GHAPPcast

Christina Hanson, FNP, and Dr. Marcelo Kugelmas of South Denver Gastroenterology review linerixibat, an ileal bile acid transporter (IBAT) inhibitor, and its role in managing cholestatic pruritus in primary biliary cholangitis (PBC). This medication review podcast explores how blocking bile acid reabsorption in the ileum targets a pathway involved in persistent itching. The discussion covers the phase 2 GLIMMER study and phase 3 GLISTEN trial, including findings on itch reduction, sleep interference, and treatment response in patients with moderate to severe pruritus. The speakers also examine safety and tolerability considerations, including diarrhea, abdominal pain, nausea, elevated liver enzymes, and treatment discontinuation. Additional topics include preliminary results from the linerixibat long-term safety and tolerability study (LLSAT), maintenance of itch relief, and the need for further research on combining linerixibat with PPAR agonists. Designed for nurse practitioners, physician assistants, and other gastroenterology and hepatology professionals, this episode offers a clinical perspective on IBAT inhibitor therapy, persistent PBC-related itching, and the balance between symptom improvement and treatment tolerability.

Clarifications and context within the video 👇

• Linerixibat, an IBAT inhibitor, is the first FDA approved treatment for cholestatic pruritus in adults with PBC.
• WI-NRS is used to assess itch severity on a scale of 0-10.
• At 6:43, correction regarding the diagnosis of cirrhosis: It was 10% in the placebo group and 11% in the linerixibat group.
• At 10:24, the primary endpoints of the LLSAT study are frequency and severity of adverse events.
• At 11:20, the LLSAT mean WI-NRS reduction of 4.87 is for patients assigned to linerixibat in GLISTEN Part A and Part B after 52 weeks of continuous treatment.

How can clinicians better recognize and manage itching and fatigue in primary biliary cholangitis (PBC)? In this podcast, hepatology clinicians from RUSH University Medical Center discuss the impact of PBC-related pruritus and fatigue on sleep, daily activities, and quality of life. The conversation explores proactive symptom screening, assessing itch severity, and individualizing treatment with options such as cholestyramine, PPAR therapies, rifampin, and sertraline. The speakers discuss how their treatment approaches have evolved and why ongoing communication helps identify when symptom management needs to change. For patients experiencing PBC fatigue, they address evaluating contributing factors such as thyroid dysfunction, vitamin D deficiency, and anemia, along with sleep hygiene, exercise, and realistic expectations for treatment. Throughout the discussion, they emphasize that symptom severity does not necessarily reflect liver disease progression or biochemical response. This episode highlights the importance of looking beyond liver tests, validating patients’ experiences, and encouraging patient advocacy and support networks as part of comprehensive PBC care.

In this episode, HoChong Gilles of the Richmond VA Medical Center, and Alison Moe of Atlanta Gastroenterology discuss a practical, step-by-step approach to screening for and diagnosing cholestatic liver disease. The conversation reviews how to recognize a cholestatic liver test pattern, evaluate symptoms such as pruritus and jaundice, and confirm that an elevated alkaline phosphatase is hepatic in origin through fractionation and gamma-glutamyl transferase (GGT) testing. The experts explain how clinical history, medication and supplement use, laboratory findings, and imaging can help distinguish intrahepatic cholestasis from extrahepatic biliary obstruction. They also examine the roles of ultrasound, MRI/MRCP, endoscopic ultrasound, and ERCP when evaluating bile duct dilation, strictures, gallstones, primary sclerosing cholangitis, and possible malignancy. Additional topics include autoimmune testing for conditions such as primary biliary cholangitis, the importance of considering drug-induced liver injury and herbal supplements, and when a liver biopsy may be appropriate after a comprehensive noninvasive workup. This educational podcast provides gastroenterology and hepatology clinicians, advanced practice providers, and other healthcare professionals with a clear clinical framework for evaluating abnormal liver tests and identifying the underlying cause of cholestasis.

Thank you to Salix for their support on this podcast episode.

In this GHAPP podcast, host Christina Hanson, FNP, welcomes Janet Gripshover, DNP, FNP-BC, MBA, for a practical discussion on recognizing and managing overt hepatic encephalopathy (OHE) in patients with chronic liver disease and cirrhosis. The episode reviews how liver disease may progress from fibrosis to compensated and decompensated cirrhosis, where OHE can emerge as a serious complication. Christina and Janet highlight early signs that may be easy to overlook, including sleep-wake reversal, forgetfulness, personality changes, difficulty concentrating, slowed or slurred speech, balance problems, and challenges completing familiar daily activities.

Drawing on real-world patient scenarios, they discuss common OHE triggers and risk factors, including infection, gastrointestinal bleeding, constipation, dehydration, electrolyte imbalances, prolonged fasting, sedating medications, portosystemic shunting, and sarcopenia. The conversation also emphasizes that OHE is primarily a clinical diagnosis, the importance of involving family members and caregivers in symptom recognition, and the limited role of ammonia testing. Christina and Janet also review nutritional considerations, the use of FIB-4 in broader liver fibrosis assessment, timely follow-up, treatment adherence, and safety conversations surrounding driving, cooking, falls, and other daily activities. For more expert-driven GI and liver disease education, visit the GHAPP Digital Hub and GHAPP ACE app.

Thank you to Salix for their support on this FAQ video module.

In this FAQ video module, Natalie Oliver, PA-C, discusses how healthcare professionals can counsel patients and caregivers about overt hepatic encephalopathy (OHE). This educational overview explains how cirrhosis and portal hypertension can reduce the liver’s ability to clear toxins from the blood, potentially leading to changes in thinking, behavior, and daily functioning. Viewers will learn how OHE may present through obvious symptoms—such as disorientation, slurred speech, or severe confusion—or through more subtle changes, including fatigue, irritability, difficulty concentrating, and trouble finding the right words.

This video also highlights the importance of involving caregivers in symptom recognition while preserving patient autonomy, reviewing warning signs that require immediate medical attention, and reinforcing medication adherence through clear patient education. Natalie discusses additional counseling considerations, including avoiding sedating medications and constipation, supporting adequate protein intake and physical activity, and maintaining skeletal muscle mass. Ideal for gastroenterology and hepatology providers and advanced practice providers, this FAQ offers practical strategies for helping patients and families recognize OHE early and work collaboratively with the liver care team to manage this often-reversible complication. For more expert-driven GI and liver disease education, visit the GHAPP Digital Hub and GHAPP ACE app.

Thank you to Salix for their support on this FAQ video module. In this FAQ video module, Samantha Ramirez, NP-C, discusses how healthcare professionals can identify and diagnose overt hepatic encephalopathy (OHE) in patients with severe liver disease or cirrhosis. This educational overview highlights early signs that may be subtle or vary between patients, including changes in sleep patterns, slower thinking, difficulty concentrating, irritability, and mild confusion. Samantha also explains how tools such as FIB-4 can contribute to the broader assessment of liver disease severity and help providers understand a patient’s overall clinical picture.

This video reviews OHE as a primarily clinical diagnosis, including the importance of evaluating other potential causes of altered mental status and using the West Haven criteria to describe disease severity. It also explores the impact of OHE on patients and caregivers, as well as the need for strong communication, multidisciplinary collaboration, and continuity of care across inpatient and outpatient settings. Ideal for gastroenterology and hepatology providers and advanced practice providers, this FAQ offers practical guidance for recognizing OHE and supporting patients throughout their care.

For more expert-driven GI and liver disease education, visit the GHAPP Digital Hub and GHAPP ACE app.

Thank you to Johnson & Johnson for their support on this podcast episode.

In this GHAPP podcast, Amy Stewart, NP, of Capital Digestive Care, introduces a practical inflammatory bowel disease discussion with Amanda Wilhite, PA-C, of Houston Methodist Gastroenterology Associates. The episode explores how healthcare professionals may approach the two FDA-approved subcutaneous guselkumab maintenance dosing options for adults with moderate-to-severe Crohn’s disease and ulcerative colitis: 100 mg every eight weeks or 200 mg every four weeks.

Drawing on data from the Phase 3 GALAXI 2 and 3 Crohn’s disease studies and the QUASAR ulcerative colitis maintenance study, Amy and Amanda discuss how disease severity, inflammatory burden, C-reactive protein levels, endoscopic response, previous advanced-therapy exposure, and individual patient needs may inform maintenance-dosing conversations. They also share real-world perspectives on monitoring treatment response and using the lowest effective recommended dosage to maintain therapeutic response.

For additional IBD education, visit the GHAPP ACE app or digital hub.

Thank you to AbbVie for their support of this Medication Review Video Module.

In this medication review, Melissa Ferrari, PA, and Jennifer Hamilton, MSPAS, PA-C, provide a comprehensive overview of the INSPIRE and COMMAND clinical trials evaluating risankizumab for the treatment of moderately to severely active ulcerative colitis. The discussion reviews the trial design, patient populations, induction and maintenance dosing strategies, clinical and endoscopic endpoints, and the rationale behind the approved dosing regimen. The presenters also explain the significance of the phase 2 dose-ranging study and how the clinical development program informed the FDA-approved treatment approach.

Melissa and Jennifer review key efficacy findings, including clinical remission and endoscopic improvement during both induction and maintenance, with a particular focus on outcomes in advanced therapy-naïve patients. They also discuss practical considerations for selecting between the available maintenance doses, the role of top-down treatment strategies, administration using the on-body injector, and recommendations for patient counseling and liver enzyme monitoring. Safety outcomes are reviewed, reinforcing the established safety profile of risankizumab and providing clinicians with practical guidance for incorporating this IL-23 inhibitor into routine clinical practice.

This educational video is designed for gastroenterology nurse practitioners, physician assistants, gastroenterologists, and other healthcare professionals seeking practical insights into evidence-based treatment of ulcerative colitis. Viewers will gain a deeper understanding of the INSPIRE and COMMAND clinical trial data and how these findings can help guide treatment selection, optimize long-term disease control, and support shared decision-making with patients receiving risankizumab.

For more GI and hepatology education, visit the GHAPP Digital Hub and the GHAPP ACE app.

Thank you to AbbVie for their support on this Medication Review Video Module.

In this medication review, Sharon Dudley-Brown, CRNP, PhD from Johns Hopkins University and Angelina Collins, MSN, ANP-BC, from the University of California San Diego, provide a comprehensive overview of the SEQUENCE trial, a landmark head-to-head study comparing risankizumab and ustekinumab in patients with moderate to severe Crohn’s disease who had previously failed anti-TNF therapy. The discussion explores the trial design, patient population, dosing strategies, primary and secondary endpoints, and the significance of efficacy assessor blinding in an open-label study.

Sharon and Angelina review key findings demonstrating the superiority of risankizumab over ustekinumab across multiple clinical and endoscopic outcomes, including clinical remission, endoscopic response, corticosteroid-free remission, and long-term disease control. They also discuss the importance of objective disease assessment using centrally read endoscopy and the role of steroid tapering in evaluating treatment success. Safety outcomes are examined, highlighting the absence of new safety signals and reinforcing the established safety profile of risankizumab.

This educational video is designed for gastroenterology nurse practitioners, physician assistants, and other healthcare professionals seeking practical insights into evidence-based treatment selection for Crohn’s disease. Viewers will gain a deeper understanding of how the SEQUENCE study may influence treatment positioning of IL-23 therapies in anti-TNF-experienced patients and how emerging long-term extension data continue to support durable clinical remission and endoscopic improvement with risankizumab.

Thank you to Johnson & Johnson for their support on this FAQ Video Module.

In this educational video, Jamie Brogan, APRN, from Northwestern Medicine, reviews the latest QUASAR long-term extension data evaluating the efficacy and safety of guselkumab in adults with moderate to severe ulcerative colitis. This discussion highlights approximately two years of follow-up data, offering healthcare providers valuable insight into the long-term durability of treatment response, clinical remission, endoscopic improvement, and overall safety outcomes associated with guselkumab maintenance therapy.

Jamie walks through the key findings from the ongoing multicenter extension study, including sustained clinical remission rates, corticosteroid-free remission, endoscopic healing, and histologic-endoscopic mucosal improvement through week 92. The video also reviews the maintenance dosing strategies of guselkumab, including 100 mg every 8 weeks and 200 mg every 4 weeks, and discusses how patients who responded during earlier phases of treatment maintained those responses over time. In addition, the presentation covers important long-term safety findings, including rates of serious infections and adverse events observed throughout the study.

This video is designed for gastroenterology APPs, nurse practitioners, physician assistants, gastroenterologists, and healthcare professionals looking to stay current on emerging ulcerative colitis therapies, long-term biologic data, and evolving treatment goals in inflammatory bowel disease (IBD).

For more educational content on ulcerative colitis, Crohn’s disease, gastroenterology, and hepatology, visit the GHAPP Digital Hub and the GHAPP ACE app.