ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two)

Video Transcription

Video Summary

The transcript captures a GI Q&A session focused on chronic diarrhea, SIBO/IMO, constipation, and related treatments. Clinicians note fecal elastase for pancreatic insufficiency is most accurate with formed stool, and pancreatic enzymes (e.g., Creon) remain expensive; porcine origin requires religious/dietary discussion and non-porcine supplements lack evidence. For SIBO when rifaximin isn’t covered, metronidazole 250 mg TID for 10 days is a common alternative; neomycin is generally reserved for methane-predominant overgrowth (IMO) due to ototoxicity and poor tolerability. Refractory cases merit reassessment of diagnosis, mental health comorbidities, and possible tertiary referral. Some use herbal adjuncts (e.g., “Atrantil,” berberine) and emphasize motility support (erythromycin low-dose “holidays,” or prucalopride/Motegrity), though insurance barriers are common. For constipation, Miralax is used for normal/slow transit but may need added small-dose psyllium to “bulk” stools; lactulose is avoided due to taste and gas. Overflow diarrhea from constipation is frequent in older adults and abdominal X-ray helps education. Microscopic colitis requires biopsies; refusal of colonoscopy complicates care. H. pylori management stresses retesting off PPIs (taper if rebound), avoiding antibody tests, and using alternative regimens (vonoprazan-amoxicillin, rifabutin) after failures, guided by local resistance. Bile acid diarrhea can be treated with cholestyramine or colestipol, though taste and technique matter.

Keywords

chronic diarrhea evaluation

SIBO and IMO treatment

rifaximin alternatives metronidazole

methane-predominant overgrowth neomycin

constipation overflow diarrhea management

pancreatic insufficiency fecal elastase Creon

H. pylori retesting and salvage regimens