Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
What therapies would be considered safe and effective in pregnant patients with EoE?
Would start with two-diet elimination, milk and wheat can give you close to 50% success. If needed can add esomeprazole, and you should be closer to 70%.
When managing patients with suspected MASLD, what specific criteria or findings would prompt you to refer them to hepatology?
In patients with suspected MASLD, I consider referral to hepatology when there is evidence of fibrosis by elastography or if I don't see improvements in related parameters with weight loss and/or medical therapies (GLP1-related meds, SGLT2i, TZDs).
When do you consider scheduled antiemetics in hospitalized patients experiencing severe nausea?
The biggest problem I see is antiemetics given PRN when a patient has consistent nausea. The goal is to get above the nausea so that the patient begins to feel better. This is similar to how one treats pain. Thus, if a patient is taking an antiemetic more than once a day and has consistent nausea, I...
Can patients "age out" of screening colonoscopies if, on their last colonoscopy prior to turning 76, they had tubular adenomas?
How long ago was the last colonoscopy? How many adenomas? How old is the patient now? State of health and expected longevity? What does the patient want? Frankly, at this point, I think I’d probably be content with an annual FIT.
Should GLP-1 agonists be held during chemotherapy?
I think there are several aspects to this question. First, is there evidence that as a class GLP-1 RAs increase the risk of cancer or worsen prognosis during cancer? I could find nothing to raise concerns about outcomes. One recent report even showed a decreased risk of some cancers with GLP-1 RA co...
How do you approach surveillance of gastric hyperplastic polyps of various sizes?
Gastric hyperplastic polyps are the second most common gastric polyps, behind fundic gland polyps. Unlike hyperplastic polyps in the colon, gastric hyperplastic polyps can be associated with chronic inflammation, notably Helicobacter pylori gastritis or autoimmune gastritis, for example. The neoplas...
Do you routinely use single-use duodenoscopes for ERCPs in patients with a history of infections secondary to MDR organisms?
Since we have single-use duodenoscopes available now, it makes sense to use these for patients with a history of MDR infection.
Do you feel there is any difference between performing an ERCP with an EDGE together in a single session or separately in two sessions in a patient with Roux-en-Y anatomy?
Experts do both approaches - I think the minority will do EDGE (or GATE = gastric access temporary for endoscopy, a more inclusive term than EDGE, which is for ERCP only, although GATE only refers to gastric access) with ERCP in a single session as a routine, while more do the 2-step approach. Of co...
Do you recommend, based on current evidence, avoiding antimotility agents in patients with non-fulminant C. difficile infection who have no evidence of ileus?
I generally avoid their use based on the notions that diarrhea may contribute to the elimination of non-invasive GI pathogens and that impairment of intestinal motility could increase the risk of complications, such as toxic megacolon.The data and recommendations have not progressed beyond the follo...
What precautions should be taken when discharging a patient from the medical setting on new medication assisted therapy for alcohol use disorder?
Great question. This article absolutely adds to the argument for using medications for alcohol use disorder. The precautions would mostly explain side effects, just as you would for any new medication. A few specific considerations depend on the medication (I'll restrict this to four more common cho...