This morning I went to Stone Mountain for a hike. There were a huge number (perhaps 500) of firefighters from across the region in full gear climbing to honor the 343 firefighters and other victims who perished 25 years ago on this day. This annual hike started about 12 years ago. It made this hike quite solemn.
Recently, Dr. Barbara McElhanon gave our group a terrific update on the GI Manifestations Associated with Autism. My notes below may contain errors in transcription and in omission. Along with my notes, I have included many of her slides.
Related blog posts:
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.
R Chen et al. Gut. Epub ahead of print, August 31, 2026. doi:10.1136/
gutjnl-2026-339257. Childhood exposure to a sibling with Crohn’s disease alters gut microbiome and Crohn’s disease susceptibility
Thanks to Mike Hart for sharing this reference. This study is worth reading in its entirety due to the combination of experiments. This is a fairly long post to summarize the most important findings.
Background:
“In a study of 2756 Dutch families, gut microbiome composition and function were more alike between siblings than between parent-offspring pairs or spouses…These findings suggest that increased disease susceptibility among siblings of individuals with CD may be mediated by their shared gut microbiome.”
Methods:
Key findings:
Discussion
Limitations:
My take: The increasing prevalence of Crohn’s disease, particularly over the last few decades, must be related to environmental factors; population genetics and genetic predisposition are unlikely to rapidly change. This is a very important study supporting the notion that exposure to siblings with Crohn’s disease and alteration of the gut microbiome increases the risk of Crohn’s disease. By identifying a microbiome group with a higher risk, this study may facilitate research to determine whether manipulation of the gut microbiome could reduce the likelihood of developing Crohn’s disease. If we can reduce Crohn’s disease in a high risk population, it may allow broader use of the same treatment principles to lower risk groups as well.
Related blog posts:
L Barash et al. J Pediatr Gastroenterol Nutr. 2026; doi.org/10.1002/jpn3.70545. The role of audio‐recorded gut‐directed hypnotherapy onsleep and abdominal pain: A pilot and feasibility study.
Background: Gut-directed hypnotherapy (GDH) is an evidence-based treatment that improves abdominal pain and quality of life in pediatric DGBI both in the short- and long term.3, 4 Home-based audio-guided GDH has shown comparable efficacy to in-person treatment, while enhancing access to care for families with logistical or socioeconomic barriers.5, 6
Methods: This was a non-blinded randomized controlled trial with partial crossover. Treatment includes three 25-min audio sessions every 2 weeks and daily 10–20-min sessions, with a goal of ≥5 sessions per week. Out of 25 participants who initiated GDH 16 (64%), completed treatment. Reasons for dropout included side effects (nausea, n = 2), lack of improvement (n = 1), resolution of symptom (n = 1), and unknown (n = 5).
Key findings:
In a separate study (n=230) (JTW Snijkers et al. Gut Published Online First: 25 July 2026. doi: 10.1136/gutjnl-2026-338385. Open Access! In-person therapist-delivered hypnotherapy versus smartphone-based self-guided hypnotherapy in IBS: a multicentre three-armed randomised controlled trial), a self-guided smartphone hypnotherapy program did not meet the prespecified threshold for noninferiority to in-person hypnotherapy for abdominal pain response in patients with irritable bowel syndrome (IBS). At weeks 13-16, Food and Drug Administration-defined abdominal pain response rates were 48.1% with in-person therapist-delivered hypnotherapy, 33.3% with smartphone-based self-guided hypnotherapy, and 21.8% with online psychoeducation.
My take (borrowed in part from the JPGN authors): “Providers may consider GDH as a low-risk, home-based therapeutic option for children with DGBI, particularly when sleep is also a concern.”
Rigorous pharmacologic studies show that medications, to date, recommended for patients with DGBIs have difficulty outperforming placebo. With hypnotherapy, having an adequate control group is problematic. It would not be surprising, though, for GDH to have difficulty outperforming pharmacologic agents/placebo despite its good response in patients with DGBIs. In this setting, the use of GDH or medications with a low incidence of adverse effects and plausible beneficial effects continue to have a role in improving symptom control.
NBC News (9/4, Edwards) reports, “A 6-week-old baby girl is one of two people with measles who died in Pennsylvania, the Lancaster County coroner said Friday, as the nation’s measles tally hit a new 35-year record of 3,134 cases. … At least 115 more people in Pennsylvania, mostly in Lancaster County, have been diagnosed with measles in the last week, the health department said Friday, bringing the state’s outbreak to about 577 cases within the last few months.” Experts say there are likely many more across the country who have contracted measles but have not gotten tested. NBC adds, “The new milestone, the highest number of confirmed cases since 1991, is yet another indication that the highly contagious virus is taking over, particularly in areas of the country with plummeting vaccination rates.”
Related blog posts (for DGBIs):
Related blog posts (for Measles)
This past month I helped diagnose a 2nd young child with eosinophilic colitis. This was an 8 month old who developed rectal bleeding over a 6 week period with subsequent anemia (Hgb 7.1). His colonoscopy showed patchy deep erythema in the right colon and transverse colon; his biopsies identified >100 eosinophils/hpf.
This prompted me to review a case of a child presenting with eosinophilic colitis at 13 months of age.
Case study: He was born at 36 week gestation with a prenatal diagnosis of proximal bowel obstruction due to type IIIb jejunal atresia, s/p ex-lap and tapering enteroplasty for long dilated jejunal segment and with subsequent short gut syndrome (~50 cm of small bowel). He required supplemental HAL dependency for his initial 9 months of life. At 13 months of age, he developed bloody diarrhea (up to 12/day) with associated anemia and peripheral eosinophilia (max elevation of AEC during his course was 23,000).
Initial endoscopy took place in January 2022. Images are noted below and histology confirmed eosinophilic colitis (>100 eos/hpf).
He underwent extensive testing and no monogenetic/immune dysregulation disorders were identified. After not improving with an elemental diet, his treatment consisted of prednisolone along with enteral antibiotics (vancomycin/gentamicin). His symptoms recurred with steroid taper and he was changed from antibiotic therapy to mesalamine. This was also ineffective. Subsequently, he started with vedolizumab therapy.
Due to ongoing symptoms, tacrolimus (along with PCP prophylaxis) was added two months later (this was 4 months after initial colonoscopy). The target level was between 8-10. He had a rapid and sustained response allowing him to stop corticosteroids which had been used intermittently for more than 6 months. His vedolizumab was stopped shortly thereafter.
After a followup panendoscopy demonstrated resolution of his colitis (see image below), his diet was gradually advanced (no restrictions) while continuing tacrolimus.
His tacrolimus was discontinued after 2.5 years and he has continued to do well off therapy for two years at this point. He still requires periodic vitamin-micronutrient monitoring for his short bowel syndrome.
My take: Eosinophilic colitis is a rare disorder in pediatrics with sparse data to guide management. In this young pediatric patient, tacrolimus was effective. It is possible that vedolizumab would have been effective if given for a longer duration prior to administration of tacrolimus. At the time of presentation, dupilumab had not been approved for eosinophilic esophagitis. There have been case reports of its use off-label for eosinophilic colitis (T Sia et al. Clin Transl Gastroenterol. 2025 Aug 26;16(10):e00908. Dupilumab for Adult and Adolescent Patients With Primary Eosinophilic Colitis).
Related blog posts:
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.
JA Damianos et al. Alimentary Pharmacology & Therapeutics, 2026; 0:1–12. Open Access! Review Article: Immune Effector Cell-Mediated Enterocolitis Following CAR-T Cell Therapy—Clinical Features, Pathophysiology and Management
Background: “Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment of hematologic malignancies, and its use is expanding rapidly into numerous other disease states including autoimmune diseases. However, CAR-T therapy is associated with a spectrum of immune-related toxicities…it has become apparent that rarely, CAR-T can cause gastrointestinal mucosal inflammation, termed immune effector cell-mediated enterocolitis (IEC-EC).”
Other treatments affecting the immune system can result in gastrointestinal inflammation. “Immune checkpoint inhibitors, including cytotoxic T lymphocyte associated anti-gen 4 (CTLA- 4) inhibitors, programmed death-1 (PD1) inhibitors, and PD-ligand 1 (PDL-1) inhibitors have been associated with colitis (with or without enteritis) in up to 54% of patients treated with these agents”
Key points:
My take: There are a growing number of individuals needing CAR-T cell therapy. Recognizing this delayed complication quickly may help improve outcomes.
Related blog posts:
BA Barsky et al. N Engl J Med 2026;395:419-421. Medical Standards by Federal Fiat
An excerpt:
“Historically, the federal–state division of authority over medical practice has been strict. This division is evident in health care financing and medical product regulation, for example. States license physicians and set standards for medical care, often incorporating standards established by the medical profession while allowing broad discretion for physician judgment.1…
The Trump administration has attempted to alter the balance of federal–state authority in the area of gender-affirming care in two important ways. First, in June 2025, the U.S. Department of Justice (DOJ) issued administrative subpoenas to more than 20 health systems and clinics providing gender-affirming care, demanding unusually broad information related to off-label prescribing of puberty blockers and hormones…The DOJ’s subpoenas, however, demanded information at the heart of physician judgment and the patient–doctor relationship, including physicians’ case-specific clinical assessments justifying off-label prescriptions and information that could be used to identify patients, including children, by name…
The second federal disruption came in December 2025, when Secretary of Health and Human Services Robert F. Kennedy, Jr., issued a declaration stating that gender-affirming care for children and adolescents is unsafe and does not meet professionally recognized standards of care…
Much of the authority and discretion now held by medical professionals and the states would move upward to a federal government that would exert expanded control over the health care that patients receive. Such a shift would potentially force all states to accept a single federal standard of care in various areas of medicine while concentrating immense medical power in the hands of political appointees. Federal authority over health care standards is appropriate in some instances. But this authority should be established using a proper legal process — Congress acting within its enumerated constitutional powers, or the executive branch acting under properly delegated authority — not by fiat.”
My take: While this issue primarily affects a narrow area currently, it is not difficult to imagine that other administratioins could similarly impose policies affecting other sensitive decisions like abortion (expanding or limiting options), contraceptive availability, discussions about guns, and viability decisions.
Dr. Michael Wilsey gave our group an excellent update on Endoscopy Pearls and Ergonomics. My notes below may contain errors in transcription and in omission. Along with my notes, I have included many of his slides.
Yesterday’s post focused on endoscopy pearls. Today’s post focuses on ergonomics. Most of the attendees realized that we could use a lot of improvement in this area after listening to this presentation. This issue is likely of even greater importance in those with a high endoscopy case load.
Dr. Michael Wilsey gave our group an excellent update on Endoscopy Pearls and Ergonomics. My notes below may contain errors in transcription and in omission. Along with my notes, I have included many of his slides.
Endoscopy Pearls:
Related blog posts:
P Bose et al. American Journal of Gastroenterology. DOI: 10.14309/ajg.0000000000004117 Dose May Matter: CYP2C19 Genotype and Proton-Pump Inhibitor Response in Pediatric Eosinophilic Esophagitis
Methods: A cohort study of pooled data from 2 tertiary-care pediatric centers (Riley Children’s Health,Indianapolis, IN, and Children’s Hospital of Philadelphia, Philadelphia, PA) was conducted. N=131, mean age 8.5 yrs. Individuals with certain CYP2C19 polymorphisms were classified as normal (NMs), intermediate/slow(IMs), and rapid metabolizers (RMs) of PPIs based on the presence of normal function (*1), loss-of-function (*2), or gain-of-function (*17) alleles. PPI choice and dosing:
Key findings:
Discussion: “Atypical dosing for PPI use in EoE may be related to mechanisms of action apart from gastric acid suppression, such as inhibiting eosinophil migration or restoring esophageal mucosal barrier integrity, which have been previously proposed.”
There may have been a selection bias in this population. The methods section does not detail these cohorts precisely. It is unclear if all patients in these centers undergo CYP2C19 genotype testing. In most centers, CYP2C19 genotype testing is uncommon and may be more likely in those who have not responded to therapy.
My take:
Related blog posts:
gutsandgrowth 