Thread by @valcohranmd

@MondayNightIBD @DCharabaty @TakedaPharma 2/ #MedTwitter #GITwitter #MedPeds @BonumCE

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@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut 3/ #Parenteralnutrition is used in cases w GI dysfunction
➡️replace nutrients ➡️essential components pt would otherwise be unable to absorb from their 🥪🍜🍱

In pts w #ShortBowelSyndrome, PN is given @ home🏠 usually @ nt🌛
#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut 4/@AmerGastroAssn Clin Practice Update on #ShortBowelSyndrome #ParenteralNutrition

🌟Best practices
💎 Pref of tunneled CVCs
💎Micronutrient deficiencies monitoring
💎PN volume/contents based on pt weight, labs, stool/ostomy & urine output, signs of dehydration
#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn 5/Pts w SBS can become dependent 🪢on #ParenteralNutrition as only source of nutrition

1⃣study among pts w #ShortBowelSyndrome:

♠️Dependency on PN at 1yr = 74%
♠️Went ⬇️ @ 5yrs
♠️Still nearly 1/2 pts (48%) PN dependent🪢

#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn 6/ 🚨As magnitude of intestinal insufficiency⬆️🆙so does degree of GI malabsorption
⏭️ in turn 🟰 pt dependency on #ParenteralNutrition
#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn 7/#IBDPoll #MondayNightIBD

🟢Which of the following characteristics most likely leads to #ParenteralNutrition dependency in pts w #ShortBowelSyndrome?

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn 8/ 👏That's right! Small bowel length📏

➕ type of anastomosis has been shown to impact likelihood of #ParenteralNutrition dependency in pts w #ShortBowelSyndrome 💥

#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger 9/ #IBDPoll #MondayNightIBD @BonumCE

🟢Which is a complication of #ParenteralNutrition?

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger 10/#ParenteralNutrition can be 🛟but also a source of complications in pts w #ShortBowelSyndrome

@AmerGastroAssn strategies 4 PN complications:
🎯Limit lipids for hepatobiliary issues
🎯Correct metabolic acidosis 4 🦴disease
🎯Potassium citrate & CaCO3 to prevent kidney injury

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger 11/ While less common, #ParenteralNutrition can also be a cause of mortality in pt w #ShortBowelSyndrome

2012 LT Study of PN independence
📎Cohort of 268 pts w non-malignt SBS
🚑13 of 105 deaths attributed to PN
🚑10 due to sepsis & 3 due to liver failure

#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger 12/Pediatric #ShortBowelSyndrome pts
❤️Goal = optimal intestinal absorption for proper growth/development
♣️Enteral nutrition(EN) preferred over #ParenteralNutrition

♣️EN benefits:
⬇️gut atrophy
⬇️infections
⬇️overfeeding risk
⬆️cost effectiveness
⬆️ gut motility
#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger 13/ 🚧Burden on pts w #ShortBowelSyndrome & families is significant 🪫
⚠️Pts on #ParenteralNutrition have reduced📉HRQoL

🚨Impacts:
1⃣Physical
2⃣Emotional
3⃣Social

#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD 14/🔋Coping strategies for #ShortBowelSyndrome pts on #ParenteralNutrition include👇

🗓️Adaptation - Tailor day around PN reqs
🌃Night Off - allow time for social activities 🪩 or to just feel "normal"
🫶 Support - Friends, family, pt support groups

#MondayNightIBD #BonumCE

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD 15/#ParenteralNutrition weaning is a LTG for pts w #ShortBowelSyndrome
🗜️Unfortunately weaning is difficult🗜️

⚠️Impacted by⚠️
📏Length and function of remaining small bowel segments
➕/➖Colon
⚙️Degree of bowel adaptation

#MondayNightIBD #BonumCE

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD 16/#IBDPoll #MondayNightIBD #BonumCE

67yo/F w 5yr history of #ShortBowelSyndrome due to cancer-caused resection
#ParenteralNutrition reqs have steadily↗️over the last year
🩸Last bloodwork showed slightly⬆️AST/ALT

🟢Which tx should be considered for her?

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD 17/ ⚓️STEPS trial assessed ability of teduglutide to wean pts from #ParenteralNutrition

💎Teduglutide led to doubling of the % of pts able to achieve a ≥20% reduction in weekly PN volume

#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD @raghu_vikram @bc_diet @ShwetaNamjoshi @WenjingZong @Gastro4Kids @pricetedwards @DanielJDrucker @RachelHerdes 18/STEPS trial🔸ability of teduglutide to wean pts from #ParenteralNutrition

💎TDG led to doubling % of pts able to achieve a ≥20% reduction ➖in wkly PN volume

AEs similar TDG v placebo
Most GI-related:
🔸Abd pain
🔸🤢
🔸stoma complication
🔸Abd distension
#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD @raghu_vikram @bc_diet @ShwetaNamjoshi @WenjingZong @Gastro4Kids @pricetedwards @DanielJDrucker @RachelHerdes 19/🔶STEPS-2 open-label extension study🔶

💎In 65 pts 👉reductions in #ParenteralNutrition volumes
🟰translated to more➕ days off per week

#MondayNightIBD

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD @raghu_vikram @bc_diet @ShwetaNamjoshi @WenjingZong @Gastro4Kids @pricetedwards @DanielJDrucker @RachelHerdes 20/❤️♠️♦️♣️ Thanks for joining me & @DCharabaty @MondayNightIBD❤️♠️♦️♣️

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🗳️Answer the #PostConvo #IBDPoll below! 👇

#IBDPoll 1️⃣
Which of the following most likely leads to PN dependency in pts w #ShortBowelSyndrome?

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD @raghu_vikram @bc_diet @ShwetaNamjoshi @WenjingZong @Gastro4Kids @pricetedwards @DanielJDrucker @RachelHerdes 21/ 🔴 #PostConvo #IBDPoll 2️⃣
#MondayNightIBD
🎟️ #CME ➡️ bit.ly/3CByXVm

Which is a complication of #ParenteralNutrition?

@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut @AmerGastroAssn @Paul_Wischmeyer @jlightdale @GI_and_BowtieMD @BoCoxGastro @DSTEINGIMD @DrMikeDolinger @drlauriekeefer @DrHBurtonMurray @GuadagnoliLivia @DrAlyseBedell @GregSayuk @IrisWangMD @ReenaChokshiMD @raghu_vikram @bc_diet @ShwetaNamjoshi @WenjingZong @Gastro4Kids @pricetedwards @DanielJDrucker @RachelHerdes 22/🔴#PostConvo #IBDPoll 3️⃣
#MondayNightIBD
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67yo/F w 5yr history of SBS (cancer-caused resection)
#Parenteralnutrition reqs have steadily↗️over the last yr
🩸Last bloodwork showed slightly⬆️AST/ALT

Which tx should be considered for her?