Thread by @MondayNightIBD

1/📣#GITwitter last but not least
#ShortBowelSyndrome #MNIBDTweetorial🧵w @valcohranmd @DCharabaty

🤝Role of MDT 4 strongest 💪team
🏥Intestinal rehab. program breakdown

🏆#CME ℹ️bit.ly/40OZTdp
Support by an edu grant from @TakedaPharma

📌Where r u in your career?

2/#MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds #BonumCE

🟠Earn #CME 🏆on Twitter!
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📸 Faculty disclosures & important CME info 👇

3/#MondayNightIBD
#IBDPoll 1️⃣

➡️50-yo pt w 1y hx of SBS after multiple short bowel resections for stricturing Crohn’s
Labs show dehydration & nutrient deficiencies
U discuss initiating #ParenteralNutrition

➡️You focus on educating pt on which of the possible complications...

4/#ShortBowelSyndrome =most common cause of intestinal failure
⚖️Both SBS & #ParenteralNutrition are assc'd w significant complications
✳️Reqs complex, & lifelong, course of disease mgmt
⚠️Early appraisal & mgmt of CVC issues is vital for salvaging CVC & ⬆️QoL for the pt on PN

5/#MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds #BonumCE

#IBDPoll 2️⃣

Which is best practice, at a minimum, for a #Multidisciplinary team for pts w/ SBS?

6/#MondayNightIBD

🌀Given the complicated nature of #ShortBowelSyndrome, it is recommended that tx is:

✳️Individualized
✳️Mngd by a #Multidisciplinary team (MDT) encompassing all aspects of care

⚓️Pts can benefit from @ minimum an MDT composed of GI, Surgeon, Nurse, Dietician

7/#MondayNightIBD
For pediatric #ShortBowelSyndrome pts, MDT can also include neonatologists, child-life specialists, & other peds specialists

In transition from pediatric➡️adult, it becomes essential to plan 4:
✏️Continuity of care
✏️Pt independence
✏️Maintaining/improving QoL

8/#MondayNightIBD #ShortBowelSyndrome

🏠Home #ParenteralNutrition & #EnteralNutrition
✔️Pt selection essential: acceptable home environment w support
✔️Pt/caregiver edu, routine monitoring essential to prevent/reduce complications
✔️Support groups provide support & networking

9/#MondayNightIBD

⚡️Essential that the MDT continues to engage in collaborative care even as pt initiates & responds to tx such as teduglutide
📊Monitor labs as pt weans from #ParenteralNutrition
🥪Adjust diet w changing nutrition needs
👨🏻‍🏫Educate & engage to optimize #adherence

10/#MondayNightIBD #MedTwitter
#IBDPoll 3️⃣

2yo pt w hx of necrotizing enterocolitis & new dx of SBS after surgery
Parents meet w GI to discuss her care & voice confusion w diverse care recommendations.

Which approach is recommended to facilitate integrated mgmt for this pt?

11/#MondayNightIBD
IRP=med centers w interdisciplinary teams experienced in centrlizd & integrated mgmt of SBS

Goals of IRP
🎯Promote intestinal adaptation
🎯Facilitate enteral autonomy
🎯⬇️M&M

IRPs provide expertise in PN mgmt, diet & fluid optimization, pharmacologic mgmt &✂️

12/#MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds #BonumCE

💫IRPs can be focused on👧🏽Pediatric,👨Adults, ☑All ages
🚗Some pts don't have access to IRPs and/or unable to travel to one
🎯Telemedicine allows for virtual consult w IRP team

13/#MondayNightIBD

💎Pts w #ShortBowelSyndrome managed in an IRP benefit from better survival vs historical ctrls treated w/o MDT care
✔️Systematic rev/meta-analysis:⬆️in OS (22% to 42%) among peds pts
✔️Retrospective cohort:⬇️in peds pts who died before transplant (15% to >60%)

14/#MondayNightIBD #ShortBowelSyndrome

#GITwitter; mgmt of SBS may feel daunting 😣
Fortunately, you're not alone

RESOURCES👇
🩺HCPs: @sbsfoundation @ASPEN_nutrition
🙋‍♀️Patients: @IFFGD @OleyFoundation
Caregivers: 📸👇

& the mentoring network developed by @MondayNightIBD 🤝

15/#MondayNightIBD

🔑Pts
✔️GI, Surg, RN, Dietician best 4 SBS MDT; ped pts benefit from neonatologists, child-life specialists, & other ped specialists
✔️Essential MDT continues even w tx
✔️IRPs: centers w MDT expertise in PN mgmt, diet & fluid optimization, pharm mgmt & surgery

16/#MondayNightIBD #MedTwitter #GITwitter #MedPeds #BonumCE

Thanks for participating in our last #shortbowelsyndrome #MNIBDTweetorial🧵

🗳️Answer the post-polls below👇
🆓 #CME🔗bit.ly/40OZTdp

17/#MondayNightIBD
#IBDPoll 1️⃣

➡️50-yo pt w 1y hx of SBS after multiple short bowel resections for stricturing Crohn’s
Labs show dehydration & nutrient deficiencies
U discuss initiating #ParenteralNutrition

➡️You focus on educating pt on which of the possible complications...

18/#MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds #BonumCE

#IBDPoll 2️⃣
🆓 #CME🔗bit.ly/3lQrYSZ

Which is best practice, at a minimum, for a #Multidisciplinary team for pts w/ SBS?

19/#MondayNightIBD
#IBDPoll 3️⃣
#CME🔗bit.ly/3lQrYSZ

2yo pt w hx of necrotizing enterocolitis & 🆕dx of SBS after surgery
Parents meet w GI to discuss care & voice confusion w diverse care recommendations

Which approach is rec. 2 facilitate integrated mgmt for this pt?

20/#ICYMI #MondayNightIBD #ShortBowelSyndrome #MedTweetorial
💡 Focus: #ParenteralNutrition

https://twitter.com/MondayNightIBD/status/1579581166860275712

21/#ICYMI #MondayNightIBD #ShortBowelSyndrome #MedTweetorial
💡 Focus: Pharmacologic Treatment

https://twitter.com/MondayNightIBD/status/1617629375826120705