August 07, 2021
5 min read

July top 10: Malnutrition following COVID-19, sleeve gastroplasty, colorectal neoplasia

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Healio Gastroenterology presents the following report on the top 10 peer-tested stories in July.

These stories include reports on persistent malnutrition post-COVID, endoscopic sleeve gastroplasty among patients with nonalcoholic steatohepatitis, clinical practice updates on chemoprevention of colorectal neoplasia from the American Gastroenterological Association and more.

Malnutrition persistent in patients with COVID-19 at 3- and 6-months post-infection

For patients with COVID-19, at 3- and 6-months, malnutrition was the most persistent gastrointestinal sequalae, according to a study published in Clinical Gastroenterology and Hepatology.

“It’s overall reassuring that most GI symptoms, for patients who presented with severe COVID-19, resolve within 3 to 6 months,” Arvind Trindade, MD, FASGE, director of endoscopy, Long Island Jewish Medical Center, Northwell Health System in New York, told Healio Gastroenterology. “Inability to gain weight in patients diagnosed with COVID and malnutrition is a lingering symptom that deserves more attention. These patients should follow up with a nutritionist. Future research needs to identify the mechanism of why these patients are unable to gain weight. In addition, we will be looking at 1-year follow up data to determine if this resolves within this time span.” READ MORE.

Endoscopic sleeve gastroplasty may be safe for managing weight loss in NASH

Endoscopic sleeve gastroplasty in patients with nonalcoholic steatohepatitis vs. life-style intervention alone was safe and effective for achieving weight loss correlated with significant improvements, according to a presentation at the International Liver Congress.

“Endoscopy sleeve gastroplasty is an effective and safe method to promote weight reduction associated with significant improvement in liver function test, stiffness and histological parameters compared to life-style intervention alone,” Javier Abad Guerra, MD, from Puerta de Hierro Hospital, Gastroenterology and Hepatology in Madrid, Spain, said during his presentation. “According to this interim analysis, endoscopic sleeve gastroplasty could be an option in the management of these patients failing to lose weight by life-style intervention.” READ MORE.

AGA publishes clinical practice update on chemoprevention of colorectal neoplasia

The American Gastroenterological Association published a clinical practice update to describe the role of medications for the chemoprevention of colorectal neoplasia.

“Colorectal cancer is the second leading cause of cancer death in the U.S., but incidence and mortality have both steadily declined since the 1980s. These encouraging trends have been attributed to a combination of increased CRC screening and population-level reduction in lifestyle risk factors,” Peter S. Liang, MD, MPH, NYU Langone Health, and colleagues wrote. “There has also been longstanding interest in the use of medications to lower CRC risk, known as chemoprevention. In this clinical practice update, we summarize the evidence and offer best practice advice on chemoprevention against colorectal neoplasia.” READ MORE.

Severe food avoidance, restriction reduces quality of life in IBS

Patients with irritable bowel syndrome who engaged in severe food avoidance and restriction experienced more severe IBS symptoms and a reduced quality of life, according to study results.

“Food intake is an important trigger of GI symptoms in IBS and the presence of food-related GI symptoms are associated with more severe IBS symptoms and a reduced quality of life. However, the factors explaining these meal-related symptoms are still not clear,” Chloe Melchior, MD, PhD, Institute for Research and Innovation in Biomedicine at Normandy University, and colleagues wrote in Clinical Gastroenterology and Hepatology. “IBS patients are more likely to avoid or restrict some food items themselves to improve their symptoms, but the factors involved in food avoidance and restriction in IBS or the link to nutrient intake are not known.” READ MORE.

Switching infliximab biosimilars carries no adverse impact on IBD management

Patients with inflammatory bowel disease who switched from one infliximab biosimilar to another had no significant change in disease activity, according to research published in Alimentary Pharmacology and Therapeutics.

“Biological medicines account for a significant cost to health care systems in the management of IBD patients. However, since the expiration of patents for anti-tumor necrosis factor originators, biosimilars have offered the possibility of using cheaper alternatives with the potential for marked cost savings,” Raphael P. Luber, MBBS, FRACP, Guy’s and St. Thomas’ NHS Foundation Trust, and colleagues wrote. “With the licensing of more biosimilars, another conundrum has arisen, namely, the effect on disease activity and pharmacokinetics with biosimilar-to-biosimilar switching and particularly with multiple switches. Guidance with respect to interchangeability of biosimilars, encompassing both physician-directed switching and automatic substitution, differs internationally.” READ MORE.

Cholangiopathy after severe COVID-19 may lead to liver injury, failure

For patients with severe COVID-19, cholangiopathy was a late complication with potential for progressive biliary injury or liver failure, according to a study published in the American Journal of Gastroenterology.

“COVID-19 cholangiopathy must be considered in patients who have experienced severe COVID-19 illness and are found to have persistently elevated liver tests with a cholestatic pattern,” Ira M. Jacobson, MD, professor of medicine, director of hepatology, New York University Grossman School of Medicine told Healio Gastroenterology. “[Magnetic resonance cholangiopancreatography (MRCP)] demonstrates features resembling those of sclerosing cholangitis. Progressive biliary tract injury associated with deteriorating liver function may ensue in the months following hospital discharge, culminating in liver transplantation required in one of our patients, and a few others recently reported in the literature, within a year of COVID-19 illness. The pathogenesis of this syndrome may involve factors similar to those suggested to underlie secondary sclerosing cholangitis of critical illness, including ischemic biliary injury and cytokine storm, but a possible role for viral infection of cholangiocytes should be explored further.” READ MORE.

VIDEO: Telemedicine shaped future of health care during COVID-19

In this video exclusive, Maria T. Abreu, MD, AGAF, Stephen B. Hanauer, MD, and Carol Burke, MD, leaders in the field of gastroenterology, discussed how COVID-19 impacted them professionally and personally. READ MORE.

Low-FODMAP, gluten-free diet improves IBS symptoms

Patients with irritable bowel syndrome had improved symptom severity and normalized gut microbiota while following a low-FODMAP diet combined with a gluten-free diet, according to data published in BMC Gastroenterology.

“Recently, dietary components including wheat, gluten and fermentable oligo-di-monosaccharides and polyols have been suggested to play an essential role in the induction of IBS symptoms. Accordingly, there is some evidence supporting a clinically relevant positive effect for low-FODMAP and gluten-free diets in patients with IBS,” Kaveh Naseri, Shahid Beheshti University of Medical Sciences, and colleagues wrote. “The significant effect acknowledged to date is alterations in gut microbiota by varying gluten intake. ... However, the roles of alterations of gut microbiota due to the reduction in FODMAP intake in ongoing efficacy have yet to be explored.” READ MORE.

Q&A: Multitarget FIT bests regular FIT in adenoma detection

Multitarget fecal immunochemical testing yielded better diagnostic accuracy in the detection of advanced adenomas compared with basic FIT, according to research published in Annals of Internal Medicine.

“Early detection is the most realistic approach for reducing death from colorectal cancer and programmatic stool-based screening, using FIT, has been very successful,” Meike de Wit, PhD, Netherlands Cancer Institute, told Healio. “However, the sensitivity of FIT for relevant precursor lesions, advanced adenomas, is not that high and improving that sensitivity for advanced adenomas is critical to improve the early detection of CRC.” READ MORE.

FDA advisory committee unanimously agrees donor liver portable system is safe, effective

The FDA’s Gastroenterology and Urology Devices Panel, Medical Devices Advisory Committee voted unanimously that a portable system for near-normothermic continuous perfusion of donor livers with perfusate was safe and effective.

The system will be prepared by hospital pharmacy and include compatible packed red blood cells. READ MORE.