Video Capsule Endoscopy in VEO-IBD — Is the Juice Worth the Squeeze?

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S-I Hagiwara et al.  Inflammatory Bowel Diseases, 2025; izaf144, https://doi.org/10.1093/ibd/izaf144. Open Access! Feasibility and Safety of Small Bowel Capsule Endoscopy in Very Early-Onset Inflammatory Bowel Disease: A Multi-Institutional Study

This article shows that video capsule endoscopy (VCE) (aka small bowel capsule endoscopy [SBCE]) is feasible in children with very early-onset inflammatory bowel disease (VEO-IBD). There were 82 patients (median age, 3.8 years; median body weight, 13.0 kg) who underwent 104 SBCEs. All capsules were deployed endoscopically. Gastrointestinal patency was assessed in 95% of procedures, most commonly using patency capsules (70%).

Key findings:

  • Observation of the entire small intestine was achieved in 100 (96.1%) patients
  • Of the remaining 4 patients, 3 could not undergo a complete observation of the entire small intestine due to battery depletion, and 1 had the capsule retained in the stomach
  • Abnormal small bowel findings were observed in 42% of patients, with aphthae being the most common (34%), followed by ulcers (18%)

In their discussion, the authors note that due to young age, the capsules and the patency capsules required endoscopic deployment (best in duodenum). Thus, most patients received general anesthesia or intravenous sedation twice within a short period.

The authors note that “SBCE has been reported to be superior to MRE in detecting superficial mucosal activity… [and] offers a radiation-free, relatively well-tolerated, and highly sensitive method for mucosal evaluation in VEO-IBD.”

My take: Given the typical use of a patency capsule and thus the need for two separate anesthesia dates, I doubt the “juice is worth the squeeze” in utilizing SBCE for most patients VEO-IBD.

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Useful repurposing of phone booth in Cotwolds, UK

Genetic Risk Assessment and Testing for Gastrointestinal Cancers and Polyposis (2025)

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K Monahan et al. Gastroenterol 2025; 169: 1147-1165. Open Access! In Our Scope of Practice: Genetic Risk Assessment and Testing for Gastrointestinal Cancers and Polyposis in Gastroenterology

This open access review is a great up-to-date reference/resource on risks, evaluation/surveillance, and genetic testing in a wide range of disorders. This includes the myriad of polyposis syndromes as well as colorectal cancer, pancreatic cancer, and gastric cancer.

Table 2 describes the Genetic Syndromes Associated With Risks for GI Cancers and Polyposis and the recommended surveillance/testing. For example –FAP (familial adenomatous polyposis) and JPS (juvenile polyposis syndrome):

“Yield of MGPT in GI cancers and polyposis. MGPT has been evaluated in a number of GI cancers/polyposis. Shown in this figure are rates of positive findings on MGPT. Some of the variability among studies could be attributed to the number of genes included on the panels. [As an example,] among CRC patients, 9.9%–15% of cases were found to carry pathogenic variants in cancer-related genes.62,65,66“

One recent new twist is the availability of direct-to-consumer testing (DTC). “Caution is advised as DTC tests can vary with regard to their quality and clinical validity. For example, some nonclinical DTC genetic tests use arrays (or “chips”) to detect single nucleotide polymorphisms associated with cancer risk in genome-wide association studies, and do not perform comprehensive sequencing of the genes of interest or evaluate for genomic deletions or duplications. DTC testing may focus on selected high-risk variants and thus incomplete test results could be falsely reassuring.

Furthermore, DTC tests do not usually include pre- and post-test genetic counselling to inform individuals about the genomic information being evaluated, as well as the broad implications for them as an individual, and for their families.”

My take: This article provides useful updated guidance on genetic testing for a wide range of GI disorders that predispose to cancer.

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Is Surveillance Helpful For Patients with Barrett’s Esophagus?

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Key finding: Compared with at need endoscopy, 2-yearly surveillance costs $115,563/QALY
gained.

Related editorial: SN Van Munster et al. Gastroenterol; 2025: 169: 1116 – 1118. Open Access! Endoscopic Surveillance for Nondysplastic Barrett’s Esophagus: Are We Violating “Primum Non Nocere”?

“Although guidelines have historically endorsed surveillance, this endorsement has rested on observational studies vulnerable to bias and confounding. The first RCT now available provides no evidence that routine surveillance improves survival or decreases cancer burden. These findings align with an expanding body of prospective cohort evidence suggesting that the annual progression rate from NDBE to EAC [Non-Dysplastic Barrett’s Esophagus to Esophageal Adenocarcinoma] is substantially lower than historically believed—approximately 0.3%–0.5% per year,8–10,13,14 as opposed to the 2.0%–4.0% per year estimated in the early 1990s.15–17“

The authors note that recent Dutch guidelines have been revised: “Routine surveillance is no longer recommended for low-risk Barrett’s patients—defined as those with segments with a maximal extent (Prague M) of <5 cm and no prior dysplasia.”

My take: While Barrett’s esophagus is a rare issue for pediatric gastroenterologists, it is worth noting that these recent studies cast doubt on the benefit of routine surveillance endoscopy in patients with nondysplastic Barrett’s esophagus.

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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.

Christmas House Light Show Repost & More Favorite Books

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I posted this link in 2019 – this nearby house continues with pretty cool lights, though they change their songs each year. There are more than 25,000 lights which are synchronized to music. Cool stuff!  Here’s a 1 minute clip: Holiday Lights 2019

——-

Last year I posted a list of some of my favorite books. Here are a few of my favorite that I read from the past year (not in any particular preference order):

  • Wild Dark Shore
  • The Perfect Divorce
  • Isola
  • The Kite Runner
  • The Correspondent
  • Station Eleven

The Risks and Absolute Risks of GLP-1 RAs and Gastrointestinal Adverse Events

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C-H Chiang et al. Gastroenterol 2025; 169: 1268-1281. Glucagon-Like Peptide-1 Receptor Agonists and Gastrointestinal Adverse Events: A Systematic Review and Meta-Analysis

With the widespread adoption of GLP-1 RAs, there have been increasing reports of adverse effects. This systematic review/meta-analysis (with 55 randomized controlled trials involving 106,395 participants) more fully describes the likelihood of GI adverse events.

Key findings:

  • GLP-1RAs increased the risk of cholelithiasis (risk ratio [RR], 1.46; 95% CI, 1.09–1.97; 2 more cases per 1000) and probably increased the risk of GERD (RR, 2.19; 95% CI, 1.48–3.25; 4 more cases per 1000) compared with placebo
  • GLP-1RAs probably have little or no effect on the risk of other gastrointestinal or biliary events

Figures 2 & 3 use a Forest plot to look at a large number of potential adverse gastrointestinal/biliary events. For example, cholecystitis and cholangitis had increased RR at 1.17 and 1.54 respectively. However neither reached statistical significance.

My take: GLP-1 RAs definitely cause adverse gastrointestinal effects, especially nausea, vomiting, diarrhea, bloating and reduced appetite. More severe adverse effects are quite uncommon and are unlikely to influence the decision to use these medications.

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Wegovy Pill Now FDA Approved

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NBC News 12/22/25: FDA approves Wegovy weight loss pill from Novo Nordisk

An excerpt:

“The Food and Drug Administration on Monday approved a pill version of Wegovy…The Wegovy pill, as it’s called, is first oral version of a GLP-1 drug that has been brought to market for weight loss…

In November, Novo Nordisk reached a deal with the Trump administration to sell the lowest dose of the pill for $149 a month for people who pay out of pocket, in exchange for tariff relief…

Phase 3 clinical trial results published in the New England Journal of Medicine found that people who took the highest dose of the Wegovy pill lost 16.6% of their body weight, on average, after 64 weeks, compared with 2.2% weight loss in the placebo group…

The company expects that the Wegovy pill will be available widely in January.”

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Postoperative Outcomes with Tofacitinib Following Colectomy for ASUC and Real-World Outcomes for Upadacitinib in Crohn’s Disease

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C Larson et al. Clin Gastroenterol Hepatol 2025; 23: 2263-2271. Postoperative Outcomes in Tofacitinib-Treated Patients With Acute Severe Ulcerative Colitis Undergoing Colectomy

This  was a multicenter, retrospective, case-control study of patients hospitalized with ASUC who underwent colectomy, comparing patients treated with tofacitinib (n=41) prior to colectomy with infliximab-treated controls (n=68).

Key findings:

  • Compared with tofacitinib-treated patients, infliximab-treated patients had higher overall rates of overall (44 [64.7%] vs 13 [31.7%]; P = .002) and serious (19 [27.9%] vs 3 [12%]; P = .019) postoperative complications

My take: This study supports the safety of JAK inhibitor therapy for ASUC. It showed a significantly lower rate of overall postoperative complications in ASUC patients treated with tofacitinib compared with infliximab; the authors note that “these findings can likely be extrapolated to upadacitinib, a selective JAK inhibitor, given its similar mechanism of action.”

J Devi et al. Clin Gastroenterol Hepatol 2025; 23: 2281-2291. Open Access! Real-World Effectiveness and Safety of Upadacitinib in Crohn’s Disease: A Multicenter Study

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Retrospective Pediatric Study of GLP1-RAs for MASLD

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AM Tou, J Panganibanl. J Pediatr Gastroenterol Nutr. 2025; DOI: 10.1002/jpn3.70242. Glucagon‐like peptide‐1 receptor agonists in pediatric metabolic dysfunction‐associated steatotic liver disease

Background: “Recent seminal studies such as the ESSENCE trial have demonstrated MASH resolution with improvement in fibrosis in adult patients with biopsy-proven steatohepatitis treated with semaglutide.18 This has led to the pivotal FDA approval of semaglutide for the treatment of MASH in adults.”

Methods: 42 patients with MASLD (see study for details). 71% of patients had a therapeutic indication for T2DM and 29% for obesity. Of the GLP-1RA medications, liraglutide was most frequently prescribed (44%), followed by semaglutide (27%), dulaglutide (25%), and exenatide (4%).

Key findings:

  • ALT improved by a mean of 56 U/L at 6 months (p = 0.04), and by 37 U/L at en-of-treatment (p = 0.004).
  • GLP-1RA use was associated with significant improvements in alanine transaminase (ALT) along with other cardiometabolic biomarkers even in the absence of improvements in body mass index percentile or z-score. There were reductions in GGT, AST, triglycerides, and HbA1C
  • In this study, there was not a significant decline in weight. Prior studies have shown less weight loss in patients with T2DM compared to those with obesity (w/o T2DM)

My take: It is helpful to have a pediatric study that shows that GLP1-RAs are effective specifically in those with MASLD.

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Operating Room Privacy: What Patients May Record and Hear

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J Goldstein, NY Times, 12/1/25: The Transgender Cancer Patient and What She Heard on Tape

This article focuses on the experience of a transgender patient who recorded unfavorable remarks while under anesthesia.

An excerpt:

On the recording, the health care workers express a variety of opinions about transgender identity more generally….And in the middle of the conversation, one person suggests updating Ms. Capasso’s medical file. “Yeah, it needs to say ‘male,’” the person says.Ms. Capasso said it appeared that hospital staff had in fact changed her electronic medical records, all while she was unconscious…

Ms. Capasso insists that she was not trying to catch the medical staff speaking disrespectfully about her. She said she was motivated by curiosity and a desire to know exactly what the surgeons discovered. It may not be such an unusual impulse.

Dr. Alexander Langerman, a surgeon at Vanderbilt University Medical Center, led a medical conference in 2021 on surgical recordings.

There is often “a really strong desire by patients to know what happened to them in the operating room,” Dr. Langerman said. “And, I think, a valid right to know what happened.”

Surgery was once a relatively public event — operating rooms were called “theaters” for a reason. But infection control and malpractice litigation pulled the operating room out of public view.

“Operating rooms and surgery have become one of the most secretive environments in modern society,” said Dr. Teodor Grantcharov, a Stanford University professor who started a company that uses operating room recordings to improve patient safety and hospital efficiency.

My take: While a patient is under anesthesia, it is best to treat them in the same manner as if they were awake.

“The true test of a man’s character is what he does when no one is watching.”

― John Wooden

Sandy Springs, GA

Likelihood of Celiac Disease with Conflicting Serology Results

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R Mandile et al. J Pediatr Gastroenterol Nutr. 2025;81:1482–1487. Advantages of anti-endomysial evaluation in children with low titers of anti-transglutaminase antibodies: A retrospective study

This was a single center retrospective study examining children (n=202) undergoing EGD (2022-2024) to evaluate for celiac. Among those with low anti-TTG IgA titers, Group 1 (n=25) was EMA negative and Group 2 (n=100) was EMA positive.

Key findings:

  • The finding of discordant serology (anti-transglutaminase [anti-TG] positive and EMA negative) is infrequent (12% cases, 25 out of 202), and all patients with discordant serology had anti-TG positive at low titer (<4 times the upper limit of normality).
  • Group 1 (N = 25) had a mean anti-TG titer of 1.86× ULN and villous atrophy (VA) in only 8% (2/25). Group 2 (N = 100) had VA in 35% (35/100)
Percentage of patients with villous atrophy between EMA positive and EMA negative children.

Discussion Points:

  • The diagnosis of CD still requires performing an EGD in at least half of the cases
  • This “study suggests that patients with low levels of anti-TG but EMA positive antibodies should anyway receive an EGDS in the next 6 months, since in around one-third of the cases a duodenal atrophy will be detected”
  • In those with low anti-TG but EMA negative, ” it could be reasonable to initially follow-up patients over time with clinical and serological monitoring (in particular of anti-TG titer), postponing the EGDS to a later stage, when the disease is more advanced and the chance of finding a concomitant VA (and thus the need to start a GFD) is higher”

My take: In patients with minimal symptoms and low level anti-TG, my strategy has been to follow with serological monitoring and if repeatedly abnormal, proceed with endoscopy. This study suggests that obtaining EMA early may influence choice to proceed earlier with endoscopy.

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