GHAPPcast

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Join Monica Nandwani, GI nurse practitioner in California, as she explores the complex causes and progression of Irritable Bowel Syndrome (IBS), a common yet often misunderstood disorder of gut-brain interaction (DGBI). In this episode, Monica breaks down the multifactorial nature of IBS, including key contributors like gastrointestinal dysmotility, visceral hypersensitivity, post-infectious changes, intestinal inflammation, food sensitivities, bacterial overgrowth (SIBO), microbiome imbalances, genetics, and psychosocial stressors. Learn how IBS symptoms—ranging from chronic abdominal pain to diarrhea and constipation—can persist, shift, or even improve over time. Monica also reviews data on long-term outcomes and how IBS subtypes may evolve. Whether you're a healthcare provider or someone living with IBS, this discussion offers valuable clinical insight into one of the most common reasons for GI referral. For more expert content, visit the GHAPP website or the GHAPP ACE App.

Thank you to AbbVie for your support on this podcast episode.

In this episode, Kim Orleck, PA-C, and Kristina Skarbinski, NP, dive into the critical topic of setting patient expectations when initiating therapy for IBS-C (Irritable Bowel Syndrome with Constipation). Building on their previous discussion around diagnosing IBS with confidence using a positive diagnostic strategy, Kim and Kristina now focus on how to effectively transition patients from over-the-counter options to prescription therapies. They emphasize the importance of shared decision-making, clear communication, and addressing common patient concerns, such as fears about medication dependence, side effects like diarrhea, and long-term treatment timelines. The episode explores how to guide patients through symptom tracking, establish realistic goals for bowel movement improvements versus pain or bloating, and use resources like the Rome IV criteria, ACG guidelines, and bowel diaries to improve adherence and outcomes. Listeners will learn how to proactively address discontinuation risks, personalize follow-up plans, and empower patients to be active partners in managing their IBS-C. Whether you’re a seasoned APP or new to GI care, this discussion offers practical tools to enhance medication adherence, improve patient satisfaction, and support long-term success in IBS-C management.

Discover more resources and educational tools at GHAPP.org and on the GHAPP ACE App.

In addition to GHAPP's IBS educational resources, please see essentialsofibs.com for more.

#PatientExpectations #NewTherapy #TreatmentInitiation #PatientEducation #SharedDecisionMaking #ChronicDiseaseManagement #HealthcareCommunication #TherapyOutcomes #ClinicalPractice #MedicalEducation #ProviderTips

Thank you to AbbVie for your support on this podcast episode.

In this episode, Kim Orleck, PA-C, and Kristina Skarbinski, NP, share a practical, guideline-based approach to diagnosing irritable bowel syndrome (IBS) with confidence. Drawing on years of clinical experience in GI, they highlight the importance of applying the Rome IV criteria and shifting from outdated diagnostic strategies to a positive diagnostic approach that relies on patient history, absence of alarm symptoms, and minimal lab testing. The conversation explores how to effectively rule out red flags like anemia, rectal bleeding, weight loss, and family history of IBD or colon cancer, while avoiding unnecessary colonoscopies in low-risk patients. Listeners will learn how to implement ACG and AGA guidelines, optimize limited diagnostic workups (CBC, CRP, celiac panel, fecal calprotectin), and build trust with patients through shared decision-making. Kim and Kristina also offer tips for advanced practice providers (APPs) on improving patient engagement—like using tools such as the Bristol Stool Scale and symptom tracking to increase diagnostic clarity and treatment adherence. Whether you're a new or experienced GI provider, this episode reinforces how to diagnose IBS with clinical confidence and reduce diagnostic overuse, while keeping patient education and communication at the center of care.

Access more resources at GHAPP.org or download the GHAPP ACE App to stay updated on evidence-based GI practice.

In addition to GHAPP's IBS educational resources, please see essentialsofibs.com for more.

#IBS #IrritableBowelSyndrome #IBSDiagnosis #DigestiveHealth #FunctionalGI #Gastroenterology #RomeCriteria #ChronicGIConditions #PatientCare #MedicalEducation #GIHealth #ConfidentDiagnosis

Thank you to AbbVie for your support on this podcast episode.

In this episode, Carol Antequera, DMSc, PA-C, and Jennifer Geremia, PA-C, dive into the clinical nuances of diagnosing and managing exocrine pancreatic insufficiency (EPI). Guided by AGA best practices, they explore how to recognize hallmark symptoms such as chronic diarrhea, steatorrhea, weight loss, and fatigue, even in patients without overt pancreatic disease. From identifying key risk factors—including chronic pancreatitis, cystic fibrosis, pancreatic cancer, diabetes, and post-surgical anatomy—to the appropriate use of diagnostic tools like fecal elastase testing, this conversation provides a clear roadmap for providers managing suspected EPI in both tertiary and community care settings. The discussion emphasizes practical guidance for initiating pancreatic enzyme replacement therapy (PERT), determining optimal dosing, addressing challenges with adherence, and monitoring nutritional deficiencies and vitamin absorption. Carol and Jennifer also highlight the importance of dietary counseling, managing psychosocial factors, and the long-term safety of empiric therapy, even when diagnostic certainty is limited. Whether you're new to managing EPI or seeking tips for improving outcomes in complex cases, this episode offers actionable, evidence-based strategies to enhance your GI practice.

Learn more or access related resources via the GHAPP ACE App and GHAPP.org.

In addition to GHAPP's IBS educational resources, please see essentialsofibs.com for more.

#EPI #ExocrinePancreaticInsufficiency #PERT #PancreaticEnzymes #Gastroenterology #DigestiveHealth #EPIDiagnosis #PERTDosing #FatMalabsorption #ChronicGIConditions #MedicalEducation #GIHealth

Thank you to AbbVie for your support on this podcast episode.

In this episode, gastroenterology experts Amy Ladewski, PA-C and Hannah Ryan, NP discuss how to effectively implement the 2022 AGA and ACG IBS guidelines into clinical practice. Together, they explore real-world applications of both pharmacologic and non-pharmacologic recommendations for IBS-C and IBS-D, highlighting differences in treatment approaches, diagnostic strategies, and personalized care pathways. Listeners will learn how to confidently apply Rome IV criteria, reduce unnecessary diagnostic testing, and make evidence-based transitions from over-the-counter options to prescription therapies like linaclotide and plecanatide. The conversation emphasizes the importance of a multidisciplinary model that includes GI dietitians, pelvic floor physical therapists, and behavioral health support, while also addressing common challenges such as insurance barriers, patient expectations, and time constraints in clinical settings. Amy and Hannah also share strategies for enhancing patient education, supporting those with varying levels of health literacy, and advocating for more time and resources to improve long-term outcomes. Whether you're new to managing IBS or looking to refine your current approach, this episode offers practical tools to enhance your care for patients with motility disorders and gut-brain interaction syndromes.

Visit GHAPP.org to learn more, and download the GHAPP App for more education on IBS, motility disorders, and neurogastroenterology.

In addition to GHAPP's IBS educational resources, please see essentialsofibs.com for more.

#IBS #IBSGuidelines #IrritableBowelSyndrome #FunctionalGI #Gastroenterology #DigestiveHealth #GuidelineBasedCare #IBSManagement #ChronicGIConditions #RomeCriteria #MedicalEducation #EvidenceBasedPractice

Thank you to Johnson & Johnson for your support of this GHAPPcast episode.

Join host Gabriella McCarty, NP-C, and special guest Teddy Solomon, NP, from Cedars-Sinai, for an in-depth discussion on The Clinical Utility of Guselkumab in Crohn’s Disease. In this episode of GHAPPcast—the official podcast of the Gastroenterology & Hepatology Advanced Practice Providers (GHAPP)—we examine how this IL-23 inhibitor may fit into the evolving treatment landscape for patients with Crohn’s disease.

Teddy, a recognized IBD expert and plenary speaker at the recent GHAPP National Conference, shares clinical insights, trial data, and personal perspectives on the unique mechanism of action behind guselkumab. You’ll learn about its potential role in induction and maintenance therapy, the results of the GRAVITI and GALAXI trials, and how it compares to other therapies like ustekinumab and risankizumab. We also explore which patient profiles may benefit most from guselkumab and which scenarios may call for a different approach.

Whether you're biologic-naive or exploring options beyond TNF inhibitors, this episode will give you tools to navigate shared decision-making and better support patients through personalized IBD care.

Subscribe to GHAPPcast on your favorite podcast platform, and visit ghapp.org for more expert-led resources and clinical tools for APPs in GI and hepatology.

Thank you to Intercept for your support of this podcast episode.

Welcome to the CLDF/GHAPP PBC Podcast Series. In this episode, Dr. Kimberly Brown, Associate Medical Director at Henry Ford Hospital in Detroit, Michigan, is joined by Dr. Sonal Kumar, Assistant Professor of Medicine and Director of Clinical Hepatology at Weill Cornell in New York City. Together, they explore the real-world management of Primary Biliary Cholangitis (PBC), focusing on optimizing first-line therapy with ursodiol (UDCA) and the shift toward earlier initiation of second-line therapies. The conversation highlights evidence-based dosing strategies, side effects commonly seen with ursodiol—such as GI discomfort and hair loss—and the variation in tolerability among different generic formulations. Drs. Brown and Kumar also discuss how clinicians are rethinking the timing for evaluating response, moving from the traditional 12-month window to as early as 3 to 6 months, based on changes in alkaline phosphatase and bilirubin levels. They share how they prepare patients for second-line therapy, set expectations, and use lab trends and annual FibroScan assessments to demonstrate treatment success—even when symptoms may not noticeably improve. This episode provides expert insights from two leading hepatologists in Detroit and New York City, offering practical, patient-centered strategies for improving long-term outcomes in PBC management.

Thank you to Intercept for your support of this podcast episode.

In this episode of the CLDF/GHAPP PBC Podcast Series, Dr. Kimberly Brown, Professor of Medicine at Henry Ford Hospital in Detroit, Michigan, and Dr. Sonal Kumar, Assistant Professor and Director of Clinical Hepatology at Weill Cornell Medicine in New York City, explore how clinical practice is evolving when it comes to earlier intervention and individualized treatment in Primary Biliary Cholangitis (PBC). With second-line therapies now available, the discussion centers on when to move beyond ursodiol (UDCA), how to evaluate response using markers like alkaline phosphatase and bilirubin, and why the traditional 12-month assessment window is shifting earlier to 3 or 6 months. Drs. Brown and Kumar share insights from their respective practices, emphasizing a more proactive and personalized approach to managing PBC patients—especially those with advanced fibrosis at baseline, men, and patients from underrepresented populations who may be at higher risk for progression. They also discuss the importance of treatment normalization, monitoring response trends over time, and using early biochemical signals to determine the need for second-line therapies. This episode provides real-world perspectives from hepatology leaders in two major academic centers, highlighting the importance of shifting away from “wait-and-see” models and toward timely, aggressive care that optimizes long-term outcomes in PBC.

Thank you to Intercept for your support of this podcast episode.

In this episode of the CLDF GHAPP PBC Podcast Series, Dr. Kimberly Brown joins Dr. Steven Flamm for an important discussion on building a sense of urgency around evaluating and monitoring patients with Primary Biliary Cholangitis (PBC). Together, they explore how clinical practice has evolved to recognize the variability and unpredictability of PBC progression, emphasizing the importance of early assessment, frequent follow-up, and timely adjustments to therapy. Drawing on new guidance from the CLDF and their own experience at major transplant centers, Drs. Brown and Flamm stress the importance of tracking alkaline phosphatase and bilirubin levels as key indicators of disease activity and risk. They highlight that certain high-risk populations—such as men, patients of color, and younger individuals—require even closer monitoring due to more aggressive disease trajectories. The conversation also addresses the need to reassess patients within three to six months of initiating therapy, the clinical implications of inadequate response to first-line treatment with ursodiol (URSO), and when to consider second-line options. Additionally, the episode explores the intersection of PBC and other liver conditions like MASH, underscoring the importance of a comprehensive approach in complex patients. This discussion, rooted in real-world hepatology practice in the Midwest, offers practical, timely guidance for clinicians nationwide who are striving to deliver optimal care for patients with PBC.

Thank you to Intercept for your support of this podcast episode.

Welcome to the CLDF GHAPP PBC Podcast Series. In this episode, Dr. Kimberly Brown is joined by Dr. Steven Flamm for an in-depth discussion on primary biliary cholangitis (PBC). Together, they explore the unpredictable progression of PBC to fibrosis and cirrhosis, offering real-world insights into how liver disease develops even in patients who may not exhibit symptoms early on.

The conversation emphasizes the importance of early diagnosis, close monitoring, and timely intervention to improve outcomes. Drs. Brown and Flamm dive into non-invasive methods for assessing fibrosis—including elastography and proprietary serum biomarkers—and discuss why simple tools like APRI and FIB-4 are helpful for initial risk stratification but less reliable for monitoring long-term disease progression. They also discuss the clinical significance of rising bilirubin levels in PBC, the limitations of routine imaging in identifying advancing fibrosis, and the importance of identifying secondary causes of liver disease.

This episode also touches on when to consider second-line therapies, how to identify candidates for liver cancer screening, and the role of transplant centers in managing advanced disease. If you’re a clinician treating PBC or other chronic liver conditions, this conversation provides valuable guidance on how to optimize care and improve outcomes across the entire spectrum of liver disease.