The Mother of Invention: Central Line Vest to Reduce Complications

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RE St Pierre-Hetz et al. JPGN Reports. 2026;1–6. A novel central line securement vest reduces line trauma and improves quality of life in patients with intestinal failure

This single center study compared a novel central line securement vest (n=12) to traditional securing methods (n=11).

Key findings:

  • The vest group had lower rates of line trauma during the period of vest use versus prior to its use. The rates of infections and replacements were a little lower during vest use (not statistically-significant) compared to prior to use. The control group had similar rates of trauma, infections, and replacements before and during the study period.
  • The vest group had much higher rates of line issues prior to vest use than the control group
  • 5 of the 12 vest patients discontinued use before the planned 12-month evaluation

The story behind the inventor is fascinating as well. “Gus Gear” was “founded by Sarah Palya over a decade ago after her son Gus was diagnosed with intestinal failure.” Due to this, he required long-term parenteral nutrition. “Gus also has autism, and his constant movement and activity put him at risk for accidental line trauma and infection. Sarah looked for ways to secure his central line while also allowing him to live as normally as possible, without severely restricting his activity. Finding no solutions, she sat down at her sewing machine and created the very first Gus Gear Central Line Vest to secure his catheter.” The company now makes a similar product to secure GTubes, LOCK 3000 Belt.

My take: This small study supports the use of this product, especially in those prone to line trauma: Gus Gear Central Line Vest® (Dr. Hochman has no commercial ties to this company)

Origin of the expression: “Necessity is the mother of invention“

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Proactive Therapeutic Drug Monitoring is Routine Part of Pediatric IBD Care Plus SNL Humor

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RJ Colman et al. Crohn’s & Colitis 360, Volume 7, Issue 3, July 2025, otaf050. https://doi.org/10.1093/crocol/otaf050. Open Access! Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease: A Nationwide Survey of Anti-TNF Therapy Practices, Attitudes, and Barriers 

Methods: A 28-item survey of therapeutic drug monitoring (TDM) was deployed through the ImproveCareNow Learning Health System Network between February and June 2023.

Key findings:

  • Among 380 invitees, 256 (77%) completed the questionnaire. Among respondents, 67% (171) were academic-affiliates
  • In contrast to the adult literature, most pediatric gastroenterologists report undertaking proactive TDM for anti-TNF agents in IBD management
  • TDM: All 256 respondents reported using TDM for infliximab, while 252 (98%) used TDM for adalimumab (ADL)
  • Proactive TDM: Proactive TDM was more common for infliximab 98% (205/256) compared to ADL 92% (232/252; P = .0007)
  • Overall, 61% (156/255) of respondents reported that they experienced barriers in undertaking TDM. Insurance denial (50%) and cost (31%) were the 2 most commonly reported barriers
Frequency of therapeutic drug monitoring use stratified by anti-TNF agent.

Limitation: Only surveyed practitioners in ICN. However, “approximately 65% of US pediatric gastroenterologists practice within ICN-affiliated institutions, [thus] our findings likely reflect national trends.”

My take (borrowed from authors): “Proactive TDM, is a widely practiced strategy, and represents the current standard of care among pediatric gastroenterologists in the United States.” 

How to explain a complication with Will Ferrell, YouTube Link: SNL Post-Op (5 minutes)

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What to Make of Popular “Liver Detox” Therapies

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An excerpt:

A cross-sectional study of the 20 highest-ranked purported “liver-cleansing” products sold on Amazon found that they generated almost $40 million in annual revenue, yet their detoxification claims and ingredients were unsupported by data and, in some cases, these products caused adverse events…evidence assessment showed that even the most common ingredients have limited scientific support.

The most common ingredient in the analyzed products was milk thistle, which appeared in 19 of 20 products. This was followed by dandelion root (13) and turmeric root (13). Other, less common ingredients included zinc (12), beetroot (11), artichoke extract (10), choline (10), ginger (9), chicory (8), and berberine (7)…

The investigators recommended “several policy improvements, including mandatory pre-market safety testing, standardized manufacturing practices, enhanced post-market surveillance, and requirements for scientific substantiation of marketing claims.”

My take: Herbal and dietary supplements can cause drug-induced liver injury, sometimes life-threatening. It would be best for those who claim these products are effective to provide proof of this.

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Mount Fitz Roy, Argentina

Management of Colorectal Adenomas in Adolescents

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BJ Hoskins et al.  J Gastroenterol Hepatol. 2026 Apr 24. Open Access! Incidental Colorectal Adenomas in Adolescents: Clinical Management, Genetic Evaluation, and Surveillance (Review article)

Key points:

  • “Although most isolated colorectal adenomas identified in adolescents are ultimately sporadic, their rarity at this age justifies a lower threshold for genetic evaluation—without routine shortening of surveillance intervals in the absence of hereditary disease”
  • “Current guidelines recommend initiating upper gastrointestinal surveillance at age 20–25 years for FAP and attenuated FAP [17]. Notably, a meta-analysis reported that 42% of children with FAP who underwent EGD had duodenal adenomas…, supporting the biological rationale for upper gastrointestinal screening once a polyposis syndrome is identified”
  • Table 1 lists polyposis syndromes that can be associated with isolated adenomas in adolescents
  • “All visible adenomas should be completely removed when technically feasible'”

My take: This review provides useful guidance when identifying an adenomatous polyp in the pediatric age group.

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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

How Helpful is FLIP for Pyloric Dysfunction?

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A Porto et al. JPGN Reports. 2026;7:59–63. Open Access! Feasibility and clinical value of pyloric functional luminal imaging probe in an infant

Case report: “This case highlights the feasibility, safety, and clinical effectiveness of FLIP as a diagnostic and treatment tool in an infant with pyloric dysfunction.”

In brief, the authors describe a former 26 week premature infant with gastric dysfunction with gastric output >100 mL/kg/day while on GJ feeds. “His history was notable for necrotizing enterocolitis with multiple intestinal perforations and bowel resections with resultant short bowel syndrome (97 cm small bowel, intact colon) and chronic respiratory failure requiring tracheostomy and mechanical ventilation.” After obtaining FLIP measurements, IPBI (intrapyloric botulinum toxin injection) was performed with 100 international units of botulinum toxin A. Esoflip dilatation was performed using a 20 mm balloon. This led to full tolerance of gastric bolus feeds. When symptoms recurred, repeat IPBI and dilatation were performed with resolution of symptoms.

 FLIP demonstrated high pyloric pressures up to 105 mmHg,
Max diameter 13.3 mm (arrow) at 45 mL balloon inflation 

My take: I am not an expert on FLIP; however, it does not appear to be needed in this situation. Many practitioners would recommend botox injection with or without dilatation in patients with this type of presentation without using FLIP. The authors acknowledge that there are a “lack of reference values for infants” which makes FLIP interpretation more subjective.

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Beneficial GI Effect of GLP-1 Receptor Agonists: Lower Risk of Peptic Ulcer Disease

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P Seika et al. Clin Gastroenterol Hepatol 2026; 24: 974-985. Glucagon-like Peptide-1 Receptor Agonists Are Associated With a Lower Risk of Peptic Ulcer Disease: A Nationwide Cohort Study

Background: “Emerging evidence suggests that GLP-1RAs may exhibit anti-inflammatory properties and could play a role in GI mucosal protection. Proposed mechanisms include the suppression of proinflammatory cytokines, attenuation of reactive oxygen species, and enhancement of mucosal defences, which may reduce susceptibility to PUD.”

Methods: This was a nationwide retrospective study of adults with T2DM (66,102 participants) using the “All of Us” National Institutes of Health database, including a sub-group analysis of adults who were newly initiated on GLP-1RAs or insulin as second-line therapy. 

Key findings:

  • After adjusting for possible confounders, GLP-1RAs were associated with significantly lower odds of PUD diagnosis (adjusted odds ratio 0.56; P < .001)
  • Our subgroup included a total of 3313 patients (1270 new GLP-1RA users; 2043 new insulin users). In this analysis, switching to a GLP-1RA as second-line therapy was associated with a significantly lower hazard of PUD compared with switching to insulin (adjusted hazard ratio [HR], 0.44; P < .001)

My take:

  1. GLP-1 RAs are a remarkable advance. However, we need still more long-term data. Many times in healthcare, new treatments often receive a lot of favorable studies/good press. Over time and with more scrutiny, more adverse effects become evident.
  2. Though these medications can cause a lot GI symptoms, it is helpful to know that they are associated with a lower risk of peptic ulcer disease.

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We Are Going to See More Measles Tragedies

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“One death is a tragedy; a million is a statistic.” This quote is often misattributed to Joseph Stalin but is likely derived from the German journalist and satirist Kurt Tucholsky. So much of the arguments for vaccines focus on the millions of lives that have been saved. Yet, it is the individual sad stories that are often much more powerful. I was thinking of this quote as I read a NY Times Commentary by Rebecca Archer (4/21/26): Measles Took My Daughter. This Is What I Want Everyone to Know.

An excerpt:

When my daughter Renae, my firstborn, was 5 months old she spiked a fever…At the hospital the doctors noted the red spots on her body and diagnosed her with measles.

This was 2013, and Manchester, England, where we lived, was experiencing a measles outbreak that resulted in more than 1,000 suspected cases. A 1998 study by a British doctor, Andrew Wakefield, linking the measles, mumps and rubella vaccine to autism had caused vaccination rates to plummet. The study was later retracted and Mr. Wakefield stripped of his medical license, but the damage had been done. In 2013, most of the cases were among school-age children whose parents had refused to give them the vaccine, which is not compulsory in Britain, or among babies too young to be vaccinated, like my daughter…

Within a week she seemed back to normal. What I didn’t know was that measles can cause long-term complications. A child can seem fine while the virus slowly replicates in her brain, poised to exact a terrible toll years later…

Toward the end of the summer [2023], … she had also started moving very slowly, almost robotically, and often seemed confused. We took her back to the hospital, where another M.R.I. showed the swelling in her brain had become much worse… Renae had subacute sclerosing panencephalitis, a rare complication of measles. The doctors told me it was fatal, and there was nothing else they could do…

Last year, the United States saw its highest rate of measles cases in more than three decades and the country may soon lose its measles elimination status as well. Despite this, Health Secretary Robert F. Kennedy Jr. said he doesn’t think the government should be mandating vaccines, and that they should be a matter of personal choice.

Parents must realize that refusing vaccinations doesn’t just put your own child at risk. It puts other children at risk. 

Related articles:

  • LA Bacheschi, et al. NEJM 2026; 394: 1662. Measles 2025. Subacute sclerosing panencephalitis “was not rare before vaccination, as shown by an account of 82 cases… in Brazil from 1961 to 1983.”
  • DN Durrheim, JK Andrus. NEJM 2026; 394: 1662-1663. Measles 2025. The “measles still kills more than 100,000 children worldwide each year.”

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Mount Fitz Roy, Argentina

“Evidence-Practice Gap” and How It Applies to H pylori Treatment

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There is a well-described “evidence-practice gap” which has been cited to describe the lag between initial discovery and widespread, evidence-based clinical implementation (M Beauchemin et al. ANS Adv Nurs Sci. 2019 Oct-Dec;42(4):307–324); it has been suggested that this gap is typically about 17 years.

I was looking this up after reading a “practice tips” article on H pylori and was surprised at how infrequentlly practitioners follow guidelines for optimal treatment.

M Ventoso, SF Moss. Gastroenterology & Hepatology 2026; 22: 80-86. Open Access! Practice Tips From the Updated Helicobacter pylori Treatment Guidelines 

Background: “The American College of Gastroenterology (ACG) recently published H pylori management guidelines6 with significant updates to the prior recommendations published in 2017.7 Importantly, the 2017 management guidelines relied heavily upon extrapolation from studies performed outside of North America. Since then, new data from US patients have become available that highlights the rising rates of resistance of commonly used antibiotics for treatment of H pylori.”

Key points:

  • “Bismuth Quadruple Therapy Is First Line and Should Be Optimized” (see below). A 14-day course is recommended (except when using Pylera which is a 10 day treatment).
  • “3 new regimens have received US Food and Drug Administration (FDA) approval for H pylori therapy, each based on high levels of gastric acid inhibition. “
  • “The first is a combination tablet of rifabutin with amoxicillin and omeprazole (Talicia, RedHill Biopharma), given in daily doses of 150 mg, 3 g, and 120 mg, respectively. If the combination tablet is not available, generic equivalents can be substituted at similar doses (omeprazole 40 mg and amoxicillin 1 g each 3 times daily). Because the lowest available dose of generic rifabutin is only 150 mg, the best option is likely 150 mg twice daily”
  • “The second regimen is based on vonoprazan (Voquezna, Phathom Pharmaceuticals), the first potassium-competitive acid blocker (P-CAB) approved in the United States. substituting the P-CAB vonoprazan for lansoprazole in clarithromycin triple therapy produced higher eradication rates (81% compared with 69%). Similar statistically high rates (77%) were achieved with a dual vonoprazan-amoxicillin combination in the same trial, leading to FDA approval of both the triple and dual regimens14“
  • For “both rifabutin- and vonoprazan-containing regimens use amoxicillin and cannot be used in the confirmed penicillin-allergic patient. For patients with unproven penicillin allergy (approximately 10% of the US population), allergy testing is recommended”
  • “Use Clarithromycin or Levofloxacin Only If Antimicrobial Susceptibility Is Confirmed“
  • “The majority of practitioners continue to use clarithromycin-based triple therapy and have not followed the 2017 ACG H pylori guidelines …It is striking that clarithromycin-PPI triple therapy still dominates the US market, comprising greater than 80% of all treatments in 2016 to 2019.11 Notably, in approximately half of the cases where clarithromycin-PPI triple therapy failed, exactly the same prescription was given a second time.11 Thus, a massive implementation gap exists.”

My take:

  1. While this article focuses on adult guidelines, there are similar issues in pediatrics. There is an even greater need for research involving children with H pylori. As vonoprazan appears to improve eradication rates, more guidance is needed regarding drug regimens with vonoprazan in kids.
  2. I frequently see patients who have received empiric clarithromycin-based therapy. Based on this article, I should be less surprised that this is so commonplace.

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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.

Mirikizumab for Pediatric Ulcerative Colitis

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K Jimbo et al. Inflammatory Bowel Diseases 2026; 32: 711-720. Real-World Effectiveness of and Optimization Strategies for Mirikizumab in Pediatric Ulcerative Colitis: A Prospective, Observational Study

Methods: This prospective cohort study included Japanese children (n=28) with UC receiving intravenous mirikizumab (300 mg at weeks 0, 4, 8), followed by subcutaneous maintenance (200 mg every 4 weeks). The cohort had a median age 13 years (50% female) with a median PUCAI 67.5; 67.4% were biologics-naive. In those with clinical remission at 12 weeks, sucutaneous injections were started; otherwise, IV infusions (prolonged induction, n=11) continued every 4 weeks. Complete remission was defined as PUCAI<10 and colonic wall thickness on IUS <3.0 mm with no detectable color Doppler flow signal throughout the colon.

Key findings:

  • The median time to complete remission (CR) was 10 weeks. All patients ultimately achieved CR
  • Durable CR was achieved in 27/28 (96%).
  • SF-CR generally increased over time: 17/28 (61%) at week 12, 28/28 (100%) at week 24, and 27/28 (96%) at wek 52
  • No serious adverse events were noted. 6 children developed self-limiting flu-like symptoms

Limitations included relatively small number of patients at a single center. Also, the majority of patients had not received prior advanced therapies.

My take: It is encouraging to see favorable pediatric data. Though, the complete remission rate of 100% will likely be an outlier as more data become available.

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ImmunogenicityTable by Tauseef Ali IBD Library

Rising Rates of Extensively Drug-Resistant Shigellosis

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 Logan N, Birhane MG, McDonald SL, et al. MMWR Morb Mortal Wkly Rep 2026;75:173–178. Open Access! Emergence of Extensively Drug-Resistant Shigellosis — United States, 2011–2023. DOI: http://dx.doi.org/10.15585/mmwr.mm7513a1

Background: “Shigellosis is a nationally notifiable diarrheal illness caused by gram-negative bacteria. Shigella infection is spread through fecal-oral transmission (infection can occur with as few as 10 organisms) and sexual contact. Although most infections are self-limited, antibiotics are indicated for severe illness or to reduce transmission in settings with high risk for spread. Since 2015, a growing proportion of cases has been caused by extensively drug-resistant (XDR) Shigella species, defined as being resistant to ampicillin, azithromycin, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. No Food and Drug Administration–approved oral antimicrobial agents are available to treat these XDR infections.”

Key finding:

  • The percentage of Shigella isolates with resistance data that were XDR increased from 0% during 2011–2015 to 8.5% in 2023

Limitations included the following:

  • “Surveillance likely underestimated XDR Shigella isolate incidence: not all isolates were sequenced or had AST, many specimens that were positive by culture-independent diagnostic tests were not cultured, underdiagnosis and incomplete reporting occurred>”

My take (borrowed from authors): “It is concerning that resistance is increasing.”XDR Shigella infection is an emerging concern in the United States. Because no oral antimicrobial agents are FDA approved, prevention, early detection, AST-guided therapy, and timely reporting are important to protect populations at higher risk for XDR Shigella infection”

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