Publications

Microscopic colitis (MC) is a histologically confirmed cause of chronic diarrhea with normal endoscopy, and limited data complicate diagnosis and management during pregnancy. We report a 31-year-old woman with lymphocytic colitis, initially misdiagnosed as irritable bowel syndrome, who experienced an MC flare at 15 weeks' gestation after starting sertraline. Symptoms resolved with sertraline discontinuation and budesonide, with remission maintained postpartum. This case underscores the importance of medication review, early recognition, and multidisciplinary care in pregnant patients with persistent diarrhea, particularly when coordinating gastrointestinal and psychiatric management.

INTRODUCTION: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction that affects over 6% of Americans. Increased physical activity improves IBS symptoms and may be associated with lower odds of IBS; however, prior studies are small or limited by self-reported measurements. This study aimed to investigate associations between Fitbit-recorded physical activity data and the prevalence of IBS.

METHODS: A retrospective, cross-sectional analysis was conducted using the All of Us Research Program. Adults over 18, who shared Fitbit and electronic healthcare record data, were included. Participants were placed into quartiles based upon their mean daily activity metrics: steps, active minutes, sedentary minutes, and maximum heart rate. Covariates included demographics, lifestyle factors (alcohol and smoking), BMI, education, income, and comorbidities. Multivariable logistic regression was used to analyze associations between activity metrics and IBS.

RESULTS: Of 43,967 participants, 1551 (3.5%) had an IBS diagnosis. The IBS group was 83% female, 79% White, with a median age of 53 years. Compared to the lowest quartile, participants in the highest quartile of average daily steps (OR: 0.82; p=0.028), very active minutes (OR: 0.72; p<0.001), and maximum heart rate (OR: 0.65; p<0.001) had significantly lower odds of IBS. Conversely, those in the highest quartile of sedentary minutes had higher odds of IBS (OR: 1.24; p=0.007).

DISCUSSION: This large, real-world study, using objective physical activity data, demonstrates that higher levels of physical activity is associated with lower odds of IBS. Prospective studies are warranted to determine whether physical activity has a causal protective effect against IBS.

This review offers information and practical guidance for professionals who care for patients with disorders of gut-brain interaction (DGBI). It summarizes evidence-based psychosocial approaches for adult and pediatric populations, organized into 4 sections: background, assessment, management, and training. The review begins by establishing a biopsychosocial framework, highlighting the bidirectional influences of biological and psychosocial factors on gut physiology and brain mechanisms. It then outlines key assessment strategies, including targeted patient interview questions and guidance on interpreting responses followed by empirically supported psychosocial treatments suitable for integrated and standalone care settings. The final section presents curriculum recommendations for providers in DGBI-specific psychosocial care. Emphasizing the brain-gut axis and the importance of the patient-provider relationship, this review underscores the need for accurate psychosocial assessment and contextually informed intervention. It concludes with future directions for training and research to enhance clinical outcomes in this complex and multifaceted domain.

BACKGROUND AND AIMS: Real-world data are needed to better understand the burden and outcomes of patients hospitalized with severe ulcerative colitis (UC).

METHODS: This retrospective cohort study analyzed US electronic health record (EHR) data with linked insurance claims to identify adults hospitalized for UC who received intravenous corticosteroids during an inpatient admission (index hospitalization) between January 1, 2014, and December 31, 2022, with ≥180 days of prior EHR activity. Results were analyzed for the overall cohort, in three subgroups: (1) no prior UC diagnosis in the EHR, (2) prior UC diagnosis without prior advanced therapy, and (3) prior UC with prior advanced therapy, and in a nested cohort of patients discharged without colectomy. Multivariable analyses assessed factors associated with colectomy before discharge.

RESULTS: Overall, we identified 9716 patients (mean [SD] age, 46.3 [17.4] years); 83.3% had a previous diagnosis of UC and 23.8% had prior biologic use for UC. During hospitalization, 13.1% received advanced therapy; 12.2% underwent colectomy. The rate of colectomy was 12.6% in subgroup 1, 9.2% in subgroup 2, and 19.6% in subgroup 3 (P < .0001). Prior UC diagnosis with prior advanced therapy use and abnormal/missing albumin labs were associated with higher risk of colectomy. The cumulative risk of colectomy <1 year after index hospitalization was 20.4% overall and 18.5%, 16.1%, and 32.7% in subgroups 1, 2, and 3, respectively. In the nested cohort (n = 4383), one-third received advanced therapy within 90 days; 38.4% experienced a UC-related hospitalization <1 year after index hospitalization.

CONCLUSION: These data from a large contemporary cohort elucidate the burden and outcomes for patients hospitalized with severe UC.

Gastrointestinal malignancies such as signet-ring cell carcinoma can mimic inflammatory bowel disease, leading to diagnostic uncertainty. We present the case of a 39-year-old woman who presented with cramping abdominal pain, watery diarrhea, and unintentional weight loss. Imaging revealed multifocal colonic strictures and pelvic ascites, initially suspected to represent Crohn's disease. Bidirectional endoscopy showed gastric edema and colonic strictures without typical inflammatory features. Following laparoscopic-assisted subtotal colectomy for progressive obstruction, histopathology revealed diffuse infiltration of signet-ring cells consistent with metastatic gastric adenocarcinoma. This case highlights the importance of maintaining a broad differential diagnosis when atypical features are present. Clinicians should maintain a high index of suspicion for malignancy in young patients with atypical strictures, especially when accompanied by systemic features such as weight loss or ascites, even when initial endoscopic biopsies are non-diagnostic.

PURPOSE: Studies show women are underrepresented in gastroenterology (GI). Understanding representation is crucial to improving representation. This study describes the geographic distribution of women in academic GI in the United States (US).

METHODS: We conducted a cross-sectional study of 224 US GI fellowship programs in 2023 by review of program websites and direct inquiry. Gender distribution of trainees and faculty across US regions was evaluated. Program characteristics were examined in univariate analyses. Logistic regression models assessed factors associated with women in leadership, adjusting for program type and region.

RESULTS: Women comprised 39.3% of 1,801 fellows and 30.2% of 3,899 GI faculty. Percentage of women fellows was highest in the West (50%), Northeast (38%), South (33%), and Midwest (33%), (p = 0.014). Median percentage of senior women faculty was highest in the Northeast (27%) (p = 0.009). Programs with women GI division chiefs had more women GI fellowship program directors (60% vs 40%, p = 0.001) and higher median percentage of women faculty (33% vs 26%, p = 0.016). The presence of a woman GI division chief was independently associated with having a woman GI fellowship program director (p = 0.008) and increased percentage of women faculty (p < 0.001).

CONCLUSION: Gender representation varied regionally, with some institutions lacking women faculty or trainees. Women in leadership are associated with greater faculty gender diversity, potentially impacting trainee recruitment, faculty retention, and patient care. The association between women GI division chiefs and increased women faculty and program directors highlights how leadership gender diversity may support recruitment and retention of women in academic GI.

BACKGROUND: Sucrose malabsorption and small intestinal bacterial overgrowth (SIBO) present with symptoms that overlap with those of disorders of gut-brain interaction (DGBI). Recent studies suggest that sucrose malabsorption is more prevalent than previously thought. This study aims to determine the prevalence of sucrose malabsorption based on 13C-sucrose breath test (SBT) in patients undergoing SIBO breath testing and assess whether symptoms distinguish sucrose malabsorption from SIBO.

METHODS: Three hundred patients referred for SIBO breath testing between August 2020 and March 2022 were recruited and asked to complete the Rome IV Questionnaire for bowel disorders, Irritable Bowel Syndrome Severity Score (IBS-SSS), and the Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM). After in person SIBO breath testing, they were provided an at-home 13C-SBT.

RESULTS: One-hundred-and-forty patients returned the SBT. Of the SIBO negative patients, 22% (25/113) were SBT positive. No statistically significant differences were found in predominant symptoms or Rome IV diagnoses (IBS, functional constipation, or functional diarrhea), bloating frequency, IBS-SSS, or PAGI-SYM Scores between SBT positive and SBT negative patients. SBT positive only patients (n = 24) reported less abdominal pain (p = 0.04) than abnormal SIBO test only patients (n = 23).

CONCLUSION: Sucrose malabsorption was present in 22% of SIBO negative patients, indicating that it is a possible contributor to DGBI symptoms. Symptom profile alone did not predict sucrose malabsorption, nor distinguish between sucrose malabsorption and SIBO. This emphasizes the importance of considering carbohydrate malabsorption syndromes, such as sucrose malabsorption, when evaluating patients with symptoms consistent with functional gastrointestinal disorders (FGID).

BACKGROUND & AIMS: Safe and effective treatment for irritable bowel syndrome with diarrhea (IBS-D) is needed. ORP-101 is a novel partial μ receptor agonist and full κ receptor antagonist designed to act peripherally without central nervous system exposure. This study evaluated the efficacy and safety of ORP-101 in IBS-D.

METHODS: In this randomized, double-blind, adaptive design placebo-controlled trial, eligible participants were randomized to receive ORP-101 50 mg, 100 mg, or placebo once daily for 12 weeks. As part of the adaptive design, the 50 mg ORP-101 dose was discontinued after interim analysis. The primary endpoint was composite response status of improvement in abdominal pain (improvement of 30% from baseline) and stool consistency (average daily stool consistency <5 on the Bristol Stool Form Scale, or 30% improvement in abdominal pain if no bowel movement) for 50% of days over 12-week treatment period.

RESULTS: 320 participants with IBS-D were randomized to ORP-101 50 mg (n=65), 100 mg (n=127), or placebo (n=128). The proportion of primary endpoint responders for ORP-101 50 mg, 100 mg, and placebo participants was 16.9%, 28.3%, and 21.9%, respectively (p= 0.79 for the three groups and p= 0.12 for ORP-101 100 mg vs. placebo). Secondary and exploratory endpoints favored ORP-101 100 mg vs placebo across multiple endpoints. ORP-101 was well tolerated, including in those without gallbladders.

CONCLUSION: In this phase II trial, ORP-101 100 mg did not achieve a statistically significant difference vs. placebo for the primary endpoint; however, it showed higher response across multiple key endpoints. Future studies will study ORP-101 in other chronic pain conditions.