Do pharmacokinetics justify dose-optimization for loss of response to Vedolizumab in IBD?

Knowledge surrounding therapeutic drug monitoring (TDM) in inflammatory bowel disease is growing, especially for tumor necrosis factor-? inhibitors class of drugs. Yet, TDM for the ?4?7 integrin antibody vedolizumab (VDZ) has not been equally established, as real-life data on VDZ pharmacokinetics, VDZ drug level and treatment response are scarce. We summarize the @GIJournal discussion held on July 14, 2021 during which the article by Ungar et al. “Dose-optimization for loss-of-response to vedolizumab - pharmacokinetics and immune mechanisms” was critically reviewed by our expert Dr. Aline Charabaty (AC), and moderated by Dr. Asad ur Rahman (AR).

Effects of diaphragmatic breathing on the pathophysiology and treatment of upright reflux: a randomized controlled trial

Patients with upright reflux have predominantly nonerosive esophagitis and can be successfully treated with non-pharmacological treatments. In some studies, diaphragmatic breathing reduced acid exposure and improved gastroesophageal reflux disease (GERD) symptoms in reflux patients. Further investigation is needed to assess the mechanism of action and efficacy of Diaphragmatic breathing. We summarize the @GIJournal discussion held on March 17, 2021 during which we discussed the article by Halland et Al titled “Effects of diaphragmatic breathing on the pathophysiology and treatment of upright reflux: a randomized controlled trial.” Key findings were reviewed by our expert Dr. Magnus Halland (MH) and the session was moderated by Dr Linda Nguyen (LN).

Sleeve Gastrectomy Pre-Liver Transplant compared to Medical Weight Loss

Methods to optimize obesity-related metabolic complications post liver transplant (LT) are needed given their impact on patient outcomes. Some transplant centers also have concerns about offering transplantation for obese patients due to concern for complications. In this study, selected patients with cirrhosis and medically complicated obesity either underwent sleeve gastrectomy (SG) or medical weight loss (MWL) and then were subsequently listed for LT. The impact of pre–LT SG and MWL on post-LT diabetes, post-LT hypertension, and recurrent and de novo nonalcoholic fatty liver disease (NAFLD) were evaluated.1 We summarize the @GIJournal discussion held on May 26, 2021, during which the article by Sharpton et al. “Sleeve gastrectomy prior to liver transplantation is superior to medical weight loss in reducing posttransplant metabolic complications” was critically discussed by our experts, Dr. Suzanne Sharpton (@SharptonSuzanne) and Dr. Julie Heimbach (@JulieHeimbach), and moderated by Dr. Anjana Pillai (@AnjanaPillaiMD).

Clearing the air

There is tremendous interest in the use of probiotics to treat gastrointestinal diseases such as irritable bowel syndrome (IBS), but significant limitations to the research, lack of regulation of the probiotic market, and limited education surrounding probiotics have led to confusion and misinformation. In this article, we summarize our #TuesdayNightIBS discussion on the current state of affairs in probiotics research as it relates to IBS. We include a compilation of evidence based strains and combinations of strains specifically for IBS, and provide suggestions and resources that relate to the prescribing of probiotics for IBS.

Should we be concerned about histologic changes caused by novel submucosal injection agents used for EMR and ESD?

Normal saline mixed with dyes is a widely used submucosal lifting agent for endoscopic resection of small gastrointestinal (GI) lesions. For larger GI lesions, novel agents are used to achieve optimal results. ORISE gel is a novel, premixed submucosal lifting solution for endoscopic resection procedures. The initial histologic appearance of endoscopic specimens with injection of ORISE gel is characterized by a pale, basophilic amorphous appearance which has the potential to be misinterpreted as a pathologic finding. The histologic appearance changes overtime to an eosinophilic appearance that is reflected by an inflammatory, foreign body reaction. We summarize the @GIJournal discussion held on May 12, 2021, about the article by Olivas et al “Histologic changes caused injection of a novel submucosal lifting agent for endoscopic resection in GI lesions” 1. The guest experts to discuss pathology included Drs. Emma Furth (EF), and Pallavi Patil (PP), the discussion was moderated by Dr. Dmitriy Kedrin (DK).

Functional Dyspepsia and Gastroparesis: A spectrum of the same disease?

We summarize the @GIJournal discussion held on May 19, 2021 that covered the manuscript by Pasricha et al., titled “Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes with Common Clinical and Pathologic Features.” During the discussion, our expert Dr. Madhusudan Grover (MG) reviewed key findings and Dr. Zubair Malik (ZM) moderated the session.

Balloon up or balloon away? Examining the management of postoperative dysphagia following fundoplication

Dysphagia following laparoscopic fundoplication for medically refractory gastroesophageal reflux disease (GERD) is common. In patients without an anatomic defect, it has been hypothesized that the ant reflux wrap may be too tight. Therefore, pneumatic dilation may help relieve the obstruction. While retrospective data support this hypothesis, prospective data are lacking. We summarize the @GIJournal discussion held on February 17, 2021, during which the article by Schuitenmaker et al. “Pneumatic dilation for persistent dysphagia after ant reflux surgery, a multicentre single-blind randomized sham-controlled clinical trial” was critically reviewed by our expert Dr. John Pandolfino (JP), and moderated by Dr. Marianna Papademetriou (MP).

Is Endoscopic Submucosal Dissection (ESD) Ready for Primetime in North America?

Endoscopic submucosal dissection (ESD) is a novel technique for endoscopic en bloc resection of neoplastic and dysplastic lesion in the gastrointestinal tract. Endoscopic Mucosal Resection (EMR) has been used historically however ESD carries the added advantage of providing accurate histopathologic evaluation for resection margins, low recurrence rate, curative resection. Also compared to surgery it carries a lower risk of morbidity and mortality. ESD is well established in Asia however its adoption is lagging in North America. We summarize the @GIJournal discussion held on March 10th, 2021 during which Draganov et al. “Endoscopic Submucosal Dissection (ESD) in North America: A Large Prospective Multicenter Study” was critically reviewed by our expert panel: Drs. Neil Sharma (NS), and Mohamed Othman (MO) and moderated by Dalbir Sandhu (DS).

Fiber Wars: Are mixed soluble and insoluble fibers the answer for irritable bowel syndrome?

Fiber is known to exert various favorable effects on the gastrointestinal tract via modulation of the microbiota, formation of metabolites (such as short chain fatty acids), altered motility, and manipulation of stool form. While there has been tremendous interest in utilizing fiber in the treatment of irritable bowel syndrome, results have been conflicting, with some studies finding benefit and others finding no effect or even worsening of symptoms. Nopal is a fiber derived from a cactus plant which is predominantly composed of soluble fiber. We summarize the @GIJournal discussion held on April 21, 2021 during which Remes-Troche et al. “Nopal fiber (Opuntia ficus?indica) improves symptoms in irritable bowel syndrome in the short term: a randomized controlled trial” was critically reviewed by our expert Dr. Mark Pimentel (MP), and moderated by Dr. Linda Nguyen (LN).