GHAPPcast

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...

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...

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 phys...

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 be...

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 th...

In this episode, physician assistant Alison Moe, P-C, and Carolyn Legaspi, NP, explore the future of hepatitis B research and management, including promising therapeutic developments and critical care gaps. Together, they discuss the complexity of chronic hepatitis B infection, the global burden of disease, and why achieving a functional cure remains elusive despite current antiviral therapies. The conversation highlights cutting-edge research on therapeutic vaccines—including the first entering Phase 1 clinical trials in early 2024—and the potential role of immune modulators in achieving long-term viral suppression. Carolyn and Alison also address major research challenges, such as targeting HBV’s persistent cccDNA...

In this clinical discussion on CHB, Scott Springer, PA-C, and Dawn Drazek, NP, explore real-world application of treatment guidelines, including the 2018 AASLD recommendations. They break down when to initiate therapy based on HBV DNA levels, ALT elevations, and HBeAg status, while also highlighting the importance of patient-centered care—especially in unique populations such as those who are pregnant, have chronic kidney disease, or present with cirrhosis. The conversation also covers HCC screening best practices, simplified treatment approaches inspired by hepatitis C management, and clinical considerations when choosing between agents like tenofovir DF, tenofovir AF, and entecavir. With practical insights an...

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 celi...

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...

Join physician assistants Helen Adams, Mount Sinai Medical Center, and Emily Przybyl, Erie County Medical Center, as they dive into the clinical complexities of chronic hepatitis B in this insightful discussion. With over 250 million people living with chronic hepatitis B worldwide, the episode emphasizes the urgency of early diagnosis, proper screening, and effective long-term monitoring to prevent progression to cirrhosis and hepatocellular carcinoma (HCC). Helen and Emily review the importance of comprehensive hepatitis B triple panel testing (surface antigen, surface antibody, core antibody), the nuances of interpreting serologies, and updated screening guidelines for high-risk populations—including pregnant women, individuals bo...

In this podcast episode, Future Directions in PBC Research and Management, Christina Hanson, FNP, South Denver Gastroenterology, and Patrick Horne, NP, University of Florida, explore the evolving landscape of Primary Biliary Cholangitis (PBC)—highlighting advances in biomarkers, treatment targets, and personalized care. The conversation addresses a shift in clinical thinking beyond alkaline phosphatase alone, emphasizing the role of additional markers like bilirubin, GGT, albumin, and fibrosis stage in risk stratification and treatment planning. The episode also underscores the importance of symptom assessment, especially for pruritus and fatigue, which are often underreported by patients but have a significant impact on qu...

In this insightful discussion, nurse practitioners HoChong Gilles and Sarah Dawkins explore the critical role of multidisciplinary care in the management of Primary Biliary Cholangitis (PBC). As a complex autoimmune liver disease, PBC often requires more than hepatology alone—patients benefit from a collaborative approach that includes endocrinology for bone health, primary care for fatigue evaluation, dermatology for refractory pruritus, mental health specialists, pharmacists, social workers, cardiology, rheumatology, and registered dietitians. Gilles and Dawkins emphasize how coordinated care improves quality of life, supports symptom management, and addresses barriers to access such as medication affordability and social determinants of health. Th...

In this expert conversation, Andrea Gossard, NP, and Ann Moore, NP, share real-world strategies for managing Primary Biliary Cholangitis (PBC) with a strong focus on symptom control and quality of life. While PBC is a chronic autoimmune liver disease requiring long-term management, patients often struggle most with debilitating symptoms like pruritus (itching) and fatigue—which can significantly impact their day-to-day well-being. Gossard and Moore discuss stepwise treatment approaches for pruritus, including cholestryramine, rifampin, naltrexone, and off-label options, as well as non-pharmacologic interventions. They also explore the complex, often misunderstood nature of fatigue in PBC and the importance of patient ed...

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. Whet...

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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...

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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...

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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 mana...

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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...

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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 u...

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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...

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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...

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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...

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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...

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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...

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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...

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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...

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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 d...

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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...

In the final installment of our Simplified Access Series, we turn our focus to the evolving drug distribution landscape, including specialty pharmacy dynamics, hospital-based models, and the increasing influence of white bagging, brown bagging, and payer mandates.

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...

In Episode 2 of our Simplified Access Series, we continue our deep dive into practical strategies to streamline the prior authorization (PA) process and reduce delays in patient care. Nurse practitioners Tedra Gray and Allison Moser return alongside Jeff Dunn, PharmD, a veteran in managed care and president of a transparent PBM, to explore real-world solutions for improving first-attempt PA success.

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...

Welcome to Episode 1 of our Simplified Access Series, where we explore real-world strategies to navigate prior authorizations and medication distribution challenges in hepatology and gastroenterology. In this conversation, hepatology nurse practitioners Allison Moser, Rush University Medical Center, Chicago, and Tedra Gray, Sinai, Chicago, are joined by Jeff Dunn, PharmD, a managed care veteran and CEO of a transparent pass-through PBM.

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...

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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 effe...

Thank you Johnson & Johnson for your support of this GHAPPcast episode.

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...

Cirrhosis is often considered an irreversible liver disease, but is there a chance for early-stage reversal? In this episode, Janet Gripshover, CRNP, Nurse Manager for the Cedars-Sinai Liver Transplant Program, dives deep into the latest advancements in cirrhosis treatment, liver transplant eligibility, and the evolving landscape of transplantation. She discusses the critical role of early detection, how decompensated cirrhosis impacts survival rates, and the growing trend of earlier liver transplants across the nation.

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...

Cirrhosis is a progressive liver disease that requires early detection, effective management, and patient education to improve outcomes. In this video, Allison Moser, NP, a Transplant Hepatology Nurse Practitioner at Rush University Medical Center, shares key strategies for healthcare professionals to enhance 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 crit...

Explore the latest findings on Guselkumab as a maintenance therapy for moderate to severe ulcerative colitis from the Phase 3 QUASAR Maintenance Study. In this Journal Club video module, Shayla Schoenoff, PA-C, reviews key efficacy and safety outcomes in patients who demonstrated a clinical response to Guselkumab IV induction. The randomized, placebo-controlled trial assessed subcutaneous Guselkumab (100 mg every 8 weeks or 200 mg every 4 weeks), showing significant improvements in clinical remission, symptomatic remission, endoscopic response, and steroid-free remission compared to placebo. Additionally, safety outcomes remained consistent across treatment groups, with no new major safety concerns. Watch now to learn how Guselkumab maintenance...

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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...

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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), especi...

In this video, Sherona Bau, NP, at Pfleger Institute at UCLA, shares the latest advancements in cirrhosis management, including newly FDA-approved medications and updated AASLD (American Association for the Study of Liver Diseases) guidelines. While there are still limited medications specifically for cirrhosis, recent developments provide promising options for patients with liver disease.

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...

In this video, Shayla Schoenoff, PA-C, reviews the Phase 3 QUASAR maintenance study, evaluating the efficacy and safety of Guselkumab as a maintenance therapy for moderately to severely active ulcerative colitis. This randomized, double-blind, placebo-controlled study assessed patients who previously had an inadequate response to conventional or advanced therapies and demonstrated a clinical response to GUS IV induction therapy.

Key findings show that GUS subcutaneous maintenance therapy significantly improved clinical remission rates, symptomatic remission, endoscopic improvement, and steroid-free remission at Week 44 compared to placebo. Patients receiving 100 mg GUS every 8 weeks and 200 mg GUS every 4 weeks showed higher remission...