Thread by @BattatMD4IBD

@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma 1/ #IBDPoll1️⃣ 30M non-smoker w stricturing #Crohns ileocolitis dx 1 year ago is now s/p ileocecal resection due to refractory symptoms despite adalimumab.

What would you recommend post-surgery? #MondayNightIBD

🔦= C-scope
🔥= Active disease
Metronid= Metronidazole

@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma 2/ #IBDPoll2️⃣ The pt was started on IFX 4 weeks post-op, but now presents @ 8 weeks post op w #Diarrhea 6-8 loose BM/day, no abdo pain, no blood. Stool Cdiff & Cx negative. FCP, CRP nml,

What’s next ? #MondayNightIBD

@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma 3/ #IBDPoll3️⃣ Pt is dx w #BAD w 7C4 level 80ng/mL, & started cholestyramine. Now presents w abdo pain, MRE multiple SB #Strictures ➡️Sx complicated by leaks & more✂️. Now w foul smelling diarrhea, Wt loss, dry mouth, orthostasis. CLN & Stool studies nml.
What’s next?

@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma ok, poll#3: good news: era of biologics--> less surgery#1, bad news: no change in 2nd surgery
academic.oup.com/bjs/article/10…

Multiple surgeries--> risk of short bowel: what to look for? orthostatic symptoms, excess #thirst, 10% #weight loss, steatorrhea. @DCharabaty @MondayNightIBD

@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma initially should treat with hydration, TPN.
#Bile acid sequestrant--> worse symptoms! more bile acid loss --> less fat absorption.
look out! #vitamin ADEK B12
10% wt loss, dehydration sx, IV dependence 3x/wk--> eligible for Teduglutide #mondaynightIBD