Editorial

Looking Back at 2019’s Top 10, Peer Tested by You

As we enter the 6th year of Healio Gastroenterology and Liver Disease, it is worth looking back at what made us stand out in 2019: the Peer Tested content from online and print as it fared throughout the year.

Edward V. Loftus Jr., MD
Edward V. Loftus Jr.

As a reminder, the publication is primarily built by the numbers. We use analytics to bring to you in the print pages what our peers are reading online. In this Top 10, it is encouraging to see that not only are physicians reading our online-first content, but some of our print-first articles resonated as well.

It is easy to see that our interests as physicians reflect those of the general public, with the ranitidine recall and diet’s impact on microbiome and IBD ranking as some of our most frequently read items, but our interests in keeping on top of the latest FDA approvals and data reflect throughout the list as well.

I thank you for recognizing the quality content – some of which were read more than 24,000 times by physicians — produced by the team and ask that you share Healio with your peers, fellows, mentors and friends. I look forward to 2020 and the news Healio will bring to me and my peers. Happy New Year!

– Edward V. Loftus Jr., MD

Chief Medical Editor

Healio Gastroenterology and Liver Disease

1. Q&A: How Three GIs are Handling the Zantac Recall

A week after halting the distribution of Zantac in September, Sandoz, the drug’s manufacturer, voluntarily recalled several formulations of the heartburn medication after noting confirmed contamination with N-Nitrosodimethylamine (NDMA), a possible human carcinogen, above established FDA levels.

To gauge how gastroenterologists aimed to approach the evolving landscape with this medication, Healio reached out to John E. Pandolfino, MD, Dhyanesh A. Patel, MD, and Sushama Gundlapalli, MD, MS, about the initial distribution halt and subsequent voluntary recall.

In this Q&A, these physicians offered advice on what to tell patients about the recall as well as if they recommended switching therapies.

“It is very easy to switch this medication and although it is probably OK to stay on it for now, why would you if there are good alternatives,” Pandolfino said.

READ MORE

2. ‘Everyone Needs to See This’: Will Smith Gets a Colonoscopy

In August, Will Smith, who turned 50 in 2018, underwent a colonoscopy screening for colorectal cancer for the first time, but, unlike most people, decided to share his experience by posting a vlog on his YouTube page.

In the video, Smith takes viewers through the entire process of successfully completing a colonoscopy as he went through some questions about the procedure with his concierge doctor, Ala Stanford, MD, to the morning of — and aftermath of the colonoscopy bowel prep — and the post-procedure recovery period.

Healio spoke with two physicians who shared their insights on the significance of this screening on social media:

Darrell Gray II, MD, MPH, FACG, said, “Certainly, there’s such a thing as machismo. It’s common when I go into the community for some men to say, ‘I don’t want anything up my behind.’” Gray said. “I suspect that Will Smith’s video will help other men and particularly, African American men to overcome that barrier.”

Sophie Balzora, MD, FACG, said, “I think it will encourage [others] to do the same or at least have that conversation with their family or be a little bit more comfortable talking about it with their doctor.”

READ MORE

3. Comparative Study Finds Most Effective Bowel Preps

A comparison study, published in the American Journal of Gastroenterology, found the most effective and best tolerated bowel preparations, which researchers hope will help provide some guidance on which one of the many commercially available options to use.

“Future large, pragmatic, multicenter comparative effectiveness studies are needed to confirm these findings and to extend them to evaluate the impact on other outcomes, including ADR and cancer detection and prevention,” Christopher V. Almario, MD, MSHPM, and colleagues wrote.

READ MORE

4. FDA Approves Reintroduction of Zelnorm for IBS-C in Certain Women

The FDA approved the reintroduction of Zelnorm, a twice-daily oral treatment for irritable bowel syndrome with constipation in women aged under 65 years, according to a company press release.

In this instance, Healio gathered a perspective that placed context around this approval:

William D. Chey, MD, said, “While tegaserod was previously removed from the U.S. market because of concerns surrounding increased risks for cardiovascular events, there have subsequently been studies that have evaluated large databases and found no association between tegaserod and increased risks for cardiovascular events.”

READ MORE

5. High-fat Diet Linked to Unfavorable Gut Microbiota Changes

Eating a diet high in fat and low in carbohydrates can lead to changes in the gut at the microbiome level that could lead to the development of metabolic disorders, according to data published in Gut.

In this instance, Healio Gastroenterology and Liver Disease gathered a perspective from a registered dietitian on what these findings could mean.

Kelly Issokson, MS, RD, CNSC, said, “The results of this study are limited in terms of generalizability, and because the study was conducted in a young and healthy population, it is hard to say how these diet changes would affect other groups of people.”

READ MORE

6. Common Medications Linked to Changes in Gut Microbiome

A group of commonly used drug categories have a significant impact on the makeup of the gut microbiome, which could increase the risk for infection, obesity and other conditions, according to study results presented at UEG Week.

In this instance, Healio gathered a perspective on how these results might impact practice.

Taha Qazi, MD, said, “[PPIs and laxatives] have been linked to antibiotic resistance patterns by the authors. However, in the absence of longitudinal data, I don’t think it changes my practice in providing these agents.”

READ MORE

7. Crohn’s Disease Exclusion Diet Well-tolerated in Children

The Crohn’s Disease Exclusion Diet appeared to be an effective and well-tolerated, first-line therapy for children with mild-to-moderate Crohn’s disease, according to data presented at Digestive Disease Week.

In a perspective on these results, Joel R. Rosh, MD, FAAP, FACG, AGAF, said, “Will this diet work for the moderate to severe patient, who is commonly encountered at diagnosis or, is this a therapy best used as an alternative to going back to corticosteroids in a patient who loses response? Clearly this is not the last we will hear of CDED and this remains a very exciting area of clinical and translational research.”

Follow us on Twitter @HealioGastro for our onsite coverage of Digestive Disease Week in May.

READ MORE

8. Updated ACG Ulcerative Colitis Guidelines Provide ‘Practical’ Management Approach

The American College of Gastroenterology released updated guidelines on the diagnosis and management of patients with mildly and moderately to severely active ulcerative colitis.

The guidelines also address the prevention of colorectal cancer in patients with ulcerative colitis, as well as patients hospitalized with the disease.

“The guidelines are supposed to guide practitioners and to propel the field forward in accepting and incorporating new therapies and new approaches in our management, and they are also importantly supposed to support our providers and patients so that payers will acknowledge and approve different treatment strategies,” David T. Rubin, MD, FACG, said in an interview with Healio Gastroenterology and Liver Disease.

READ MORE

9. ImmusanT Discontinues Phase 2 Trial of Celiac Disease Vaccine

ImmusanT announced that it discontinued its phase 2 global study of Nexvax2, a peptide-based immunomodulatory vaccine intended to treat celiac disease, according to a company press release.

In a perspective on the discontinuation of this therapy, Peter H.R. Green, MD, said, “It is a great shame that the vaccine did not appear to induce tolerance of gluten for the study participants. ... Most early drugs fail in the beginning and that leads to better drugs later. It’s part of the process, and without smart ideas there wouldn’t be advances. ImmusanT likely has a lot of information that we can learn from.”

READ MORE

10. FDA Issues Safety Alert on Fecal Transplants After Patient Dies

Two adults with weakened immune systems who received investigational fecal microbiota transplantations developed invasive infections caused by extended-spectrum beta-lactamase-producing Escherichia coli, according to an FDA press release.

One of those individuals subsequently died.

In this instance, Healio gathered two perspectives on this devastating news:

Jasmohan S. Bajaj, MD, said, “The safety alert from the FDA highlights a critical piece of this procedure, which is donor selection. Prior studies have shown that a very miniscule proportion of potential donors are ultimately approved for donation due to multiple testing and interviewing strategies employed by stool banks and investigators.”

Monika Fischer, MD, MS, FACG, AGAF, said, “This incident and subsequent safety alert proved that it’s not just theoretically possible to transplant a deadly infection through FMT. It can happen. It did happen. We can all learn from this.”

READ MORE

As we enter the 6th year of Healio Gastroenterology and Liver Disease, it is worth looking back at what made us stand out in 2019: the Peer Tested content from online and print as it fared throughout the year.

Edward V. Loftus Jr., MD
Edward V. Loftus Jr.

As a reminder, the publication is primarily built by the numbers. We use analytics to bring to you in the print pages what our peers are reading online. In this Top 10, it is encouraging to see that not only are physicians reading our online-first content, but some of our print-first articles resonated as well.

It is easy to see that our interests as physicians reflect those of the general public, with the ranitidine recall and diet’s impact on microbiome and IBD ranking as some of our most frequently read items, but our interests in keeping on top of the latest FDA approvals and data reflect throughout the list as well.

I thank you for recognizing the quality content – some of which were read more than 24,000 times by physicians — produced by the team and ask that you share Healio with your peers, fellows, mentors and friends. I look forward to 2020 and the news Healio will bring to me and my peers. Happy New Year!

– Edward V. Loftus Jr., MD

Chief Medical Editor

Healio Gastroenterology and Liver Disease

1. Q&A: How Three GIs are Handling the Zantac Recall

A week after halting the distribution of Zantac in September, Sandoz, the drug’s manufacturer, voluntarily recalled several formulations of the heartburn medication after noting confirmed contamination with N-Nitrosodimethylamine (NDMA), a possible human carcinogen, above established FDA levels.

To gauge how gastroenterologists aimed to approach the evolving landscape with this medication, Healio reached out to John E. Pandolfino, MD, Dhyanesh A. Patel, MD, and Sushama Gundlapalli, MD, MS, about the initial distribution halt and subsequent voluntary recall.

In this Q&A, these physicians offered advice on what to tell patients about the recall as well as if they recommended switching therapies.

“It is very easy to switch this medication and although it is probably OK to stay on it for now, why would you if there are good alternatives,” Pandolfino said.

READ MORE

2. ‘Everyone Needs to See This’: Will Smith Gets a Colonoscopy

In August, Will Smith, who turned 50 in 2018, underwent a colonoscopy screening for colorectal cancer for the first time, but, unlike most people, decided to share his experience by posting a vlog on his YouTube page.

In the video, Smith takes viewers through the entire process of successfully completing a colonoscopy as he went through some questions about the procedure with his concierge doctor, Ala Stanford, MD, to the morning of — and aftermath of the colonoscopy bowel prep — and the post-procedure recovery period.

Healio spoke with two physicians who shared their insights on the significance of this screening on social media:

Darrell Gray II, MD, MPH, FACG, said, “Certainly, there’s such a thing as machismo. It’s common when I go into the community for some men to say, ‘I don’t want anything up my behind.’” Gray said. “I suspect that Will Smith’s video will help other men and particularly, African American men to overcome that barrier.”

Sophie Balzora, MD, FACG, said, “I think it will encourage [others] to do the same or at least have that conversation with their family or be a little bit more comfortable talking about it with their doctor.”

READ MORE

3. Comparative Study Finds Most Effective Bowel Preps

A comparison study, published in the American Journal of Gastroenterology, found the most effective and best tolerated bowel preparations, which researchers hope will help provide some guidance on which one of the many commercially available options to use.

“Future large, pragmatic, multicenter comparative effectiveness studies are needed to confirm these findings and to extend them to evaluate the impact on other outcomes, including ADR and cancer detection and prevention,” Christopher V. Almario, MD, MSHPM, and colleagues wrote.

READ MORE

PAGE BREAK

4. FDA Approves Reintroduction of Zelnorm for IBS-C in Certain Women

The FDA approved the reintroduction of Zelnorm, a twice-daily oral treatment for irritable bowel syndrome with constipation in women aged under 65 years, according to a company press release.

In this instance, Healio gathered a perspective that placed context around this approval:

William D. Chey, MD, said, “While tegaserod was previously removed from the U.S. market because of concerns surrounding increased risks for cardiovascular events, there have subsequently been studies that have evaluated large databases and found no association between tegaserod and increased risks for cardiovascular events.”

READ MORE

5. High-fat Diet Linked to Unfavorable Gut Microbiota Changes

Eating a diet high in fat and low in carbohydrates can lead to changes in the gut at the microbiome level that could lead to the development of metabolic disorders, according to data published in Gut.

In this instance, Healio Gastroenterology and Liver Disease gathered a perspective from a registered dietitian on what these findings could mean.

Kelly Issokson, MS, RD, CNSC, said, “The results of this study are limited in terms of generalizability, and because the study was conducted in a young and healthy population, it is hard to say how these diet changes would affect other groups of people.”

READ MORE

6. Common Medications Linked to Changes in Gut Microbiome

A group of commonly used drug categories have a significant impact on the makeup of the gut microbiome, which could increase the risk for infection, obesity and other conditions, according to study results presented at UEG Week.

In this instance, Healio gathered a perspective on how these results might impact practice.

Taha Qazi, MD, said, “[PPIs and laxatives] have been linked to antibiotic resistance patterns by the authors. However, in the absence of longitudinal data, I don’t think it changes my practice in providing these agents.”

READ MORE

7. Crohn’s Disease Exclusion Diet Well-tolerated in Children

The Crohn’s Disease Exclusion Diet appeared to be an effective and well-tolerated, first-line therapy for children with mild-to-moderate Crohn’s disease, according to data presented at Digestive Disease Week.

In a perspective on these results, Joel R. Rosh, MD, FAAP, FACG, AGAF, said, “Will this diet work for the moderate to severe patient, who is commonly encountered at diagnosis or, is this a therapy best used as an alternative to going back to corticosteroids in a patient who loses response? Clearly this is not the last we will hear of CDED and this remains a very exciting area of clinical and translational research.”

Follow us on Twitter @HealioGastro for our onsite coverage of Digestive Disease Week in May.

READ MORE

PAGE BREAK

8. Updated ACG Ulcerative Colitis Guidelines Provide ‘Practical’ Management Approach

The American College of Gastroenterology released updated guidelines on the diagnosis and management of patients with mildly and moderately to severely active ulcerative colitis.

The guidelines also address the prevention of colorectal cancer in patients with ulcerative colitis, as well as patients hospitalized with the disease.

“The guidelines are supposed to guide practitioners and to propel the field forward in accepting and incorporating new therapies and new approaches in our management, and they are also importantly supposed to support our providers and patients so that payers will acknowledge and approve different treatment strategies,” David T. Rubin, MD, FACG, said in an interview with Healio Gastroenterology and Liver Disease.

READ MORE

9. ImmusanT Discontinues Phase 2 Trial of Celiac Disease Vaccine

ImmusanT announced that it discontinued its phase 2 global study of Nexvax2, a peptide-based immunomodulatory vaccine intended to treat celiac disease, according to a company press release.

In a perspective on the discontinuation of this therapy, Peter H.R. Green, MD, said, “It is a great shame that the vaccine did not appear to induce tolerance of gluten for the study participants. ... Most early drugs fail in the beginning and that leads to better drugs later. It’s part of the process, and without smart ideas there wouldn’t be advances. ImmusanT likely has a lot of information that we can learn from.”

READ MORE

10. FDA Issues Safety Alert on Fecal Transplants After Patient Dies

Two adults with weakened immune systems who received investigational fecal microbiota transplantations developed invasive infections caused by extended-spectrum beta-lactamase-producing Escherichia coli, according to an FDA press release.

One of those individuals subsequently died.

In this instance, Healio gathered two perspectives on this devastating news:

Jasmohan S. Bajaj, MD, said, “The safety alert from the FDA highlights a critical piece of this procedure, which is donor selection. Prior studies have shown that a very miniscule proportion of potential donors are ultimately approved for donation due to multiple testing and interviewing strategies employed by stool banks and investigators.”

Monika Fischer, MD, MS, FACG, AGAF, said, “This incident and subsequent safety alert proved that it’s not just theoretically possible to transplant a deadly infection through FMT. It can happen. It did happen. We can all learn from this.”

READ MORE