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Trial by Jury: Irritable Bowel Syndrome Brooks Cash, MD ; Lin Chang, MD ; William Chey, MD ; David Kunkel, MD ; Mark Pimentel, MD VIEW WEBCAST Recorded at ACG 2019 meeting in San Antonio, TX. Target Audience: This activity has been designed to meet the educational needs of gastroenterologists and other healthcare providers involved in the care of patients with irritable bowel syndrome (IBS). Educational Objectives After completing this program, participants should be better able to: Design treatment plans for patients with IBS that are aligned with current evidence-based recommendations Explain the quality of evidence, magnitude of benefit, safety, and tolerability of specific treatments for IBS Incorporate new IBS therapies effectively into clinical practice Provided by Supported by educational grants from Salix Pharmaceuticals and Shire. This program is neither sponsored nor endorsed by ACG.

Mice study offers new insight on irritable bowel syndrome Sometimes the end of an intestinal infection is just the beginning of more misery. Of those who contract traveler's diarrhea, for example, an unlucky few go on to develop irritable bowel syndrome (IBS), a chronic inflammation of the intestinal tract. Scientists aren't sure exactly how this happens, but some think an infection may contribute to IBS by damaging the gut nervous system. A new Rockefeller study takes a close look at why neurons in the gut die and how the immune system normally protects them. Conducted with mice, the experiments described recently in Cell offer insight on IBS and could point toward potential new treatment approaches. Keeping inflammation in check In a healthy gut, the immune system must strike a careful balance between responding to threats and keeping that response in check to avoid damage. Full article >> https://www.news-medical.net/news/20200112/Mice-study-offers-new-insight-on-irritable-bowel-syndrome.aspx Source: Rockefeller University Matheis, F., et al. (2020) Adrenergic Signaling in Muscularis Macrophages Limits Infection-Induced Neuronal Loss. Cell. doi.org/10.1016/j.cell.2019.12.002. AZoNetwork, © 2000-2020

At a recent American College of Gastroenterology conference, Lin Chang MD, UCLA shared that a large number of IBS sufferers began symptoms as post-infectious IBS (PI-IBS)

Fructan can cause symptoms in non celiacs ingesting wheat products Another important slide to understand mechanisms why we have symptoms by ingesting wheat and have negative diagnosis of celiac #ACG2019 by @umfoodoc Ironwood Pharmaceuticals, Inc. (IRWD), a GI-focused healthcare company, today announced the presentation of clinical data for linaclotide and MD-7246, as well as results from a survey for patients with persistent gastroesophageal reflux disease (GERD), from Ironwood and its collaborators during the American College of Gastroenterology (ACG) 2019 Annual Scientific Meeting being held in San Antonio, TX, October 25 through October 30, 2019. A linaclotide poster at the meeting was recognized by the ACG as a Presidential Poster Award recipient. Every year less than 5% of accepted abstracts receive this distinction for high quality, novel, unique, and interesting research. The abstract features safety and efficacy data from a Phase II trial of linaclotide in pediatric patients aged six to 17 with functional constipation. Linaclotide, a guanylate cyclase‐C (GC‐C) agonist, is activated by a mechanism pioneered by Ironwood scientists. Phase I data demonstrating the limited effect of MD-7246 on bowel frequency and stool consistency in healthy volunteers will be presented in a poster session. MD-7246, an investigational product, is being evaluated as an oral, intestinal, non-opioid, pain-relieving agent for patients suffering from abdominal pain associated with certain GI diseases, including IBS with diarrhea (IBS-D). MD-7246 is a delayed-release formulation of linaclotide designed to provide targeted delivery of linaclotide to the colon, where the majority of the abdominal pain associated with IBS-D is believed to originate, and to limit fluid secretion in the small intestine resulting in minimal impact on bowel function. Salix Pharmaceuticals to Present New Clinical Data at the American College of Gastroenterology (ACG) Annual Meeting Published: Oct 28, 2019 TRULANCE® (plecanatide) Poster Presentation Recognized with Presidential Poster Award Distinction TRULANCE® (Plecanatide) Darren M. Brenner, MD. "Impact of Plecanatide on Symptoms and Quality of Life for Patients with Chronic Idiopathic Constipation: Analysis of PAC-SYM and PAC-QOL From Two Phase III Clinical Trials." Poster #P0341; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level); Recipient of the Presidential Poster Award Gregory Sayuk, MD. "Plecanatide for Patients with Chronic Idiopathic Constipation and Irritable Bowel Syndrome-Constipation: Analysis of Abdominal Bloating from Four Randomized Phase 3 Clinical Trials." Poster #P2157; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) XIFAXAN® (Rifaximin) Brian Lacy, PhD, MD. "Impact of Colonoscopy Timing on Rifaximin in Patients with Irritable Bowel Syndrome with Diarrhea (IBS-D)." Poster #P2164; Tuesday, Oct. 29, 1:00 p.m. – 2:15 p.m. CT; Exhibit Halls 3 and 4 (street level) PLENVU® (polyethylene glycol 3350, sodium ascorbate, sodium sulfate, ascorbic acid, sodium chloride and potassium chloride for oral solution), also known as NER1006 Michael S. Epstein, MD, FACG; "Electrolyte Shifts of NER1006 Bowel Preparation for Colonoscopy in the Elderly Are Transient and Well-Tolerated." Poster #P0368; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Michael S. Epstein, MD, FACG, "1 L NER1006 Improves High-Quality Colon Cleansing and Mean Polyp Detection versus Oral Sulfate Solution and 2 L Polyethylene Glycol Plus Ascorbate." Poster #P2030; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Michael S. Epstein, MD, FACG; "In Patients with an Overall Cleansing Success the 1L Polyethylene Glycol NER1006 Achieves More High-Quality Cleansed Segments per Patient Than Three Standard Bowel Preparations." Poster #2031; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Brooks D. Cash, MD, FACG. "Patient Experience with NER1006 as a Bowel Preparation for Colonoscopy: A Prospective, Multicenter U.S. Survey." Poster #P0372; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Avoidant/Restrictive Food Intake Disorder May Be Underdiagnosed Gastroenterology patients with avoidant/restrictive food intake disorder (ARFID) are less likely to be taking psychotropic medications, have less-severe body image concerns, and are frustrated with being unable to eat what they want compared with patients without ARFID, according to study findings presented at the American College of Gastroenterology (ACG) 2019 Annual Scientific Meeting and Postgraduate Course. The findings suggest the need to appropriately screen gastroenterology patients for ARFID and the importance of a using a multidisciplinary treatment approach. >> https://www.consultant360.com/exclusive/gastroenterology/insights-american-college-gastroenterology-2019/avoidantrestrictive-food >> https://www.healio.com/gastroenterology/nutrition/news/online/{eda3e067-5b29-40d5-90bd-8f999c2a1c9f}/avoidant-food-intake-disorder-rarely-connected-with-body-image-concerns Plenary Session at ACG 2019 Conference Reports Unique Blend of HMOs Significantly Improves IBS Symptoms A nationwide multi-center, open label trial on human milk oligosaccharides (HMOs) found that daily intake of a unique formulation of glycans can significantly improve patients' IBS symptoms. “Human Milk Oligosaccharides Improve All the Central Symptoms of Irritable Bowel Syndrome: A Multi-Center, Open Label Trial” will be presented by Magnus Simrén, MD, PhD, Professor and Senior Consultant at the Department of Internal Medicine & Clinical Nutrition for the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. Dr. Simrén is also an adjunct professor of medicine at the University of North Carolina School of Medicine in Chapel Hill. Patients were given daily doses of a proprietary blend of HMOs — 2’-FL (2’-fucosyllactose) and LNnT (lacto-N-neotetraose) — found in Holigos® (hōly-gōs) IBS, a medical food to be taken under medical supervision, available without a prescription. The trial results demonstrated significant improvement in overall symptoms (fecal consistency, abdominal pain, and bloating) as well as improved quality of life as measured by IBS Severity Scoring System (IBS-SSS). The findings in this new study support the growing acceptance in the medical community of microbiota-directed therapies, such as the inclusion of prebiotic HMOs in IBS dietary planning. Glycom is a global biotechnology company dedicated to the scientific, clinical, and commercial development of human milk oligosaccharides (HMOs) for a broad range of health applications. Glycom, headquartered in Hørsholm, Denmark, is the world’s leading supplier of HMOs and has a U.S. facility located in Covington, La. Glycom is privately held. For more information about Glycom, visit glycom.com. Additional info from MD Magazine >> https://www.mdmag.com/conference-coverage/acg-2019/human-milk-oligosaccharides-may-help-ease-irritable-bowel-syndrome-symptoms >> https://www.prnewswire.com/news-releases/study-shows-human-milk-oligosaccharides-significantly-improve-ibs-symptoms-300947860.html >> https://www.gastroenterologyadvisor.com/irritable-bowel-syndrome-ibs/effects-of-human-milk-oligosaccharides-on-gastrointestinal-symptoms-in-ibs-qa-with-dr-magnus-simren/ >> https://www.medpagetoday.com/meetingcoverage/acg/83031 Celiac disease patients diet is perceived to be higher burden than patients with HTN, DM2, GERD, IBD or IBS. #ACG2019

Maya Pimentel (Cedar-Sinai): Elevated levels of Campylobacter jejuni in appendicitis (females n=50) seen in microbial DNA analysis. May support the use of antibiotics in a subgroup of patients with appendicitis.