Pennsylvania Society of Gastroenterology

This week we recognize #MentalHealth Awareness Week. #PAGastro SoMe Ambassador, Shannon Tousonian, has provided some info below on the relationship between your GI Health and your Mental Health: When it comes to mental health, it may surprise you how intertwined this is with gastrointestinal health. One major part of the nervous system is the gut-brain axis that allows our intestines to communicate with our brain. Our gut nerves contain the majority of our body’s serotonin, as well as dopamine! It makes sense then, that there can be reciprocal affects when one of these systems is not well. Poor mental health may result in GI symptoms, and GI disease can affect our mental health. BOTH are equally important to address. It is ALWAYS a good time to seek help if you are feeling depressed, anxious, or overwhelmed.

PSG is proud to have so many patient advocates featured in the media recently. Austin Chiang, MD discusses the recent uptick of #ColonCancer in younger & Black Americans: Philadelphia Inquirer Article: https://bit.ly/2ZNVvyl... NBC Philadelphia Spot: https://t.co/JPx91JPDdE?amp=1 See more

With more than 400 deaths each year, suicide among physicians is a crisis we cannot ignore. Today, we recognize National Physician Suicide Awareness Day. If you or someone you know is struggling, please visit this website for access to resources on this important topic: https://bit.ly/2RBxeag #PhysicianSuicideAwareness

Tomorrow, September 9, PSG SoMe Ambassador Keerthi Kesavarapu, DO will be taking over our Instagram Story! Be sure to check out our Insta story tomorrow to learn more about Dr. Kesavarapu and about a day in the life of a Gastroenterology & Hepatology Fellow at Temple University. Follow PSG on Instagram now to ensure you don't miss out! www.instagram.com/pagastrosoc @pagastrosoc #PAGastro

It can be difficult to manage patients with #gastroparesis and it becomes important to understand the options in the current market. The gastric electrical neurostimulator (Enterra Therapy system) is approved as a humanitarian use device in those patients that have refractory idiopathic, diabetic gastroparesis, and other possible compassionate use applications. Refractory gastroparesis is defined as severe nausea and vomiting that are refractory to aggressive antiemetic and ...prokinetic drug therapy for at least one year are considered candidates for gastric electrical stimulation. These simulators, once implanted, work by delivering a low-energy, high-frequency gastric electrical neurostimulation. However, how this leads to clinical improvement is uncertain. The benefits of gastric neurostimulation are seen in patients with predominant symptoms of nausea and vomiting and those without narcotic dependence. Individuals with diabetes are more likely than those with idiopathic gastroparesis. While uncontrolled studies suggest clinical benefits of gastric neurostimulation, including improvements in nausea and vomiting, there is inconsistent evidence of benefit in randomized controlled crossover trials. Patients with diabetic gastroparesis have greater symptom reduction compared with other causes.

There is a growing interest in understanding the role of the pylorus in #gastroparesis. While much is unknown, we know that there is a degree of pyolospasm that can interrupt gastric emptying. Additionally, histology has shown depletion of interstitial cells of cajal and fibrosis in patients with gastroparesis. Therapeutic procedures targeting the pylorus include botox, dilation, endoscopic stenting, and per oral pyloromyotomy (G-POEM). The technique involves 4 quadrant inj...ection with a dose ranging from 100-200 units. Botox injections are overall a safe intervention; however, the efficacy has not yet been proven. Two trials randomized patients to saline or botox injection. There was no statistical difference in both groups at 1 month suggesting poor long-term efficacy. Currently, ACG recommends against using botox as primary therapy; however, its role in patients with refractory gastroparesis not amenable to surgery is yet to be established. #PAGastro

As we know, the most performed test to evaluate gastric emptying is a gastric scintigraphy or gastric emptying test. This test involves ingestion of usually eggs labeled with radioactive isotope and measurement of percentage of gastric emptying after 1, 2 and 4 hours after ingestion. Delayed gastric emptying is defined as gastric retention of > 10% at 4 hours and/or >60% at 2 hours when using the standard low-fat, scrambled egg meal. While many centers end their exam after 2... hours, this is sub-optimal. Gastric emptying at four hours has a higher sensitivity for diagnosing #gastroparesis compared with the two-hour measurement; therefore evaluation should be extended to four hours. Patients who cannot eat eggs, have the option of substituting oatmeal for their meal. Some patients are often too sick to tolerate a solid meal, a liquid nutrient meal containing radioisotope may be used; however, liquids might not truly reflect gastric emptying. #pagastro #GastroparesisAwarenessMonth

Prokinetics are agents that stimulate gut motility through a direct effect on gut muscle or activation of its excitatory innervation. Prokinetics may be of benefit in patients with delayed gastric emptying or with symptoms suggesting postprandial distress. Currently in the United States, not much is available. Metoclopramide is the only approved drug for gastroparesis but given its risk of tardive dyskinesia its use should be short term. Alternatives include erythromycin and ...domperidone. Domperidone is sourced by patients from Canada and Mexico and acquired via an expanded access investigational new drug application. Erythromycin is not reliably sourced in all hospitals/pharmacies and again is only recommended for short-term use. Recent data on the efficacy of prucalopride appears to be promising with many more agents being studied. #PAGastro #gastroparesis #GastroparesisAwarenessMonth See more

In the latest edition of Rumblings, Aaron Martin, MD, provides a detailed plan for Fellows searching for the right job for them! Read now: https://www.pasg.org/rumblings.html

Gastroparesis is a disease in which the stomach cannot empty itself of food in a normal fashion. Symptoms include heartburn, nausea, vomiting and feeling full quickly when eating. August is #Gastroparesis Awareness Month and we will be sharing content throughout the month regarding this gastrointestinal disease. Throughout the month of August, PSG will be sharing timely and informative content on Gastroparesis to our social channels. Check back weekly for more content!

Pennsylvania Medical Society (PAMED) President Dr. Lawrence John contributed to the latest edition of Rumblings with an article addressing physician burnout. Read the article to learn more about the importance in finding balance as a physician: (Page 3) https://pasg.org/rumblings #PAGastro

The Summer 2020 Edition of Rumblings is now available to read online! Check it out here: https://pasg.org/rumblings.html #PAGastro

Multiple studies have found that the average daily gluten consumption for adults on strict gluten-free diet was between 200-360mg, which is well above the recommended level for "safe." Given the incomplete response to a gluten-free diet and the difficulty of adherence to this diet, new and effective modalities are necessary for management. Larazotide acetate, a small intestinal zonulin inhibitor, belongs to a new class of medications currently in phase 3 clinical trials that ...regulate tight junctions. Gliadin is known to cause secretion of zonulin, which alters intestinal permeability, facilitates transport of gluten into the cells, and triggers an inflammatory response. Phase 2 trials have shown that larazotide acetate is well tolerated and appears to reduce gastrointestinal symptoms, but its effect on intracellular tight junctions is to be elucidated. #PaGastro #CeliacDiseaseAwareness See more