Thread by @john_damianosMD

@dunleavy_katie @MondayNightIBD @DCharabaty @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 @FrontGastro @BeyderLab @AliRezaieMD @JPandolfinoMD @DarrellPardi @GuiRamosMD 7/12 #MondayNightIBD

MultiD Rx of #IBS in #IBD
🩺target predominant symptom(s)- pain, diarrhea, constipation, bloating
🌱supplements: peppermint oil, #probiotics
🥑diet: ⬇️FODMAP, Mediterranean
💊antibiotics, panc enzymes, neuromodulators, secretagogues
🧠CBT, hypnotherapy

@dunleavy_katie @MondayNightIBD @DCharabaty @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 @FrontGastro @BeyderLab @AliRezaieMD @JPandolfinoMD @DarrellPardi @GuiRamosMD 8/12 #MondayNightIBD

#SIBO is common in #IBD, especially
👩‍🦰F>M
🔥CD>UC
✂️prior surgeries
📿strictures
🧪⬇️albumin
🦥⬇️transit times

Testing (🌬️or🦠) and treating improves symptoms & outcomes!

Treatment
⛽️hydrogen▶️rifaximin
🐄methane▶️rifaximin+neomycin
🩺See ACG guidelines!

@dunleavy_katie @MondayNightIBD @DCharabaty @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 @FrontGastro @BeyderLab @AliRezaieMD @JPandolfinoMD @DarrellPardi @GuiRamosMD 9/12 #MondayNightIBD

Anxiety, depression, & #PTSD are very common in #IBD and are associated with worse disease outcomes, ⬆️🏥utilization, & ⬇️quality of life.
🔍screen for ψ disorders
💊neuromodulators can treat IBD/IBS and ψ symptoms
🧠CBT, GDH
🤝refer to #GastroPsych

@dunleavy_katie @MondayNightIBD @DCharabaty @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 @FrontGastro @BeyderLab @AliRezaieMD @JPandolfinoMD @DarrellPardi @GuiRamosMD 10/12 #MondayNightIBD

Other DGBIs in #IBD
🧠66% have one or more DGBIs
🧠34% have >1
🧠After IBS, most common▶️functional dyspepsia🤢, belching disorders😮‍💨, disorders of nausea and vomiting🤮, functional diarrhea or constipation💩, fecal incontinence🌊, and proctalgia fugax😖

@dunleavy_katie @MondayNightIBD @DCharabaty @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 @FrontGastro @BeyderLab @AliRezaieMD @JPandolfinoMD @DarrellPardi @GuiRamosMD 11/12 #MondayNightIBD

Treating DGBIs in #IBD
🫂reassurance: symptoms❌reflective of inflammation or CA
🧠Education re: gut-brain axis
💊Symptom-based treatment
🧘‍♀️😴Lifestyle change
🤝MultiD approach: #GI #GastroRD, #GastroPsych #PelvicPT

@dunleavy_katie @MondayNightIBD @DCharabaty @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 @FrontGastro @BeyderLab @AliRezaieMD @JPandolfinoMD @DarrellPardi @GuiRamosMD 12/12 #MondayNightIBD

Summary
🤕new/persistent GI symptoms are common in #IBD in remission
⚕️large differential diagnosis
🔥Rule out active IBD, IBD complications, mimics diseases
🧠DGBIs, esp #IBS, are very common and▶️⬇️QoL and worse outcomes
💊symptom-based rx and MDT

@dunleavy_katie @MondayNightIBD @DCharabaty @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 @FrontGastro @BeyderLab @AliRezaieMD @Badr_AlBawardy @JillGaidosMD @DebProctorMD