Podcasts about gastroenterology hepatology

Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Holly Knotowicz, a speech-language pathologist living with EoE, who serves on APFED's Health Sciences Advisory Council, have a conversation about food-induced immediate response in eosinophilic esophagitis (EoE), with guest Dr. Nirmala Gonsalves, Professor of Medicine in the Division of Gastroenterology and Hepatology at Northwestern University, Feinberg School of Medicine, and Co-Director of the Northwestern Eosinophilic Gastrointestinal Disorders Program.   In this episode, Ryan, Holly, and Dr. Nirmala Gonsalves discuss food-induced immediate response in EoE, recent and ongoing research into FIRE, and advice for providers.   Listen to this episode to learn about food-induced immediate response (FIRE). Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Ryan Piansky and co-host Holly Knotowicz introduce the topic of today's episode, food-induced immediate response in eosinophilic esophagitis, and their guest, Dr. Nirmala Gonsalves, Professor of Medicine in the Division of Gastroenterology and Hepatology at Northwestern University, Feinberg School of Medicine.   [1:38] Dr. Gonsalves is the Co-Director of the Northwestern Eosinophilic Gastrointestinal Disorders Program. Her research and clinical career are dedicated to improving the care of patients with eosinophilic gastrointestinal diseases, or EGIDs.   [1:53] Dr. Gonsalves's extensive clinical experiences with EGIDs have shaped her research goals, which include identifying novel treatments and determining the best methods to measure disease activity.   [2:20] Dr. Nirmala Gonsalves has been at Northwestern for 25 years and has been involved in the EGID and EoE space for the last 20 years. Dr. Gonsalves met Ryan during her first introduction to APFED when Ryan was “much, much younger,” so she is pleased to see him co-hosting this podcast.   [2:56] Within Northwestern Medicine, Dr. Gonsalves is part of the Esophageal Group. Within the Esophageal Group, she co-directs the Eosinophilic GI Disorders Program with Dr. Ikuo Hirano. Working in the EGID space for the last 20 years has been incredibly rewarding.   [3:11] Dr. Gonsalves feels lucky to be a part of The International Gastrointestinal Eosinophil Researchers (TIGERS) and the Consortium of Eosinophilic and Gastrointestinal Disease Researchers (CEGIR).   [3:26] Dr. Gonsalves has focused her clinical career on understanding eosinophilic GI disorders, helping to get better diagnoses, increased awareness, and better treatments, and improving the quality of life for patients with these conditions.   [4:19] Dr. Gonsalves describes the study of food-induced immediate response in eosinophilic esophagitis (FIRE). In 2017, gastroenterologist Dr. Alex Straumann, and allergist Dr. Mark Holbreich, both very familiar with EGID, started a multi-center effort and project, working with many physicians and patients to define this condition of FIRE.   [4:45] The symptoms of FIRE are very different from what we typically think about as EoE symptoms. The classic symptoms of EoE in adults are dysphagia (difficulty swallowing), or food impaction (a bolus of food stuck in the esophagus).   [5:37] This team of researchers in Switzerland, Northwestern, Indiana, North Carolina, Colorado, and Mt. Sinai, to name a few centers, noticed patients describing different symptoms; a more immediate response that was happening in their esophagus when they were exposed to certain specific foods, like beer or wine and avocado or banana.   [6:19] Patients described an immediate reaction in their esophagus, occurring any time from seconds to minutes after ingesting that food, as a painful, squeezing sensation, and a narrowing in their esophagus that was temporally related to these foods.   [6:42] It started to increase the researchers' awareness that this symptom was different from the classic dysphagia that adults and older children typically present with.   [7:12] In the study, they did a two-phased investigation. First, they sent a survey to physicians used to treating EoE, to understand what their experience was about these symptoms. Based on that knowledge, they convened twice to develop a questionnaire for patients, to understand how common this is in the patient population.   [7:38] The response was 47 physicians (an 82% response rate). They sent the patient survey to the EoE Swiss cohort and the response was 239 patients (a 65% response rate.)   [7:58] Of the physicians, 90% reported patients reporting these symptoms. The physicians estimated this to occur in 5 to 20% of EoE patients. Looking at the patients who had FIRE with EoE, vs. EoE without FIRE, the FIRE patients were younger and more likely to have other atopic conditions like rhinitis, asthma, and dermatitis.   [8:42] Patients with FIRE were more likely to have had a prior food impaction, a longer duration of disease, and a longer time to symptom presentation. Those were the risk factors in the patients.   [8:56] In the patient questionnaire, 40% of the EoE patients surveyed reported that they had symptoms of FIRE. [9:29] Most of the patients in the study were adult patients. Looking at the average age of the EoE cohort vs. the EoE with FIRE cohort, the EoE with FIRE patients tended to be younger. Dr. Gonsalves suspects that patients are experiencing FIRE earlier on, but they don't know what is occurring. [9:56] Dr. Gonsalves thinks that is where the investigation is going: to understand when FIRE is happening. The symptoms are quite different than the typical first EoE symptom when something is going down slower or getting caught in the esophagus.   [10:27] As far as whether FIRE is experienced by other patients besides EoE patients, the survey team only noticed FIRE in EoE patients. A follow-up study could look at the control cohort or the regular reflux cohort. Patients don't express these types of symptoms, other than EoE patients, so it seems unique to EoE patients.   [10:53] When the team talked about and tried to understand more about the background of FIRE, and the risk factors, they wondered if it was similar to oral pollen syndrome, with a more immediate reaction in the esophagus.   [11:49] With adults, certain liquors, wines, beers, avocados, and bananas stand out among triggers. The symptoms are so significant that patients would say on a scale of one to ten, it's a seven intensity. It's fairly immediate, within seconds to minutes, with a duration of minutes to several hours.   [12:18] A lot of times, patients compensate by not eating those specific foods because they don't want that condition to happen. For some patients, it's a profound spasm-type squeezing in their chest that will occur when this happens.   [13:44] Dr. Gonsalves says many patients will confuse FIRE with an anaphylactic reaction; it's not clear what it is. The multidisciplinary group of physicians that worked on this study included allergists and gastroenterologists all tried to come up with the mechanism that causes FIRE. It does not appear to be an anaphylactic reaction.   [14:13] When FIRE occurs, the doctors of the multidisciplinary group ask their patients to seek care from their allergist and discuss this with their allergist, to get more testing and understanding of what's occurring. They want to be mindful if there's any risk of anaphylaxis, but it does not appear that the FIRE condition is related to anaphylaxis.   [14:55] Dr. Gonsalves says we're at the very early stages of understanding the mechanisms of why FIRE is occurring. The first step was to increase awareness, define FIRE, understand it, and separate it from both EoE symptoms and anaphylaxis. We don't yet understand the mechanisms.   [15:18] At Northwestern, they are looking at a study to define FIRE better. They look to see if there is IgE sensitivity to these foods. If there are not, they look to see if there are any nanometric changes in the esophagus when these foods are in the esophagus. Are people having the esophageal spasms that equate to the symptoms they describe?   [16:03] That study is to understand more about the mechanisms causing FIRE. What happens to the FIRE symptoms? Once a physician treats a patient with EoE, the FIRE gets better. Patients sometimes can reintroduce the foods when their EoE is quiet. There is a short window of time to identify FIRE in a patient before treatment.   [16:43] Early identification and early treatment is the mantra. They don't want to delay treatment in any patient. When the EoE goes in remission from treatment, the FIRE symptoms tend to go into remission, also.   [17:01] This is unpublished data and research they are working on. Hopefully, they will learn more and be able to share it with APFED. These are their speculations.   [18:17] At Northwestern, they are known for dietary therapy. Their patients gravitate toward diet therapy. The foods involved in FIRE symptoms are not big EoE triggers. In dietary therapy, when foods are reintroduced, patients describe recurrent dysphagia, heartburn, and EoE-type symptoms.   [18:56] Patients having foods reintroduced don't typically describe this immediate reaction where their esophagus is spasming, contracting, and feeling very tight right after. That's a very different symptom.   [19:17] For the patients studied, the foods most consistently triggering FIRE symptoms were fruits, wines, vegetables, honey, beers, and vinegar. The foods driving FIRE tend to be the foods driving oral allergy but the symptoms are different; no mouth, tongue, or lip itching, but a squeezing sensation in the esophagus.   [20:29] Dr. Gonsalves says they have not identified long-term consequences of FIRE. They are very early in the stages of understanding and following it. The long-term consequences come from untreated EoE. Dr. Gonsalves lists some consequences of untreated EoE, including worsening scarring, strictures, and dysphagia.   [21:08] Dr. Gonsalves speculates and wonders if physicians were sometimes confused between dysphagia, oral-pollen allergy symptoms, and FIRE symptoms, without it being clear what the patient was experiencing, leading to a delay in diagnosis.   [21:52] Dr. Gonsalves says having patients with FIRE symptoms highlights the importance of having a multidisciplinary program and having a good collaboration with allergists, dieticians, and GI health psychologists to address food fear and anxiety, pathologists, and pediatricians. It's important to have conversations with colleagues.   [22:31] Dr. Gonsalves says there's no test for FIRE, which is why we're doing this research project; understanding what is behind FIRE, now that we know FIRE exists, we have a description, and we know how prevalent it is. We need to look at the patient and look for contractions of the esophagus upon exposure to the food with manometry.   [23:18] Manometry is a tube with pressure sensors used for measuring esophageal pressure and the strength of contractions. Patients with EoE have various abnormalities in their esophageal contractions. To study FIRE, with the manometry tube in place, the patient will eat the trigger food or drink to see if there are heightened contractions.   [25:24] Manometry is not an easy test. It is done when necessary to understand esophageal motility and function. It's not easy to recruit for these tests and there are not many candidates as the symptoms go away quickly with treatment. The technicians are skilled in doing the testing. It's done routinely and safely.   [26:47] Dietary, pharmacological, steroidal, and biological treatments can be effective in treating EoE symptoms. When EoE symptoms stop, FIRE typically stops. There has not been a study to document this, but it has been observed clinically. After a patient has been treated and then is tested for esophageal motility, FIRE does not typically recur.   [28:05] Dr. Gonsalves shares her suspicion that there is something related to esophageal inflammation that triggers this type of response and a hypercontractile state in that setting. Ryan reminds listeners that this podcast is not medical advice; always consult with your physician before making any changes or trying new treatment options.   [29:40] When a provider talks to a patient, they might ask about dysphagia if they are making modifications for swallowing, and how they swallow something dry or dense. Can they perceive it going slowly down their esophagus? Are they taking in lots of liquid to help this food pass? Are they chewing excessively? Are they avoiding foods or pills?   [30:40] These questions help providers understand if there is disease activity and if they are not symptomatic because of avoiding these types of foods. Those are EoE questions.   [30:52] Asking about FIRE symptoms or oral pollen allergy symptoms, the provider will go down a list of allergic history questions about allergic rhinitis, asthma, eczema, and anaphylactic symptoms. Also, mouth itching, lip-tingling, or throat itching when they eat certain foods.   [31:20] After they eat these foods, do they ever experience an immediate sensation of narrowing or tightening or spasm in the esophagus, or burning pain that happens secondary to the dysphagia? The important thing is to separate the transit dysphagia of things moving slower down the esophagus from this perception of squeezing pain.   [32:18] Holly thanks Dr. Gonsalves for sharing her expertise to help others.   [32:37] Dr. Gonsalves's last word is that this condition exists. Providers, ask your patients about them. It was remarkable to Dr. Gonsalves how profound the symptoms were that patients described to the point where they avoided these foods and were scared of these foods.   [32:56] Interestingly, FIRE is very different from EoE symptoms. It does exist. Ask about it! That will help tease out the reactions that are occurring. Especially, understand that when going on a food elimination diet, these are separate from the EoE triggers.   [33:18] If you identify these symptoms, or oral pollen symptoms, or coexisting atopic conditions, partner with an allergist so that we understand the mechanisms behind this and make sure that nobody is at risk for anaphylaxis from these types of things.   [33:49] Dr. Gonsalves is pleased to partner with TIGERS and to be on a site for the CEGIR Group. Dr. Gonsalves heads up the development of the Non-EoE Consensus Guidelines, to understand what goes into a diagnosis of Non-EoE EGID and what that entails. She continues to research dietary therapy and making it better for patients.   [34:31] She works to understand different metrics to measure activity in the esophagus, histologically as well as motility-based, and the genetic changes that occur with different treatments, and doing all this, partnered with an amazing group of collaborators through the CEGIR Consortium and others to improve patients' quality of life.   [35:01] Dr. Gonsalves feels lucky that 20-something years ago, she bumped into the leaders of APFED and other patient advocacy groups and shared their experience with Northwestern. She is grateful for the privilege of working with all the wonderful physicians and patients who help us learn about these conditions.   [35:46] To learn more about Dr. Gonsalves's research, please check out the links in the show notes. To learn more about eosinophilic gastrointestinal disorders, visit apfed.org/egids. If you're looking for a specialist who treats eosinophilic disorders, use APFED's specialist finder at apfed.org/specialist. [36:10] To connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [36:21] Ryan thanks Dr. Nirmala Gonsalves for joining us today. Holly thanks APFED's Education Partners, AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Sanofi, and Regeneron, linked below, for supporting this episode.   Mentioned in This Episode: Nirmala Gonsalves, MD Northwestern Medicine Feinberg School of Medicine Ikuo Hirano, MD Publication discussed: Food-induced immediate response of the esophagus — A newly identified syndrome in patients with eosinophilic esophagitisAmerican Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/egids apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Sanofi, and Regeneron.   Tweetables:   “Working in the EGID space for the last 20 years; it's been incredibly rewarding. I've been lucky enough to be invited to be a part of The International Gastrointestinal Eosinophil Researchers (TIGERS).” — Nirmala Gonsalves, M.D.   “Our patients will describe it; it's a profound spasm-type squeezing in their chest that will occur when FIRE happens.” — Nirmala Gonsalves, M.D.   “There's no clear test yet for FIRE, which is why we're doing this research project; really understanding what is behind FIRE, now that we know FIRE exists, we have a description of it and we know how prevalent it is.” — Nirmala Gonsalves, M.D.   Bio: Dr. Gonsalves is a Professor of Medicine in the Division of Gastroenterology & Hepatology at Northwestern University Feinberg School of Medicine and Co-Director of the Northwestern Eosinophilic Gastrointestinal Disorders Program. She completed her undergraduate training at the University of Notre Dame, medical school at Robert Wood Johnson Medical School in New Jersey, and her internship, residency, and fellowship at Northwestern, where she has stayed on as an attending physician since 2005. In this role, she has co-authored more than 60 manuscripts and presented at more than 40 national or international meetings that focus on eosinophilic gastrointestinal diseases (EGIDs). Her research and clinical career is dedicated to improving the care of patients with these rare disorders. Her extensive clinical experiences with EGIDs have shaped the overarching research goals that include identifying novel treatments and determining the best methods to measure disease activity. She is a site investigator for the NIH-funded U54 Grant Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR, PI-Rothenberg) and Core Lead for the Northwestern Biorepository for an NIH sponsored PPG Grant on Esophageal Biomechanics (PI-Pandolfino).

This podcast is made possible through an educational grant from Baxter Healthcare. Our guest Our guest on this episode of the DNS Podcast is physician and nutrition support clinician, Dr. Mark DeLegge, here to talk about a topic impacting virtually all clinicians across the globe – parenteral nutrition related drug shortages. Dr. DeLegge completed his medical degree at the University of Maryland followed by a residency in Internal Medicine at the University of Connecticut Health Center and a fellowship in Gastroenterology/Hepatology and Nutrition at the Medical College of Virginia. He is board certified in Internal Medicine, Gastroenterology and Nutrition, is extensively published, and has been a frequent invited speaker nationally and internationally. This episode is hosted by Christina M. Rollins, MBA, MS, RDN, LDN, FAND, CNSC and was recorded on 10/18/22.

This episode features Dr. Rohit Kohli, Chief of the Division of Gastroenterology, Hepatology and Nutrition; Director of the The George Donnell Society for Pediatric Scientists; & Associates Chair in Liver and Intestinal Research at Children's Hospital Los Angeles (CHLA). Here, he discusses his work with pediatric liver transplants at CHLA, the long-term benefits of living liver donations, the importance of health equity, and more.

Dr. Marvin Singh Bio: Marvin Singh, MD, is the Founder of Precisione Clinic and one of only a few Integrative Gastroenterologists in the United States. After graduating from Virginia Commonwealth University School of Medicine, he went on to do his Internal Medicine training at the University of Michigan Hospitals, after which he completed a Gastroenterology/Hepatology fellowship at Scripps Clinic Torrey Pines. He went on to fulfill a fellowship in Integrative Medicine and was trained by Dr. Andrew Weil at the Andrew Weil Center for Integrative Medicine in Tucson, Arizona. Dr. Singh is currently a Diplomate and Member of the Board of the American Board of Integrative Medicine and the first Director of Integrative Gastroenterology at the Susan Samueli Integrative Health Institute at the University of California Irvine, previously having served as a faculty member at UCLA and Johns Hopkins University. He co-edited the textbook of Integrative Gastroenterology, 2nd Edition, and has contributed to many other articles and books. In addition to being a sought after speaker and consultant, Dr. Singh has been featured on ABC News, Reader's Digest, Mind Body Green, SiriusXM Radio, and many other platforms. He is also the host of this podcast, Precisione: The Healthcast and currently serves as the Health Advisor for Bottomless Closet in NYC, an organization that helps women in need. Dr. Singh's book, Rescue Your Health, is highly acclaimed and one of the first books of its kind to outline how to use precision medicine to optimize your health and longevity. What you will learn from this episode: 1) What precision medicine truly means 2) The difference between sick care and well care 3) Important tests to help understand what your risks might be 4) The importance of lifestyle medicine in overall health and wellness 5) Key concepts to help improve your chromosomal health (telomeres) and the strength of your gut microbiome How to learn more: Websites: www.RescueYourHealth.com www.PrecisioneClinic.com www.DrMarvinSingh.com IG/Facebook/Twitter: @DrMarvinSingh LinkedIn: https://www.linkedin.com/in/marvin-singh-md-845641110 Please enjoy, share, rate and review our podcast and help us bring the message about precision health care to the world!

Dr. Constantine Karvellas, MD, MsC, FRCPC, FCCM Professor of Medicine (Critical Care Medicine and Gastroenterology/Hepatology) at the University of Alberta and Adjunct Professor in the School of Public Health Sciences presents on Critical Care Grand Rounds on "Current Evidence for extracorporeal liver support in acute and acute-on-chronic liver failure"

PSC Partners Seeking a Cure is pleased to present Living With PSC, a podcast moderated by Niall McKay. Each month, this podcast explores the latest research and knowledge about primary sclerosing cholangitis (PSC), a rare liver disease. From patient stories, to the latest research updates from PSC experts, to collaborations that are necessary to find better treatments and a cure, this podcast has it all! In episode 26, Host Niall McKay talks with Dr. Cyriel Ponsioen, senior staff member at the Department of Gastroenterology & Hepatology at the Academic Medical Center (AMC) in Amsterdam, about research being done to determine the benefits of fecal microbiota transplantation in PSC patients with IBD. During the conversation, McKay and Ponsioen also speak about antibiotics, bacteriophages, the creation of the International PSC Study Group, and more.

Dr. Singh did his Internal Medicine training at the University of Michigan, after which he completed a Gastroenterology/Hepatology fellowship at Scripps Clinic Torrey Pines. He served as faculty member at Johns Hopkins University and UCLA, before completing a fellowship in Integrative Medicine at the Andrew Weil Center for Integrative Medicine in Tucson, Arizona. Dr. Singh is not only a board certified gastroenterologist, but also a Diplomate and Member of the Board of the American Board of Integrative Medicine and the first Director of Integrative Gastroenterology at the Susan Samueli Integrative Health Institute at the University of California Irvine. He co-edited the 2nd Edition of the textbook of Integrative Gastroenterology, and has contributed to many other articles and books. He is also the host of the podcast, Precisione: The Healthcast and currently serves as the Health Advisor for Bottomless Closet in NYC, an organization that helps women in need. Follow Dr. Mayer: https://linktr.ee/emayer Learn more at www.emeranmayer.com

Dr. Singh did his Internal Medicine training at the University of Michigan, after which he completed a Gastroenterology/Hepatology fellowship at Scripps Clinic Torrey Pines. He served as faculty member at Johns Hopkins University and UCLA, before completing a fellowship in Integrative Medicine at the Andrew Weil Center for Integrative Medicine in Tucson, Arizona. Dr. Singh is not only a board certified gastroenterologist, but also a Diplomate and Member of the Board of the American Board of Integrative Medicine and the first Director of Integrative Gastroenterology at the Susan Samueli Integrative Health Institute at the University of California Irvine. He co-edited the 2nd Edition of the textbook of Integrative Gastroenterology, and has contributed to many other articles and books. He is also the host of the podcast, Precisione: The Healthcast and currently serves as the Health Advisor for Bottomless Closet in NYC, an organization that helps women in need. Follow Dr. Mayer: https://linktr.ee/emayer Learn more at www.emeranmayer.com

Marvin Singh, M.D is an Integrative Gastroenterologist in San Diego, California, and a Member of the Board and Diplomate of the American Board of Integrative Medicine. He is also trained and board certified in Internal Medicine and Gastroenterology/Hepatology. A graduate of Virginia Commonwealth University School of Medicine, Singh completed his residency training in Internal Medicine at […]

Recent studies have shown that factors like diet, exercise, sleep, stress, and toxins have a significant impact on your microbiome balance and therefore your overall health. Join us today to learn how to optimize your gut health and some insights into intermittent fasting. Key Takeaways From This Episode Personalized diet based on genes and microbiome Food sensitivity test effectiveness Types of intermittent fasting Disadvantages of snacking before bed Use of natural vs artificial sweeteners How to keep a healthy microbiome Resources Mentioned In This Episode Precisione: The Healthcast About Dr. Marvin Singh Marvin Singh, M.D is an Integrative Gastroenterologist in San Diego, California, and a Member of the Board and Diplomate of the American Board of Integrative Medicine. He is also trained and board-certified in Internal Medicine and Gastroenterology/Hepatology. He founded the Precisione Clinic, whose primary aim is to help people understand their body, how it works and what it needs. Connect with Dr. Marvin Website: www.precisioneclinic.com Facebook: Precisione Clinic Instagram: @precisioneclinic YouTube: DrMarvinSingh   If you are struggling with feeling overworked or overwhelmed, access the Top 10 Stress Management Tips for the Overworked free right now.  Kristel Bauer, the Founder of Live Greatly, is on a mission to help people awaken to their ultimate potential.  She is a wellness expert, Integrative Medicine Fellow, Keynote Speaker, Physician Assistant, & Reiki Master with the goal of empowering others to live their best lives! Follow her on: Instagram: @livegreatly_co Clubhouse: @livegreatly LinkedIn: Kristel Bauer  Youtube: Live Greatly, Kristel Bauer To learn more about Live Greatly's transformative online courses for personal development and self-improvement, to discuss collaborations and partnerships, or to book Kristel as a speaker or consultant, click here.

NPR reports that there has been a "sharp, 'off the charts' rise in alcoholic liver disease among young women." Experts say pandemic stressors have led to a rise in drinking, and pop culture has validated drinking as a coping mechanism. Survival rates for alcoholic hepatitis and cirrhosis, which are types of alcoholic liver disease, can be as low as ten percent. This hour, we talk about the rise in the disease, the psychological components tied to it, and what experts say can help people experiencing these challenges. Our guests: Marie Laryea, M.D. , associate professor in the Department of Medicine, Gastroenterology/Hepatology; Department of Surgery, Transplant; and associate chair of diversity, equity and inclusion in the Department of Medicine at the University of Rochester Medical Center Myra Mathis, M.D. , senior instructor in the Department of Psychiatry, Addiction Psychiatry at the University of Rochester Medical Center Sean Yantz, certified peer recovery advocate, and certified

This time our Podcast is full of both important and interesting studies.  We present new evidence on how to treat pancreatic pseudocysts with hydrogen peroxide, the benefit of PPI's on EoE, an large study of endoscopic treatment of appendicitis, and find that our trusty indigo carmine dye spray is still going strong!  Then we have an interesting paper on the appalling effect of mountain sickness on the stomach, transplantation on the risk of polyps and when to stop Barrett's surveillance.  Thanks to our Partners at Pentax medical for your Support ! References reviewed includes;  Laserna MEJ et.al. Efficacy of Therapy for Eosinophilic Esophagitis in Real-World Practice. Clinical Gastroenterology & Hepatology. 18(13):2903-2911.e4, 2020 12. Greuter T et.al. Effectiveness and Safety of High- vs Low-Dose Swallowed Topical Steroids for Maintenance Treatment of Eosinophilic Esophagitis: A Multicenter Observational Study. Clinical Gastroenterology & Hepatology. 2020 Aug 13. Ding W et.al. Endoscopic retrograde appendicitis therapy (ERAT) for management of acute appendicitis. Surgical Endoscopy. 2021 May 13. Becq A et.al. ERCP within 6 or 12 h for acute cholangitis: a propensity score-matched analysis. Surgical Endoscopy. 2021 May 11. Ashkar MH et.al. Increased Risk of Advanced Colonic Adenomas and Timing of Surveillance Colonoscopy Following Solid Organ Transplantation. Digestive Diseases & Sciences. 2021 May 10. Chandrasekhara V et.al. Predicting the need for step-up therapy after EUS-guided drainage of pancreatic fluid collections with lumen-apposing metal stents. Clinical Gastroenterology & Hepatology. 2021 May 06. Messallam AA et.al. Endoscopic Necrosectomy With and Without Hydrogen Peroxide for Walled-off Pancreatic Necrosis: A Multicenter Comparative Study. American Journal of Gastroenterology. 116(4):700-709, 2021 Apr. Shiroma S et.al. Timing of bleeding and thromboembolism associated with endoscopic submucosal dissection for gastric cancer in Japan. Journal of Gastroenterology & Hepatology. 2021 May 07 Yasuda T et.al. Benefits of linked color imaging for recognition of early differentiated-type gastric cancer: in comparison with indigo carmine contrast method and blue laser imaging. Surgical Endoscopy. 35(6):2750-2758, 2021 Jun. Kim JW et.al. Narrowband imaging with near-focus magnification for discriminating the gastric tumor margin before endoscopic resection: A prospective randomized multicenter trial. Journal of Gastroenterology & Hepatology. 35(11):1930-1937, 2020 Nov. Surek A et.al. Risk factors affecting failure of colonoscopic detorsion for sigmoid colon volvulus: a single center experience. International Journal of Colorectal Disease. 36(6):1221-1229, 2021 Jun. Clark G et.al. Transition to quantitative faecal immunochemical testing from guaiac faecal occult blood testing in a fully rolled-out population-based national bowel screening programme. Gut. 70(1):106-113, 2021 Jan. Gachabayov M et.al. Performance evaluation of stool DNA methylation tests in colorectal cancer screening: a systematic review and meta-analysis. Colorectal Disease. 23(5):1030-1042, 2021 05. Forbes N et.al. Association Between Endoscopist Annual Procedure Volume and Colonoscopy Quality: Systematic Review and Meta-analysis. Clinical Gastroenterology & Hepatology. 18(10):2192-2208.e12, 2020 09. Fruehauf H et.al. Evaluation of Acute Mountain Sickness by Unsedated Transnasal Esophagogastroduodenoscopy at High Altitude. Clinical Gastroenterology & Hepatology. 18(10):2218-2225.e2, 2020 09. Goverde A et.al. Yield of Lynch Syndrome Surveillance for Patients With Pathogenic Variants in DNA Mismatch Repair Genes. Clinical Gastroenterology & Hepatology. 18(5):1112-1120.e1, 2020 05. Lamba M et.al. Associations Between Mutations in MSH6 and PMS2 and Risk of Surveillance-detected Colorectal Cancer. Clinical Gastroenterology & Hepatology. 18(12):2768-2774, 2020 11. Omidvar AH et.al. The optimal age to stop endoscopic surveillance of Barrett's esophagus patients based on sex and comorbidity: a comparative cost-effectiveness analysis. Gastroenterology. 2021 May 08.

The commonality of gastrointestinal complications in those who have recovered from or suffer with eating disorders is astounding. Most studies demonstrate upwards of 95 percent of those with a documented eating disorder (ED) fit the criteria for a functional gut disorder (FGD) and upwards of 50 percent for Irritable Bowel Syndrome (IBS). In this episode, we discuss how digestive issues differ in types of EDs and how the trauma caused by an ED may predisposed one to develop a FGD. I also discuss my recent diagnosis of IBS and how healing has become infinitely more complicated with concomitant disorders.    Bibliography (show notes): Decker, Carrie A. “Digestive Issues - The Overlap of Anxiety and Eating Disorder Struggles.” Eating Disorder Hope, 12 Feb. 2015, www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/anxiety/digestive-issues-the-overlap-of-anxiety-and-eating-disorder-struggles. Der, Kolk Bessel van. The Body Keeps the Score. Penguin, 2015. “Digestive Disorders and Eating Disorders: A Complicated Mix.” Marci R.D., 21 Oct. 2020, marcird.com/digestive-disorders-eating-disorders-a-complicated-mix/. Fenkanyn, Stephani. “Digestive Issues & Eating Disorders: How to Ease Discomfort without Obsessing.” BANA, 7 May 2020, bana.ca/digestive-issues-eating-disorders/. Harer, Kimberly N. “Irritable Bowel Syndrome, Disordered Eating, and Eating Disorders.” Gastroenterology Hepatology, www.gastroenterologyandhepatology.net/archives/may-2019/irritable-bowel-syndrome-disordered-eating-and-eating-disorders/. Judge, Erin. “The Connection Between Eating Disorders and IBS - Gutivate - IBS & SIBO Nutrition Counseling & Coaching.” Gutivate, Gutivate - IBS & SIBO Nutrition Counseling & Coaching, 15 Mar. 2021, gutivate.com/blog/eating-disorders. Leon, Erica. “GI Symptoms in Eating Disorders - Mirror.” Mirror, 18 June 2020, mirror-mirror.org/gi-symptoms-in-eating-disorders. Long, Jessica. “The Intersection of Anxiety, Eating Disorders, and IBS.” Sunny Side Up Nutrition, 1 Aug. 2019, sunnysideupnutrition.com/anxiety-eating-disorders-ibs/. Mahoney, Ben. “How Eating Disorders Affect the Digestive System - MEDA - Multi-Service Eating Disorders Association.” MEDA, 22 May 2018, www.medainc.org/eating-disorders-affect-digestive-system/. MBA, Reid J. Robison MD. “The Body Keeps Score.” Medium, Beat Eating Disorders, 21 Nov. 2017, medium.com/beat-eating-disorders/the-body-keeps-score-14790ec3fae7. Rodriguez, Tori. “Expert Q&A: Low-FODMAP Diet Risky in Patients With Eating Disorders.” Gastroenterology Advisor, 8 Oct. 2019, www.gastroenterologyadvisor.com/irritable-bowel-syndrome-ibs/expert-qa-low-fodmap-diet-risky-in-patients-with-eating-disorders/. Santonicola, Antonella, et al. “Eating Disorders and Gastrointestinal Diseases.” Nutrients, vol. 11, no. 12, 2019, p. 3038., doi:10.3390/nu11123038. Sato, Yasuhiro, and Shin Fukudo. “Gastrointestinal Symptoms and Disorders in Patients with Eating Disorders.” Clinical Journal of Gastroenterology, Springer Japan, 26 Oct. 2015, link.springer.com/article/10.1007/s12328-015-0611-x.   

Today we are reporting on the 'FLIP device' and give you an update on the likely aetiology of achalasia.  There have been studies on 'motorised spiral enteroscopy'. Is a motor really a good thing inside the small bowel?  We are surprised to see a complete turnaround in the recommendations from Sheffield on how to diagnose Coeliac disease !  Sadly, surveillance in patients with MUTyH related polyposis doesn't seem to save lives.  Should we all start doing 'full thickness' colonic resections?  I urge caution!   Finally, there have been some good news and some bad news on the topic of emergency GI bleeding ... References: Savarino E. T Use of the Functional Lumen Imaging Probe.  American Journal of Gastroenterology 2020;115(11):1786-96 Campagna RAJ. Intraoperative assessment of oesophageal motility using FLIP during myotomy for achalasia.  Surgical Endoscopy 2020;34(6):2593-2600 Ikebuchi Y. microRNAs in biopsy samples of lower oesophageal sphincter muscle during peroral endoscopic myotomy for oesophageal achalasia.  Digestive Endoscopy. 2020;32(1):136-42 Ramchandani M. Diagnostic yield and therapeutic impact of novel motorized spiral enteroscopy in small-bowel disorders: a single-center, real-world experience from a tertiary care hospital.  Gastrointestinal Endoscopy.  2020 Jul 12. Beyna T. Total motorized spiral enteroscopy: first prospective clinical feasibility trial.  Gastrointestinal Endoscopy.  2020 Oct 31. Penny HA. Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts. Gut 2020 Nov 02. Guz-Mark A. High rates of serology testing for coeliac disease, and low rates of endoscopy in serologically positive children and adults in Israel: lessons from a large real-world database.  European Journal of Gastroenterology & Hepatology. 2020;32(3):329-34 Thomas LE.  Duodenal adenomas and cancer in MUTYH-associated polyposis: an international cohort study.  Gastroenterology.  2020 Oct 29. Patel R.  MUTYH-associated polyposis - colorectal phenotype and management.  Colorectal Disease 2020;22(10):1271-78 Yeh JH.  Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis.  Clinical Gastroenterology & Hepatology. 2020;18(12):2813-23 Boger P.  Endoscopic full thickness resection in the colo-rectum: outcomes from the UK Registry. European Journal of Gastroenterology & Hepatology.  2020 Oct 29. Zwager LW.  Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry.  Endoscopy. 2020;52(11):1014-23 Lee HS.  Comparison of conventional and modified endoscopic mucosal resection methods for the treatment of rectal neuroendocrine tumors.  Surgical Endoscopy.  2020 Oct 22. Kherad O. Systematic review with meta-analysis: limited benefits from early colonoscopy in acute lower gastrointestinal bleeding. [Review] Alimentary Pharmacology & Therapeutics. 52(5):774-88, 2020 09. Alzoubadi D. Outcomes from an international multicenter registry of patients with acute gastrointestinal bleeding undergoing endoscopic treatment with Hemospray.  Digestive Endoscopy. 2020;32(1):96-110

Today we are reviewing 15 recent endoscopy publications ranging from the effect of Covid on our endoscopy service and training, a Delphi review of water immersion vs exchange, AI and scoring colitis, adrenaline and pancreatitis.  We are asking if gastric GIST's are not better removed laparoscopically after all. Finally, a reminder about the new WHO criteria for the diagnosis of SSPS. Rutter M. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. GUT 2020, July 20 (http://dx.doi.org/10.1136/gutjnl-2020-322179 ) Lantinga MA. Impact of the COVID-19 pandemic on gastrointestinal endoscopy in the Netherlands: analysis of a prospective endoscopy database. Endoscopy 2020, Oct 20 Clarke K. Impact of COVID-19 Pandemic on Training: Global Perceptions of Gastroenterology and Hepatology Fellows in the USA. Digestive Diseases & Sciences.  2020 Oct 19 Sonnenberg A. Digestive Diseases & Sciences. 2020 Oct 21 (https://doi.org/10.1007/s10620-020-06661-0) Maclean W. Adoption of Faecal Immunochemical Testing for two-week wait colorectal patients during the COVID-19 pandemic: An observational cohort study reporting a new service at a regional centre. Colorectal Disease. 2020 Oct 17 McSorley ST. Yield of colorectal cancer at colonoscopy according to faecal haemoglobin concentration in symptomatic patients referred from primary care. Colorectal Disease.  2020 Oct 16 Pin-Vieito N. Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test. World Journal of Gastroenterology 2020 26(1):70-85, 2020 Ebigbo A. Cost-effectiveness analysis of SARS-CoV-2 infection-prevention strategies including pre-endoscopic virus testing and use of high-risk personal protective equipment.. Endoscopy.  2020 Oct 20 Cadoni S. Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations. Gastrointestinal Endoscopy. 2020 Oct 15. Bhambhvani HP. Deep learning enabled classification of Mayo endoscopic subscore in patients with ulcerative colitis. European Journal of Gastroenterology & Hepatology.  2020 Oct 16 Luo H. Rectal Indomethacin and Spraying of Duodenal Papilla with Epinephrine Increases Risk of Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography. Clinical Gastroenterology & Hepatology. 17(8):1597-1606.e5, 2019 07 Dong X. Laparoscopic resection is better than endoscopic dissection for gastric gastrointestinal stromal tumor between 2 and 5 cm in size: a case-matched study in a gastrointestinal center. Surgical Endoscopy. 34(11):5098-5106, 2020 Nov Ezaz G. Association Between Endoscopist Personality and Rate of Adenoma Detection. Clinical Gastroenterology & Hepatology. 17(8):1571-1579.e7, 2019 07 Lee JY. Association Between Cigarette Smoking and Alcohol Consumption and Sessile Serrated Polyps in Subjects 30 to 49 Years Old. Clinical Gastroenterology & Hepatology. 17(8):1551-1560.e1, 2019 07 Dekker E. Update on the World Health Organization Criteria for Diagnosis of Serrated Polyposis Syndrome. Gastroenterology 2020, January 23 (https://doi.org/10.1053/j.gastro.2019.11.310)

FDA 连续批准2个治疗胆管癌的靶向药 Lancet 细胞海绵-三叶因子3监测法筛查Barrett食管Nature 胃肠道也有独立的神经系统培米加替尼（Pemigatinib）约20%的肝内胆管癌患者存在成纤维细胞生长因子受体（FGFR）2融合基因突变，培米加替尼（Pemigatinib）是一种选择性FGFR抑制剂。2020年4月，FDA批准培米加替尼治疗复发性的FGFR2基因融合或重排的局部晚期胆管癌。《FIGHT-202研究：培米加替尼治疗晚期胆管癌的临床研究》Lancet Oncology，2020年5月 (1)这个多中心、非盲、单臂、2阶段研究纳入FGFR2融合或重排的晚期胆管癌患者、其他FGF/FGFR基因突变的患者、和没有FGF/FGFR基因突变的患者肱146人。所有入组患者均接受培米加替尼治疗直到疾病进展、不可接受的毒性、撤回同意或医生决定。中位随访17·8个月，FGFR2融合或重排患者中35·5%达到客观缓解（其中3例完全缓解，35人部分缓解）。高磷酸盐血症是最常见的不良事件，49%的患者在研究期间死亡，最常见的原因是疾病进展，与治疗无关。结论：培米加替尼在以前治疗过的发生FGFR2融合或重排的胆管癌患者中均有一定疗效。艾伏尼布（ivosidenib）基因组分析表明，胆管癌中有13%的患者存在IDH1基因突变，艾伏尼布（ivosidenib）是一种新型的小分子靶向异柠檬酸脱氢酶1（IDH1）抑制剂。艾伏尼布2018年被FDA批准用于急性髓细胞性白血病的一线治疗，2020年4月批准用于胆管癌靶向治疗药物。《ClarIDHy研究：针对胆管癌异柠檬酸脱氢酶1（IDH-1）突变的新型靶向疗法的3期临床研究》Lancet Oncology，2020年8月 (2)胆管癌是一种对化疗敏感的癌症。尽管吉西他滨联合顺铂的一线化疗是标准治疗方案，但二线治疗却效果有限。这项国际性、双盲、安慰剂对照的、随机的、3期临床试验中，招募了185例携带IDH-1突变的胆管癌患者，其中大部分患者原发性肝内胆管癌（90%～95%）伴远处转移（92%～93%），随机接受艾伏尼布或安慰剂治疗。中位随访6.9个月时，艾伏尼布组的中位无进展生存期优于安慰剂组（2.7个月 vs 1.4个月，P

FDA 连续批准2个治疗胆管癌的靶向药 Lancet 细胞海绵-三叶因子3监测法筛查Barrett食管Nature 胃肠道也有独立的神经系统培米加替尼（Pemigatinib）约20%的肝内胆管癌患者存在成纤维细胞生长因子受体（FGFR）2融合基因突变，培米加替尼（Pemigatinib）是一种选择性FGFR抑制剂。2020年4月，FDA批准培米加替尼治疗复发性的FGFR2基因融合或重排的局部晚期胆管癌。《FIGHT-202研究：培米加替尼治疗晚期胆管癌的临床研究》Lancet Oncology，2020年5月 (1)这个多中心、非盲、单臂、2阶段研究纳入FGFR2融合或重排的晚期胆管癌患者、其他FGF/FGFR基因突变的患者、和没有FGF/FGFR基因突变的患者肱146人。所有入组患者均接受培米加替尼治疗直到疾病进展、不可接受的毒性、撤回同意或医生决定。中位随访17·8个月，FGFR2融合或重排患者中35·5%达到客观缓解（其中3例完全缓解，35人部分缓解）。高磷酸盐血症是最常见的不良事件，49%的患者在研究期间死亡，最常见的原因是疾病进展，与治疗无关。结论：培米加替尼在以前治疗过的发生FGFR2融合或重排的胆管癌患者中均有一定疗效。艾伏尼布（ivosidenib）基因组分析表明，胆管癌中有13%的患者存在IDH1基因突变，艾伏尼布（ivosidenib）是一种新型的小分子靶向异柠檬酸脱氢酶1（IDH1）抑制剂。艾伏尼布2018年被FDA批准用于急性髓细胞性白血病的一线治疗，2020年4月批准用于胆管癌靶向治疗药物。《ClarIDHy研究：针对胆管癌异柠檬酸脱氢酶1（IDH-1）突变的新型靶向疗法的3期临床研究》Lancet Oncology，2020年8月 (2)胆管癌是一种对化疗敏感的癌症。尽管吉西他滨联合顺铂的一线化疗是标准治疗方案，但二线治疗却效果有限。这项国际性、双盲、安慰剂对照的、随机的、3期临床试验中，招募了185例携带IDH-1突变的胆管癌患者，其中大部分患者原发性肝内胆管癌（90%～95%）伴远处转移（92%～93%），随机接受艾伏尼布或安慰剂治疗。中位随访6.9个月时，艾伏尼布组的中位无进展生存期优于安慰剂组（2.7个月 vs 1.4个月，P

Resources/Links: https://drmarvinsingh.com/   https://www.amazon.com/Integrative-Gastroenterology-Weil-Medicine-Library/dp/0190933046   Marvin Singh, M.D is an Integrative Gastroenterologist in San Diego, California, and a Member of the Board and Diplomate of the American Board of Integrative Medicine. He is also trained and board certified in Internal Medicine and Gastroenterology/Hepatology. A graduate of Virginia Commonwealth University School of Medicine, Singh completed his residency training in Internal Medicine at the University of Michigan Health System followed by fellowship training in Gastroenterology at Scripps Clinic Torrey Pines. Singh was trained by Andrew Weil, M.D., a pioneer in the field of integrative medicine, at the Andrew Weil Center for Integrative Medicine. Singh is currently the Director of Integrative Gastroenterology at the Susan Samueli Integrative Health Institute at UC Irvine. He is also currently a voluntary Assistant Clinical Professor at UCSD in the Department of Family Medicine and Public Health; prior to this, he has been a Clinical Assistant Professor at UCLA and an Assistant Professor of Medicine at Johns Hopkins University. Singh is a member of the American Academy of Anti-Aging Medicine, American College of Lifestyle Medicine, and many other societies. He is actively involved in the American Gastroenterological Association. He is one of the editors of the textbook of Integrative Gastroenterology, 2nd edition (a Weil Series text) and has written several book chapters and articles. He is dedicated to guiding his clients toward optimal wellness every step of the way, using the most cutting edge technologies to design highly personalized precision based protocols and help them stay on top of their health, rather than underneath disease. Towards this end, he founded Precisione Clinic, to bring the best in preventive medicine to his clients.

Our Guest today is Marvin Singh, M.D is an Integrative Gastroenterologist in San Diego, California, and a Member of the Board and Diplomate of the American Board of Integrative Medicine. He is also trained and board certified in Internal Medicine and Gastroenterology/Hepatology. As Dr. Singh says in one of his interviews "My best piece of wellness advice is to never give up or get discouraged. Find a provider who's beliefs and goals are aligned with yours and who has the training and expertise you need to help you optimize your health and well-being but will also guide you through the process every step of the way. This is what I love and enjoy doing everyday! And don't be afraid to ask questions and learn about topics you aren't familiar with. It's when we push ourselves to ask these difficult questions or think about things that others might not think about as readily that we can sometimes truly gain unique insight. Get to know your body, your gut microbiome, your genes, your sensitivities and much more....within these mysteries lies the path to a truly individualized and highly personalized wellness program" Dr. Marvin Singh Social Media: Website: drmarvinsingh.com Instragram : @DrMarvinSingh In this podcast we talked about : - Gut health & Emotions - Integrative & Precision Medicine - Keto & Intermittent Fasting - Social Media Diet - Caffeine Microdosing We are hopeful that you would appreciate this episode and share it amongst your family & friends. Any suggestion, feedback or comment that you might have, feel free to get in touch on saadia@dhaani.online

Are you actually what you eat? Thankfully, we can finally settle the debate. Join us for this week's LearnSkin podcast as Marvin Singh, MD walks us through integrative gastroenterology, its impacts on your skin, and how a healthy body starts with the gut microbiome. Each Thursday, join Dr. Raja and Dr. Hadar, board certified dermatologists, as they share the latest evidence based research in integrative dermatology. For access to CE/CME courses, become a member at LearnSkin.com.   Dr. Marvin Singh is an Integrative Gastroenterologist and founder of Precisione Clinic in San Diego, California. He is also a Member of the Board and Diplomate of the American Board of Integrative Medicine as well as being trained and board certified in Internal Medicine and Gastroenterology/Hepatology.

Today we are going to tackle Coronavirus, specifically SARS-CoV-2 which causes the disease COVID 19 in relation to gastrointestinal symptoms and disease. I will be interviewing Dr Kaushal Majmudar who is one of our great GI fellows at Advocate Lutheran General Hospital. He recently did a Grand Rounds for our GI department on this very topic and went over all the recent data regarding pathogenesis, treatment and also recommendations from various GI societies for specific clinical scenarios regarding liver disease, endoscopy and inflammatory bowel disease. This will be valuable information for clinicians in all specialties and definitely for those working in GI. Though at times this does become technical at certain points, it will be valuable information for the non-physician audience too. At the end I will give my own thoughts about COVID 19 and IBD with comments on the relevance of the hygiene hypothesis, infusion centers and specific risks of medications. As a disclaimer, we are not the CDC or members of committees creating the guidelines that will be discussed. Opinions are our own. This is an open discussion and should not be interpreted as medical advice.

My guest this week is Dr. Marvin Singh, an Integrative Gastroenterologist in San Diego, California and a Member of the Board and Diplomate of the American Board of Integrative Medicine. Dr. Singh is trained and board-certified in Internal Medicine and Gastroenterology/Hepatology. He was later trained by Andrew Weil, M.D., a pioneer in the field of integrative medicine, at the Andrew Weil Center for Integrative Medicine. Currently, Dr. Singh is a voluntary Assistant Clinical Professor at UCSD in the Department of Family Medicine and Public Health. He is an editor of the textbook of Integrative Gastroenterology, 2nd edition and has written several book chapters and articles. Dr. Singh is dedicated to guiding his clients toward optimal wellness every step of the way, using the most cutting edge technologies to design highly personalized precision-based protocols and help them stay on top of their health, rather than underneath disease. As a result, he founded Precisione Clinic, to bring the best in preventive medicine to his clients.  In this episode, Dr. Singh and I discuss how families can improve their health and wellness collectively to help prevent future chronic illnesses in their households with a precision medicine-based approach. To learn more about Dr. Singh click here.   Where to learn more about Dr. Marvin Singh... Dr. Marvin Singh Website Precisione Clinic Website Facebook  Twitter: @drmarvinsingh Instagram:  @drmarvinsingh Instagram: @Precisioneclinic   Connect with Dr. Nicole Beurkens on... Instagram Facebook Drbeurkens.com   Need help with improving your child's behavior naturally?  My book Life Will Get Better is available for purchase, click here to learn more.  Looking for more? Check out my Blog and the Better Behavior Naturally Parent Program - a resource guide for parents who want to be more effective with improving their child's behavior.  Interested in becoming a patient? Contact us here.

#4 Natalia Khalaf, MD, Baylor College of Medicine, Assistant Professor of Medicine, Section of Gastroenterology & Hepatology

Interview #1: Clark Hair, MD, Assistant Professor, Gastroenterology & Hepatology, BCM, Houston, TX. Next up, Rhonda Cole, MD!

PSC Partners Seeking a Cure is pleased to present Living With PSC, a podcast moderated by Niall McKay. Each month, this podcast will explore the latest research and knowledge about PSC. From patient stories, to the latest research updates from PSC experts, to collaborations that are necessary to find better treatments and a cure, this podcast has it all! In the fifth episode of Living with PSC, Niall McKay interviews Dr. Cyriel Ponsioen about Fecal Microbiota Transplantation (FMT). Dr. Ponsioen is a senior staff member at the Department of Gastroenterology & Hepatology at the Academic Medical Center in Amsterdam, and is a member of PSC Partners' Scientific/Medical Advisory Committee. Enjoy!

http://www.augusta.edu/mcg/medicine/gastro/faculty SIBO And SIFO http://learntruehealth.com/sibo-and-sifo/ SIBO (Small Intestinal Bacterial Overgrowth) and SIFO (Small Intestinal Fungal Overgrowth) are two health conditions plaguing many people today. SIBO stands for small intestinal bacterial overgrowth and SIFO stands for small intestinal fungal overgrowth. Respected expert Dr. Satish Rao is here with us today to explain what SIBO and SIFO are all about and how to treat it. This episode was hard for me to do since Dr. Satish Rao is an allopathic doctor. His way of treating SIBO and SIFO is different from experts in Natural Medicine, but his research about SIBO and SIFO is worth talking about. I have been recently tackling topics about gut health and the best treatment for gut issues. So, I highly recommend everyone to listen to episodes 245 and 247. Family of Physicians Dr. Satish Rao came from a family of physicians. His father was a Professor of Medicine and a University Dean. When he was young, Dr. Satish Rao recalls that his father used to carry around a Sheaffer pen with a white dot on it. He wanted the pen, but his father told him only doctors could have that pen. That apparently became Dr. Satish Rao’s motivation to become a doctor. Dr. Satish Rao pursued medical studies in India and took post-graduate studies in England. He, later on, discovered that deficiency of selenium causes cystic fibrosis and muscular dystrophy. Dr. Satish Rao also learned about gastroenterology and focused on research as well as an essential area of the gut called Neurogastroenterology and motility. That branch of medicine was still in its infancy in the early 80s. Dr. Satish Rao was mentored by two outstanding professors and has helped many patients. “We have been able to understand some key disorders and dysfunctions in the gut and find a remedy to help them. That’s been my journey over the past 25 years,” said Dr. Satish Rao. Understanding Nutrition Medical doctors are not taught nutrition and how food plays a significant role in our gut health. We are just given drug after drug. Dr. Satish Rao, on the other hand, identified a new illness that is man-made because of drugs and over prescription. He’s a very conventional doctor but is treated as an outsider by the community. Dr. Satish Rao says he would love to implement diet and a healthy lifestyle as a solution for health problems. Having practiced in three different continents—India, U.K. and the United States, Dr. Satish Rao feels it is tough to teach people proper nutrition, especially in the United States. “One of the hardest things I found in America is to change people’s behavior, culture and eating habits. Every patient in India, asks me restrictions on their diet,” shares Dr. Satish Rao. “But in the United States, I never get that question. Even when I advise them, it is very hard for people to change.”  He adds,”I do believe there are tremendous things one can do to change their lifestyle and behavior and that can do along with healing. But it has to be done in tandem with other things that we can do as physicians and the prescription drugs. It cannot be done without it.”  Right Mindset Dr. Satish Rao also makes it clear that in the long-term, it is not the drugs that are going to help and conquer the problem. He says it is probably their lifestyle issues that will give the long-term remedy. Unfortunately, American and Canadian cultures are similar. Americans and Canadians are not raised to see that their lifestyle has an impact on their health. Countries like India, on the other hand, is more in touch with Holistic healing. “In the U.K., the patient I had were very willing to institute changes and take on recommendations. In the United States, I don’t think people like to change. They may, under some duress but it’s not going to come soon,” predicted Dr. Satish Rao. We have seen a difference in the last five years. I remember having a demographer on the show who said the millennials—aged 14 to 33, have now outnumbered the baby boomers and the generation in between. Millenials have a different mindset, and I hope they would change their mind before it’s too late. Symptoms of SIBO and SIFO Dr. Satish Rao says he tends to see a challenging group of SIBO and SIFO patients from all over the country and internationally as well. He says people suffering from SIBO and SIFO usually have significant unexplained symptoms of bloating, pain and gas. “To characterize if there was indeed an infection in the gut, we look inside the stomach lining or small bowel lining and see if there is anything unusual. Then we’ll take biopsies. Or if there is celiac disease, we will take biopsies, too,” said Dr. Satish Rao. According to Dr. Satish Rao, there’s also a test wherein it takes 24 hours to study a patient’s gut motility. This is to see if the muscles and nerves are working or not. Another option is taking juice from the small bowel to study if there is an infection in the patient’s small bowel. Dr. Satish Rao then sends the specimen to the microbiology lab to see if it would grow any bacteria or fungal organisms. Test Findings Dr. Satish Rao reveals that he has encountered different findings over the years. In the mid-90s, doctors will treat patients with antibiotics if there is a bacterial infection. Treatment for fungus it is administered in another way. Then fast forward 2005 or 2006, Dr. Satish Rao thought of doing further research on SIBO and SIFO. The results became quite controversial. When Dr. Satish Rao and his team looked at the data carefully, they found that a quarter of the patients had exclusive fungal overgrowth. A quarter had a mix of bacteria and fungus. Another group had pure bacteria, and 30 to 40% of patients were clean. “Then I tried to publish that work. But lo and behold, if you’re ahead of the curve in the medical literature, you get frown upon. No one would accept it. They wanted to publish my work on SIBO thought my research about fungus was rubbish,” said Dr. Satish Rao. In around 2010, Dr. Satish Rao finally found a very reputable journal that was willing to publish his findings. For the first time, the SIBO and SIFO were published as a major G.I. article. Now, there was more recognition that this is a valid entity.  When Should We Be Alarmed? Dr. Satish Rao says that a significant growth pertains to a thousand colony-forming fungi per milliliter of fluid or more. Some of them grow a million or more. Aside from that, Dr. Satish Rao says we should also remember the area from where it is growing. “The stomach is full of hydrochloric acid. It has a strong way of attacking and killing bacteria, fungus, and everything,” explains Dr. Satish Rao. “The duodenum is the tube that comes out of the stomach, and we are sampling within the first 6-9 in of the stomach.”  He adds, “It is an area continuously bathed in stomach acid, and it has a very high exposure to the acidic environment. So, in that area, there should be no bacteria or fungus. If there is, then there is a problem.” Unfortunately, Dr. Satish Rao says, looking at symptoms profiles, we are not able to distinguish who has this condition or not. Those who have and don’t have an overgrowth have very similar symptom profiles. And he says that the only way to separate it is by doing the culture. Understanding Fungus Infection Dr. Satish Rao says that fungus infection can be anywhere in the body. Typically, he says people who have an underlying depressed immune system, like with cancer, lymphoma, leukemia, HIV infection, are strong candidates. “These are a prime group of individuals who don’t have the right immunity to ward off infection from fungus. And fungus is naturally present on our skin, in our mouth and areas exposed to the environment. It is normal for them to be there,” Dr. Satish Rao said.  He adds, “But when something happens inside the body like an infection, diabetes, overuse of steroids or antibiotics, it is a risk for fungus infection. But two factors stood out about our patients. One was the use of proton pump inhibitor and the presence of small intestinal dysmotility. They increase the risk to develop SIFO.” Impact of Drugs It is not surprising that the overuse of drugs has an impact on the gut. According to Dr. Satish Rao, the gut has a very interesting program of small intestinal dysmotility, typically the upper gut. Dr. Satish Rao explains that every 90 minutes or so, as long as you remain fasting, there is a beautiful, strong, sweeping process that goes through the gut and sweeps its way through the colon. It happens every 60 to 90 minutes. If this pattern doesn’t happen, they say you have a problem in your small bowel. This means you no longer have the capability to clean its contents. “The problem of SIBO and SIFO is unfortunately man-made. I have been practicing G.I. for 25 to 30 years, and I don’t believe I’ve seen that many patients with these kinds of symptoms for a long time,” said Dr. Satish Rao. “It’s no question that we recognize it, and we are diagnosing it. But we were never using these powerful drugs for this length of time.” Recommended Treatment Dr. Satish Rao usually tries to eradicate the problem through a 3-week course of antifungal therapy with fluconazole. Fluconazole gets absorbed into the bloodstream and acts on the problem. Dr. Satish Rao explains that he has to maintain people on antibiotics because of the underlying gut motility problem. Plus, patients need long-term treatment. “The other component of treatment gets rid of any potential and incriminating factors. If they have a motility problem, I can try and place them on drugs that stimulate motility. Unfortunately, we don’t have many good drugs, so I try to give those drugs in small amounts,” said Dr. Satish Rao. As for administering intravenous magnesium, Dr. Satish Rao has not used it to treat patients. He says magnesium tends to have a calming effect rather than a stimulating effect on gut motility. So that is why it is not Dr. Satish Rao’s drug of choice for his patients. Role Of Food Dr. Satish Rao recommends more acidic-containing food because the fungus hates an acidic environment. This way, we can kill off the fungal bacteria through acidic foods. “But more acidic food can also trigger reflux symptoms. There should be a fine balance between acidic and alkaline foods. Look also at your tolerance for different food products. I usually have my patients do a three-day food chart then come up with a formula diet,” clarifies Dr. Satish Rao.  Other Concerns Dr. Satish Rao also reveals that people who had surgery in the gut, particularly colon surgery, is the classic set up for SIBO. People who had this surgery have disrupted the normal barriers between the small and large bowel. But despite that, Dr. Satish Rao was quick to explain that he’s not disputing the reason for the surgery. He’s just saying that unfortunately, that group of individuals are highly susceptible and prone to SIBO and SIFO. “Most patients go on lifelong antibiotics because we have no other way of preventing it. But I don’t treat them with large doses. I recommend maintenance doses and the easiest regime usually a week to ten days or after a month. There are only a few who need continuously,” said Dr. Satish Rao. Bio Dr. Satish Rao received his MD from Osmania Medical College, Hyderabad, India, his Ph.D. from the University of Sheffield, U.K., and the Fellowship of the Royal College of Physicians (FRCP) in London, UK, in 1997. Having spent 20 years at Iowa where he was a Professor of Medicine and Director, Neurogastroenterology and GI Motility and Biofeedback Program, University of Iowa Carver College of Medicine, Iowa City, Dr. Satish Rao recently moved to Medical College of Georgia, Georgia Regents University, Augusta, Georgia where he is a Professor of Medicine, Division Chief, Gastroenterology/Hepatology and Founding Director, Digestive Health Center.  Dr. Satish Rao is one of a rare breed of academicians who has excelled as an outstanding researcher, distinguished educator and as a Master Clinician. His research interests focus on the pathophysiology and treatment of IBS, food intolerance particularly fructose intolerance, constipation and fecal incontinence and visceral pain, particularly esophageal chest pain.  Dr. Satish Rao is the only physician to date who has received all three meritorious honors from the AGA: the AGA Distinguished Clinician Award, AGA Masters Award for Outstanding Clinical Research, and the AGA Distinguished Educator Award. In 2005, he received an ACG Auxiliary Research Award, and in 2007 the ACG Novartis Motility research award for the best research paper.  Dr. Satish Rao has edited several books, Disorders of the Anorectum (2001), Anorectal and Pelvic Floor disorders (2008) for Gastroenterology Clinics of North America, Gastrointestinal Motility- Tests and problem-Oriented Approach and GI Motility Testing-a Laboratory and Office Handbook (2010, Co-editor). He has published over 300 articles.  Dr. Satish Rao is an astute clinician with an international reputation and has been selected as one of the “Best Doctors in America” and America’s Top Doctors for over 15 years. He is Past President of the American Neurogastroenterology & Motility society. Get Connected With Dr. Satish Rao: Augusta University Recommended links: Episode 226 – Demography – Kenneth Gronbach Episode 245 – Sunlighten Saunas – Connie Zack Episode 247 – Gut Issue – Evan Brand   The Links You Are Looking For: Support Us on Patreon & Join the Learn True Health Book Club!!! 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