In this episode of Lion’s Digest – Advances in GI and Hepatology, Dr. Matthew Coates sits down with Dr. Prashant Nighot to explore the intricate biology of autophagy, intestinal permeability, and tight junction regulation—and how these processes shape gastrointestinal and liver health.

Dr. Nighot shares his expertise on how autophagy, the cell’s internal recycling and quality-control system, plays a critical role in maintaining epithelial integrity and barrier function. The discussion highlights how disruptions in autophagy can lead to increased gut permeability (“leaky gut”), altered tight junction dynamics, and downstream inflammation.

The conversation dives into the translational relevance of this work, focusing on how these mechanisms contribute to the pathogenesis of inflammatory bowel disease and chronic liver disease. Dr. Nighot explains how impaired barrier function may serve as a key link between luminal factors, immune activation, and systemic disease.

The episode also explores practical and emerging areas of interest, including the impact of fasting and exercise on autophagy pathways, and whether these interventions may have therapeutic implications. Dr. Nighot provides insights into his current research, including ongoing efforts to better understand how modulation of autophagy and tight junctions could lead to novel treatment strategies.

This episode bridges basic science and clinical relevance, offering a compelling look at how cellular processes influence disease—and how they may be harnessed to improve patient outcomes.

Topics discussed include:

• The fundamentals of autophagy and its role in cellular health
• The relationship between barrier dysfunction and inflammation
• Implications for IBD and liver disease
• The effects of fasting and exercise on autophagy
• Current and future directions in translational research

Episode Description: In this episode of Lion’s Digest – Advances in GI and Hepatology, host Dr. Manny Williams sits down with Dr. Matthew Coates to explore the emerging concept of “silent IBD.” While inflammatory bowel disease is often associated with significant gastrointestinal symptoms, some patients harbor active intestinal inflammation despite minimal or absent clinical symptoms—a phenotype that can delay diagnosis and treatment.

Dr. Coates discusses how clinicians can begin to recognize and identify patients with silent IBD, highlighting key clues from biomarkers, endoscopy, and cross-sectional imaging that may reveal ongoing disease activity even when patients report feeling well. The conversation also dives into his current research efforts aimed at better characterizing this underrecognized population and understanding why some individuals develop inflammation without the expected symptom burden.

A major focus of the discussion is the discovery of a gene associated with this silent IBD phenotype, offering new insights into the biological mechanisms that may influence symptom perception, immune signaling, and disease presentation. Dr. Coates explains how these findings could shape future diagnostics, risk stratification, and personalized treatment strategies for patients with IBD.

This episode provides a fascinating look at how genetics, immunology, and clinical observation are reshaping our understanding of inflammatory bowel disease—and why recognizing silent inflammation may be critical to preventing long-term complications.

Tune in to hear how Penn State researchers are advancing the science of IBD and what these discoveries could mean for the future of patient care.

Topics discussed include:

• What defines the silent IBD phenotype
• Strategies to detect inflammation in minimally symptomatic patients
• The role of biomarkers, endoscopy, and imaging
• New genetic discoveries linked to silent disease
• Implications for future research and personalized IBD care

We host Dr. Hadie Razjouyan from Penn State and Dr. Ibrahim Yaghnam from the University of Arizona for a discussion of their recent publication, "Impact of Scheduled Outpatient Endoscopy Procedures on Inpatient Endoscopy Procedures: Prospective Analysis from a Single Tertiary Care Center," published in Digestive Diseases and Sciences in August 2025. They discuss the rationale for the study, how it was executed, their results, and how these findings my impact and improve our inpatient Endoscopy scheduling processes.