Smart drug delivery technologies for Inflammatory Bowel Diseases (IBD) focus on site-specific therapeutic delivery, enhancing treatment efficacy while minimizing side effects. Recent advancements, including ingestible smart capsules, offer precise targeting within the gastrointestinal (GI) tract. Despite previous commercialization challenges, progress in technology, miniaturization, and component design has reignited interest. Smart capsules, equipped with drug reservoirs, sensors, and localization mechanisms, promise improved treatment for IBD by accurately releasing drugs at disease sites, overcoming limitations of traditional drug delivery methods.
Author: Abhay Panchal
In the podcast episode of Small Talk Big Topics, Drs. Laurel Fisher and Asma Khapra discuss the evolving role of women in gastroenterology. Both share their career journeys and emphasize the importance of networking, self-care, and reducing burnout. They highlight the growing representation of women in GI leadership and the support provided by workshops and organizations like AGA. While progress has been made, they stress the need for further efforts to increase female participation and leadership in the field.
The rapid adoption of GLP-1 receptor agonists for diabetes and weight loss has raised concerns in the endoscopy suite due to potential risks like delayed gastric emptying and aspiration during procedures requiring sedation. Anesthesiologists have called for holding GLP-1s a week prior to elective procedures, causing tensions with gastroenterologists who argue the evidence is insufficient. Both sides agree more research is needed to guide best practices, and new guidelines are being developed to address these concerns while minimizing unnecessary cancellations.
In this crossover podcast, Jeffrey Roberts, Kate Scarlata, Dr. William Chey, and Amanda Lynett discuss advancements in the management of IBS, including the role of nutrition, FODMAPs, and integrative care. Dr. Chey emphasizes evolving IBS treatments, including prebiotics, probiotics, and mast cell stabilizers. Amanda Lynett shares insights on planning conferences like FOOD the Main Course and her passion for GI nutrition. They highlight the importance of pelvic floor therapy and a multidisciplinary approach to IBS care, offering hope to patients and guidance for healthcare providers.
The gastroenterology industry faces challenges like declining reimbursement rates and staffing shortages, even as demand for GI procedures increases due to a lowering of the recommended age for colonoscopies and rising obesity rates. Cuts proposed for 2025 by CMS could exacerbate these issues, particularly for private practice, which makes up a large part of the specialty. This may lead to more consolidation in the industry as independent practices struggle to compete with larger hospitals offering higher salaries to new graduates.
A study conducted by Dr. Rafael Bandeira Lages and colleagues in Brazil explored a less invasive alternative to traditional impedance-pH monitoring for diagnosing GERD. By measuring esophageal mucosal impedance during endoscopy, the research found high diagnostic accuracy, particularly at 2 cm above the esophagogastric junction. This method, which is more comfortable for patients, holds promise as a diagnostic tool but requires further validation and refinement before it can be used widely in clinical practice.
A recent study suggests that combining fecal immunochemical testing (FIT) with colonoscopy could improve colorectal cancer surveillance for individuals with a family history of the disease. The optimal strategy involves 10-yearly colonoscopy with 2-yearly FIT screenings, providing a balance of cost-effectiveness and clinical outcomes. The study highlights the growing interest in less-invasive screening options and emphasizes the importance of maintaining quality assurance in both colonoscopy and FIT procedures. While FIT alone has limitations, the combined approach could potentially offer better cancer prevention and detection rates.
Exact Sciences presented data from a study on its blood-based colorectal cancer test at the European Society for Medical Oncology Congress. The test showed 88.3% sensitivity for detecting colorectal cancer and 31.2% for advanced precancerous lesions, with a specificity of 90.1%. This development brings the test closer to providing a non-invasive screening option. Analysts reacted positively but expressed concern over potential performance degradation, with final results from the BLUE-C study expected by the first half of 2025.
In 2021, colonoscopy screenings in the U.S. cost $23.7 billion, with rising colorectal cancer (CRC) rates contributing to increasing demand. Colonoscopy costs vary by setting, averaging $925 in Ambulatory Surgery Centers (ASCs) and $1,224 in hospitals. Despite this, reimbursements for gastroenterologists have declined, with a 38% drop in colonoscopy-related payments between 2007 and 2022.
A 35-year-old patient at the University of Chicago Medicine became the first person globally to receive Tremfya (guselkumab) after its FDA approval for treating moderate to severe ulcerative colitis. The drug, previously used for psoriasis and psoriatic arthritis, was shown to be effective for ulcerative colitis in a study led by Dr. David T. Rubin at UChicago Medicine.