Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
What is your general approach to an immunocompetent patient with chronic, non-infectious diarrhea?
If the diarrhea has lasted more than a few weeks and all infectious workup is negative, then I'll send serologies for IBD/celiac, especially if there is any weight loss. Where we practice in New York City, these patients almost always end up getting an EGD/colonoscopy.
How do you approach surveillance of gastric hyperplastic polyps of various sizes?
Gastric hyperplastic polyps are the second most common gastric polyps, behind fundic gland polyps. Unlike hyperplastic polyps in the colon, gastric hyperplastic polyps can be associated with chronic inflammation, notably Helicobacter pylori gastritis or autoimmune gastritis, for example. The neoplas...
Do you routinely use single-use duodenoscopes for ERCPs in patients with a history of infections secondary to MDR organisms?
Since we have single-use duodenoscopes available now, it makes sense to use these for patients with a history of MDR infection.
Do you feel there is any difference between performing an ERCP with an EDGE together in a single session or separately in two sessions in a patient with Roux-en-Y anatomy?
Experts do both approaches - I think the minority will do EDGE (or GATE = gastric access temporary for endoscopy, a more inclusive term than EDGE, which is for ERCP only, although GATE only refers to gastric access) with ERCP in a single session as a routine, while more do the 2-step approach. Of co...
What precautions should be taken when discharging a patient from the medical setting on new medication assisted therapy for alcohol use disorder?
Great question. This article absolutely adds to the argument for using medications for alcohol use disorder. The precautions would mostly explain side effects, just as you would for any new medication. A few specific considerations depend on the medication (I'll restrict this to four more common cho...
How do you practically approach a tailored elimination diet in young patients with numerous food impactions and esophageal strictures who are intermittently compliant with PPI or topical steroids?
The first thing I would do is discuss with them the different approaches and efficacy of diet therapy. Currently an empiric elimination diet is the favored approach. Which empiric elimination diet is chosen is a discussion to have with each individual patient in a shared decision approach. The six f...
How do you use gut microbiome or gut microbiota analysis in your clinical practice, if at all?
While I am presented with microbiome analyses on a regular basis by patients, I do not believe that these are useful, as we are still not there when it comes to defining the "normal" microbiome. This indeed may vary tremendously between individuals depending on age, gender, diet, geographic location...
In patients with longstanding UC or Crohn's colitis, would you extend the interval of surveillance colonoscopy to longer than 3 years if they have had little inflammatory disease over the years and no other factors to increase their risk (ie, history of polyps, history of dysplasia, or family history)?
AGA Practice Update says you can go to 5-year interval. Murthy et al., PMID 34416977
Are there cirrhotic patients in whom you might withhold or shorten duration of prophylactic antibiotics after UGIB?
No
How does the presence of gallbladder sludge vs stones on POCUS impact your suspicion for gallbladder disease as a cause of abdominal pain?
With all point-of-care ultrasound, so much depends on your pre-test probability before you acquire the image. If you are simply trying to identify biliary colic in a patient with a good history of the disease, then the presence of either sludge or stones is quite an effective test with bedside provi...