Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
Given that cardiovascular disease is the top cause of morbidity/mortality in patients with MASLD, do you perform any additional screening and/or testing for these patients to minimize this impact?
MASLD should likely be thought of as part of a cardiometabolic disease with a wide spectrum of manifestations. I see my clinic as part of this management, but I do not do a complete cardiac assessment routinely on all my patients. I do not do this simply for the challenge of addressing all these iss...
How long do you treat an isolated bacterial liver abscess which has either undergone percutaneous drainage or for which an indwelling drain is placed?
Until it's gone... Percutaneous drainage of liver abscesses is, in my experience, less effective than drainage of intra-abdominal abscesses, which isn't very effective. Neither type of abscess isn't, as I explain to other doctors and pts, a water balloon. Liver abscesses are more complicated than ot...
Do you have any specific recommendations to prevent large fluctuations in sodium levels during a colonoscopy prep in patients with central diabetes insipidus on DDAVP?
Interesting, I have just received a message from a patient in this very same situation. I am not aware of any specific literature on this. In absence of such data, I usually recommend remaining on the same desmopressin dose and obeying to thirst, as I worry about hyponatremia that may be caused by a...
Do you have any concerns about lower extremity compression (e.g., compression stockings, intermittent pneumatic compression, etc.) worsening ascites in a patient with portal hypertension?
This is an interesting question, and I have to admit, not one I've thought about regularly. When I think of lower extremity compression and the contraindications, portal hypertension and ascites are not contraindications that immediately come to mind. I do understand the reasoning behind the questio...
Which GI cancer patients do you use oral contrast in staging CT scans?
We do not use oral contrast for most of our patients and only offer oral contrast CT scans for patients we are concerned about perforation.
How do you approach the decision to repeat small-bowel biopsies in a patient with persistent gastrointestinal symptoms, like abdominal pain and diarrhea, when prior biopsies performed years earlier were normal?”
I typically do not repeat small bowel biopsies IF the symptoms have not changed in intensity or frequency. Repeat endoscopic evaluation and biopsies are done in patients with persistent GI symptoms if any changes have occurred: these may include significant worsening of symptoms, of symptoms occurri...
Do you routinely check vitamin K levels in post-bariatric surgery patients?
Vitamin K levels are not checked routinely in post-bariatric surgery patients. Deficiency of this vitamin is very uncommon in patients who have undergone a sleeve gastrectomy and even with Roux-en-Y gastric bypass. There is more potential for deficiency in patients who have had biliopancreatic diver...
In patients on long-term proton pump inhibitors for GERD with stable symptoms, do you routinely attempt discontinuation or continue indefinitely given relapse risk?
This is a good question, as we see many patients who were placed on PPIs and continued indefinitely for GERD. As this question implies, this may not be necessary, and long-term PPI use comes with risks that include C. diff. There are additional studies that suggest fractures, CKD, and nutrient defic...
How do you approach an otherwise healthy patient with an incidental 1 mm GIST involving the serosal surface in terms of staging workup, EGD, and surveillance?
An EGD periodically, driven by the reason why the patient needed it in the first place, could guide the interval. I would not subject the patient to CT scans or routine oncology follow-ups.
What vitamins and minerals do you check yearly for patients post gastric bypass surgery?
Following Roux-en-Y gastric bypass it is essential to monitor micronutrients, vitamins, and minerals because malabsorption and long-term complications may occur with improper care. Based on ASMBS 2016 Nutrition Guidelines, AACE/TOS/ASMBS 2019 updates, and Endocrine Society recommendations, here are ...