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John Damianos, M.D. Profile picture
@john_damianosMD
Oct 24, 2021 • 16 tweets • 7 min read • Read on X
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Therapies for #NAFLD by @klkrok

@AmCollegeGastro #ACG2021 #LiverTwitter #Liver #fattyliver #GITwitter
A case!
⚠️11% of patients with incidentally discovered steatosis may be at risk for advanced hepatic fibrosis!
Don't ignore patients with incidentally found steatosis!
Determining degree of fibrosis: NAFLD fibrosis score and FIB-4 are easy, noninvasive, and useful!
Treatment of #NAFLD

Note metformin is ABSENT, since it's NOT an effective therapy for NAFLD!
WEIGHT LOSS is 🔑

7-10% of body weight loss ▶️ 50% regression of liver scarring/fibrosis

> 10% ▶️ >80% regression!!!!
Vitamin D may protect against hepatic inflammation
Vitamin E is recommended in patients with biopsy proven #NASH, except in patients with diabetes.
✅GLP-1 analogues
✅Statins should be given to ALL patients with NASH/NAFLD. They are SAFE even if elevated liver chemistries!!!
✅Coffee! ☕️ ☕️ ☕️ ☕️ ☕️ ☕️ ☕️ ☕️

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More from @john_damianosMD

John Damianos, M.D. Profile picture
Oct 27
Gastroparesis with @BMoshiree

#MedTwitter #GITwitter #ACG2024 @AmCollegeGastro Image
Prevalence of gastroparesis-like symptoms: 1.3% worldwide, 3.7% in the US Image
Working up gastroparesis-like symptoms Image
Read 21 tweets
John Damianos, M.D. Profile picture
Oct 26
Treatment of upper gastrointestinal bleeding

#MedTwitter #GITwitter #ACG2024 @AmCollegeGastro Image
✅Erythromycin
❌Metoclopramide Image
Image
Image
❓PPI Image
Image
Read 15 tweets
John Damianos, M.D. Profile picture
Mar 14
A master class on prokinetics from @NGMJournal! Here is a summary! 🧵👇

⚡️🎈〽️🪠🫀💩🚄🧠✳️🗯️💊📰🚽🔌🧪💡🧲📊🔎

#MedTwitter #GITwitter #motility #pharmacology

onlinelibrary.wiley.com/doi/full/10.11…
Image
Pyridostigmine & neostigmine
⚡️cholinesterase inhibitors
🧠pyrido should not cross the blood-brain barrier
🚽evidence in chronic idiopathic constipation and acute colonic pseudo-obstruction
🫄pregnancy class C; excreted in breastmilk
🫀cholinergic side effects, esp bradycardia Image
Acotiamide
⚡️inhibits cholinesterase and enhances ACh release via muscarinic receptors
🎈enhances gastric emptying and accommodation
🔥NERD & FD
🫄no safety data
💊side effects: nausea, abdominal distension, constipation Image
Read 20 tweets
John Damianos, M.D. Profile picture
Dec 15, 2022
I gave a talk on inpatient bowel regimens today for the @YaleMed @YaleIMed residents and students, with additional 💎s on outpatient #constipation. Here are the slides!

💩 💩 💩

#MedTwitter #GITwitter #motility #MedEd @YaleIM_Chiefs @MayoClinicGIHep
Most inpatients require a bowel regimen. Our patients typically have most of the risk factors for #constipation!
#Constipation is more about symptoms than frequency! 🚽

It’s also a *symptom* (like chest pain), so need to figure out what’s causing it and treat accordingly.
Read 20 tweets
John Damianos, M.D. Profile picture
Dec 13, 2022
Diet, gas, and the #microbiome 💨

#MedTwitter #GITwitter #diet #nutrition #IBS #SIBO

sciencedirect.com/science/articl…
💨The gut microbiota generates ~0.2L–1.5L of gas per day
💨>99%: hydrogen (H2), carbon dioxide (CO2), & methane (CH4)– *odorless*
💨foul smell of gas from <1%: sulfur–containing gases hydrogen sulfide (H2S), methanethiol (CH3SH), dimethyl sulfide [(CH3)2S] + volatile compounds
🦠bacteria in the colon ferment substrates that are not digested or absorbed in the upper GI tract (e.g. carbohydrates, proteins, fats)
🦠produce short-chain fatty acids, branched-chain fatty acids, ammonia, N-nitro compounds, phenolic and indolic compounds, and various gases
Read 15 tweets
John Damianos, M.D. Profile picture
Oct 23, 2022
Summarizing our learning at #ACG2022 today! 🧑‍🎓

@tinahamd @AmCollegeGastro #MedTwitter #GITwitter
💎 GI bleeding🩸
💎#IBD
Read 8 tweets

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