Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University in Norfolk, Virginia.
I've just returned from Digestive Disease Week (DDW) 2025 in San Diego, California, and want to give you the highlights. I selected several noteworthy abstracts, which I'm going to cover in two separate presentations.
If you registered for DDW 2025, you can access these abstracts on the conference website. However, if you didn’t register, you'll need to wait for them to come out in publication.
Inulin: A Promising Prebiotic
The first abstract I’d like to highlight comes from a translational study,[1] which offered important data related to the use of inulin, a prebiotic that enhances short-chain fatty acid production.
In previous studies, the team of researchers from Montreal, Canada, demonstrated inulin-enhanced anastomotic healing in mice as part of testing its efficacy for preventing leaks following colorectal surgery. In this current study, they assessed inulin’s ability to hinder colorectal cancer cell growth in mice “humanized” with microbiota. They found that inulin had a dramatic effect in the form of decreased dissemination of liver metastasis and subcutaneous growth of colorectal cancer cells. Mechanistically, they ascribed this to activation of the peroxisome proliferator-activated receptor pathway in the gut, which seems logical.
Inulin is a naturally occurring dietary fiber, found in many plant species including chicory root, and is readily available commercially. There's no known risk associated with inulin, which makes these results actionable now.
In a separate study,[2] researchers at the Children's Hospital of Philadelphia conducted a double-blind randomized trial looking at inulin’s effects in children with subclinical active inflammatory bowel disease (IBD).
They showed that inulin supplementation was associated with a reduction in fecal calprotectin levels, as well as improvements in the relative abundance of Bifidobacterium. These findings indicate that shifts in microbial health and reduced inflammation can be achieved in children with IBD using supplements with this naturally occurring oligosaccharide.
Inulin is simple to implement. While I'm not sure about its use in adults, I plan on immediately using it as an intervention for the populations identified in these studies. It seems to be a no brainer.
Alternatives to FMT for C. difficile
In December 2024, gastroenterologists faced a conundrum following the news that fecal microbiota transplantation (FMT) would no longer be available from OpenBiome.
A real-world study,[3] presented at DDW 2025, sheds some light on possible alternatives to standard FMT by comparing it with the US Food and Drug Administration-approved treatments of Rebyota (fecal microbiota, live-jslm), which is usually administered via enema, and Vowst (fecal microbiota spores, live-brpk), which is administered via oral capsules. Researchers assessed C difficile recurrence within 8 and 24 weeks, with stratification of results based on the presence of other relative risks like bezlotoxumab and presence of IBD.
At 8 weeks, there was a significantly lower risk of recurrent C difficile following treatment with Rebyota and Vowst, which were approximately 20% better when compared with standard FMT, a difference that was maintained out to 24 weeks.
Although we no longer have access to OpenBiome, these other therapies seem to offer a comparable — and perhaps superior — intervention.
The only caveat is that the improvement was statistically superior when Rebyota was administered via colonoscopy, which was more frequently done than via enema in this study, although the latter administration method showed improvement. This may simply be due to the larger number of people who received it via colonoscopy, but we'll have to wait and see.
However, I don’t think we need to step back from treatment for C difficile, given that we have these commercially available products.
AI in Adenoma Detection
We're all aware that artificial intelligence (AI) is being used in many gastrointestinal (GI) indications of late and showing how it can improve outcomes. This was proven again in a study[4] from King's College London, where researchers performed a randomized, open-label trial using GI Genius, an AI module.
They analyzed the adenoma detection rate (ADR) among colonoscopists classified as either non-expert or expert, categories defined as having performed less than or more than 2000 lifetime colonoscopies, respectively. Furthermore, the experts had an ADR > 40%, which is within the range of typical standards. The American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology Quality Task Force recommends an ADR of at least 35%, so the experts on this study really were.
Colonoscopies were performed at eight sites by 34 endoscopists, with an approximately 2:1 ratio for non-experts to experts. The findings showed that the ADR was improved by 9.5% when using the AI module. Interestingly, the experts’ ADR actually decreased with the use of the AI module, and it seemed most beneficial for those with lower detection rates.
There were three guidelines produced in 2025 regarding the use of computer-assisted detection colonoscopy. One says we should use AI, one says we shouldn't, and the third— from the American Gastroenterological Association — says that we don't have enough evidence to support it yet.
All in all, the recommendations are very conflicting. However, for me, the evidence seems to clearly indicate that lower-end ADR is considerably improved with AI and makes a difference.
Wearable Technology
There were a pair interesting studies around the use of technological tools in GI indications.
The first study[5] comes from Lynn Chang's brilliant research group, who analyzed outcomes in patients with irritable bowel syndrome wearing a Fitbit, a popular device used by approximately 38.5 million people. The researchers used the Fitbit to capture participants’ daily step count and sleep data. It should be noted that there are data indicating that a Fitbit seems relatively comparable with polysomnography, which is the gold standard for monitoring sleep efficiency.
The team found that increased daily step count and median hours of sleep were associated with lower irritable bowel syndrome severity.
In the next study,[6] researchers from Cedar-Sinai Medical Center in Los Angeles, California, conducted a prospective study with the Garmin vivofit, another activity tracker. The study essentially performed the same analysis, focusing on sleep and physical activity. However, in this case, they looked at preoperative and postoperative outcomes in patients with ulcerative colitis and Crohn's disease undergoing colorectal surgery. Once again, researchers found that increased physical activity and optimal sleep efficiency improved outcomes. Specifically, they were associated with fewer surgical complications and decreased length of stay.
As with some of the previously mentioned interventions, these wearable devices are commercially available. Together, the findings from these two studies indicate that wearable devices could be a very valuable self-management tool to encourage patients to monitor themselves, strive for improvement, and do so at a negligible cost.
Immune Checkpoint Inhibitors
Two studies offered important findings on the use of checkpoint inhibitors, which are being used more frequently for GI complications. In fact, GI immune-related adverse events account for up to 41% of adverse events in patients with IBD.
The first study[7] comes from Memorial Sloan Kettering Cancer Center in New York City. Researchers looked at a retrospective cohort of patients with IBD treated with immune checkpoint inhibitors over an 11-year period, assessing for a variety of outcomes related to GI toxicity. They found that GI toxicity led to immune checkpoint inhibitor discontinuance in 72% of patients. Discontinuation was more common in patients with active IBD at treatment initiation and among those whose pre-treatment disease was more severe.
This finding suggests how important it is to receive consultation and disease assessment from an IBD specialist. They can help proactively determine how to optimize immune checkpoint inhibitor therapy before it begins. Treating these high-risk patients really does call for a multidisciplinary care team.
The second study[8] caught my attention because I was unfamiliar with the topic: immune checkpoint inhibitor-related esophagitis.
Researchers conducted a retrospective study with a 15-year follow-up on patients who underwent esophagogastroduodenoscopy with biopsy after receiving at least one dose of an immune checkpoint inhibitor. A diagnosis of immune checkpoint inhibitor-related esophagitis was confirmed by an expert GI pathologist. They identified 13 patients with symptoms, which were variable and included weight loss, dysphagia, anorexia, and nausea. Of the 13 patients, 54% had abnormalities on endoscopy.
The takeaway is that we must perform biopsies when evaluating these patients. There are treatments available for esophageal toxicity. In this particular study, patients responded to proton pump inhibitors and budesonide, and some required an immunosuppressant medications such as biologics and systemic corticosteroids.
Esophageal Complications With GLP-1s
Another noteworthy study[9] delved into drug-related GI and esophageal-specific complications, in this case resulting from treatment with GLP-1 receptor agonists. We see GI motility and anesthesia issues related to these agents, but this complication concerns the effect on esophageal dysmotility.
Researchers from the Mayo Clinic assessed the association of GLP-1 receptor agonist exposure on high-resolution manometry findings obtained over a 10-year period. They identified 447 patients who had been exposed to these medications, with a final comparison cohort of 84 cases and 84 controls. They found very specific, integrated relaxation pressures were statistically different in the patients taking GLP-1 receptor agonists. Distal contraction intervals were greater, as were the number of hypercontractile supine swallows, the incidence of hypercontractile esophagus, and the incidence of esophagogastric junction outflow obstruction.
It's important to recognize this risk when performing manometry evaluations, and to be aware of the potential for new GI complications resulting from treatment with GLP-1 receptor agonists.
Ergonomics and Endoscopy
The final study[10] in this video relates to endoscopy. I thought this was important, given the ASGE guideline on ergonomics for preventing endoscopy-related musculoskeletal issues.
This study comes from a team of researchers in South Korea. Using a variety of monitors, they assessed the ergonomics of endoscopists, who tend to hold static and repetitive upper limb postures. They found that 52% of endoscopists’ postures fell into the high-risk category. The wrist and lower arm segments were most affected, with notable strain also placed in the head and torso regions. Fellows were more likely to be at risk, which makes sense since they’re less experienced.
These findings indicate that ergonomic challenges persist, despite current recommendations that we need to do better. Ensuring a robust system and emphasizing robotic ergonomic training and monitoring are important for self-preservation as we get older and further along in our endoscopy career.
Stay tuned for part two of my highlights from DDW 2025, which offers exciting new findings that you won’t want to miss.
I’m Dr David Johnson. Thanks for listening.
David A. Johnson, MD, a regular contributor to Medscape, is professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia, and a past president of the American College of Gastroenterology. His primary focus is the clinical practice of gastroenterology. He has published extensively in the internal medicine/gastroenterology literature, with principal research interests in esophageal and colon disease, and more recently in sleep and microbiome effects on gastrointestinal health and disease.
https://www.medscape.com/viewarticle/10-actionable-easy-interventions-gi-conditions-2025a1000bws
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