GiT Updates and More

Oesophageal features of EoE

🌙 Night shifts don’t just disrupt sleep—they may disrupt your gut too. In a cohort study of 239K+ adults by Yao et al 🇨🇳, night shift work was linked to a 21–25% higher risk of developing IBS 😣 🧠🔁 Low-grade inflammation of gut may be the link https://shrinkme.ink/mpvvVUZ

Conclusions: PPI use after prophylactic EVL did not reduce bleeding risk and was linked to higher rates of adverse events.These findings suggest routine use may not be beneficial and should be reconsidered in cirrhotic patients who undergo EVL for primary prophylaxis.

SUMMARY : Integrating Diet and Physical Activity When Prescribing GLP-1s—Lifestyle Factors Remain Crucial - GLP-1 RAs and Weight Loss: GLP-1 receptor agonists (GLP-1 RAs) can produce significant weight loss, ranging from 15% to 21%, but clinicians face challenges in managing gastrointestinal symptoms, maintaining adequate nutrition, and preserving lean body mass. - Monitoring Weight Loss: Clinicians should monitor weight loss responses monthly during dose escalation and at least quarterly thereafter. For low responders, consider continuing standard dose escalation, assessing for missed doses, and switching to an alternative GLP-1 RA if necessary. - Excessive Weight Loss Management: Excessive weight loss should be determined individually. Indications include a body mass index less than 18.5, anorexia (consuming <800 calories/d), or very low protein intake. Clinicians should rule out secondary causes, assess for correlated harms, and consider dose reduction or temporary cessation. - Dietary Assessment and Nutritional Management: Initial registered dietitian evaluation is ideal, with follow-up visits every 2 to 3 months during dose escalation. Clinicians should emphasize nutrient quality over rigid calorie counting and consider periodic tracking of food and fluid intake. - Nutrient Absorption and Deficiencies: GLP-1 RAs may impact micronutrient absorption, and their appetite suppression can exacerbate preexisting micronutrient deficiencies. Clinicians should address common deficiencies and consider a multivitamin for patients with substantial appetite reduction. - Physical Activity Recommendations: All weight loss interventions result in lean body mass loss, but these effects can be mitigated through physical activity modification. Clinicians should recommend a 3-step approach to physical activity, including regular movement, resistance training, and aerobic exercise. - Weight Loss Maintenance and Medication Discontinuation: Weight regain after GLP-1 RA discontinuation is common. Clinicians should discuss this with patients at the start of treatment and consider medication reinitiation or dose increase if weight regain exceeds 5%. - Comprehensive Approach: Lasting treatment success with GLP-1 RAs requires integrating medication with individualized nutrition and physical activity interventions. This comprehensive approach optimizes sustained weight loss while mitigating side effects, preserving muscle mass, and limiting nutritional deficiencies. - MEAL Mnemonic: The MEAL mnemonic (muscle maintenance, energy balance, avoid side effects, liquid intake) can guide GLP-1 RA dietary management. This includes encouraging adequate protein intake, structured physical activity, smaller nutrient-dense meals, and increased liquid intake. - Long-Term Management: Obesity is a chronic condition typically requiring long-term management, similar to hypertension. Clinicians should base treatment decisions on this premise and continue to assess weight, metabolic health, diet and activity levels, appetite, sleep patterns, mood changes, and muscle strength.

JAMA : Integrating Diet and Physical Activity When Prescribing GLP-1s—Lifestyle Factors Remain Crucial http://bit.ly/4nNvvMH

🔴Pathophysiology of sarcopenia in patients with liver disease such as cirrhosis or hepatic encephalopathy is multifactorial: involving metabolic, inflammatory, hormonal, and nutritional disturbances. Cirrhosis induces a chronic catabolic state with increased muscle protein breakdown and reduced synthesis, driven by altered protein metabolism, particularly decreased availability of branched-chain amino acids (BCAAs), which are diverted for ammonia detoxification and gluconeogenesis rather than muscle anabolism. Impaired hepatic ammonia clearance and portosystemic shunting result in hyperammonemia, which is directly myotoxic: ammonia impairs muscle protein synthesis, increases autophagy and proteolysis, disrupts mitochondrial function, and upregulates myostatin, a negative regulator of muscle growth. 🔶Chronic systemic inflammation: characterized by elevated cytokines (e.g., IL-6, TNF-α), further suppresses muscle protein synthesis and promotes degradation. 🔶Endocrine dysfunction is common: with low testosterone, insulin resistance, and reduced IGF-1 contributing to anabolic resistance and muscle loss. Malnutrition, reduced oral intake, and malabsorption—often due to anorexia, dietary restrictions, altered taste, or gut dysbiosis—exacerbate muscle wasting.Physical inactivity and increased muscle fatigue, common in advanced liver disease, accelerate loss of muscle mass and function.

Type 1 autoimmune pancreatitis is the pancreatic manifestation of IgG4-related disease, a systemic fibroinflammatory disorder. It typically affects older individuals, is associated with elevated serum IgG4 levels, and shows abundant infiltration of IgG4-positive plasma cells in tissue. Extrapancreatic organ involvement (e.g., biliary tree, salivary glands, kidneys, retroperitoneum) is common. Histologically, it is characterized by lymphoplasmacytic sclerosing pancreatitis with storiform fibrosis and obliterative phlebitis. Relapse rates are high, and maintenance immunosuppression is often required to prevent recurrence. There is a dramatic response to corticosteroids, but relapses are frequent, necessitating long-term management strategies such as low-dose steroids, immunomodulators, or rituximab. Type 2 autoimmune pancreatitis is a pancreas-specific disease, not associated with IgG4 or systemic involvement. It tends to affect younger patients and is more frequently associated with inflammatory bowel disease, particularly ulcerative colitis. Serum IgG4 levels are typically normal, and tissue does not show significant IgG4-positive plasma cell infiltration. Histologically, it is defined by granulocytic epithelial lesions (GELs) and duct-centric inflammation. Relapses are rare, and long-term immunosuppression is generally not required after initial corticosteroid therapy.

All 4️⃣ GI Society Guidelines in 1️⃣ Place AGA 48 guidelines ACG 55 guidelines ASGE endoscopy 83 guidelines AASLD 23 guidelines https://bit.ly/40cQy1m

Treatment of Naive patient with eosinophilic esophagitis

Types of Achalasia