Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
Is prophylactic anticoagulation indicated in patients with frequent ulcerative colitis flares?
Background: We know that inflammatory bowel disease (IBD) is a risk for incident and recurrent venous thromboembolism (VTE). What is not clearly established is whether the IBD needs to be 'active' in order for it to be a risk factor, e.g. would patients who have had proctocolectomy (and perhaps no e...
Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?
Patients on plavix and/or aspirin are at risk for bleeding whether in relation to surgery or bleeding from the gi tract. Much like the management of patients on anticoagulation temporary reversal of antiplatelet drugs is only achieved by normalizing platelet function. This is the same principle used...
How do you counsel patients with acute intermittent porphyria when it comes to fasting for religious reasons?
This is a very difficult question and it depends on the individual patient, their disease severity, their particular triggers, and how they have done in the past with caloric restriction. The patient may want to speak with a clergy member for guidance in this situation as well. For inst...
Do you usually recommend a modified diet for Clostridioides difficile infection (CDI)?
Post-infection IBS is common after C. diff infection, and some of these patients have dietary intolerances. Other than avoiding foods that exacerbate these symptoms, I do not recommend any particular diet. I also do not recommend probiotics, in keeping with society guidelines.
What is your approach to treatment of patients with fulminant C difficile infection who required ileostomy creation or colectomy?
Great question. If the entire colon has been removed, I do not see a role for oral vancomycin.
Is there a role for radiation in palliating malignant small bowel obstruction?
This problem has similarities to the management of symptomatic brain metastases. In both cases, cancer has caused a buildup of pressure in a vital organ. In both cases, it would be important to take non-radiotherapeutic measures (steroids in the case of brain mets, upstream decompression for SBO) to...
Is there a role for use of dupilumab for hypereosinophilic GI disorders distal to the esophagus?
No definitive studies performed yet and no FDA approval regarding using Dupilumab for EoG; however, in my opinion, I do believe that Dupilumab may be an effective treatment for some eosinophilic disorders beyond the esophagus.
Is there a role for anti-IL5 therapy in the treatment of EoE?
When looking at the use of IL-5 pathway drugs such as mepolizumab, reslizumab, and benralizumab in the treatment of eosinophilic esophagitis (EoE) studies to date have not demonstrated efficacy in terms of symptomatic improvement as related to the use of these series of medications. Each of these me...
How would you manage a patient with highly active ankylosing spondylitis, iritis and Crohn’s, controlled with weekly adalimumab with co-morbid IgG4RD and intolerance of azathioprine due to elevated LFTs?
There is not a known association between IgG4-RD and IBD or spondyloarthritis. Given that these are rare diseases, it is important to ensure diagnostic accuracy, as the combination of these diseases would be unusual, though not impossible. There are two types of autoimmune pancreatitis: type 1 (IgG4...
What is your treatment approach for a patient with metastatic hepatocellular carcinoma with Child's Pugh B cirrhosis?
Child Pugh B cirrhosis is a spectrum of disease, and requires careful consideration of the underlying cause of the cirrhosis as well as the potential impact of cancer therapy. As @Dr. First Last pointed out, there is data for sorafenib in this patient population, demonstrating a similar relative ben...