GiT Updates and More

How to Biopsy when Investigating Microscopic Colitis diagnosis of microscopic colitis can always be reached when evaluating biopsies of the ascending AND descending colon.

How to perform endo tx for gastric varices ▪️Use 22–23g injection needle ▪️Prepare CYA + water ▪️Needle out before puncture ▪️Inject varix away from base ▪️1 mL glue + 1 mL water ▪️Repeat until bleeding stops ▪️Confirm varix firmness ▪️Watch for embolization risk #DDW2025

✅ New multicenter study of >3,000 patients shows prophylactic clip closure after colorectal ESD does not significantly reduce delayed bleeding—even in high-risk or anticoagulated patients

Mild crohn’s

Management of LI-RADS 4 Lesions ▪️LR-4 management is size-based ▪️<1 cm: CT/MRI q3mo x1yr ▪️1–2 cm: Multidisciplinary review ▪️≥2 cm: Proceed to biopsy ▪️Stable 2 yrs? Downgrade to LR-3 ▪️Transplant eligible? Stage lesion ▪️Consider bx if growing ▪️No empiric tx recommended #DDW2025

Varices Needing Treatment ▪️50% have varices; CTP B: 85% ▪️Incidence: ~8% develop small varices ▪️Progression: ~8% to large varices ▪️Bleeding risk: ~16% yearly ▪️Risk: large varices, red signs ▪️Risk ↑ with CTP B/C ▪️VNT = large or red wale ▪️Red wale = higher bleed risk #DDW2025

Why is shunt important for gastric varices? ▪️Shunt supplies variceal blood ▪️Shunt → higher recurrence post-EGD ▪️Risk of systemic embolization ▪️Enables IR access to varices ▪️Needed for BRTO, PARTO, CARTO ▪️TIPS improves ascites ▪️BRTO/TIPS may worsen encephalopathy #DDW2025

Carvedilol preferred NSBB! ▪️Reduces vascular resistance too ▪️Start: 6.25 mg once daily ▪️Titrate to 6.25 mg BID ▪️Max dose: 12.5 mg/day ▪️No HR target needed ▪️Maintain SBP ≥90 mmHg ▪️Adverse: ortho BP, constipation ▪️No endoscopy if on therapy #DDW2025

Digestive Disease Week #DDW25

MO ( microbial overgrowth)

Vonoprazan as a Long-term Maintenance Treatment for Erosive Esophagitis: VISION, a 5-Year, Randomized, Open-label Study Vonoprazan is evaluated as a long-term maintenance treatment for erosive esophagitis in a 5-year randomized, open-label study called VISION. The study compared the safety and efficacy of vonoprazan with lansoprazole, a common proton pump inhibitor (PPI). Patients initially received induction therapy with either vonoprazan (20 mg) or lansoprazole (30 mg) for up to 8 weeks. Those with healed erosive esophagitis then continued with maintenance therapy for 260 weeks, receiving either vonoprazan (10 mg) or lansoprazole (15 mg). The primary endpoint focused on monitoring for malignant epithelial cell alterations and various types of hyperplasia in the gastric mucosa. Results showed that 202 out of 208 patients achieved healed erosive esophagitis, with no malignant alterations or gastric neuroendocrine tumors observed. A higher percentage of patients on vonoprazan exhibited parietal cell hyperplasia (97.1% vs. 86.5%) and foveolar hyperplasia (14.7% vs. 1.9%) compared to those on lansoprazole. Median serum gastrin levels were significantly higher in the vonoprazan group (625 pg/mL) compared to the lansoprazole group (200 pg/mL). Adverse events were comparable between both treatments, indicating a similar safety profile. The study concludes that vonoprazan does not increase the long-term risk of malignant gastric mucosal changes and may provide a safer alternative for managing erosive esophagitis compared to traditional PPIs.

Title: Vonoprazan as a Long-term Maintenance Treatment for Erosive Esophagitis: VISION, a 5-Year, Randomized, Open-label Study Vonoprazan is evaluated as a long-term maintenance treatment for erosive esophagitis in a 5-year randomized, open-label study called VISION. The study compared the safety and efficacy of vonoprazan with lansoprazole, a common proton pump inhibitor (PPI). Patients initially received induction therapy with either vonoprazan (20 mg) or lansoprazole (30 mg) for up to 8 weeks. Those with healed erosive esophagitis then continued with maintenance therapy for 260 weeks, receiving either vonoprazan (10 mg) or lansoprazole (15 mg). The primary endpoint focused on monitoring for malignant epithelial cell alterations and various types of hyperplasia in the gastric mucosa. Results showed that 202 out of 208 patients achieved healed erosive esophagitis, with no malignant alterations or gastric neuroendocrine tumors observed. A higher percentage of patients on vonoprazan exhibited parietal cell hyperplasia (97.1% vs. 86.5%) and foveolar hyperplasia (14.7% vs. 1.9%) compared to those on lansoprazole. Median serum gastrin levels were significantly higher in the vonoprazan group (625 pg/mL) compared to the lansoprazole group (200 pg/mL). Adverse events were comparable between both treatments, indicating a similar safety profile. The study concludes that vonoprazan does not increase the long-term risk of malignant gastric mucosal changes and may provide a safer alternative for managing erosive esophagitis compared to traditional PPIs.