ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day Two)

Video Transcription

Video Summary

The transcript captures a Q&A session with faculty discussing management of Barrett’s esophagus, GERD, and inflammatory bowel disease. Clinicians explain how to counsel patients hesitant about long-term proton pump inhibitors (PPIs), emphasizing guideline recommendations and weighing uncertain observational PPI risks (osteoporosis, dementia, kidney disease) against the risk of Barrett’s progression. They note PPIs differ in potency and may trial step-down therapy (H2 blockers/antacids) if patients insist, often leading to symptom-driven return to PPIs. TissueCypher testing is used selectively to reassure low-risk patients about longer surveillance intervals, though high-risk results don’t automatically justify ablation.<br /><br />IBD questions include treatment options for steroid-dependent ulcerative colitis with biologic reactions/failure, favoring JAK inhibitors or IL-23 agents, and noting NSAIDs can raise fecal calprotectin. High-dose infliximab may be appropriate if trough levels are appropriate. Additional discussion covers hiatal hernia surgery in Barrett’s, distinguishing irregular Z-line intestinal metaplasia from true Barrett’s, and managing gastric intestinal metaplasia (often H. pylori–related). For suspected IBD, colonoscopy with pathology is prioritized over serologic panels.

Keywords

Barrett’s esophagus management

GERD proton pump inhibitor counseling

TissueCypher risk stratification surveillance

Steroid-dependent ulcerative colitis biologics JAK inhibitors IL-23

IBD diagnosis colonoscopy pathology fecal calprotectin NSAIDs