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AJG Podcast

Each month the Co-Editors-in-Chief of The American Journal of Gastroenterology, Dr. Brian Lacy and Dr. Brennan Spiegel, select a topic from the table of contents to highlight important clinical science for practicing gastrointestinal specialists.

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ACG Clinical Guideline: Hereditary Hemochromatosis

August 2019

Dr. Kris Kowdley

Kris Kowdley, MD, FACG, summarizes highlights from the new ACG Clinical Guidelines on hereditary hemochromatosis. (20:09)

Fecal Microbiota Transplant for Patients With Primary Sclerosing Cholangitis

July 2019

Dr. Jessica Allegretti

Jessica Allegretti, MD, MPH, discusses the relationship between primary sclerosing cholangitis and inflammatory bowel disease, the biologic plausibility of fecal microbiota transplant for this condition, and the design of this pilot clinical trial. (18:57)

Cannabinoid Use in Patients With Gastroparesis and Related Disorders

June 2019

Dr. Henry Parkman

Henry Parkman, MD, FACG, discusses current treatment options for gastroparesis, reasons why those treatments may fall short, and how cannabis may improve symptoms for these patients. (18:49)

Detection of Gluten in Gluten-Free Labeled Restaurant Food: Analysis of Crowd-Sourced Data

May 2019

Dr. Benjamin Lebwohl

Benjamin Lebwohl, MD, MS, discusses results from a study analyzing presence of gluten in "gluten-free" restaurant food, based on data from users of the Nima gluten detection device. (19:30)

Using Ergonomics to Prevent Injuries for the Endoscopist

April 2019

Dr. Patrick Young

Patrick Young, MD, FACG, discusses the types of injuries common to endoscopists and suggests strategies to minimize these overuse injuries. (10:09)

ACG Clinical Guideline: Ulcerative Colitis in Adults

March 2019

Dr. Millie Long

Millie Long, MD, MPH, FACG, summarizes highlights from the new ACG Clinical Guidelines on ulcerative colitis in adult patients. (21:11)

A Randomized Controlled Trial of TELEmedicine for Patients with IBD (TELE-IBD)

March 2019

Dr. Raymond Cross

Raymond Cross, MD, MS, explains what TELEmedicine is, how it can be useful for gastroenterologists, and how this study found improved quality of life for IBD patients using this service. (15:07)

Influence of Dietary Restriction on Irritable Bowel Syndrome

February 2019

Dr. Mark Pimentel

Mark Pimentel, MD, FACG, discusses non-pharmaceutical management approaches for IBS, including gluten-free diet, dairy-free diet, low FODMAP diet, and fiber. (21:55)

Diagnosis and Management of Primary Biliary Cholangitis

January 2019

Dr. Zobair Younossi

Zobair Younossi, MD, MPH, FACG, explains the definition, pathophysiology, diagnosis, and treatment of primary biliary cholangitis. (18:26)

Pros and Cons of CRC Screening for Adults Aged 45-49 Years

December 2018

Dr. Jewel Samadder

Jewel Samadder, MD, debates the pros and cons of changing the screening age for colorectal cancer to 45 years. (32:23)

Vedolizumab for Ulcerative Colitis: Treatment Outcomes from the VICTORY Consortium

September 2018

Dr. Parambir Dulai

Parambir Dulai, MD, describes how vedoluzimab works, the design of the VICTORY study, and provides tips for using this agent for ulcerative colitis patients. (11:24)

Complications of Antireflux Surgery

August 2018

Dr. Rena Yadlapati

Rena Yadlapati, MD, discusses which patients are candidates for antireflux surgery, as well as the preparation, technique, and potential complications of this procedure. (13:09)

ACG Monograph on Management of Irritable Bowel Syndrome

July 2018

Dr. Eamonn Quigley

Eamonn Quigley, MD, MACG, reviews the new ACG Monograph on the management of IBS, including recent data on probiotics, fiber, antibiotics, antispasmodics, psychological therapies, and prosecretory agents. (29:00)

ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts

April 2018

Dr. Grace Elta

Grace Elta, MD, FACG, discusses why pancreatic cysts are identified more and more frequently, the best imaging modalities for diagnosis and following pancreatic cysts, and common biomarkers used to diagnose malignancy. Dr. Elta also walks through her algorithm for cyst classification. (17:00)

ACG Clinical Guideline: Management of Crohn’s Disease in Adults

April 2018

Dr. Gary Lichtenstein

Gary Lichtenstein, MD, FACG, discusses highlights from the comprehensive new guideline about the diagnosis, treatment, and management of Crohn’s disease. (32:15)

ACG Clinical Guideline: Alcoholic Liver Disease

February 2018

Dr. Vijay Shah

Vijay Shah, MD, FACG, discusses definition of alcohol use disorder, diagnostic tests for suspected cirrhosis and alcoholic hepatitis, and current treatment modalities, including when to refer for transplant. (16:45)

Bezafibrate Plus Ursodeoxycholic Acid for Treatment of Pruritus in Primary Biliary Cholangitis

January 2018

Dr. Albert Pares

Albert Pares, MD, PhD, discusses the symptoms, causes, and diagnostic approaches to primary biliary cholangitis. Dr. Pares also describes the results of his study, which combines bezafibrate with ursodeoxycholic acid (UDCA) to treat severe pruritus, the cardinal symptom of primary biliary cholangitis. (17:33)

Low-Dose Linaclotide (72 μg) for Chronic Idiopathic Constipation

January 2018

Dr. Philip Schoenfeld

Philip Schoenfeld, MD, discusses results from a double-blind, randomized controlled trial of low-dose linaclotide for patients with chronic idiopathic constipation. (28:21)

When and How to Stop Surveillance Colonoscopy in Older Adults

January 2018

Dr. Sameer Saini

Sameer Saini, MD, MS, discusses the five rules of thumb for stopping screening colonoscopy in older adults: know the data, get a full history, individualize benefits and harms, engage the patient, and work with primary care colleagues. (21:42)

Bariatric Surgery Complications: What to Expect in Your GI Practice

November 2017

Dr. Allison Schulman

Allison Schulman, MD, MPH, discusses the growing popularity and evolution of bariatric surgery as a weight-loss solution for morbidly obese patients and describes the most commonly performed bariatric procedures. She provides a thorough review of the most frequent complications for each procedure, including Roux-en-Y gastric bypass, sleeve gastrectomy, and intragastric balloons. (20:00)

Living on Liquids: A GI Dietitian’s Experience on EEN

October 2017

Kelly Issokson, MS, RD, CNSC

Kelly Issokson, a GI dietitian, discusses how she underwent an exclusive enteral nutrition (EEN) trial for 30 days in order to better understand her patients’ experience. She describes the physical and psychological effects of living exclusively on liquid formula for an extended period of time, and provides tips for physicians prescribing EEN for patients. (18:38)

ACG and the 80% by 2018 Colorectal Cancer Initiative

September 2017

Dr. Jordan Karlitz

Jordan Karlitz, MD, reviews the dedicated contributions of the National Colorectal Cancer Roundtable and various ACG committees to the 80% by 2018 initiative, which aims to screen 80% of eligible U.S. adults for colorectal cancer by 2018. (17:59)

Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge

August 2017

Dr. Juan Malagelada

Juan R. Malagelada, MD, explains the definitions and mechanisms of bloating and distension, how visceral hypersensitivity heightens patient sensation of bloating, and what treatments work best for persistent gas and bloating. (17:58)

ACG and CAG Clinical Guideline: Management of Dyspepsia

July 2017

Dr. Paul Moayyedi

Paul Moayyedi, MB, ChB, PhD, MPH, FACG, co-author of new guidelines on management of dyspepsia, discusses the evolving definition and diagnosis of dyspepsia, when and when not to use endoscopy, and how H. pylori factors into dyspepsia treatment. (30:14)

Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis

May 2017

Dr. James Buxbaum

James L. Buxbaum, MD, discusses the controversies surrounding aggressive fluid hydration in acute pancreatitis, why lactated ringer’s solution may be superior to normal saline, and how a weight-based fluid infusion approach can help prevent fluid overload during hydration. (14:08)

Do Primary Care Provider Strategies Improve Patient Participation in CRC Screening?

April 2017

Dr. Nancy Baxter

Nancy N. Baxter MD, PhD, author of research on primary care provider (PCP) strategies to increase colorectal cancer screening participation, discusses the various strategies reported by PCPs in this study, and why combining multiple strategies led to highest participation. (19:34)

Aspiration Therapy for Weight Loss: Is the Squeeze Worth the Juice?

March 2017

Dr. Patrick Okolo

Patrick Okolo, MD, author of an editorial commenting on recently published research into the AspireAssist device, discusses the difficulty faced by some obese patients losing weight through diet and exercise, the rise in bariatric surgery as a promising treatment for these patients, and the mechanisms of the AspireAssist device studied in the original article by Thompson, et al. (24:05)

ACG Clinical Guideline: Preventive Care in IBD

February 2017

Dr. Francis Farraye

Francis Farraye, MD, MSc, FACG, co-author of a recent ACG Clinical Guideline on preventive care in IBD, discusses the importance of collaboration between the gastroenterologist and the primary care team for IBD patients, the safety and timing of vaccinations, and recommendations for preventive screening for patients on immunosuppresants. (18:27)

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

February 2017

Dr. Bill Chey

Bill Chey, MD, FACG, co-author of a recent ACG Clinical Guideline on H. pylori infection, discusses the changing prevalence of H. pylori infection and its relationship to disorders beyond peptic ulcer disease. The complicated landscape of diagnosis and treatment are also discussed. (29:39)

ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries

January 2017

Dr. Paul Kwo

Paul Kwo, MD, FACG, FAASLD, co-author of a recent ACG Clinical Guideline on abnormal liver chemistries, discusses the change in terminology from “liver function tests,” the lowered upper limit of normal for ALT levels, and the importance of screening patients born between 1945 and 1965 for HCV. (20:13)

Biomarkers for Precision Medicine in IBD

December 2016

Dr. Gwo-tzer Ho

Gwo-tzer Ho, PhD, co-author of a recent review of recent developments for precision medicine in IBD talks with AJG co-editor Dr. Brian Lacy about the definition and scope of precision medicine, newly discovered IBD biomarkers that could be used to guide precision therapies, and the practical and ethical implications of these new developments. (21:38)

Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D

December 2016

Dr. William Chey

William D. Chey, MD, FACG, co-author of new research comparing the effectiveness of the low FODMAP diet versus a modified NICE diet for IBS-D, speaks with AJG co-Editor in Chief Dr. Brennan Spiegel about improvements in bloating and abdominal pain found with the low FODMAP diet, the value of individual symptom response compared to an overall “adequate relief” end point, and practical advice for guiding patients through the low FODMAP diet process. (24:05)

Financial Incentives for Promoting Colorectal Cancer Screening

November 2016

Dr. Samir Gupta

Samir Gupta, MD, MSCS, co-author of recent study examining the impact of small financial incentives for completion of FIT testing, speaks with AJG co-Editor in Chief Dr. Brennan Spiegel about why use of financial incentives to encourage health behavior is not always effective, and the behavioral economics underlying this research. This article was published in the recent Negative Issue of AJG. (15:43)

Oropharyngeal pH Testing Does Not Predict Response to PPI Therapy in Patients with Laryngeal Symptoms

November 2016

Dr. John Pandfino

John Pandolfino, MD, MS, co-author of a recent study examining the effect of PPIs on laryngeal reflux symptoms, talks with AJG co-editor Dr. Brian Lacy about why laryngopharyngeal reflux symptoms are so difficult to diagnose and treat, whether PPIs are the correct approach, and how acid exposure and laryngeal pH factor into the equation. (18:16)

Prospective EUS-Based Approach to the Evaluation of Idiopathic Pancreatitis

September 2016

Dr. C. Mel Wilcox

C. Mel Wilcox, MD, MSPH, co-author of new research on the causes, response to therapy, and long-term outcome of idiopathic pancreatitis, speaks with AJG co-Editor in Chief Dr. Brian Lacy about the evolving definition of idiopathic pancreatitis, the role of EUS vs MRCP in its diagnosis, and when you should consider pancreas divisum or autoimmune disorders in your etiology. (12:35)

Harnessing the Hashtag: A Standard Approach to GI Dialogue on Social Media

August 2016

Dr. Austin Chiang

Austin Chiang, MD, co-author of a recent Red Section article on GI ontology in social media, speaks with AJG co-Editor in Chief Dr. Brian Lacy about the benefits and logistics of using social media, specifically Twitter, in a GI practice, how new users can best take the first steps. (11:22)

Clinical Features and Outcomes of CAM-Induced Acute Liver Failure and Injury

July 2016

Dr. William Lee

William Lee, MD, co-author of an new article comparing complementary and alternative medicine (CAM)-induced liver injury to that caused by prescription medications, speaks with AJG co-Editor in Chief Dr. Brian Lacy about the definition of CAM, the regulatory approval process (or lack thereof) for CAM compared to prescription medication, and the most frequent CAM and prescription offenders for drug-induced liver injury. Dr. Lee also provides advice for clinicians trying to diagnose and counsel patients with suspected CAM-induced liver injury. (15:50)

ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

May 2016

Dr. Mark S. Riddle

Mark S. Riddle, MD, DrPH, co-author of the new ACG Clinical Guideline, speaks with AJG co-Editor in Chief Dr. Brian Lacy about the public health threat of acute diarrheal infections, the most effective diagnostic tests, and the appropriateness of antibiotics. The role of oral rehydration, probiotics, and anti-diarrheal medication is also discussed. (19:51)

ACG Clinical Guideline: Management of Patients With Acute Lower GI Bleeding

April 2016

Dr. Lisa Strate

Lisa Strate, MD, MPH, FACG, co-author of the new ACG Clinical Guideline, speaks with AJG co-Editor in Chief Dr. Brennan Spiegel about the timing of endoscopy for management of lower GI bleeding, how to assess high-risk patients for whom colonoscopy should not be performed, and the important questions surrounding the topic that remain unanswered in the current literature. (18:22)

ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient

March 2016

Dr. Steve McClave

Steve McClave, MD, co-author of the new ACG Clinical Guideline, speaks with AJG co-Editor in Chief Dr. Brian Lacy about how to recognize nutritionally deficient patients, the most common deficiencies by condition, how to determine if a patient will tolerate enteral feeds, and the pros and cons of orgastric, nasogastric, and jejunal feeding. Dr. McClave dispels some common myths, provides advice on peripheral PN (Don’t do it!), and emphasizes the invaluable support GIs can provide for the nutritional team. (16:25)

Adverse Event and Complication Management in Gastrointestinal Endoscopy

March 2016

Dr. Andrew Feld

Andrew Feld, MD, JD, co-author of a recent editorial on endoscopic adverse events, speaks with AJG co-Editor in Chief Dr. Brian Lacy about the concept of informed consent, essential elements to any endoscopist’s consent forms, how to best communicate risk to patients, and how physicians can reduce their risk of litigation. The dos and don’ts of complication management are also covered. (17:37)

ACG Clinical Guideline: Liver Disease and Pregnancy

February 2016

Dr. Tram T. Tran

Tram T. Tran, MD, FACG, FAASLD, co-author of the new ACG Clinical Guideline on the management of liver diseases in pregnant women, speaks with AJG co-Editor in Chief Dr. Brennan Spiegel about the liver function tests that may be abnormal during pregnancy, which ones to be concerned about, and how to best pursue imaging or endoscopic follow-up in pregnant women. Advice for patients who are pregnant or who wish to become pregnant is also included. (21:18)

Food: The Main Course to Wellness and Illness in Patients with IBS

February 2016

Dr. William D. Chey

William D. Chey, MD, FACG, presenter of the 2015 David Sun Lecture and author of a recently published review of the same topic, speaks with AJG co-Editor-in-Chief Dr. Brennan Spiegel about the evolution of food from sustenance and medicine to entertainment and enjoyment and the gradual shift back toward food as medicine and therapy for disease. Learn more about the complex interplay between food and GI symptoms and the FODMAP diet as a promising treatment approach. The emerging academic focus on diet and nutrition in GI care and the essential role of dietitians in the lives of IBS patients are also discussed. (25:35)

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

January 2016

Dr. Nicholas Shaheen

Nicholas Shaheen, MD, MPH, FACG, co-author of the new ACG Clinical Guideline on the management of Barrett’s Esophagus (BE), speaks with AJG co-Editor in Chief Dr. Brian Lacy about the changing definition of BE and reasons for a new guideline. Learn more about biopsy strategies, which patients should be screened, and proper surveillance strategies once a diagnosis is made. Treatment and prevention strategies are also discussed. (16:20)

Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp

January 2016

Dr. Jasmohan S. Bajaj

Jasmohan S. Bajaj, MD, co-author of a multi-center study validating a new app to diagnose minimal hepatic encephalopathy (MHE), speaks with AJG co-Editor in Chief Dr. Brennan Spiegel about the difficulty diagnosing MHE in cirrhotic patients, and the importance of a valid, rapid, and accessible diagnostic tool for this disabling and dangerous condition. Dr. Bajaj also discusses the difficulty of creating validated, user-friendly apps that provide both accurate diagnostics for patients and their doctors as well as usable data for researchers. (22:33)

Which CRE Prevention Strategy for ERCP Endoscopes Is Most Cost-Effective? 

December 2015

Dr. Christopher Almario

Christopher Almario, MD, MSHPM, co-author of a recent article examining the cost-effectiveness of various approaches for preventing transmission of carbapenem-resistant Enterobacteriaceae (CRE) through ERCP endoscopes, discusses the genesis of the study and the finding that newly issued FDA recommendations for endoscope reprocessing were most cost-effective compared to the other approaches studied. Dr. Almario explains why a “do nothing strategy” was not included in the model, and addresses other underlying assumptions of the analysis. (20:39)

IBD Patients Are at Increased Risk of Invasive Pneumococcal Disease

November 2015

Dr. Tine Jess

Tine Jess MD, MSc, co-author of a recent article about the risk of invasive pneumococcal disease (IPD) in IBD patients, talks with AJG Co-Editor Dr. Paul Moayyedi about the increased risk of IPD as long as 4 years prior to IBD diagnosis, the risk of IPD associated with various IBD drug therapies, including the lack of risk associated with biologic therapies and oral corticosteroids, and whether physicians should be routinely offering the pneumococcal vaccine to IBD patients. (16:28)

The Clinical Impact of Immediate On-Site Cytopathology Evaluation During EUS-FNA of Pancreatic Masses

October 2015

Dr. Sachin Wani

Sachin Wani MD, co-author of a recent article about on-site cytopathology evaluation during EUS-FNA for pancreatic masses, talks with AJG Co-Editor Dr. William Chey about why EUS has been come such an important part of evaluation for pancreatic masses and cancer, the benefits and limitations of on-site cytopathology, an presents advice on cost-minimization and quality indicator adherence. (18:21)

ACG Clinical Guideline: Small Bowel Bleeding

September 2015

Dr. Lauren Gerson

Lauren Gerson, MD, MSc, FACG, co-author of the new ACG Clinical Guideline on small bowel bleeding talks with AJG Co-Editor Dr. Paul Moayyedi about recommended diagnostic techniques, including second look endoscopy, capsule endoscopy, push enteroscopy, and double-balloon enteroscopy. Efficacy of hormonal therapies, somatostatin analogs, biologic therapy, and angiogenic therapy is discussed, as well as the role of anticoagulants in the management of patients with obscure bleeding. (20:28)

Should Chromoendoscopy Become the Standard of Care in IBD Surveillance? 

July 2015

Dr. Peter Higgins

Peter Higgins, MD, PhD, co-author of a recent editorial regarding the use of chromoendoscopy surveillance in IBD and ulcerative colitis, talks with AJG Co-Editor Dr. William Chey about the relationship between chronic ulcerative colitis and dysplasia, the real rate of dysplasia development in these patients, and how frequently surveillance colonoscopy should be performed. Dr. Higgins also summarizes recent research on the use of chromoendoscopy for surveillance and weighs the costs and benefits of applying this procedure to IBD patients in clinical practice. (21:08)

ACG Clinical Guideline: Primary Sclerosing Cholangitis

May 2015

Dr. Keith D. Lindor

Keith D. Lindor, MD, FACG, co-author of the new ACG Clinical Guideline on primary sclerosing cholangitis talks with AJG Co-Editor Dr. Paul Moayyedi about recommended diagnostic techniques, symptom management strategies, and the role of liver transplantation. Recommendations for colon and cholangiocarcinoma surveillance are also discussed. (18:18)

Constipation and Fecal Incontinence During and After Pregnancy

April 2015

Dr. Ron Schey

Ron Schey, MD, FACG, co-author of a recent article reviewing common bowel changes for women during pregnancy and in the postpartum period, talks with AJG Co-Editor Dr. William Chey about the temporary and possibly permanent changes to pelvic floor anatomy and physiology during pregnancy and how preexisting functional GI disorders may change during and after pregnancy. The prevalence and risk factors constipation and fecal incontinence are discussed, as well as the safety and effectiveness of various treatments for both conditions. (21:34)

Gluten Avoidance in Non-Celiac Patients

March 2015

Dr. Joseph A. Murray

Joseph A. Murray, MD, co-author of a recent article on the racial/ethnic trends in celiac disease and gluten-free diets, talks with AJG Co-Editor Dr. William Chey about the racial differences in the prevalence of celiac disease, the startling increase in this prevalence over the last 20 years, and how physicians should consider celiac disease in the context of related disorders for at-risk populations. Dr. Murray also discusses the puzzling recent trend of non-celiac patients adhering to a gluten-free diet for “health” reasons not supported by science. (24:57)

Medical Marijuana: High Time to Prescribe?

February 2015

Dr. Mark E. Gerich

Mark E. Gerich, MD, co-author of a recent Red Section article on medical marijuana and digestive disorders, talks with AJG Co-Editor Dr. Paul Moayyedi about the controversies surrounding medical marijuana, the changing legal landscape, and the challenges of conducting clinical research on the drug’s effects. The specific pharmacological agents in marijuana and their potential treatment applications for a variety of digestive disease states and symptoms are also discussed. (18:32)

Epidemiology, Pathophysiology, and Treatment of Fecal Incontinence

January 2015

Dr. Adil Bharucha

Adil Bharucha, MBBS, MD, co-author of the NIDDK state of the science summary on fecal incontience, talks with AJG Co-Editor Dr. William D. Chey about the highly common but often taboo topic of fecal incontinence. Dr. Bharucha discusses the personal and economic costs of a disorder affecting up to 15% of community-dwelling adults, as well as some key risk factors, diagnostic tests, and treatments. Clinicians will hear valuable advice on how to broach this topic with patients and how to provide meaningful care for a condition with significant emotional consequences. (26:35)

New Quality Indicators for Colonoscopy and What They Mean for Your Practice

January 2015

Dr. Philip Schoenfeld

Philip Schoenfeld, MD, co-author of new Quality Indicators for Colonoscopy published on behalf of the ACG and ASGE, talks with AJG Co-Editor Dr. William D. Chey about the transition of screening colonoscopy practice from a fee-for-service model to a quality-based model. Dr. Schoenfeld explains pre-procedure, intra-procedure, and post-procedural quality indicators, performance targets for meeting those indicators, and impact of performance data on reimbursement rates from both CMS and third-party payers. Compliance dates and reporting systems such as GIQuIC are also discussed in this essential podcast for any practicing gastroenterologist. (30:11)

What Level of Bowel Prep Quality Requires Early Repeat Colonoscopy

November 2014

Dr. Loren Laine

 Loren Laine, MD, co-author of a new systematic review of the impact of bowel prep quality on early repeat colonoscopy and adenoma detection rate (ADR), talks with AJG Co-Editor Dr. William D. Chey about the real-world differences in ADR during colonoscopies with high, intermediate, and poor quality bowel preps. Meta-analysis of high-quality studies found no significant difference in ADR between high and intermediate quality preps, suggesting that intermediate preps might be “good enough.” Dr. Laine also discusses the impact of withdrawal time, documentation of prep quality, and recommendations for repeat colonoscopies after intermediate or poor quality preps. (20:55)

ACG Monograph on the Management of IBS and Chronic Idiopathic Constipation

October 2014

Dr. Eamonn M. M. Quigley and Dr. Paul Moayyedi

Eamonn M. M. Quigley, MD, FACG and Paul Moayyedi, BSc, MB ChB, PhD, MPH, FACG, co-authors of the new ACG Monograph on the management of IBS and CIC, talk with AJG Co-Editor Dr. William D. Chey about the rapidly changing field of IBS and CIC treatments, the new relevance of products such as probiotics and antibiotics in altering the microbiome in IBS patients, recommendations for PEG and newer prosecretory agents in IBS-C and CIC, and the use of drugs such as alosetron and ondansetron for severe IBS-D. (22:44)

ACG Clinical Guideline: The Diagnosis and Management of Focal Liver Lesions

September 2014

Dr. Joseph Ahn

Joseph Ahn, MD, FACG, co-author of the new ACG Clinical Guideline on management of focal liver lesions talks with AJG Co-Editor Dr. William D. Chey about the epidemiology of focal liver lesions, use of imaging modalities and blood tests as diagnostic tools for this disorder, and treatment recommendations for different types of focal liver lesions, including hepatocellular carcinoma and adenoma, cholangiocarcinoma, hemangioma, nodular regenerative hyperplasia, and cystic liver lesions. (22:44)

ACG Clinical Guideline: Management of Benign Anorectal Disorders

August 2014

Dr. Arnold Wald

Arnold Wald, MD, MACG, co-author of the new ACG Clinical Guideline on management of benign anorectal disorders, talks with AJG Co-Editor Dr. Paul Moayyedi about the definitions and treatment of dyssynergic defecation disorders, proctalgia syndromes, and fecal incontinence. They discuss the importance of determining the causes of these disorders before pursuing treatment, and the overall merits of conservative treatments over more invasive measures. (26:44)

ACG Clinical Guideline: The Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury

July 2014

Dr. Naga P. Chalasani and Dr. Herbert L. Bonkovsky

Naga P. Chalasani, MD, FACG, and Herbert L. Bonkovsky, MD, FACG, co-authors of the new ACG Clinical Guideline on drug-induced liver injury (DILI) talks with AJG Co-Editor Dr. William D. Chey about the definition of DILI and its different subtypes, risk factors for the disorder, the drug classes that pose the greatest risk of liver injury, and the essentials of clinical work-up for DILI patients, including when to perform a liver biopsy. Special note is paid to herbal and dietary supplements, which are largely unregulated and have caused increasing harm to patients over the past few years. (32:17)

Synergistic Effects of Alcohol and Tobacco on the Risk of Esophageal Squamous Cell Carcinoma

June 2014

Dr. Joel H. Rubenstein

Joel H. Rubenstein, MD, MSc, co-author of new research on the synergistic effects of alcohol and tobacco consumption on the risk of esophageal squamous cell carcinoma talks with AJG Co-Editor Dr. Paul Moayyedi about the concept of synergy in epidemiological research, the potential confounding factors and variability of the studies included in the meta-analysis, and the explanations and implications of this synergistic effect of tobacco and alcohol on esophageal cancer. (16:10)

Novel Role of the Serine Protease Inhibitor Elafin in Gluten-Related Disorders 

May 2014

Dr. Elena F. Verdu

Elena F. Verdu, MD, PhD, co-author of new research on the role of the serine protease inhibitor elafin in celiac disease published in the May 2014 issue of AJG, talks with AJG Co-Editor Dr. William D. Chey about the pathophysiology of celiac disease, the role of various serine proteases, including elafin, in the inflammatory processes of celiac disease, and the potential diagnostic and treatment implications of the study findings. (15:37)

Avoiding Burnout: Finding Balance Between Work and Everything Else

April 2014

Dr. Christina M. Surawicz

Christina M. Surawicz, MD, MACG, author and presenter of the J. Edward Berk Distinguished Lecture at ACG 2013, which was published in the April 2014 issue of AJG, talks with AJG Co-Editor Dr. Paul Moayyedi about physician burnout, which has been defined as “a state of mental exhaustion caused by one’s professional life.” She discusses the components of burnout (namely emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment), frequent contributing factors to burnout such as work-home conflicts, and suggestions for how to prevent and manage burnout if it occurs. (21:00)

Trends in Esophageal Adenocarcinoma Incidence and Lifestyle Factors Between the US, Spain, and The Netherlands

March 2014

Dr. Nicholas J. Shaheen

Nicholas J. Shaheen, MD, MPH, FACG, author of an editorial on a recent article on esophageal adenocarcinoma trends across three nations published in the March 2014 issue of AJG, talks with AJG Co-Editor Dr. William Chey about the rising incidence of esophageal adenocarcinoma, the most important and interesting conclusions drawn from this ecological study, and the role that GERD, Barrett’s esophagus, tobacco smoking, alcohol consumption, and obesity all play in the pathogenesis of this disease. (22:25)

Impact of Physical Complaints, Social Environment, and Psychological Functioning on IBS Patients’ Health Perceptions

February 2014

Dr. Jeffrey M. Lackner

Jeffrey M. Lackner, PsyD, co-author of new research on the correlation between self-ratings of health and IBS symptom severity published in the February 2014 issue of AJG, talks with AJG Co-Editor Dr. Paul Moayyedi about how fatigue, somatization, and negative social interactions might serve as key predictors for self-rated health in IBS, how IBS symptom severity has a surprisingly modest role in self-rated health, and how doctors can better consider the psychological experience of IBS and how that impacts treatment and patient response. (22:31)

Differential Effects of FODMAPs on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI

January 2014

Dr. Robin C. Spiller

Robin C. Spiller, MD, FRCP, co-author of new research on the effect of FODMAPs such as fructose and fructans on irritable bowel syndrome (IBS) symptoms published in the January 2014 issue of AJG, talks with AJG Co-Editor Dr. William D. Chey about the dietary substances included in the FODMAP classification, the MRI imaging techniques used to measure FODMAP impact on colonic distention and gas production in this study, and how clinicians might consider FODMAPs along with gluten and lactose when recommending dietary interventions for IBS patients. (21:53)

Clinical and Endoscopic Characteristics Do Not Reliably Differentiate PPI-Responsive Esophageal Eosinophilia and Eosinophilic Esophagitis

December 2013

Dr. Evan S. Dellon

Evan S. Dellon, MD, MPH, co-author of new research on the distinguishing features of PPI-responsive esophageal eosinophilia and eosinophilic esophagitis (EoE) published in the December issue of AJG, talks with AJG Co-Editor Dr. Paul Moayyedi about the clinical features evaluated in the study, the lack of significant distinguishing association of these features to either disease, the role of PPIs in reducing eosinophils, and potential future studies worthy of pursuit in this area. (20:05)

Patient Assessments and Online Ratings of Quality Care

November 2013

Dr. David A. Johnson

David A. Johnson, MD, FACG, co-author of new research on the emerging impact of online patient evaluation websites (PEWs) published in the Red Section of the November issue of AJG, talks with AJG Co-Editor William D. Chey, MD, FACG, about the rating metrics used by these websites, the characteristics of typical users, and the potential ways in which physicians can interact with these sites to improve doctor-patient communication and manage their online reputation. (18:34)

Temporal Bacterial Community Dynamics Vary Among Ulcerative Colitis Patients After FMT

October 2013

Dr. Sieglinde Angelberger and Dr. David Berry

Sieglinde Angelberger, MD, and David Berry, PhD, co-authors of new research on the efficacy of fecal microbiota transplantation (FMT) in patients with ulcerative colitis published in the October issue of AJG, talk with AJG Co-Editor Dr. Paul Moayyedi about the highlights of their case series, including choice of stool donors, route and duration of administration, impact of FMT on these patients’ gut microbiota, and what the disappointing response to FMT in these ulcerative colitis cases suggests for further research into this practice. (16:20)

ACG Clinical Guideline: Acute Pancreatitis

September 2013

Dr. Scott M. Tenner

Scott M. Tenner, MD, MPH, FACG, co-author of the ACG Clinical Guideline on the Management of Acute Pancreatitis, published in the September issue of AJG, talks with Co-Editor Dr. William Chey about the increasing prevalence of acute pancreatitis; the appropriateness of CT, MR, ERCP, and genetic testing in diagnosis of the disease; and the role of antibiotics, re-feeding, surgical debridement, and lactated ringer’s solution versus normal saline in the management of acute pancreatitis. (24:54)

ACG Clinical Guideline: Diagnosis and Management of Achalasia

August 2013

Dr. Michael F. Vaezi, Dr. John E. Pandolfino and Dr. Marcelo F. Vela

Michael F. Vaezi, MD, FACG, John E. Pandolfino, MD, and Marcelo F. Vela, MD, co-authors of the ACG Clinical Guideline on the Diagnosis and Management of Achalasia published in the August issue of AJG, talk with Co-Editor Dr. Paul Moayyedi about the incidence, prevalence, and diagnosis of this disorder; the best treatment options—including myotomy, pneumatic dilatation, and botulinum toxin—according to achalasia subtype and patient age, gender, and preference; as well as the long-term outlook and risks for achalasia patients after successful therapy. (25:58)

The Acid Pocket: A Target for Treatment in Reflux Disease?

July 2013

Dr. Peter J. Kahrilas

Peter J. Kahrilas, MD, FACG, co-author of new research published in the July issue of AJG about the “acid pocket,” an area of unbuffered gastric acid that accumulates in the proximal stomach after meals, talks with AJG Co-Editor William D. Chey, MD, FACG, about the definition and genesis of the acid pocket concept; the relationship between this phenomenon and hiatal hernia, erosive esophagitis, and Barrett’s esophagus; as well as evolving methods to identify and target the acid pocket for the treatment of GERD. (21:50)

High Economic Burden of Caring for Patients with Suspected Extraesophageal Reflux 

June 2013

Dr. Michael F. Vaezi and Dr. David O. Francis

Michael F. Vaezi, MD, FACG, and David O. Francis, MD, co-authors of new research on the high costs of caring for patients with extraesophageal reflux symptoms published in the June issue of AJG, talk with AJG Co-Editor Dr. Paul Moayyedi about the prevalence of various extraesophageal reflux symptoms, the costs of treating these symptoms, the impact of tertiary care centers in both patient improvement and health care costs, and whether the best treatment for extraesophageal reflux is perhaps no treatment at all. (26:44)

ACG Clinical Guideline: Diagnosis and Management of Celiac Disease 

May 2013

Dr. Joseph A. Murray and Dr. Ciarán P. Kelly

Joseph A. Murray, MD, FACG, and Ciarán P. Kelly, MD, FACG, co-authors of the ACG Clinical Guideline on the Diagnosis and Management of Celiac Disease, talk with AJG Co-Editor William D. Chey, MD, FACG, about the key components of the guidelines, including the working definition of celiac disease, screening techniques such as small bowel biopsy and genetic testing, best practices for gluten challenge, as well as routine celiac patient monitoring and emerging treatments. (35:42)

ACG Clinical Guideline: Esophageal Eosinophilia and Eosinophilic Esophagitis

May 2013

Dr. David A. Katzka

David A. Katzka, MD, FACG, co-author of the ACG Clinical Guideline on the Diagnosis and Management of Esophageal Eosinophilia and Eosinophilic Esophagitis (EoE), talks with AJG Co-Editor Dr. Paul Moayyedi about the key components of the guidelines, including the epidemiology of the disease, the difficulty of diagnosis for EoE, the role of diet and pharmacological therapy for treatment of EoE, and the urgent need for more research into this disease. (40:38)

Nuevas Guías de Práctica sobre el Diagnóstico y Manejo de la Enfermedad Celíaca

May 2013

Dr. Alberto Rubio-Tapia

Alberto Rubio-Tapia, MD, co-autor de la American College of Gastroenterology Guía Clínica por el Diagnóstico y Manejo de la Enfermedad Celíaca, discute los elementos clave de las directrices con Editor Asociado Max Schmulson, MD. (28:00)

ACG Clinical Guideline: Clostridium difficile Infections

April 2013

Dr. Christina Surawicz

Christina M. Surawicz, MD, MACG, talks about the key components of the guideline, including the epidemiology of the disease, the criteria for diagnosis of severe C. difficile infection, and appropriate treatment regimens for both mild-to-moderate and severe disease, including fecal transplantation. (14:10)

ACG Clinical Guideline: Diagnosis and Management of Gastroesophageal Reflux Disease

March 2013

Dr. Philip O. Katz and Dr. Lauren B. Gerson

Philip O. Katz, MD, FACG and Lauren B. Gerson, MD, MSc, FACG, two authors of the ACG Clinical Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease (GERD), talk with AJG Co-Editor Paul Moayyedi, MD, FACG, about the key components of the guidelines, including the prevalence of GERD, the recommendations for the approach to diagnosis and management, and the potential adverse events associated with PPI therapy. (33:33)

The Role of Fecal Microbiota Transplant in Treating C. difficile

February 2013

Dr. Lawrence J. Brandt

William D. Chey, MD, FACG, talks with Lawrence J. Brandt, MD, MACG, on the efficacy of this potentially lifesaving procedure and how the FDA’s recent classification of stool as a “drug” could impact physicians who want to use FMT as a treatment option for their patients. A leading pioneer in the use of fecal microbiota transplantation (FMT) in treating C. difficile infection, Dr. Brandt gave the 2012 AJG Lecture that was also published in the February issue. (33:10)

ACG Clinical Guideline: Management of Gastroparesis

January 2013

Dr. Henry P. Parkman

Paul Moayyedi, MD, FACG, talks with Henry P. Parkman, MD, FACG, co-author of the ACG Clinical Guideline for the management of gastroparesis. Published in the January issue of AJG, the guideline addresses the definition, diagnosis, differential diagnosis, and treatment of gastroparesis, including nutritional supplementation, glycemic control, pharmacological, endoscopic, device, and surgical therapy. Dr. Parkman provides insight on the guideline’s key recommendations, including the scientifically-based evidence behind them. (25:43)

Non-Celiac Wheat Sensitivity: Distinct Clinical Condition?

December 2012

Dr. Joseph A. Murray

Recent research by Antonio Carroccio, MD, that suggests the existence of non-celiac wheat sensitivity as a distinct clinical condition is the basis for a discussion between AJG Co-Editor William D. Chey, MD, FACG, and Joseph A. Murray, MD, who is lead author of an upcoming clinical management guideline for celiac disease that will be published in the Red Journal. Dr. Murray helps define non-celiac gluten sensitivity, explores why gluten-free diets are unsatisfactory as a diagnostic tool, and explains the need for scientific advancement in this area. Dr. Carroccio’s paper was published in the December issue of The American Journal of Gastroenterology. (37:17)

Linaclotide for Irritable Bowel Syndrome (IBS)

November 2012

Dr. William D. Chey and Dr. Satish Rao

Dr. Paul Moayyedi talks with William D. Chey, MD, FACG and Satish Rao, MD, PhD, FACG about two randomized controlled trials on linaclotide in irritable bowel syndrome (IBS) published in the December issue of The American Journal of Gastroenterology. The phase 3 trials report that this new therapy significantly reduces constipation and abdominal pain associated with some kinds of IBS. (35:31)

Prevalence of Irritable Bowel Syndrome Symptoms in IBD

October 2012

Dr. Alexander C. Ford and Dr. Eamonn M. M. Quigley

Paul Moayyedi, MD, FACG, talks with Alexander C. Ford, MD, and Eamonn M. M. Quigley, MD, FACG, about the findings from the first systematic review of the literature of irritable bowel syndrome symptoms in inflammatory bowel disease. In the review, Dr. Ford and his co-investigator Stephen J. Halpin, MD, demonstrated that prevalence of symptoms compatible with IBS in patients with IBD is as high as 40%. This article and Dr. Quigley’s editorial “Irritable Bowel Symptoms in IBD: Diagnostic Uncertainty Meets Pathological Reality” were published in the October issue of the AJG. (23:08)

New Meta-Analysis Shows No Protective Effect of 5-ASA Against CRC in IBD

September 2012

Dr. Geoffrey C. Nguyen and Dr. Charles N. Bernstein

Findings from a new meta-analysis focusing on non-referral studies suggest that 5-Aminosalicylic Acid offers little, if any, protection against colorectal cancer in Inflammatory Bowel Disease. In a conversation with AJG Co-Editor Dr. Paul Moayyedi, co-investigators Geoffrey C. Nguyen, MD, PhD, FRCPC and Charles N. Bernstein, MD explain why their findings conflict with previous clinic-based population studies and why 5-ASA should not be prescribed to IBD patients solely for their putative effects against CRC. (32:30)

Gut Microbes: Role In GI Health & Disease

August 2012

Dr. Mark Pimentel

The importance of gut microflora in digestive health and disease is the topic of a July 2012 AJG Supplement. A podcast with Guest Editor Mark Pimentel, MD in conversation with Dr. Bill Chey covers post-infectious functional GI conditions, SIBO, IBS, and the role of methanogens, as well as an interesting perspective on probiotics in treating GI diseases. (20:36)

Evidence Shows Higher Risk of C. difficile Infection with PPIs

July 2012

Dr. Yoon K. Loke

Findings from a new meta-analysis portray a cautionary tale on the use of PPI therapy in patients at significant risk of C. difficile infection. In conversation with AJG Co-Editor, Dr. William D. Chey, MD, Dr. Yoon K. Loke discusses his research findings that suggest concurrent use of antibiotics with PPIs increases the risk of CDI; and a lower risk of CDI with use of H2RAs. (17:00)

Endotherapy for Barrett’s Esophagus

June 2012

Dr. Irving Waxman

Endotherapy for Barrett’s esophagus is the featured topic of the June 2012 Author Podcast featuring Dr. Irving Waxman of the University of Chicago. In conversation with Co-Editor of AJG, Dr. Paul Moayyedi, Dr. Waxman reviews Barrett’s surveillance and management strategies for patients with high grade dysplasia including a discussion of EMR and various ablative modalities. (27:10)

Food Choice as a Key Management Strategy for Functional Gut Symptoms

May 2012

Dr. Peter Gibson

Professor Peter Gibson reviews the quality of the evidence on diets high or low in poorly absorbed short-chain carbohydrates, known as FODMAPs (Fermentable Oligo-, Di- and Mono-saccharides and Polyols) and their impact on functional gastrointestinal symptoms. In a discussion with Co-Editor Dr. Bill Chey, Professor Gibson provides insights on implementing dietary approaches in the office and discusses the challenges of recognizing patients with non-celiac gluten sensitivity. (28:10)

PPIs vs. H2RAs for Preventing GI Bleeding in Critically Ill Patients

April 2012

Dr. Alan Barkun

Dr. Alan Barkun from McGill in Montreal, Canada is the author of a new systematic review and meta-analysis on PPIs vs. H2-receptor antagonists for stress related mucosal bleeding prophylaxis in critically ill patients. In a conversation with Dr. Paul Moayyedi, Professor Barkun reviews the evidence on the efficacy of PPIs vs. H2RAs in recurrent GI bleeding, ICU stay, mortality, and nosocomial pneumonia. (23:06)

Management of Patients with Ulcer Bleeding

March 2012

Dr. Loren Laine

A conversation with Dr. Loren Laine.