Post

How to get URL link on X (Twitter) App

On the Twitter thread, click on or icon on the bottom
Click again on or Share Via icon
Click on Copy Link to Tweet
Paste it above and click "Unroll Thread"!
More info at Twitter Help

John Damianos, M.D.

@john_damianosMD

Oct 24, 2021 • 25 tweets • 11 min read • Read on X

Scrolly

@LinChangMD

Evidence-based approach to #IBS (C and D) from @LinChangMD at @AmCollegeGastro #ACG2021

#GITwitter

FGIDs ▶️ DGBIs 🧠

#IBS diagnosis

🚨 Alarm features

Limited diagnostic testing in #IBS to rule out certain other disorders

@RomeFoundation

After limited screening for other disorders, make a POSITIVE diagnosis of #IBS (NOT a diagnosis of exclusion) using the @RomeFoundation IV criteria

Characterize #IBS by subtype using the Bristol 💩 scale

Use the 2⃣5⃣% mark

Diagnosing #IBS

Overview of #IBS-D treatment options

Treatment algorithm for #IBS-D

Consider peppermint oil, antispasmodics, and TCAs

Rifaximin is useful and can be repeated up to twice

Eluxadoline for IBS-D

💎s on #IBS-D treatment

Treatment options for #IBS-C

Algorithm for the treatment of #IBS-C

Approved therapies for #IBS-C and #CIC

Linaclotide effective for #constipation, pain, and bloating

Tegaserod is another good option

💎s on #IBS-C treatment

Modify treatment based on response

Pharmacology of neuromodulators

💎s on neuromodulators in #IBS

Psychological-based therapies in #IBS

Behavioral therapy in #IBS

• • •

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

This Thread may be Removed Anytime!

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

More from @john_damianosMD

John Damianos, M.D.

@john_damianosMD

Mar 14

A master class on prokinetics from @NGMJournal! Here is a summary! 🧵👇

⚡️🎈〽️🪠🫀💩🚄🧠✳️🗯️💊📰🚽🔌🧪💡🧲📊🔎

#MedTwitter #GITwitter #motility #pharmacology

onlinelibrary.wiley.com/doi/full/10.11…

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

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

Read 20 tweets

John Damianos, M.D.

@john_damianosMD

Dec 15, 2022

@YaleMed

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.

@john_damianosMD

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