Discover and read the best of Twitter Threads about #B2BPearl

Most recents (7)

@MondayNightIBD 1/ 📣 #GITwitter #IBDTwitter
It’s a new🔥#Back2Basics session with #GI #Fellow @JosephHabibi_MD

Let’s talk AZA/6-MP in IBD

#IBDPolls 1️⃣&2️⃣👆🏽
✅Role as Mono/combo therapy
✅Escalation consideration
✅TPMT & NUDT15 testing
✅Side effects & counseling Image
@MondayNightIBD @NavreetChowlaMD @MilestoneIBD @IBD_FloMD @tinahamd @DrCoreySiegel @HorstIBDDoc @MLongMD @LauraRaffalsMD @doc_ibd @IBDBen 2/ AZA trials in IBD:

🔹Corticosteroids needed to induce remission
🔹Takes ~12 wks for AZA/6MP to become effective, so taper steroids accordingly
🔹AZA/6-MP effective for maintenance of remission (mainly in UC); Not effective for induction ImageImage
@MondayNightIBD @NavreetChowlaMD @MilestoneIBD @IBD_FloMD @tinahamd @DrCoreySiegel @HorstIBDDoc @MLongMD @LauraRaffalsMD @doc_ibd @IBDBen @IBDHorizons @IBD_Houston @IrisWangMD @LoriPlung @vaibhav_manu @KatieFalloonMD @amneethansmd @ManuelBragaMD @Chatterjee_MD @SuhaAbushamma 3/ AZA in today’s practice

1⃣CS-sparing monotherapy for maintenance of moderate IBD
2⃣Combo w/ TNFi to
↑ TNFi levels
↓ Ab formation
2nd MOA for severe/complex IBD not responsive to mono💉
Perianal Crohn’s

...⏬
Read 18 tweets
Read 6 tweets
@yaransarkis @MondayNightIBD @AmerGastroAssn @Spencerkelley7 @ayshaslam999 @jalpa_devi @purnie_mae @dunleavy_katie @KanikaGargMD @MarcelYibirin @JHaydek @DCharabaty @mjayoushe @AmCollegeGastro @ASGEendoscopy @Realcecum 8/ What’s in a C-scope ?
💎 #B2BPearl💎New guidelines @AmerGastroAssn
🔹Use High Def scope+++
🔹HDef scope ➕ Chromo (dye spray or virtual) if h/o dysplasia
🔹If using Standard Def: SD scope ➕Chromo dye spray only (not virtual)
🔗journals.lww.com/ajg/Abstract/2…
@yaransarkis @MondayNightIBD @AmerGastroAssn @Spencerkelley7 @ayshaslam999 @jalpa_devi @purnie_mae @dunleavy_katie @KanikaGargMD @MarcelYibirin @JHaydek @DCharabaty @mjayoushe @AmCollegeGastro @ASGEendoscopy @Realcecum 9/ What to biopsy ?
➕Targeted Bx🎯 of abnormal mucosa
➕Resection of polypoid lesion
➕Random Bx to document histologic extent/ healing
➕Extensive Random 4 quadrant bx every 10 cm IF no chromo, h/o dysplasia, poor visualization, PSC, foreshortened colon
@yaransarkis @MondayNightIBD @AmerGastroAssn @Spencerkelley7 @ayshaslam999 @jalpa_devi @purnie_mae @dunleavy_katie @KanikaGargMD @MarcelYibirin @JHaydek @DCharabaty @mjayoushe @AmCollegeGastro @ASGEendoscopy @Realcecum 10/ What’s next after dx of Invisible dysplasia ?
💎 #B2BPearl💎
🔹Invisible dysplasia
→ Get 2nd opinion from expert #GIPath
→ HD CLN + dye chromo by expert endoscopist + Extensive non-targeted Bx if no resectable lesion seen
Read 9 tweets
@MondayNightIBD @DCharabaty 1/ Thiopurines are associated with an increased risk of NMSC (non-melanoma skin cancer)

Which of the following is true about this risk relative to non-exposed IBD pts, duration of thiopurine use , and after thiopurine cessation 🛑#Back2Basics #MondayNightIBD
@MondayNightIBD @DCharabaty 32 y/o M with UC here for f/u. In remission x7 yrs on AZA 75mg/d. He is here to discuss his concerns about his risk of lymphoma associated w/ AZA. (HSTCL= hepatosplenic T cell; EBV-L= EBV assoc lymphoma) Which statement is true?
#Back2Basics #MondayNightIBD
@MondayNightIBD @DCharabaty 2/ ‼️Cancer risk in IBD‼️can be→

🔺Disease related (eg CRC, anal CA)

🔺Therapy related ( Skin, Lymphoma, Cervical, Anal)
Read 14 tweets
@MondayNightIBD @SobiaMujtabaMD @NabilQuraishi @CholestasisDoc @DCharabaty 1/ 35 y/o M presents with fatigue & generalized pruritus x 6weeks. No skin rash, No abdo pain, diarrhea or 🩸 in stool. AST 62 ALT 64 ALP 435 Tbili 1.3. MRI/MRCP: multifocal strictures & areas of dilatation of intra +extra hepatic ducts. What’s the next step?💡 #Back2Basics #B2B
@MondayNightIBD @SobiaMujtabaMD @NabilQuraishi @CholestasisDoc @DCharabaty 2/ What’s #PSC & phenotypes?

🧩Idiopathic chronic inflam dis. of the biliary tree

🧩90%: Large ducts (LD): "Beads on string appearance” on ERCP/MRCP (pt👆)

🧩5% Small IHD only: nml MRCP, dx by liver bx, slide👇

🧩5% PSC w AIH overlap: abnl MRCP+liver bx w⬆️AST/ALT or IgG ImageImage
@MondayNightIBD @SobiaMujtabaMD @NabilQuraishi @CholestasisDoc @DCharabaty 3/ 💎#B2BPearl #PSC w ⬆️IgG4

📌15% of LD-PSC

📌⬆️IgG4 serum>140mg/dL +/- tissue
💎✅IgG4 at least once w PSC dx

📌Assoc. w AI pancreatitis; other Ig4 dis.

💎⬆️severity of UC, colectomy
📌More rapid progression to cirhhosis

💎Steroid responsive: ️ ⬇️AlPhos, TBili, IgG4
Read 15 tweets
@MondayNightIBD @SobiaMujtabaMD @SchwartzbergMD @DCharabaty 1/ 27 yo F, crohns colitis on AZA, presents w 2wk perianal pain. One week ago a “boil” developed adjacent to the anus, painful to touch and draining cloudy fluid. PE: Perianal fistulous opening tender & draining pus on palpation. What is the next best step ? #B2B
@MondayNightIBD @SobiaMujtabaMD @SchwartzbergMD @DCharabaty 2/Recap #Crohns:
📌Transmural inflammation involving any part of GIT
📌B for Phenotypes: inflammatory/stricturing/penetrating
📌L for location: UGI,SB,Colon
📌Penetrating Behaviors:
Fistulae
Perforations
Intra-abdominal abscesses(IAA)

recall this #B2B MTL classification table👇🏼 Image
@MondayNightIBD @SobiaMujtabaMD @SchwartzbergMD @DCharabaty 3/♦️p->Perianal ds in CD
♦️Can occur w any B&L
♦️May be initial manif in ~10%
♦️Can be isolated(no luminal dis)
♦️Affect up to 1/3 of CD pts
♦️Incidence cld be ⬇️w⬆️use of biologics @sang_hyoung @EdwardLoftus2 pubmed.ncbi.nlm.nih.gov/30346531/

♦️One of most challenging manif for pts+MDs
Read 8 tweets
@MondayNightIBD @SobiaMujtabaMD @DuekerJeffrey @DCharabaty 25y/oM quit🚬3 mos ago, now 3🩸loose BM/day,mild abdo cramps;Cousin w Crohns;Stool➖for infection;CLN: erythematous granular mucosa rectum+sigmoid, superficial ulcers;BX:Acute cryptitis,crypt abscess,crypt architecture distortion. What helps most dx UC vs Crohn’s?
#B2B #IBDPoll
@MondayNightIBD @SobiaMujtabaMD @DuekerJeffrey @DCharabaty UC and CD:

🔻Chronic inflammation of the GI tract

🔻Affects all ages: Typically starts between age 20-39

🔻Second peak of incidence age >50

🔻Flares of GI symptoms +/-systemic symptoms +/- EIM
@MondayNightIBD @SobiaMujtabaMD @DuekerJeffrey @DCharabaty 3/ CD:

💡Skipped lesion, any part of GI tract

💡Most common:Colon+ileum
Hallmark➡️ulcers: aphthous,deep large/linear/serpiginous

💡Transmural inflamm -> stricturing, perforating dis.

🚩#B2BPearl
👉🏼Rectum can be involved in CD;➕anorectal ulcers → ⬆️risk of perianal disease
Read 16 tweets

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