Learn how to apply practical, non-invasive tools like FIB-4 and FibroScan to assess fibrosis risk, when to refer patients, and how to navigate common challenges such as intermediate scores and normal liver labs. With MASH becoming a leading cause of liver disease, this discussion provides actionable strategies for advanced practice providers and primary care clinicians to improve early detection and patient outcomes.

Visit the GHAPP Digital Hub and GHAPP ACE app for more educational content.

This expert discussion dives into key clinical considerations such as induction versus maintenance strategies, patient selection, safety, and real-world implementation of SubQ therapies. The episode also emphasizes the importance of multidisciplinary collaboration between rheumatology and GI providers, especially when managing patients with overlapping conditions like psoriatic arthritis and axial spondyloarthritis. Listeners will gain practical insights on optimizing treatment decisions, enhancing patient education, and leveraging a shared “toolbox” of therapies to better manage complex, multi-system disease.

For more expert-driven education and cross-specialty insights, visit the RhAPP Content Rheum, GHAPP Digital Hub & both GHAPP & RhAPP ACE apps.

In this FAQ video module, Tedra Gray, a gastroenterology nurse practitioner at Sinai Chicago, breaks down the key differences between treat-through and randomized withdrawal clinical trial designs in inflammatory bowel disease (IBD). This educational overview explains how these two study designs impact the evaluation of new IBD therapies, including their role in assessing safety, efficacy, and long-term patient outcomes. Viewers will learn how treat-through trials randomize patients at baseline to receive either active treatment or placebo throughout the study, offering insights into real-world effectiveness from induction through maintenance. In contrast, randomized withdrawal designs focus on patients who initially respond to therapy, re-randomizing them to continue treatment or switch to placebo—allowing for more efficient study design, reduced placebo exposure, and a focus on maintenance of response.

This video also explores key considerations such as population selection, ethical implications, study objectives, and how these designs are applied in major Phase 3 IBD trials like ASTRO, GRAVITI, GALAXY, and QUASAR. Ideal for gastroenterology providers and advanced practice providers, this content provides practical insights into interpreting clinical trial data and optimizing treatment strategies in IBD.

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

The conversation highlights early screening for overlapping immune-mediated inflammatory diseases (IMIDs), recognizing subclinical gut inflammation, and selecting cross-indication therapies such as JAK inhibitors and IL-23 inhibitors based on disease severity, comorbidities, and cardiovascular risk. Listeners will gain practical insights into biomarker use (including fecal calprotectin), second-line treatment strategies after TNF failure, and the importance of real-time collaboration between rheumatology and GI providers to optimize patient outcomes.

For more educational content, visit the GHAPP Digital Hub or GHAPP ACE app.

In this journal club review, Kimberly Orleck, PA-C, discusses the long-term efficacy and safety of risankizumab, an IL-23 p19 inhibitor, in moderate to severely active Crohn’s disease, highlighting results from the FORTIFY maintenance trial and its open-label extension. Data show strong Week 52 clinical remission and endoscopic response and remission rates in both biologic-naïve and biologic-experienced patients, many with prior biologic failure, reinforcing the importance of treat-to-target goals and STRIDE-II recommendations. Long-term findings out to 276 weeks demonstrate sustained clinical and endoscopic outcomes with a favorable safety profile and no new safety signals over four years. The review also covers updated 2025 ACG and AGA guideline positioning and real-world U.S. claims data showing lower treatment switch rates and healthcare utilization with risankizumab compared to other advanced therapies, underscoring its role in evolving Crohn’s disease management. For more educational content, visit the GHAPP digital hub and GHAPP ACE app.

In this GHAPP podcast episode, Brooke Hodnik, PA, and Jamie Brogan, APRN, discuss the October 10, 2025 FDA label update for upadacitinib in adults with moderate to severe ulcerative colitis and Crohn’s disease. They break down what the expanded indication means in practice, including how clinicians should interpret terms like “clinically inadvisable” and “approved systemic therapy,” and how this update allows for more individualized treatment decisions beyond mandatory prior TNF exposure in certain scenarios. The conversation highlights key considerations such as high inflammatory burden in IBD, steroid-refractory disease, low albumin, immunogenicity concerns, and real-world barriers to biologic therapy. Brooke and Jamie emphasize the importance of clinical judgment, earlier access to appropriate advanced therapy when needed, and the goal of reducing hospitalizations, surgery risk, and long-term complications—ultimately improving quality of life for patients with moderate to severe IBD.

For more educational content visit GHAPP.org, the GHAPP Digital Hub or the GHAPP ACE app.

In this FAQ video module, Patrick Horne, NP, President of GHAPP and nurse practitioner at the University of Florida, provides a clear, practical overview of FDA-cleared biomarkers used in the detection and risk assessment of hepatocellular carcinoma (HCC). This discussion walks through key blood-based tests including AFP-L3, des-gamma-carboxy prothrombin (DCP), and how these markers—when combined with patient age and sex—are used to calculate the GALAD score to estimate the probability of HCC. The video also introduces newer diagnostic approaches such as the HelioLiver LDT, which evaluates tumor-associated DNA methylation patterns, and the Oncoguard-Liver test, a multi-target liquid biopsy analyzing both protein biomarkers and cancer-associated DNA. Designed for clinicians involved in liver disease management, this module highlights how FDA-cleared biomarkers can support earlier detection, improved risk stratification, and informed clinical decision-making in patients at risk for liver cancer.

Visit GHAPP.org, the GHAPP Digital Hub, and the GHAPP ACE app for additional gastroenterology and hepatology education and resources.

In this FAQ video module, Brooke Hodnick, PA-C, breaks down key updates to the expanded upadacitinib label for adults with moderate to severe ulcerative colitis and Crohn’s disease, effective October 10, 2025. The discussion focuses on what qualifies as an “approved systemic therapy” in the context of patients who have had an inadequate response to prior treatments or for whom TNF inhibitors are clinically inadvisable. Viewers will gain clarity on FDA-approved systemic therapies for induction and maintenance of remission, including TNF inhibitors, anti-integrins, IL-12/23 and IL-23 inhibitors, JAK inhibitors, and S1P modulators, as well as important distinctions around therapies such as steroids and immunomodulators that are commonly used but not FDA-approved as systemic maintenance options. The conversation also highlights the role of clinical judgment, individualized risk–benefit assessment, and current guidance from organizations such as the American College of Gastroenterology and the American Gastroenterological Association.

For more educational information, please visit GHAPP.org, the GHAPP Digital Hub or the GHAPP ACE app.

In this FAQ video module, Jamie Brogan, APRN from the IBD Center at Northwestern Medicine, breaks down the October 2025 FDA label expansion for upadacitinib in adult patients with moderate to severely active ulcerative colitis and Crohn’s disease. The discussion focuses on the updated indication for patients with an inadequate response or intolerance to TNF inhibitors—and importantly, the newly emphasized language around when TNF therapy may be considered “clinically inadvisable.” Jamie explores what this term means in real-world clinical practice, including patient-specific factors such as contraindications to TNF agents, need for rapid onset of action, prior treatment exposure, comorbidities, and access or adherence challenges. She shares practical insights on how this label expansion has impacted IBD management, increased treatment access, and supported individualized, risk-benefit decision-making between providers and patients.

In this FAQ video, Allysa Saggese, NP, reviews how clinicians can balance systemic and liver-directed therapies in the treatment of metabolic dysfunction–associated steatohepatitis (MASH) and shares insights on the evolving role of combination therapy. The discussion explores current guideline-aligned options, including GLP-1–based systemic therapies and liver-directed agents, and emphasizes individualized treatment decisions based on fibrosis stage, metabolic comorbidities, patient preferences, and access considerations. Designed for APPs and clinicians, this overview highlights why multimodal therapy—alongside lifestyle interventions like diet and exercise—is likely the future of MASH management.

In this FAQ video, Alison Moe, PA-C, discusses how alcohol consumption impacts the evaluation and progression of metabolic dysfunction–associated steatohepatitis (MASH) and why accurate assessment is critical in clinical practice. The discussion reviews the synergistic effects of alcohol and metabolic liver disease on fibrosis progression, explains current alcohol intake thresholds associated with increased risk, and outlines how biomarkers such as phosphatidylethanol (PEth) can provide objective insight into recent alcohol use. Designed for APPs and clinicians, this practical overview highlights how to differentiate MASH, alcohol-related liver disease (ALD), and MetALD to ensure accurate diagnosis, documentation, and treatment decisions.

In this medication review module, Michelle Barnett, PA-C, provides an in-depth overview of resmetirom, the first FDA-approved liver-directed thyroid hormone receptor beta (THR-β) agonist for adults with non-cirrhotic metabolic dysfunction–associated steatohepatitis (MASH) and moderate to advanced fibrosis (F2–F3). The discussion reviews MASH risk factors, resmetirom’s mechanism of action, dosing considerations, and key findings from the phase 3 MAESTRO-NASH trial, including improvements in liver histology and lipid parameters. Designed for APPs and clinicians, this concise review highlights how resmetirom fits into contemporary MASH management alongside lifestyle interventions such as diet and exercise.

#Hepatology #LiverDisease #ChronicHepatitisB #AdvancedPracticeProviders #GHAPP #TransplantHepatology #PatientCommunication #CulturalCompetency #HealthLiteracy #LiverCare #ChronicDiseaseManagement

In this short FAQ video module, Patrick Horne, President of GHAPP and a nurse practitioner at the University of Florida, discusses the critical role of noninvasive tests (NITs) in risk stratification and patient selection for patients with metabolic dysfunction–associated steatohepatitis (MASH). He explains how serum biomarkers and imaging help establish baseline fibrosis, clarify disease severity, and guide clinical decision-making in a condition with variable and non-linear progression. This overview emphasizes the importance of integrating NITs with a thorough patient history and physical exam to better understand fibrosis stage and optimize patient evaluation.

Visit the GHAPP Digital Hub or GHAPP ACE 2.0 app for more gastroenterology and hepatology education.

This journal club review explores the 2025 focused recommendations for the management of metabolic dysfunction–associated steatohepatitis (MASH) developed by advanced practice providers (APPs) across the United States and published in the Journal of Clinical Gastroenterology. Brian Lam, PA-C, reviews the evolving role of APPs in MASH care, key epidemiology insights, risk stratification using non-invasive tests, and practical guidance on identifying and treating at-risk patients with F2–F3 fibrosis. The discussion highlights real-world use of ELF, FibroScan, and FIB-4, an overview of resmetirom therapy, monitoring strategies, and a look ahead at emerging therapies shaping the future of MASH management.

Discover how Resmetirom is reshaping the treatment landscape for metabolic dysfunction–associated steatohepatitis (MASH) in this expert-led medication review with HoChong Gilles, DNP. This short medication review breaks down the therapy’s mechanism of action, pivotal MAESTRO-NASH trial data, fibrosis and steatohepatitis endpoints, ideal patient selection (F2–F3 disease), and key safety considerations. Learn how this first-in-class THR-β agonist delivers meaningful improvements in fibrosis and steatohepatitis without worsening disease, and why 2024 marked a turning point in MASH care. Perfect for APPs and clinicians looking to stay ahead in the rapidly evolving world of liver disease management.

In this episode, Christina Hanson, NP, breaks down the key functional and prognostic differences between fibrosis stage F3 and F4, explaining how liver architecture, portal hypertension, and risk of decompensation shape patient outcomes. Learn how staging impacts mortality risk in MASLD/MASH, why accurate identification of advanced fibrosis is critical, and how management strategies differ for patients with severe fibrosis versus cirrhosis. Christina reviews how clinicians can intervene early, slow progression, and monitor for complications such as variceal bleeding, ascites, and hepatic encephalopathy, while emphasizing the importance of addressing underlying liver disease to improve long-term survival.

#Fibrosis #LiverDisease #MASLD #MASH #Cirrhosis #F3Fibrosis #F4Fibrosis #LiverHealth #Hepatology #AdvancedFibrosis #LiverCare #NAFLD #NASH #PortalHypertension #LiverTransplant

Navigating pregnancy with inflammatory bowel disease (IBD) can bring unique questions, concerns, and misconceptions—especially for women of childbearing age. In this expert-led episode, Janette Villalon, PA and Angelina Collins, MSN, ANP-BC, two dedicated IBD specialists break down the latest evidence and global consensus recommendations on pregnancy and IBD. Together, they explore fertility considerations, preconception counseling, voluntary childlessness, medication safety during pregnancy and breastfeeding, the impact of disease activity on maternal and fetal outcomes, and how to debunk persistent myths around IBD and pregnancy. Learn why remission at conception is critical, how to approach family planning conversations in the clinic, which therapies—including biologics and biosimilars—can be safely continued, and when to involve maternal–fetal medicine or colorectal surgery. The hosts also discuss managing flares during pregnancy, monitoring strategies such as fecal calprotectin each trimester, and when C-section may be recommended. This conversation provides timely, practical guidance to help clinicians counsel women with Crohn’s disease or ulcerative colitis with confidence, reduce fears, and support healthy pregnancies and postpartum outcomes for IBD patients.

In this GHAPP FAQ Video Module, Christie Morrison, from Oshi Health and Texas Digestive Disease Consultants, explains how to discuss clinical remission with patients living with inflammatory bowel disease (IBD), including both Crohn’s disease and ulcerative colitis. She breaks down the different types of remission—clinical, biochemical, endoscopic, and steroid-free—and offers clear, practical ways for APPs and healthcare providers to communicate these concepts during patient visits. Christie discusses how to use objective markers such as CRP, ESR, fecal calprotectin, and lactoferrin, and how endoscopic scoring tools like the SES-CD and Mayo score can help track improvement and long-term disease control. She also emphasizes setting realistic expectations, the importance of treat-to-target goals, and the ultimate aim of achieving deep remission while minimizing steroid use. Watch to gain actionable strategies to educate your IBD patients about their treatment journey and the steps toward sustained remission.

#IBD #CrohnsDisease #UlcerativeColitis #ClinicalRemission #GHAPP #IBDTreatment #APPeducation #TreatToTarget #IBDManagement

In this episode of the GHAPP Podcast, Alison Krustapentus, NP-C and Christie Morrison, NP, join for an open discussion on mental and sexual health in inflammatory bowel disease (IBD). Together they explore the often-overlooked psychological and relational challenges that accompany chronic conditions like Crohn’s disease and ulcerative colitis—covering strategies to normalize sensitive conversations, screen for anxiety and depression using PHQ-2, PHQ-9, and GAD tools, and incorporate behavioral-health collaboration into routine care. The conversation also highlights practical ways to integrate IBD mental-health screening, sexual-wellness counseling, vaccine and health-maintenance checklists, and patient-partner communication into everyday gastroenterology practice. This episode underscores the importance of whole-person care in IBD management and offers real-world insights for APPs and healthcare professionals supporting patients living with chronic inflammatory disease.

#IBD #CrohnsDisease #UlcerativeColitis #MentalHealth #SexualHealth #Gastroenterology #InflammatoryBowelDisease #AdvancedPracticeProviders #GHAPPodcast #IBDCare

In this video, Amy Ladewski, PA-C, a physician assistant at Northwestern Memorial Hospital in Chicago, shares expert insights on how to develop a personalized treatment plan for irritable bowel syndrome with constipation (IBS-C). Amy explains why a one-size-fits-all approach doesn’t work, emphasizing the importance of reviewing each patient’s medical and psychosocial history, prior therapies, and most bothersome symptoms—whether constipation, abdominal pain, bloating, or distension. She highlights the role of FDA-approved therapies, gut-directed behavioral interventions such as cognitive behavioral therapy and hypnotherapy, as well as dietary strategies like the low FODMAP diet in optimizing care. Amy also stresses the importance of health literacy, insurance access, and collaboration with GI dietitians to ensure patients understand and can apply their treatment plan. For those with overlapping functional defecatory disorders, she underscores the value of diagnostic testing and pelvic floor physical therapy to achieve better outcomes. This holistic, individualized approach empowers patients with IBS-C to improve both bowel function and overall quality of life. For additional educational resources, visit GHAPP.org and the GHAPP ACE App.

#IBSC #IrritableBowelSyndrome #Gastroenterology #DigestiveHealth #GutHealth #GIHealth #IBSConstipation #IBSManagement #PatientEducation

In this podcast, Gabriella McCarty, NP, and Kimberly Orleck, PA-C, dive into the complexities of irritable bowel syndrome with constipation (IBS-C) and the wide range of therapies available to help patients. They discuss the importance of taking a thorough patient history to understand whether the primary symptom is constipation, bloating, abdominal pain, or overflow diarrhea—emphasizing that IBS-C treatment is not one-size-fits-all. Gabriella and Kim break down the differences between over-the-counter therapies like fiber and osmotic laxatives, which often help with bowel movements but do little for abdominal pain, and FDA-approved prescription options that also address visceral hypersensitivity, bloating, and global IBS symptoms. They explain how secretagogues and retenagogues work, set realistic expectations around therapy timelines, and highlight the importance of preparing patients for possible side effects such as diarrhea or nausea. By focusing on patient education, shared decision-making, and scheduled follow-up visits, they empower patients to better understand their condition and stay engaged in their care. This conversation provides practical guidance for both GI providers and patients navigating IBS-C management. For more educational resources, visit GHAPP.org and download the GHAPP ACE App.

#IBSC #IrritableBowelSyndrome #Gastroenterology #DigestiveHealth #GutHealth #GIHealth #IBSManagement #IBSConstipation #PatientEducation #GHAPPcast

In this episode of GHAPPcast, the official podcast of Gastroenterology and Hepatology Advanced Practice Providers, host Samantha Ramirez, NP-C is joined by Tracy Licari, PA-C to explore the rise of biomarker-based algorithms like GALAD in the surveillance of hepatocellular carcinoma (HCC). With more than 25 years of hepatology experience, Tracy shares insights on how combining biomarkers such as AFP, AFP-L3, and DCP with demographic factors like age and gender can improve diagnostic accuracy, risk stratification, and early detection compared to AFP alone. The discussion highlights how GALAD has consistently demonstrated higher accuracy in retrospective studies, the importance of ongoing prospective validation, and the potential for these algorithms to reshape surveillance, treatment response monitoring, and post-transplant risk assessment. Samantha and Tracy also provide practical ways for clinicians to explain complex biomarker concepts to patients without overwhelming them, reinforcing the importance of education and shared decision-making in liver cancer care. This episode delivers actionable insights for APPs, hepatologists, and GI clinicians seeking to stay ahead in the evolving landscape of biomarker-driven surveillance.

In this educational discussion, Mikhail Alper, PA-C, from Fresno, California, highlights the critical role of biomarkers like fecal calprotectin and C-reactive protein (CRP) in managing inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease. He explains how these biomarkers provide objective measures of inflammation and treatment response—often revealing more than patient-reported symptoms alone. Michael outlines a practical monitoring timeline, recommending assessment at six weeks to gauge early symptom improvement, followed by biomarker testing at 12 weeks, and endoscopic evaluation at six months to confirm mucosal healing. He also notes the growing value of intestinal ultrasound, though access remains limited in some regions. This video underscores why integrating biomarker monitoring into IBD management is essential for optimizing therapy and improving patient outcomes.

In this educational video, Alison Krustapentus, NP-C from Beth Israel Deaconess Medical Center in Boston discusses how to approach persistent inflammation in patients with inflammatory bowel disease (IBD). She outlines a step-by-step process for confirming true disease activity using objective measures such as C-reactive protein (CRP), fecal calprotectin, cross-sectional imaging, and endoscopy.

Alison also explains the role of therapeutic drug monitoring in optimizing anti-TNF therapy, including how to interpret trough levels and antibody testing to guide dose escalation or frequency adjustments. When drug levels are adequate but inflammation persists, she discusses switching mechanisms of action—from anti-TNF agents to IL-23 inhibitors, JAK inhibitors, or vedolizumab—to regain control of disease activity.

This video helps clinicians distinguish between primary non-response and secondary loss of response, emphasizing the importance of tracking biomarkers and imaging over time to make informed treatment decisions.

In this video, Amy Ladewski, PA-C, a physician assistant at Northwestern Memorial Hospital in Chicago, shares her expertise on having focused and meaningful conversations with patients living with irritable bowel syndrome with constipation (IBS-C) and other neurogastromotility disorders. Amy emphasizes the importance of building rapport, using a patient-centered approach, and assessing not only bowel habits but also quality of life outcomes—from the ability to work and attend school to participating in family and social activities without being limited by symptoms. She explains how to use tools like the Bristol Stool Scale, evaluate stool frequency and evacuation, and ask targeted questions about abdominal pain, bloating, and distension to determine whether current therapies are effective. Amy also highlights the need to monitor side effects, ensure predictability of treatment, and adjust therapies when symptoms remain uncontrolled. With several FDA-approved therapies available for IBS-C, patients do not need to settle for ongoing discomfort. This discussion provides clinicians with practical strategies to guide therapy decisions and empowers patients to seek treatments that truly improve their daily lives. For more educational resources, visit GHAPP.org and the GHAPP ACE App.

In this episode of the GHAPPcast, Patrick Horne, NP and Chris Lovell, CRNP discuss the critical role of biomarkers in hepatology and liver disease management. They explain what biomarkers are, how they are used in clinical practice to detect conditions such as hepatocellular carcinoma (HCC), and how they can measure treatment response. The conversation explores the rigorous biomarker development and validation process, beginning with discovery and assay development, through retrospective and prospective validation, and ultimately assessing population impact. Patrick and Chris highlight the role of the Early Detection Research Network (EDRN), established by the National Cancer Institute, in ensuring biomarkers meet strict scientific standards before clinical application. They also emphasize why it is important for clinicians to understand these processes—so they can have greater confidence in applying biomarkers to improve early detection and patient outcomes. This discussion offers a clear, evidence-based perspective on how biomarkers shape the future of liver disease diagnosis and care.

In this podcast episode, nurse practitioner Gabriella McCarty and physician assistant Kim Orleck share expert insights on IBS with constipation (IBS-C)—one of the most common yet misunderstood gastrointestinal conditions. They explain how the diagnostic approach has shifted from a “diagnosis of exclusion” to a positive diagnostic strategy supported by ACG and AGA guidelines and the Rome criteria. Together, they highlight the importance of taking a thorough history, identifying red flags such as rectal bleeding, family history of colon cancer, unexplained weight loss, and anemia, while avoiding unnecessary and costly testing. Gabriella and Kim also explore how to communicate the brain–gut connection and concepts like visceral hypersensitivity to patients, helping them feel validated and understood rather than dismissed. By focusing on patient education, shared decision-making, and timely diagnosis, they show how providers can build confidence, reduce delays in care, and start treatment sooner for patients struggling with IBS-C. This conversation provides practical guidance for GI clinicians and reassurance for patients navigating IBS constipation. For more educational resources, visit GHAPP.org and explore the GHAPP ACE App.

In this video, physician assistant Kim Orleck of Atlanta Gastroenterology Associates, part of United Digestive, answers some of the most common questions about IBS medications and how to evaluate treatment success. Kim explains how clinical studies show bowel improvement—measured by complete spontaneous bowel movements—can often begin as early as one week, sometimes even within days, while abdominal pain relief typically takes 6–8 weeks to reach maximal benefit. She emphasizes the importance of setting realistic expectations so patients don’t discontinue therapy too soon. With no current biomarkers for IBS, Kim highlights how progress is assessed by carefully tracking the patient’s response across constipation, abdominal pain, and bloating symptoms. She also shares best practices on when to reassess therapy—usually at the 2–3 month mark—to ensure both bowel and pain improvements are achieved. This discussion offers valuable guidance for clinicians and patients navigating the complexities of irritable bowel syndrome (IBS-C) management.

In this episode, nurse practitioner Gabriella McCarty draws on over 26 years of GI, IBD, and hepatology experience to discuss irritable bowel syndrome with constipation (IBS-C) and why patient education and shared decision-making are essential for better outcomes. Gabriella highlights how IBS-C can present with a variety of symptoms, including bloating, several days without a bowel movement, or even diarrhea caused by overflow constipation, making it a condition that is often misunderstood. She emphasizes that treatment is not one-size-fits-all—ranging from diet and lifestyle changes to over-the-counter options, prescription therapies, and newer targeted treatments such as guanylate cyclase-C agonists. By empowering patients with knowledge about the many available options, clinicians can improve patient confidence, encourage collaboration in care, and address years of frustration many individuals experience when they feel unheard. This conversation underscores the importance of individualized treatment approaches in IBS-C and offers practical insights for GI providers and their patients. Learn more at GHAPP.org

You’ll hear how APPs act as the “quarterback” of care—providing education beyond the clinic visit, coordinating with multidisciplinary teams (dermatology, endocrinology, mental health, pharmacy), and connecting patients to trusted resources and support groups. Visual aids, personalized communication styles, and continuous follow-up all help patients better understand their diagnosis, medications, and long-term management.

Whether you’re a healthcare professional seeking best practices or a patient looking for clarity and support, this conversation highlights why APPs are essential in managing chronic liver disease and ensuring patients with PBC feel informed, empowered, and never alone.

In this episode of the GHAPPcast, the official podcast of Gastroenterology and Hepatology Advanced Practice Providers, host Mikhail Alper, PA-C, sits down with Natalie Oliver, PA-C, a hepatology expert from Houston Methodist Hospital and Liver Specialists of Texas. Together, they explore the critical topic of biomarker validation in liver cancer, highlighting the role of the NCI Early Detection Research Network (EDRN) in setting standards for HCC surveillance. This conversation dives into why standardization, validated assays, and harmonized study designs are essential to making biomarkers reliable across different patient populations and practices. Natalie shares her firsthand experience using tools like AFP, AFP-L3, DCP (PIVKA-II), and the GALAD score to improve the accuracy of HCC detection, reduce false positives, and guide patient conversations. Real patient stories emphasize the life-saving impact of early detection and the importance of consistent surveillance, especially in high-risk groups such as those with cirrhosis, chronic hepatitis B or C, and MASLD. Whether you’re a clinician, researcher, or student, this episode provides valuable insights into how biomarker innovation and collaboration can improve outcomes in liver cancer care and transplant medicine.

In this video, Mary Clarke, a GI motility nurse practitioner in San Diego, addresses the difference between functional constipation and constipation-predominant Irritable Bowel Syndrome (IBS-C). Drawing from the Rome IV criteria developed by the Rome Foundation, Mary explains how functional constipation is defined by infrequent bowel movements, hard stool consistency, and difficulty evacuating—without the presence of significant pain. In contrast, IBS-C includes the same constipation symptoms plus recurrent abdominal pain related to defecation, bloating, and visceral hypersensitivity. Mary also explores the role of gut-brain interaction and how altered motility and stress can influence symptom patterns in DGBIs (Disorders of Gut-Brain Interaction). She emphasizes the importance of accurate diagnosis, as conventional treatments for constipation—like fiber supplements or OTC laxatives—may not be effective and could worsen symptoms in IBS-C. Instead, IBS-C may respond better to targeted therapies, including prescription treatments, exercise, cognitive behavioral therapy (CBT), and complementary alternative medicine (CAM). This overview helps clinicians and patients better understand how to differentiate these two GI conditions and tailor treatment plans accordingly. For more education, visit the GHAPP website or download the GHAPP Ace App.

In this episode of the GHAPPcast, Kate Scarlata, RDN, a nationally recognized GI-focused dietitian, joins Amy Ladewski, PA-C, from Northwestern Medicine, to explore personalized, evidence-based dietary strategies for patients with Irritable Bowel Syndrome with Constipation (IBS-C). Using a real-world case study approach, they discuss the impact of fiber choice, the role of psyllium versus fermentable fibers like wheat dextrin and inulin, and how over-supplementation can worsen IBS symptoms. Kate provides practical, patient-friendly tips on how to reduce symptom-triggering foods without overwhelming dietary restrictions, highlighting how to reintroduce safe, low-FODMAP options without using the term "FODMAP." The episode also compares the benefits of kiwi fruit versus prunes, addresses common dietary missteps, and emphasizes the need for a gentle, individualized approach to fiber and food intake. Amy and Kate discuss when to escalate care with pharmacologic therapies, how to identify pelvic floor dysfunction, and why partnering with GI dietitians and psychologists is key to long-term success. For APPs treating patients with IBS, this episode is full of clinical pearls, counseling strategies, and lifestyle interventions to improve outcomes. Learn more by visiting GHAPP.org or downloading the GHAPP ACE App to access more GI-focused content and patient care tools.

In this episode, Mary Clarke, a GI motility nurse practitioner based in San Diego, discusses the powerful role of complementary and alternative therapies—especially exercise—in managing Irritable Bowel Syndrome (IBS). With a focus on IBS-C (constipation-predominant IBS), Mary explains how regular physical activity can improve gastrointestinal motility, reduce abdominal pain and bloating, support emotional well-being by lowering stress levels, and positively influence the gut microbiome. She reviews different forms of aerobic and low-impact exercise, including walking, cycling, swimming, and yoga, and provides practical strategies for patients at all activity levels to build sustainable routines. Mary also highlights the physiological mechanisms behind exercise-induced gut improvement, including cytokine regulation, enhanced digestion, improved nutrient absorption, and reduced inflammation. This video offers actionable guidance for clinicians and patients looking to incorporate lifestyle interventions into IBS treatment plans. Learn more at the GHAPP website or by visiting the GHAPP ACE App.

In this insightful episode, GI nurse practitioners Mary Clarke, Kristina Skarbinski, and Monica Nandwani explore the powerful connection between mental health and irritable bowel syndrome (IBS)—with a focus on IBS-C. The discussion highlights how stress, poor sleep, and emotional health can significantly impact gut function and symptom severity. Drawing on the updated 2024 Real-World IBS Survey, the team shares data showing how IBS affects quality of life, from daily discomfort to dietary restrictions and social withdrawal. Mary reviews how stress alters gut motility and gut-brain signaling, while Christina outlines pharmacologic strategies like neuromodulators (e.g., TCAs, SNRIs, SSRIs) and behavioral therapies including CBT and gut-directed hypnotherapy. The conversation also dives into dietary considerations, such as the low FODMAP diet, food reintroduction strategies, and identifying common symptom-triggering foods. Monica emphasizes the importance of collaborative care involving dietitians, psychologists, and telehealth resources to create a personalized treatment plan. This episode offers a practical, compassionate, and multidisciplinary approach to managing IBS-C through both medical and lifestyle interventions. Learn more at GHAPP.org or by downloading the GHAPP ACE App for on-the-go access to IBS education and resources.

In this episode, Kristina Skarbinski, a seasoned GI nurse practitioner based in Boston, shares essential insights on identifying alarm symptoms that may help distinguish Irritable Bowel Syndrome (IBS) from more serious gastrointestinal conditions. While IBS is a common functional disorder, it’s critical to recognize red flag symptoms that require further evaluation before making a diagnosis. Christina walks through key warning signs, including rectal bleeding, melena (black tarry stools), nocturnal bowel movements, progressive abdominal pain, unexplained weight loss, and anemia. She also explains the significance of an elevated fecal calprotectin level and the importance of family history in assessing the risk for colorectal cancer or inflammatory bowel disease (IBD). Patients over 50 should be up to date on colon cancer screening, especially when symptoms are new or worsening. If no alarm features are present, clinicians can confidently proceed with IBS evaluation using the Rome IV criteria and symptom-based testing. This educational overview offers a practical guide for primary care and GI professionals. Learn more by visiting the GHAPP website or the ACE App for additional clinical resources.

#HepatitisB #HBVCure #LiverHealth #HepatologyEducation #TherapeuticVaccines #FunctionalCure #ChronicHBV #LiverDiseaseAwareness #Gastroenterology #AdvancedPracticeProviders #GHAPP #MedicalResearch #HBVElimination #ViralHepatitis

Join Monica Nandwani, GI nurse practitioner in California, as she outlines key diagnostic strategies for identifying Irritable Bowel Syndrome (IBS), one of the most common functional gastrointestinal disorders. In this detailed overview, Monica explains how to recognize IBS using symptom-based criteria such as the Rome IV diagnostic guidelines, which focus on recurrent abdominal pain and changes in stool habits. She emphasizes the importance of a positive diagnostic strategy over exclusion-based testing, as supported by the 2020 ACG Clinical Guidelines. This video explores IBS subtypes—including IBS-C, IBS-D, IBS-M, and IBS-U—and explains when to consider additional testing such as serologic celiac panels, fecal calprotectin, CRP, and colonoscopy to rule out inflammatory bowel disease (IBD), microscopic colitis, or other conditions. Learn how to identify red flags that require further evaluation, and discover how tools like the Bristol Stool Form Scale and patient stool diaries can guide diagnosis. Whether you're a clinician or a patient seeking clarity on IBS, this evidence-based discussion provides practical insights for timely and accurate diagnosis. For more education, visit the GHAPP website or GHAPP ACE App.

Join Kristina Skarbinski, a GI nurse practitioner with over a decade of experience, as she explains how to use the Bristol Stool Scale to monitor treatment response in patients with Irritable Bowel Syndrome (IBS). Based in Boston, Christina emphasizes the importance of tracking bowel patterns as a key component of patient-centered IBS management. This educational video highlights how the Bristol Stool Form Scale—ranging from Type 1 (hard pellets) to Type 7 (watery stool)—can empower patients to log stool consistency, identify trends, and stay engaged in their care. Christina shares how she uses stool diaries to adjust treatment plans over time and encourages regular check-ins to optimize outcomes between follow-up visits. Whether you're a provider looking to implement practical tools in clinical practice or a patient navigating IBS treatment, this video offers valuable insights on improving symptom tracking and communication. For more GI-focused education, visit the GHAPP website or download the ACE App.

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.

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

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

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

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

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.

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.

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.

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.

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.

Welcome to Episode 7 of the GHAPP CLDF PBC Podcast Series, hosted by Andrea Gossard, NP. In this pivotal episode, we explore the cumulative impact of nonresponse to ursodeoxycholic acid (UDCA) in patients with Primary Biliary Cholangitis (PBC). Andrea is joined by Anne Moore, NP, a GHAPP board member and expert in PBC management, to discuss the concept of “area under the curve” as it relates to prolonged biochemical nonresponse and progressive liver injury over time. Together, they emphasize the critical need for early identification of inadequate response, how to define therapeutic targets (such as normalization of alkaline phosphatase and bilirubin), and why timely escalation to second-line therapies is key to preventing long-term complications like advanced fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and portal hypertension. This episode also provides valuable insights into esophageal varices screening, bone health monitoring, and the economic and access-related challenges of liver transplant, particularly in rural areas. With evidence-based commentary and real-world strategies, this conversation empowers hepatology and GI providers to recognize the importance of ongoing monitoring, proactive treatment adjustments, and comprehensive care planning for patients with PBC. Don't miss this essential episode in a series focused on advancing liver care.

Welcome to another episode of the GHAPP CLDF PBC Podcast Series, hosted by Andrea Gossard, NP. In this episode, we explore one of the most challenging aspects of Primary Biliary Cholangitis (PBC): identifying progression rates and implementing timely, personalized management strategies. Andrea is joined by fellow GHAPP member and hepatology expert Ann Moore, MD, who brings decades of clinical experience to the conversation. Together, they discuss how the natural history of PBC has evolved since the approval of ursodeoxycholic acid (UDCA), and why differentiating between slow and rapidly progressing patients is critical to improving long-term outcomes. The episode dives into the importance of monitoring biomarkers such as alkaline phosphatase and bilirubin, interpreting non-invasive tests like FibroScan and ELF, and understanding when to escalate to second-line therapy. Ann shares real-world strategies for risk stratification, including using CBC, imaging, and prognostic scoring tools like the GLOBE and UK-PBC scores. The discussion also touches on disparities in access to liver transplant and the economic burden of late-stage disease. If you’re a hepatology or GI provider managing patients with PBC, this episode provides actionable insights on how to intervene earlier, track disease progression more effectively, and ultimately prevent the need for liver transplantation. Don’t forget to catch the other episodes in this high-impact series on Primary Biliary Cholangitis.

Welcome to the eighth and final episode of the GHAPP CLDF PBC Podcast Series, hosted by Andrea Gossard, ARNP. In this powerful conclusion to our educational journey on Primary Biliary Cholangitis (PBC), we shift focus toward a holistic approach to PBC management, emphasizing lifestyle modifications, integrative medicine, symptom relief, and long-term well-being beyond standard pharmacologic therapy. Andrea is joined once again by Christina Hanson, FNP-C and GHAPP board member, for a deep dive into the comprehensive care strategies that support not just liver health, but the overall quality of life in patients with PBC. Together, they discuss how to manage extrahepatic manifestations such as fatigue, pruritus, bone disease, dyslipidemia, and fat-soluble vitamin deficiencies, while also addressing common patient concerns around statin use, alcohol consumption, and over-the-counter supplements. With insights on lifestyle counseling, diet, exercise, vitamin D, sleep hygiene, and non-pharmacologic approaches like meditation and complementary therapies, this episode offers actionable takeaways for clinicians and patients alike. Whether you're treating PBC in Detroit, Denver, or anywhere across the U.S., this episode reinforces the importance of a patient-centered, multidisciplinary strategy to optimize care in this complex liver disease. Don't forget to explore the full podcast series for more expert-led discussions on PBC.

Welcome to the CLDF GHAPP PBC Podcast Series! In this episode of our eight-part series, host Andrea Gossard, NP, is joined by Christina Hanson, FNP and CLDF GHAPP board member, to explore the evolving role of biomarkers in the diagnosis, monitoring, and personalized treatment of Primary Biliary Cholangitis (PBC). Together, they examine how clinicians are rethinking the utility of traditional markers such as alkaline phosphatase and bilirubin, and how newer data support the use of additional biomarkers—including ALT, AST, and GGT—for a more comprehensive picture of disease activity and therapeutic response. This discussion includes practical guidance on baseline evaluation with FibroScan, interpretation of liver stiffness measurements, and when to consider second-line therapies. Christina shares her clinical insights from real-world hepatology practice, emphasizing the importance of early intervention, individualized timelines for assessing treatment response, and the growing recognition that even small elevations in liver enzymes may signal a need for more aggressive care. This episode is a must-listen for hepatology providers and GI specialists who want to stay up to date with the latest evidence-based strategies in PBC management. Subscribe and follow along as we continue this educational journey throughout the full series.

The GALAXI 2 and 3 Phase 3 trials provide critical insights into the 48-week efficacy of guselkumab and ustekinumab in patients with moderate to severely active Crohn’s disease, evaluating outcomes based on prior biologic therapy response. In this Journal Club video module, Alison Moe, PA-C, from Atlanta Gastroenterology, breaks down the trial results, highlighting endoscopic and clinical remission rates, deep remission outcomes, and safety data. Both guselkumab dosing regimens (200 mg and 100 mg subcutaneous maintenance) demonstrated superiority to ustekinumab across key endoscopic response endpoints at week 48, particularly in biologic-naïve and biologic-experienced patients. The study also confirms guselkumab as a viable option for Crohn’s disease patients who have failed previous therapies, offering a targeted IL-23 therapy with consistent clinical benefits in deep remission and long-term disease control.

For more details on the GALAXI trials and the latest in IBD treatment advancements, visit the GHAPP website or download the GHAPP ACE app.

Join host Allison Moser, NP, with returning guests Tedra Gray, NP, and Jeff Dunn, PharmD (President of a transparent PBM), as they explore how these shifts are impacting real-world patient access and clinical workflow.

In this episode, we break down the rising use of limited distribution drugs, strategies for navigating specialty pharmacy restrictions, and how clinicians are adapting to maintain timely access to infusion therapies. Allison and Tedra share how close collaboration with hospital-based specialty pharmacists is helping to overcome administrative and logistical hurdles, while Jeff offers an industry view on why payers are pushing toward pharmacy benefit distribution and the cost pressures behind it.

We also explore the disconnect between payers and hospitals in negotiating drug costs, and how silos in coverage, formularies, and rebates may be contributing to access barriers. The episode wraps with a forward-looking conversation on shared risk models, value-based care, and the need for stronger collaboration across healthcare stakeholders to build a more sustainable and equitable system.

To catch up on the full series, watch Episodes 1 and 2 on the GHAPP digital hub.

This episode focuses on the proactive steps clinicians can take to avoid common PA denials, including accurate documentation, ICD coding, benefit verification, use of electronic prior authorization tools, and collaboration with pharmacy liaisons. We also unpack how templates, test claims, and payer-specific nuances can strengthen submissions.

Jeff offers valuable insights from the payer perspective, detailing the most common reasons for PA denials—such as missing clinical information or lack of step therapy documentation—and how providers can better align their approach with evidence-based policies. The conversation wraps with actionable ideas on how APPs and payers can build trust, improve communication, and leverage technology and AI to reduce administrative burden and deliver faster access to care.

If you're a GI or hepatology clinician, pharmacist, or APP navigating the complexities of the medication approval process, this episode is packed with expert guidance and proven strategies to elevate your access workflow.

Don’t forget to watch Part 1 on our GHAPP digital hub, and stay tuned for Part 3 of this essential series on simplifying access.

Together, they break down the daily clinical and administrative impact of prior authorization (PA), explore common frustrations providers face, and share actionable solutions to streamline the process. From documenting medical necessity to collaborating with payers and pharmacists, this episode offers practical tips to reduce delays, improve patient outcomes, and strengthen the provider-payer dynamic.

Jeff also offers an insider's view on what payers are really looking for when reviewing PA requests, why payer priorities can influence approval timelines, and how evidence-based decision-making intersects with healthcare cost trends.

If you're an advanced practice provider, pharmacist, or clinician navigating medication access barriers, this episode delivers valuable insights to advocate more effectively for your patients.

Be sure to subscribe to GHAPPcast to stay updated as we continue this three-part series on simplifying access. Visit ghapp.org for more tools and resources to support gastroenterology and hepatology APPs.

The GRAVITI study provides compelling Phase 3 data on guselkumab, an IL-23 p19 subunit inhibitor, demonstrating its efficacy and safety in patients with moderate to severely active Crohn’s disease. In this Journal Club video module, Alison Moe, PA-C, from Atlanta Gastroenterology, breaks down the key findings, discussing clinical remission rates, endoscopic outcomes, and patient safety data at week 12, week 24, and week 48. The study highlights guselkumab’s dual mechanism of action, blocking IL-23 and binding to CD64, with both IV induction and subcutaneous maintenance proving effective in both biologic-naïve patients and those with prior biologic failure. The data show significant improvements in clinical and endoscopic remission rates, with no major serious adverse events beyond mild upper respiratory infections. The findings reinforce guselkumab’s role as a treatment option for patients needing a targeted IL-23 therapy with flexible dosing options.

For more details on the GRAVITI study and the latest updates in IBD management, visit the GHAPP website or download the GHAPP ACE app.

Join us for a compelling episode of GHAPPcast, the official podcast for advanced practice providers in gastroenterology and hepatology. In this episode, host Gabriella McCarty, NP-C, welcomes esteemed guest Sharon Dudley-Brown, PhD, a leading expert from Johns Hopkins and a professor at the University of Delaware. Together, they dive deep into the clinical role of guselkumab, a newly approved IL-23 inhibitor for ulcerative colitis (UC).

This discussion unpacks the mechanism of action, efficacy, safety profile, and potential patient candidates for this innovative therapy. Sharon provides expert insights on how guselkumab compares to other biologics and small molecules, its advantages in targeting the IL-23 pathway, and the latest clinical trial data supporting its use. The episode also covers key considerations for patient selection, dosing flexibility, and the evolving role of combination therapy in inflammatory bowel disease (IBD) management.

Whether you’re a healthcare provider looking to optimize UC treatment strategies or seeking clarity on the latest biologic advancements, this episode offers practical takeaways to enhance your clinical decision-making.

Tune in now to stay ahead in the evolving landscape of ulcerative colitis treatments!

Subscribe to GHAPPcast on your favorite podcast platform and visit GHAPP.org for more expert-led education in gastroenterology and hepatology. Download the GHAPP ACE app to continue watching expert-led educational modules in gastroenterology and hepatology.

Janet also explores how alcohol use disorder (AUD) and metabolic-associated steatotic liver disease (MASLD) are shaping transplant needs, along with groundbreaking efforts to incorporate AUD treatment into hepatology clinics. With MASLD (formerly known as NAFLD) now being the fastest-growing cause of cirrhosis and liver transplantation, she emphasizes the importance of weight loss as a key strategy for disease management. Research shows that a 7% weight loss can significantly improve liver health by mobilizing fat out of the liver and reducing disease progression.

Additionally, she highlights why identifying a surrogate decision-maker is crucial for patients with advanced cirrhosis. Once a patient experiences their first decompensated episode, the average life expectancy is less than two years, and some complications can impair decision-making. Having a surrogate involved early ensures that medical choices align with the patient’s values and preferences.

For more expert insights on liver disease and transplantation, subscribe now and visit the Gastroenterology & Hepatology Advanced Practice Provider (GHAPP) website or download the GHAPP app on iOS and Android. Stay informed, stay empowered, and improve patient care.

She discusses the importance of early screenings for high-risk individuals, including those with a history of alcohol use, metabolic syndrome, and viral hepatitis. By utilizing blood tests, imaging, and elastography, providers can detect cirrhosis early and intervene before complications arise. Managing the root cause—whether through antivirals, alcohol cessation, or lifestyle modifications—is critical to slowing disease progression.

As cirrhosis advances, patients may develop ascites, esophageal varices, and hepatic encephalopathy. Allison explains how medications like diuretics, beta-blockers, lactulose, and rifaximin help manage these complications and reduce hospitalizations. For patients with end-stage liver disease, early referral for liver transplant evaluation using MELD score assessments can be life-saving.

Beyond medical treatment, patient education and mental health support play a crucial role. Healthcare professionals must emphasize healthy lifestyle choices, alcohol avoidance, and emotional well-being to empower patients in managing their condition. A multidisciplinary approach, involving hepatologists, dietitians, and mental health specialists, ensures comprehensive patient care.

Stay informed on the latest research and treatment options to provide the best possible outcomes for cirrhosis patients. Subscribe for more expert insights and visit the Gastroenterology & Hepatology Advanced Practice Provider (GHAPP) website for additional resources. #Cirrhosis #LiverHealth #Hepatology #Transplant #Gastroenterology

Visit the GHAPP website or GHAPP ACE app for more educational content.

In this video, Erin Darguzas, NP, from the Inflammatory Bowel Disease Center at Northwestern Medicine, discusses how Guselkumab data aligns with STRIDE II guidelines for monitoring IBD (Inflammatory Bowel Disease) patients over time. Developed by International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) members, STRIDE II provides a treat-to-target framework that outlines short-term, intermediate, and long-term goals for achieving disease control.

Erin explains how Guselkumab's clinical trials align with these treatment targets. In induction studies, patients were evaluated at Baseline and Week 12, with clinical remission as the primary outcome—matching STRIDE II's short-term targets. The results showed symptom improvement and mucosal healing by Week 12, supporting early treatment efficacy.

In maintenance trials, clinical responders from the induction phase were randomized into maintenance arms, with Week 44 clinical remission as the primary endpoint. Additional key outcomes included corticosteroid-free remission, sustained clinical response, endoscopic improvement, and mucosal healing—meeting intermediate and long-term STRIDE II targets.

By demonstrating both short- and long-term efficacy, Guselkumab shows potential for long-term IBD management in alignment with STRIDE II treatment goals. For more expert insights on IBD treatment strategies, visit the Gastroenterology & Hepatology Advanced Practice Provider (GHAPP) website.

In this video, Anne Feldman, NP, from Cleveland Clinic, discusses Guselkumab (Tremfya), an FDA-approved treatment for adults with moderate to severe ulcerative colitis, plaque psoriasis, and psoriatic arthritis. With promising Phase 3 clinical trial results, Guselkumab is expected to receive FDA approval for Crohn’s disease, making it a potential first-line advanced therapy or an option for patients who have failed other advanced treatments.

Beyond gut-related inflammation, extraintestinal manifestations (EIMs)—affecting the skin, joints, and eyes—are common in IBD (Inflammatory Bowel Disease), especially Crohn’s disease. Up to 40% of IBD patients experience EIMs, sometimes even before their IBD diagnosis. Because Guselkumab is already FDA-approved for psoriasis and psoriatic arthritis, it offers a multisystem treatment approach, addressing both IBD and associated autoimmune conditions. By targeting multiple inflammatory pathways, this therapy has the potential to reduce disease burden and significantly improve quality of life.

For more information on IBD treatment strategies and Guselkumab’s role in patient care, visit the Gastroenterology & Hepatology Advanced Practice Provider (GHAPP) website or download the GHAPP ACE mobile app.

One key update is in the management of portal hypertension, where AASLD now recommends non-selective beta blockers like carvedilol for variceal bleeding prophylaxis, particularly due to its vasodilatory effects. Patients with medium or large varices are advised to take these medications to reduce bleeding risks. Another significant procedure being emphasized is the TIPS (Transjugular Intrahepatic Portosystemic Shunt), which is considered for patients with recurrent variceal bleeding or refractory ascites. However, it is generally preferred for those already on a liver transplant list, as there is a small risk of liver failure.

There have also been notable advancements in treating Primary Biliary Cholangitis (PBC) with two newly FDA-approved medications: Ivarix (approved June 10) and Cadazopa (approved August 14). While these treatments are not approved for decompensated cirrhosis, they are safe for Child-Pugh Class A patients, though providers are advised to discontinue treatment if the disease progresses to Child-Pugh Class B or C. Additionally, for patients with Metabolic Dysfunction-Associated Steatohepatitis (MASH), the FDA recently approved Rivumet on April 9, marking the first-ever FDA-approved therapy for MASH with liver fibrosis (F2-F3). Although it is not yet approved for cirrhotic patients, further data is expected soon.

As liver disease management continues to evolve, staying informed on new treatments and best practices is crucial for improving patient outcomes. For more details, visit the GHAPP website and subscribe for expert insights on liver disease care!

A low-sodium, high-protein diet is also vital for cirrhosis management. Reducing sodium intake helps prevent fluid retention, which can cause discomfort, swelling, and difficulty breathing. Adequate protein intake—about 1.2 grams per kilogram of body weight—is crucial to prevent muscle loss often associated with cirrhosis. Since the body struggles to absorb protein efficiently, maintaining proper nutrition and engaging in strength training can help preserve lean muscle mass and overall strength.

Regular exercise and staying active play a crucial role in supporting liver function and overall health. Additionally, individuals with cirrhosis should ensure they are up to date on preventive health screenings, including mammograms, prostate exams, and colonoscopies, especially if a liver transplant is a future consideration.

Watch this video to learn more about cirrhosis management and practical steps to enhance your health. For additional resources, visit the GHAPP website or download the GHAPP ACE app on iOS and Android.

#Cirrhosis #LiverHealth #LiverDisease #CirrhosisManagement #TransplantCare #Hepatology #LiverTransplant #HealthyLiving #LowSodiumDiet #HighProteinDiet #PreventiveCare

In this FAQ video module, Erin Darguzas, NP, Gastroenterology Specialist at Northwestern Medicine, discusses the predictive risk factors for disease severity in Crohn’s disease and ulcerative colitis. Over the past 15 years, researchers have identified multiple prognostic factors that can help predict disease progression and guide individualized IBD management.

For moderate to severe Crohn’s disease, key factors include age at diagnosis (before 40), disease location (small bowel, colonic, or upper GI involvement), and disease behavior (structuring, penetrating, or perianal disease). Additional concerns include deep ulcers on endoscopy, significant weight loss, low albumin levels, smoking history, and genetic markers.

For ulcerative colitis, predictors of severity include age at diagnosis (before 50), frequency of disease flares, need for frequent therapy changes, and failure to achieve endoscopic remission. Pathology findings, such as persistent neutrophil infiltration, and treatment adherence history are also crucial in determining long-term outcomes.

Early identification of these prognostic factors allows for a more personalized treatment approach, improving patient outcomes in inflammatory bowel disease (IBD) management. Watch this video to learn more about Crohn’s disease and ulcerative colitis risk factors. For additional resources, visit the GHAPP website or download the GHAPP ACE app.

A low-sodium diet is also essential, with a daily limit of no more than 2,000 mg of sodium to help reduce fluid retention, leg swelling, and abdominal ascites. Patients should avoid processed and canned foods, which are often high in sodium, and eliminate raw or undercooked shellfish to prevent infections. Additionally, reducing sugary drinks, refined sugar, and red meat intake can support overall liver health.

It’s also important to avoid NSAIDs (nonsteroidal anti-inflammatory drugs), as they can increase the risk of kidney injury, and refrain from using herbal supplements without consulting a healthcare provider. Lastly, regular physical activity—such as walking 20 to 30 minutes daily—can help maintain overall health and improve disease outcomes.

Making these lifestyle changes can significantly improve quality of life and liver function for patients with cirrhosis. Watch this video for expert insights, and visit the GHAPP website or download the GHAPP ACE app for more information.

In this video, Jamie Brogan, NP, from Northwestern Medicine in Chicago, discusses the efficacy and safety of Guselkumab therapy for patients with moderate to severely active Crohn’s disease, highlighting results from the Galaxy 2 and Galaxy 3 trials. Guselkumab is a dual-acting IL-23p19 subunit inhibitor, designed to neutralize IL-23 and bind to the CD64 receptor, which plays a role in the production of IL-23.

The Galaxy 2 and 3 Phase 3 trials used a randomized, double-blind, double-dummy treat-through design to evaluate IV induction and subcutaneous maintenance therapy in Crohn’s patients. The co-primary endpoints included clinical response at Week 12 and clinical remission at Week 48, along with clinical response at Week 12 and endoscopic response at Week 48. Achieving endoscopic response is particularly significant, as it has been shown to reduce disease progression, flares, hospitalizations, and the need for surgery.

The study results showed strong efficacy for Guselkumab therapy. In Galaxy 2, 49% to nearly 55% of Guselkumab patients achieved clinical response at Week 12 and remission at Week 48, compared to 11.8% on placebo. In Galaxy 3, 46.9% and 48% of Guselkumab patients met the same criteria, compared to 12.2% on placebo. Additionally, Guselkumab met all secondary endpoints and demonstrated superiority to ustekinumab at Week 48 for endoscopic response, endoscopic remission, and deep remission.

The safety profile of Guselkumab therapy remained consistent and favorable. The most common adverse events reported were COVID-19, upper respiratory infections, Crohn’s disease worsening, arthralgia, and headache, with no deaths observed.

These results underscore Guselkumab’s potential as an effective maintenance therapy for Crohn’s disease. Watch this video for an in-depth analysis, and visit the GHAPP website or download the GHAPP ACE app for more details.

Effective shared decision-making begins with active listening—understanding the patient’s concerns, goals, and priorities. It also involves clear communication, providing easy-to-understand explanations of treatment options, risks, and benefits. Visual aids and simple language can help improve comprehension, allowing patients to make well-informed decisions. Healthcare providers play a crucial role in guiding patients through their options, acknowledging uncertainties, and reassuring them that it’s okay to take time or seek second opinions.

By fostering a trusting partnership, providers can empower patients to take an active role in their health journey, leading to better engagement, satisfaction, and health outcomes. Watch the full video to learn how to implement shared decision-making in clinical practice. For more expert insights, visit the GHAPP website and subscribe for more healthcare discussions!

In this comprehensive medication review, Peter Byrne, FNP, from South Denver Gastroenterology, discusses the efficacy of guselkumab in treating ulcerative colitis (UC) and Crohn’s disease (CD) based on key clinical trials, including Quasar and Galaxy 1.

Guselkumab has demonstrated significant efficacy in treating both ulcerative colitis (UC) and Crohn’s disease (CD), as highlighted in key clinical trials, including Quasar and Galaxy 1. In the Quasar trial, a Phase 3, randomized, placebo-controlled study, 701 patients with moderate to severe ulcerative colitis who had an inadequate response or intolerance to conventional or advanced therapies were evaluated. Patients received IV guselkumab (200 mg) or placebo at Weeks 0, 4, and 8, with the primary endpoint being clinical remission at Week 12. Results showed that 22.6% of guselkumab-treated patients achieved clinical remission compared to 7.9% with placebo, while 61.5% of patients on guselkumab showed a clinical response versus 27.9% on placebo. Additionally, 23.5% achieved histologic-endoscopic mucosal improvement (HEMI) versus 7.5% with placebo. In the maintenance phase, clinical remission at Week 44 was 50% with higher-dose guselkumab, 45.2% with the lower dose, and 18.9% with placebo, confirming its sustained efficacy.

For Crohn’s disease, the Galaxy 1 Phase 2 trial assessed guselkumab in patients with moderate to severe Crohn’s disease through an IV induction phase followed by subcutaneous maintenance therapy. At Week 12, 53% of guselkumab-treated patients achieved clinical remission compared to 16.4% on placebo, while clinical response rates were 65.9% versus 24.6% on placebo. Endoscopic response, defined as at least a 50% reduction in SC-CD score, was observed in 35.7% of guselkumab patients compared to 11.5% with placebo. Notably, bio-naïve patients had even higher response rates, with 47.5% achieving clinical remission versus 10% on placebo. In the maintenance phase, patients were assigned different dosing regimens, with 64%-73% achieving clinical remission depending on the dosage, compared to 57% in the ustekinumab group. Additionally, 44%-46% of guselkumab-treated patients showed an endoscopic response, while 18%-33% achieved endoscopic remission, compared to 30% and 6% in the ustekinumab group, respectively.

Overall, guselkumab has shown strong efficacy and a favorable safety profile in both ulcerative colitis and Crohn’s disease, with superior clinical, endoscopic, and histologic response rates compared to placebo. The Quasar and Galaxy 1 trials support its potential as a promising treatment option for inflammatory bowel disease (IBD). For further insights, visit the GHAPP website or download the GHAPP ACE app for more educational content.

Once cirrhosis is diagnosed, patient education becomes essential. Providers should emphasize the importance of abstinence from alcohol, as patients may unknowingly continue drinking if unaware of their condition. It is also vital to stress adherence to medications like lactulose to prevent complications such as hepatic encephalopathy. Additionally, patients should undergo liver cancer screening every six months through abdominal ultrasound and alpha-fetoprotein testing, as cirrhotic patients are at higher risk for liver cancer.

Preventive care, such as vaccinations for flu, hepatitis A, and hepatitis B, should also be part of the treatment plan. For patients whose cirrhosis is alcohol-related, referring them to addiction medicine can help address alcohol cravings and support long-term recovery. By fostering a non-judgmental, communicative approach, healthcare providers can build trust, encourage adherence to treatment plans, and ensure timely follow-up appointments. These steps can significantly improve care for patients living with cirrhosis. For more information visit the GHAPP website or download the GHAPP ACE mobile app.

In this medication review module, Peter Byrne, FNP at South Denver Gastroenterology, discusses the safety of guselkumab in the treatment of Ulcerative Colitis and Crohn's disease. The Quasar trial, a phase 3 double-blind study, evaluated the safety of guselkumab in patients with inadequate responses to conventional therapies. Results showed that the incidence of serious adverse events was lower in the guselkumab group (2.9%) compared to placebo (7.1%), with a minimal occurrence of serious infections (less than 1%) in both groups. The safety profile of guselkumab was consistent with known data from plaque psoriasis and psoriatic arthritis studies.

In the Galaxy 1 trial for Crohn’s disease, serious adverse events were similar across treatment groups, with infection rates at 15.1% for guselkumab and 21.4% for placebo. One notable event in the guselkumab group was toxic hepatitis, which was reversible after treatment and discontinuation of the drug. Serious infections such as viral gastroenteritis and anal abscesses occurred in the guselkumab group but were determined not to be drug-related. Both trials reported no deaths, no active tuberculosis, and no opportunistic infections. The most frequent infections reported were upper respiratory infections and nasopharyngitis. The data suggests that guselkumab maintains a favorable safety profile for patients with inflammatory bowel diseases. For additional information, visit the GHAPP website or download the GHAPP ACE mobile app.

In this Journal Club video module, Jamie Brogan, NP, from Northwestern, discusses findings from the Phase 2 GALAXI-1 Study, which evaluated guselkumab, a selective IL-23p19 antagonist, for the treatment of moderate-to-severe Crohn’s disease. This randomized, placebo-controlled study assessed intravenous guselkumab at doses of 200 mg, 600 mg, and 1200 mg, alongside ustekinumab and placebo. At week 12, the results demonstrated significant reductions in Crohn’s Disease Activity Index (CDAI) scores among patients receiving guselkumab compared to those in the placebo group.

Clinical remission was achieved in up to 57% of patients who received the 200 mg IV dose, with additional improvements in biomarker and endoscopic responses. These findings support the 200 mg IV dosing regimen for Phase 3 clinical trials. For more details, visit the GHAPP website or download the GHAPP ACE mobile app for more educational content.

As a healthcare provider, it’s essential to rely on a variety of resources to stay up-to-date on the latest guidelines and treatment options for chronic liver disease and cirrhosis. He mentions several online resources like GHAPP, AASLD, and EASL as key platforms he uses in his practice. He also mentions up-to-date clinical practice guidelines as a helpful tool, but acknowledges the difficulty of keeping up with the vast number of guidelines coming from different societies.

Both Jordan and Patrick agree that staying on top of rapidly changing guidelines can be overwhelming, but they stress the importance of continuing medical education to stay informed about the latest treatments, clinical trials, and medication updates. Patrick emphasizes that medical education platforms, including webcasts, podcasts, and in-person meetings, are valuable resources. Additionally, Jordan mentions that referencing specific medication manufacturers’ websites has been especially helpful in prescribing medications for patients, as they provide up-to-date, patient-friendly resources, such as package inserts and copay assistance information. This type of information is beneficial not only for healthcare providers but also for patients, who can access the resources independently.

One key topic the pair discusses is the emotional burden that patients with cirrhosis and their families face. Diagnosing a patient with cirrhosis can be overwhelming, both for the patient and their caregivers. The providers stress that cirrhosis is a chronic condition, and the journey of managing it can be long and difficult. They emphasize that patients may have to undergo multiple tests and frequent follow-ups. This can create a sense of emotional fatigue for both patients and their families, and it’s important for healthcare providers to understand and address this burden.

Patrick explains that education is a critical aspect of helping patients navigate their diagnosis. He mentions that it’s essential to reiterate important information during each visit, such as the need for liver cancer screening (HCC), monitoring signs of decompensation, and possibly the future need for a liver transplant. This type of education should be ongoing, even in between visits, to ensure the patient remains informed and empowered to take control of their health. Patrick also advises providers to stress that if a patient has any concerns, even if they’re unsure, it’s always better to reach out for clarification than to wait for problems to worsen.

In addition to supporting the patients themselves, Patrick highlights the importance of supporting caregivers, who often take on a large part of the responsibility in managing the care of a loved one with cirrhosis. Both providers agree that caregivers are often underappreciated and may also need resources and guidance. Jordan mentions that at UT Southwestern, there are fewer resources available for caregivers, but they do their best to provide emotional support and act as the primary source of care coordination. They both stress the importance of listening to patients and caregivers and offering resources when possible, especially for those without access to social workers or other support services.

The discussion also touches on the multidisciplinary nature of managing chronic liver disease and cirrhosis. Providers often work with other specialists to address the various complications that may arise, as cirrhosis is rarely the only medical issue a patient faces. Patrick notes that cirrhosis is often part of a complex array of health problems that require a comprehensive treatment approach. Both providers acknowledge the importance of collaborating with other healthcare professionals to provide well-rounded, holistic care.

Ultimately, this episode emphasizes that managing chronic liver disease and cirrhosis requires not only a deep understanding of medical guidelines and treatment options but also emotional and practical support for patients and their families. Healthcare providers must continuously educate themselves, revisit guidelines, and be open to using a variety of resources. More importantly, they need to recognize the emotional toll of the disease on patients and their caregivers and offer ongoing support and education. By doing so, providers can help patients manage their condition effectively and improve their quality of life.

For further information on managing liver disease, cirrhosis, and supporting both patients and caregivers, visit the GHAPP website and explore the range of educational resources and tools available for healthcare professionals.

In this video module, Amy Stewart, NP, from Capital Digestive Care, in Washington, D.C., explores the potential correlation between CD64-expressing myeloid cells and endoscopic disease severity in patients with inflammatory bowel disease (IBD).

CD64 is a plasma membrane receptor found on myeloid cells, a category of blood cells originating from the bone marrow. Myeloid cells include monocytes, macrophages, granulocytes, and dendritic cells, all of which play an essential role in the innate immune response.

In IBD, these immune cells contribute to inflammation through the production of pro-inflammatory cytokines, such as IL-23 and IL-12, which are generated by mononuclear phagocytes. Research has identified CD64-positive myeloid cells as a primary source of IL-23 in inflamed gut tissues, particularly in patients with Crohn’s disease.

One study has demonstrated that in patients with Crohn’s disease, the Simple Endoscopic Score for Crohn’s Disease (SES-CD) was positively correlated with the presence of CD64-expressing cells. Additionally, CD64-positive cells accumulate in inflamed colonic tissues, and their proportion is directly associated with disease severity, regardless of treatment history, demographics, or disease classification.

Understanding the underlying pathogenesis of inflammatory bowel disease is crucial for treatment decision-making. The presence of CD64-positive myeloid cells as key players in IL-23-driven inflammation suggests that targeting these pathways could provide new therapeutic insights for managing moderate to severe IBD.

For more insights on emerging research in IBD, visit the GHAPP website for the latest updates on disease mechanisms, treatment options, and clinical guidelines.

When diagnosing cirrhosis, Jordan Mayberry emphasizes a multi-faceted approach that includes lab work, physical exams, and imaging. Essential diagnostic markers include liver enzyme tests to assess inflammation, albumin, bilirubin, and INR tests to evaluate liver function, and platelet counts, as thrombocytopenia is often an early indicator of cirrhosis. In addition to laboratory tests, a thorough physical exam is necessary to assess signs such as ascites, lower extremity edema, spider angiomata, and palmar erythema. Imaging techniques like ultrasound help detect liver nodularity and signs of portal hypertension, making early diagnosis possible.

As cirrhosis progresses, staging the disease becomes critical for determining treatment strategies. Non-invasive tests have become increasingly important in this process. These include FibroScan, an elastography tool that assesses liver stiffness, the FIB-4 score, a blood test used to evaluate fibrosis, and the ELF score, another serum marker for fibrosis assessment. For patients requiring more detailed evaluation, MR elastography (MRE) is a secondary option for staging liver fibrosis.

Although liver biopsy was once considered the gold standard for diagnosing cirrhosis, its role has diminished with the advancement of non-invasive testing. However, it remains essential when a diagnosis is unclear or when required for clinical trials and certain treatment plans.

Once a cirrhosis diagnosis is established, managing potential complications is crucial. Common complications include fluid overload (ascites), jaundice, esophageal varices, hepatic encephalopathy (HE), and hepatocellular carcinoma (HCC). Jordan stresses the importance of patient education to ensure early intervention. Patients should be informed about the risks of rapid weight gain due to fluid retention and be encouraged to seek medical attention if symptoms worsen. Screening for esophageal varices through endoscopy is essential, and patients at risk of HCC should undergo imaging and AFP testing every six months.

Ongoing care for cirrhosis patients requires regular monitoring and patient education. Jordan highlights the necessity of involving both patients and their families in the management process, teaching them to recognize early signs of complications such as fluid retention and gastrointestinal bleeding. By staying informed, patients can receive timely medical care and prevent severe health issues.

Lifestyle modifications also play a significant role in slowing the progression of cirrhosis. Patients should abstain from alcohol, particularly if their cirrhosis is alcohol-related. A healthy diet and exercise regimen are strongly recommended, with a focus on a Mediterranean-style diet and a combination of cardiovascular and resistance exercises. Interestingly, research suggests that caffeine consumption may have potential benefits in reducing liver inflammation. While not a universal recommendation, coffee drinkers may find reassurance in continuing their habit, as it could positively impact liver health.

For patients with specific liver conditions, such as autoimmune hepatitis or viral hepatitis, appropriate medical treatment should be initiated to manage their disease effectively. By using a combination of diagnostic tests, non-invasive tools, and proactive patient education, healthcare providers can ensure that cirrhosis patients receive optimal monitoring and care.

With regular screening, lifestyle modifications, and comprehensive medical support, patients with cirrhosis can achieve better health outcomes and an improved quality of life. For more information on cirrhosis diagnosis, treatment, and management, visit the GHAPP website or download the GHAPP ACE app.

This GHAPPcast podcast, supported by Johnson & Johnson, underscores the importance of ongoing medical education and advancements in patient care.

Join Sarah Enslin, PA-C, from the University of Rochester Medical Center, as she explores the latest advancements in CD64-positive cell targeting and IL-23-directed therapy. This innovative approach enhances the specificity and effectiveness of treatment for psoriasis, psoriatic arthritis, and inflammatory bowel disease (IBD) by engaging immune cells responsible for chronic inflammation.

Learn how CD64, a high-affinity receptor on monocytes, macrophages, and dendritic cells, becomes upregulated during inflammation, making it a critical target for IL-23 inhibitors. Discover the role of monoclonal antibodies like GOMAB, which neutralize IL-23 while binding to CD64-expressing cells, optimizing treatment impact, reducing inflammation, and improving patient outcomes.

For more information on the latest research in rheumatology and immunology, visit the GHAPP website or download the GHAPP ACE app.

Through their discussion, they explain how chronic liver diseases gradually progress, starting with liver inflammation that leads to fibrosis and eventually to cirrhosis. Understanding this progression is crucial for proper staging of liver disease and determining the right treatment approach. The episode emphasizes the importance of early diagnosis and monitoring, especially as patients transition from compensated cirrhosis (where they show no major complications) to decompensated cirrhosis, which involves severe complications like jaundice, ascites, and hepatic encephalopathy.

Special focus is given to hepatocellular carcinoma (HCC), a major risk in patients with cirrhosis. Jordan and Patrick outline the vital screening practices, including ultrasound imaging and alpha-fetoprotein testing, to detect early-stage liver cancer. With HCC being a cumulative risk, they stress the importance of regular screenings for cirrhotic patients, and the impact early detection can have on treatment outcomes, including potential liver transplant and localized therapies.

Moreover, the hosts emphasize the need for patient education—especially for those newly diagnosed with cirrhosis. Teaching patients to recognize early signs of complications ensures timely intervention and better management of their condition. Jordan and Patrick discuss how healthcare providers can play a key role in improving patient care by educating patients about the disease process, the importance of regular check-ups, and the monitoring protocols that can help manage cirrhosis and prevent further complications.

Whether you’re in hepatology practice or involved in the care of liver disease patients, this episode provides practical, actionable insights for managing chronic liver diseases and cirrhosis effectively. For more resources, visit the GHAPP website or download the GHAPP ACE app for the latest updates in liver disease management.

In this medication review video module, Anne Feldman, NP, from the Cleveland Clinic Foundation, provides an in-depth overview of Guselkumab, an FDA-approved treatment for moderately to severely active ulcerative colitis. Anne explains the mechanism of action of Guselkumab, which is a dual-action monoclonal antibody that targets key pro-inflammatory proteins and their receptors, disrupting the inflammatory cascade responsible for chronic inflammation in conditions like ulcerative colitis, psoriasis, and psoriatic arthritis.

This monoclonal antibody therapy works by inhibiting the IL-23 protein, which plays a pivotal role in immune system activation and inflammation. Guselkumab reduces disease activity and promotes tissue healing by blocking the effects of IL-23, making it an effective treatment option for patients with ulcerative colitis.

Anne also outlines the dosing regimen for Guselkumab, starting with induction doses of 200 mg IV at weeks 0, 4, and 8, followed by maintenance doses either 200 mg every 4 weeks or 100 mg every 8 weeks, depending on the patient's response. It is administered in an infusion center, taking approximately one hour per infusion. Guselkumab is soon expected to be FDA-approved for Crohn’s disease, offering a first-line advanced therapy option or as a subsequent therapy after failure of other treatments.

Safety considerations are highlighted, including the need for vaccination and tuberculosis screening prior to starting the therapy. Patients on Guselkumab should avoid live vaccines due to its potential to suppress the immune system, which can increase the risk of infections. Common side effects include respiratory infections, sore throat, headaches, and injection site reactions. Guselkumab is not approved for use in pediatric patients (under 18 years of age), and its safety during pregnancy or breastfeeding is not fully established.

This detailed review provides essential information for healthcare providers and patients considering Guselkumab as part of their treatment for ulcerative colitis and other autoimmune diseases. For further information, visit the GHAPP website or download the GHAPP ACE app.

In this insightful episode of GHAPPcast, the official podcast of the Gastroenterology and Hepatology Advanced Practice Providers, host Gabriella McCarty, NP-C, delves into the complex yet critical topic of CD64 positive binding and its relevance in inflammatory bowel disease (IBD) treatment, particularly in relation to Interleukin-23 (IL-23) inhibition. Gabriella is joined by Andrea Banty, NP, a respected GHAPP faculty member and expert in gastroenterology, who provides valuable insights into the role of CD64 in the immune system and its impact on diseases like Crohn’s disease and ulcerative colitis.

In this episode, Andrea explains how CD64 receptors, found on immune cells, are upregulated during inflammation and can contribute to IL-23 production. This protein plays a significant role in the pathogenesis of IBD and other inflammatory conditions. By targeting CD64 and inhibiting IL-23, therapies may reduce inflammation and promote healing in the GI mucosal lining, improving patient outcomes in ulcerative colitis and Crohn’s disease.

The podcast also discusses current therapies that target IL-23, including those that work at the P40 and P19 subunits, with an exciting focus on the potential of Guselkumab, a therapy that targets IL-23 at the P19 subunit and also binds CD64. This unique dual-action therapy has shown promise for the treatment of psoriasis and psoriatic arthritis and is anticipated to receive FDA approval for the treatment of IBD as well, offering a new avenue for advanced therapy.

As new therapeutic options emerge, Andrea and Gabriella explore the potential clinical applications of CD64 inhibition and IL-23 targeting, emphasizing the importance of personalized care in IBD management. The discussion highlights how advanced practice providers can make informed therapeutic decisions to improve IBD patient outcomes by considering factors such as efficacy, safety, and patient preferences for treatment routes.

This episode is a must-listen for gastroenterology professionals, advanced practice providers, and anyone interested in the evolving landscape of IBD treatment and immune modulation therapies. Visit the GHAPP website or download the GHAPP ACE app for more information.

In this informative FAQ video module, Sarah Enslin, a physician assistant at the University of Rochester Medical Center, discusses the role of Interleukin-23 (IL-23) in treating immune-mediated inflammatory diseases, particularly inflammatory bowel disease (IBD). Sponsored by Johnson & Johnson, this video highlights how IL-23 directed therapies have revolutionized the management of IBD, including Crohn’s disease and ulcerative colitis.

Sarah explains how IL-23, primarily produced by dendritic cells and macrophages, is central to the development of TH17 cells, a subset of CD4+ T cells involved in chronic inflammation. In IBD, IL-23 signaling promotes the activation and differentiation of TH17 cells in the intestinal mucosa, which secrete pro-inflammatory cytokines like IL-17, damaging the intestinal barrier, leading to inflammation and disease progression.

One of the leading therapies in this class is Guselkumab, a monoclonal antibody that selectively targets the p19 subunit of IL-23, inhibiting its signaling pathway. By targeting IL-23 without affecting other immune responses (such as IL-12 driven pathways), Guselkumab can reduce TH17 cell activation and the inflammation they cause, leading to improved disease outcomes. This selective blockade not only benefits the gut but also extends to skin and joints, offering a comprehensive approach to treating IBD.

Clinical trials have demonstrated the efficacy of IL-23 directed therapies, with patients experiencing significant reductions in disease severity, improved clinical symptoms, and an overall enhanced quality of life.

This module is a valuable resource for advanced practice providers, including physician assistants and nurse practitioners, who are looking to expand their knowledge on the latest IBD treatment advancements and IL-23 inhibition therapies. For more information visit the GHAPP website or download the GHAPP ACE app.

In this Journal Club video module, Shayla Scheonoff, a physician assistant from Rochester, Minnesota, provides a comprehensive review of the efficacy and safety of Guselkumab induction therapy for moderately to severely active ulcerative colitis (UC). Sponsored by Johnson & Johnson, this detailed analysis covers both the Phase 2B and Phase 3 QUASAR induction studies for Guselkumab, a dual-acting IL-23 p19 subunit inhibitor that blocks IL-23 and binds to CD64 on cells that produce IL-23. Previously approved for psoriasis and psoriatic arthritis, Guselkumab has shown remarkable promise as a treatment for ulcerative colitis.

The Phase 2B study involved 313 patients with severe UC who had failed previous therapies. Results showed that 61% of patients receiving Guselkumab 200 mg and 60% of patients receiving Guselkumab 400 mg achieved a clinical response at 12 weeks, significantly outperforming the placebo group, where only 27% responded. The study also demonstrated that Guselkumab was well-tolerated, with a 1% rate of serious adverse events compared to 5.7% in the placebo group. The Phase 3 QUASAR study further confirmed Guselkumab's effectiveness, with 22.6% of patients achieving clinical remission at week 12, compared to 7.9% in the placebo group. Secondary endpoints like symptomatic remission, endoscopic improvement, and histologic improvement also showed significant benefits for patients on Guselkumab.

The Guselkumab induction therapy demonstrated consistent safety profiles in both studies, with similar rates of infection and serious infections across both treatment and placebo arms. This Journal Club video provides an in-depth look at the promising results of Guselkumab in treating moderately to severely active ulcerative colitis, offering an innovative therapy option for patients who have not responded to traditional treatments.

For more information on Guselkumab and its role in the treatment of ulcerative colitis, visit the GHAPP website or GHAPP ACE mobile app and access additional resources tailored for advanced practice providers.

Clinical trials play a crucial role in guiding treatment decisions, but the way missing data is handled can significantly impact the results. In this medication review video module, Whitney Steinmetz, NP, from Presbyterian Medical Group in Albuquerque, NM, explains the concept of non-responder imputation (NRI)—a widely used statistical method in clinical trials.

Non-responder imputation is a conservative approach used to address missing data by assuming that participants who drop out or have missing responses did not respond to treatment. This method helps prevent overestimating a therapy’s effectiveness, ensuring that clinical trial results remain reliable. However, it can also underestimate a treatment’s true impact, particularly if patients drop out for reasons unrelated to treatment failure. Understanding how this statistical method influences trial outcomes is essential for healthcare providers, as it directly affects the interpretation of treatment efficacy and patient care decisions.

By reducing bias and offering a straightforward approach to data analysis, non-responder imputation helps maintain the integrity of clinical trial results. However, its conservative nature can sometimes skew findings, making a treatment appear less effective than it actually is. This is why it’s important for clinicians to be aware of how missing data is managed in studies. If non-responder imputation was used, the reported effectiveness of a treatment might be a cautious estimate rather than a complete reflection of its potential benefits.

For more information please visit the GHAPP website or download the GHAPP ACE app.

Inflammatory Bowel Disease (IBD) is a complex condition influenced by genetic, environmental, and microbial factors. In this FAQ video module, Amy Stewart, ARNP, from Capital Digestive Care in Washington, DC, explains the critical role of the IL-23/IL-17 axis in the pathogenesis of IBD. Supported by Johnson & Johnson, this discussion explores the cytokine-driven inflammatory pathways that contribute to chronic intestinal inflammation and how they can be targeted for effective treatment.

IL-23 (Interleukin-23) is a pro-inflammatory cytokine primarily produced by macrophages and dendritic cells in response to microbial stimulation. It plays a pivotal role in promoting chronic inflammation in IBD by inducing a unique inflammatory gene signature. This leads to the differentiation of T-helper 17 (Th17) cells, a specialized subset of T cells that drive inflammation. The activation of IL-23 receptors triggers a cascade of immune responses through the JAK-STAT signaling pathway, further amplifying the inflammatory process. Additionally, IL-17, a key cytokine regulated by IL-23, plays a major role in neutrophil activation and immune modulation, influencing both infection resistance and autoimmune pathology.

Given the central role of the IL-23/IL-17 axis in IBD and other autoimmune diseases, understanding these inflammatory pathways is crucial for developing targeted therapies. Many modern biologic treatments for IBD are designed to modulate these specific cytokines, helping to reduce inflammation and improve patient outcomes.

Join Amy Stewart, NP, in this expert discussion to gain deeper insights into the IL-23/IL-17 pathway and its implications for IBD treatment strategies. For more information and to explore the latest advancements in IBD care, visit the GHAPP website.

Welcome to this FAQ video module, proudly supported by Johnson & Johnson. In this educational session, Erica Heagy, NP, from Alaska Digestive and Liver Disease, explores the IL-23/IL-17 axis, a crucial pathway in the pathogenesis of inflammatory bowel disease (IBD), psoriasis, psoriatic arthritis, multiple sclerosis, and other immune-mediated disorders.

The IL-23 cytokine plays a pivotal role in promoting Th17 cell differentiation, which in turn produces pro-inflammatory cytokines like IL-17A, IL-17F, tumor necrosis factor (TNF), and IL-6. IL-17, a key driver of chronic inflammation, is overexpressed in patients with autoimmune diseases, contributing to tissue damage, immune dysregulation, and inflammation. These effects are particularly evident in conditions such as Crohn’s disease, ulcerative colitis, and psoriatic arthritis, making the IL-23/IL-17 axis a major target for emerging biologic therapies.

Therapeutic strategies that block IL-23 or its receptor have been FDA-approved for treating psoriasis, psoriatic arthritis, and IBD. By inhibiting this inflammatory pathway, these treatments help reduce disease progression, alleviate symptoms, and improve patient outcomes. Understanding this mechanism is essential for healthcare providers seeking optimized, targeted treatment options for their patients.

For more information on IL-23-targeted therapies and advances in gastroenterology, hepatology, and immune-mediated disease treatment, visit GHAPP.org or download the GHAPP ACE mobile app on Android or IOS. Stay connected with us on LinkedIn, YouTube, X (formerly Twitter), and Instagram for expert insights and updates.

Welcome to GHAPPcast, the official podcast of Gastroenterology and Hepatology Advanced Practice Providers (GHAPP), where we delve into the latest advancements in GI and liver diseases. In this enlightening episode, host Gabriella McCarty, NP-C, from NorthShore Gastroenterology, explores the intricate role of the IL-23/IL-17 axis in inflammatory bowel disease (IBD). This discussion, supported by Johnson & Johnson, offers invaluable insights into how this immunological pathway influences IBD progression and how targeted therapies are shaping the future of treatment.

Joining the conversation is Allison Krustapentus, NP, from Beth Israel Deaconess Medical Center, an expert in IBD patient care and immunology. Together, they break down the IL-23/IL-17 signaling cascade, explaining its impact on immune-mediated inflammation and how disruptions in this pathway contribute to chronic GI conditions like Crohn’s disease and ulcerative colitis. They discuss how IL-23 promotes Th17 cell differentiation, leading to IL-17-driven inflammation, which, when dysregulated, fuels tissue damage, immune overactivity, and chronic inflammation in IBD.

This episode also highlights the therapeutic implications of targeting the IL-23/IL-17 pathway. With the rise of precision medicine, newer biologics are offering more effective, patient-specific treatments that can slow disease progression and improve patient outcomes. The discussion also covers shared decision-making in patient care, emphasizing the importance of educating patients about their disease and available treatment options.

Subscribe to GHAPPcast on your favorite podcast platform for in-depth discussions on IBD, hepatology, and GI innovations. Visit GHAPP.org, download the GHAPP ACE app and follow us on LinkedIn, YouTube, X (formerly Twitter), and Instagram for our latest updates and expert insights.

In this medication review, Whitney Steinmetz, NP, from Presbyterian Medical Group in Albuquerque, New Mexico, explores the mechanism of action of Guselkumab, a promising monoclonal antibody therapy for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD).

IBD is driven by chronic gastrointestinal inflammation, resulting from a complex interplay of genetic predisposition, environmental triggers, and immune system dysregulation. A crucial element in this inflammatory process is interleukin-23 (IL-23), a pro-inflammatory cytokine that promotes the differentiation, expansion, and survival of Th17 cells. These Th17 cells produce additional inflammatory cytokines, such as IL-17 and IL-22, which contribute to intestinal inflammation and disease progression.

Guselkumab, a monoclonal antibody therapy, specifically targets the p19 subunit of IL-23, preventing its interaction with the IL-23 receptor on T cells. By blocking IL-23 signaling, Guselkumab reduces Th17 cell activation and cytokine production, leading to a decrease in gut inflammation. This mechanism positions Guselkumab as a promising treatment option for IBD, aiming to mitigate chronic inflammation, improve mucosal healing, and enhance patient outcomes.

For more information on IL-23 inhibitors, biologic therapies, and advancements in gastroenterology, visit GHAPP.org or download the GHAPP ACE app on IOS and Android. Follow us on LinkedIn, YouTube, X (Twitter), and Instagram for the latest updates and expert insights.

In this FAQ video module, Erica Heagy, NP, from Alaska Digestive and Liver Disease, breaks down the key differences between humoral immunity and cell-mediated immunity, two crucial components of the adaptive immune system that protect the body from infections.

Adaptive immunity is triggered when the body is exposed to antigens, allowing it to mount a targeted defense against viruses, bacteria, and toxins. Within this system, humoral and cell-mediated immunity function in distinct but complementary ways.

Humoral immunity, also known as antibody-mediated immunity, is driven by B cells, which produce antibodies to neutralize extracellular pathogens such as bacteria and toxins. This response develops rapidly, offering quick protection, but it tends to be shorter-lasting compared to cellular immunity.

In contrast, cell-mediated immunity is primarily led by T cells and plays a crucial role in combating intracellular pathogens, including virus-infected cells. This response takes longer to activate, but it provides long-term protection by directly targeting and eliminating infected cells.

Understanding the balance between humoral and cellular immunity is essential in infectious disease management, vaccine development, and autoimmune disorder research. A strong grasp of these immune responses helps healthcare providers make informed decisions about treatments, immunotherapies, and disease prevention strategies.

For more information on immune system functions, immunotherapy, and advancements in gastroenterology, visit GHAPP.org or download the GHAPP ACE app on IOS and Android. Follow us on LinkedIn, YouTube, X (Twitter), and Instagram for expert insights and updates.

In this insightful discussion, the experts explore the science behind CSID and how sucrase-isomaltase deficiency impacts digestion. They break down the common symptoms that mimic IBS, the challenges in diagnosing the condition, and the importance of proper testing, such as the C13 breath test and small bowel biopsy. Insurance barriers often make it difficult for patients to access enzyme replacement therapy, leaving many untreated or mismanaged. The conversation also covers effective dietary strategies, emphasizing how food choices, portion control, and timing influence symptoms. Caitlyn Colella shares her personal journey of living with CSID, highlighting the struggle of being misdiagnosed for years and how she successfully manages her condition through a combination of dietary adjustments and enzyme therapy.

With CSID affecting a significant percentage of adults previously diagnosed with IBS, this discussion sheds light on an under-recognized condition that has a profound impact on gut health. Healthcare providers and patients alike will gain valuable insights into the latest advancements in diagnosis, treatment, and lifestyle management. Watch now to learn how proper diagnosis and treatment can drastically improve quality of life. For more resources, visit the GHAPP website or download the GHAPP ACE app.

With the approval of seladelpar and elafibranor, clinicians now have more tools to not only lower alkaline phosphatase (ALP) levels but also to improve cholestatic pruritus, a debilitating symptom that has long remained difficult to manage. Our experts share insights on how these new therapies are addressing both biochemical and symptomatic aspects of PBC, creating a more comprehensive approach to patient care.

This discussion also highlights key considerations for integrating these second-line PBC therapies into clinical practice, including insurance approvals, specialty pharmacy access, and patient support programs that are helping to streamline the prescribing process. The conversation delves into real-world experiences with initiating treatment, the challenges of prior authorizations, and how pharmaceutical support programs are making it easier for patients to access these breakthrough medications.

Watch now to learn how new therapies are shaping the future of PBC management and stay tuned for Part 3 of this series! For more resources, visit the GHAPP website or download the GHAPP ACE app.

Although PBC is classified as a rare disease, its identification rates are increasing, thanks to better diagnostic tools, heightened primary care awareness, and expanded hepatology workups. Our experts explore whether this trend represents a true increase in prevalence or if improved screening and referrals are leading to earlier diagnosis and more accurate detection.

With newly approved treatments bringing renewed focus to PBC, this conversation also examines how greater access to healthcare, advanced liver disease diagnostics, and growing provider awareness are transforming PBC management. The panel highlights key statistics, such as the estimated prevalence of 1 in 1,000 women over the age of 40, and discusses how evolving treatment landscapes are shaping clinical decision-making.

Watch now to stay informed on the latest developments in PBC awareness and diagnosis. Be sure to check out Parts 2 and 3 for more insights into new therapies and treatment strategies. For additional resources, visit GHAPP.org or download the GHAPP ACE app.

A major highlight from this year’s meeting is the shifting treatment paradigm in PBC, moving beyond traditional Poise criteria to a more aggressive target of achieving completely normal alkaline phosphatase (ALKP) levels and a bilirubin of ≤0.6. Experts emphasize that new therapies, including seladelpar and elafibranor, are helping clinicians push treatment goals further, optimizing patient outcomes and disease management.

With the PBC treatment landscape evolving, the panel discusses how the mindset around ALKP reduction has changed, underscoring the importance of setting normalization as the primary goal rather than just achieving a modest reduction. With new and emerging therapies, there is growing excitement about more effective disease control and improved long-term prognosis for patients with PBC.

Watch now to stay ahead on the latest PBC treatment advancements, and don’t forget to check out the full miniseries! For more resources, visit GHAPP.org or download the GHAPP ACE app.

The conversation explores how new treatments are addressing fatigue and itching, two of the most challenging symptoms for PBC patients, while also improving overall liver function. The panel highlights the advantages of monotherapy options for patients who cannot tolerate UDCA, as well as strategies to optimize UDCA dosing to maximize effectiveness. They also stress the importance of regularly assessing pruritus and fatigue during patient visits, as many patients may not recognize these symptoms as part of their disease. Additionally, they discuss how once-daily dosing of new medications is improving treatment adherence and patient compliance compared to older regimens.

With PBC treatment strategies evolving, these newly approved medications provide greater flexibility, enhanced safety profiles, and improved long-term disease management. The discussion highlights why now is an exciting time in liver disease care, offering new hope for PBC patients. Watch now to stay ahead on the latest PBC treatment advancements! For more resources, visit GHAPP.org or download the GHAPP ACE app.

As PBC patients often struggle with persistent itching that significantly impacts daily activities, the availability of FDA-approved therapies specifically addressing PBC-related pruritus represents a major advancement. Jordan Mayberry emphasizes the importance of screening for PBC in patients experiencing chronic pruritus, as early diagnosis and treatment can lead to better disease management and improved symptom control.

With more therapeutic options available, providers can now offer a comprehensive treatment plan that not only targets disease progression but also alleviates pruritus, a symptom that has long been difficult to manage. Watch now to learn more about these groundbreaking therapies and how they are reshaping PBC treatment strategies. For additional resources, visit the GHAPP website or download the GHAPP ACE mobile app.

In this Journal Club Video Module, Lisa Richards, NP, a hepatology specialist with over 20 years of experience at UC San Diego Health, presents the pivotal findings of the Phase 3 randomized controlled trial of Resmetirom for the treatment of Metabolic Dysfunction-Associated Steatohepatitis (MASH) with liver fibrosis. Published in The New England Journal of Medicine in February 2024, this study provided the data that led to FDA approval of Resmetirom in March 2024 for adults with moderate to advanced fibrosis (F2-F3) due to MASH.

MASH, formerly known as Non-Alcoholic Steatohepatitis (NASH), is a progressive liver disease characterized by hepatic steatosis, hepatocellular damage, and inflammation. Once fibrosis reaches Stage 2 or 3, the risk of cirrhosis, liver failure, and hepatocellular carcinoma (HCC) significantly increases. Resmetirom is an oral, liver-directed, thyroid hormone receptor beta (THR-β) selective agonist designed to improve mitochondrial function, enhance fatty acid oxidation, and reduce fibrosis progression. The MAESTRO-NASH trial assessed its safety and efficacy in adults with biopsy-confirmed MASH and liver fibrosis.

The 52-week results from 966 patients demonstrated that Resmetirom at both 80 mg and 100 mg doses significantly improved MASH resolution and fibrosis reduction compared to placebo. In the study, MASH resolution without worsening fibrosis was achieved in 25.9% of patients in the 80 mg group and 29.9% in the 100 mg group, compared to just 9.7% in the placebo group. Similarly, fibrosis improvement by at least one stage without worsening MASH was observed in 24.2% of the 80 mg group and 25.9% of the 100 mg group, whereas only 14.2% of placebo patients showed fibrosis improvement. Both primary endpoints were statistically significant, confirming the therapeutic potential of Resmetirom.

In addition to its effects on liver health, Resmetirom also demonstrated benefits in lipid metabolism. LDL cholesterol levels decreased by 13.6% in the 80 mg group and by 16.3% in the 100 mg group, compared to a 0.1% increase in the placebo group, indicating a potential cardiometabolic advantage of this treatment.

The overall safety profile of Resmetirom was favorable, with the incidence of serious adverse events comparable across treatment groups: 10.9% (80 mg group), 12.7% (100 mg group), and 11.5% (placebo group). The most commonly reported side effects were diarrhea and nausea, though they were generally well tolerated and did not lead to treatment discontinuation in most cases.

These findings led to the FDA approval of Resmetirom on March 14, 2024, making it the first approved therapy for non-cirrhotic MASH with moderate to advanced fibrosis. The MAESTRO-NASH trial is ongoing for up to 54 months to further assess long-term liver outcomes, including the progression to cirrhosis.

The approval of Resmetirom represents a major breakthrough in MASH treatment, providing the first targeted therapy that directly addresses liver fat accumulation, inflammation, and fibrosis progression. With MASH being a leading cause of liver failure, cirrhosis, and liver transplantation, this approval marks a significant advancement in the management of the disease.

For more expert discussions on MASH and liver disease management, visit the GHAPP website or download the GHAPP ACE mobile app.

In this FAQ Video Module, Corrie Berk, NP, Director of Hepatology and Transplant Outreach Programs at the Texas Liver Institute, answers key questions about Metabolic Dysfunction-Associated Steatohepatitis (MASH)—a progressive liver disease that was previously known as Non-Alcoholic Steatohepatitis (NASH).

MASH is the inflammatory form of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and is caused by the buildup of excess fat in the liver in individuals who consume little to no alcohol. This condition can lead to liver inflammation, fibrosis, cirrhosis, and an increased risk of liver cancer. While genetics may play a role, MASH is closely linked to metabolic disorders such as obesity, insulin resistance, type 2 diabetes, and dyslipidemia, which contribute to disease progression.

Diagnosing MASH requires a combination of clinical evaluation, imaging studies, and non-invasive tests. Physicians often use ultrasound or MRI to detect liver fat, while FibroScan helps assess liver stiffness and fibrosis. In some cases, a liver biopsy may be necessary to confirm the diagnosis and rule out other liver diseases. By integrating these diagnostic tools, healthcare providers can better assess the severity of MASH and guide treatment decisions.

The transition from NASH (Non-Alcoholic Steatohepatitis) to MASH (Metabolic Dysfunction-Associated Steatohepatitis) reflects a major shift in medical understanding. The previous term emphasized the absence of alcohol use but failed to highlight the metabolic dysfunction driving the disease. By renaming it MASH, the medical community now recognizes that metabolic health plays a critical role in disease progression. The name change also aligns research efforts and public health messaging, emphasizing the importance of early detection, lifestyle interventions, and emerging treatments that address both liver disease and metabolic risk factors.

With MASH now recognized as a metabolic-driven condition, healthcare providers are shifting their focus toward comprehensive management strategies that target obesity, insulin resistance, and dyslipidemia alongside liver-specific treatments. This new approach aims to improve patient outcomes by addressing the root causes of MASH rather than just its symptoms.

For more expert insights on MASH diagnosis, treatment, and management, visit the GHAPP website or download the GHAPP ACE App.

In this Medication Review Video Module, Robin Soto, NP, from UC San Diego Health Hepatology, provides an in-depth look at the mechanism of action of Resmetirom, the first and only FDA-approved drug for the treatment of Metabolic Dysfunction-Associated Steatohepatitis (MASH) in adults with F2, F3, or mild to moderate fibrosis.

Resmetirom is an oral, liver-directed, beta-selective thyroid hormone receptor agonist (THR-β agonist). In MASH, the accumulation of lipotoxic lipids leads to hepatocyte injury, inflammation, and hepatic stellate cell activation, resulting in progressive fibrosis and an increased risk of cirrhosis and hepatocellular carcinoma (HCC). By activating THR-β receptors primarily in the liver, Resmetirom reduces fat accumulation, enhances fatty acid oxidation, and lowers lipotoxicity, helping to slow disease progression.

Resmetirom works by regulating lipid metabolism, enhancing cholesterol conversion, and improving mitochondrial health. It upregulates genes involved in fatty acid oxidation, which helps reduce intrahepatic fat accumulation and improve overall lipid profiles. Additionally, Resmetirom increases the expression of bile acid synthesis enzymes, promoting cholesterol conversion to bile acids, which assists in lowering excess cholesterol in the liver.

Beyond its role in metabolism, Resmetirom enhances mitochondrial biogenesis and removes unhealthy mitochondria, increasing the liver's ability to metabolize free fatty acids. By reducing hepatic stellate cell activation, Resmetirom also decreases collagen deposition, which helps slow the progression of fibrosis and reduces inflammation associated with MASH.

Unlike systemic thyroid hormone therapies, Resmetirom selectively targets the liver, minimizing systemic thyroid-related side effects and making it a safe and effective treatment option for MASH.

For more expert insights, visit the GHAPP website and download the GHAPP ACE mobile app.

In this FAQ Video Module, Corrie Berk, NP, Director of Hepatology and Transplant Outreach Programs at the Texas Liver Institute, discusses the serious consequences of untreated Metabolic Dysfunction-Associated Steatohepatitis (MASH) and how Advanced Practice Providers (APPs) can play a crucial role in patient education and early intervention.

MASH is often a silent liver disease, meaning symptoms may not appear until significant damage has occurred. If left untreated, MASH can progress to liver inflammation, fibrosis, cirrhosis, and even liver failure. Alarmingly, MASH is now the fastest-growing cause of liver cancer and the leading indication for liver transplants in the U.S.. Beyond liver complications, the metabolic dysfunction associated with MASH—including insulin resistance, obesity, and dyslipidemia—increases the risk of cardiovascular disease, heart attack, and stroke. Additionally, poorly managed MASH can worsen insulin resistance, leading to the development or progression of type 2 diabetes. These life-threatening consequences make early detection and proactive management essential in preventing long-term health complications.

APPs, including nurse practitioners (NPs) and physician assistants (PAs), play a vital role in educating patients about MASH and the importance of early intervention. One of the most effective strategies is to simplify complex medical concepts by using layman's terms, visual aids, and relatable analogies to explain MASH, its progression, and how it affects liver health. Avoiding medical jargon ensures that patients fully understand the risks associated with the disease.

Another key approach is to highlight the connection between MASH and metabolic health. Educating patients about the links between MASH, obesity, type 2 diabetes, and high cholesterol helps them understand how managing metabolic syndrome can help prevent or slow MASH progression. It’s also crucial to emphasize the benefits of early intervention, explaining that MASH progression can be prevented through lifestyle changes, medical management, and early detection. Taking action early can help prevent MASH from advancing to cirrhosis, liver failure, or cancer.

Encouraging lifestyle modifications is another essential role for APPs. Providing patients with practical, achievable strategies for improving diet, exercise, and metabolic health can lead to long-term success. Offering referrals to dietitians, structured fitness plans, and nutrition guidelines can support sustainable changes without overwhelming patients.

Finally, staying updated on the latest research, treatment guidelines, and clinical recommendations for MASH allows APPs to provide the most effective and up-to-date patient education. Sharing real-life patient success stories can also be a powerful motivator, demonstrating that early lifestyle modifications and treatment can significantly improve patient outcomes.

By implementing these education and engagement strategies, APPs can enhance patient understanding of MASH, encourage early intervention, and ultimately help reduce the growing burden of MASH-related liver disease and metabolic complications.

For more expert insights on MASH prevention, diagnosis, and management, visit the GHAPP website or download the GHAPP ACE App.

In this FAQ Video Module, Jonathan Yeh, PA, from Columbia University Irving Medical Center, discusses the evolution of Metabolic Dysfunction-Associated Steatohepatitis (MASH) diagnosis and fibrosis staging. Formerly known as NASH, MASH was traditionally diagnosed through liver biopsy, but non-invasive testing (NITs) is now widely accepted for fibrosis assessment.

Key non-invasive methods include FibroScan, which uses Vibration-Controlled Transient Elastography (VCTE), the Enhanced Liver Fibrosis (ELF) Test, and the FibroSure Blood Test. When used together, these tests provide a reliable assessment of fibrosis stage, significantly reducing the need for invasive liver biopsy.

Fibrosis staging follows the METAVIR system, which categorizes fibrosis from Stage 0 (no fibrosis) to Stage 4 (cirrhosis). Additionally, necroinflammatory activity is scored from A0 to A3, representing increasing hepatitis severity. By integrating FibroScan with ELF or FibroSure blood test results, healthcare providers can improve diagnostic accuracy and ensure more effective patient management.

As non-invasive fibrosis staging continues to evolve, incorporating these advanced diagnostic tools allows for earlier detection, better disease monitoring, and improved treatment strategies for patients with MASH.

For more expert insights, visit the GHAPP website or download the GHAPP ACE app on IOS or Android.

In this Medication Review Video Module, Whitney Steinmetz, NP, provides an in-depth discussion on the clinical profile of Retam (Resd) for Metabolic-Associated Steatohepatitis (MASH) with moderate to advanced F2 or F3 fibrosis. While Retam is not currently FDA-approved for patients with cirrhosis, ongoing trials are evaluating its potential in this population.

As a partial agonist of the thyroid hormone receptor beta, Retam targets hepatic metabolism, reducing intrahepatic triglycerides and improving liver health without significantly affecting thyroid hormone receptor alpha—which mediates effects on the heart and bones. The 52-week study demonstrated its effectiveness in resolving steatohepatitis and improving fibrosis without worsening inflammation.

Available in 60 mg, 80 mg, and 100 mg tablets, dosage is weight-based, with 80 mg recommended for patients under 100 kg and 100 mg for those over 100 kg. Due to its metabolism via CYP2C8, Retam should not be used with strong inhibitors like gemfibrozil, and statin doses may require adjustment.

Common side effects include nausea and diarrhea, which typically resolve over time. Mild serum aminotransferase elevations may occur early in treatment but often decrease within 3-6 months, correlating with reductions in hepatic fat and steatohepatitis.

For more expert insights on MASH management, visit the GHAPP website or the GHAPP ACE app.

In this GHAPPcast episode, Patrick Horne, NP, from the University of Florida, and April Morris, NP, from Richmond VA, discuss how to recognize the severity of MASH, identify at-risk patients, and implement early intervention strategies to prevent disease progression.

MASH is strongly linked to metabolic dysfunction, making certain populations more vulnerable to developing the disease. Some of the key risk factors include type 2 diabetes, obesity, hypertension, and high cholesterol. Family history also plays a crucial role, as many patients with MASH have relatives who have experienced early heart attacks, strokes, or diabetes. As Patrick Horne, NP, points out, genetic predisposition often contributes to metabolic diseases, making a detailed family history essential for identifying at-risk individuals.

One of the biggest challenges in MASH management is that liver enzyme levels (ALT, AST) do not always indicate disease severity. Many patients with advanced fibrosis or cirrhosis can have completely normal liver function tests, leading to missed diagnoses. To accurately stage MASH and assess fibrosis risk, providers should rely on non-invasive liver assessments in addition to bloodwork. Tools like the FIB-4 Score, FibroScan, MRI Elastography (MRE), and ultrasound help stratify risk, guide treatment decisions, and reduce the need for liver biopsy in many cases.

While pharmacologic treatment for MASH has recently emerged, lifestyle modification remains the foundation of management. Healthcare providers should emphasize dietary changes and exercise to slow MASH progression. The Mediterranean diet is often recommended due to its benefits in liver and metabolic health. Increasing intake of vegetables, lean proteins, and fiber-rich foods while reducing processed foods and sugar-sweetened beverages is key. Exercise is equally critical, as regular physical activity helps reduce liver fat, improve insulin sensitivity, and lower cardiovascular risk. One simple but effective intervention is eliminating sugar-sweetened beverages, such as sodas and energy drinks, which can significantly contribute to liver fat accumulation.

Until recently, there were no FDA-approved medications for MASH, but in March 2024, the FDA approved Resmetirom as the first therapy for non-cirrhotic MASH with moderate to advanced fibrosis (F2-F3). Resmetirom is a thyroid hormone receptor beta (THR-β) selective agonist that targets liver fat metabolism, inflammation, and fibrosis progression. Clinical trials have shown that Resmetirom significantly improves MASH resolution and reduces fibrosis progression, making it a breakthrough therapy for patients at risk of cirrhosis. However, insurance coverage varies, and providers may need to assist with prior authorizations to ensure patient access to treatment.

Once a patient is diagnosed with MASH, regular follow-up and monitoring are essential. For those started on medication therapy, providers typically schedule follow-up visits every 4-6 weeks to evaluate symptoms and ensure medication adherence. Lab work and imaging studies (FibroScan, MRI elastography) may also be used to track treatment response and liver fibrosis progression over time. Weight loss goals should be individualized, but even a 7-10% reduction in body weight has been shown to significantly improve liver health. Patients should be encouraged to approach weight loss gradually, as rapid weight loss can actually worsen liver disease.

MASH is a serious yet manageable disease that requires early recognition, metabolic risk assessment, and proactive intervention. With the availability of new non-invasive diagnostics and FDA-approved treatments, providers now have more tools than ever to improve patient outcomes and reduce the burden of MASH-related liver disease. By emphasizing early detection, lifestyle interventions, and personalized treatment strategies, healthcare providers can help patients mitigate their risk of fibrosis progression and improve overall metabolic health.

For more expert discussions on MASH diagnosis, treatment, and liver disease management, visit the GHAPP website or download the GHAPP ACE app.

In this FAQ Video Module, Kim Orleck, PA-C, from Atlanta Gastroenterology Associates, discusses best practices to accelerate the process of identifying the right therapy for patients with Irritable Bowel Syndrome with Constipation (IBS-C). A timely and accurate diagnosis is the foundation for effective treatment, helping reduce unnecessary testing, lower financial burdens, and get patients on the right therapy as quickly as possible.

One of the most significant advancements in managing IBS-C is the shift to a positive diagnostic strategy. Rather than relying on extensive exclusion-based testing, this approach allows providers to confidently diagnose IBS-C sooner, reducing diagnostic delays and improving patient outcomes. A faster diagnosis leads to earlier treatment, which not only improves symptoms sooner but also builds patient trust and confidence in their healthcare provider.

Once patients begin therapy, follow-up at 2-3 months is essential to assess both bowel symptom improvement and global symptom relief. If a patient has not achieved their therapeutic goals by this time, providers should reevaluate treatment options and consider alternative therapies. Factors influencing treatment selection include dosing frequency (once daily vs. multiple doses per day), timing of medication in relation to meals, side effect profile and individual patient tolerance, patient preferences and lifestyle considerations.

Shared decision-making is crucial in selecting the best treatment for IBS-C. Involving patients in the discussion helps ensure better adherence and satisfaction with the prescribed therapy. Additionally, cost and insurance coverage should always be factored into the treatment plan to avoid delays in access to medications. Keeping detailed records of previous treatment trials and patient responses helps prevent unnecessary medication switches and streamlines insurance approvals.

By adopting a structured and patient-centered approach, providers can significantly reduce the time to effective IBS-C treatment, enhance patient-provider relationships, and improve long-term management of IBS-C symptoms.

For more expert insights on IBS-C diagnosis, treatment strategies, and patient management, visit the GHAPP website or download the GHAPP ACE mobile app.

In this episode of GHAPPcast, the official podcast for Gastroenterology and Hepatology Advanced Practice Providers, host Christina Hanson, NP, is joined by Kim Kearns, NP, to explore the complex pathophysiology of IBS-C (Irritable Bowel Syndrome with Constipation) and the evolving neuromodulation strategies that enhance patient care.

The discussion kicks off by addressing IBS as a disorder of gut-brain interaction (DGBI)—a paradigm shift from the older classification of functional GI disorders. The speakers dive deep into the physiological and neurological pathways that contribute to IBS symptoms, including visceral hypersensitivity, dysbiosis, motility dysfunction, and altered mucosal immunity. Kim and Christina explain how neurotransmitters like serotonin and dopamine play a critical role in gut function, and how disruption in their signaling can exacerbate abdominal pain, bloating, and altered bowel habits.

With a growing arsenal of IBS-C treatments, this episode highlights the clinical utility of neuromodulators such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Kim shares practical insights into when and how to implement neuromodulation for patients with persistent pain and visceral hypersensitivity while addressing common patient concerns about antidepressant use for GI conditions. The conversation also explores cognitive behavioral therapy (CBT) and gut-directed hypnotherapy as emerging non-pharmacologic interventions that can reduce symptom severity and improve patient outcomes.

A central theme of the episode is patient-centered care and shared decision-making. The speakers emphasize the importance of validating the patient experience, educating them on the biopsychosocial model of IBS, and setting realistic expectations for symptom management. They discuss effective communication strategies, the role of digital therapeutics, and ways to enhance patient-provider trust to ensure adherence to treatment plans.

Tune in to GHAPPcast for this expert-led discussion on best practices for IBS-C management and learn how to integrate neuromodulation, cognitive therapy, and patient education into your clinical approach. For more information, visit GHAPP.org or download the GHAPP ACE app for more information.

Join Tedra Gray, NP, as she dives into what it means for a biosimilar to be interchangeable. Interchangeability is a key designation in the world of biosimilars, ensuring that these medications can be substituted for their reference products at the pharmacy level without the need for prescriber approval. Only a select few biosimilars have earned interchangeability status, meaning they have undergone rigorous FDA evaluation to demonstrate that switching between the biosimilar and the reference product does not compromise safety, efficacy, or patient outcomes. This designation plays a critical role in reducing healthcare costs for both patients and payers by allowing for seamless substitutions when the reference product is unavailable.

To receive FDA approval as an interchangeable biosimilar, manufacturers must conduct extensive clinical studies assessing safety and effectiveness when patients alternate between the reference product and the biosimilar. The results must confirm no loss of effectiveness or increase in safety risks associated with switching. This process ensures that patients receive continuous treatment without unnecessary delays or interruptions in care.

Interchangeable biosimilars are essential in improving access to treatment and managing diseases in a cost-efficient manner. To learn more about biosimilars, interchangeability, and their impact on patient care, visit www.ghapp.org or visit the GHAPP ACE mobile app.

In this FAQ Video Module, Kim Orleck, PA-C, from Atlanta Gastroenterology Associates, shares the most valuable resources for staying up to date on the latest approaches to managing IBS-C patients. As treatment strategies continue to evolve, leveraging evidence-based guidelines, professional conferences, industry expertise, and peer discussions can enhance patient care and optimize treatment outcomes.

One of the most critical resources for managing IBS-C is clinical guidelines. Both the American College of Gastroenterology (ACG) and American Gastroenterological Association (AGA) guidelines offer comprehensive, evidence-based recommendations for diagnosing and treating IBS-C. These guidelines align closely on key management strategies, making them essential reading for any healthcare provider treating patients with IBS-C.

Beyond published guidelines, attending conferences is an invaluable way to stay current with emerging research and treatment advancements. Events like GHAPP’s regional and national conferences provide networking opportunities, peer collaboration, and expert-led discussions tailored for advanced practice providers (APPs) in gastroenterology and hepatology. Additionally, the ACG Annual Meeting is another excellent platform for learning about the latest research, therapeutic innovations, and clinical best practices in IBS-C management.

Industry partnerships also play a crucial role in expanding knowledge about new therapies, clinical trial data, and medication access. Engaging with pharmaceutical representatives and medical science liaisons (MSLs) can provide deeper insights into treatment efficacy, side effect profiles, and insurance coverage considerations. Attending industry-sponsored dinners, webinars, and educational programs can further enhance clinical understanding and keep providers informed on the latest advancements in IBS-C treatment.

Lastly, peer-to-peer discussions are a valuable and often underutilized resource. Collaborating with fellow APPs, supervising physicians, and GI specialists fosters shared learning and exchange of best practices. Discussing real-world cases and patient experiences with colleagues can provide practical insights that go beyond textbook knowledge and help refine individualized patient care approaches.

By utilizing clinical guidelines, conferences, industry expertise, and peer collaboration, APPs can ensure they are delivering evidence-based, patient-centered care for individuals with IBS-C.

For more expert insights on IBS-C diagnosis, treatment strategies, and patient management, visit the GHAPP website or download the GHAPP ACE app.

In this episode, Kim Orleck, PA-C, discusses key strategies for evaluating treatment response in patients with IBS-C (Irritable Bowel Syndrome with Constipation). With multiple therapeutic options now available, it is essential for providers to take a patient-centered approach to ensure meaningful symptom improvement and treatment satisfaction.

A critical component of effective IBS-C management is setting realistic treatment goals and ensuring that both providers and patients align on expectations. Since bowel symptoms typically improve faster than pain and bloating, clinicians must educate patients on realistic timelines for symptom relief. Additionally, understanding which symptoms are most bothersome allows providers to focus on personalized treatment strategies that target the patient's specific concerns.

Kim Orleck emphasizes the importance of open-ended questioning, as this allows providers to gain deeper insights into the patient's experience rather than relying on simple yes/no answers. Evaluating global symptom relief, including pain, bloating, and overall quality of life, ensures a more comprehensive assessment of treatment success. With more treatment options available than ever before, it is essential that patients feel empowered to explore alternative therapies if their current treatment is not delivering optimal results.

Watch now to learn how to optimize IBS-C treatment strategies and improve patient outcomes. For more resources, visit the GHAPP website or download the GHAPP ACE mobile app on IOS or Android.

Welcome to GHAPPcast, the official podcast for gastroenterology and hepatology advanced practice providers. Hosted by Gabriella McCarty, a nurse practitioner at NorthShore Gastroenterology in Cleveland, this episode dives into a crucial topic—biosimilars from a patient’s perspective. As a founding member of GHAPP and a provider with 25 years of experience in general GI, IBD, and hepatology, Gabriella is excited to explore the real-world impact of biosimilars through the eyes of a patient.

In this episode, we welcome Emily, a Crohn’s disease patient who has firsthand experience transitioning to and from biosimilars. She shares her journey, initial concerns, and how switching medications impacted her health. With insurance-driven transitions from Remicade to Inflectra and back, Emily provides valuable insights into the realities of biosimilar treatment, debunking misconceptions, and highlighting the importance of open communication with healthcare providers.

For patients, providers, and caregivers navigating biosimilar treatments, this discussion offers a unique perspective on the transition process, medication efficacy, and long-term remission maintenance. Whether you’re a clinician seeking to guide patients or someone facing a biosimilar switch, this episode provides essential takeaways for ensuring a smooth and informed treatment journey.

Subscribe to GHAPP for more expert insights into gastroenterology, hepatology, IBD, and patient-centered care. Visit ghapp.org and download the GHAPP ACE app for more educational content.

In this episode of GHAPPcast, host Christina Hanson, FNP, alongside guest Kim Orleck, PA-C, dives into advanced strategies for diagnosing and managing IBS-C. They discuss the importance of the positive diagnostic strategy, ways to differentiate IBS-C from other conditions, and share valuable insights on how to optimize patient care and treatment. Listeners will gain practical tips for effectively communicating with patients, setting realistic expectations, and making informed decisions on therapeutic options. Tune in to enhance your approach to managing IBS-C and stay up-to-date with the latest in GI and hepatology care. Don't forget to subscribe and visit GHAPP's website for more resources!

Join Tedra Gray, NP, as she explains how biosimilars and generics play a crucial role in modern medicine, especially in fields like gastroenterology, rheumatology, and dermatology. She explains the key differences between biosimilars and generic medications, helping both healthcare providers and patients make informed treatment decisions.

Generic medications are identical copies of brand-name drugs, containing the same active ingredients, dosage, and route of administration. These drugs are FDA-approved and become available once the patent for the original brand-name drug expires. On the other hand, biosimilars are highly similar but not identical to biologic drugs, which are derived from living organisms or cells. These medications are often used to treat complex diseases like inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis. While biosimilars must demonstrate no clinically meaningful differences in pharmacokinetics or pharmacodynamics, they are not exact replicas like generics due to the complexity of biologic drugs.

For gastroenterology patients and providers, understanding the differences between biosimilars and generics is essential when choosing effective treatment options. Whether managing chronic GI conditions or exploring cost-effective alternatives, recognizing these distinctions ensures better patient care. For more information on biosimilars, generics, and GI treatment strategies, visit the GHAPP website or GHAPP ACE 2.0 mobile app to stay informed and empowered in your healthcare journey!

For years, the primary treatment options for irritable bowel syndrome with constipation (IBS-C) have been limited to secretagogues, offering varying doses and tolerability. However, a new mechanism of action (MOA) is now available, revolutionizing treatment choices for healthcare providers and patients alike. In this discussion, Kim Orleck, PA-C, from Atlanta Gastroenterology Associates, explores the triple-action MOA of this novel IBS-C therapy and how it enhances clinical decision-making.

This innovative therapy works by targeting the sodium-hydrogen exchanger isoform 3 (NHE3) on the apical surfaces of the small intestine and colon. By inhibiting NHE3, three key physiological effects occur. First, dietary sodium absorption is reduced, leading to increased luminal water content, which accelerates intestinal transit and softens stool consistency. Second, intestinal permeability is decreased, which helps to reduce abdominal pain. Lastly, visceral hypersensitivity is lowered, further alleviating the pain associated with IBS-C. These combined actions address multiple aspects of IBS-C pathophysiology, providing a minimally absorbed yet highly effective approach to symptom management.

With this exciting advancement, healthcare providers now have a novel treatment option that expands beyond traditional secretagogues, offering a new level of relief for patients struggling with IBS-C. To learn more, visit the GHAPP website for additional insights and expert perspectives on IBS-C management.

In this episode of GHAPPcast, the official podcast for Gastroenterology and Hepatology Advanced Practice Providers, host Gabriella McCarty, NP, is joined by Tedra Gray, NP, to explore the role of biosimilars in GI treatment. They dive into the differences between biosimilars and generics, the cost savings associated with biosimilars, their safety and efficacy, and strategies for effectively educating patients about making the switch. With insights into the FDA approval process, insurance challenges, and real-world clinical experience, this discussion provides essential guidance for APPs looking to enhance patient care and communication.

Key topics covered include what biosimilars are and how they differ from generics, the benefits of switching to a biosimilar—including improved access and cost savings—how biosimilars are tested for safety and efficacy, and best practices for discussing these treatments with patients. The episode also addresses common patient concerns, potential barriers to biosimilar adoption, and how to navigate insurance requirements.

To stay informed, visit ghapp.org for more resources or download the GHAPP ACE app. Don’t forget to subscribe to GHAPPcast for more expert insights into gastroenterology and hepatology. Tune in now to gain valuable knowledge that will help you empower your patients and improve their treatment experience.

They explore patient-centered care, lifestyle modifications, and non-invasive tests for identifying at-risk patients. Tune in for insights on balancing clinical trial participation with approved therapies, addressing patient access and equity, and the need for ongoing education in hepatology. This episode offers valuable information for healthcare providers committed to improving liver health. Don't miss this engaging and informative discussion!

Hosted by: Nadege Gunn, MD
With Special Guests: Elizabeth Goacher, PA, and Ann Moore, NP

• Design methods to appropriately explain biosimilars to patients
• Address potential patient perceptions of biosimilars
• Devise methods to combat the nocebo effect when discussing biosimilars with patients
• Explain the potential benefits of biosimilars for patients

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• Define the nocebo effect
• Appraise nocebo effect research as it pertains to biosimilars
• Explain effective ways to counter the nocebo effect such as patient counseling

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• Interpret the AGA Biosimilars Roundtable meeting report and the Crohn’s & Colitis Foundation Biosimilar position statement
• Discuss the use of biosimilars in the treatment of gastrointestinal diseases
• Produce strategies for implementing the use of biosimilars in gastroenterology practice

Please take our evaluation regarding this podcast here:   https://www.ghapp.org/biosimilars-podcast-eval

• Interpret the ACR white paper on biosimilars in rheumatology
• Discuss the use of biosimilars in the treatment of rheumatic diseases
• Produce strategies for implementing the use of biosimilars in rheumatology practice

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• Outline the cost savings of biosimilars for patients
• Summarize the cost savings for healthcare organizations
• Discuss  healthcare providers  feeling the pressure and burden of rising costs and how biosimilars may help in bridging the transition from volume-based to value-based care

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• Discuss managed care implications for biosimilars reaching the market
• Identify the benefits of biosimilars in managed care
• Formulate strategies managed care professionals can employ to establish clinical pathways and increase biosimilar uptake in practice

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• Define extrapolation
• Understand why extrapolation is important.
• Understand the key aspects that may be considered for scientific justification of extrapolation including:
         -MOA in each condition
         -Pharmacokinetics and biodistribution
         -Expected toxicities
         -Other- concomitant medications/comorbidities

Please take our evaluation regarding this podcast here: https://www.ghapp.org/biosimilars-podcast-eval