Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
How do you manage GI side effects related to CFTR modulator therapy?
We have found that for most patients liver enzymes abnormalities are small and transient; however, for about 1% of patients there are severe elevations and these patients are much more difficult to manage, even after withdrawal, and tough to re-challenge; it is also not patients with severe liver di...
In a patient with recurrent fibrolamellar HCC a year after upfront resection (previously refused adjuvant therapy) with a solitary abdominal mass, would you offer neoadjuvant therapy to assess response?
Recurrent disease is the best care for under clinical trials for FLC. There are not many, sadly because of limited support. But there are some, like NCT03860272.
What is your approach to continuing or altering therapy when inheriting a patient with combined biologic immunosuppression that is in excess of guidelines?
This is by far the hardest task assigned for a practicing rheumatologist. Inheriting a patient on a regimen you did not develop and are uncomfortable continuing poses a daunting challenge: you are challenging the patient’s relationship with the previous rheumatologist, the control of the patient’s d...
How long do you anticoagulate for cirrhosis patients who have portal vein thrombosis extending to the mesenteric veins?
I recommend indefinite anticoagulation for most patients with portal vein thrombosis, and at least 3-6 months if there are risk factors for bleeding. Once they complete anticoagulation for the first 6 months, I re-evaluate their risk of recurrent thrombosis vs bleeding, and if there is an underlying...
How do you manage patients with suspected cholangiocarcinoma that presents with biliary obstruction but has repeated negative brushings/biopsies?
This is often encountered in patients with PSC. Patients present with jaundice and biliary stricture, rising CA 19-9, and repeat ERCP with brushing/biopsies have shown no evidence of malignancy (often showed abnormal cells). Brushings have high specificity if positive (99%) but very poor sensitivity...
How do you approach an obese patient on long-term methotrexate with normal liver tests in terms of workup for underlying fatty liver?
Screen with ultrasound.