Latest news with #DDW
Medscape
21-05-2025
- Health
- Medscape
Blood Test May Predict Crohn's Disease 2 Years Before Onset
SAN DIEGO — Crohn's disease (CD) has become more common in the United States, and an estimated 1 million Americans have the condition. Still, much is unknown about how to evaluate the individual risk for the disease. 'It's pretty much accepted that Crohn's disease does not begin at diagnosis,' said Ryan Ungaro, MD, associate professor of medicine at the Icahn School of Medicine at Mount Sinai, New York City, speaking at Digestive Disease Week (DDW) 2025. Although individual blood markers have been associated with the future risk for CD, what's needed, he said, is to understand which combination of biomarkers are most predictive. Now, Ungaro and his team have developed a risk score they found accurate in predicting CD onset within 2 years before its onset. It's an early version that will likely be further improved and needs additional validation, Ungaro told Medscape Medical News . 'Once we can accurately identify individuals at risk for developing Crohn's disease, we can then imagine a number of potential interventions,' Ungaro said. Approaches would vary depending on how far away the onset is estimated to be. For people who likely wouldn't develop disease for many years, one intervention might be close monitoring to enable diagnosis in the earliest stages, when treatment works best, he said. Someone at a high risk of developing CD in the next 2 or 3 years, on the other hand, might be offered a pharmaceutical intervention. Developing and Testing the Risk Score To develop the risk score, Ungaro and colleagues analyzed data of 200 patients with CD and 100 healthy control participants from PREDICTS, a nested case-controlled study of active US military service members. The study is within the larger Department of Defense Serum Repository, which began in 1985 and has more than 62.5 million samples, all stored at −30 °C. The researchers collected serum samples at four timepoints up to 6 or more years before the diagnosis. They assayed antimicrobial antibodies using the Prometheus Laboratories platform, proteomic markers using the Olink inflammation panel, and anti–granulocyte macrophage colony-stimulating factor autoantibodies using enzyme-linked immunosorbent assay. Participants (median age, 33 years for both groups) were randomly divided into equally sized training and testing sets. In both the group, 83% of patients were White and about 90% were men. Time-varying trajectories of marker abundance were estimated for each biomarker. Then, logistic regression modeled disease status as a function of each marker for different timepoints and multivariate modeling was performed via logistic LASSO regression. A risk score to predict CD onset within 2 years was developed. Prediction models were fit on the testing set and predictive performance evaluated using receiver operating characteristic curves and area under the curve (AUC). Blood proteins and antibodies have differing associations with CD depending on the time before diagnosis, the researchers found. The integrative model to predict CD onset within 2 years incorporated 10 biomarkers associated significantly with CD onset. The AUC for the model was 0.87 (considered good, with 1 indicating perfect discrimination). It produced a specificity of 99% and a positive predictive value of 84%. The researchers stratified the model scores into quartiles and found the CD incidence within 2 years increased from 2% in the first quartile to 57.7% in the fourth. The relative risk of developing CD in the top quartile individuals vs lower quartile individuals was 10.4. The serologic and proteomic markers show dynamic changes years before the diagnosis, Ungaro said. A Strong Start The research represents 'an ambitious and exciting frontier for the future of IBD [inflammatory bowel disease] care,' said Victor G. Chedid, MD, MS, consultant and assistant professor of medicine at Mayo Clinic, Rochester, Minnesota, who reviewed the findings but was not involved in the study. Currently, physicians treat IBD once it manifests, and it's difficult to predict who will get CD, he said. The integrative model's AUC of 0.87 is impressive, and its specificity and positive predictive value levels show it is highly accurate in predicting the onset of CD within 2 years, Chedid added. Further validation in larger and more diverse population is needed, Chedid said, but he sees the potential for the model to be practical in clinical practice. 'Additionally, the use of blood-based biomarkers makes the model relatively noninvasive and easy to implement in a clinical setting,' he said. Now, the research goal is to understand the best biomarkers for characterizing the different preclinical phases of CD and to test different interventions in prevention trials, Ungaro told Medscape Medical News . A few trials are planned or ongoing, he noted. The trial PIONIR trial will look at the impact of a specific diet on the risk of developing CD, and the INTERCEPT trial aims to develop a blood-based risk score that can identify individuals with a high risk of developing CD within 5 years after initial evaluation. Ungaro reported being on the advisory board of and/or receiving speaker or consulting fees from AbbVie, Bristol Myer Squibb, Celltrion, ECM Therapeutics, Genentech, Jansen, Eli Lilly, Pfizer, Roivant, Sanofi, and Takeda. Chedid reported having no relevant disclosures.
Medscape
19-05-2025
- Health
- Medscape
Blood Detection Capsule May Help in Upper GI Bleeding
SAN DIEGO — A real-time, blood-sensing capsule (PillSense) is a safe and effective diagnostic tool for patients with suspected upper gastrointestinal (GI) bleeding that can aid patient triage, reduce unnecessary procedures, and optimize resource use, a study found. Notably, patients with negative capsule results had shorter hospital stays and lower acuity markers, and in more than one third of cases, an esophagogastroduodenoscopy (EGD) was avoided altogether without any observed adverse events or readmissions, the study team found. 'Our study shows that this novel capsule that detects blood in the upper GI tract (PillSense) was highly sensitive and specific (> 90%) for detecting recent or active upper GI blood, influenced clinical management in 80% of cases and allowed about one third of patients to be safely discharged from the emergency department, with close outpatient follow-up,' Linda Lee, MD, medical director of endoscopy, Brigham and Women's Hospital and associate professor of medicine, Harvard Medical School, Boston, told Medscape Medical News . The study was presented at Digestive Disease Week (DDW) 2025. Real-World Insights EGD is the gold standard for diagnosing suspected upper GI bleeding, but limited access to timely EGD complicates diagnosis and resource allocation. Approved by the US Food and Drug Administration, PillSense (EnteraSense) is an ingestible capsule with a reusable receiver that provides a rapid, noninvasive method for detecting upper GI bleeding. The capsule analyzes light absorption to identify blood and transmits the result within 10 minutes. Lee and colleagues evaluated the real-world impact of this point-of-care device on clinical triage and resource allocation, while assessing its safety profile. They analyzed data on 43 patients (mean age 60 years; 72% men) with clinical suspicion of upper GI bleeding in whom the device was used. The most common symptoms were symptomatic anemia (70%), melena (67%), and hematemesis (33%). Sixteen PillSense studies (37%) were positive for blood detection, and 27 (63%) were negative. Compared to patients with a positive capsule results, those without blood detected by the capsule had shorter hospital stays (mean, 3.8 vs 13.4 days, P = .02), lower GBS scores (mean, 7.93 vs 12.81; P = .005), and fewer units of blood transfused (mean, 1.19 vs 10.94; P = .01) and were less apt to be hemodynamically unstable (5 vs 8 patients; P = .03). Capsule results influenced clinical management in 80% of cases, leading to avoidance of EGD in 37% and prioritization of urgent EGD in 18% (all had active bleeding on EGD). Capsule use improved resource allocation in 51% of cases. This included 12 patients who were discharged from the ED, six who were assigned an inpatient bed early, and four who underwent expedited colonoscopy as upper GI bleeding was ruled out, they noted. Among the eight patients who did not undergo EGD, there were no readmissions within 30 days and no adverse events. There were no capsule-related adverse events. 'Clinicians should consider using this novel capsule PillSense as another data point in the management of suspected upper GI bleed,' Lee told Medscape Medical News . 'This could include in helping to triage patients for safe discharge from the ED or to more urgent endoscopy, to differentiate between upper vs lower GI bleed and to manage ICU patients with possible rebleeding,' Lee said. Important Real-World Evidence Reached for comment, Shahin Ayazi, MD, esophageal surgeon, Director, Allegheny Health Network Chevalier Jackson Esophageal Research Center, Pittsburgh, Pennsylvania, said this study is important for several reasons. 'Prior investigations have established that PillSense possesses a high negative predictive value for detecting upper GI bleeding and have speculated on its utility in triage, decision-making, and potentially avoiding unnecessary endoscopy. This study is important because it substantiates that speculation with clinical data,' Ayazi, who wasn't involved in the study, told Medscape Medical News . 'These findings support the capsule's practical application in patient stratification and clinical workflow, particularly when diagnostic uncertainty is high and endoscopic resources are limited,' Ayazi noted. In his experience, PillSense is 'highly useful as a triage adjunct in the evaluation of suspected upper GI bleeding. It provides direct and objective evidence as to whether blood is currently present in the stomach,' he said. 'In patients whose presentation is ambiguous or whose clinical scores fall into an intermediate risk zone, this binary result can provide clarity that subjective assessment alone may not achieve. This is particularly relevant in settings where the goal is to perform endoscopy within 24 hours, but the volume of consults exceeds procedural capacity,' Ayazi explained. 'In such scenarios, PillSense enables physicians to stratify patients based on objective evidence of active bleeding, helping to prioritize those who require urgent endoscopy and defer or even avoid endoscopic evaluation in those who do not. The result is a more efficient allocation of endoscopic resources without compromising patient safety,' he added. Ayazi cautioned that the PillSense capsule should not be used as a replacement for clinical evaluation or established risk stratification protocols. 'It is intended for hemodynamically stable patients and has not been validated in cases of active or massive bleeding. Its diagnostic yield depends on the presence of blood in the stomach at the time of capsule transit; intermittent or proximal bleeding that has ceased may not be detected, introducing the potential for false-negative results,' Ayazi told Medscape Medical News. 'However, in prior studies, the negative predictive value was high, and in the present study, no adverse outcomes were observed in patients who did not undergo endoscopy following a negative PillSense result,' Ayazi noted. 'It must also be understood that PillSense does not localize the source of bleeding or replace endoscopy in patients with a high likelihood of active hemorrhage. It is not designed to detect bleeding from the lower GI tract or distal small bowel. Rather, it serves as an adjunct that can provide immediate clarity when the need for endoscopy is uncertain, and should be interpreted within the broader context of clinical findings, laboratory data, and established risk stratification tools,' he added.
Yahoo
18-05-2025
- Health
- Yahoo
Using Your Phone on The Toilet May Dramatically Increase Risk of Hemorrhoids
Reading on the toilet is something people many do, but the time-sucking powers of smartphones may have us sitting on the ceramic stool for an unhealthy amount of time. A new survey has found that those who use their phones on the toilet face a 46 percent increased risk for hemorrhoids – swollen veins in the lower rectum, thought to be caused by too much pressure. A participant's age, sex, body mass, exercise, or fiber intake did not have an impact on the results. The survey – presented recently at the Digestive Diseases Week (DDW) conference in San Diego, CA – considered 125 participants who were receiving a colonoscopy. More than 40 percent had a hemorrhoid, and 93 percent said they used their phone on the toilet at least once a week. About half that group said they read news on the toilet, whereas about 44 percent said they were on social media, and about 30 percent were emailing or texting, according to presenter Trisha Satya Pasricha of the Beth Israel Deaconess Medical Center in Boston. Some of the respondents said they spent more than 6 minutes on the toilet, per visit, and many said they believed they were on the toilet longer because of their smartphones. A small survey like this one can only show correlations and possible risk factors. Whether or not reading on the toilet actually predisposes someone to hemorrhoids needs further research. In the United States, nearly 4 million doctor and emergency department visits annually are due to hemorrhoids, and yet the condition is poorly understood and tracked. At this point, we only have hypotheses as to how it occurs. In fact, the only US national survey on hemorrhoids was conducted in 1989. No newer data exists at this level. Hemorrhoids are clusters of blood vessels, smooth muscle, and connective tissue in and around the lower rectum, and while everyone has these cushions, which are thought to make pooping easier, when the tissues swell or bleed, they are known colloquially as hemorrhoids. While there are probably a variety of factors that lead to hemorrhoids, scientists generally think they are caused by overstraining, extended defecation time, or frequent bowel movements. Some studies suggest, for instance, that prolonged sitting may be a contributing factor, possibly because sitting on the toilet weakens and dilates blood vessels in and around the anus and rectum. As a result, some doctors advise we spend no more than 10 minutes on the john. But other experts suggest spending no more than 3 minutes. This latter recommendation is based on a study of 100 patients with confirmed hemorrhoids, who spent more time reading on the toilet than their age and sex-matched counterparts without hemorrhoids. Reading on the toilet is hardly a modern phenomenon. In colonial times, it is said that people used to wipe their butts with newspapers because that is what they had on hand. But phones are attention-suckers on a whole other scale, and there's a chance that their use on the toilet is distracting us from the task at hand. In light of this possible risk factor, some health experts have warned that 'toilet scrolling' may be messing with our 'toilet hygiene'. "It may be time to designate the washroom as a smartphone-free zone," wrote a team of researchers in a paper from 2024. Until we know more, the takeaway seems to be: Keep your time on the toilet limited. Going number two should be your number one priority – not scrolling on your phone. The newest survey was presented on May 5 at Digestive Diseases Week (DDW) 2025. Common Parasite Rips The Face From Your Cells to Wear as a Disguise Scientists '3D Print' Material Deep Inside The Body Using Ultrasound The Secret to Happiness Seems to Depend Upon You, Study Finds
Medscape
16-05-2025
- Health
- Medscape
Colorectal Cancer Screening Choices: Is Compliance Key?
SAN DIEGO — In the ever-expanding options for colorectal cancer (CRC) screening, blood tests using precision medicine are becoming more advanced and convenient than ever; however, caveats abound, and when it comes to potentially life-saving screening measures, picking the optimal screening tool is critical. Regarding tests, 'perfect is not possible,' said William M. Grady, MD, of the Fred Hutchinson Cancer Center, University of Washington School of Medicine, in Seattle, who took part in a debate on the pros and cons of key screening options at Digestive Disease Week (DDW) 2025. 'We have to remember that that's the reality of colorectal cancer screening, and we need to meet our patients where they live,' said Grady, who argued on behalf of blood-based tests, including cell-free (cf) DNA (Shield, Guardant Health) and cfDNA plus protein biomarkers (Freenome). A big point in their favor is their convenience and higher patient compliance — better tests that don't get done do not work, he stressed. He cited data that showed suboptimal compliance rates with standard colonoscopy: Rates range from about 70% among non-Hispanic White individuals to 67% among Black individuals, 51% among Hispanic individuals, and the low rate of just 26% among patients aged between 45 and 50 years. With troubling increases in CRC incidence among younger patients, 'that's a group we're particularly concerned about,' Grady said. Meanwhile, studies show compliance rates with blood-based tests are ≥ 80%, with similar rates seen among those racial and ethnic groups, with lower rates for conventional colonoscopy, he noted. Importantly, in terms of performance in detecting CRC, blood-based tests stand up to other modalities, as demonstrated in a real-world study conducted by Grady and his colleagues showing a sensitivity of 83% for the cfDNA test, 74% for the fecal immunochemical test (FIT) stool test, and 92% for a multitarget stool DNA test compared with 95% for colonoscopy. 'What we can see is that the sensitivity of blood-based tests looks favorable and comparable to other tests,' he said. Among the four options, cfDNA had a highest patient adherence rate (85%-86%) compared with colonoscopy (28%-42%), FIT (43%-65%), and multitarget stool DNA (48%-60%). 'The bottom line is that these tests decrease CRC mortality and incidence, and we know there's a potential to improve compliance with colorectal cancer screening if we offer blood-based tests for average-risk people who refuse colonoscopy,' Grady said. Blood-Based Tests: Caveats, Harms? Arguing against blood-based tests in the debate, Robert E. Schoen, MD, MPH, professor of medicine and epidemiology, Division of Gastroenterology, Hepatology and Nutrition, at the University of Pittsburgh, Pittsburgh, checked off some of the key caveats. While the overall sensitivity of blood-based tests may look favorable, these tests don't detect early CRC well,' said Schoen. The sensitivity rates for stage 1 CRC are 64.7% with Guardant Health and 57.1% with Freenome. Furthermore, their rates of detecting advanced adenomas are very low; the rate with Guardant Health is only about 13%, and with Freenome is even lower at 12.5%, he reported. These rates are 'similar to the false positive rate, with poor discrimination and accuracy for advanced adenomas,' Schoen said. 'Without substantial detection of advanced adenomas, blood-based testing is inferior [to other options].' Importantly, the low advanced adenoma rate translates to a lack of CRC prevention, which is key to reducing CRC mortality, he noted. Essential to success with blood-based biopsies, as well as with stool tests, is the need for a follow-up colonoscopy if results are positive, but Schoen pointed out that this may or may not happen. He cited research from FIT data showing that among 33,000 patients with abnormal stool tests, the rate of follow-up colonoscopy within a year, despite the concerning results, was a dismal 56%. 'We have a long way to go to make sure that people who get positive noninvasive tests get followed up,' he said. In terms of the argument that blood-based screening is better than no screening at all, Schoen cited recent research that projected reductions in the risk for CRC incidence and mortality among 100,000 patients with each of the screening modalities. Starting with standard colonoscopy performed every 10 years, the reductions in incidence and mortality would be 79% and 81%, respectively, followed by annual FIT, at 72% and 76%; multitarget DNA every 3 years, at 68% and 73%; and cfDNA (Shield), at 45% and 55%. Based on those rates, if patients originally opting for FIT were to shift to blood-based tests, 'the rate of CRC deaths would increase,' Schoen noted. The findings underscore that 'blood testing is unfavorable as a 'substitution test,'' he added. 'In fact, widespread adoption of blood testing could increase CRC morbidity.' 'Is it better than nothing?' he asked. 'Yes, but only if performance of a colonoscopy after a positive test is accomplished.' What About FIT? Arguing that stool-based testing, or FIT, is the ideal choice as a first-line CRC test Jill Tinmouth, MD, PhD, a professor at the University of Toronto, Ontario, Canada, pointed to its prominent role in organized screening programs, including regions where resources may limit the widespread utilization of routine first-line colonoscopy screening. In addition, it narrows colonoscopies to those that are already prescreened as being at risk. Data from one such program, reported by Kaiser Permanente of Northern California, showed that participation in CRC screening doubled from 40% to 80% over 10 years after initiating FIT screening. CRC mortality over the same period decreased by 50% from baseline, and incidence fell by as much as 75%. In follow-up colonoscopies, Tinmouth noted that collective research from studies reflecting real-world participation and adherence to FIT in populations in the United Kingdom, the Netherlands, Taiwan, and California show follow-up colonoscopy rates of 88%, 85%, 70%, and 78%, respectively. Meanwhile, a recent large comparison of biennial FIT (n = 26,719) vs one-time colonoscopy (n = 26,332) screening, the first study to directly compare the two, showed noninferiority, with nearly identical rates of CRC mortality at 10 years (0.22% colonoscopy vs 0.24% FIT) as well as CRC incidence (1.13% vs 1.22%, respectively). 'This study shows that in the context of organized screening, the benefits of FIT are the same as colonoscopy in the most important outcome of CRC — mortality,' Tinmouth said. Furthermore, as noted with blood-based screening, the higher participation with FIT shows a much more even racial/ethnic participation than that observed with colonoscopy. 'FIT has clear and compelling advantages over colonoscopy,' she said. As well as better compliance among all groups, 'it is less costly and also better for the environment [by using fewer resources],' she added. Colonoscopy: 'Best for First-Line Screening' Making the case that standard colonoscopy should in fact be the first-line test, Swati G. Patel, MD, director of the Gastrointestinal Cancer Risk and Prevention Center at the University of Colorado Anschutz Medical Center, Aurora, Colorado, emphasized the robust, large population studies showing its benefits. Among them is a landmark national policy study showing a significant reduction in CRC incidence and mortality associated with first-line colonoscopy and adenoma removal. A multitude of other studies in different settings have also shown similar benefits across large populations, Patel added. In terms of its key advantages over FIT, the once-a-decade screening requirement for average-risk patients is seen as highly favorable by many, as evidenced in clinical trial data showing that individuals highly value tests that are accurate and do not need to be completed frequently, she said. Research from various other trials of organized screening programs further showed patients crossing over from FIT to colonoscopy, including one study of more than 3500 patients comparing colonoscopy and FIT, which had approximately 40% adherence with FIT vs nearly 90% with colonoscopy. Notably, as many as 25% of the patients in the FIT arm in that study crossed over to colonoscopy, presumably due to preference for the once-a-decade regimen, Patel said. 'Colonoscopy had a substantial and impressive long-term protective benefit both in terms of developing colon cancer and dying from colon cancer,' she said. Regarding the head-to-head FIT and colonoscopy comparison that Tinmouth described, Patel noted that a supplemental table in the study's appendix of patients who completed screening does reveal increasing separation between the two approaches, favoring colonoscopy, in terms of longer-term CRC incidence and mortality. The collective findings underscore that 'colonoscopy as a standalone test is uniquely cost-effective,' in the face of costs related to colon cancer treatment. Instead of relying on biennial tests with FIT, colonoscopy allows clinicians to immediately risk-stratify those individuals who can benefit from closer surveillance and really relax surveillance for those who are determined to be low risk, she said.
Time of India
13-05-2025
- Health
- Time of India
How AI is reshaping the doctor's role
Digestive Disease Week (DDW) held in San Diego, California During Digestive Disease Week (DDW) held in San Diego, California and attended by more than 12,000 physicians, Dr. Prateek Sharma, President of the American Society for Gastrointestinal Endoscopy (ASGE), and Dr. Eric Horvitz, Chief Scientific Officer at Microsoft, explored the rapidly evolving role of artificial intelligence (AI) in healthcare. Their conversation highlighted how AI is shaping patient care, improving efficiency in the physician's office, and redefining the role of the clinician. Both their fireside chat and individual lectures at the Presidential Plenary Session drew a large and engaged audience, which reflects the increased interest of integrating AI in healthcare. ASGE president Prateek Sharma and Microsoft leader Eric Horvitz discuss the impact of AI in healthcare Dr. Sharma shared real-world examples of how AI is already transforming gastroenterology, from computer-aided detection (CADe) and diagnosis (CADx) in endoscopy to workflow optimisation and predictive modelling. He emphasised that the speciality is entering a point where AI reduces documentation burden, scheduling tools improve clinic flow, and how digital twins may one day enable real-time coaching during procedures. Dr. Horvitz, who leads Microsoft's health and AI initiatives, discussed broader trends in the field, highlighting AI's growing role in early disease detection and clinical decision support. He emphasised that AI systems should assist rather than replace human intelligence, serving as tools that support, not override, clinical judgment. Both speakers underscored the importance of thoughtful, clinically grounded progress. He also touched on the need for explainable AI, stating that systems must be transparent and trustworthy if they are to be safely adopted into practice. Both speakers acknowledged that as AI capabilities accelerate, so do challenges facing their integration into clinical practice. Dr. Sharma emphasis ed the importance of clinical validation, integration across platforms, and policy reform. Dr. Horvitz echoed his concerns, along with the need for ethical guardrails that evolve alongside the technology. Dr. Sharma emphasized that tomorrow's clinicians must be fluent in AI. 'AI won't replace you, but a gastroenterologist who knows how to use AI might', he said. Both leaders agreed that training must include interdisciplinary learning to responsibly evaluate and deploy AI tools. Dr. Horvitz added that doctors must be involved from day one in AI development to ensure these tools are clinically relevant and usable for patient needs. As AI continues to advance, both speakers underscored the importance of thoughtful, clinically grounded progress. They encouraged healthcare professionals to stay informed, engage with new technologies, and contribute their perspectives to ensure AI evolves in ways that serve patients, providers, and the healthcare system. The conversation made clear that shaping the future of AI in medicine is not just a technical challenge, but a clinical responsibility.
