Here are the new @BritSocGastro guidelines for #IBS in @Gut_BMJ! I'll summarize in 🧵 ⬇️⬇️⬇️!

😖💩🦠🧠🥦🍞💊

#GITwitter #GI #gut #braingut #motility #DGBI #FGID #microbiome #probiotics #MedTwitter #MedEd

gut.bmj.com/content/early/…
🧑‍⚕️-😷
Doctor-patient communication
🧑‍⚕️A strong 🧑‍⚕️-😷 relationship is fundamental to the management of #IBS
😷Patients want their 🧑‍⚕️ to ⬆️empathy, support and information about the nature of IBS, diagnosis, and treatment options
DIAGNOSIS
🩸New pt: CBC, CRP or ESR, celiac serology and, if <45 w diarrhea, fecal calprotectin
➕Make POSITIVE diagnosis based on @RomeFoundation criteria
➡️Refer to #GI when: diagnostic doubt, pt w symptoms that are severe or refractory to 1stline tx,or when pt wants specialist
DIAGNOSIS
❌Colonoscopy unless🚩features OR #IBS-D with atypical features that may suggest microscopic colitis (female,≥50, autoimmune disease,nocturnal or severe, watery diarrhea, duration of 💩 <12 months, weight loss or use of potential precipitating 💊 inclu NSAIDs & PPIs
DIAGNOSIS
💩If atypical feature (as above) or a prior cholecystectomy, consider 23-seleno-25-homotaurocholic acid scanning or serum 7α-hydroxy-4-cholesten-3-one to exclude bile acid diarrhea (#BAD)

😢Not in U.S.A. 🇺🇸
DIAGNOSIS
🚽If coexisting signs of defecatory disorder or fecal incontinence, consider anorectal physiology tests (to assess if biofeedback warranted)
❌testing for exocrine pancreatic insufficiency
❌breath testing for #SIBO
❌testing for carbohydrate intolerance

#IBS
DIAGNOSIS
🧑‍🎓NAME the diagnosis #IBS
🧑‍🎓Explain as a DISORDER OF GUT-BRAIN INTERACTION
🧑‍🎓Explain how diet, stress, cognitive, behavioral, emotional responses to symptoms, and infections can contribute to brain-gut dysfunction
TREATMENT
🚴‍♀️Exercise
❌IgG elimination diet
🍞⬆️Soluble fiber (eg ispaghula), watch out for insoluble fiber (eg wheat bran) which can ⬆️symptoms
🥦⬇️FODMAP diet is 2nd line, in conjunction w RD, and with gradual reintroduction of foods
❌Gluten free
💊✅#probiotics but❓strain
TREATMENT
💊✅loperamide for diarrhea, but may ⬆️abdominal pain, bloating, nausea, & constipation, so start lo and go slow
💊✅certain antispasmodics, but may⬆️dry mouth, visual disturbance, & dizziness
💊✅peppermint oil, but may⬆️#GERD
💊✅PEG for #constipation, but may⬆️pain
2nd line TREATMENT
💊EXPLAIN why we use neuromodulators
💊✅TCAs
💊✅SSRIs
💊✅Eluxadoline for #IBS-D (❌in sphincter of Oddi d/o, cholecystectomy, alcohol dependence, pancreatitis, severe liver impairment)
💊✅Serotonin modulators alosetron and ramosetron or ondansetron IBS-D
2nd line TREATMENT
💊✅Rifaximin #IBS-D
💊✅Linaclotide IBS-C (⚠️most effective secretagogue!), may➡️diarrhea
💊✅Lubiprostone IBS-C (less likely to➡️diarrhea)
💊✅Plecanatide IBS-C
💊✅Tenapanor IBS-C
💊✅Tegaserod IBS-C
PSYCHOLOGICAL THERAPY
🧠Consider when symptoms have❌improved after 12 months of 💊 OR earlier if patient wants
🧠✅CBT
🧠✅gut-directed hypnotherapy

#IBS
SEVERE/REFRACTORY #IBS
💩Consider alternate diagnoses & appropriate w/u
💩Multidisciplinary care (RD, #gastropsych)
💩avoid iatrogenesis w opioids, unnecessary surgery, unproven/unregulated diagnostic/therapeutic approaches incentivized by💰or reputation
💩combo neuromodulators
Postlude on #probiotics:
Signals found for
🦠combination probiotics
🦠Lactobacilli
🦠Bifidobacteria
🦠Escherichia
"Variations in study design, strain&species of probiotic used&heterogeneity btw studies make it difficult to give specific recommendations. However, it is reasonable to advise pts...to take...for up to 12 weeks, & to discontinue treatment if there is no improvement in symptoms."

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with John Damianos, M.D.

John Damianos, M.D. Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @john_damianosMD

6 Apr
Foods in our #diet can alter the pro-inflammatory vs anti-inflammatory milieu of the intestinal #microbiome.

See 🧵 below for the findings!

🥬🍑🍅🍠🥚🍎🧀🍆🫒🫓🍇🥦🥑🥥🥯🌶️🧄🥖

#GITwitter #GI #gut #nutrition

gut.bmj.com/content/early/…
🥖 🥜 🐠 🌰
Breads, legumes, fish and nuts⬇️several pro-inflammatory pathways:
🫓⬇️pathogenic growth factors & endotoxins
🫓⬇️ pathogenic E. coli, Bacteroides fragilis, parabacerioides
🫓⬆️ammonia detoxification pathway
🌰🐟 🍑🥦
Nuts, oily fish, fruit, vegetables & cereals ⬆️short-chain fatty acid producers
🫑⬆️Faecalibacterium prausnitzii, roseburia hominis, and more

Bacteria ferment fiber and pectins to acetate and butyrate.

SCFAs have anti-inflammatory effects on the mucosa!
Read 20 tweets
8 Mar
A little late but better late than never! ⌚️ Here's a recap of @AmCollegeGastro Virtual Grand Rounds by @ScottGabbardMD on...... FUNCTIONAL DYSPEPSIA!
🤢🤢🤢

This is a VERY common entity that is underdiagnosed! #MedTwitter take notice!

#GITwitter #GI #gut
DYSPEPSIA = epigastric #pain. (can be associated with any other upper #GI symptom such as epigastric fullness, nausea, vomiting, or heartburn).

Dyspepsia is COMMON, and most cases are FUNCTIONAL (i.e., caused by brain-gut axis dysfunction)!
Like all disorders of gut-brain interactions FD pathophysiology is❌completely understood, but is thought to be complex+multifactorial. Components include
🤢disrupted duodenal barrier
🤢altered duodenal #microbiome
🤢dysmotility
🤢visceral hypersensitivity
🤢psychosocial stress
Read 22 tweets
28 Feb
Let's talk about something common, hard to treat, and often misunderstood: CHRONIC BLOATING AND DISTENSION!

A 🧵 summarizing from the excellent @AGA_CGH article cghjournal.org/article/S1542-…

#GI #GITwitter #motility #IBS #DGBI #FGID #microbiome #health #MedEd
🟢Bloating: subjective sensation of gassiness, trapped💨, or a feeling of pressure or being distended w/o obvious visible distension.

🟢Distension: objective physical manifestation of an⬆️in abdominal girth. Patients commonly say they look like 🎈 or 🤰
Bloating and distension are COMMON

🔴16-31% in the general population

🔴Women > men

🔴66-99% in #IBS

🔴IBS-C > IBS-D

🟢Bloating and distension are distressing to patients and ⬇️quality of life
Read 13 tweets
15 Dec 20
🚨New @AmCollegeGastro guidelines for the treatment of irritable bowel syndrome! I will summarize in this🧵 ⬇️⬇️⬇️

journals.lww.com/ajg/Abstract/9…

Authors: #BrianLacy, @MarkPimentelMD, @dbrennerGIMD, @umfoodoc, @drlauriekeefer, @MLongMD, @BMoshiree

#GITwitter #GI #IBS #gut #MedEd
🔘In pts w diarrhea, rule out #celiac disease🍞
🔘In pts w diarrhea + no🚨features, check fecal calprotectin/fecal leukocytes AND CRP to rule out #IBD
🔘❌routine 💩testing for enteric pathogens in #IBS
🔘❌colonoscopy in IBS if <45 and no🚨s
🔘Make POSITIVE IBS dx (Rome), ❌DOE
🔘Identify #IBS subtype to target therapy
🔘❌testing for food allergies/sensitivities
🔘Test anorectal physiology in pts w IBS + symptoms suggestive of pelvic floor disorder +/or refractory #constipatoin
🔘Limited trial of low-#FODMAP #diet
🔘✅soluble fiber,❌insoluble fiber
Read 7 tweets
11 Dec 20
Very important and high-yield #AIBD2020 session with @UmaMahadevanIBD on #IBD in #pregnancy! 🤰🔥💩👶
⬇️⬇️⬇️

@IBDConference #GITwitter #GI #OBGYNtwitter #OBGYN
Management of a healthy pregnancy begins... before pregnancy!

#AIBD2020 @IBDConference @UmaMahadevanIBD #IBD
Start planning early!

Want 3 months of steroid-free remission before conception.

#AIBD2020 @IBDConference @UmaMahadevanIBD #IBD
Read 23 tweets
18 Sep 20
Recapping @AmCollegeGastro's #VirtualGrandRounds on #IBS! Let's begin!
🟣IBS can be diagnosed with the Rome criteria
🟣Making a positive diagnosis is very helpful to patients, many of whom have gone years without a name for their symptoms
#IBS is heterogeneous, and so are its pathogenesis and pathophysiology.
🟣Identifying underlying factors in patients can help target treatment!

@AmCollegeGastro
Important principles when diagnosing and treating #IBS.

@AmCollegeGastro
Read 34 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!