Methods: The researchers conducted a 17‐item Qualtrics survey of patients who participated in intensive multidisciplinary intervention treatment to improve the volume and variety of solid food intake and replace enteral feeding due to chronic food refusal an average of 6 years following intervention. 75 met eligibility criteria; 36 caregivers (48%) completed the survey
Key findings:
Most patients (80%) who achieved full wean from feeding tube dependence at program discharge maintained their wean at the time of the survey
Most caregivers (89%) described their child’s relationship with food as “good” or “neutral”
My take:
Our group works closely with the authors and appreciate all of their help
Survey studies have a lot of limitations and often conclusions are hampered by low participation
It looks like intensive feeding therapy has good durability. It would be interesting if we could know what would have happened to these children without therapy. How many would have gradually improved on their own?
Methods: Of 8,764 studies screened, 34 studies involving 10,016 first-degree relatives (FDRs) of patients with Celiac Disease (CeD) were included
Key findings:
The pooled estimates for seroprevalence and the biopsy-confirmed CeD prevalence in FDRs were 11% and 7%, respectively
Daughters and sisters had the highest prevalence rates at 23% and 14%, compared with sons and brothers at 6% and 9%, respectively. Mothers/fathers prevalence rates were 5%. It is noted, however, that the stud only included 32 daughters and 41 sons, making these estimates less reliable
Abdominal pain (42%), bloating (39%), and flatulence (38%) were the most common gastrointestinal symptoms, while 34% of FDRs with CeD were asymptomatic
Discussion points:
Discrepancy between serology and biopsy: “First, not all individuals who tested positive through serological screening underwent a confirmatory duodenal biopsy. Second, some individuals with positive anti-tTG Ab may have false-positive results, or the disease process is still in the early stages of the disease, where intestinal damage is not yet detectable. This highlights that relying solely on serological screening without follow-up evaluations and intestinal biopsy can lead to overestimating the true prevalence of CeD.”
Limitations: “Some included studies only screened the siblings of indexed patients with CeD. For example, one study reported a prevalence of 22% among siblings. Given that genetic factors play a pivotal role in the pathogenesis of CeD and that the prevalence of CeD among siblings is often higher than that of other FDRs, this selective screening approach could potentially introduce selection bias into the overall prevalence of CeD in FDRs.”
My take: This study supports routine screening of first-degree relatives of patients with Celiac Disease, especially as many are asymptomatic.
Roughly 15 million people — six percent of adults in the United States — have metabolic dysfunction-associated steatohepatitis, known as MASH. Rates of the disease are rising…
Wegovy, which is a weekly injection, is now approved for adults with MASH and moderate-to-advanced levels of fibrosis, or excessive scar tissue in the liver. The drug is not intended for people with cirrhosis…
Wegovy will be a welcome addition to the options doctors can prescribe — as long as their patients can access them. The drug carries a list price of over $1,300 a month, although most people do not pay that full amount. Many people have lost insurance coverage for weight-loss drugs, as plans struggle to keep up with the costs.
Related review article:G Targher et al. NEJM 2025; 393: 683-698. Metabolic Dysfunction–Associated Steatotic Liver Disease. This review article succinctly covers the epidemiology, manifestations, disease progression and pivotal pharmacologic advances.
“A team of researchers found evidence of shady organizations churning out fake or low-quality studies on an industrial scale. And their output is rising fast, threatening the integrity of many fields…“If these trends are not stopped, science is going to be destroyed,” said Luís A. Nunes Amaral, a data scientist at Northwestern University and an author of the study”
““Science relies on trusting what others did, so you do not have to repeat everything,” Dr. Amaral said….By the 2010s, journal editors and watchdog organizations were warning that this trust was under threat. They flagged a growing number of papers with fabricated data and doctored images. In the years that followed, the factors driving this increase grew more intense.”
“As more graduate students were trained in labs, the competition for a limited number of research jobs sharpened. High-profile papers became essential for success, not just for landing a job, but also for getting promotions and grants. Academic publishers have responded to the demand by opening thousands of new scientific journals every year…”
“Organizations known as paper mills are now turning scientific fraud into a lucrative business. Scientists eager to pad out their resumes can pay hundreds to thousands of dollars to be named as an author of a paper that they had nothing to do with…paper mills often use artificial intelligence to alter the text they lift from other papers…”
“The papers that Dr. Amaral and his colleagues could study came to light only because of the work of independent sleuths. To estimate how many paper mill papers have yet to be exposed, Dr. Amaral’s team created a statistical model that accurately predicted the rate at which suspicious papers surfaced. They estimate that the number of paper mill products may be 100 times greater than the ones they have identified…”
“In their new study, they calculated that the number of suspicious new papers appearing each year was doubling every 1.5 years. That’s far faster than the increase of scientific papers overall, which is doubling every 15 years.”
““We need to stop making it profitable to game the system.”
My take: This problem has preceded the widespread use of AI, although Al makes it harder to detect. Unfortunately, fake scientific reporting appears to be worsening.
Related article: Jessica Steier NY Times 8/19/25: The Playbook Used to ‘Prove’ Vaccines Cause Autism This article details very specifically how David Geier (now appointed by RFK Jr to evaluate vaccines and autism) and his father have produced multiple flawed studies regarding vaccine safety. This commentary takes a particularly deep dive into one of his articles on the preservative thimerosol. She shows that the authors likely used p-hacking to identify “atypical autism” since there was not a significant association with autism, compared different time cohorts (the control group was from a period with different diagnostic criteria/lower rates of autism), did not include confounders, and supported their arguments with “personal citing.”
Some excerpts:
There have been some 70 studies since Mr. Wakefield’s looking for any link between vaccines and autism. Of these, 26 have linked vaccines to autism in some way, and 43 found no connection between vaccines and autism.
A whopping two-thirds of studies that claimed to have found a link were written by David and Mark Geier. These studies have been heavily criticized for using deceptive research techniques and flawed data.
Among the eight other studies that found a link, four were retracted for data manipulation, flawed methods or undisclosed conflicts of interest. Most of the authors have been involved in anti-vaccination campaigns and have had other papers retracted.
One such study that Mr. Kennedy referred to in his Senate confirmation hearing was published in a WordPress blog disguised as a journal and was funded by an anti-vaccine organization, among other problems.
Fortunately, independent scientists have conducted more than 40 high-quality studies since 1998 involving over 5.6 million people across seven countries. All found no connection between vaccines and autism. These studies were rigorously designed, were reviewed by independent peers and do not contain telltale signs of data manipulation, as the Geier studies do.
Recently Dr. Bezerra gave our group a terrific lecture. I have taken some notes and shared some of his slides. There may be inadvertent omissions and mistakes in my notes. In addition, Dr. Bezerra’s presentation included several lengthy animations which helped explain the basic science concepts. These are not included in this summary.
Prior to his presentation to our group, Dr. Bezerra’s accomplishments had been recognized with the Shwachman Award, the highest honor bestowed by our national pediatric GI organization NASPGHAN (NASPGHAN Awards 2025). On a personal note, Jorge was the first person to give me hands-on instruction with an endoscope and I have a great deal of admiration for his humility, thoughtfulness and scientific achievements.
Liver biopsy from patient with BA showing bile duct proliferation .Operative cholangiograms from a patient with normal anatomy and one with BA that shows contrast extravasation without patent biliary tract
Key points:
Cytomegalovirus (CMV) is frequently associated with biliary atresia (BA). Treatment of CMV when detected may improve outcomes
Hepatoportoenterostomy (HPE) (aka Kasai procedure) is effective in about half of patients. The remainder develop complications that include recurrent cholangitis, portal hypertension, and cirrhosis which may lead to the need for liver transplantation
10-year survival rates for liver transplantation are >85%.
Historical controls in red and new protocol in blue
The role of the microbiome is being explored as a factor in the predisposition to BA
Biliary atresia organoid studies: Biliary atresia organoids had decreased expression of genes related to EGF signaling and FGF2 signaling. When treated with EGF+FGF2, biliary atresia organoids expressed differentiation markers, which restored polarity (Reference: Hepatology 2022 Jan;75(1):89-103. doi: 10.1002/hep.32107. Biliary organoids uncover delayed epithelial development and barrier function in biliary atresia). Thus, these organoids can help understand the underlying pathogenesis and may lead to improved treatments
More recently, compared to normal liver organoids, the epithelium of BA organoids was fragmented and peribiliary glands (PBGs) were small, had abnormal intercellular junction (ZO1 expression), and expressed markers of epithelial-mesenchymal transition (EMT), with a prominent expression of TGF-β3. Upon TGF-β inhibition, EMT decreased in the diseased epithelium, the population of PBGs increased, and ZO1 expression improved. In vivo, TGF-β inhibition suppressed the BA phenotype and substantially decreased liver fibrosis in neonatal mice. Thus, the modulation of TGF-β-dependent EMT regulates bile duct epithelial development and influences the susceptibility of neonates to biliary injuries. (Reference: Nat Commun 2025 Jul 17;16:6575. doi: 10.1038/s41467-025-61442-5. Open Access! Cellular crosstalk mediated by TGF-β drives epithelial-mesenchymal transition in patient-derived multi-compartment biliary organoids)
RRV (rhesus rotavirus) can create an experimental model of BA in the mouse. In this mouse model, ILC2 cells (innate lymphoid cells in yellow) play a role in bile duct proliferation, possible attempt at recanalizing damaged bile ducts
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
Methods: This was a retrospective review of records of children (n=54, median age 9 years) who underwent MRI of spine between January 2021 and December 2023 for evaluation of refractory constipation (RC). RC was defined as constipation not responding to optimal conventional treatment for at least 3 months. Conventional treatment included—education, disimpaction (if required), osmotic and stimulant laxatives, timed‐toileting and biofeedback.
Key findings:
Thirteen children (24%) had an abnormal MRI. Findings included—syringomyelia‐8,sacral canal meningeal cyst‐2, filum terminale lipoma‐1,spina bifida occulta‐1 (SBO‐1), and Schmorl’s node‐1. None of these patients had a tethered cord
Only one patient with a Chiari malformation and syrinx required a neurosurgical intervention. The surgery did not improve his constipation
On a median follow‐up duration of 677 (range181–1240) days, constipation resolved in 48% (n = 26) of the entire cohort
There was no difference in the number of patients or time to constipation resolution between those with and without abnormal MRI respectively
My take: In children with refractory constipation who do not have abnormal cutaneous/abnormal neurological exam, an MRI is unlikely to be helpful.
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
Background: “Serious adverse events (SAEs) are unavoidable occurrences for those performing complex endoscopic interventions. These affect not only the patient (the first victim), but also possibly the proceduralist (the second victim). Second victim syndrome (SVS) was first described by Dr. Wu detailing the negative psychological effects of adverse patient events on physicians (Ref: Wu AW. Medical error: the second victim. BMJ. 2000;320(7237):726-727).”
Methods: Survey responses form “X” platform (n=195) were collected in 2023. Only responses from advanced endoscopists (defined as those who perform either endoscopic ultrasound or endoscopic retrograde cholangiopancreatography annually) and advanced endoscopy fellows were included.
Key findings:
Higher procedural volume (>1000/year) was associated with feelings of greater emotional preparedness for SAEs
Speaking with colleagues (53%), exercise (33%), discussions at conferences (17%) and meditation (8%) were rated as used and very or extremely helpful
Discussion Points: “Peer support programs have proven to be well received and highly utilized. Additionally, surgeons criticize the often-punitive handling of SAEs, and note that the tone and culture in the review process following an SAE dictates reduction or exacerbation of SVS.”
My take: When I have had a complication in a patient, speaking with colleagues has provided a lot of support. One book I have recommended to others is the following: Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande.
I was recently listening to a radio program (On Point) about the beneficial effects of sunlight.
The program notes that the potential beneficial effects of sunlight are much greater than the risks. Increased sunlight has been associated with lower rates of death, as well as lower rates of cardiovascular disease and autoimmune conditions like multiple sclerosis, type 1 diabetes, and Crohn’s disease.
When dermatologists recommend avoiding sunlight, they may be focused on the risks but not the benefits (though this varies among individuals). In addition, despite the more than 5-fold rise of melanoma diagnosis (especially in wealthy communities), there has not been a change in the rate of deaths due to melanoma. Skin cancers associated with sun exposure are mainly basal cell tumors and squamous cell tumors. These non-melanoma skin cancers have excellent survival rates.
Here is a link: The Healing Power of Sunlight (48 minutes) The most important part of this is in the middle, starting around 20 minutes.
My take: It’s a good idea to avoid sunburns but getting sunshine is good for health.
Related article:
Environ Epidemiol 2025. 9(3):e401. doi: 10.1097/EE9.0000000000000401. The association between time spent outdoors during daylight and mortality among participants of the Adventist Health Study 2 Cohort. Conclusion: “Moderate time outdoors in daylight during warmer months could be associated with lower risks of all-cause, CVD, and noncancer non-CVD mortality”
From AGA Today (8/5/25): “Sterile Water is Unnecessary for Endoscopy”
GI and Hepatology News (8/4, Pass) reports a review suggests that “endoscopists can safely forgo sterile water in favor of tap, reducing both environmental and financial costs.” Researchers found that only two studies since 1975 “directly compared sterile and tap water use in endoscopy,” and “neither showed an increased risk of infection from tap water. In fact, some cultures from allegedly sterile water bottles grew pathogenic bacteria, while no patient complications were reported in either study.” Current guidelines “recommend sterile water for procedures involving mucosal penetration but acknowledge low-quality supporting evidence.” However, they pointed out that “these recommendations are based on outdated studies, some unrelated to GI endoscopy.” Furthermore, the “review estimates that the production and transportation of sterile water bottles contributes over 6,000 metric tons of emissions per year from US endoscopy units alone.” The review was published in Gastro Hep Advances.
“With a conservative estimate of using half of a 1-L sterile bottle for irrigation per endoscopy, 22 million yearly endoscopies in the US could result in an additional 6000 tons of eCO2.”
Economic Costs:
“A 1-L bottle of sterile water costs $3–$10. For an endoscopy unit performing 30 procedures daily and a conservative estimate of half a water bottle per case, the average monthly direct costs could be $1000–$3000”
Discussion:
“There is no direct supporting evidence for using sterile water during endoscopy…a Cochrane review show no difference in infection risk when using tap or sterile water to irrigate wounds…Similarly, there is no benefit in using sterile water for enteral feeds in immunosuppressed patients, and tap water enemas are routinely acceptable for colon cleansing before sigmoidoscopies in all patients, irrespective of immune status.
My take: Plastic water bottles in endoscopy centers contribute to health-care waste, climate change and increased costs.
E Van Daele et al.J Pediatr Gastroenterol Nutr. 2025;81:217–225. Aberrant microbiota signatures precede symptomdevelopment in infantile colic
My take: There has been an interest in altered microbiome and colic for a long time. Whether these alterations are causally-related to colic and whether there is a way to treat these alterations remains unclear.
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