Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
How do you practically approach a tailored elimination diet in young patients with numerous food impactions and esophageal strictures who are intermittently compliant with PPI or topical steroids?
The first thing I would do is discuss with them the different approaches and efficacy of diet therapy. Currently an empiric elimination diet is the favored approach. Which empiric elimination diet is chosen is a discussion to have with each individual patient in a shared decision approach. The six f...
What patient characteristics guide the selection of a step-up versus a step-down elimination diet strategy in the management of eosinophilic esophagitis?
It is a shared decision making between the Physician and the patient. The step-up approach requires fewer endoscopies and may be better tolerated and accepted by the patient. But again a detailed discussion with the patient is needed for any kind of diet strategy to work.
How do you use gut microbiome or gut microbiota analysis in your clinical practice, if at all?
While I am presented with microbiome analyses on a regular basis by patients, I do not believe that these are useful, as we are still not there when it comes to defining the "normal" microbiome. This indeed may vary tremendously between individuals depending on age, gender, diet, geographic location...
In patients with longstanding UC or Crohn's colitis, would you extend the interval of surveillance colonoscopy to longer than 3 years if they have had little inflammatory disease over the years and no other factors to increase their risk (ie, history of polyps, history of dysplasia, or family history)?
AGA Practice Update says you can go to 5-year interval. Murthy et al., PMID 34416977
How do you remove and code for the following polyps?
I would inject and remove with a hot snare. It also depends on the location of the polyp. If the polyp is in the cecum, I would use a cold snare. I would code this as EMR. I would inject and remove this one also in one piece if possible. I would code this as EMR.
Are there cirrhotic patients in whom you might withhold or shorten duration of prophylactic antibiotics after UGIB?
No
How does the presence of gallbladder sludge vs stones on POCUS impact your suspicion for gallbladder disease as a cause of abdominal pain?
With all point-of-care ultrasound, so much depends on your pre-test probability before you acquire the image. If you are simply trying to identify biliary colic in a patient with a good history of the disease, then the presence of either sludge or stones is quite an effective test with bedside provi...
When do you send for genetic testing (e.g., SPINK1, PRSS1, CFTR) in a patient with recurrent or chronic pancreatitis without an obvious etiology and how does it impact your management?
I offer and discuss getting genetic testing in patients with idiopathic recurrent acute pancreatitis or chronic pancreatitis, more frequently in younger patients. Impact of testing can help identify undiagnosed CFTR patients, for whom further CF evaluation and management including options to try new...
Is there a role for use of GLP1 R agonist or dual agonist therapy for management of post bariatric hypoglycemia and dumping syndrome?
There is little systematically collected information in this area on which to base judgments. A case series of 5 post-bariatric surgical patients treated empirically with liraglutide described reduction of hypoglycemic events based on patient history. In an experimental study comparing several treat...
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...