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Forbes
a day ago
- Health
- Forbes
The 10 Best Baby Shampoos Parents And Experts Love
There aren't many things better than a clean, snuggly baby. The best baby shampoo is gentle on their skin, which is often achieved by leaving out irritating ingredients and incorporating moisturizing, soothing elements. Our top pick, Cerave Baby Wash And Shampoo, is free from harsh ingredients like parabens, sulfates and synthetic fragrance, and includes gentle cleansing agents like coco-betaine and sodium cocoyl glycinate. The best baby shampoos cleanse while being gentle on their hair and skin. Other factors to consider when shopping for baby shampoo include allergens and whether the shampoo is tear-free. 'Their top skin layer, called the stratum corneum, is still developing. That makes it more susceptible to issues such as dryness, rashes or irritation from things such as chemicals or harsh soaps,' says dermatologist Dr. David Johnson. Many baby shampoos double as body washes, making it even more important to find something gentle on their skin. Since different babies have different needs, I spoke to four dermatologists and drew upon my own experience as a mom of three to curate a list of the best baby shampoos for every kind of baby skin. Amazon I've tested many baby shampoos, and Cerave stands out as a top pick because it's so clean and gentle. It doesn't contain any parabens, sulfates or fragrance. It also has gentle cleansing ingredients, including coco-betaine and sodium cocoyl glycinate, which pediatric dermatologist Dr. Daniela Russi recommends, along with three ceramides, which can help protect your baby's sensitive skin barrier. I can attest that the tear-free claim is true for this shampoo—it has never bothered my kids' eyes. This is also a good pick for babies with eczema, as it's accepted by the National Eczema Association (NEA). Amazon Baby Dove was the first shampoo I used with my first baby, and it never irritated her eczema-prone skin. It's fragrance-free, and I really like that the back of the bottle breaks down each ingredient along with its purporse so you know you're not putting unnecessary ingredients on your baby's skin. It's free from sulfates, phthalates and parabens and it's also accepted by the NEA. After using this shampoo, my baby's hair was always super soft and clean. Amazon I often hear Eucerin recommended by pediatricians and dermatologists as a top choice, particularly for kids with sensitive skin. This shampoo contains Vitamin B5 and shea butter, both of which are known to help moisturize and even repair and soothe damaged skin. It's fragrance-, dye- and tear-free. These factors make it a great choice to try for babies who have extra sensitive skin or who may not have reacted well to other baby shampoos with artificial dyes or fragrances in them. Amazon Another baby shampoo I use with my kids in heavy rotation, Aveeno Baby Daily Moisture Gentle Bath Wash And Shampoo leaves their hair super soft and doesn't irritate their sensitive skin. The oat extract is a great addition, helping to moisturize and relieve the itchiness that often accompanies dry skin. The tear-free formula has never bothered my kids' eyes. The shampoo is free from parabens, sulfates and phthalates. It's worth noting that it is lightly scented—so if you're looking for something completely fragrance-free, check out some of our other top picks. Amazon For some babies, cradle cap can be difficult to control. Though the condition isn't typically harmful and eventually resolves on its own, shampoos and special tools can help you get rid of it faster. Unlike most baby shampoos, Mustela Cradle Cap Foam Shampoo For Newborns is designed to gently exfoliate your baby's scalp to get rid of those flakes. It also uses avocado polyphenols to soften the flakes on your baby's scalp. Since it's tear-free, you can also use it on your baby's eyebrows, another common spot where cradle cap pops up. The fragrance-free shampoo is also paraben- and phthalate-free. Amazon For babies with eczema, you want something that isn't going to strip away moisture and make their skin even more dry and itchy. 'Vanicream's line of baby products are all gentle and hydrating, as well as soothing for eczema-prone skin or skin that's already irritated,' says dermatologist Dr. Rachel Day. It has a very small list of ingredients, which is helpful because the more ingredients, the more likely there will be something in the product that will irritate your baby's skin. Vanicream Foaming Wash For Baby is free from dyes, fragrances, lanolin, paraben, botanical extracts, formaldehyde releasers and gluten. Amazon Many pediatricians and dermatologists recommend fragrance-free shampoos for babies to reduce the risk of irritation. However, some parents prefer products that smell really good. Alaffia Babies And Kids Shampoo And Body Wash smells so delicious, I want to eat it—though, obviously, don't do that. There are three scents available: coconut strawberry, coconut chamomile and lemon lavender. It's free from sulfates, parabens, phthalates, silicones, mineral oil and artificial colors. It's also made without synthetic fragrance, so while it has a scent, it's less likely to irritate your baby's skin compared to an artificial fragrance. Parents should note that due to some of the ingredients like alcohol and phenoxyethanol, there's a chance it could dry or irritate baby's skin. None of my three kids have ever reacted poorly to it, and they all loved the smell. Tubby Todd Bath Co. When I've used Tubby Todd shampoo with my kids, it has always lathered well and left their skin soft. Their hair and body wash is available fragrance-free or with a lavender and rosemary scent. They also occasionally offer limited-edition seasonal scents. Some parents love lavender to help their kids wind down for bed and find the scent very soothing. The shampoo is free from sodium lauryl sulfate, gluten, dairy, synthetic fragrances, parabens and steroids. To me, it feels extra soothing and effective because it's able to create the suds that many other baby shampoos can't while still being gentle. 'My youngest had mild eczema as a baby and this was our go-to baby shampoo. It's super mild and smells great,' says Forbes Vetted baby and kids gear editor Esther Carlstone. Though this is a pricier option, the brand offers refill pouches that can help save both money and plastic. Walmart Pipette Baby Shampoo And Wash is an eco-friendly option that's Environmental Working Group (EWG)-verified. This certification ensures transparency and helps parents feel confident that the ingredients in the shampoo are safe. 'It will wash and cleanse the skin with hydrating ingredients like squalane without drying or causing irritation. This entire brand is great for babies' skin,' says dermatologist Dr. Anna Chacon. You can choose from fragrance-free, vanilla and ylang-ylang or sweet wildflower scents. All of the scents are derived from plants, so there aren't any synthetic fragrances. When I've used this shampoo with my kids in the past, I've noticed a natural or musky smell—even with the fragrance-free version. Amazon This EWG-verified shampoo is so natural that it's made of 100% edible ingredients. Babies often don't understand that they need to keep their mouth closed when there's soap or shampoo running down their face, and when they become toddlers, they'll probably drink bath water like it's a delicacy. While we don't advise eating shampoo, knowing it's full of familiar ingredients like oats, arugula, radish and coconut oil, may give you some peace of mind. The shampoo doesn't have any sulfates, parabens or synthetic fragrances, either. The baby and kids gear team at Forbes Vetted is made up of journalists and parents who know how important it is to choose the right products for your baby's skin. We frequently test and research products so we can help you find the right options for your kids, like the best bassinets and the best baby pool floats. I've used a lot of different baby shampoos over the years. To curate our list, we considered my experience, interviewed experts and compared properties and ingredients of various baby shampoos. Though many baby shampoos are designed to reduce irritation, every baby is different. It's always a good idea to do a small patch test before using a new shampoo with your baby and keep an eye out for any reactions or irritation. 'When choosing a baby shampoo, you want to look out for ingredients that can trigger irritation or, if your baby's skin is eczema-prone, worsen inflammation,' says Day. Some of the ingredients you want to avoid include: Many of these ingredients can cause irritation and dryness. On the flip side, there are some helpful ingredients that you may want to look for in your baby's shampoo. Some of these include: These ingredients can do many things to help a baby's skin, including moisturizing it, hydrating it, gently cleansing it and helping build the skin barrier. There are a few different formulations you often see with baby shampoo, including tear-free, fragrance-free, hypoallergenic and pH-balanced. These are all great to look out for, but since they're not regulated terms, it's still important to watch how your baby responds to the shampoo. 'Even if it is 'hypoallergenic,' read the ingredients. Fewer chemicals in simpler formulations are best,' says Johnson. Gentle ingredients can also help make a shampoo less irritating to the eyes. As a mom of three and product tester who has tested many baby and kids shampoos, I can attest that just because a shampoo says it's tear-free doesn't necessarily mean it is. Look for tear-free formulations, but know that it could still irritate your baby's eyes. Many parents like to use a baby shampoo that smells good, but that's not always what's best for your baby's skin. 'I think it's easy to be persuaded into delicious-smelling options for babies, scents like lavender, for example, are often marketed as 'calming or relaxing' which sounds like a dream to any new parent,' says Chacon. 'However, fragrance, even from naturally derived essential oils, can be harsh on delicate tissues. There really is nothing better than the smell of a fresh clean baby but I would recommend their own unique smell over something harsh or synthetic any day.' If you decide to get a shampoo with fragrance, look for one that comes from natural ingredients rather than synthetic fragrances. Which Brand Is Best For Baby Shampoo? Our top pick for baby shampoo is Cerave. It has gentle ingredients, is designed to protect baby's skin barrier and doesn't have added synthetic fragrances. It's also NEA approved, making it ideal for babies with eczema. Do Babies Need Special Shampoo? Yes, babies need special shampoo because it's gentler on their delicate skin. 'We should always remember that baby skin is not the same as adult skin. When shopping for baby products like body wash or shampoo, parents should prioritize gentleness, safety, and natural ingredients more than they might when choosing these products for themselves,' says Russi. What Is The Difference Between Baby Wash And Baby Shampoo? For most baby shampoo brands, there is no difference. Many baby shampoos and washes are all-in-one, so you can use the same product for their hair and body.
Medscape
23-05-2025
- Health
- Medscape
‘Seismic' Shifts May Be Ahead in GI Care
This transcript has been edited for clarity. Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University in Norfolk, Virginia. Welcome back to part 2 of my highlights from Digestive Disease Week (DDW) 2025. I've selected another 10 presentations for you, in addition to the 10 presented in part 1 of this series. If you've registered for DDW 2025, you can access these abstracts or presentations at the conference website. If you haven't, you'll need to wait for the published manuscripts, which hopefully will arrive not too long from now. Secondary Spontaneous Bacterial Peritonitis Prophylaxis The standard of care for prior spontaneous bacterial peritonitis (SBP) is to place patients on an antibiotic, typically a quinolone. In this analysis,[1] researchers looked at the Veterans Affairs database of nearly 5200 patients with a first episode of SBP. Within this cohort, they identified those on secondary SBP prophylaxis with quinolone or Bactrim, as defined as continuous use with at least one documented refill. They observed that patients on secondary prophylaxis had strikingly higher rates of SBP recurrence as well as any non-SBP infections. This raises the important question of whether we are doing more harm than good with this treatment approach owing to bacterial resistance patterns and the risks of repeated exposure to quinolones, which is associated with the potential for tendon rupture and other complications. It also challenges the recommendations put forward in national guidelines. However, we'll need to wait and see how this plays out with further analysis before we consider revisiting those guidelines. Early TIPS for Acute Variceal Bleeding The results from the second study[2] I'd like to highlight were described at DDW 2025 as being potentially 'seismic.' Current guidelines recommend early transjugular intrahepatic portosystemic shunts (TIPS) in patients with variceal hemorrhage, although this is rarely practiced. Researchers performed a systematic review and meta-analysis of randomized controlled trials to determine whether early TIPS actually improves outcomes in this setting. They analyzed trials with 689 patients, approximately half of whom received early TIPS and the remainder standard therapy. They observed no difference in all-cause mortality between these groups. However, the difference for the risk for rebleeding was striking — it was 80% lower in patients who underwent early TIPS. Surprisingly, early TIPS was not associated with an increased risk for hepatic encephalopathy and new or worsening ascites. These results suggest that when we treat patients with acute variceal bleeding, we really should consider early TIPS. Portal Hypertension Guidance DDW 2025 featured a great discussion led by Dr David Kaplan,[3] the primary author of the recent guidance on risk stratification and management of portal hypertension and varices in cirrhosis from the American Association for the Study of Liver Diseases (AASLD). Kaplan did a bang-up job, and I wanted to highlight a couple of crucial points. Firstly, he noted that if you have a patient with compensated cirrhosis, it should be the standard of care to assess them for clinically significant portal hypertension, defined as portal pressure gradient ≥ 10 mm. You'll want to ensure you can adequately evaluate for it in your locale. If you determine that the patient does have clinically significant portal hypertension, the new AASLD guidance endorses using carvedilol as prophylactic treatment. The use of pharmacotherapy precludes the necessity of screening endoscopy for most patients. This is another seismic shift, as we certainly have not been practicing that way. However, certain patients may have risks that do not make them eligible candidates for beta-blockers like carvedilol. In these instances, patients will require endoscopic intervention and evaluation. Kaplan also noted that the AASLD guidance discusses evaluating patients for whether they are candidates for preemptive placement of TIPS. Given that the 6-week mortality for acute variceal hemorrhage is in the 10%-15% range, this is something that we really need to be doing a better job at addressing. Predicting MASLD Earlier Another noteworthy study was presented in the liver population,[4] this one on the topic of predicting metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease. A team of researchers from China analyzed proteomics data from UK Biobank participants. They looked at approximately 2700 proteins, identifying five that were highly accurate in predicting MASLD. These proteins had an approximate prediction accuracy of 86% at 5 years from onset and 76% at 16 years. Their predictive performance was improved when augmented with clinical biomarkers, such as body mass index and daily exercise, which increased the accuracy to approximately 90% at 5 years and 82% at 16 years. It should be noted that this study did not set out to establish causality between MASLD and how these proteins interacted. For that, we'll need to await further analysis. The researchers did externally validate their results in populations in China. While we'll need to see what the eventual published manuscript reports, these data do indicate that promising new MASLD predictors may be on the horizon. GLP-1 Receptor Agonists for MASLD Glucagon-like peptide 1 (GLP-1) receptor agonists have recently emerged as an alternative to bariatric surgery for managing obesity. In this study from Stanford Medicine, Beth Israel, and the Allegheny Health Network,[5] researchers retrospectively analyzed a cohort obtained from the TriNetX database over a 6-year period. They compared outcomes in patients with MASLD receiving either GLP-1 receptor agonists or bariatric surgery. Surprisingly, they found that patients who received GLP-1 receptor agonists had significantly lower rates of major adverse liver outcomes (0.6% vs 1.2%) and all-cause mortality (0.3% vs 1.4%). If patients are willing and able to undergo medical therapy with GLP-1 receptor agonists, then we may want to consider revisiting how we approach metabolic liver disease. We need a multicenter prospective trial to evaluate this, but I'm certainly relieved to see this may make a difference in eligible patients. Timing Matters in Biliary Necrotizing Pancreatitis Patients with biliary necrotizing pancreatitis are expected to undergo cholecystectomy. The axiom is to wait for 6 weeks if they have had complications, particularly a pseudocyst. We're already familiar with using this intervention earlier in patients who present with uncomplicated pancreatitis or cholecystitis. In this study,[6] researchers conducted a retrospective analysis of a cohort of patients with biliary necrotizing pancreatitis, using data obtained from TriNetX. Their results suggested that it's better to delay cholecystectomy to beyond 16 weeks, given that it reduces the risk for adverse events without increasing mortality. Obviously, these patients still face the risk for recurrent biliary events, but delaying this surgery may be warranted in complicated biliary pancreatitis. 3D Tech Comes Up Short for Cancer Detection There was a study whose negative findings I think are worth mentioning. In it, researchers analyzed wide-angle transepithelial sampling with 3D analysis (WATS3D) as an adjunct to random forceps biopsies in patients with Barrett esophagus.[7] The technology has been suggested to have clinical benefit for detecting dysplasia and adenocarcinoma. This study from Europe, led by Jacques Bergman and colleagues, is the largest conducted to date on the topic. They found no significant diagnostic advantage for using WATS3D, which caught my attention given that guidelines have also not been able to fully endorse this technology based on existing evidence. During the 3-year follow-up, there were no cases of high-grade dysplasia or early adenocarcinoma confirmed by WATS3D that hadn't already been identified as at-risk via random forceps biopsies. This is a wake-up call that we should scrutinize its utilization. The juice may not be worth the squeeze. Microbiome Alterations in Esophageal Disorders The esophageal microbiome is a topic of particular interest to me. Therefore, I was pleased to see this study from Dr Mark Pimentel and his group at Cedars-Sinai,[8] who analyzed the small-bowel microbiome in patients with and without gastroesophageal reflux disease or Barrett esophagus. They found that there was a significant alteration in small-bowel microbiome changes in patients with these conditions, particularly linked with hydrogen sulfide–producing species. Anxiety/Hypervigilance Associated With Laryngopharyngeal Symptoms The next study[9] also relates to the esophagus, specifically to those patients with laryngopharyngeal symptoms who are often referred to us by our ENT colleagues. In this retrospective analysis, researchers evaluated adult patients presenting with both typical esophageal and laryngopharyngeal symptoms for symptom-specific anxiety and hypervigilance using patient-reported outcome measures. Patients with laryngopharyngeal presentation had a higher systemic burden as compared to those without this condition, particularly for hypervigilance. When treating these patients, I find it helpful to have them do diaphragmatic breathing. There are also emerging interventions in the form of virtual reality and gut-brain axis interventions, which may be worth considering in your practice. Extrapancreatic Cancer Risk in Chronic Pancreatitis Although we know patients with chronic pancreatitis are at an increased risk for pancreatic cancer, there have been few studies on extrapancreatic cancer. This provocative evaluation[10] comes to us from researchers at Johns Hopkins University, who looked at nearly 500 patients with chronic pancreatitis. They found that these patients had a threefold increase in the incidence of extrapancreatic cancers, in addition to an increased risk for pancreatic cancer. The most common extrapancreatic cancers were in the lung; however, bladder cancer, esophageal cancer, and a range of gastrointestinal cancers, including colon cancer, were observed as well. Smoking was associated with an almost three times greater incidence of extrapancreatic cancers. Among smokers, pack-year history was significantly higher in those who developed cancer. These results should encourage us providers who are entrusted with taking care of patients with chronic pancreatitis to do a better job. The delay between diagnosis of chronic pancreatitis and extrapancreatic cancers and pancreatic cancer was approximately 8 and 6 years, respectively. We need to improve our monitoring of these patients following their chronic pancreatitis diagnosis. This year's DDW was as exciting as ever, with important new information. We'll look forward to reviewing the manuscripts for these studies when they arrive. But, hopefully, these abstract highlights provide you with some actionable guidance now that you can apply to your clinical management. I'm Dr David Johnson. Thanks again for listening.
Medscape
16-05-2025
- Health
- Medscape
10 Actionable, Easy Interventions for GI Conditions
This transcript has been edited for clarity. Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University in Norfolk, Virginia. I've just returned from Digestive Disease Week (DDW) 2025 in San Diego, California, and want to give you the highlights. I selected several noteworthy abstracts, which I'm going to cover in two separate presentations. If you registered for DDW 2025, you can access these abstracts on the conference website. However, if you didn't register, you'll need to wait for them to come out in publication. Inulin: A Promising Prebiotic The first abstract I'd like to highlight comes from a translational study,[1] which offered important data related to the use of inulin, a prebiotic that enhances short-chain fatty acid production. In previous studies, the team of researchers from Montreal, Canada, demonstrated inulin-enhanced anastomotic healing in mice as part of testing its efficacy for preventing leaks following colorectal surgery. In this current study, they assessed inulin's ability to hinder colorectal cancer cell growth in mice 'humanized' with microbiota. They found that inulin had a dramatic effect in the form of decreased dissemination of liver metastasis and subcutaneous growth of colorectal cancer cells. Mechanistically, they ascribed this to activation of the peroxisome proliferator-activated receptor pathway in the gut, which seems logical. Inulin is a naturally occurring dietary fiber, found in many plant species including chicory root, and is readily available commercially. There's no known risk associated with inulin, which makes these results actionable now. In a separate study,[2] researchers at the Children's Hospital of Philadelphia conducted a double-blind randomized trial looking at inulin's effects in children with subclinical active inflammatory bowel disease (IBD). They showed that inulin supplementation was associated with a reduction in fecal calprotectin levels, as well as improvements in the relative abundance of Bifidobacterium . These findings indicate that shifts in microbial health and reduced inflammation can be achieved in children with IBD using supplements with this naturally occurring oligosaccharide. Inulin is simple to implement. While I'm not sure about its use in adults, I plan on immediately using it as an intervention for the populations identified in these studies. It seems to be a no brainer. Alternatives to FMT for Clostridioides difficile In December 2024, gastroenterologists faced a conundrum following the news that fecal microbiota transplantation (FMT) would no longer be available from OpenBiome. A real-world study,[3] presented at DDW 2025, sheds some light on possible alternatives to standard FMT by comparing it with the US Food and Drug Administration-approved treatments of Rebyota (fecal microbiota, live-jslm), which is usually administered via enema, and Vowst (fecal microbiota spores, live-brpk), which is administered via oral capsules. Researchers assessed C difficile recurrence within 8 and 24 weeks, with stratification of results based on the presence of other relative risks like bezlotoxumab and presence of IBD. At 8 weeks, there was a significantly lower risk of recurrent C difficile following treatment with Rebyota and Vowst, which were approximately 20% better when compared with standard FMT, a difference that was maintained out to 24 weeks. Although we no longer have access to OpenBiome, these other therapies seem to offer a comparable — and perhaps superior — intervention. The only caveat is that the improvement was statistically superior when Rebyota was administered via colonoscopy, which was more frequently done than via enema in this study, although the latter administration method showed improvement. This may simply be due to the larger number of people who received it via colonoscopy, but we'll have to wait and see. However, I don't think we need to step back from treatment for C difficile , given that we have these commercially available products. AI in Adenoma Detection We're all aware that artificial intelligence (AI) is being used in many gastrointestinal (GI) indications of late and showing how it can improve outcomes. This was proven again in a study[4] from King's College London, where researchers performed a randomized, open-label trial using GI Genius, an AI module. They analyzed the adenoma detection rate (ADR) among colonoscopists classified as either non-expert or expert, categories defined as having performed less than or more than 2000 lifetime colonoscopies, respectively. Furthermore, the experts had an ADR > 40%, which is within the range of typical standards. The American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology Quality Task Force recommends an ADR of at least 35%, so the experts on this study really were. Colonoscopies were performed at eight sites by 34 endoscopists, with an approximately 2:1 ratio for non-experts to experts. The findings showed that the ADR was improved by 9.5% when using the AI module. Interestingly, the experts' ADR actually decreased with the use of the AI module, and it seemed most beneficial for those with lower detection rates. There were three guidelines produced in 2025 regarding the use of computer-assisted detection colonoscopy. One says we should use AI, one says we shouldn't, and the third— from the American Gastroenterological Association — says that we don't have enough evidence to support it yet. All in all, the recommendations are very conflicting. However, for me, the evidence seems to clearly indicate that lower-end ADR is considerably improved with AI and makes a difference. Motivating Patients With Wearable Technology There were a pair interesting studies around the use of technological tools in GI indications. The first study[5] comes from Lynn Chang's brilliant research group, who analyzed outcomes in patients with irritable bowel syndrome wearing a Fitbit, a popular device used by approximately 38.5 million people. The researchers used the Fitbit to capture participants' daily step count and sleep data. It should be noted that there are data indicating that a Fitbit seems relatively comparable with polysomnography, which is the gold standard for monitoring sleep efficiency. The team found that increased daily step count and median hours of sleep were associated with lower irritable bowel syndrome severity. In the next study,[6] researchers from Cedar-Sinai Medical Center in Los Angeles, California, conducted a prospective study with the Garmin vivofit, another activity tracker. The study essentially performed the same analysis, focusing on sleep and physical activity. However, in this case, they looked at preoperative and postoperative outcomes in patients with ulcerative colitis and Crohn's disease undergoing colorectal surgery. Once again, researchers found that increased physical activity and optimal sleep efficiency improved outcomes. Specifically, they were associated with fewer surgical complications and decreased length of stay. As with some of the previously mentioned interventions, these wearable devices are commercially available. Together, the findings from these two studies indicate that wearable devices could be a very valuable self-management tool to encourage patients to monitor themselves, strive for improvement, and do so at a negligible cost. Immune Checkpoint Inhibitors Two studies offered important findings on the use of checkpoint inhibitors, which are being used more frequently for GI complications. In fact, GI immune-related adverse events account for up to 41% of adverse events in patients with IBD. The first study[7] comes from Memorial Sloan Kettering Cancer Center in New York City. Researchers looked at a retrospective cohort of patients with IBD treated with immune checkpoint inhibitors over an 11-year period, assessing for a variety of outcomes related to GI toxicity. They found that GI toxicity led to immune checkpoint inhibitor discontinuance in 72% of patients. Discontinuation was more common in patients with active IBD at treatment initiation and among those whose pre-treatment disease was more severe. This finding suggests how important it is to receive consultation and disease assessment from an IBD specialist. They can help proactively determine how to optimize immune checkpoint inhibitor therapy before it begins. Treating these high-risk patients really does call for a multidisciplinary care team. The second study[8] caught my attention because I was unfamiliar with the topic: immune checkpoint inhibitor-related esophagitis. Researchers conducted a retrospective study with a 15-year follow-up on patients who underwent esophagogastroduodenoscopy with biopsy after receiving at least one dose of an immune checkpoint inhibitor. A diagnosis of immune checkpoint inhibitor-related esophagitis was confirmed by an expert GI pathologist. They identified 13 patients with symptoms, which were variable and included weight loss, dysphagia, anorexia, and nausea. Of the 13 patients, 54% had abnormalities on endoscopy. The takeaway is that we must perform biopsies when evaluating these patients. There are treatments available for esophageal toxicity. In this particular study, patients responded to proton pump inhibitors and budesonide, and some required an immunosuppressant medications such as biologics and systemic corticosteroids. Esophageal Complications With GLP-1 Receptor Agonists Another noteworthy study[9] delved into drug-related GI and esophageal-specific complications, in this case resulting from treatment with GLP-1 receptor agonists. We see GI motility and anesthesia issues related to these agents, but this complication concerns the effect on esophageal dysmotility. Researchers from the Mayo Clinic assessed the association of GLP-1 receptor agonist exposure on high-resolution manometry findings obtained over a 10-year period. They identified 447 patients who had been exposed to these medications, with a final comparison cohort of 84 cases and 84 controls. They found very specific, integrated relaxation pressures were statistically different in the patients taking GLP-1 receptor agonists. Distal contraction intervals were greater, as were the number of hypercontractile supine swallows, the incidence of hypercontractile esophagus, and the incidence of esophagogastric junction outflow obstruction. It's important to recognize this risk when performing manometry evaluations, and to be aware of the potential for new GI complications resulting from treatment with GLP-1 receptor agonists. Ergonomics and Endoscopy The final study[10] in this video relates to endoscopy. I thought this was important, given the ASGE guideline on ergonomics for preventing endoscopy-related musculoskeletal issues. This study comes from a team of researchers in South Korea. Using a variety of monitors, they assessed the ergonomics of endoscopists, who tend to hold static and repetitive upper limb postures. They found that 52% of endoscopists' postures fell into the high-risk category. The wrist and lower arm segments were most affected, with notable strain also placed in the head and torso regions. Fellows were more likely to be at risk, which makes sense since they're less experienced. These findings indicate that ergonomic challenges persist, despite current recommendations that we need to do better. Ensuring a robust system and emphasizing robotic ergonomic training and monitoring are important for self-preservation as we get older and further along in our endoscopy career. Stay tuned for part two of my highlights from DDW 2025, which offers exciting new findings that you won't want to miss. I'm Dr David Johnson. Thanks for listening.
