Gastroenterology   

Questions discussed in this category


There seems to be little guidance on vitamin replacement in these patients. Vitamin K level < 50 yet PT/INR is normal. Is the vitamin K assay usefu...

Do any special adjustments need to be made for any particular biologic therapies?

Do you avoid using these agents only in patients with history of medullary thyroid cancer or pancreatic cancer? Are there other cancer risks we should...

Would you send a CMV DNA PCR in blood, and if you elect to treat with anti-CMV medication, how long would you treat and what parameters would you use,...

How do you practically approach a tailored elimination diet in young patients with numerous food impactions and esophageal strictures who are intermit...

Do you discontinue the use of certain medications that have been associated with microscopic colitis (ie, PPIs, SSRIs)?

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies? 

I have a patient with recently diagnosed primary biliary cholangitis/cirrhosis (PBC) with SSc. Her laboratory values are within normal limits, but end...

Is there a role for oral vancomycin in these patients, or is oral vancomycin redundant if other routes of administration are being used (i.e intracolo...

Does histology (radioresistant or radiosensitive) play into this decision?

Would portal hypertensive gastropathy or colopathy sway you away from using it?

Since the COVID-19 pandemic, increasingly we see management of acute cholecystitis with cholecystostomy tubes as opposed to surgery, even amongst pati...

From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...

Would you start with a baseline ultrasound and then pursue further workup such as fibroscan if fatty liver is present, or other?

For example, in patients who are HbSAg negative, anti-HBc positive and HbSAb negative, does vaccination reduce reactivation risk?

Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...

How do you approach de-escalation or justify therapy maintenance? Do you have tiers of medications that you attempt to de-escalate first? In one parti...

A female in her 50s with iatrogenic Cushing's Syndrome presenting for management of SLE with low disease activity (but not remission) in the setting o...

Would the etiology of the thrombocytosis play a role in your decision-making?

 Should they be placed on routine EGD surveillance and if yes at what intervals?

Is radiation effective in this case and if so, what dose would you use? Is there potential for perforation?

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave150 and HIMALAYA? When do you in...

If the patient is outpatient and coming into clinic each day, at what point would you initiate a C. diff workup?

Are there any medications that you can prescribe? Diet changes? Does this typically resolve on its own after time?

Is there a specific brand or formulation you prefer? The literature supporting the use of probiotics does not standardize the type or dose of probiot...

The patient already received PLADO+sorafenib, Y90, and Atezolizumab/Bevacizumab complicated by recurrent episodes of bleeding from esophageal varices....

Would you offer liver transplant in the setting of metastatic disease? 

Would you reduce dose, e.g. from 30 Gy in 10 fractions to 20 Gy in 5 fractions, or hyperfractionate, e.g. 1.5 Gy bid to 20-30 Gy?

In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?

In a patient with a large primary and a negative PET/CT for nodal disease, would you push for EUS for radiation planning? Or would this be an unnecess...

This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet

Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT?  What if the size is >5 cm?

Would your recommendations change if you were treating a GI primary (e.g. rectal or anal cancer) vs non-GI primary? 

If so, for what platelet count threshold and do you have a preference as to which agent?

Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...

Do you have any preferred dose fractionation schedules? What kind of margins do you use?

Arterial events have clear instructions to permanently discontinue on the FDA label.  Especially in HCC without many other treatment options, giv...

Would you ever considering re-starting immunotherapy before completing the taper? According to the new guildelines on managing immunotherapy related ...


Papers discussed in this category


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J. Hepatol., 2016-05-01

Eur. J. Cancer, 2011-09-01

Lancet Oncol., 2015-10-01

Practical radiation oncology, 2015

Radiother Oncol, 2014 Jun

J Clin Oncol, 2013 May 1

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-02-10

Practical radiation oncology, 2015

Journal of the National Cancer Institute, 2017-09-01

J Gastrointest Cancer,

BMC Palliat Care, 2015 Aug 04

Lancet (London, England), 2018-03-24

J. Hepatol., 2019 Apr 06

Gastroenterology, 2018 May 17

Clin. Gastroenterol. Hepatol., 2018 Nov 28

Hepatology (Baltimore, Md.), 2019-10

Clin. Cancer Res., 2015 Oct 23

Invest New Drugs, 2015 Apr 12

J Hepatol, 2021 May 26

N Engl J Med, 2020 May 14

NEJM Evidence, 2022 June 6

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-04-10

Cancer, 2019-09-15

Journal of psoriasis and psoriatic arthritis, 2019-04

Arthritis Rheumatol, 2016 Jan

Liver Cancer, 2019 Sep 18

Arthritis care & research, 2017-03

Clin Exp Dermatol, 2018 May 24

Oncotarget,

Blood, 2020 Sep 10

Blood Adv,

The New England journal of medicine, 2018-07-05

J Gastroenterol, 2019 Nov 12

Am Heart J, 2010 Sep 18

N Engl J Med,

Lancet (London, England), 2017-01-07

The Lancet. Oncology, 2019-02

JAMA Oncol, 2020 Dec 10

Hepatology, 2019 Oct 14

Lancet,

Gut, 1999-04

Gut, 2012-12

Annals of the rheumatic diseases, 2019-04

Ann Rheum Dis, 2014 Mar 21

Am J Transplant, 2016 Jun 09

Transplantation, 2021 Apr 27

Surgery, 2017 Jun 16

J Pharm Pract, 2019 Mar 27

Arthritis and rheumatism, 1992-08

Arthritis and rheumatism, 1995-12

Seminars in respiratory and critical care medicine, 2002-12

Clinics in liver disease, 2019-05

Eur J Gastroenterol Hepatol,

Neth J Med,

Semin Respir Crit Care Med, 2020 Aug 10

Seminars in arthritis and rheumatism, 2016-02

Bull Soc Ophtalmol Fr,

Am J Hum Genet, 2021 Jan 7

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-08-20

Annals of the rheumatic diseases, 2015-06

Neth J Med,

Medicine (Baltimore),

Am J Clin Nutr, 2017 Jul 05

Autoimmun Rev, 2012 Nov 30

Proc (Bayl Univ Med Cent), 2020 Jan 30

Medizinische Klinik (Munich, Germany : 1983), 2002-11-15

Journal for scientific research. Medical sciences, 2001 Apr

Gut, 2006 May 18

Arthritis & rheumatology (Hoboken, N.J.), 2017-10

Arthritis Rheumatol, 2020 Apr 01

Ann Rheum Dis, 2022 Jul 07

Lancet Gastroenterol Hepatol, 2023 Feb 01

Dig Liver Dis, 2022 Aug 16

BMC endocrine disorders, 2024 Nov 18

International urology and nephrology, 2024 Nov 04

Cancers, 2024 Sep 22

Clinics (Sao Paulo, Brazil), 2018 Dec 10

Metabolites, 2020 Jul 11

Protein & cell, 2014 Jul 12

Trends in biochemical sciences, 2016 Jan 05

Journal of clinical medicine, 2020 Dec 23

Blood, 2014 Oct 15

Int J Radiat Oncol Biol Phys, 2019 Oct 1

Frontiers in oncology, 2020 Mar 24

International journal of radiation oncology, biology, physics, 2023 Apr 08

Cancer, 2023 Jul 28

Gastrointestinal endoscopy, 2012-01

Gastrointestinal endoscopy, 2012 Feb

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-03-10

N Engl J Med,

Nat Med, 2020 Apr 06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Jan 09

American journal of clinical oncology, 2023 Dec 22

Cancer, 2023 Jul 06

The Lancet. Oncology, 2023 Dec 08

Cardiovascular and interventional radiology, 2023 Jul 10

Therapeutic drug monitoring, 2022 Jun 01

The Journal of allergy and clinical immunology, 2012-02

Gut, 2023 Jul 09

The New England journal of medicine, 2024 Jun 27

Pharmacological research, 2016 Aug 10

The Annals of pharmacotherapy, 2018 Aug 06

Am J Gastroenterol,

Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 2016 Nov

Journal of hepatology, 2022 Jun 01

Gastrointestinal endoscopy, 2011-06

Gastrointestinal endoscopy, 2023 Nov 10

Anticancer research, 2021 Apr

The Journal of infection, 2011-11

Alimentary pharmacology & therapeutics, 2006 Nov 15

Journal of tropical medicine, 2017 Feb 26

The New England journal of medicine, 2021 Mar 04

Inflammatory bowel diseases, 2014 Dec

Inflammatory bowel diseases, 2024 Nov 04

The American journal of gastroenterology, 2023 Dec 22

Gut, 2019 Dec 20

Cancer, 2010-04-15

Clinical and translational radiation oncology, 2019 Jan 11

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 2019 Jun 05

Nutrients, 2016 Jan 02