Duke GI Journal Club

Article 1:

Preemptive-TIPS Improves Outcome in High-Risk Variceal Bleeding: An Observational Study
Hepatology, VOL . 69, NO. 1, 2019

DOI: https://doi.org/10.1002/hep.30182
PDF: Article

Summary: This is a multi-center observational study in patients with cirrhosis who are admitted with acute variceal bleeding with the main aim of evaluating whether the use of pre-emptive TIPS improves the outcome of these patients (mortality, treatment failure, rebleeding risk).

Presenter: April Wall

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Article 2:

SER-109, an Oral Microbiome Therapy for Recurrent Clostridioides difficile Infection
N Engl J Med 2022; 386:220-229

DOI: https://doi.org10.1056/NEJMoa2106516
PDF: Article

Summary: Current therapies for recurrent Clostridioides difficile infection do not address the disrupted microbiome, which supports C. difficile spore germination into toxin producing bacteria. SER-109 is an investigational microbiome therapeutic composed of purified Firmicutes spores for the treatment of recurrent C. difficile infection.  We conducted a phase 3, double-blind, randomized, placebo-controlled trial in which patients who had had three or more episodes of C. difficile infection (inclusive of the qualifying acute episode) received SER-109 or placebo (four capsules
daily for 3 days) after standard-of-care antibiotic treatment.  In patients with symptom resolution of C. difficile infection after treatment with standard-of-care antibiotics, oral administration of SER-109 was superior to placebo in reducing the risk of recurrent infection.

Presenter: Kara Wegermann

Article 1:

Comparing Costs and Outcomes of Treatments for Irritable Bowel Syndrome With Diarrhea: Cost-Benefit Analysis
Clinical Gastroenterology and Hepatology 2022;20:136–144

DOI: https://doi.org/10.1016/j.cgh.2020.09.043
PDF: Article

Summary: Irritable bowel syndrome (IBS) is one of the most expensive gastroenterological conditions and is an ideal target for developing a value-based care model. We assessed the comparative cost benefit of treatments for IBS with diarrhea (IBS-D), the most common IBS subtype from insurer and patient perspectives. We constructed a decision analytic model assessing trade-offs among guideline-recommended and recently FDA-approved drugs, supplements, low FODMAP diet, cognitive behavioral therapy (CBT). Outcomes and costs were derived from systematic reviews of clinical trials and national databases. Health-gains were represented using quality-adjusted life years (QALY).

Presenter: Jeremy Gillespie

Additional Resources:

• Price Is Right: Exploring Prescription Drug Coverage Barriers for Irritable Bowel Syndrome Using Threshold Pricing Analysis

Article 2:

MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era
Gastroenterology 2021;161:1887–1895

DOI: https://doi.org/10.1053/j.gastro.2021.08.050
PDF: Article

Summary: The Model for End-Stage Liver Disease(MELD) has been established as a reliable indicator of short term survival in patients with end-stage liver disease. The current version (MELDNa), consisting of the international normalized ratio and serum bilirubin, creatinine, and sodium, has been used to determine organ allocation priorities for liver transplantation in the United States. The objective was to optimize MELD further by taking into account additional variables and updating coefficients with contemporary data.

Presenter: Jackie Henson

Additional Resources:

• The Model for End-stage Liver Disease 3.0: an update without proven accuracy