Gastroenterology
Expert perspectives on IBD, liver disease, motility disorders, and GI diagnostic and therapeutic procedures.
Recent Discussions
In cirrhosis with suspected HRS-AKI and baseline CKD or chronically elevated creatinine, how do you define a clinically meaningful ‘improvement’ during an albumin trial (over 24–48 hours) to distinguish HRS-AKI from volume-responsive AKI?
If the acute rise in serum creatinine returns to the pre-AKI level, the patient has volume-responsive AKI.
Which types of pancreatic cancer patients should we consider sending to a center that offers EUS-guided Radiofrequency Ablation (RFA) therapy?
EUS-guided ablation for appropriately selected mucinous pancreatic cysts and, to some degree, neuroendocrine tumors is becoming increasingly standardized with multiple reviews on the subject. (Rodger et al., Techniques and Innovations in Gastrointestinal Endoscopy 2024, Moyer & Canakis, PMID 3879629...
What prompts you to obtain esophageal biopsies in patients with GERD who have a normal-appearing esophagus on EGD and no dysphagia?
This is a good question. I do not routinely, unless there are other factors that steer me in the direction of eosinophilic esophagitis (EoE), such as a young patient with extraesophageal atopic disorders, where heartburn may be the presenting symptom of EoE.
When can we consider deferring an insulin drip in patients with hypertriglyceridemia-induced pancreatitis?
Serum triglyceride levels >500 mg/dL (5.6 mmol/L) are required for hypertriglyceridemia to be considered the underlying etiology of acute pancreatitis (UpToDate).For patients with severe hypertriglyceridemic pancreatitis, such as those serum triglyceride levels >1000 mg/dL plus lipase >3 times the u...
If there is limited access to VCTE(FibroScan) and MRI elastography, which is your preferred test for fibrosis assessment?
ELF test
Do you escalate therapy based on persistent gastric eosinophilia in a patient with eosinophilic gastritis improving symptomatically on corticosteroids?
It obviously depends on steroid dose and duration. My instinct, however, when dealing with such potent therapy as corticosteroids, and in view of symptomatic improvement, would be to hold the course a bit longer before being in a rush to escalate.
Do you consider off-label dupilumab rather than dietary therapy in a patient with eosinophilic gastritis needing long-term disease control?
This is not a bad choice, but has the patient failed or been intolerant to budesonide? We give that when they chew the capsule for immediate release.
Do you recommend CBD cessation prior to screening of liver enzymes?
CBD increases liver enzymes. In a study, it took 1-2 weeks to normalize after cessation. Would recommend ideally 2 weeks, but a minimum of 1 week to remove the noise caused by CBD that may lead to an extensive and possibly unnecessary workup.
Would you avoid risankizumab in a patient with stricturing Crohn’s complicated by granulomatous bronchiolitis with stenosis who had to stop ustekinumab due to hemoptysis?
Unless there had been a rapid and dramatic beneficial response of the Crohn’s disease to ustekinumab, I would have little appetite for trying another IL-blocker. A different mechanism, like JAK, might be worth trying, but the serious pulmonary complication probably warrants steroid therapy. One coul...
Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?
Patients on plavix and/or aspirin are at risk for bleeding whether in relation to surgery or bleeding from the gi tract. Much like the management of patients on anticoagulation temporary reversal of antiplatelet drugs is only achieved by normalizing platelet function. This is the same principle used...