By the Numbers

By the Numbers

January 08, 2022
5 min read

Top 10 from 2021: ACG guidelines, constipation, gut microbiome

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Healio Gastroenterology presents the following report on the top 10 peer-tested stories from 2021.

Coverage includes guideline updates for the treatment of Clostridioides difficile infection, kiwi fruit for symptom relief in constipation, gut microbiome impact on COVID-19 and more.

These top stories and more follow.

ACG publishes guidelines for preferred treatment of C. difficile infection

ACG developed guidelines for the preferred management of adults with Clostridioides difficile infection, published in American Journal of Gastroenterology.

“These guidelines are timely — we referenced new literature up until the final revision — and very clinically oriented. [Infectious Disease Society of America and Society of Healthcare Epidemiologists of America] published their own guidelines a few years ago,” Colleen R. Kelly, MD, told Healio Gastroenterology. “We aligned our categories of severity with theirs — non-severe, severe and fulminant infection — and decided not to dive deeply into epidemiology and infection control practices, which they covered nicely. Instead, we aimed to develop an evidence-based, clinically useful guideline for the diagnosis, management and prevention of C. difficile infection and chose to expand on areas of particular interest to gastroenterologists, including diagnostic issues around diarrhea and distinguishing C. difficile colonization from active infection, and the evaluation and management of CDI in the setting of inflammatory bowel disease.” Read more.

Kiwi fruit effectively relieves symptoms in chronic constipation

Patients with chronic constipation who received kiwi fruit, prunes and psyllium reported relief in symptoms, according to a study published in American Journal of Gastroenterology.

“Patients are increasingly seeking evidence-based natural treatments for many medical conditions, including [chronic constipation (CC)],” Samuel W. Chey, MPH, of the University of Michigan, and colleagues wrote. “Many patients believe that natural products are safer and less costly than prescription medications. Along these lines, so called ‘functional foods’ are growing in popularity. This study confirms the benefits of prunes and psyllium and offer the first U.S. data for green kiwifruit as a safe, effective and well-tolerated treatment for a subset of patients with CC.” Read more.

Gut microbiome composition impacts severity of COVID-19

Correlation between gut microbiota composition, cytokine levels and inflammatory markers among COVID-19 patients demonstrated the gut microbiome is linked with the severity of COVID-19, according to a study in Gut.

“[This] survey of gut microbiota alterations in association with immune dysregulation revealed that gut microorganisms are likely involved in the modulation of host inflammatory responses in COVID-19,” Yun Kit Yeoh, MD, of the department of microbiology at The Chinese University of Hong Kong in Hong Kong, and colleagues wrote. “With mounting evidence that gut microorganisms are linked with inflammatory diseases within and beyond the gut, these findings underscore an urgent need to understand the specific roles of gut microorganisms in human immune function and systemic inflammation.” Read more.

Low FODMAP diet leads to improvements in IBS-D symptoms

A short-term strict low FODMAP diet and long-term “modified” low FODMAP diet was linked to improvements in symptoms and quality of life in irritable bowel syndrome-diarrhea predominant patients, according to study results.

“Compared to [traditional dietary advice (TDA)], [low FODMAP diet (LFD)] leads to significantly greater improvement in abdominal pain frequency, abdominal distention, bowel habit satisfaction, quality of life and significant reduction in intake of IBS medications,” Omesh Goyal, MD, associate professor in the department of gastroenterology at Dayanand Medical College and Hospital in Ludhiana, Punjab, India, and colleagues wrote. “With adequate guidance and motivation, nutritional adequacy and good compliance can be achieved.” Read more.

Higher vitamin D intake may decrease risk for CRC

Higher intake of vitamin D correlated with a decreased risk for early-onset colorectal cancer and CRC precursors among a cohort of young women, according to research published in Gastroenterology.

“Despite a decline in the overall incidence of CRC in many countries, including the U.S., the incidence of CRC in younger adults has been rising. ... Because a substantial proportion of early-onset CRC patients do not have a family history of CRC or known hereditary syndrome, recent changes in lifestyle factors and dietary patterns are hypothesized to contribute to the increasing incidence of early-onset CRC,” Hanseul Kim, PhD, of the Harvard T.H. Chan School of Public Health, and colleagues wrote. “Vitamin D intake represents a possible factor that may contribute to the recent increase in early-onset CRC incidence.” Read more.

Stool-based colorectal cancer screening preferred over colonoscopy

Individuals preferred stool-based screening for colorectal cancer over colonoscopy, according to survey results published in Cancer Prevention Research.

“Although several colorectal cancer screening methods have been shown to reduce colorectal cancer, nearly one-third of eligible adults in the United States have never completed colorectal cancer screening and colorectal cancer screening continues to be underutilized," Xuan Zhu, PhD, senior health services analyst at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and colleagues wrote. "Recommended colorectal cancer screening modalities vary with respect to safety, efficacy and cost. Better understanding of the factors that influence patient preference is, therefore, critical for improving population adherence to colorectal cancer screening." Read more.

Recognizing perfectionism, praising accomplishments reduces charting stress

The keys to reducing stress associated with charting is recognizing maladaptive perfectionism, focusing on accomplishments and “only handling it once,” according to a speaker at the Ending Physician Burnout Global Summit.

“I don’t think I have to tell you all of the impact of the electronic health record and what a large contributor the EMR is in the epidemic of burnout,” Gail Gazelle, MD, MCC, founding member of the Harvard Institute of Coaching, said. “What I find as a coach is that many physicians expend a lot of energy on things that they cannot control and with the electronic health record, sadly, what we can control is miniscule. What I want for each of you is to mobilize your energy toward the things that you can control and not dissipate your precious energy stores on the things that you can't.” Read more.

Gut microbiome impacts future weight loss

Certain baseline gut microbiome features correlated with future changes in weight following intervention, according to study results published in mSystems, an open-access journal of the American Society for Microbiology.

“In our study, we observed that only very few blood and lifestyle measures associate with future weight loss after a change in lifestyle,” Christian Diener, PhD, a research scientist at the Institute for Systems Biology in Seattle, told Healio Gastroenterology. “However, the genes carried by the bacteria in our gut do. Our results underscore the fact that our intestinal bacteria are an important filter between the food we consume and our bloodstream. Weight loss may be especially hard when our gut bacteria slow their own growth, while also breaking down dietary fibers into energy-rich sugars that make their way into our bloodstream before they can be fermented into organic acids by the microbiota.” Read more.

AGA issues new guidelines on intragastric balloon use

The American Gastroenterological Association published new clinical practice guidelines on the use of intragastric balloons in obesity management.

“Endoscopic bariatric therapies have evolved as an attractive tool for weight loss, however, less than 5% of patients with obesity seeking a weight loss therapy are aware of endoscopic weight loss options,” Thiruvengadam Muniraj, MD, MRCP, of Yale University School of Medicine, said in a press release. “Our hope is that this new guideline can lead to shared decision making between patients and providers to determine if intragastric balloons are the best weight loss option for that individual patient.” Read more.

USPSTF issues updated recommendations for colorectal cancer screening

The U.S. Preventive Services Task Force issued updated recommendations for colorectal cancer screening in JAMA.

“Colorectal cancer is a devastating disease and the third leading cause of cancer deaths in the United States, yet about a quarter of adults ages 50 to 75 have never been screened for colorectal cancer. The Task Force reviews its recommendations about every five years to make sure they reflect the latest research,” Martha Kubik, PhD, RN, professor and director of the School of Nursing in the College of Health and Human Services at George Mason University, U.S. Preventive Services Task Force (USPSTF) member, told Healio. “Screening for colorectal cancer is effective and saves lives. New science about colorectal cancer in people younger than 50 has enabled us to expand our recommendation to include people ages 45 to 49. Everyone who is 45 to 75 years old should be screened for colorectal cancer to reduce their risk of dying from this disease.” Read more.

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