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In the digital era of evidence-based medicine, there is a paucity of video endoscopy teaching platforms that use evidence-based medicine principles, or that allow for cognitive simulation of endoscopic management strategies. We created a guideline-based teaching platform for fellows that incorporates these features, and tested it.A pilot video module with embedded questions was drafted, and after incorporation of feedback from several attending gastroenterologists, an additional 2 modules were created. The embedded questions were designed to simulate cognitive management decisions as if the viewer were doing the endoscopy procedure in the video. A narrator explained the evidence behind the task being performed, and its certainty based on endoscopic guidelines. Quizzes and surveys were developed and administered to a sample of attendings and fellows who completed the video modules to test efficacy, usability, and likeability.Three video modules, named evidence-based endoscopy (EBE), incorporating low fidelity simulation, and utilizing evidence-based medicine principles, were created. Eight fellows and 10 attendings completed the video modules and all quizzes and surveys. Mean test scores improved from before to after completing the video modules (56% to 92%; mean difference = -35%; 95% confidence interval, 27%-47%). Surveys indicated that the product was viewed favorably by participants, and that there is a strong desire for this type of educational product.The EBE simulator is a unique, desirable, and effective educational platform based on evidence-based medicine principles that fills a gap in available tools for endoscopy education. Further studies are needed to assess whether EBE can aid in long-term knowledge retention and increase adherence to guideline recommendations.

The development of guidelines by gastroenterology societies increasingly stresses evidence-based endoscopic practice.We performed a systematic assessment to determine whether endoscopic video teaching platforms incorporate evidence-based educational strategies and methods in order to disseminate guideline-based endoscopic management strategies.Platforms with a video component were systematically identified using the Google search engine, Apple and Android application stores, and searching four major gastroenterology society websites and three known platforms, to identify all relevant platforms. Two video samples from each teaching platform were reviewed independently by two authors and assessed for use of a priori defined principles of evidence-based medicine, as determined by consensus agreement and for the use of simulation.Fourteen platforms were included in the final analysis, and two videos from each were analyzed. One of the 14 platforms used simulation and incorporated evidence-based medicine principles consistently. Nine of the 14 platforms were not transparent in regard to citation. None of the platforms consistently cited the certainty of evidence or explained how evidence was selected.Education of guideline-based endoscopic management strategies using principles of evidence-based medicine is under-utilized in endoscopic videos. In addition, the use of cognitive simulation is absent in this arena. There is a paucity of evidence-based cognitive endoscopy simulators designed for fellows that incorporate systematic evaluation, and efforts should be made to create this platform.

Background: Comparative effectiveness of 7 glucagon-like peptide 1 (GLP-1) agents on weight loss (WL) in obesity is unknown. Methods: Study Design: Systematic review, network meta-analysis (NMA) Data Sources: MEDLINE, EMBASE, Scopus, Cochrane Central and clinical trial registries, from inception to March 2, 2021 Prespecified Criteria for Study Inclusion: Randomized clinical trials (RCTs) of >12 weeks’ duration. Data Appraisal and Extraction: Two investigators independently, using published reports. Main Outcomes and Statistical Methods: WL over placebo (WLOP) and adverse events (AEs) among GLP-1 agents using random-effects NMA (frequentist approach); relative ranking using surface under the cumulative ranking (SUCRA) method and certainty of evidence using GRADE. Registration: None Findings: Data Synthesis: 64 RCTs (2004-2021) had 27018 patients (medians of age, 55.1y; 57.4% women; baseline weight 94.8kg and BMI 33.0kg/m2; trial duration 26 weeks). Direct meta-analysis showed significant WLOP with: -1.44kg (95% CI, -2.14 to ‑0.74) with dulaglutide ≥1.5 mg; -1.82kg (‑2.42 to ‑1.23) with exenatide IR; -2.20kg (-4.31 to -0.08) with exenatide ER; -3.20kg (-6.53 to 0.15) with efpeglenatide; -2.72kg (‑3.35 to -2.09) with liraglutide ≤1.8mg; -4.49kg (-5.26 to -3.72) with liraglutide >1.8mg; ‑0.62kg (-1.22 to -0.02) with lixisenatide; ‑4.33kg (-5.71 to -3.00) with semaglutide SQ 1.8mg (SUCRAs 100, 86.1, 82.8 respectively). Highest SUCRAs for discontinuation due to AEs were with taspoglutide and liraglutide >1.8mg.Risk of bias was high or unclear for random sequence generation (29.7%), allocation concealment (26.6%), and incomplete outcome data (26.6%). Heterogeneity (I 2 >50%) in WL and AEs reflected magnitude, not direction of effect. Interpretation: Semaglutide (SQ, oral) and liraglutide (SQ) were the most efficacious GLP-1 agents to induce WL during > 12 weeks’ treatment. Funding: NIH R01-DK67071 (Camilleri) Declaration of Interest: Dr. Michael Camilleri serves on an advisory board for Phenomix Sciences regarding the company’s development of a test to predict weight loss response to obesity therapy, and he is a stockholder in the company. Phenomix Sciences has obtained an exclusive license to Dr. Michael Camilleri’s and Dr. Andres Acosta’s biomarker technology, submitted patent, and know-how to develop a biomarker to predict response to obesity pharmacotherapy. Dr. Camilleri also serves as a consultant to Kallyope for the company’s development program regarding obesity (the consulting fee is paid to his employer, Mayo Clinic). All other authors have nothing to declare.

BackgroundSince its emergence in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions, such as coughing, and care activities, such as aerosol-generating procedures, likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of the personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. The purpose of the current study was to develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known coronavirus disease 2019 (COVID-19).MethodsThe Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists, with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and gray literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.ResultsThe IDSA guideline panel agreed on 8 recommendations, including 2 updated recommendations and 1 new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included.ConclusionsUsing a combination of direct and indirect evidence, the panel was able to provide recommendations for 8 specific questions on the use of PPE by HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2, and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.

Background Since its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. Objective Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19. Methods IDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Results The IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included. Conclusions Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.

Mucosal exposure devices including distal attachments such as the cuff and cap have shown variable results in improving adenoma detection rate (ADR) compared with high-definition white light colonoscopy (HDWLE).We performed a prospective, multicenter randomized controlled trial in patients undergoing screening or surveillance colonoscopy comparing HDWLE to 2 different types of distal attachments: cuff (CF) (Endocuff Vision) or cap (CP) (Reveal). The primary outcome was ADR. Secondary outcomes included adenomas per colonoscopy, advanced adenoma and sessile serrated lesion detection rate, right-sided ADR, withdrawal time, and adverse events. Continuous variables were compared using Student's t test and categorical variables were compared using chi-square or Fisher's exact test using statistical software Stata version16. A P value.05 was considered significant.A total of 1203 subjects were randomized to either HDWLE (n = 384; mean 62 years of age; 81.3% males), CF (n = 379; mean 62.7 years of age; 79.9% males) or CP (n = 379; mean age 62.1 years of age; 80.5% males). No significant differences were found among 3 groups for ADR (57.3%, 59.1%, and 55.7%; P = .6), adenomas per colonoscopy (1.4 ± 1.9, 1.6 ± 2.4, and 1.4 ± 2; P = .3), advanced adenoma (7.6%, 9.2%, and 8.2%; P = .7), sessile serrated lesion (6.8%, 6.3%, and 5.5%; P = .8), or right ADR (48.2%, 49.3%, and 46.2%; P = .7). The number of polyps per colonoscopy were significantly higher in the CF group compared with HDWLE and CP group (2.7 ± 3.4, 2.3 ± 2.5, and 2.2 ± 2.3; P = .013). In a multivariable model, after adjusting for age, sex, body mass index, withdrawal time, and Boston Bowel Preparation Scale score, there was no impact of device type on the primary outcome of ADR (P = .77). In screening patients, CF resulted in more neoplasms per colonoscopy (CF: 1.7 ± 2.6, HDWLE: 1.3 ± 1.7, and CP: 1.2 ± 1.8; P = .047) with a shorter withdrawal time.Results from this multicenter randomized controlled trial do not show any significant benefit of using either distal attachment devices (CF or CP) over HDWLE, at least in high-detector endoscopists. The Endocuff may have an advantage in the screening population. (ClinicalTrials.gov, Number: NCT03952611).

Introduction Teduglutide, a glucagon-like peptide-2 analog, is a novel therapy for intestinal failure that reduces need for parenteral support, especially in patients without a functional terminal ileum or colon. It can also predispose patients to accelerated progression of gastrointestinal (GI) malignancy and fluid overload. We demographically and clinically characterized American patients prescribed teduglutide. Methods The Explorys database is an aggregate of deidentified patient data from dozens of US healthcare systems. We used SNOMED classification to identify patients prescribed teduglutide from 2015 to 2019. Through the browse cohort feature we determined the demographics, postsurgical anatomy, comorbidities, and indication for teduglutide use among these patients. Results Of approximately 72 million patients, 170 were prescribed teduglutide. A large majority were female (70.6%). Most common etiologies of short-bowel syndrome were intestinal obstruction (52.9%) and Crohn's disease (41.2%). Common postsurgical anatomy included total colectomy (41.2%) and ileostomy. Common incident symptoms included abdominal pain (41.2%) and nausea (23.5%). Thirty (17.6%) patients were prescribed teduglutide despite comorbid heart failure, and 5.9% despite prior GI malignancy. A total of 11.8% of patients had a history of benign GI neoplasms before starting teduglutide. A total of 5.9% of patients had posttreatment formation of colon polyps. Conclusion In a large American database, the teduglutide prescription is rare. Only a minority have postsurgical anatomy associated with the most robust response to teduglutide. Serious adverse events appear rare, but a substantial number of patients are at risk for adverse effects because of the presence of comorbid heart failure or GI neoplasm.

Background: Hepatitis-C virus (HCV) chronic infection can lead to cirrhosis, hepatocellular carcinoma (HCC), end-stage liver disease, cardiovascular disease (CVD), and mortality. Transient Elastography (TE) is used to non-invasively assess fibrosis. Whether immune monitoring provides additive prognostic value is not established. Increased red-cell distribution width (RDW) and decreased absolute lymphocyte count (ALC) predict mortality in those without liver disease. Whether these relationships remain during HCV infection is unknown. Materials and Methods: A retrospective cohort of 1,715 single-site VA Liver Clinic patients receiving Transient Elastography (TE) 2014-2019 to evaluate HCV-associated liver damage were evaluated for RDW and ALC in relation to traditional parameters of cardiovascular risk, liver health, development of HCC, and mortality. Results: The cohort was 97% male, 55% African American, 26% with diabetes mellitus, 67% with hypertension, and 66% with tobacco use. After TE, 3% were subsequently diagnosed with HCC, and 12% (n=208) died. Most deaths (n=189) were due to non-liver causes. The TE score associated with prevalent CVD positively correlated with atherosclerotic cardiovascular disease (ASCVD) 10-Year Risk Score, age, RDW, and negatively correlated with ALC. Patients with anisocytosis (RDW above 14%) or lymphopenia (ALC level under 1.2x109/L) had greater subsequent all-cause mortality, even after adjusting for age, TE score, and comorbidities. TE score, and to a modest degree RDW, were associated with subsequent liver-associated mortality, while TE score, RDW, and ALC were each independently associated with non-liver cause of death. Conclusion: Widely available mortality calculators generally require multiple pieces of clinical information. RDW and ALC, parameters collected on a single laboratory test that is commonly performed, prior to HCV therapy may be pragmatic markers of long-term risk of mortality.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible virus that can infect healthcare personnel (HCP) and patients in healthcare settings. Specific care activities, in particular, aerosol-generating procedures, may have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 has created significant challenges in healthcare facilities, particularly with severe shortages of personal protective equipment (PPE) used to protect HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care are needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators.ObjectiveOur objective was to develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known coronavirus disease 2019 (COVID-19).MethodsThe Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel that included front-line clinicians, infectious diseases specialists, experts in infection control, and guideline methodologists with representation from the disciplines of preventive care, public health, medical microbiology, pediatrics, critical care medicine, and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then, a systematic review of the peer-reviewed and gray literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence and make recommendations.ResultsThe IDSA guideline panel agreed on 8 recommendations and provided narrative summaries of other interventions undergoing evaluations.ConclusionsUsing a combination of direct and indirect evidence, the panel was able to provide recommendations for 8 specific questions on the use of PPE for HCP who provide care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. Significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 remain, and PPE recommendations may need to be modified in response to new evidence.

Background & Aims Multiple gastrointestinal (GI) symptoms, including diarrhea, nausea/vomiting, and abdominal pain, as well as liver enzyme abnormalities, have been variably reported in patients with coronavirus disease 2019 (COVID-19). This document provides best practice statements and recommendations for consultative management based on a systematic review and meta-analysis of international data on GI and liver manifestations of COVID-19. Methods We performed a systematic literature search to identify published and unpublished studies using OVID Medline and preprint servers (medRxiv, LitCovid, and SSRN) up until April 5, 2020; major journal sites were monitored for US publications until April 19, 2020. We pooled the prevalence of diarrhea, nausea, vomiting, and abdominal pain, as well as liver function tests abnormalities, using a fixed-effect model and assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Results We identified 118 studies and used a hierarchal study selection process to identify unique cohorts. We performed a meta-analysis of 47 studies including 10,890 unique patients. Pooled prevalence estimates of GI symptoms were as follows: diarrhea 7.7% (95% confidence interval [CI], 7.2%–8.2%), nausea/vomiting 7.8% (95% CI, 7.1%–8.5%), and abdominal pain 2.7% (95% CI, 2.0%–3.4%). Most studies reported on hospitalized patients. The pooled prevalence estimates of elevated liver abnormalities were as follows: aspartate transaminase 15.0% (95% CI, 13.6%–16.5%) and alanine transaminase 15.0% (95% CI, 13.6%–16.4%). When we compared studies from China to studies from other countries in subgroup analyses, diarrhea, nausea/vomiting, and liver abnormalities were more prevalent outside of China, with diarrhea reported in 18.3% (95% CI, 16.6%–20.1%). Isolated GI symptoms were reported rarely. We also summarized the Gl and liver adverse effects of the most commonly utilized medications for COVID-19. Conclusions GI symptoms are associated with COVID-19 in

Gastric cancer is the third leading cause of cancer-related mortality and the leading infection associated cancer worldwide. In the US, there are estimated 27,510 new cases and 11,140 gastric-cancer related deaths in 2019.1 Gastric adenocarcinoma (GA) is the most common form of gastric cancer. Histologically, by the Lauren classification, GA can be divided to two types: intestinal GA and diffuse GA.2 The Cancer Genome Atlas (TCGA) initiative has identified 4 molecular subtypes of gastric cancers: genomically stable (diffuse), chromosomally stable (intestinal), microsatellite instability, and Epstein-Barr virus subtypes.3 GA is also classified based on anatomic location into cardia (CGA) or non-cardia GA (NCGA). NCGA include those arising from the antrum, incisura, body, and/or fundus.4 Intestinal-type NCGA (hereafter simply referred to as “NCGA”) results from the complex interaction between genetic, environmental, and microbial determinants, which drive the stepwise progression through a series of discrete histopathologic stages, the “Correa cascade”, from non-atrophic gastritis to gastric preneoplasia (chronic atrophic gastritis (AG), gastric intestinal metaplasia (GIM)) and dysplasia, prior to malignant transformation to invasive adenocarcinoma in a minority of patients (1–3%). Helicobacter pylori (H. pylori) is the dominant factor in this cascade with an attributable risk of 75–88% but additional pathways are recognized.5, 6 Most factors which account for the prevalence of GIM and its progression to neoplasia lack definitive evidence. Despite the established association of GIM with increased risk of incident NCGA, currently it’s not possible to predict who will develop gastric neoplasia. Furthermore, whether the endoscopic surveillance of GIM to detect early NCGA compared to no surveillance may improve patient-related outcomes, has not been established, particularly in low incidence countries like the US. Whether selected surveillance of GIM for identifiable high-risk groups within, such as racial/ethnic minorities and immigrants, is similarly unclear. These critical knowledge gaps formed the rationale behind the American Gastroenterological Association’s (AGA) Clinical Practice Guideline Committee’s constructing evidence-based guidelines to inform the management of patients who are diagnosed with GIM based on gastric biopsies performed in routine clinical practice. The technical review team systematically summarized and synthesized the literature to inform pre-defined clinical questions proposed by the AGA guideline panel using standard systematic review methodology. With guidance from the guideline committee, we developed a comprehensive list of direct and indirect evidence needed to inform the guideline questions. The direct evidence included randomized and non-randomized comparative studies that assessed the benefits and/or harms of endoscopic surveillance in patients with GIM. The indirect evidence included the prevalence of GIM, the incidence of intestinal-type NCGA in individuals with GIM, and specified risk factors and biomarkers associated with the development of NCGA in patients with GIM: family history of gastric cancer, racial/ethnic background, immigration status, smoking history, pernicious anemia and/or autoimmune atrophic gastritis, GIM topographic extent, GIM histological subtype, and predictive biomarkers (e.g., H. pylori and its virulence factors (e.g. cagA and vacA), and the pepsinogens). Our systematic literature search did not identify studies that provide direct evidence to inform our clinical questions, although we were able to identify many studies that informed our questions indirectly. It was evident that there was inconsistent and incomplete methodology among the studies and many publications were missing essential demographic, clinical, endoscopic and/or pathology data. These data elements are necessary to allow a thorough assessment of the events reported and to determine the certainty of that evidence. The lack of direct evidence and the lack of certainty in the indirect evidence limited the guideline’s panel ability to make strong recommendations for a common clinical condition. To stimulate the field to improve clinical outcomes, best practices are intended to guide future research and overcome the limitations of the available evidence. The aim of this guidance document is to highlight the methodological limitations that the technical review and guideline team encountered in the literature review and provide guidance for future design of high quality studies on GIM as a premalignant finding that is associated with development of gastric cancer. We have provided a general checklist that will facilitate standardization of future studies to advance the science of GIM with rigorous evidence to inform clinical care. For completeness, we include measures that are important yet were outside the scope of the AGA GIM technical reviews and guidelines (e.g., endoscopy imaging).

This guideline provides updated recommendations on the role of preprocedure testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (AGA) (released July 29, 2020). Since the start of the pandemic, our increased understanding of transmission has facilitated the implementation of practices to promote patient and health care worker (HCW) safety. Simultaneously, there has been increasing recognition of the potential harm associated with delays in patient care, as well as inefficiency of endoscopy units. With widespread vaccination of HCWs and the general population, a re-evaluation of AGA's prior recommendations was warranted. In order to update the role of preprocedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy; patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy; effectiveness of COVID-19 vaccine in reducing risk of infections and transmission; patient and HCW anxiety; patient delays in care and potential impact on cancer burden; and endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine preprocedure testing, and considered burden, equity, and cost using the Grading of Recommendations Assessment, Development and Evaluation framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine preprocedure testing for SARS-CoV2 in patients scheduled to undergo endoscopy. The panel placed a high value on minimizing additional delays in patient care, acknowledging the reduced endoscopy volumes, downstream impact on delayed cancer diagnoses, and burden of testing on patients.

Hepatitis B (HBV) is one of the most common viral infections of the liver worldwide. There are more than two billion people that have been infected, four million acute cases per year, and one million deaths per year. Out of those, 350–400 million are chronic carriers, and 25% of carriers die from chronic hepatitis, cirrhosis, or liver cancer.

Co-infection with HIV and hepatitis C (HCV) is common due to similar risk factors. Twenty-five to thirty percent of HIV+ patients are co-infected with HCV. HCV infection in HIV+ patients is associated with higher rates of fibrosis, progression to cirrhosis and decompensated liver disease, and liver-related mortality. The ultimate HCV treatment goal is viral eradication, or sustained virologic response (SVR) which results in decreased liver-related morbidity and mortality. Prior therapies were suboptimal in co-infected patients. However, the new HCV direct-acting antiviral agents provide excellent treatment options in co-infected patients with response rates and adverse events similar to the HCV mono-infected population. Drug interactions between HIV treatments and HCV treatments can be challenging and must be taken into consideration. To optimize outcomes, co-infected patients should be managed by experienced providers or in the setting of a collaborative multidisciplinary approach. This article will review the current treatment rationale and recommendations for HIV-HCV-co-infected patients.

Abbreviations used in this paper AGAAmerican Gastroenterological AssociationCDCCenters for Disease Control and PreventionCIconfidence intervalCOVID-19coronavirus disease 2019GIgastrointestinalGRADEGrading of Recommendations Assessment, Development and EvaluationMERS-CoVMiddle East respiratory syndrome–related coronavirusORodds ratioPAPRpowered air-purifying respiratorPPEpersonal protective equipmentRRrisk ratioSARS-CoV-2severe acute respiratory syndrome coronavirus 2WHOWorld Health Organization

OBJECTIVES: The glucagon-like peptide 2 (GLP-2) analog teduglutide (TED) is a novel therapy for intestinal failure that reduces need for parenteral support. Degree of response may correlate to location of surgical anastomoses. TED may worsen heart failure (HF) and gastrointestinal (GI) neoplasms. Using a large database we characterize American patients prescribed TED. METHODS: The Explorys national database (Cleveland, OH, USA) is an aggregate of de-identified patient data from 26 US healthcare systems. SNOMED classification was used to identify consecutive patients prescribed TED, 2015–2020. Demographics and comorbidities were collected. Preceding surgeries, suspected inciting conditions, and incident symptoms/events post TED were searched using the temporal attributes feature on Explorys. RESULTS: Of 72 million patients, 170 are prescribed TED. Age range of majority was 45–69 years. 70% were female, 82% caucasian and 12% African American. 70 used medicare, and 70 private insurance. In 50 patients, initial BMI was > 30, 40 had BMI

Acute hepatitis C virus (HCV) infection becomes persistent in a majority of cases [1], and the long-term risk of cirrhosis, liver failure, cancer, and mortality among those with chronic infection highlight the importance of effective therapy [1, 2]. HCV magnitude decrease at 4 and 12 weeks of pegylated interferon (IFN)–α plus ribavirin therapy is predictive of sustained virologic response [3]. Although mechanisms underlying IFN-α responsiveness remain unclear, factors associated with response to IFN-α therapy include HCV genotype, age, race, human immunodeficiency virus (HIV) coinfection, baseline HCV level, and polymorphism near the interleukin 28B (IL-28B) (IFN-λ3) gene locus [3–9]. Despite introduction of protease inhibitors, the need to combine these agents with IFN means that response to newer regimens continues to depend on factors regulating IFN-α responsiveness. Natural killer (NK) cells provide essential host defense during mouse hepatic viral [10, 11] and human herpesvirus infection [12–15]. They are innate lymphocytes with cytokine-producing, chemokine-producing, and cytotoxic activities regulated by activating and inhibitory receptors [16, 17]. Evidence for NK cells contributing to control of HCV derives from observations that genetically determined NK-KIR (Killer Immunoglobulin like Receptor)/ligand pairing correlates with the course of acute HCV infection [18] and that, during chronic infection, NK KIR2DL3, NKG2C, and NKp30 expression are associated with response to IFN-α–based therapy [19–21]. In addition, TRAIL expression is upregulated on NK cells during IFN-α–based therapy, and this correlates with in vitro cytolysis of HCV JFH-1–infected Huh 7.5 cells [22]. We observed NK IFN-αR and NKp30 expression to associate with IFN-α–dependent killer activity during HIV infection [23]. NK cells of individuals with preserved activity appeared to have enhanced IFN-αR expression. We hypothesized that IFN-αR expression is upregulated during chronic viral infection, in turn determining IFN-α–dependent function. Here, we evaluated NK cell subset IFN-αR and NKp30 expression in HCV genotype 1–infected patients at baseline, longitudinally over the course of IFN-α–based therapy, and in relation to IFN-α signaling capacity and viral decrease.