John Damianos, M.D. Profile picture
Oct 24, 2021 13 tweets 8 min read Read on X
It's #IBD time! Here's Crohn disease in the treatment naive patient with @YNHH @YaleDigestive @JillGaidosMD.

Loving the YALE representation here with the all⭐️ YALE IBD CREW @Badr_AlBawardy @JCPetrov @loulev_md @NadeenHussainMD

@AmCollegeGastro #ACG2021 #GITwitter
Let's dive in!
When choosing an initial therapy for Crohn disease, need to take into account
🔺disease ACTIVITY
🔻disease SEVERITY
@JillGaidosMD "I want first and foremost for your symptoms to improve. I also want your inflammation to resolve."
Even when inflammatory activity is low, intestinal damage can continue to progress. We should target disease severity early, ideally at time of diagnosis.
Treatment options in Crohn disease.

1. Give treatments enough time
2. Optimize dose
Selecting Crohn disease treatment
Treatment of Crohn disease by patient characteristics
Shared decision making is important in selecting #IBD therapy
Case conclusions
Need to continue long-term monitoring for objective measures of inflammation. This allows for dose optimization or switching therapies, to prevent steroids, hospitalization, surgery, and other complications.
💎s from @JillGaidosMD on selecting therapy for Crohn disease

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More from @john_damianosMD

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
Oct 26
Treatment of upper gastrointestinal bleeding

#MedTwitter #GITwitter #ACG2024 @AmCollegeGastro Image
✅Erythromycin
❌Metoclopramide Image
Image
Image
❓PPI Image
Image
Read 15 tweets
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
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
Dec 13, 2022
💨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
Oct 23, 2022
Summarizing our learning at #ACG2022 today! 🧑‍🎓

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

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