90 episodes

Looking to digest the latest in gastroenterology? GI Insights is here to provide updates on screening guidelines, diagnostic options, and management tools for all diseases and disorders affecting the gastrointestinal tract.

GI Insights ReachMD

    • Science

Looking to digest the latest in gastroenterology? GI Insights is here to provide updates on screening guidelines, diagnostic options, and management tools for all diseases and disorders affecting the gastrointestinal tract.

    A Specific Mutation in Muc2 Determines Early Dysbiosis in Colitis-Prone Winnie Mice

    A Specific Mutation in Muc2 Determines Early Dysbiosis in Colitis-Prone Winnie Mice

    Host: Ivy Ka Man Law, PhD


    A Specific Mutation in Muc2 Determines Early Dysbiosis in Colitis-Prone Winnie Mice
    Marina Liso, Stefania De Santis, Giulio Verna, Manuela Dicarlo, Maria Calasso, Angelo Santino, Isabella Gigante, Rajaraman Eri, Sathuwarman Raveenthiraraj, Anastasia Sobolewski, Valeria Palmitessa, Antonio Lippolis, Mauro Mastronardi, Raffaele Armentano, Grazia Serino, Maria De Angelis, Marcello Chieppa

    Background: Inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), is a multifactorial disorder characterized by chronic inflammation and altered gut barrier function. Dysbiosis, a condition defined by dysregulation of the gut microbiome, has been reported in patients with IBD and in experimental models of colitis. Although several factors have been implicated in directly affecting gut microbial composition, the genetic determinants impacting intestinal dysbiosis in IBD remain relatively unknown.
    Methods: We compared the microbiome of normal, uninflamed wild-type (WT) mice with that of a murine model of UC (ie, Winnie strain). Winnie mice ...

    Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

    Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

    Host: Abdullah Abdussalam, MD


    Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s
    Diana M Negoescu, Eva A Enns, PhD, Brooke Swanhorst, Bonnie Baumgartner, James P Campbell, Mark T Osterman, MD, Konstantinos Papamichael, PhD, Adam S Cheifetz, MD, Byron P Vaughn, MD

    Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX.
    Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.
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    Real-World Pattern of Biologic Use in Patients with Inflammatory Bowel Disease

    Real-World Pattern of Biologic Use in Patients with Inflammatory Bowel Disease

    Guest: Anish Patel, DO, FACG


    Real-world Pattern of Biologic Use in Patients With Inflammatory Bowel Disease: Treatment Persistence, Switching, and Importance of Concurrent Immunosuppressive Therapy
    Chao Chen, PhD, Abraham G Hartzema, PhD, Hong Xiao, PhD, Yu-Jung Wei, PhD, Naueen Chaudhry, MD, Ofor Ewelukwa, MD, Sarah C Glover, DO, Ellen M Zimmermann, MD
    BACKGROUND AND AIMS:
    Medication persistence, defined as the time from drug initiation to discontinuation of therapy, has been suggested as a proxy for real-world therapeutic benefit and safety. This study seeks to compare the persistence of biologic drugs among patients with inflammatory bowel disease (IBD).
    METHODS:
    Patients with newly diagnosed IBD were included in a retrospective study using Truven MarketScan database. Treatment persistence and switching was compared among biologic medications including infliximab, adalimumab, certolizumab, golimumab, and vedolizumab. Predictors for discontinuation and switching were evaluated using time-dependent proportional hazard regression.
    RESULTS:
    In total, 5612 patients with Crohn's disease (CD) and 3533 patients with ulcerative colitis (UC) were included in this analysis. Less than half of the patients continued using their initial biologic treatment after 1 year (48.48% in CD cohort; 44.78% ...

    Improving the Quality of Inpatient Ulcerative Colitis Management

    Improving the Quality of Inpatient Ulcerative Colitis Management

    Guest: Robin Dalal, MD


    Improving the Quality of Inpatient Ulcerative Colitis Management: Promoting Evidence-Based Practice and Reducing Care Variation With an Inpatient Protocol
    Sara M Lewin, MD, Ryan A McConnell, MD, Roshan Patel, MD, Suzanne R Sharpton, MD, MAS, Fernando Velayos, MD, MPH, Uma Mahadevan, MD
    BACKGROUND:
    Hospitalization for ulcerative colitis is a high-risk period associated with increased risk of Clostridium difficile infection, thromboembolism, and opiate use. The study aim was to develop and implement a quality-improvement intervention for inpatient ulcerative colitis management that standardizes gastroenterology consultant recommendations and improves delivery of evidence-based care.
    METHODS:
    All adult patients hospitalized for ulcerative colitis between July 1, 2014, and December 31, 2017, who received intravenous corticosteroids were included. On July 1, 2016, the UCSF Inpatient Ulcerative Colitis Protocol was implemented, featuring standardized core recommendations and a daily checklist for gastroenterology consultant notes, a bundled IBD electronic order set, and an opiate awareness campaign. The composite primary outcome was adherence to all 3 evidence-based care metrics: C. difficile testing performed, pharmacologic venous thromboembolism (VTE) prophylaxis ordered, and opiates avoided.
    RESULTS:
    Ninety-three ulcerative colitis hospitalizations occurred, including 36 preintervention and 57 ...

    Assessing Biosimilar Medications for Inflammatory Bowel Diseases

    Assessing Biosimilar Medications for Inflammatory Bowel Diseases

    Host: Thomas Ullman, MD

    Guest: Juli Tomaino, MD

    Guest: Sarah Yim, MD


    Biosimilar medications have now entered the clinical landscape of treatment protocols for several disciplines—including gastroenterology. Joining Dr. Thomas Ullman to discuss the biosimilars that are available for Crohn’s disease and ulcerative colitis and how other parts of the world are using them are Dr. Sarah Yim, Acting Director of the Office of Therapeutic Biologics & Biosimilars, and Dr. Juli Tomaino, a pediatric gastroenterologist and Lead Medical Officer at the FDA.

    A Pre-Teen’s Perspective on Living with IBD

    A Pre-Teen’s Perspective on Living with IBD

    Host: Jennifer Caudle, DO


    To gain more insights into how inflammatory bowel disease (IBD) affects our young patients, Dr. Jennifer Caudle connects with Caroline, a 12-year-old patient who was diagnosed with IBD at the age of 4, and her parents, Preston and Rachelle, about the challenges they face and the strategies and solutions available that can help children and teens like Caroline manage this condition.

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