John Damianos, M.D. Profile picture
Dec 10, 2021 23 tweets 13 min read Read on X
🥊 #HitMeWithYourBestShot: Reguiero vs Siegel

@MRegueiroMD➕anti-TNFs "Why wouldn't we use anti-TNF as first line #IBD therapy?!"

#AIBD2021 @IBDConference @DrCoreySiegel ImageImageImageImage
Anti-TNFs are EFFECTIVE ImageImageImageImage
We know a LOT about #TDM in anti-TNFs ImageImageImageImage
We have PRECISION MEDICINE with anti-TNFs Image
Anti-TNFs
⬆️infections, but otherwise very safe Image
Anti-TNFs work for MULTIPLE ASPECTS of #IBD, especially fistulae Image
Anti-TNFs are effective for POSTOP CROHN DISEASE ImageImage
Anti-TNFs are THE BEST treatment for EIMs Image
ACESS is easiest with anti-TNFs

Think of biosimilars like fingerprints ImageImageImageImage
"Dr. @DrCoreySiegel, @DartmouthHitch gastroenterologist, scientist, and future Nobel Prize winner 🏅: -@MRegueiroMD 😂 Image
Cons of non anti-TNF biologics ImageImage
@MRegueiroMD: start with anti-TNFs Image
@DrCoreySiegel: anything BUT anti-TNF!

Many factors go into choosing the right therapy for the right patient Image
The data for safety of VDZ and UST speak for themselves. "Probably as safe as not being on any drug in terms of side effects." ImageImage
While there is a small ⬆️ risk of lymphoma and skin cancers in anti-TNFs, there is NO risk of cancers in vedolizumab or ustekinumab. Image
"@MRegueiroMD, this is YOUR safety pyramid!" 😂

While efficacy is about equivalent, safety is better for VDZ/UST Image
Need to consider the efficacy and safety profile of COMBO therapy with anti-TNFs Image
Immunogenicity is highest for anti-TNFs Image
From real world EVOLVE-UC, it doesn't matter if we start or end at anti-TNF. So we CAN try non-TNFs first without worry. Image
Ustekinumab used first ⬆️⬆️⬆️⬆️QALYs Image
How to select first biologic:

Apart from ASUC and perianal CD, the efficacy of TNFs and non-TNFs are basically the same. The non-TNFs are safer. We don't lose efficacy of TNF if we start with non-TNF.

Shared decision making with patient! 🤝 Image

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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
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❓PPI Image
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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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