Discover and read the best of Twitter Threads about #AmJGastro

Most recents (7)

Breaking data: Today we released a new study of 53K Americans revealing that use of proton pump inhibitors (eg. Prilosec, Prevacid, Nexium) is associated w/ a 2-4x risk of #COVID19. In this thread I explain why we did this study, what we found, what it may mean, & key limitations
2. Here is a link to the full peer-reviewed study published online in #AmJGastro:…. Also, the @AmCollegeGastro released this fact sheet with answers to FAQs:…. Both documents are more effective than tweets to convey the full results.
3. Let's start with biological plausibility. There's a reason we have stomach acid; it helps sterilize food by killing pathogens. We've known for years that acid can rapidly inactivate certain viruses. For example, this 2004 study shows pH<5 inactivates SARS-CoV-1.
Read 19 tweets

This test has such a big footprint in the landscape of liver disease management. But it is just too complicated to deserve its spotlight

Reposting this #tweetorial

NH3 levels:
1⃣a potent biomarker of illness
3⃣only part of the HE story
Since I posted this tweetorial:

1. ISHEN released a consensus, touching on NH3.…. This features the fig below
2. A major publication on the variability and lability of Nh3 levels from @JasmohanBajaj @BloomPringle @AmCollegeGastro #amjgastro #livertwitter…
Read 4 tweets
“TODAY in #AmJGastro:
48% of patients w. #COVID19 presented w. #GI symptoms first.
They did worse/had delayed admission (⬆️ community transmission?). Do we need broader testing criteria. #GITwitter remember to keep in mind when seeing new-onset GI symptoms”
Dr. Badgley, M.D. Response:
GI SYMPTOMS IN COVID-19 INFECTION: the described symptoms suggest that parasympathetic dysautonomia might be result of the coronavirus pathophysiology.
Anosmia and headache are also reported as common premonitory symptoms, and these bespeak of central neurological dysfunction; perhaps at brainstem level.
Read 13 tweets
Evolving #COVID19 data, please share: Could COVID19 spread through stool? In this thread, I will summarize what our editorial team at #AmJGastro knows about the risk of fecal spread. I will start by emphasizing that we do *not* yet know, for sure, if it spreads though... (1/10)
...stool. But we do know the following: (1) #COVID19 genetic material is frequently found in stool. This study found 53% of stool samples were positive:…. (2) The virus sheds into the stool for weeks, even after respiratory symptoms subside. This... (2/10) found that for >50% of patients, fecal samples remain positive for ~11 days after respiratory samples are negative:…. The authors suggests the virus replicates in the GI tract even after viral clearance in the lungs. (3) The virus can be... (3/10)
Read 10 tweets
Breaking #COVID19 Data – Please Share (1/10): On behalf of @AmCollegeGastro, our editorial team at #AmJGastro just released a study from Wuhan, China reporting 48.5% of patients presented to hospital with a digestive symptom as their chief complaint. Coronavirus is #NotJustCough.
(2/10) One in 5 presented with either diarrhea, nausea, vomiting or belly pain as the presenting complaint. “Clinicians must bear in mind,” write the authors, “that digestive symptoms, such as diarrhea, may be a presenting feature of #COVID-19, & that the index of suspicion may…
(3/10) …need to be raised earlier in these cases rather than waiting for respiratory symptoms to emerge.” Moreover, patients with digestive symptoms had a worse clinical outcome and higher mortality. Emphasizes importance of including symptoms like diarrhea to suspect #COVID19.
Read 10 tweets
Hepatic encephalopathy in the hospital (An ode to #lactulose):
A brief #livertwitter #tweetorial
1. Share the greatest t-shirt ever made
2. Rule out infection!
3. Laxation now! But how?

keywords: #cirrhosis, paracentesis, stool pH
1. This shirt, made by a patient, reminds us:
▶️HE is horrible, unpredictable
▶️Preventing HE is hard
▶️Dont be quick 2 label pts as 'noncompliant' - there's more to the story
▶️Our patients are awesome. Hepatology is the best

2. Think of hepatic encephalopathy as a biomarker.

For what? The answers form a mandatory checklist of sorts

1. Para to r/o SBP. Delay @ your patient's peril. (Fig1)
2. GI Bleeding?
3. UA/Blood Cultures/CXR
3. What's the Cr? Na? K?
Read 14 tweets
A celebration of paracentesis: a QI #Tweetorial

For all my twitter friends who care for inpatients with #cirrhosis

Take home messages: paras for all, FFP for none
Keywords: #SBP and the #cirrhotic #coagulopathy
First - which hospitalized patient needs a diagnostic para?

Patients with ascites and:
Spontaneous bacterial peritonitis (SBP) is a deadly condition. Appropriate tx can prevent hepatorenal syndrome and death.

How many patients are asymptomatic?


In this study from Pinzello et al, 1 in 3 patients with SBP were "silent"…
Read 19 tweets

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