J Pharm Pract. 2013 Oct;26(5):498-505. doi: 10.1177/0897190013499527. PMID: 23966282. More modern review: Herbin SR, et al. Breaking the Cycle of Recurrent Clostridioides difficile Infections: A Narrative Review Exploring Current and Novel Therapeutic Strategies. J Pharm Pract. 2024 Dec;37(6):1361-1373. doi: 10.1177/08971900241248883. Epub 2024 May 13. PMID: 38739837. Review on designing microbiota based therapies (pre-print only): Ke S, et al. Rational Design of Live Biotherapeutic Products for the Prevention of Clostridioides difficile Infection. 2024 May 02. doi: 10.1101/2024.04.30.591969. [FDA Guidance regarding IND requirements for fecal microbiota transplant](https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-regarding-investigational-new-drug-requirements-use-fecal-microbiota). 2022 Nov. OpenBiome webpage with resources for hospitals: How to Start an FMT Program. 2025. Peery AF, et al. AGA Clinical Practice Guideline on Fecal Microbiota-Based Therapies for Select Gastrointestinal Diseases. Gastroenterology. 2024 Mar;166(3):409-434. doi: 10.1053/j.gastro.2024.01.008. PMID: 38395525. Johnson S, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clin Infect Dis. 2021 Sep 7;73(5):755-757. doi: 10.1093/cid/ciab718. PMID: 34492699. Henry Ford's experience getting fecal microbiota products for patients: Abene S. Fecal Microbiota Capsules Improve CDI Access Through Specialty Pharmacy Integration. Contagion Live. 2025 Jul 11. An international view on CDI management: Mendo-Lopez R, et al. Best Practices in the Management of Clostridioides difficile Infection in Developing Nations. Trop Med Infect Dis. 2024 Aug 19;9(8):185. doi: 10.3390/tropicalmed9080185. PMID: 39195623. Review on investigational LBP agents: Monday L, et al. Microbiota-Based Live Biotherapeutic Products for Clostridioides Difficile Infection- The Devil is in the Details. Infect Drug Resist. 2024 Feb 15;17:623-639. doi: 10.2147/IDR.S419243. PMID: 38375101. More on quorum sensing: Falà AK, et al. Quorum sensing in human gut and food microbiomes: Significance and potential for therapeutic targeting. Front Microbiol. 2022 Nov 25;13:1002185. doi: 10.3389/fmicb.2022.1002185. PMID: 36504831. Economic impacts of CDI pts: Reilly J, et al. Economic impact of multiple recurrent Clostridioides difficile infection in a community teaching hospital. Infect Control Hosp Epidemiol. 2025 Sep 29:1-3. doi: 10.1017/ice.2025.10295. Epub ahead of print. PMID: 41020576.

SIBO and IMO: Understanding Gut Overgrowth, Methane, and Archaea

Gastro Girl

Play Episode Listen Later Nov 13, 2025 44:55

In this follow-up to one of our most popular episodes, host Jacqueline Gaulin welcomes back Dr. Mark Pimentel, Executive Director of the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai, to dive deeper into the science behind SIBO (Small Intestinal Bacterial Overgrowth) and IMO (Intestinal Methanogen Overgrowth). Dr. Pimentel answers listener questions and explains how these complex conditions relate to IBS-D and IBS-M, why methane and archaea matter for gut health, and how motility and the Migrating Motor Complex (MMC) play a crucial role in prevention and treatment. You'll also learn about the latest insights and therapeutic approaches that can help patients find lasting relief. Produced in collaboration with the American College of Gastroenterology's Patient Care Committee, this evidence-based discussion helps you better understand the "why" behind SIBO and IMO—and what steps you can take toward better gut health.

executive director american colleges sibo imo methane gastroenterology pimentel cedars sinai overgrowth archaea ibs d

Reflux and Robotic Foregut Surgery (upper GI)

Franciscan Health Doc Pod

Play Episode Listen Later Nov 10, 2025

Today we are joined by general surgeon, Dr. Kirpal Singh with Franciscan Health. Dr. Singh gives us an overview of reflux and how it may present in adults. He further discusses treatment options, including how robotic surgery is used in the treatment of reflux.

surgery robotics singh gastroenterology reflux upper gi franciscan health foregut

From Transplants To Tailored IBD Treatment with Janette Villalon, PA

Play Episode Listen Later Nov 5, 2025 51:42 Transcription Available

Send us a textWant a clear, human guide to modern IBD care without the jargon? We're joined by Janette Villalon, a physician assistant at UC Irvine's IBD Center, who brings a front-line view of what truly helps patients: personalized therapy choices, honest safety talk, and practical plans that fit real life. She traces the evolution from a handful of anti-TNFs to a wider toolkit—anti-integrins, IL-12/23 and IL-23 inhibitors, JAK inhibitors, and S1P modulators—and explains how we match treatments to goals like fast relief, fewer side effects, and coverage of extraintestinal issues such as arthritis, uveitis, and psoriasis.We dig into how APPs power the day-to-day of IBD clinics, from education to monitoring and rapid access, and how the GHAPP Conference and national societies elevated advanced practice training. Janette breaks down when clinical trials make sense, why strict inclusion criteria matter, and how logistics can steer decisions when someone is very sick. She demystifies biosimilars, outlining FDA standards that support confident switches when insurance demands it, and shares how she helps patients balance infusions, injections, or pills against travel, work, and adherence.For those planning a family, Janette offers timely guidance: aim for clinical and endoscopic remission three to six months before conception, continue pregnancy-safe maintenance therapy, and discuss starting low-dose aspirin at 12 to 16 weeks to lower preeclampsia risk, coordinated with maternal-fetal medicine.Looking ahead, we explore precision medicine and AI—predictive markers, microbiome insights, and smarter monitoring that could reduce trial-and-error and catch flares early. The throughline is empowerment: ask questions, read, return for follow-ups, and shape your care around your life. We close with community resources from the Crohn's & Colitis Foundation and a shout-out to Camp Oasis for young patients.If this conversation helped you, subscribe, share it with a friend, and leave a quick review—what's the one topic you want us to go deeper on next?Links: Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) organization Camp Oasis- Crohn's & Colitis Foundation USAIBD Medication Guide- Crohn's & Colitis Foundation USAPregnancy & IBD video- Crohn's & Colitis Foundation USALet's get social!!Follow us on Instagram!Follow us on Facebook!Follow us on Twitter!

Season 7 Kickoff: Meet the New Hosts!

chicago credit kickoff blue sky drs pediatrics cme gastroenterology jennifer lee new hosts showthis pediatric gastroenterology jason silverman

Play Episode Listen Later Nov 3, 2025 27:21

We are kicking off Season 7 with a HUGE announcement -- we have TWO new podcast cohosts!Hosts Drs. Temara Hajjat, Jennifer Lee, Peter Lu, and Jason Silverman take a look back at Season 6 and introduce our new podcast hosts, Drs. Amber Hildreth and Jordan Whatley! We get to know them a little better and also talk about ways we focus on wellness despite the craziness of our work (and non-work) lives.And sorry for the subpar audio quality -- Peter was recording from a hotel bathroom...See you all at the NASPGHAN Annual Meeting in Chicago later this week! #NASPGHAN25Support the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Pharmascope Épisode 90: Anémie ferriprive: on ne sait plus quoi en fer! – partie 2

Practical Talks for Family Docs

Play Episode Listen Later Oct 31, 2025 34:23

Un nouvel épisode du Pharmascope est disponible! Dans ce 90ème épisode et la deuxième et dernière partie de notre série concernant l'usage du fer, Nicolas, Sébastien et Isabelle décortiquent les subtilités de la posologie optimale de fer. Les objectifs pour cet épisode sont les suivants: Comparer les avantages et les inconvénients des différentes posologies de fer possibles (prise intermittente, uniquotidienne, biquotidienne) Conseiller un patient lors de l'initiation d'un traitement de fer Expliquer dans quel contexte l'administration de fer intraveineux est indiqué Ressources pertinentes en lien avec l'épisode Lignes directrices Snook J et coll. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021;70:2030-51. British Columbia Ministry of Health. Iron Deficiency – Diagnosis and Management. BCGuidelines.ca. Avril 2019. Article de revue Pasricha S-R et coll. Iron deficiency. Lancet. 2021;397:233-48. Articles portant sur la posologie du fer oral Lee H et coll. Iron dosing frequency. Can Fam Physician. 2021;67:436. Rimon E et coll. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J Med. 2005;118:1142-7. Fernandez-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Cochrane Database Syst Rev. 2019;1:CD009218. Düzen Oflas N et coll. Comparison of the effects of oral iron treatment every day and every other day in female patients with iron deficiency anaemia. Intern Med J. 2020;50:854-8. Kaundal R et coll. Randomized controlled trial of twice-daily versus alternate-day oral iron therapy in the treatment of iron-deficiency anemia. Ann Hematol. 2020;99:57-63. Utilisation du fer intraveineux Litton E et coll. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013;347:f4822. Ponikowski P et coll. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet. 2020;396:1895-1904.

health management safety comparison dans gut intermittent lancet sait gastroenterology bmj conseiller randomized utilisation lignes british society expliquer comparer cochrane database syst rev lee h am j med british columbia ministry ferric

Pharmascope Épisode 89: Anémie ferriprive: on ne sait plus quoi en fer! – partie 1

Practical Talks for Family Docs

Play Episode Listen Later Oct 31, 2025 31:04

Un nouvel épisode du Pharmascope est disponible! Dans ce 89ème épisode, premier d'une série de deux concernant l'usage du fer, Nicolas, Sébastien et Isabelle animeront vos globules rouges en vous parlant de l'évaluation d'une carence en fer, des indications de traitement ainsi que des différences cliniques entre les différentes formulations de fer. Les objectifs pour cet épisode sont les suivants: Interpréter un résultat de ferritine Identifier les patients pouvant bénéficier d'un traitement de fer Comparer les avantages et inconvénients cliniques des différentes formulations de fer Ressources pertinentes en lien avec l'épisode Lignes directrices Snook J et coll. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021;70:2030-51. British Columbia Ministry of Health. Iron Deficiency – Diagnosis and Management. BCGuidelines.ca. Avril 2019. Article de revue Pasricha S-R et coll. Iron deficiency. Lancet. 2021;397:233-48. Document de l'INESSS sur l'utilisation du bilan martial Boughrassa F, Framarin A. Usage judicieux de 14 analyses biomédicales. Institut national d'excellence en santé et en services sociaux. Avril 2014. Revues du traitement de la carence en fer sans anémie Miles LF et coll. Intravenous iron therapy for non anaemic, iron deficient adults. Cochrane Database Syst Rev. 2019;12:CD013084. Houston BL et coll. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials. BMJ Open. 2018;8:e019240. McKennitt D, Allan GM. Iron Supplementation in Non-Anemic Women with Unexplainable Fatigue: Another Tired Theory? Tools for Practice 79. Août 2016. Revue de la comparaison de l'efficacité et l'innocuité de types de fer Moe S, Allan GM. New iron supplements for anemia. Can Fam Phys. 2019;65(8):556. Étude portant sur la prise concomitante de vitamine C Li N et coll. The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia: A Randomized Clinical Trial. JAMA Network Open. 2020;3:e2023644.

Episode #84: Streamlining Specialty Medication Management | Louisiana Gastroenterology Associates | Squad Health

Gastro Broadcast

Play Episode Listen Later Oct 29, 2025

Dr. Lisa Mathew interviews Mallika Khandelwal, founder and CEO of Squad Health, and Tasha Cieslak, practice manager of Louisiana Gastroenterology Associates about how independent GI practices can streamline the management of complex prescription workflows. Squad Health is an AI-enabled healthcare technology company developing solutions to streamline access to specialty medications and reduce the workload around prior authorizations and appeals. Join Lisa, Mallika, and Tasha as they discuss how technology can ease administrative burden in gastroenterology, what early automation looks like inside a busy practice, and the innovations ahead for practices adopting AI-driven solutions to improve efficiency and access to care. Produced by Andrew Sousa and Hayden Margolis for Steadfast Collaborative, LLC Mixed and mastered by Hayden Margolis Gastro Broadcast, Episode 84, presented by TissueCypher from Castle Biosciences

ceo health ai louisiana squad associates medications gi specialty streamlining gastroenterology mallika medication management castle biosciences

TSLP and EoE: Exploring the Science Behind a Potential Treatment Target

Real Talk: Eosinophilic Diseases

Play Episode Listen Later Oct 29, 2025 33:10

Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Andrew Lee, Vice President, Clinical Research at Uniquity Bio, about Thymic Stromal Lymphopoietin (TSLP) and eosinophilic esophagitis (EOE). Disclaimer: The information provided in this podcast is designed to support, not replace, the relationship 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] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz. [1:13] Holly introduces today's topic, Thymic Stromal Lymphopoietin (TSLP) and eosinophilic esophagitis (EOE), and today's guest, Dr. Andrew Lee, Vice President, Clinical Research at Uniquity Bio. [1:36] Dr. Lee has nearly 20 years of experience in the clinical development of new vaccines, biologics, and drugs. Holly welcomes Dr. Lee. [1:52] Dr. Lee trained in internal medicine and infectious diseases. [1:58] Dr. Lee has been fascinated by the immune system and how it can protect people against infections, what happens when immunity is damaged, as in HIV and AIDS, and how to apply that knowledge to boost immunity with vaccines to prevent infections. [2:16] Dr. Lee led the clinical development for a pediatric combination vaccine for infants and toddlers. It is approved in the U.S. and the EU. [2:29] Dr. Lee led the Phase 3 Program for a monoclonal antibody to prevent RSV, a serious infection in infants. That antibody was approved in June 2025 for use in the U.S. [2:44] In his current company, Dr. Lee leads research into approaches to counteract an overactive immune system. They're looking at anti-inflammatory approaches to diseases like asthma, EoE, and COPD. [2:58] Dr. Lee directs the ongoing Phase 2 studies that they are running in those areas. [3:28] Dr. Lee sees drug development as a chance to apply cutting-edge research to benefit people. He trained at Bellevue Hospital in New York City in the 1990s. [3:40] When Dr. Lee started as an intern, there were dedicated ICU wards for AIDS patients because many of the sickest patients were dying of AIDS and its complications. [3:52] Before the end of Dr. Lee's residency, they shut down those wards because the patients were on anti-retroviral medications and were doing so well that they were treated as outpatients. They didn't need dedicated ICUs for AIDS patients anymore. [4:09] For Dr. Lee, that was a powerful example of how pharmaceutical research and drug regimen can impact patients' lives for the better by following the science. That's what drove Dr. Lee to go in the direction of research. [4:48] Dr. Lee explains Thymic Stromal Lymphopoietin (TSLP). TSLP serves as an alarm signal for Type 2 or TH2 inflammation, a branch of the immune responses responsible for allergic responses and also immunity against parasites. [5:17] When the cells that line the GI tract and the cells that line the airways in our lungs receive an insult or an injury, they get a danger signal, then they make TSLP. [5:28] This signal activates other immune cells, like eosinophils and dendritic cells, which make other inflammatory signals or cytokines like IL-4, IL-13, and IL-5. [5:47] That cascade leads to inflammation, which is designed to protect the body in response to the danger signal, but in some diseases, when there's continued exposure to allergens or irritants, that inflammation goes from being protective to being harmful. [6:15] That continued inflammation, over the years, can lead to things like the thickened esophagus with EoE, or lungs that are less pliant and less able to expand, in respiratory diseases. [6:48] Dr. Lee says he thinks of TSLP as being a master switch for this branch of immune responses. If you turn on TSLP, that turns on a lot of steps that lead to generating an allergic type of response. [7:06] It's also the same type of immune response that can fight off parasite infections. It's the first step in a cascade of other steps generating that type of immune response. [7:30] Dr. Lee says people have natural genetic variation in the genes that incur TSLP. [7:38] Observational studies have found that some people with genetic variations that lead to higher levels of TSLP in their bodies had an increased risk for allergic inflammatory diseases like EoE, atopic dermatitis, and asthma. [8:13] Studies like the one just mentioned point to TSLP being important for increased risk of developing atopic types of diseases like EoE and others. There's been some work done in the laboratory that shows that TSLP is important for activating eosinophils. [8:38] There's accumulating evidence that TSLP activation leads to eosinophil activation, other immune cells, or white blood cells getting activated. [9:07] Like a cascade, those cells turn on T-cells and B-cells, which are like vector cells. They lead to direct responses to fight off infections, in case that's the signal that leads to the turning on TSLP. [9:48] Ryan refers to a paper published in the American Journal of Gastroenterology exploring the role of TSLP in an experimental mouse model of eosinophilic esophagitis. Ryan asks what the researchers were aiming to find. [10:00] Dr. Lee says the researchers were looking at the genetic studies we talked about, the observational studies that are beginning to link more TSLP with more risk for EoE and those types of diseases. [10:12] The other type of evidence that's accumulating is from in vitro (in glass) experiments or test tube experiments, where you take a couple of cells that you think are relevant to what's going on. [10:28] For example, you could get some esophageal cells and a couple of immune cells, and put TSLP into the mix, and you see that TSLP leads to activation of those immune cells and that leads to some effects on the esophageal cells. [10:42] Those are nice studies, but they're very simplified compared to what you can do in the body. These researchers were interested in extending those initial observations from other studies, but working in the more realistic situation of a mouse model. [11:00] You have the whole body of the mouse being involved. You can explore what TSLP is doing and model a disease that closely mimics what's happening with EoE in humans. [12:23] They recreated the situation of what seems to be happening in EoE in people. We haven't identified it specifically, but there's some sort of food allergen in patients with EoE that the immune system is set off by. [12:55] What researchers are observing in this paper is that in these mice that were treated with oxazolone, there is inflammation in the esophagus, an increase in TSLP levels, and eosinophils going into the esophageal tissues. [13:15] Dr. Lee says, that's one of the main ways we diagnose EoE; we take a biopsy of the esophagus and count how many eosinophils there are. Researchers saw similar findings. The eosinophil count in the esophageal tissues went way up in these mice. [13:34] Researchers also saw other findings in these mice that are very similar to EoE in humans, such as the esophageal cells lining the esophagus proliferating. They even saw that new blood vessels were being created in that tissue that's getting inflamed. [14:00] Dr. Lee thinks it's a very nice paper because it shows that correlation: Increase TSLP and you see these eosinophils going to the esophagus, and these changes that are very reminiscent of what we see in people with EoE. [14:51] In this paper, the mice made the TSLP, and researchers were able to measure the TSLP in the esophageal tissue. The researchers didn't introduce TSLP into the mice. The mice made the TSLP in response to being repeatedly exposed to oxazolone. [15:20] That's key to the importance of the laboratory work. The fact that the TSLP is made by the mice is important. It makes it a very realistic model for what we're seeing in people. [15:41] In science, we like to see correlation. The researchers showed a nice correlation. [15:46] When TSLP went up in these mice, and the mice were making more TSLP on their own, at the same time, they saw all these changes in the esophagus that look a lot like what EoE looks like in people. [16:01] They saw the eosinophils coming into the esophagus. They saw the inflammation go up in the esophagus. What Dr. Lee liked about this paper is that they continued the story. [16:15] The researchers took something that decreases TSLP levels, an antibody that binds to and blocks TSLP, and when they did that, they saw the TSLP levels come down to half the peak level. [16:35] Then they saw improvement in the inflammation in the esophagus. They saw that the amount of eosinophils decreased, and the multiplication of the esophageal cells went down. The number of new blood vessels went down after the TSLP was reduced. [16:53] Dr. Lee says, you see correlation. The second part is evidence for causation. When you take TSLP away, things get better. That gives us a lot of confidence that this is a real finding. It's not just observational. There is causation evidence here. [18:26] Ryan asks if cutting TSLP also help reduce other immune response cells. Dr. Lee says TSLP is the master regulator for this Type 2 inflammation. It definitely touches and influences other cells besides eosinophils. [18:44] TSLP affects dendritic cells, which are an important type of immune cell, like a coordinating cell that instructs other cells within the immune system what to do. In this paper, they looked at a lot of other effects of TSLP on the tissues of the body. [19:10] Dr. Lee says, There's a lot of research on TSLP, and one of the reasons we're excited about the promise of TSLP is that it's so far upstream; so much of the beginning, that it's affecting other cells. [19:29] Its effects could be quite broad. If we're able to successfully block TSLP, we could block a lot of different effects. [19:40] One treatment for EoE is dupilumab, which blocks IL-4 and IL-13 specifically, and that works well, but TSLP has the potential to have an even greater effect than blocking IL-4 and IL-13, since it is one step before turning on IL-4 and IL-13. [20:14] That's one of the reasons researchers are excited about the promise of blocking TSLP. There are studies ongoing of TSLP blockers in people with EoE. [20:34] Ryan asks if there are negative repercussions from blocking TSLP. Dr. Lee says in this study and in people, we are not completely blocking TSLP by any means. There will still be residual TSLP activated, even with very potent drugs. [21:01] In the study, they block TSLP about 50%‒60%. TSLP is involved in immunity against parasites. In studies with people, they make sure not to include anybody who has an active parasitic infection. A person under treatment should not be in a study. [21:27] Dr. Lee says we haven't seen any problems with parasitic infections becoming more severe, but that is a theoretical possibility, so for that reason, in studies with TSLP blockers, we generally exclude patients with known parasitic infections. [22:17] What excited Dr. Lee in this paper was that they showed that when you block TSLP in the mice, then you get real effects in their tissues. Eosinophils went away. The thickening of the basal layers in the esophagus got much better. [22:38] That kind of real effect reflected in the tissue is super exciting to see. That gives us more confidence that this could work in people, since we're seeing it in a realistic whole-body model in the mice. [23:12] Dr. Lee says there are ongoing clinical studies on TSLP blockers for EoE. His company is studying an antibody that blocks TSLP in eczema, COPD, and EoE. One of the exciting things about immunology is that it affects many different parts of the body. [23:42] EoE is associated with other immune-type disorders. There's a high percentage of patients with EoE who have other diseases. EoE coexists with asthma, atopic dermatitis, and chronic rhinitis. [24:09] It's exciting that if you figure out something that's promising for one disease that TSLP affects, it could have very broad-ranging implications for a variety of diseases. [24:22] Ryan shares his experience of his doctor talking to him about a TSLP blocker, tezepelumab, as a potential option when it's out of clinical trials. It would target something a little higher up the chain and help with some of his remaining symptoms. [24:59] Ryan is excited to hear that this research is so encouraging and how it could potentially help treat EoE, asthma, and other conditions, all at once. [25:16] Dr. Lee says that being in these later-stage studies is super exciting. If these late-stage trials are successful, the next step is to apply for regulatory approval with the various agencies around the world. [26:40] Dr. Lee shares one takeaway for listeners to remember. Think of TSLP as an alarm that turns on inflammation. He compares TSLP to turning on an alarm during a robbery. There are multiple steps designed to protect the bank and the money. [27:20] To extend that analogy, with TSLP, once you turn it on, all these other steps are going to happen. Inflammation is designed to protect the body. It's a protective response. If there's an infection, it can clear the infection. [27:38] If the infection persists, as in HIV, the immune response, which is protective and beneficial, eventually becomes damaging. It becomes dysfunctional. In EoE, if you continually eat the allergic food, the inflammation becomes damaging to the esophagus. [28:27] Long-term inflammation leads to replacing the normal esophageal tissue with fibrotic tissue, and that's why the esophagus eventually gets hardened and less able to let the food go through. [28:40] In respiratory diseases, the soft tissue of the lung gets replaced with thicker tissue, and the lung is not able to expand. [28:54] Dr. Lee says he people to think about TSLP as this master alarm switch. We hope that if you could turn off that TSLP, you could then avoid a lot of the complications that we see with chronic inflammation in these conditions. [29:14] We're hopeful that you could even take away the symptoms that you see in these diseases, make patients feel better, and with extended treatment, you could begin to reverse some of the damage resulting from inflammation. [29:32] Ryan likes that analogy and how Dr. Lee has concisely explained these complicated concepts. [29:51] Dr. Lee thanks Holly and Ryan and adds one more plea to listeners. Please consider getting involved with research. Clinical trials cannot be done without patients. We need patients to advance new treatments. [30:27] Researchers like Dr. Lee spend a lot of time thinking about how to make the studies not only informative but also fair to patients who decide to become involved. It's a lot of work and a fair amount of time commitment. [30:44] If you don't want to be in a study, you can help by being on a patient feedback panel and reviewing protocols and informed consents. Follow your interests. Think about getting involved with research, however you can. [31:06] Ryan and Holly are very grateful for the community, with so many wonderful clinicians and researchers, and so many patients who are willing to volunteer their time and their data to help researchers find better solutions going forward. [31:26] Ryan thanks Dr. Lee for coming on and putting out that call to action. It's a great reminder for listeners and the patients in the community to look for those opportunities. Chat with your physician. Go to APFED's website. There's a link to active clinical trials. [31:47] For our listeners who want to learn more about eosinophilic disorders, we encourage you to visit apfed.org and check out the links in the show notes below. [31:53] For those looking to find specialists who treat eosinophilic disorders, we encourage you to use APFED's Specialist Finder at apfed.org/specialist. [32:01] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections. [32:11] Ryan thanks Dr. Andrew Lee for joining us today. We learned a lot. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda for supporting this episode. Mentioned in This Episode: Andrew Lee, M.D., VP Clinical Research, Uniquity Bio "A Mouse Model for Eosinophilic Esophagitis (EoE)" Current Protocols, Wiley Online Library APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections apfed.org/research/clinical-trials Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda. Tweetables: "I see drug development as a chance to apply cutting-edge research to benefit people." — Andrew Lee, M.D. "When the cells that line the GI tract and the cells that line the airways in our lungs receive an insult or an injury, they get a danger signal, then they make TSLP." — Andrew Lee, M.D. "Observational studies have found that some people with genetic variations that lead to higher levels of TSLP in their bodies had an increased risk for allergic inflammatory diseases like EoE, atopic dermatitis, and asthma." — Andrew Lee, M.D. "There's a lot of research on TSLP, and one of the reasons we're excited about the promise of TSLP is that it's so far upstream; so much of the beginning, that it's affecting other cells." — Andrew Lee, M.D. "Please consider getting involved with research. We can't do these clinical trials without patients. We need patients to advance new treatments for patients." — Andrew Lee, M.D.

Mind, Body, Gut: A Comprehensive Look at Gastroenterology, Part 2

Intelligent Medicine

Play Episode Listen Later Oct 28, 2025 41:50

Dr. Hoffman continues his conversation with Dr. Alexandra Shustina, NYC's and Miami's premier Integrative board-certified Gastroenterologist and gut health specialist, an expert in the gut microbiome and its role in health and wellness.

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Mind, Body, Gut: A Comprehensive Look at Gastroenterology, Part 1

Intelligent Medicine

Play Episode Listen Later Oct 28, 2025 45:01

In this episode of the Intelligent Medicine podcast, Dr. Ronald Hoffman is joined by Dr. Alexandra Shustina, a distinguished integrative gastroenterologist based in New York City and Miami. They delve into Dr. Shustina's journey from conventional to integrative medicine, the importance of addressing the microbiome, and holistic approaches to treating gastrointestinal ailments like IBS, Crohn's disease, and ulcerative colitis. Dr. Shustina shares her insights on diet, the impact of stress, and the role of supplements and herbal remedies. She discusses the significance of personalized care, visceral manipulation, and mind-body techniques in promoting gut health. The episode also touches on the rising incidence of gastrointestinal cancers in young people and the potential benefits of proactive, integrative healthcare approaches.

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Diagnosing and Treating Hemochromatosis: Expert Insights

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Play Episode Listen Later Oct 28, 2025

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Paul Adams, MD Hemochromatosis, a genetic condition that causes the body to absorb too much iron from food, often goes unrecognized despite its prevalance. With unique diagnostic and management challenges, it's crucial to understand how it presents, which testing strategies are most effective, and what treatment options are available. Tune in to hear Dr. Peter Buch and Dr. Paul Adams, Professor in the Division of Gastroenterology at the Western University in London, Canada, discuss the latest on hemochromatosis.

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Mayo Clinic Test Predicts Who Gets GLP-1 Side Effects, with Dr. Andres Acosta

Causes Or Cures

Play Episode Listen Later Oct 22, 2025 54:55

Send us a textDr. Acosta returns to Causes or Cures to talk about the next big leap in obesity research: using genetics and machine learning to predict which patients will get side effects to popular GLP-1 weight-loss medications like Wegovy and Zepbound. Previously, he was on Causes or Cures to discuss your individual obesity type. He and his team are uncovering why some people experience major weight loss while others face tough side effects—especially nausea. The goal? True precision medicine for obesity: matching the right treatment to the right person before treatment even begins. (You can learn more about their available tests and company here.) Topics We DiscussDr. Acosta's background and what drew him to obesity researchWhy not all obesity is the same—and why that matters for patients and doctorsThe most common questions patients ask about GLP-1 drugs like Wegovy and ZepboundHow big a problem side effects like nausea really are in practiceNew research using genetic markers to predict who's more likely to experience side effectsWhether eating style affects nausea and how Dr. Acosta coaches patients on nutrition while using these medicationsThe possibility of genetic testing before prescribing GLP-1sWhat we know about rarer side effects, from vision to hearing changes, if he thinks more side effects will emergeWhat “satiation” (feeling full) means and why it varies so much between peopleHow genetic risk and satiation scores could determine which obesity treatment works bestDr. Acosta's thoughts on obesity prevention, especially on renewed energy to take on the unhealthy food industryThe persistence of stigma—why “willpower” doesn't tell the whole storyWhether the current obsession with obesity drugs distracts from prevention, nutrition, and community health Listen if you've ever wondered:Why GLP-1 drugs don't work the same for everyoneWhat your genes have to do with weight loss, feeling full and side effectsHow soon doctors could use genetic tests to personalize obesity treatmentWhether prevention is being overshadowed by the pharma spotlightWhy it mattersObesity isn't a one-size-fits-all condition—and neither should its treatment be. Dr. Acosta's research could mark a turning point in how we approach weight loss: scientifically, compassionately, and individually. Dr. Acosta is a Consultant of Gastroenterology and Hepatology at the Mayo Clinic, as well as an Associate Professor of Medicine. His research focus is on gastrointestinal physiology and the complexity of food intake regulation as it relates to obesity. You can learn more about his work here.You can contact Dr. Eeks at bloomingwellness.com.Follow Eeks on Instagram here.Or Facebook here.Or X.On Youtube.Or TikTok.SUBSCRIBE to her WEEKLY newsletter here! (Now featuring interviews with top experts on health you care about!)Support the show

Jose T- From Boxing Dreams To IBD Advocacy

Play Episode Listen Later Oct 22, 2025 49:17 Transcription Available

Send us a textA boxer in training. A terrifying spiral of symptoms. A life-saving surgery that changed everything. Jose Torres joins us to share how ulcerative colitis pulled him out of the ring and propelled him into purpose—building community, advancing equity, and living well with a J‑pouch in a city that isn't designed for urgent needs.We trace Jose's path from misdiagnosis in Brooklyn to specialized care in Manhattan and the brutal logistics of public transit without bathrooms. He opens up about the cultural currents in his Mexican and Puerto Rican family—why speaking up took time, why steroids raised tough questions, and how food traditions collided with new IBD realities. The story turns on resilience: a colectomy and J‑pouch, early pouchitis, iron infusions, and then a decade of medication-free stability supported by smart nutrition, consistent exercise, and honest attention to mental health.Jose also brings us inside the Crohn's & Colitis Foundation—from literally ringing the office doorbell to roles in advancement, business development, and DEI leadership. We talk about real lived experience, research into disparities, and why culturally fluent care changes outcomes. Along the way, he shares practical tactics for managing frequency, a nudge toward pelvic floor physical therapy, and a grounded philosophy: don't chase perfection, cultivate accountability and hope.If stories of grit, culture, and community help you feel less alone with IBD, this one's for you. Cheers!Links: Camp Oasis- Crohn's & Colitis Foundation USACamp Purple- Crohn's & Colitis Foundation New ZealandAbout IBD podcast with Amber Tresca episode- "IBD in the Hispanic Community with Dr. Oriana Damas"Let's get social!!Follow us on Instagram!Follow us on Facebook!Follow us on Twitter!

Kevin Watson - AI in GI: Can AI Write My Notes for Me?

CCO Medical Specialties Podcast

Play Episode Listen Later Oct 20, 2025 37:41

In this episode of Bowel Sounds, hosts Dr. Peter Lu and Dr. Jenn Lee talk to Dr. Kevin Watson, pediatric gastroenterologist and Assistant Director of Clinical Informatics at Akron Children's Hospital and Associate Professor at Northeastern Ohio Medical University. We talk about the use of AI-powered ambient listening technology for clinical documentation and his experience introducing AI scribes to his hospital.Learning objectivesUnderstand the advantages and limitations of the current state of ambient listening technology for clinical documentation.Review practical guidance on usage of this technology in pediatric gastroenterology.Recognize key strategies for successful implementation and adoption of this technology.Support the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

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How Women Physicians Buy Back Time And Achieve Money Freedom: Dr. Latifat's Money Secrets

Dr. Tamara Beckford Show

Play Episode Listen Later Oct 20, 2025 57:18

Money is a tool. Freedom is the goal. A plan is the bridge. Join us for a powerful conversation with Dr. Latifat Akintade, a board-certified gastroenterologist, founder of MoneyFitMD and The Money Coaching School for Women Physicians, bestselling author of The Power to Choose and Done With Broke, and host of the MoneyFitMD Podcast.We will cover the mindset and mechanics that help women physicians achieve true financial freedom without losing wellness or identity. Learn how to create a simple money plan, pay off six-figure debt, grow your net worth, and invest with confidence. Discover how to align money choices with your values, career, and life.About Dr. LatifatDr. Latifat Akintade trained at the University of California, Davis School of Medicine, completed Internal Medicine residency at the Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, and pursued Gastroenterology fellowship at the University of California, San Francisco School of Medicine. She is board certified in Gastroenterology by the American Board of Internal Medicine. As the visionary behind MoneyFitMD and The Money Coaching School for Women Physicians, she blends clinical expertise, money coaching, and life coaching to help women physicians build wealth without sacrificing wellness or identity. She is a sought after speaker, an Amazon bestselling author, a dynamic podcast host, and a proud mother of three daughters who loves great books, loud laughs, and ocean views.What you will learnA step by step money plan for women physiciansHow to crush debt and build wealth with clarityInvesting basics that reduce stress and boost confidenceHow to protect wellness while you grow your net worthThe power of choice in career, family, and freedomLearn more.www.moneyfitmd.com

Keeping Up With New Developments in PBC

Play Episode Listen Later Oct 17, 2025 48:04

Tune in to listen as expert faculty, Dr Christopher L. Bowlus and Dr Sonal Kumar, discuss recent developments in treating primary biliary cholangitis (PBC) with new and emerging agents, as well as strategies to integrate these advances into clinical practice.Topics covered include: Methods of Assessing PBC Disease ProgressionNewer Agents for Second-line Treatment of PBCPrioritizing Symptom Management and Quality of Life With PBC TreatmentPresenters:Christopher L. Bowlus, MDLena Valenta Professor and ChiefDivision of Gastroenterology and HepatologySchool of Medicine University of California Davis Sacramento, CaliforniaSonal Kumar, MD, MPHAssistant Professor of MedicineDivision of Gastroenterology and HepatologyWeill Cornell Medical CollegeNew York, New YorkLink to full program: https://bit.ly/43nHx6UGet access to all of our new podcasts by subscribing to the CCO Medical Specialties Podcast on Apple Podcasts, Google Podcasts, or Spotify.  Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Consult on Disorders of Gut-Brain Interaction

Pediatric Consult Podcast

Play Episode Listen Later Oct 15, 2025 47:53

Pediatrician Dr. Paul Bunch consults Dr. Kahleb Graham from the Division of Gastroenterology, Hepatology, and Nutrition and Dr. Megan Miller from the Division of Behavioral Medicine and Clinical Psychology on disorders of gut-brain interaction. Episode recorded on September 17, 2025. Resources discussed in this episode: Anxiety Assessment - Community Practice Support Tool Anxiety Management - Community Practice Support Tool Chronic Nausea and Vomiting - Community Practice Support Tool Functional Abdominal Pain - Community Practice Support Tool Financial Disclosure: The following relevant financial relationships have been disclosed: None All relevant financial relationships listed have been mitigated. Remaining persons in control of content have no relevant financial relationships. To Claim Credit: Click "Launch Activity." Click "Launch Website" to access and listen to the podcast. After listening to the entire podcast, click "Post Test" and complete. Accreditation In support of improving patient care, Cincinnati Children's Hospital Medical Center is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Specific accreditation information will be provided for each activity. Physician: Cincinnati Children's designates this Enduring Material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nursing: This activity is approved for a maximum 0.75 continuing nursing education (CNE) contact hours. ABP MOCpt2: Completion of this CME activity, which includes learner assessment and feedback, enables the learner to earn up to 0.75 points in the American Board of Pediatrics' (ABP) Maintenance of Certification (MOC) program. Cincinnati Children's submits MOC/CC credit for board diplomates. Credits AMA PRA Category 1 Credits™ (0.75 hours), ABP MOC Part 2 (0.75 hours), CME - Non-Physician (Attendance) (0.75 hours), Nursing CE (0.75 hours)

Episode 38 - Countdown to Chicago: What's Ahead at the CPNP Nutrition Symposium

Nutrition Pearls: The Pediatric GI Nutrition Podcast

Play Episode Listen Later Oct 15, 2025 17:06

Episode 38 - Countdown to Chicago: What's Ahead at the CPNP Nutrition SymposiumIn this episode of Nutrition Pearls: the Podcast, host Nikki Misner speaks with Dr. Brock Williams and Tamara Sims Dorway about the upcoming CPNP Nutrition Symposium at the annual NASPGHAN meeting on November 6-8th in Chicago, Illinois. Brock Williams is a Registered Dietitian and Postdoctoral Research Fellow at the University of British Columbia (Vancouver, Canada). Over the past 10 years, he has worked as both a clinical and research dietitian at the Hospital for Sick Children (SickKids; Toronto), and at BC Children's Hospital (Vancouver) in areas such as Translational Medicine, Gastroenterology, and Allergy. His major clinical and research interests lie in micronutrients and childhood feeding (human milk feeding, complementary feeding and the prevention and treatment of food allergy). Brock currently serves as President-elect of CPNP. Tamara Sims Dorway is an experienced Registered Dietitian who is a board-certified specialist in pediatric nutrition. She is an integral part of the multidisciplinary team at the Center for Digestive Health and Nutrition at Arnold Palmer Hospital, where she provides comprehensive nutritional care for children and families facing a range of GI challenges. She has previously served on the CPNP planning committee for NASPGHAN and was the communications co-chair for POWER (Pediatric Obesity Weight Evaluation Registry). She enjoys volunteering in her community and spending time with her family. She is the current CPNP Program ChairNutrition Pearls is supported by an educational grant from Mead Johnson Nutrition.Resources:NASPGHAN 2025 Annual Meeting NASPGHAN 2025 App Produced by: Corey IrwinNASPGHAN - Council for Pediatric Nutrition Professionalscpnp@naspghan.org

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Clinical Hypnosis for IBD with Dr. Ali Navidi: Tools, Science, and Real Relief

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Play Episode Listen Later Oct 8, 2025 52:15 Transcription Available

Send us a textImagine being able to turn down the volume on gut pain, food fear, and medical anxiety—without white-knuckle coping or guesswork. We sit down with Dr. Ali Navidi, co-founder of GIpsychology.com and past president of the Northern Virginia Society of Clinical Hypnosis, to unpack how clinical hypnosis and gut-focused CBT help people with inflammatory bowel disease interrupt the gut-brain loop that keeps symptoms alive. No stage tricks here—just practical tools that retrain the nervous system, reduce visceral hypersensitivity, and restore a sense of control.We explore the real differences between stage and clinical hypnosis and why trance is a natural state you already know how to access. Dr. Navidi explains how anchors—a simple conditioned cue—can trigger a calming response within seconds, whether you're prepping for a colonoscopy, calling the insurance company, or navigating an unexpected flare. We dig into disorders of gut-brain interaction (DGBIs) that can drive symptoms even when labs look great, and why gut-focused CBT plus hypnosis outperforms one-size-fits-all mental health approaches for persistent GI distress.Trauma and nocebo effects show up in subtle ways across the IBD journey. We get candid about medical trauma, memory reconsolidation, EMDR as a hypnotic protocol, and how conditioned food sensitivities form—like the “pizza panic” that lingers long after a flare. You'll hear how to calm hypervigilance, rebuild trust with your body, and reintroduce foods safely. We also share details on a new eight-week telehealth group, created with the Crohn's & Colitis Foundation and the American College of Gastroenterology, that pairs weekly skills training with recorded hypnosis sessions for daily practice.Ready to try tools that actually change how your system reacts? Follow, share with a friend who needs hope, and leave a review to help others find the show. Your story might be the anchor someone else needs today.Links: Information about the IBD Psychotherapy GroupInformation on Disorder of the Gut-Brain Interaction (DGBI)Great resources from GI PsychologyArticle in the AtlanticDr. Navidi on the About IBD Podcast with Amber TrescaLet's get social!!Follow us on Instagram!Follow us on Facebook!Follow us on Twitter!

Innovation and Entrepreneurship with Amitabh Chak, MD

The Gut Doctor

Play Episode Listen Later Oct 7, 2025 23:52

Gastroenterology offers a unique and dynamic landscape for innovation and entrepreneurship but as providers we are often not aware of what steps we need to take. In today's episode, Dr. Parikh interviews Dr. Amitabh Chak, president of the American Society of Gastrointestinal Endoscopy. Dr. Chak shares his latest innovation trends in GI, key steps every GI entrepreneur should take, barriers we face, and how ASGE is creating the infrastructure to support this ecosystem. With this infrastructure in mind, they highlight ASGE's upcoming Festival of Innovation and EndoScopic Technology at ASGE (FIESTA) on November 14th and 15th. For those interested in learning more or registering for FIESTA, please visit www.ASGE.org/FIESTA.

Jordan Whatley - GI Issues in Children with Tracheostomy and Ventilator Dependence

Followership with Ryan Leak

Play Episode Listen Later Oct 6, 2025 48:56

In this episode, hosts Drs. Temara Hajjat and Jenn Lee talk to Dr. Jordan Whatley, Assitant Professor of Pediatrics at the Medical University of South Carolina and pediatric gastroenterologist at Shawn Jenkins Children's Hospital in Charleston, South Carolina. We discuss how multi-specialty clinics focusing on children with tracheostomy and ventilator dependence can improve clinical care.Learning Objectives:Describe the reasons children may require a tracheostomy and home mechanical ventilation.Explain multidisciplinary structure and purpose of an aerodigestive clinic in managing complex pediatric patients. Describe the gastroenterologist's role in evaluating and managing GERD, feeding intolerance, and nutritional needs in children with trach/vent dependence. Support the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

The Science of Forgiveness

Play Episode Listen Later Oct 6, 2025 14:17

Forgiveness isn't just a church thing. It's not just a faith thing. It's a science thing. In this episode, Ryan Leak unpacks the astounding research from both Eastern and Western medicine on how unforgiveness, bitterness, and resentment impact your physical, emotional, and mental health. From impaired liver function in Chinese medicine to reduced risk of heart disease in Western studies, the evidence is clear: your body keeps the score of what your soul is carrying.Here are a few of the studies mentioned:World Journal of Gastroenterology on liver function and chronic anger: linkJohns Hopkins Medicine on the health benefits of forgiveness: linkJournal of Behavioral Medicine study on forgiveness and mental health: linkMayo Clinic on forgiveness and stress relief: linkBut science can only take you so far. If you're wondering how to actually forgive, Ryan points to the model and the power found in Jesus Christ. If you'd like to take the next steps in your faith journey or receive prayer, text “Jesus” to 469-809-1201, and Ryan's team would love to connect with you.And if you want to dive even deeper into this topic, check out Ryan's full message on forgiveness here: Watch on YouTube

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AI in GI: Leveraging CADe to Improve Colonoscopy Performance and Accuracy

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Play Episode Listen Later Oct 3, 2025

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Charles Kahi, MD Computer-aided detection systems (CADe) are transforming adenoma detection and enhancing colonoscopy quality. Dr. Peter Buch sits down with Dr. Charles Kahi to unpack the latest American Gastroenterological Association (AGA) guideline, evidence from randomized controlled trials, and the practical implications of integrating AI tools into clinical practice. Dr. Kahi is a Professor of Medicine at Indiana University School of Medicine, and he helped develop the AGA Living Clinical Practice Guideline on Computer-Aided Detection-Assisted Colonoscopy, which was published in Gastroenterology in 2025.

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Gastroenterology Mini-Series: Acute Pancreatitis

UCONN IM Residency

Play Episode Listen Later Oct 1, 2025 18:41

In this episode of our GI Mini-Series, we touch upon Acute Pancreatitis covering its diagnosis, causes, classification, and management. The podcast also highlights risk factors for severe disease, fluid resuscitation strategies, pain control, early oral feeding, and the role of antibiotics. Tune in for an evidence-based, guideline-driven deep dive into the topic, filled with practical bedside insights you can put into practice right away.Author and Host: Dr. Ruchir Paladiya, Chief Medical Resident, UConnGuest Speaker: Dr. Neil Khoury, UConn GI Fellowship Alumnus (2022–25) and Assistant Professor of Medicine, University of South Florida (Tampa General Hospital)Editor: Dr. Ruchir Paladiya, Chief Medical Resident, UConnMusic: LoFi Girl by Snoozy Beats | Free Music Archive | License: CC BY

Probiotics in GI Practice: Evidence, Guidelines, and Emerging Innovations

Visceral: Listen to Your Gut

Play Episode Listen Later Oct 1, 2025

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Alexa Weingarden, MD PhD Probiotic use in gastroenterology remains a complex and evolving topic, shaped by variable evidence and growing patient demand. Dr. Peter Buch sits down with Dr. Alexa Weingarden to review current data, discuss distinctions between probiotic-related therapies, and explore the clinical utility of microbiome testing. Dr. Weingarden is an Assistant Professor of Gastroenterology, Hepatology, and Nutrition at the University of Minnesota Medical School.

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10 Challenges of IBD (complete)

Play Episode Listen Later Sep 30, 2025 31:48

Featuring: David T. Rubin, MD, University of Chicago MedicineThe GI Research Foundation was able to produce this podcast with sponsorships from Metro Infusion Center.David T. Rubin, MD, Joseph B. Kirsner Professor of Medicine and Chief of Gastroenterology, Hepatology and Nutrition at the University of Chicago Medicine, explores the top ten challenges faced by people with Crohn's disease and ulcerative colitis. He shares how health care providers and researchers are working to overcome these obstacles and improve patients' lives.To access other episodes of Visceral: Listen to Your Gut and learn more about the GI Research Foundation's support of clinical and laboratory research to treat, prevent, and cure digestive diseases, please visit https://www.giresearchfoundation.org/.Available on Apple Podcasts, Spotify, and everywhere else you listen.

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10 Challenges of IBD

Visceral: Listen to Your Gut

Play Episode Listen Later Sep 29, 2025 31:48 Transcription Available

Featuring: David T. Rubin, MD, University of Chicago MedicineThe GI Research Foundation was able to produce this podcast with sponsorships from Metro Infusion Center.David T. Rubin, MD, Joseph B. Kirsner Professor of Medicine and Chief of Gastroenterology, Hepatology and Nutrition at the University of Chicago Medicine, explores the top ten challenges faced by people with Crohn's disease and ulcerative colitis. He shares how health care providers and researchers are working to overcome these obstacles and improve patients' lives.To access other episodes of Visceral: Listen to Your Gut and learn more about the GI Research Foundation's support of clinical and laboratory research to treat, prevent, and cure digestive diseases, please visit https://www.giresearchfoundation.org/.Available on Apple Podcasts, Spotify, and everywhere else you listen.

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Ep. 576 Biliary Endoscopy Techniques: Managing Strictures & Drains with Dr. Ahsun Riaz

BackTable Podcast

Play Episode Listen Later Sep 26, 2025 57:24

So you've placed the biliary drain—are your patients getting the follow up that they need? In this episode, Dr. Ahsun Riaz from Northwestern University joins host, Dr. Christopher Beck, for a deep dive into biliary strictures—how to manage them effectively and navigate the potential complications of this challenging chronic condition.---This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISDr. Riaz takes us inside his journey of building a specialized hepatobiliary service at Northwestern, highlighting innovative practices like endoscopic techniques and radiofrequency ablation. He unpacks the nuances of distinguishing benign from malignant strictures, shares technical pearls for patient management, and emphasizes the power of collaboration with Gastroenterology to improve long-term patient outcomes. He outlines key technical considerations, including the use of the Hudson loop and strategic equipment selection to address intra-procedural challenges. He further emphasizes the importance of comprehensive patient care—ensuring appropriate follow-up, minimizing drain duration, and prioritizing quality of life as essential components of optimal management.---TIMESTAMPS00:00 - Introduction01:28 - Biliary Drain Management04:18 - Approach to Biliary Strictures19:20 - Endoscopic Evaluation and Techniques27:53 - Practical Tips and Experiences with Endoscopy30:39 - Post-Procedure Follow-Up and Patient Outcomes31:16 - Learning from the Hudson Roof Technique32:48 - Innovations in Benign Stricture Management36:48 - Endobiliary Ablation: Equipment and Procedure40:23 - The Double Dragon Technique Explained46:02 - Considerations for Malignant Biliary Stenting52:37 - Future Innovations and Collaborative Care

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Living with Crohn's Disease Doesn't Stop Ian Goldstein from Finding the Humor

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Play Episode Listen Later Sep 24, 2025 45:51 Transcription Available

Send us a textComedian Ian Goldstein takes us through his journey with Crohn's disease, beginning with his diagnosis at 16 when he was just trying to navigate the already challenging world of high school, SATs, and planning for college. With candid humor, he recounts the moment he realized something was seriously wrong – not just from frequent bathroom trips, but when a coworker pointed out his dramatic weight loss.What follows is a rollercoaster of medical experiences that many in the IBD community will recognize – from the shock of needing a colonoscopy as a teenager to the trial and error of finding effective medications. Ian vividly describes his first major bowel obstruction during his senior year of college, complete with what he calls the "modern-day torture device" known as an NG tube. Despite his best efforts to manage his condition through diet alone, he eventually required surgery in 2022 to remove seven strictures from his small intestine.The conversation takes a fascinating turn when Ian shares how he's transformed his medical journey into comedy shows. From "The Autoimmune Saloon" to a celebration party for meeting his healthcare deductible (complete with custom cupcakes and hats), he's found ways to create community while addressing serious issues like medical debt. These creative outlets not only helped him process his experiences but connected him with others who could offer crucial advice about doctors and treatments.Perhaps most valuable are Ian's insights about navigating the healthcare system with a chronic illness. He speaks honestly about the frustration of insurance denials, the anxiety of unexpected medical bills, and the challenges of having an invisible disability. His experiences highlight the importance of self-advocacy, finding the right medical team, and building a supportive community.Ready to laugh, cry, and feel a little less alone in your IBD journey? Listen as Ian shares his practical wisdom: record your doctor appointments to remember important information, and seek out community connections that might literally change your life. Whether you're newly diagnosed or a veteran of chronic illness, this conversation reminds us all that finding humor in dark places might be our most powerful medicine.Links: Ian's websiteNew York Times article about Ian's party to celebrate meeting his healthcare deductibleThe Squeaky Wheel- satire publication that focuses on the experiences of people living with disabilities. Tina's episode with usDr. David Schwartzberg's episode with usNicole's episode with us- Ian mentioned Nicole and how supportive she's been to him but we sadly had to cut that part out for length. But- get to know Nicole!! Let's get social!!Follow us on Instagram!Follow us on Facebook!Follow us on Twitter!

Navigating Life with Inflammatory Bowel Disease with Jannine Purcell, CNP

Doc Talk with Monument Health

Play Episode Listen Later Sep 23, 2025 23:55

Living with Inflammatory Bowel Disease (IBD) means encountering life-changing challenges, but it doesn't have to define your future. Jannine Purcell, CNP, Gastroenterology, discusses how IBD affects young adults in their 20s and 30s, often disrupting major life milestones. Jannine explains the difference between Crohn's disease and ulcerative colitis and why team-based care is essential. She shares inspiring success stories of patients who've achieved deep remission and provides insight into why close follow-up and patient education are crucial for helping young people reclaim their quality of life. Hosted on Acast. See acast.com/privacy for more information.

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La banane constipe-t-elle vraiment ?

Choses à Savoir SANTE

Play Episode Listen Later Sep 23, 2025 1:35

C'est une question qui revient souvent, car la banane a la réputation ambiguë de constiper. Mais que disent les données scientifiques ?D'abord, il faut savoir que toutes les bananes ne se valent pas ! Tout dépend de son degré de maturité. Une banane encore verte contient beaucoup d'amidon résistant, une forme d'amidon que l'intestin grêle digère mal. Résultat : il arrive presque intact dans le côlon, où il nourrit le microbiote. Cet amidon a un effet plutôt rassasiant, mais peut aussi ralentir un peu le transit. C'est probablement de là que vient la croyance que les bananes « bloquent ».En revanche, quand elle mûrit, l'amidon de la banane se transforme en sucres simples et la teneur en fibres solubles, comme la pectine, augmente. Ces fibres solubles retiennent l'eau dans l'intestin et ramollissent les selles, ce qui favorise au contraire un meilleur transit. Autrement dit : une banane mûre a plutôt un effet régulateur qu'un effet constipant.Qu'en dit la science ? Une étude publiée en 2014 dans le World Journal of Gastroenterology a montré que l'amidon résistant de la banane verte ralentissait effectivement le transit intestinal chez certains sujets sensibles. Mais d'autres travaux, comme une revue parue en 2017 dans Nutrients, soulignent le rôle bénéfique des fibres de la banane mûre dans la prévention de la constipation, notamment chez les enfants.Chez l'enfant justement, une étude menée en 2012 au Sri Lanka sur plus de 350 écoliers (Journal of Nutrition and Metabolism) a révélé que la consommation de banane mûre réduisait significativement les plaintes de constipation. Les auteurs insistent cependant : l'effet dépend du degré de maturité du fruit et de l'alimentation globale de l'enfant.En pratique, tout est donc une question de nuance :Banane verte → plus d'amidon résistant, peut ralentir le transit.Banane mûre → plus de sucres et de fibres solubles, aide à ramollir les selles.Dernier point : la banane contient aussi du potassium et du magnésium, qui participent à la contraction musculaire, y compris celle des muscles intestinaux. Un apport régulier contribue ainsi à un transit équilibré.Verdict : faux, la banane ne constipe pas… sauf si elle est encore verte. Mûre, elle agit même plutôt comme un régulateur naturel du transit. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

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Amber Hildreth - Genetic Testing for Children With GI Disorders

Play Episode Listen Later Sep 22, 2025 43:42

In this episode of Bowel Sounds, hosts Dr. Peter Lu and Dr. Jason Silverman talk to Dr. Amber Hildreth, pediatric gastroenterologist and transplant hepatologist at Rady Children's Hospital and Assistant Professor at the University of California San Diego. She is also a clinician scientist at the Rady Children's Institute for Genomic Medicine. We discuss how genetic testing is transforming the way we care for children with rare GI and liver diseases.Learning objectivesRecognize key differences between various types of genetic testing.Discuss several applications of genetic testing in care for children with GI disorders.Understand the role of the genetic counselor in integrating genetic testing into GI practice.Support the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

79: Colon Cancer Screening: Why It Is Important & Your Options

Your Checkup

Play Episode Listen Later Sep 22, 2025 30:40 Transcription Available

Send us a message with this link, we would love to hear from you. Standard message rates may apply.Colon cancer screening saves lives by catching cancer early and even preventing it, yet only 69% of eligible adults are up to date with their screenings. We explore who needs screening, what tests are available, and how to choose the right one for you.• Most adults should start colon cancer screening at age 45, even if healthy• Family history may mean you need to start screening earlier• Stool-based tests like FIT and Cologuard are convenient home options• Colonoscopy remains the gold standard, allowing doctors to remove polyps• One in 23 men and one in 25 women will develop colorectal cancer• The best screening test is the one you'll actually completePlease get screened! Check with your doctor about which test is right for you based on your risk factors and preferences.References1. Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians (Version 2). Qaseem A, Harrod CS, Crandall CJ, et al. Annals of Internal Medicine. 2023;176(8):1092-1100. doi:10.7326/M23-0779.2. AGA Clinical Practice Update on Risk Stratification for Colorectal Cancer Screening and Post-Polypectomy Surveillance: Expert Review. Issaka RB, Chan AT, Gupta S. Gastroenterology. 2023;165(5):1280-1291. doi:10.1053/j.gastro.2023.06.033.3. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Davidson KW, Barry MJ, Mangione CM, et al. JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238.4. Colorectal Cancer Screening and Prevention. Sur DKC, Brown PC. American Family Physician. 2025;112(3):278-283.5. Increasing Incidence of Early-Onset Colorectal Cancer. Sinicrope FA. The New England Journal of Medicine. 2022;386(16):1547-1558. doi:10.1056/NEJMra2200869.6. From Guideline to Practice: New Shared Decision-Making Tools for Colorectal Cancer Screening From the American Cancer Society. Volk RJ, Leal VB, Jacobs LE, et al. CA: A Cancer Journal for Clinicians. 2018;68(4):246-249. doi:10.3322/caac.21459.7. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. JAMA. 2021;325(19):1978-1998. doi:10.1001/jama.2021.4417.8. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. JAMA. 2016;315(23):2564-2575. doi:10.1001/jama.2016.5989.9. How Would You Screen This Patient for Colorectal Cancer? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Burns RB, Mangione CM, Weinberg DS, Kanjee Z. Annals of Internal Medicine. 2022;175(10):1452-1461. doi:10.7326/M22-1961.Support the showSubscribe to Our Newsletter! Production and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

Diagnosing and Treating Immune Checkpoint Inhibitor Colitis Effectively

Visceral: Listen to Your Gut

Play Episode Listen Later Sep 19, 2025

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Yinghong Wang, MD, PhD, MS Immune checkpoint inhibitor (ICI) colitis comes with unique diagnostic and treatment challenges, which means that recognizing and managing it effectively is key to the best outcomes. Joining Dr. Peter Buch to share her insights on caring for patients with this complex condition is Dr. Yinghong Wang. Dr. Wang is a Professor in the Department of Gastroenterology, Hepatology, and Nutrition at MD Anderson Cancer Center in Houston, Texas, as well as Director of the Oncology-GI Toxicity Program, Director of Fecal Microbiota Transplantation, Deputy Division Head of Research in the Division of Internal Medicine, and Chair of the MD Anderson Cancer Center Immunotherapy Toxicity Working Group.

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10 Challenges of IBD (Part 2)

Play Episode Listen Later Sep 16, 2025 17:38 Transcription Available

Featuring: David T. Rubin, MD, University of Chicago Medicine The GI Research Foundation was able to produce this podcast with sponsorships from Metro Infusion Center. David T. Rubin, MD, Joseph B. Kirsner Professor of Medicine and Chief of Gastroenterology, Hepatology and Nutrition at the University of Chicago Medicine, explores challenges 6-10 of the top ten faced by people with Crohn's disease and ulcerative colitis. He explains how providers and researchers are working to overcome these challenges and improve care for patients. To access other episodes of Visceral: Listen to Your Gut and learn more about the GI Research Foundation's support of clinical and laboratory research to treat, prevent, and cure digestive diseases, please visit https://www.giresearchfoundation.org/. Available on Apple Podcasts, Spotify, and everywhere else you listen.

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ACG Guideline Update: Preventive Care Essentials for Adults with IBD

Gastro Girl

Play Episode Listen Later Sep 10, 2025 39:08

What does preventive care really mean for people living with inflammatory bowel disease (IBD)? In this episode, we break down the latest ACG Clinical Guideline Update: Preventive Care in IBD with two of its lead authors, Dr. Francis Farraye (Mayo Clinic, Jacksonville, FL) and Dr. Freddy Caldera (University of Wisconsin School of Medicine and Public Health). Together, we explore: Why preventive care is critical in IBD management Key vaccination recommendations for IBD patients How to prioritize cancer and bone health screening The role of mental health and lifestyle in long-term outcomes Produced in collaboration with the American College of Gastroenterology's Patient Care Committee, this episode offers clear, evidence-based insights for both patients and providers.

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LGBTQ+ Inclusive IBD Care with Dr. Victor Chedid

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Play Episode Listen Later Sep 10, 2025 53:56 Transcription Available

Send us a textImagine visiting your gastroenterologist and feeling comfortable enough to discuss every aspect of how IBD affects your life—including your sexual health and practices. For many patients, particularly those in the LGBTQI+ community, this remains an elusive dream rather than reality.Dr. Victor Chedid, gastroenterologist and director of Mayo Clinic's Pride Clinic, joins Bowel Moments to tackle this crucial gap in IBD care. With disarming honesty and clinical expertise, he reveals why addressing sexuality isn't just about inclusivity—it's about providing complete medical care. When 95% of providers believe discussing sexual health is important but only 27% actually do it, patients suffer in silence with questions that directly impact their quality of life.The conversation dives deep into practical approaches for both patients and providers. Dr. Chedid shares his framework for discussing sexual practices with patients, from the straightforward question "What do you do for sex?" to navigating complex conversations around surgical interventions like J-pouch formation. For transgender patients, he unpacks recent research on gender-affirming hormones and IBD, emphasizing that life-saving gender-affirming care should never be withheld due to IBD concerns.Perhaps most compelling is Dr. Chedid's perspective on cultural humility and intersectionality. Each patient's experience is shaped by multiple overlapping identities—their sexuality, gender, race, nationality, and more. Rather than making assumptions, he advocates for providers to "leave their biases at the door" and approach each person's unique situation with curiosity and respect."People living with IBD are the experts of their own bodies," Dr. Chedid reminds us in his powerful closing thoughts. "When they say something feels off, it's not a guess—it's lived experience." This principle forms the foundation of truly inclusive care—care that sees patients as whole people deserving of dignity, understanding, and comprehensive treatment.Ready to advocate for more inclusive IBD care? Share this episode with your healthcare team and join the conversation about creating safe spaces for everyone in our community.Links: AGA's Pride Month Provider Spotlight on Dr. ChedidDr. Chedid talking about forming the IBD Pride Clinic"Your Top 6 Questions Answered by Dr. Victor Chedid" -A Program Dedicated to IBD Patients from the LGBTQIA+ Community- Crohn's & Colitis Foundation- USALet's get social!!Follow us on Instagram!Follow us on Facebook!Follow us on Twitter!

Episode 118 - Is It IBS or Your Diet? with Mohammad Farivar MD

Productivity Smarts

Play Episode Listen Later Sep 9, 2025 40:06

In this enlightening episode of the Productivity Smarts Podcast, host Gerald J. Leonard sits down with Dr. Mohammad Farivar, a board-certified gastroenterologist and author of “Is It IBS or Your Diet?”. With more than 55 years of medical experience, Dr. Farivar brings deep insights into the connection between gut health, productivity, and overall well-being. Many people struggle with Irritable Bowel Syndrome (IBS), a condition that can drastically impact daily life, work performance, and even mental clarity. Dr. Farivar reveals how diet, stress, and gut health play pivotal roles in both IBS symptoms and productivity and why traditional treatments often miss the mark. Through real-life patient stories and science-backed strategies, you'll discover how small dietary shifts, the right testing, and an informed approach to gut health can make a world of difference. Whether you or someone you know is battling digestive health issues, this conversation will equip you with practical steps to regain control and unlock your full potential. What We Discuss [00:00] Introduction to Dr. Mohammad Farivar [05:47] Impact of IBS on patients' lives [09:12] Motivation to write the book [12:19] Proper approach to IBS diagnosis [15:12] IBS and productivity loss [17:21] Stress and its effects on IBS [22:54] Critique of probiotic industry [27:16] FODMAP diet explained [30:44] Complementary and alternative medicine for IBS [32:44] Hydrogen breath test for IBS [37:19] Where to find the book and final advice Notable Quotes [05:03] “We are all born with a mission. Even as a child, I knew I wanted to be a doctor.” – Dr. Farivar [06:39] “In my practice, I was able to find the cause of IBS in more than 90% of cases — most of the time, it was diet-related.” – Dr. Farivar [15:12] “IBS is the second most common cause of lost productivity after colds and infections.” – Dr. Farivar [22:59] “Forget probiotics. A spoonful of yogurt gives you more than any pill.” – Dr. Farivar Resources Dr. Mohammad Farivar Website - IsItIBSOrYourDiet.com LinkedIn: Mohammad Farivar Book: Is It IBS or Your Diet? Productivity Smarts Podcast Website - productivitysmartspodcast.com Gerald J. Leonard Website - geraldjleonard.com Turnberry Premiere website - turnberrypremiere.com Scheduler - vcita.com/v/geraldjleonard Kiva is a loan, not a donation, allowing you to cycle your money and create a personal impact worldwide. https://www.kiva.org/lender/topmindshelpingtopminds

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Conversations in Chronic Cough: A Pulmonologist's Perspective

CCO Medical Specialties Podcast

Play Episode Listen Later Sep 9, 2025 16:43

Listen as pulmonologist Peter Dicpinigaitis discusses his approach to the diagnosis and management of patients with refractory chronic cough in the context of a clinically relevant case and provides insights regarding emerging therapies.PresenterPeter Dicpinigaitis, MDProfessor of MedicineAlbert Einstein College of MedicineDivision of Critical Care MedicineMontefiore Medical CenterDirector, Montefiore Cough CenterBronx, New YorkLink to full program:https://bit.ly/4kweynG

S6.13.1 - Major Issues: Developing a More Integrated Approach to MASH Patient Management

Surfing the Nash Tsunami

Play Episode Listen Later Sep 9, 2025 19:48

Send us a textThis discussion on ways to improve MASH patient management comes from the early July roundtable on "Major Issues of the First Six Months of 2025." As a reminder, that roundtable included the three co-hosts (Louise, Jörn Schattenberg and Roger Green) Louise drives this conversation based on two related issues she sees emerging: (i) increasing opportunities for motivated patients to manage their own health and (ii) managing the total patient in an environment where people may be taking incretin agonists as if they are consumer drugs. With increased access to scanning, providers can monitor patients (and patients can self-monitor) more closely. However, some of the issues a provider might find are tricky: patients who undertake what Louise describes as "the sneaky areas patients think are normal, but are probably contributing to disease" due to miseducation or no education on healthy eating and lifestyle, or patients purchasing and using incretin agonists through consumer channels, but possibly at subtherapeutic doses. Vigilance and probing are key here, but health systems will need to train more people on the types of probing that uncover underlying issues and behaviors that patients mistakenly believe to be healthy. The discussion also extends to the role of NITs in diagnosis and patient management, and how providers need to shift the paradigm away from describing a patient by fibrosis stage and instead focus on the amount of fat in the liver and its overall suppleness.

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Justine Turner - Non-Biopsy Diagnosis in Celiac Disease

Play Episode Listen Later Sep 8, 2025 44:13

In this episode, hosts Drs. Peter Lu and Jason Silverman talk to Dr. Justine Turner about a non-biopsy approach to diagnosis for celiac disease in children. Dr. Turner is a Professor of Pediatrics and Divisional Director for the Division of Gastroenterology and Nutrition at the University of Alberta and also the medical lead for the Multidisciplinary Pediatric Celiac Disease Clinic at Stollery Children's Hospital in Edmonton. Learning Objectives:Review current clinical guidelines for the diagnosis of celiac disease in childrenUnderstand the potential pros and cons of a non-biopsy approach to diagnosis for celiac diseaseRecognize the potential impacts of serologic diagnosis for celiac disease on patients, their families and healthcare systemsLinks (to be added!!):Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and NutritionNASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten-related DisordersEuropean Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020Positive Predictive Value of Tissue Transglutaminase IgA for Celiac DiseaseSupport the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Episode 972: Hepatic Encephalopathy

Emergency Medical Minute

Play Episode Listen Later Sep 3, 2025 3:59

Contributor: Alec Coston, MD Educational Pearls: Hepatic encephalopathy (HE) is defined as a disruption in brain function that results from impaired liver function or portosystemic shunting. Manifests as various neurologic and psychiatric symptoms such as confusion, inattention, and cognitive dysfunction Although ammonia levels have historically been recognized as important criteria for HE, the diagnosis is ultimately made clinically. An elevated ammonia level lacks sensitivity and specificity for HE Trends in ammonia levels do not correlate with disease improvement or resolution A 2020 study published in the American Journal of Gastroenterology evaluated 551 patients diagnosed with hepatic encephalopathy and treated with standard therapy Only 60% of patients had an elevated ammonia level, demonstrating the limitations of ammonia levels However, a normal ammonia level in a patient with concern for HE should raise suspicion for other pathology. In patients with cirrhosis presenting with neuropsychiatric symptoms, consider HE as the diagnosis after excluding other potential causes of altered mental status (i.e., Seizure, infection, intracranial hemorrhage) The primary treatment is lactulose Works by acidifying the gastrointestinal tract. Ammonia (NH₃) is converted into ammonium (NH₄⁺), which is poorly absorbed and subsequently eliminated from the body Also exerts a laxative effect, further enhancing elimination References: Haj M, Rockey DC. Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis. Am J Gastroenterol. 2020 May;115(5):723-728. doi: 10.14309/ajg.0000000000000343. PMID: 31658104. Lee F, Frederick RT. Hepatic Encephalopathy-A Guide to Laboratory Testing. Clin Liver Dis. 2024 May;28(2):225-236. doi: 10.1016/j.cld.2024.01.003. Epub 2024 Jan 30. PMID: 38548435. Vilstrup, Hendrik1; Amodio, Piero2; Bajaj, Jasmohan3,4; Cordoba, Juan1,5; Ferenci, Peter6; Mullen, Kevin D.7; Weissenborn, Karin8; Wong, Philip9. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver. Hepatology 60(2):p 715-735, August 2014. | DOI: 10.1002/hep.27210 Weissenborn K. Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles. Drugs. 2019 Feb;79(Suppl 1):5-9. doi: 10.1007/s40265-018-1018-z. PMID: 30706420; PMCID: PMC6416238. Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Jorge Chalit, OMS4 Get your tickets to Tox Talks Event, Sept 11, 2025: https://emergencymedicalminute.org/events-2/ Donate: https://emergencymedicalminute.org/donate/

Irritable Bowel Syndrome and Beyond: Food The Main Course 2025 Live Recap (Crossover with Tuesday Night IBS)

Gut Talk

Play Episode Listen Later Aug 27, 2025 49:43

In this special crossover podcast episode, Tuesday Night IBS hosts Jeffrey Roberts, MSEd, BSc, Erica Dermer and Kate Scarlata, MPH, RDN, are joined live by William Chey, MD, and Amanda Lynett, MS, RDN, at FOOD the Main Course Conference in Ann Arbor, MI. • Intro :02 • About Scarlata :30 • About Chey 1:07 • About Lynett 1:49 • Chey, what are your goals for this year's FOOD the Main Course Conference? 2:58 • How do you feel that mechanisms of diet are affecting microbiomes? 5:37 • Amanda, what have you learned over the years as you have put together this conference, and how do you think this experience has shaped a more well-rounded program for clinicians? 8:23 • What are you personally going to take away from the conference this year? 11:17 • A discussion on peer-to-peer interactions, the spirit of collaborative care, and what each provider is bringing to the table. 12:22 • Kate, tell us about why you come back to this conference every year. 17:32 • What challenges did you overcome to move the needle forward in diet and GI conditions? 19:14 • Chey, can you talk about the correlation between stress and diet when it comes to IBS? 24:21 • How are we dealing with the ramifications of GLP-1s? 29:33 • As providers, what is your first instinct when patients tell you they started GLP-1s? 32:28 • How is the community going to help listeners weed through Internet noise to find accurate information? 35:01 • Group discussion on the rise of severe constipation. 41:31 • Who decides to send patients for colectomy consultations? 43:33 • Is there anything else you want to share or highlight from the conference? 47:25 • Thank you all 48:58 • Thanks for listening 49:42 Erica Dermer is an IBS and Celiac Disease patient who hosts the Celiac and the Beast blog and You Had Me at Eat podcast series. Amanda Lynett MS, RDN, is a registered dietitian with her masters. Amanda is with the Division of Gastroenterology at Michigan Medical in Ann Arbor. Jeffrey Roberts, MSEd, BSc, is a patient advocate and creator of the first website for IBS sufferers. He is the co-founder of Tuesday Night IBS. Kate Scarlata, MPH, RDN, is a US-based dietitian with over 30 years of experience. Kate's expertise is in gastrointestinal disorders and food intolerance. We'd love to hear from you! Send your comments/questions to guttalkpodcast@healio.com. Follow us on X @HealioGastro @sameerkberry @umfoodoc. For more Tuesday Night IBS, be sure check out TuesdayNightIBS.com and to follow and subscribe to their podcast. Disclosures: Chey and Roberts report no relevant financial disclosures. Scarlata reports stock options with Epicured LLC and FODY Food Company, financial support from Dr. Schar, Mahana Therapeutics, Nestle Health Science, Olipop, Pendulum, QOL Medical.

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Living with Whoopie: Rachel's Crohn's Journey

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Play Episode Listen Later Aug 27, 2025 50:41 Transcription Available

Send us a textFor two decades, Rachel Gebhardt has navigated the complex terrain of Crohn's disease with a refreshing perspective shaped by her father's experience with the same condition. Where her father let illness define him, Rachel chose a different path—one filled with humor, openness, and resilience—despite her case being more medically severe.Rachel's journey encompasses four bowel surgeries and fourteen hospital admissions since 2020 alone, including a colostomy she affectionately named "Whoopie." With disarming candor, she shares the moment her surgeon showed her a photo of a woman in an American flag bikini with a matching ostomy bag cover as encouragement—a moment that eventually inspired her own celebratory beachside photo years later. Through skin infections, bowel obstructions, and dietary restrictions, Rachel maintains her commitment to living fully and modeling positive coping for her children.The military healthcare system presented unique challenges, but also connected Rachel with Dr. Anish Patel at Brook Army Medical Center, who became not just her gastroenterologist but her advocate and ally. Their relationship exemplifies the profound difference compassionate, specialized care makes for patients with complex conditions. Rachel details her experience with hyperbaric treatments, medication complications, and the surprising remission she experienced only during pregnancy and breastfeeding—highlighting the understudied connection between hormones and IBD.What resonates most deeply is Rachel's transformation from initially viewing her ostomy as "the end of the world" to embracing it as a source of freedom. Now training for a half marathon and hiking mountains previously inaccessible when bathroom urgency controlled her life, she's become an outspoken advocate for ostomy awareness. Her message is clear and powerful: life with an ostomy can be not just manageable, but genuinely good—a perspective desperately needed by those facing similar paths. For anyone navigating IBD or supporting someone who is, Rachel's story offers both practical wisdom and heartening hope.Links: United Ostomy AssociationOur episode with Dr. Anish PatelPregnancy and Crohn's - video from Brigham & Women's IBD CenterPregnancy & Breastfeeding info- Crohn's Colitis UKLet's get social!!Follow us on Instagram!Follow us on Facebook!Follow us on Twitter!

Understanding Diverticulosis and Diverticulitis: What Patients Need to Know

Gastro Girl

Play Episode Listen Later Aug 26, 2025 25:33

Diverticulosis and diverticulitis sound alike but are very different conditions—and knowing the difference is key to protecting your digestive health. In this episode, host Jacqueline Gaulin welcomes Dr. Lisa Strate, Professor and Chief of Gastroenterology and Hepatology at the University of Wisconsin, and one of the nation's leading experts in diverticular disease. Together, they clear up common questions and misconceptions about diverticulosis and diverticulitis, including: What causes these conditions and who is most at risk The symptoms and warning signs patients should watch for Whether it's possible to have one without the other How diet and lifestyle affect treatment and prevention This episode is produced in collaboration with the American College of Gastroenterology's Patient Care Committee.

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Bowel Sounds Summer School - Endoscopy