Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
What is the role of Botox for pelvic floor dyssynergia?
No personal experience, but there is clinical trial data to support the thought that the quality of the data is poor.
What is your preferred approach in treating recurrent bleeding from GAVE?
If repeated APC has not helped, I ask our advanced endoscopists to perform RFA. If it is a nodular GAVE, then banding is another option.
How would you approach the treatment of a patient with solid food esophageal dysphagia and GERD without a detectable esophageal stricture on upper endoscopy?
I would obtain a barium esophagram followed by high-resolution esophageal manometry and 48-hour esophageal pH testing.
What is your stepwise approach to treating constipation in a patient with symptoms such as abdominal pain, nausea, decreased appetite, etc?
For patients that are symptomatic, I favor more aggressive management, often starting with polyethylene glycol (preferred) or another osmotic agent as first line. I will also usually supplement this with some sort of management from "below" but will usually discuss with the patient and nursing wheth...
Do you continue antiplatelet/anticoagulant therapy in patients with hemodynamically stable diverticular bleeding to improve localization and treatment of source of bleeding?
Usually the decision to stop antiplatelet/anticoagulant therapy is dependent on the indication for starting the therapy, the severity of the bleeding and hemodynamic status of the patient. Based on the current ACG guidelines, it is ok to continue antiplatelet/anticoagulant therapy for hemodynamicall...
Do you recommend the use of SGLT2 inhibitors to reduce the risk of liver cirrhosis in patients with Type 2 diabetes mellitus?
Metabolic dysfunction-associated steatotic liver disease (MASLD) can be found in about 30% of adults in the U.S. Diabetes is a significant co-morbidity and increases the risk of progression to metabolic dysfunction-associated steatohepatitis (MASH). I calculate a FIB-4 index in these patients to see...
Is there a role for the use of transient elastography (FibroScan) to monitor liver fibrosis in patients on long term methotrexate?
Liver elastography is a useful tool to use when assessing the potential hepatotoxicity of various drug therapies. Traditionally, methotrexate accounted for nearly all the hepatotoxicity issues that we faced; however, we can add many other drugs to that list. Virtually, every immune suppressive drug ...
Which type of colonic polyps or mass-like lesions do you refer to an advanced endoscopist?
Generally speaking, endoscopists should remove all polyps that he or she can confidently remove as their skills and time schedule will allow. I would avoid sending polyps to an advanced endoscopist at a separate procedure simply because it would take longer or the lesion is in a "tough spot". On the...
What intervention would you choose for a patient with a post-bulbar NSAID-related diaphragm or stricture with a luminal diameter of 5–6 mm?
LAMS needs an advanced GI service to do it. Balloon dil has very limited results.
Do you switch to an alternative agent for C difficile colitis for a patient with suspected infection and positive testing who continues to have >3 watery bowel movements daily despite multiple days of oral vancomycin treatment?
The question about switching to another agent for Clostridioides difficile (Cdif) colitis in a patient who tests positive for Cdif but continues to have diarrhea despite multiple days of oral vancomycin treatment does not include any information regarding the clinical status of the patient, the pres...