Dietary disparities among racial and ethnic minority populations contribute significantly to chronic disease burdens across the lifespan. This review synthesizes evidence on dietary behaviors among middle-aged and older adults, adolescents, and low-income children, highlighting how socioeconomic and structural barriers limit access to healthy foods. Non-Hispanic Black and Latino adults often fall short of fruit and vegetable intake recommendations, while adolescents from low socioeconomic backgrounds demonstrate lower nutritional knowledge and self-efficacy. Children enrolled in supplemental nutrition programs show racial/ethnic disparities in nutrient intake, with Non-Hispanic Black children particularly affected. Supplement use, a potential strategy to reduce nutrient deficiencies, is significantly lower among minority groups, especially women of color. Cultural, educational, and economic factors shape these patterns. Culturally informed nutrition education and policy interventions are needed to address the root causes of these disparities and promote dietary equity.
Computer aided polyp detection (CADe) is one of the most heavily studied applications of artificial intelligence in clinical medicine and may serve as a valuable adjunct for gastrointestinal endoscopists. Randomized controlled trials have demonstrated that CADe improves adenoma detection rates, particularly of smaller polyps and sessile serrated lesions. In this review, we provide an overview of the potential benefits and harms associated with CADe, as well as the limitations observed in real-world implementation. While modeling studies have demonstrated that CADe may be a cost-effective strategy to improve colonoscopy quality, it remains to be seen whether it will have a meaningful impact on colon cancer incidence rates, highlighting an important direction for future research.
Effective management of Disorders of Gut-Brain Interaction (DGBIs) often requires an interdisciplinary approach that extends beyond the gastrointestinal (GI) provider. DGBIs are characterized by dysregulation of the gut-brain axis, and growing evidence supports behavioral and dietary therapies that target these bidirectional pathways. Behavioral health providers and registered dietitians (RD) with specialized gastroenterology training - hereafter referred to as GI-psychologists and GI-RDs - deliver evidence-based interventions that have potential to improve patient symptoms and quality of life (QoL), with GI-psychologists using Brain-Gut Behavioral Therapies (BGBT), such as cognitive-behavioral therapy, to address psychosocial contributors, and GI-RDs applying diet strategies, including the low FODMAP diet, to optimize gastrointestinal function. Collaboration between these providers enables comprehensive evaluation of symptoms and DGBI subtype, supporting appropriate referrals. This review is to summarize current evidence for therapy approaches and delineates the distinct and complementary contributions of GI-psychologists and GI-RDs in DGBI, with the aim of guiding interdisciplinary referral practices.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by excessive hepatic fat accumulation in individuals without significant alcohol intake. Previously termed non-alcoholic fatty liver disease (NAFLD), this condition included nonalcoholic fatty liver and nonalcoholic steatohepatitis. The Mediterranean diet, characterized by limiting saturated fats, red meat, and refined sugars with increased consumption of fiber, polyunsaturated, and monounsaturated fats, has shown efficacy in improving hepatic steatosis and metabolic parameters in NAFLD. However, as diagnostic criteria have evolved, further research is needed to assess the diet's impact specifically on MASLD outcomes. This review will discuss the prevalence and diagnosis of MASLD, its associated metabolic and lifestyle risk factors, and evaluate existing evidence on the Mediterranean diet as a therapeutic approach, underscoring its close association with the earlier NAFLD classification.
Chronic liver disease is often accompanied by cutaneous findings indicative of underlying pathology. However, in addition to the many widely-known and recognizable dermatologic manifestations, there exists a multitude of subtle, lesser-known findings which warrant increased attention. Recognition of these dermatologic findings is invaluable, as they contribute to the diagnostic picture and can aid in prioritization of the differential diagnosis. It is vital for providers across specialties to be able to recognize and describe such lesions in order to help reduce diagnostic delay and hasten time to treatment. In this article, we present the associated cutaneous findings for common liver diseases including autoimmune hepatitis, Wilson's disease, hemochromatosis, alpha-1 antitrypsin deficiency, primary biliary cholangitis, primary sclerosing cholangitis, and metabolic dysfunction-associated steatotic liver disease.
Anorectal manometry (ARM) diagnoses anorectal sensorimotor disorders, and biofeedback therapy (BT) is an evidence-based treatment. We conducted a retrospective study at a community hospital to assess factors predicting patient follow-up and symptoms improvement after ARM. Analyzing 96 patients, we found those recommended both pharmacological treatments and Kegel exercises alongside biofeedback therapy (BT) showed better follow-up compared to BT alone (58.8% vs. 9.7%, p<0.01). A history of sexual abuse (14 vs. 25 weeks, p=0.04), co-existing urinary issues (27.8% vs. 56.6%, p=0.03) and anal hypo-contractility (23% vs. 55%, p=0.03), were significant predictors of longer follow-up duration and lesser symptom improvement respectively. Our study highlights that a multi-faceted approach to treatment ensures higher follow-up rates among patients undergoing ARM for anorectal disorders. Additionally, recognizing and accommodating patient-specific factors that influence outcomes is crucial for providing tailored multidisciplinary support and more intensive therapy. This study aims to explore the factors influencing patient follow-up rates and the timing of follow-up visits in a gastroenterology clinic after first ARM at a safety net hospital. Thereby addressing a critical gap in literature affecting the effective management of these disorders.
Dermatologic findings are common in liver disease, and may represent the very earliest or most prominent signs of an underlying disorder. While most practitioners recognize jaundice as a sign of hepatobiliary disease, there are numerous cutaneous signs which can point to concomitant liver dysfunction. Additional signs of liver disease may include findings like disseminated superficial actinic porokeratosis or Terry's nails in cirrhosis, or porphyria cutanea tarda in hepatitis C. It is important for general practitioners and dermatologists alike to be able to recognize and describe such lesions, as identification of cutaneous manifestations of liver disease can lead to earlier diagnosis and treatment initiation for patients. In this article, we present the spectrum of typical associated cutaneous findings of hepatitis B, hepatitis C, and cirrhosis.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with rapid on-site evaluation (ROSE) has been a subject of debate over the past few decades. With the development of new core needles, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) with macroscopic on-site evaluation (MOSE) has been shown to provide similar diagnostic accuracy with more cost-effectiveness compared to EUS-FNA with ROSE. This article aims to review the literature to provide a detailed description and comparison of outcomes of both sampling procedures.
Non-selective beta-blockers improve outcomes in patients with cirrhosis and are recommended in (1) compensated cirrhosis and CSPH (to prevent decompensation), (2) decompensated cirrhosis without prior episodes of VH (to prevent first VH), and (3) patients with prior episodes of VH in combination with EVL (to prevent recurrent VH). NSBB should be started as soon as any of the above indications is identified, as progressive hemodynamic changes (hypotension, decreased renal perfusion) may cause the therapeutic window to be missed. Carvedilol is preferred, starting at 3.125 mg daily and titrated to 12.5 mg daily or a maximum dose of 25 mg daily. Trials have used once daily dosing, but a divided twice daily dose may be better tolerated. A specific HR should not be targeted with carvedilol, but blood pressure should be monitored, and dose should be reduced or discontinued in patients with MAP <65, systolic BP <90 or in the presence of AKI.
Iron deficiency anemia (IDA) affects about one-third of the global population and has a significant impact on individuals with gastrointestinal (GI) disorders. Its multifactorial etiology includes chronic inflammation, impaired nutrient absorption, GI tract damage, inadequate dietary intake, increased iron requirements, and medication use. Effective clinical management of IDA involves accurate diagnosis, tailored treatment strategies, and ongoing monitoring. This review provides a comprehensive overview of the physiology and pathophysiology of IDA, with a focus on its prevalence in GI populations. The strategies for screening and diagnosis, the challenges posed by inflammation in interpreting iron studies, and individualized treatment considerations are discussed. Addressing these complexities is critical to improving clinical outcomes and the quality of life for those affected by IDA.
Underfeeding in the intensive care unit (ICU) is a well-documented issue affecting patient outcomes. Volume-based feeding (VBF) represents a feeding protocol designed to mitigate the effects of frequent enteral nutrition (EN) interruptions by allowing adjustments to be made in the infusion rate to achieve a target volume for a desired caloric and nutrient delivery. Various VBF protocols exist, each differing in regimen and effectiveness. VBF protocols are safe with minimal adverse events reported. To enhance compliance, VBF protocols should be tailored to fit each institution's workflow. The development and implementation of VBF protocols should be done in collaboration with a multidisciplinary team.
As understanding of disease processes in medicine evolves, terminology must often evolve too. Terminology related to cirrhosis has been changing to better capture the spectrum of liver disease and patients' progression along that spectrum that is not adequately captured by the terms "compensated cirrhosis" and "decompensated cirrhosis" alone. This article aims to review this newer terminology that has emerged over the past several years regarding portal hypertension and cirrhosis along the spectrum of compensated and decompensated disease. Appropriate use of terminology is important. It can help direct our conversations with patients in helping them to understand their disease and provide anticipatory guidance for what their future health may look like. It is also critically important in conveying how sick a patient may be when communicating with other providers and in conveying the complexity of medical decision making in our documentation.
Irritable Bowel Syndrome (IBS) is a common gastrointestinal (GI) disorder marked by abdominal pain, bloating, and altered bowel habits. Dietary changes are key to managing symptoms, with the low-FODMAP diet being the most evidence-based approach. Its complexity and restrictiveness, however, can make adherence difficult without guidance from a registered dietitian (RD). Given rising concerns around food-related anxiety and disordered eating in IBS, a shift toward more flexible, individualized dietary strategies is emerging. More research is needed to confirm the long-term outcomes of these less restrictive approaches. This review aims to present the current state of scientific evidence on the use of the low-FODMAP diet for managing IBS, including its three-phase structure and possible application of less restrictive FODMAP diet versions. It also explores the key role of GI expert RDs in the practical implementation of diet therapy, including patient assessment for suitability.
Eosinophilic esophagitis (EoE) is a chronic allergic clinicopathologic condition with a rapidly increasing incidence and prevalence and is being increasingly seen in both specialty and primary care settings. Left untreated, EoE progresses from an inflammation-predominant to fibrostenotic condition in most patients. Diagnosis requires a combination of clinical symptoms, esophageal eosinophilia on biopsies obtained during upper endoscopy, and exclusion of other potential causes of eosinophilia. Treatments include dietary elimination, medications (proton pump inhibitors, swallowed/topical steroids, or biologics), and esophageal dilation (when strictures are present). Long-term therapy and monitoring are also required. This review discusses how commonly EoE is seen in the primary care setting, when to suspect a diagnosis of EoE, how EoE is treated, and how primary and specialty care can intersect management of this chronic disease; practical tips for the primary care provider are also presented.
Short bowel syndrome (SBS) occurs from either surgical resection or malfunction of a significant amount of small bowel. An estimated 42-50% of patients with SBS will develop kidney stones in their lifetime.1,2 Both uric acid and calcium oxalate stones are common. Increased kidney stone risk stems from a combination of possible factors including inability to maintain adequate hydration, reduced alkali absorption, enteric hyperoxaluria, hypomagnesemia, altered gut microbiome, and poor food and beverage intake. Treatment must be individualized to each patient's 24-hour urine collection results as the cause of kidney stones will differ based on etiology of SBS and natural variations. Evidence based treatments for stone prevention in SBS include improving hydration status, oral calcium to reduce oxalate absorption, reducing dietary fat and/or oxalate, alkali supplementation, and the correction of hypomagnesemia. Dietary recommendations should be made by a registered dietitian after a complete nutrition assessment to ensure the recommendations are appropriate.
Intestinal stomas, whether from the small or large bowel, are the cornerstone of the surgical management of various gastrointestinal conditions, particularly in patients with inflammatory bowel disease (IBD) and rectal cancer. This review provides an overview of stoma types, indications, complications, and the critical role of preoperative and postoperative care. This highlights the necessity for collaboration between colorectal surgeons and gastroenterologists to optimize surgical planning, manage complex cases, and prevent complications. Stomas play a pivotal role in treating refractory diseases, high-risk surgical scenarios, and emergencies. Comprehensive care involving multidisciplinary teams that include stoma nurses, dietitians, and mental health professionals is essential for addressing stoma-related challenges, minimizing complications, and improving patient outcomes. By integrating medical and surgical expertise, healthcare teams can empower patients to adapt successfully and maintain high quality of life.
Selenium, a naturally occurring trace element, serves many bodily functions through its role in a family of proteins called selenoproteins. The average daily intake in the United States is about 116 mcg/day, well above the recommended dietary reference intake of 55 mcg/day for adults. Thus, deficiency is rare among Americans. Deficiency can occur in areas of low environmental selenium or in disease states that impair intestinal absorption, such as short bowel syndrome or inflammatory bowel disease, and affects the cardiovascular, respiratory, immune/ hematologic, gastrointestinal, reproductive, central nervous, and neuromusculoskeletal systems. This review will briefly summarize the general physiologic roles of selenium, emphasizing deficiency due to various gastrointestinal disorders, monitoring, and replenishment. A summary of recent investigations into selenium levels of those on parenteral nutrition is also provided.
