Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
What is your approach to terminal ileal structure in the setting of a new diagnosis of Crohn’s disease on index colonoscopy?
If there have been episodes of symptomatic obstruction or if there is proximal dilation on imaging, I would forgo any medical therapy and move straight to resection.
How do you plan to integrate exercise programs after adjuvant chemotherapy in patients with colon cancer, given the results of the CHALLENGE trial?
The CHALLENGE study demonstrated that structured exercise following adjuvant chemotherapy significantly benefits patients with resected high-risk stage II or stage III colon cancer. The study's success hinged on its mandatory behavioral-support sessions. Unlike the control arm, which received only h...
What minimum cardiometabolic evaluation and treatment workflow do you recommend at the time of MASLD diagnosis in hepatology clinic?
Although there is no clear algorithm, the new 2026 ACC guidelines recommend checking ApoB and Lp(a) at least once in individuals who are high risk. I include those with MASLD on that list. Therefore, in addition to ensuring they have their usual metabolic labs checked (HbA1c, lipid panel, sometimes ...
With pan-genotypic treatment options available, when do you consider checking the genotype in patients with Hepatitis C?
As long as pangenotypic medications are available to you, there is no reason to check genotype anymore. However, in some situations, such as prisons or very restrictive insurance plans where only the older medications are available, it would be important to know the genotype.
What is your preferred analgesic in patients with small bowel obstruction or ileus?
I typically use IV Tylenol ATC if fully obstructed, and IV Toradol if no other contraindications to NSAIDs (and they often are quite prerenal or losing a lot of fluid from an NG tube, so I often don't feel comfortable with more than a couple doses, and if I think they are going to the OR, I do not u...
How do you approach a referral for findings of intestinal metaplasia on a biopsy of an irregular z-line?
It is true that intestinal metaplasia of the GEJ is not Barrett's esophagus but it increases the risk of cancer like it is in the stomach. In the last 5-10 years, it has attracted more attention. Now, pathologists are starting to describe complete vs incomplete intestinal metaplasia. A good study wi...
How long do you recommend waiting after variceal bleeding and banding before a transesophageal echocardiogram can be performed safely?
In the exact wording of this question, the scenario that is being presented is that the patient has had a variceal hemorrhage (VH) recently and urgent banding has already been performed to stop the VH (so that the concern would be of the TEE probe knocking off a band that is actively treating an eso...
In a patient with well-controlled ulcerative colitis on tofacitinib for several years, would you consider switching to upadacitinib for a more favorable side effect profile?
If it aint broke, dont fix it! No difference in AE profiles between tofa and upa.
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...
If a young patient with biopsy proven EOE is doing well on bid PPI, when would you consider switching to Dupixent in order to precent long term complications such as strictures?
If the patient is in proven histologic remission on PPI and the symptoms are well-controlled, then the patient has PPI-responsive EoE and can stay on PPI as maintenance therapy. There is no indication for switching to Dupixent in this scenario except for patient preference. There is no current evide...