Thread by @dunleavy_katie

@MondayNightIBD @DCharabaty 1/12
📣#GITwitter #IBDTwitter

Welcome back to #MondayNightIBD #Back2Basics w @dunleavy_katie @john_damianosMD

🎯How do you approach a pt w #IBD in remission who has new or persistent #GI symptoms?

Check out our review📜
practicalgastro.com/2022/05/18/rec…

#NeuroGI #GastroPsych #DGBI

@MondayNightIBD @DCharabaty @john_damianosMD 2/12 #MondayNightIBD #B2B

👩🏼‍⚕️have been studying “IBS-type symptoms” in #IBD for 30 yrs. But there is more work to be done to help characterize cohort & dz mechanism!

It’s important bc:
👨‍👩‍👧‍👦Affects pts QoL, mental health, sleep
🥼Causes ⬆️HC utilization, ⬆️MD visits & 💊narcotics

@MondayNightIBD @DCharabaty @john_damianosMD @MarcelYibirin @VictorChedidMD @LauraRaffalsMD @Spencerkelley7 @RomyChamoun @JosephHabibi_MD @ayshaslam999 @GroverDheera @yaransarkis @BassiMehak 3/12 #MondayNightIBD Persistent/New GI Sx in #IBD
1⃣R/o active🔥/#IBD complication (abscess, stricture):🔦, 🩻, CRP, FCP, ⚠️R/o infx like C. Difficile!

2⃣🤔Consequences of✂️: adhesion, bile acid diarrhea

3⃣🤔 #DGBI
🚩25% pts w #IBD in endo remission have #IBS @LancetGastroHep

@MondayNightIBD @DCharabaty @john_damianosMD @MarcelYibirin @VictorChedidMD @LauraRaffalsMD @Spencerkelley7 @RomyChamoun @JosephHabibi_MD @ayshaslam999 @GroverDheera @yaransarkis @BassiMehak @LancetGastroHep @ifrahfatima @SanjeevaniTomar @PriSantiagoMD @LindaNguyenMD @alex_ford12399 @kanikasehgal_ @AdvaniRashmiMD @ManasiAgrawalMD @WalterChanMD @stevenbollipo 4/12 #MondayNightIBD

3️⃣R/o common mimickers
🍞#Celiac
🦠SIBO
💊Pancreatic insufficiency
🥛Lactose/other sugar intolerance
🥶🥵Thyroid disorders
🤮Chronic GI infxn
🔪Adhesions
🩸Endometriosis
🔬Microscopic colitis
🍔Bile acid diarrhea

Important bc many have targeted Rx!!

@MondayNightIBD @DCharabaty @john_damianosMD @MarcelYibirin @VictorChedidMD @LauraRaffalsMD @Spencerkelley7 @RomyChamoun @JosephHabibi_MD @ayshaslam999 @GroverDheera @yaransarkis @BassiMehak @LancetGastroHep @ifrahfatima @SanjeevaniTomar @PriSantiagoMD @LindaNguyenMD @alex_ford12399 @kanikasehgal_ @AdvaniRashmiMD @ManasiAgrawalMD @WalterChanMD @stevenbollipo @AmyOxentenkoMD @Gut_BMJ @GuildConference @JosephCAhnMD @MarkPimentelMD @BethRosenRD @drjshapiro @mgrover_gi @GIdietitian @KewinSiah 5/12 #MondayNightIBD

🗃No current clinical criteria exists for persistent non-inflamm sx in quiescent #IBD

🇮🇹 Rome IV Criteria can help guide Rx
(NB:Not created for IBD pts)
😣recurrent abd pain 1+ day/wk in past 3 mo
a/w 2+ following:
💩rltd to defecation,🔺stool form or freq

@MondayNightIBD @DCharabaty @john_damianosMD @MarcelYibirin @VictorChedidMD @LauraRaffalsMD @Spencerkelley7 @RomyChamoun @JosephHabibi_MD @ayshaslam999 @GroverDheera @yaransarkis @BassiMehak @LancetGastroHep @ifrahfatima @SanjeevaniTomar @PriSantiagoMD @LindaNguyenMD @alex_ford12399 @kanikasehgal_ @AdvaniRashmiMD @ManasiAgrawalMD @WalterChanMD @stevenbollipo @AmyOxentenkoMD @Gut_BMJ @GuildConference @JosephCAhnMD @MarkPimentelMD @BethRosenRD @drjshapiro @mgrover_gi @GIdietitian @KewinSiah @NEJM @RomeGastroPsych @RomeFoundation @IrisWangMD @JBrandlerMD @LinChangMD @IFFGD @nataliesparacio @GIreview @Empoweringpts9 6/12 #MondayNightIBD

👯‍♀️#IBD & #IBS can coexist

🔗Likely due to IBD promoting IBS pathophysiology:
‼️CNS hypervigilance
🔪Bowel irritants (NT, microbiome, immune activation, ⬆️mucosal permeability, bile acid malab)
🎶Altrd gut sensation
🏃‍♀️Altrd gut motility
💩Defecatory disorder