Nothing dramatic...just a nice concise review of chronic diarrhea in JAMA.
🤔 Usually IBS-D/Chronic diarrhea, but remember to consider OTC/Rx'd meds, Celiac, Microscopic colitis, lactose or other disaccharidase deficiencies, etc
Useful article/charts for review or teaching.
Celiac??? It's OK.... just go ahead and kiss 'em
🤔Patients checked after kissing partner who just ate crackers.
🤔Apparently safe 5 minutes after the crackers, perhaps safer if the partner drinks 4 oz water.
So...go ahead.
Excellent review Evaluating LFT's
🤔Gastro (in Press)
🤔Link to abstract: www.gastrojournal.org/article/S001...
👍Good for teaching materials, or useful quick review.
#IMsky #Medsky #GIsky
Good point. Will work on it. Thanks!!!!
H.pylori...What is to be done?
🤔Common, perhaps up to 50% in >60 yo's
🤔Associated with Gastric Ca
🤔So many drugs...so many regimes...&still controversy re who to treat
👍JAMA nice two page review of treatment guidelines. Still favor Bis. Quadruple Therapy
#medsky #IMsky
Coming to a pt near you...Alpha-gal
🤔thought was geographically limited..but spreading
🤔Lone star tic leads to sensitivity to sugar molecule in most red meat or dairy products
🤔Reactions 2-10 hr p ingestion can range from urticaria/angioedema to N+V; abd pain
🤔Beware
#GIsky #IMsky #mdsky
Tonsillectomy & IBD?
🤔In the 60's 1 million/year in US, Recent 500K
🤔Now many for sleep disordered breathing
🤔Retrospective study, 1.4 million matched, suggests increased risk of developing IBD (HR 1.37 Crohn's; 1.29 UC)
🤔Interesting to consider Doubt will change decisions
#IMSky #MedSky
Cdiff Review: dx and mgmt.
🤔w/u PCR or GDH. If positive EIA
🤔Fidaxomicin may be clear next step as generic ⬇️cost
🤔If cured and needs another antibiotic, Vanco 125/d continue 5 days after antibiotic.
🤔FMT after 2nd recur, after 10 day of anti-CDI Rx and a washout of 48-72 hrs.
#Medsky #IMSky
Short review of post op ileus (POI), acute colon pseudo-obstruction(ACPO)
🤔POI: review MEDS; labs; ambulation
🤔Enteral feeding of benefit (POI)
🤔? SC methylnaltrexone for ACPO
🤔? prucalopride for POI & ACPO
🤔? value of chewing gum to prevent POI
🤔Does coffee prevent POI?
#Medsky #IMsky #GISky
cALD in US: Common; 85% of pts unaware they have it
🤔Compensated ALD in asymptomatic pts.
🤔Weighted preval of cALD in us 2.4%; possible cALD 3.46%
🤔85% unaware (This surprised me)
Another reminder to screen with FIB-4 and/or Elastography
#IMSky #GISky #Medsky
Add Statins to our Water? Statins associated with lower risk of HCC and Hepatic decompensation in cirrhosis
🤔Umbrella review ( EASL) 168 studies, 10 mil pts
🤔Reduced risk of HCC (HR 0.53)and decompensation
(HR 0.54)
Continue statins in these patients
Food for thought?
#IMsky #GIsky #Medsky
Hep Encephalopathy Guidelines...AJGastro3/26
🤔HN4 not useful, recommend "single test strategy" ie Stroop
🤔Do endorse consider 4l PEG
🤔Acute HE, adding rifaximin to lactulose
🤔Consider zinc levels and supplementation if not resp
🤔Protein 1.2-1.5 g/kg/d, no restrictions
🤔night snack
#Imsky #medsky
1/5 of US Adolescents have MASLD; a tenth have related fibrosis.
🤔Presented at EASL-SLD (ref below)
🤔Associated with male sex, overweight, obesity, higher waist circumferences
MASLD is potentially treatable. We need to look for it, evaluate it, and treat it to prevent its evolution to cirrhosis.
For non ICU pts with HRS/AKI ...Terlipressin seems best option
🤔Another article supporting Terlipressin vs. Octerotide plus Midodrine for hepatorenal syndrome/AKI
🤔For non ICU patients (those on general wards) (and most will be in ICU where nor epi preferred), ) a useful suggestion.
Coffee Barrett's and Gerd
🤔Review/meta-analysis
🤔Coffee associated with marginal 🔼 Gerd, but not Barrett's. "routine avoidance/reduction of coffee intake ...needs further evaluation"
👍Perhaps restrict in pts who identify it as a trigger, or improve with cessation. Not routinely
#medsky #GIsky
Screen heavy drinkers for liver disease
🤔 CCJM 2/14/26 notes this is not yet standard in primary care
🤔Modifiable risk factor. Mort rates doubled 1999-2022
👍Consider for men 5/d or 15/week. or Audit-C 4 or more; Women with 4/d or 8/ week, Audit 3 or more. Audit-C on Medscape
#IMsky #Medsky
Weight Loss in MASLD...Maybe better compliance with lower expectations?
🤔Weight Loss is the cornerstone of rx of MASLD
🤔While more weight loss is almost definitely better, article suggests that even 3% may be of real benefit
Sort of encouraging in real world practices
#IMSky #Medsky
are you using a DEFCON-based strategy to manage bowel motility in hospitalized patients?
having a clear, evidence-based treatment strategy improves efficacy & saves time
you don't need to redesign the wheel for every patient
& helpful to avert thermonuclear war
emcrit.org/ibcc/constip... #EMIMCC
I'll admit it...I'm a caffeine addict. Not to prevent dementia...but it is a good justification.
🤔JAMA article suggests lower rates of dementia and cognitive decline with greater consumption of caffeinated coffee/tea
👍2-3 cups a day coffee; 1-2 of tea seems optimal
Bring it on
#IMsky #Medsky
Let's hear it for short sleeves
🤔Long Sleeves cultured. 280 samples. 81% bacterial growth, 20.7% with potential pathogens. Fleece most likely to be contaminated.
No evidence of spread.
Even so lets hear it for "bare below the elbows."
#IMsky #Medsky #GIsky
Will PPI's ever be vindicated?
🤔Duru in BMJ - No association between PPI and Gastric
Adenocarcinoma.
🤔Ed (see below): Recognizing the conflicting and uncertain evidence base on PPI ...harms, suggest concern about adverse effects alone...not a reason to avoid prescribing.
#IMsky #GIsky #Medsky
Alfapump....? Interesting idea for refractory ascites
🤔Pumps ascitic fluid into badder
🤔Role unclear; ? if not candidates for Liver Txp, or TIPS
?Preferable to repeated large vol taps
Interesting article reviewing selection of pts and how it is placed.
#IMsky #GIsky #Medsky
reminder to liberally check carbon monoxide levels during snowmageddon
CO levels can be measured on venous blood along with routine labs (no need for a separate arterial puncture)
emcrit.org/ibcc/co/ #EMIMCC
AGA Update on Inpatient Mgmt of Adults with IBD
🤔Good summary, with nice graphics (see below)
🤔Another reminder re prophylactic anticoags
🤔Early use of IV steroids, and if no response consider additional meds.
🤔Review on dealing with abscesses and peri-rectal disease.
#IMsky #Medsky #GIsky
Cannabis in Gastroporesis (GP)??? Likely not a great idea
🤔Perhaps 18% of pop uses Cannabis
🤔Use also increasing in GP. We know it can be anti-emetic, 🔼 appetite...
😟Study shows 🔼ED visits, hospitalizations, malnutrition, need for enteral feeding in GP on Cannabis
#GIsky #IMsky #Medsky
The Things We Carry
🤔In our clinical world we do carry many things, including memories, many of which trouble us
🤔Somehow we more easily recall the troublesome, disturbing than the rewarding and fulfilling
Rory Spiegel perspective in NEJM.
Excellent.
#IMsky #GIsky #Medsky
Celiac Disease in pts with IBS.
🤔Increased risk of CD in IBS (Odds ratio vs control 4.42 for + serologies.
🤔Always interested that odds were similar across gender and IBS Subtypes. (had thought would be higher in IBS-D)
Lets keep on testing...
#Medsky #IMsky
CLEANSE your liver?
🤔Top 20 liver cleanse supplements on Amazon
😐1.4 mil sold, revenue 38 mil
😟Much hype, little evidence, and some risk
Up to 41% CLD pts on complement meds
Limited Scientific Evidence
Unlike Canada/EU not much supervision
Good editorial, last image
#GIsky #IMsky #Medsky
Hugging make you uncomfortable???
🤔16 yo severe abd pain after "bear hug"
🤔Prior abdominal fullness, rash
🤔CT (below) irreg cystic mass, free fluid
👍Ruptured Echinococcal Cyst in dog owner.
🤔Uncommon in US. High prev in some regions.
Nice review Medscape
#IMsky #Medsky #GIsky
Like IBD, ?🔼risk of thromboembolism in Microscopic Colitis
🤔Over 10 years of follow-up: VTE events in 6% with MC and 4.8% in reference pts
🤔Higher risks of PE, DVT, other VTE events
21% higher risk of VTE.
Should we follow same prophylaxis guidelines as with IBD?
#GIsky #IMsky #Medsky