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@MondayNightIBD 2/📣#IBD & meds carry an⬆️risk of #Malignancies, including lymphomas
🔺Who is at risk?
🔺Is it IBD-mediated or drug-related?
🔺What is our prevention & screening🔎strategy?
Thank you for joining this special #MondayNightIBD #Back2Basics @DuekerJeffrey
🔺Who is at risk?
🔺Is it IBD-mediated or drug-related?
🔺What is our prevention & screening🔎strategy?
Thank you for joining this special #MondayNightIBD #Back2Basics @DuekerJeffrey
@MondayNightIBD @DuekerJeffrey @amelia_kellar @DCharabaty @IBD_Afzali @drdani23 @ibddoctor @EdithHoMD @fgomollon @IBD_DrEMF @ibdgijami @MaiaKayalMD 3/ 🔥IBD may carry a unique risk of primary intestinal lymphoma (PILD), but NO🔼risk of extra-intestinal NHL
In CESAME population,
▪️Crude IR of PILD was 0.12/1000 patient-years (py)
▪️All B-cell NH LD
▪️79% ♂️, 11 CD, 3 UC
▪️86% arose in IBD lesions
▪️45% were EBV positive
In CESAME population,
▪️Crude IR of PILD was 0.12/1000 patient-years (py)
▪️All B-cell NH LD
▪️79% ♂️, 11 CD, 3 UC
▪️86% arose in IBD lesions
▪️45% were EBV positive
@MondayNightIBD @DuekerJeffrey @amelia_kellar @DCharabaty @IBD_Afzali @drdani23 @ibddoctor @EdithHoMD @fgomollon @IBD_DrEMF @ibdgijami @MaiaKayalMD @JChristieMD @KDeFelice_IBD @dunleavy_katie @IBDMD @MN_GIMD @SaraElOualiMD @nloganmd @KrugCleveland @PDulaiMD @PriSantiagoMD 4/ Lymphoma in #IBD is mostly linked to IBD therapy, particularly #Thiopurines (6MP, AZA)
🔺⬆️Risk in CD, less evidence with UC
🔺M>F
🔺Risk increases with exposure⏲️, particularly >2 years
🔺Risk decrease after cessation of AZA
🔺⬆️Risk in CD, less evidence with UC
🔺M>F
🔺Risk increases with exposure⏲️, particularly >2 years
🔺Risk decrease after cessation of AZA
@MondayNightIBD 1/Welcome back to #MondayNightIBD with our #Back2Basics team! ⭐️🔆📚
We will talk about #Obesity ➕ #IBD
with
@BassiMehak
@ifrahfatima
@MarcelYibirin
#MakeitSimple
w help from #IBDAdvocates🦸♀️🦸♂️
We will talk about #Obesity ➕ #IBD
with
@BassiMehak
@ifrahfatima
@MarcelYibirin
#MakeitSimple
w help from #IBDAdvocates🦸♀️🦸♂️
@MondayNightIBD @BassiMehak @ifrahfatima 2/🎯35% of the 🇺🇸 population is obese= BMI>30, leading to rising healthcare 💲💲.
🎯20-40% of patients with #IBD are obese.
🎯#Obesity assoc. with 34%⬆️ risk of CD, but not UC
🎯Each 5kg/m2 ⬆️ in BMI ➡️with 16% ⬆️ risk of CD
🎯20-40% of patients with #IBD are obese.
🎯#Obesity assoc. with 34%⬆️ risk of CD, but not UC
🎯Each 5kg/m2 ⬆️ in BMI ➡️with 16% ⬆️ risk of CD
@MondayNightIBD @BassiMehak @ifrahfatima @kzhuangmd @agoldowskymd @IBD_FloMD @IBD_Afzali @babudayyeh @BolandBrigid @amjohnsonMD @PopovVioleta @RobertoSimonsMD @LauraChiuMD 3/ ☸️Outcomes of pts with #Obesity & #IBD
⚠️ Little data & conflicting results, but overall: ⬇️ IBD outcomes
⬇️Remission rates
⬆️Flares
⬇️QoL
⬆️Unplanned healthcare utilization.
⬇️Time to 1st surgery in CD
⬆️ Risk of surgery & hospitalization in UC
⚠️ Little data & conflicting results, but overall: ⬇️ IBD outcomes
⬇️Remission rates
⬆️Flares
⬇️QoL
⬆️Unplanned healthcare utilization.
⬇️Time to 1st surgery in CD
⬆️ Risk of surgery & hospitalization in UC
@MondayNightIBD 1. Welcome back to #MondayNightIBD with our #Back2Basics team! ⭐️
Let’s prepare for the HOLIDAY season!! 🎉✈️
#TravelingWithIBD #TravelingWithOstomy #IBDHolidays with @GroverDheera @MarcelYibirin #MakeitSimple
w help from #IBDAdvocates
Let’s prepare for the HOLIDAY season!! 🎉✈️
#TravelingWithIBD #TravelingWithOstomy #IBDHolidays with @GroverDheera @MarcelYibirin #MakeitSimple
w help from #IBDAdvocates
@MondayNightIBD @MarcelYibirin @Empoweringpts9 @aboutIBD @ownyourcrohns @Youcantmakethi4 @Spencerkelley7 @RomyChamoun @ibdtweets @JosephHabibi_MD @dunleavy_katie @yaransarkis 2. ✈️Why is it important to talk about this
🗳️In a survey of #IBD pts in 2018
⚠️47% ✈️abroad w/o health insurance
⚠️63% didnt’ know to avoid live virus vaccine
⚠️92% didnt know high altitude can➡️flare
⚠️Most unaware of resources like “Can’t wait card” & IBDPassport.com
🗳️In a survey of #IBD pts in 2018
⚠️47% ✈️abroad w/o health insurance
⚠️63% didnt’ know to avoid live virus vaccine
⚠️92% didnt know high altitude can➡️flare
⚠️Most unaware of resources like “Can’t wait card” & IBDPassport.com
@MondayNightIBD @MarcelYibirin @Empoweringpts9 @aboutIBD @ownyourcrohns @Youcantmakethi4 @Spencerkelley7 @RomyChamoun @ibdtweets @JosephHabibi_MD @dunleavy_katie @yaransarkis @BassiMehak @snehadave98 @Clin_Med @IBDPassport @ibdesis @IBD_FloMD @ibdgijami @mlatorremd @MadhuraB_ @nataliesparacio 3. ✈️Why is it important to talk about this?
🧑🍳Change in diet & alcohol 🍸consumption & sleep 😴habits, missing meds can ➡️ GI symptoms or a flare 🔥
🥳Holidays can trigger or⬆️ anxiety & depression☹️
🔑Prepping ahead of time and advice from the medical team can go a long way!
🧑🍳Change in diet & alcohol 🍸consumption & sleep 😴habits, missing meds can ➡️ GI symptoms or a flare 🔥
🥳Holidays can trigger or⬆️ anxiety & depression☹️
🔑Prepping ahead of time and advice from the medical team can go a long way!
@MondayNightIBD 1a.
Welcome to an extra spooky #MNIBD #Back2Basics
🎃👻🎃👻🎃👻🎃👻🎃👻🎃
@JosephHabibi_MD and I will be discussing common myths in #IBD and doing our best to debunk them. Topics include:
🎃 Diet and supplement myths
🎃 Pregnancy and fertility myths
🎃 More surprise myths🔮
Welcome to an extra spooky #MNIBD #Back2Basics
🎃👻🎃👻🎃👻🎃👻🎃👻🎃
@JosephHabibi_MD and I will be discussing common myths in #IBD and doing our best to debunk them. Topics include:
🎃 Diet and supplement myths
🎃 Pregnancy and fertility myths
🎃 More surprise myths🔮
@MondayNightIBD @JosephHabibi_MD @dunleavy_katie @RomyChamoun @SanjeevaniTomar @DSTEINGIMD @BeniwalPatelMD 1b.
Shout out 📣 to all of the amazing #IBD #PatientAdvocates who helped make this happen:
@aboutIBD @nataliesparacio @mustbthemusic @Empoweringpts9 @DrTiffTaft @GutlessGlamour @IBDPassport @ownyourcrohns @bottomlineibd @GIdietitian @snehadave98 @LoriPlung @Youcantmakethi4
Shout out 📣 to all of the amazing #IBD #PatientAdvocates who helped make this happen:
@aboutIBD @nataliesparacio @mustbthemusic @Empoweringpts9 @DrTiffTaft @GutlessGlamour @IBDPassport @ownyourcrohns @bottomlineibd @GIdietitian @snehadave98 @LoriPlung @Youcantmakethi4
@MondayNightIBD @JosephHabibi_MD @dunleavy_katie @RomyChamoun @SanjeevaniTomar @DSTEINGIMD @BeniwalPatelMD @aboutIBD @nataliesparacio @mustbthemusic @Empoweringpts9 @DrTiffTaft @GutlessGlamour @IBDPassport @ownyourcrohns @bottomlineibd @GIdietitian @snehadave98 @LoriPlung @Youcantmakethi4 @shaina_sekhri @LambergMorgan @goodmra1 @KrugCleveland @john_damianosMD @AustinChiangMD @DrsMeena 1c.
See if you can find all of the spooky #IBD words in our #MondayNightIBD word search 👇
🎃👻🎃👻🎃👻🎃👻🎃👻
See if you can find all of the spooky #IBD words in our #MondayNightIBD word search 👇
🎃👻🎃👻🎃👻🎃👻🎃👻
@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
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
@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
🔹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
@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
...⏬
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
...⏬
@MondayNightIBD 1/ Hello and Welcome to today's #MondayNightIBD #Back2Basics!
Classifications are💎in IBD‼️Why⁉️:
🔹Clear assessment of disease location/extent/behavior
🔹Objective measure of flare severity
🔹Objective measure of endoscopic activity
➡️Determine treatment and prognosis‼️
Classifications are💎in IBD‼️Why⁉️:
🔹Clear assessment of disease location/extent/behavior
🔹Objective measure of flare severity
🔹Objective measure of endoscopic activity
➡️Determine treatment and prognosis‼️
@MondayNightIBD @MN_GIMD @JosephHabibi_MD @DCharabaty @RomyChamoun @AllonKahn @drsusankais 2/ Classifications in CD:
1⃣Montreal Classification🟰Clinical Classification:
🔹A=Age at dx, L=Location in GI tract, B=Behavior (cf. Slide)
⚠️Behavior pearls:
🔻B1 can progress into B2 or B3
🔻Pts can present with B2 or B3 or both
🔻Perianal disease possible with any B phenotype
1⃣Montreal Classification🟰Clinical Classification:
🔹A=Age at dx, L=Location in GI tract, B=Behavior (cf. Slide)
⚠️Behavior pearls:
🔻B1 can progress into B2 or B3
🔻Pts can present with B2 or B3 or both
🔻Perianal disease possible with any B phenotype
@MondayNightIBD @MN_GIMD @JosephHabibi_MD @DCharabaty @RomyChamoun @AllonKahn @drsusankais @AdvaniRashmiMD @DVinsard @SanjeevaniTomar @BassiMehak @GroverDheera 3/ Crohn's disease activity index (CDAI) 🟰 Clinical score
🔹Assess disease activity
🔹Quantify symptoms
🔹8 variables
🔹Index score
🔻<150: Remission
🔻221-450: Mod to Severe
🔹Assess disease activity
🔹Quantify symptoms
🔹8 variables
🔹Index score
🔻<150: Remission
🔻221-450: Mod to Severe
@MondayNightIBD @Spencerkelley7 1/
👋 to this week’s #MondayNightIBD with the #Back2Basics #B2B team
🦠 Today we are discussing #Cdifficile infection in #IBD
Stay tuned to 📝 more about #CDI :
➡️ #IBD vs. general 👩👨🦱
➡️ diagnosis
➡️ treatment options
👋 to this week’s #MondayNightIBD with the #Back2Basics #B2B team
🦠 Today we are discussing #Cdifficile infection in #IBD
Stay tuned to 📝 more about #CDI :
➡️ #IBD vs. general 👩👨🦱
➡️ diagnosis
➡️ treatment options
@MondayNightIBD @Spencerkelley7 @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD 2/
#CDI in #IBD compared to general 👩👨🦱
⬆️⬆️ common (5-8x 🔺)
⬆️ community-acquired
⬆️ w/o antibiotic 💊 exposure
⬆️ colonization
⬆️⬆️ recurrence ☹️
⬆️ colectomy risk 🔪
🚨 often no pseudomembranes on 🔦
🚨 can happen post-colectomy 🔪 in #smallbowel or #IPAA
#CDI in #IBD compared to general 👩👨🦱
⬆️⬆️ common (5-8x 🔺)
⬆️ community-acquired
⬆️ w/o antibiotic 💊 exposure
⬆️ colonization
⬆️⬆️ recurrence ☹️
⬆️ colectomy risk 🔪
🚨 often no pseudomembranes on 🔦
🚨 can happen post-colectomy 🔪 in #smallbowel or #IPAA
@MondayNightIBD @Spencerkelley7 @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD 3/
Testing for #CDI ⬇️
💩 GDH:
✅ detects organism
⬆️ sensitive
⬇️ specific
💩 PCR:
✅ detects genes that code for toxin
🚫 detect toxin
⬆️ sensitive
⬆️ specific
🚨 can over-diagnose
💩 EIA for toxin A/B:
✅ detects toxin
⬆️ specific
⬇️ sensitive
🚨 can under-diagnose
Testing for #CDI ⬇️
💩 GDH:
✅ detects organism
⬆️ sensitive
⬇️ specific
💩 PCR:
✅ detects genes that code for toxin
🚫 detect toxin
⬆️ sensitive
⬆️ specific
🚨 can over-diagnose
💩 EIA for toxin A/B:
✅ detects toxin
⬆️ specific
⬇️ sensitive
🚨 can under-diagnose
@MondayNightIBD @DCharabaty 1/12
📣#GITwitter #IBDTwitter
Welcome back to #MondayNightIBD #Back2Basics w @dunleavy_katie @john_damianosMD
🎯How do you approach a pt w #IBD in remission who has new or persistent #GI symptoms?
Check out our review📜
practicalgastro.com/2022/05/18/rec…
#NeuroGI #GastroPsych #DGBI
📣#GITwitter #IBDTwitter
Welcome back to #MondayNightIBD #Back2Basics w @dunleavy_katie @john_damianosMD
🎯How do you approach a pt w #IBD in remission who has new or persistent #GI symptoms?
Check out our review📜
practicalgastro.com/2022/05/18/rec…
#NeuroGI #GastroPsych #DGBI
@MondayNightIBD @DCharabaty @john_damianosMD 2/12 #MondayNightIBD #B2B
👩🏼⚕️have been studying “IBS-type symptoms” in #IBD for 30 yrs. But there is more work to be done to help characterize cohort & dz mechanism!
It’s important bc:
👨👩👧👦Affects pts QoL, mental health, sleep
🥼Causes ⬆️HC utilization, ⬆️MD visits & 💊narcotics
👩🏼⚕️have been studying “IBS-type symptoms” in #IBD for 30 yrs. But there is more work to be done to help characterize cohort & dz mechanism!
It’s important bc:
👨👩👧👦Affects pts QoL, mental health, sleep
🥼Causes ⬆️HC utilization, ⬆️MD visits & 💊narcotics
@MondayNightIBD @DCharabaty @john_damianosMD @MarcelYibirin @VictorChedidMD @LauraRaffalsMD @Spencerkelley7 @RomyChamoun @JosephHabibi_MD @ayshaslam999 @GroverDheera @yaransarkis @BassiMehak 3/12 #MondayNightIBD Persistent/New GI Sx in #IBD
1⃣R/o active🔥/#IBD complication (abscess, stricture):🔦, 🩻, CRP, FCP, ⚠️R/o infx like C. Difficile!
2⃣🤔Consequences of✂️: adhesion, bile acid diarrhea
3⃣🤔 #DGBI
🚩25% pts w #IBD in endo remission have #IBS @LancetGastroHep
1⃣R/o active🔥/#IBD complication (abscess, stricture):🔦, 🩻, CRP, FCP, ⚠️R/o infx like C. Difficile!
2⃣🤔Consequences of✂️: adhesion, bile acid diarrhea
3⃣🤔 #DGBI
🚩25% pts w #IBD in endo remission have #IBS @LancetGastroHep
@dunleavy_katie @MondayNightIBD @BattatMD4IBD @DCharabaty @JosephHabibi_MD @KanikaGargMD @Spencerkelley7 @BassiMehak @jalpa_devi @Empoweringpts9 @ayshaslam999 @RomyChamoun @JHaydek @BettenworthDb @MaiaKayalMD @IBD_FloMD @APandT @debby_keller @ibdseb @IBDJournals @ezzatali64 @PracUpGastro @TwittyWhitty22 @1yr @5yr @charlie_lees @P_DeepakIBDMD @EdwardLoftus2 @drvishal82 @guthealthmd @GuiRamosMD @MRegueiroMD @JanDabritz @MatthieuAllez @AmerGastroAssn @AGA_Gastro @ibdleuven @JeanFredericCo1 @SeverineVermei1 @GianlucaPellino @fgomollon @bverstockt @mchiorean4 @Gut_BMJ @BenClickMD @IBDcanruti @ASGEendoscopy @PeyrinBiroulet @BrunoSilva_MD @MatFume 7/⬆️the risk of POR❓
Patient factors:
💎👨>👸
💎 >15 🚬/day
💎Young age at the time of ✂️ (<30 y)
Disease &💊factors:
💎Short disease duration before ✂️
💎>2 prior ✂️
💎Penetrating disease
💎SB resection >50 cm
💎➕ disease at resection margin
💎➖of post✂️ anti-TNF therapy
Patient factors:
💎👨>👸
💎 >15 🚬/day
💎Young age at the time of ✂️ (<30 y)
Disease &💊factors:
💎Short disease duration before ✂️
💎>2 prior ✂️
💎Penetrating disease
💎SB resection >50 cm
💎➕ disease at resection margin
💎➖of post✂️ anti-TNF therapy
@dunleavy_katie @MondayNightIBD @BattatMD4IBD @DCharabaty @JosephHabibi_MD @KanikaGargMD @Spencerkelley7 @BassiMehak @jalpa_devi @Empoweringpts9 @ayshaslam999 @RomyChamoun @JHaydek @BettenworthDb @MaiaKayalMD @IBD_FloMD @APandT @debby_keller @ibdseb @IBDJournals @ezzatali64 @PracUpGastro @TwittyWhitty22 @1yr @5yr @charlie_lees @P_DeepakIBDMD @EdwardLoftus2 @drvishal82 @guthealthmd @GuiRamosMD @MRegueiroMD @JanDabritz @MatthieuAllez @AmerGastroAssn @AGA_Gastro @ibdleuven @JeanFredericCo1 @SeverineVermei1 @GianlucaPellino @fgomollon @bverstockt @mchiorean4 @Gut_BMJ @BenClickMD @IBDcanruti @ASGEendoscopy @PeyrinBiroulet @BrunoSilva_MD @MatFume 8/⬇️the risk of POR❓
🧬Older patient (>50 y)
🧬Nonsmoker
🧬1st Sx for a short segment of fibrostenotic disease (<10 to 20 cm)
#B2BPearl #MondayNightIBD No difference in recurrence between Eastern and Western countries‼️
Take a look!
pubmed.ncbi.nlm.nih.gov/30126030/
🧬Older patient (>50 y)
🧬Nonsmoker
🧬1st Sx for a short segment of fibrostenotic disease (<10 to 20 cm)
#B2BPearl #MondayNightIBD No difference in recurrence between Eastern and Western countries‼️
Take a look!
pubmed.ncbi.nlm.nih.gov/30126030/
@dunleavy_katie @MondayNightIBD @BattatMD4IBD @DCharabaty @JosephHabibi_MD @KanikaGargMD @Spencerkelley7 @BassiMehak @jalpa_devi @Empoweringpts9 @ayshaslam999 @RomyChamoun @JHaydek @BettenworthDb @MaiaKayalMD @IBD_FloMD @APandT @debby_keller @ibdseb @IBDJournals @ezzatali64 @PracUpGastro @TwittyWhitty22 @1yr @5yr @charlie_lees @P_DeepakIBDMD @EdwardLoftus2 @drvishal82 @guthealthmd @GuiRamosMD @MRegueiroMD @JanDabritz @MatthieuAllez @AmerGastroAssn @AGA_Gastro @ibdleuven @JeanFredericCo1 @SeverineVermei1 @GianlucaPellino @fgomollon @bverstockt @mchiorean4 @Gut_BMJ @BenClickMD @IBDcanruti @ASGEendoscopy @PeyrinBiroulet @BrunoSilva_MD @MatFume 9/💎How to⬇️ POR risk?💊✂️
#B2BPearl Risk stratify pt & manage accordingly
💊Post-op
👉Nitroimidazole x3mos, if low risk
👉TNFi, start wk4, if high risk
✂️Kono-S anastomosis + extended mesenteric resection
🔦CLN at 6mos, adjust Rx per Rutgeerts score
pubmed.ncbi.nlm.nih.gov/34977147/
#B2BPearl Risk stratify pt & manage accordingly
💊Post-op
👉Nitroimidazole x3mos, if low risk
👉TNFi, start wk4, if high risk
✂️Kono-S anastomosis + extended mesenteric resection
🔦CLN at 6mos, adjust Rx per Rutgeerts score
pubmed.ncbi.nlm.nih.gov/34977147/
@MondayNightIBD 1/📢#GITwitter"There are two main mistakes in treating #IBD pts - the undertreatment and the overtreatment"-Prof #Rutgeerts!
Let’s talk about surgery & post-op surveillance in #crohns
@GroverDheera and I will #MakeItSimple in prep for #MondayNightIBD w @BattatMD4IBD @DCharabaty
Let’s talk about surgery & post-op surveillance in #crohns
@GroverDheera and I will #MakeItSimple in prep for #MondayNightIBD w @BattatMD4IBD @DCharabaty
@MondayNightIBD @GroverDheera @BattatMD4IBD @DCharabaty @JosephHabibi_MD @KanikaGargMD @Spencerkelley7 @BassiMehak @jalpa_devi @Empoweringpts9 @ayshaslam999 @RomyChamoun @JHaydek 2/ #MondayNightIBD
Journey of #Crohns disease:
🎢 Relapses & remission
🔥 Inflamm can leads to fibrostenosis, fistula and abscess
🚧 25% have complications at dx
✂️ 26% require surgery despite biologics
Journey of #Crohns disease:
🎢 Relapses & remission
🔥 Inflamm can leads to fibrostenosis, fistula and abscess
🚧 25% have complications at dx
✂️ 26% require surgery despite biologics
@MondayNightIBD @GroverDheera @BattatMD4IBD @DCharabaty @JosephHabibi_MD @KanikaGargMD @Spencerkelley7 @BassiMehak @jalpa_devi @Empoweringpts9 @ayshaslam999 @RomyChamoun @JHaydek @BettenworthDb @MaiaKayalMD @IBD_FloMD @APandT @debby_keller @ibdseb @IBDJournals @ezzatali64 @PracUpGastro @TwittyWhitty22 3/ Today’s focus is on surgery for #Crohns ileal #stricture
🌟 Indications: obstructive symptoms, stricture associated with abscess, suspicion of malignant stricture
🪄 Surgery🚫curative : #Crohns often recurs above IC anastomosis
#MondayNightIBD #Back2Basics
🌟 Indications: obstructive symptoms, stricture associated with abscess, suspicion of malignant stricture
🪄 Surgery🚫curative : #Crohns often recurs above IC anastomosis
#MondayNightIBD #Back2Basics
@JosephHabibi_MD @MondayNightIBD @KanikaGargMD @JHaydek @MarcelYibirin @GroverDheera @purnie_mae @dunleavy_katie @yaransarkis @ayshaslam999 @jalpa_devi @AmCollegeGastro @AmerGastroAssn @CLindenmeyerMD @doctornikkid @ShimaghavimiMD @IbdClub @ESCCO_Society @IBD_Nutrition @IBDBen @IBD_FloMD @IBDMD @ibdlearn @IBDConference @IBD_Afzali @AsanIbd @PREDICTIBD @ShomronH @BenClickMD @NadeenSarsour @bsc_endoscopy @Bjorn_Rembacken @EndoscopyNow @EndoscopyOthman @UpdatesIbd @PittGILiverNutr @AdvaniRashmiMD @nljonassaint @SyedGerdezi @wabillin @ACGCRJ @drkeithsiau @DrKohli @IFFGD @LinChangMD @vibhuc7 @SLUgastro @priyakathpalia @IBDdoc_BattatMd @APandT 10/How do you maintain remission after successful induction?
✅If pt achieves remission w/ IFX ↔️Maintain w/ IFX, 🔎consider adding AZA to ❌ antibodies to IFX
✅If pts achieve remission w/ IV CysA ↔️Maintain w/ AZA or Vedolizumab
✅If pt achieves remission w/ IFX ↔️Maintain w/ IFX, 🔎consider adding AZA to ❌ antibodies to IFX
✅If pts achieve remission w/ IV CysA ↔️Maintain w/ AZA or Vedolizumab
@JosephHabibi_MD @MondayNightIBD @KanikaGargMD @JHaydek @MarcelYibirin @GroverDheera @purnie_mae @dunleavy_katie @yaransarkis @ayshaslam999 @jalpa_devi @AmCollegeGastro @AmerGastroAssn @CLindenmeyerMD @doctornikkid @ShimaghavimiMD @IbdClub @ESCCO_Society @IBD_Nutrition @IBDBen @IBD_FloMD @IBDMD @ibdlearn @IBDConference @IBD_Afzali @AsanIbd @PREDICTIBD @ShomronH @BenClickMD @NadeenSarsour @bsc_endoscopy @Bjorn_Rembacken @EndoscopyNow @EndoscopyOthman @UpdatesIbd @PittGILiverNutr @AdvaniRashmiMD @nljonassaint @SyedGerdezi @wabillin @ACGCRJ @drkeithsiau @DrKohli @IFFGD @LinChangMD @vibhuc7 @SLUgastro @priyakathpalia @IBDdoc_BattatMd @APandT 11/ ‼️Potential Role of #TOFA in #ASUC
🔺Pts had Failed >= 2 biologics; PO prednisone
🔺TOFA 10mg po TID ➡️ Rapid symptom improvement + ⬇️CRP
🔺F/U:
TOFA maintenance
❌✂️ at 30 D & 90 D
❌Readmissions at 90 D
2/4 pts ➡️ clinical + endo steroid-free remission
❌Major AEs
🔺Pts had Failed >= 2 biologics; PO prednisone
🔺TOFA 10mg po TID ➡️ Rapid symptom improvement + ⬇️CRP
🔺F/U:
TOFA maintenance
❌✂️ at 30 D & 90 D
❌Readmissions at 90 D
2/4 pts ➡️ clinical + endo steroid-free remission
❌Major AEs
@JosephHabibi_MD @MondayNightIBD @KanikaGargMD @JHaydek @MarcelYibirin @GroverDheera @purnie_mae @dunleavy_katie @yaransarkis @ayshaslam999 @jalpa_devi @AmCollegeGastro @AmerGastroAssn @CLindenmeyerMD @doctornikkid @ShimaghavimiMD @IbdClub @ESCCO_Society @IBD_Nutrition @IBDBen @IBD_FloMD @IBDMD @ibdlearn @IBDConference @IBD_Afzali @AsanIbd @PREDICTIBD @ShomronH @BenClickMD @NadeenSarsour @bsc_endoscopy @Bjorn_Rembacken @EndoscopyNow @EndoscopyOthman @UpdatesIbd @PittGILiverNutr @AdvaniRashmiMD @nljonassaint @SyedGerdezi @wabillin @ACGCRJ @drkeithsiau @DrKohli @IFFGD @LinChangMD @vibhuc7 @SLUgastro @priyakathpalia @IBDdoc_BattatMd @APandT 12/📞 URGENT surgery consult:
🤒 No response by D3-5
❌Response to 💉CS
🩸Fulminant colitis
⭕️Toxic megacolon or Perf
++ When urgent : Total colectomy w/ileostomy, later complete proctectomy +/- IPAA
🤒 No response by D3-5
❌Response to 💉CS
🩸Fulminant colitis
⭕️Toxic megacolon or Perf
++ When urgent : Total colectomy w/ileostomy, later complete proctectomy +/- IPAA
@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
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
#Back2Basics #MondayNightIBD
@MondayNightIBD @DCharabaty 2/ ‼️Cancer risk in IBD‼️can be→
🔺Disease related (eg CRC, anal CA)
🔺Therapy related ( Skin, Lymphoma, Cervical, Anal)
🔺Disease related (eg CRC, anal CA)
🔺Therapy related ( Skin, Lymphoma, Cervical, Anal)
@MondayNightIBD @SobiaMujtabaMD @JasonHouMD @DCharabaty 1/ 65 y/o M new dx #Crohns ileitis after he presented w abdo pain,diarrhea, wt loss, anemia. CLN: deep linear ulcers in TI. He has an active lifestyle,stable CAD. Symptoms recur when prednisone<15 mg. What is the LEAST effective strategy to keep this pt in remission? #Back2Basics
@MondayNightIBD @SobiaMujtabaMD @JasonHouMD @DCharabaty 2/ #IBD is not only a disease of the young !
♦️ Typical dx age 20-39, w a second smaller peak >50
♦️ Recently ⬆️ prevalence in elderly> age 60, due to:
🔺Aging of adults w #IBD
🔺⬆️elderly onset IBD > age 60 #EOIBD:
🔹⬆️awareness & dx
🔹Environment/ microbiome changes
♦️ Typical dx age 20-39, w a second smaller peak >50
♦️ Recently ⬆️ prevalence in elderly> age 60, due to:
🔺Aging of adults w #IBD
🔺⬆️elderly onset IBD > age 60 #EOIBD:
🔹⬆️awareness & dx
🔹Environment/ microbiome changes
@MondayNightIBD @SobiaMujtabaMD @JasonHouMD @DCharabaty 3/ Clinical Features of #IBD in #elderly 🔎?
📌Milder disease course, Fewer #Crohns complications, but
⬆️rates of hospitalizations
⬆️rates of colectomy in EO UC
📌❓Due to disease severity vs poor #IBD control d/t underuse of effective Rx
📌Milder disease course, Fewer #Crohns complications, but
⬆️rates of hospitalizations
⬆️rates of colectomy in EO UC
📌❓Due to disease severity vs poor #IBD control d/t underuse of effective Rx
@MondayNightIBD @ibdnaik @SobiaMujtabaMD @ibdleuven @DCharabaty 1/29 yo M, smoker, presents with RLQ abscess w fistula to the TI; he undergoes abscess drainage & then ileocecal✂️w primary ileocolonic anastomosis. Path c/w #Crohns, margins free of disease. You see him for f/up 2 weeks post-op, What's the next ? #MondayNightIBD #Back2Basics
@MondayNightIBD @ibdnaik @SobiaMujtabaMD @ibdleuven @DCharabaty 2/ Let’s talk #Crohn’s intestinal complications
CD can present w stricturing/perforating complications
50-60% CD will develop strictures, fistulas or abscesses over time
70% require surgical✂️by 15yrs of dx
Surgery not curative, most pts will have endo recurrence 1 yr post-IC✂️
CD can present w stricturing/perforating complications
50-60% CD will develop strictures, fistulas or abscesses over time
70% require surgical✂️by 15yrs of dx
Surgery not curative, most pts will have endo recurrence 1 yr post-IC✂️
@MondayNightIBD @ibdnaik @SobiaMujtabaMD @ibdleuven @DCharabaty 3/ Natural course of CD recurrence post- IC ✂️
📌Histologic e/o CD within 3 wks post-op !!
📌70-90% pts w endo recurrence at 1 year
📌30-60% pts w clinical recurrence by 3 & 5 yrs
📌50% will need ✂️by 5 yrs
@MRegueiroMD
📌Histologic e/o CD within 3 wks post-op !!
📌70-90% pts w endo recurrence at 1 year
📌30-60% pts w clinical recurrence by 3 & 5 yrs
📌50% will need ✂️by 5 yrs
@MRegueiroMD
@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
🧩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
@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
📌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
