Congratulations to Dr. Benjamin Gold who is one of the honored heros at this year’s CCFA Take Steps. Also, congratulations to Clara Cann and Lauren Leonard who are being recognized as well.
Link: Register for Take Steps 2025 (4/26/25)
V Jairath et al. Clin Gastroenterol Hepatol 2025; 23: 321-330. Open Access! Mucosal Healing With Vedolizumab in Patients With Chronic Pouchitis: EARNEST, a Randomized, Double-Blind, Placebo-Controlled Trial
Methods: EARNEST, a randomized, double-blind, placebo-controlled study, evaluated vedolizumab efficacy and safety in adults with chronic pouchitis.
Key findings:
My take: Fortunately, chronic pouchitis is uncommon in the pediatric population. This study shows that many patients with chronic pouchitis improve with vedolizumab.
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K Camero, NBC News, Feb 21, 2025. Overuse of muscle-building products associated with body image condition
An excerpt:
A Canadian study, published Wednesday in the journal PLOS Mental Health, finds that young people who consume multiple muscle-building products are more likely to show symptoms of a condition called muscle dysphoria…
About 2,730 Canadian teens and adults ages 16–30, mostly white males and females, were recruited via Instagram and Snapchat advertisements…
26% of the boys and men scored above the level for muscle dysmorphia — that is, being extremely preoccupied with a perceived lack of muscle mass or tone. Use of the workout supplements and products was associated with more symptoms of muscle dysmorphia…
About 55% adolescents and young men in the U.S. use bodybuilding supplements, according to some estimates…
Experts said the findings spotlight how unrealistic body ideals — often fueled by fitness influencers who promote or sell workout supplements online — may be driving more children and young adults to overuse powders or pills.
My take: The patients in this study may not be representative of the entire population; thus, the percentages of those affected should be interpreted carefully. Nevertheless, it is likely that a very significant proportion of young men have “muscle dysphoria” (also termed “‘bigorexia”). Supplements are poorly regulated and can result in adverse effects at any dosage (see posts below).
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Briefly noted: SD St Peter et al. The Lancet, Volume 405, Issue 10474, 233 – 240. Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: an open-label, international, multicentre, randomised, non-inferiority trial
Methods: Children (n=936) aged 5–16 years with suspected non-perforated appendicitis (based on clinical diagnosis with or without radiological diagnosis) were randomly assigned (1:1) to the antibiotic or the appendectomy group. Treatment failure: Within 1 year of random assignment, n the antibiotic group, failure was defined as removal of the appendix, and in the appendectomy group, failure was defined as a normal appendix based on pathology.
Key findings:
My take: Appendectomy was superior to antibiotic management of acute non-perforated appendicitis.
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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.
In the movie There’s Something About Mary, there is a scene (YouTube: 7-minute abs) where the main character picks up a hitchhiker. The hitchhiker reveals his brilliant idea for the 7-minute ab workout to replace the 8-minute ab workout. Of course, he becomes upset when the lead character suggests that someone else could invent the 6-minute ab workout.
This is what I was thinking of when I read a recent article describing a simplified, less restrictive low FODMAP diet.
P Singh et al. Clin Gastroenterol Hepatol 2025; 23: 362-364. Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial
This pilot study with 35 subjects with IBS-D were randomized to a standard low FODMAP diet (LFD) or to a simplified FODMAP diet which eliminated solely fructans and galactooligosaccharides. The primary endpoint was the proportion of subjects meeting the FDA responder definition for abdominal pain intensity (ie. a >/= 30% reduction in weekly average of daily abdominal pain scores for 2 of the 4-week treatment period).
Key findings:
My take: Larger trials are needed. This study suggests that a simplified version of a low FODMAP diet would improve symptoms in most patients with IBS-D.
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AJ Gumm, EB Rand. J Pediatr 2025; 277: 114389. Fontan-Associated Liver Disease
This review article provides a lot of useful advice regarding Fontan-Associated Liver Disease (FALD).
Key points:
When to refer to hepatology:
My take: There is a lot that we do not know about FALD and management is complex due to coexistent abnormal cardiac physiology.
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PA Ubel et al. NEJM 2025; 392: 729-731. Out of Pocket Getting Out of Hand — Reducing the Financial Toxicity of Rapidly Approved Drugs
Key points:
My take: The financial burdens of newer medications leave patients unable to afford other necessary medical and non-medical expenses. This is especially problematic when a new medication offers minimal benefit.
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MV Vestergaard et al. . JAMA. Published online October 15, 2024. doi:10.1001/jama.2024.20429. HLA-DRB1*01:03 and Severe Ulcerative
Colitis
Background: This study aimed to identify biomarkers by conducting a Danish nationwide genome-wide association study (GWAS) on severe vs less severe ulcerative colitis.
Methods: Severe ulcerative colitis: Patients with severe ulcerative colitis were defined as having at least 1 major ulcerative colitis–related operation, at least 2 ulcerative colitis–related hospitalizations exceeding 2 days, and/or use of at least 5000 mg of systemic corticosteroids within 3 years of diagnosis
The authors utilized two source populations
The combined cohort included 4491 patients (4153 from NBS and 338 from NorDIBD) with a mean (SD) age at diagnosis of 23.3 (8.4) years; 53% of patients were female and 27% had severe disease.
Key findings:
My take: HLA-DRB1*01:03 is a low-frequency allele, carriers have a significantly higher risk of severe ulcerative 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.
E Park. NEJM 2025; DOI: 10.1056/NEJMp2501855. Medicaid on the Chopping Block
An excerpt:
A top priority for Congress and President Donald Trump is extending and expanding tax cuts expiring at the end of 2025…Republican leaders in the House intend to make at least $880 billion in Medicaid cuts over 10 years to offset some of the tax cuts’ $4.5 trillion cost…
Medicaid, however, is more essential than it has ever been. It provides affordable, comprehensive health coverage to more than 72 million low-income Americans1…Medicaid covers about 40% of all children and births in the United States. It covers more than one third of people with disabilities and 44% of children with special health care needs…
Medicaid is especially vital for rural communities. Residents of small towns and rural areas disproportionately rely on Medicaid…
Under many of these proposals, states would face drastic reductions in federal Medicaid funding….states would have to choose among three painful options. They could dramatically raise income and sales taxes. They could deeply cut other parts of their budgets, such as budgets for K–12 education and higher education, which account for about 43% of states’ own spending. Or — the option most states would have to choose — they could slash their Medicaid programs by substantially narrowing Medicaid eligibility, restricting benefits, making it harder for eligible people to enroll in and renew coverage, and making sharp cuts to already low reimbursement rates for hospitals, physicians, and nursing homes.
As a result, many low-income children, parents, people with disabilities, older adults, and others would be at risk for becoming uninsured and forgoing needed care…As opposition becomes increasingly public, widespread, and vocal, congressional Republican leaders could ultimately view severe Medicaid cuts as too politically difficult and decide they need to drop them from budget reconciliation.
My take: This article elaborates on all the ways that Congress could curtail Medicaid spending. Ultimately, all of them will leave the states with additional costs if they are to maintain current coverage levels. Even with the proposed cuts to Medicaid, the tax cut plan is projected to add two trillion dollars each year during this administration.
Related article: 3/2/25 Patricia Murphy, AJC: Medicaid cuts from Washington would gut this Georgia pediatrician’s practice (behind paywall) “A South Atlanta pediatrician [Dr. Dorsey Norwood] says 85% of her patients are covered by government health care program…For at least one Georgia pediatrician, cutting Medicaid benefits for her young patients would leave a wound in her practice that even she couldn’t heal.”
2/16/25 NYT Caitlin Rivers: Sorry, Mr. Kennedy, Most Americans Want to Get Their Shots
An excerpt:
There is very little that Americans can agree on these days…
But one thing nearly everyone agrees on? Vaccines are good.
This simple fact has been overshadowed by fears about what will happen to vaccine policy under Robert F. Kennedy Jr., the new secretary of health and human services. He has a long history of vaccine skepticism, and critics fear his leadership could lead to interference with vaccine programs or even withdrawal of vaccines from the market. Such moves are already roiling some state health programs. In Louisiana, the Health Department will “no longer promote mass vaccination,” instead leaving vaccine education to medical providers…
Recent reports in the news media and medical journals highlight a decline in the proportion of kindergartners who have received the measles, mumps and rubella shot. In the past five years, national coverage has fallen to 93 percent, from 95 percent, and in some states like Idaho, it is as low as 80 percent. But while these numbers fall short of the national goal of 95 percent required to maintain herd immunity for measles, they remain a resounding show of confidence…
Some 92 percent of American children received the polio vaccine by age 2, and more than 90 percent were vaccinated against hepatitis B. And it’s not just because of school requirements. Nearly nine in 10 Americans — including 86 percent of Republicans — say the benefits of childhood vaccines outweigh the risks...
Emphasizing the popularity of vaccines is not merely a matter of correcting the record. Studies have shown that presenting vaccines as a subject of debate or controversy can unintentionally reinforce vaccine hesitancy by making the issue appear less settled. For instance in one study, researchers found that college students who were asked to read a news report on vaccine safety that presented both sides in a falsely balanced fashion came away with the mistaken impression that the science on vaccine safety was in flux…
Routine vaccinations are just that: routine. Nearly all children receive them, and millions have benefited by being spared painful diseases and death. Leaders who undermine this basic tool may find themselves on the wrong side of both science and voters.
My take: Caitlin Rivers provides a lot of useful advice regarding infectious diseases. She has frequent (~weekly) substack articles with up-to-date information regarding infection prevalence (eg. Flu, COVID, norovirus, etc). Link to substack: Force of Infection
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