From the Guidelines
For patients with lower Gastrointestinal Intragastric Volume (GIV), prophylaxis with proton pump inhibitors is recommended to prevent potential complications. When considering lower GIV, it is essential to prioritize the management of obesity and related gastrointestinal issues. According to the AGA clinical practice guidelines on intragastric balloons in the management of obesity 1, proton pump inhibitors are recommended for individuals undergoing IGB therapy. This recommendation is based on a strong recommendation with moderate certainty.
Some key points to consider in the management of lower GIV include:
- Prophylaxis with proton pump inhibitors to reduce the risk of gastrointestinal complications 1
- Avoiding perioperative laboratory screening for nutritional deficiencies, as suggested by the AGA guidelines 1, although this is a conditional recommendation with low certainty
- Focusing on the overall management of obesity and related gastrointestinal issues, rather than solely on lower GIV
In terms of specific management strategies, the use of proton pump inhibitors is a key consideration for patients with lower GIV. This is based on the most recent and highest quality evidence available 1. Other management strategies, such as dietary changes or other medications, may also be considered on a case-by-case basis. However, the primary focus should be on preventing potential complications associated with lower GIV, and proton pump inhibitors are a key part of this strategy.
From the Research
Considerations for Lower GIV
- The use of intravenous immunoglobulin (IVIG) has been established as a standard therapeutic option for various primary and secondary immunodeficiencies, including X-linked agammaglobulinaemia (XLA), common variable immunodeficiency (CVID), and selective IgG class deficiency 2.
- In patients with primary immunodeficiency diseases, IVIG is administered at replacement levels, whereas patients with autoimmune and inflammatory diseases receive higher doses 2, 3.
- The choice between IVIG and subcutaneous immunoglobulin (SCIG) options depends on individual patient needs, with IVIG requiring fewer infusion sites and less frequent infusions, but SCIG offering the advantage of self-administration at home and fewer systemic adverse infusion reactions 3.
- The mechanisms of action of IVIG are complex and involve modulation of the immune system, including effects on T cells, B cells, and macrophages, as well as interference with antibody production and degradation, and modulation of the complement cascade and cytokine network 4, 5.
- IVIG has been approved by the FDA for use in several conditions, including immune thrombocytopenic purpura, primary immunodeficiency, and Kawasaki disease, but most usage is for off-label indications, highlighting the need for further research and randomized controlled trials 6.