Thread by @yaransarkis

@MondayNightIBD 1/Differential of Non-infectious Non -IBD colitis:
🔆 Drug-induced
🔆 Common Variable Immunodeficiency
🔆 Behcet disease
🔆 Segmental Colitis Associated w/ Diverticulosis
🔆 Ischemic Colitis
🔆 Radiation Colitis
🔆 Malignancy

🤔Can you think of other dx?
#MondayNightIBD

@MondayNightIBD 2/Immune Checkpoint Inhibitor Enterocolitis
📌ICI = monoclonal antibodies that reactivate immune response to tumor cells
📌Activation of T‐cells can cross‐react with host antigens
📌Enterocolitis ⬆️anti‐CTLA‐4 > anti‐PD‐1/PD‐L1 agents
📌Diarrhea
⬆️risk perforation if unrecognized

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 3/ICI + Diarrhea:
📐R/o infection
🔦C-Scope: appearance of IBD; but mucosa can look normal -> always biopsy; consider EGD +Bx
🔬Path can have chronic IBD changes, crypt apoptosis
💊Depends on severity: budesonide -> IV steroids-> Biologic
✅#IBDAlgorithm👇

https://twitter.com/Waseem_AhmedMD/status/1271467254002200577?s=20

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD 4/Capecitabine (oral 5-FU) induced colitis
🎯Diarrhea in up to 50%
🎯Rarely ileitis, severe watery or bloody diarrhea, Protein-losing enteropathy
🎯Bx: severe inflammatory changes, necrosis
🎯Pathophysiol: Ischemia?
📌💊Rx: stop capecitabine, IVF

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD 5/#NSAIDs:
📌Affect distal small bowel and colon.
📌Erosions, ulcers
📌Diaphragm-like strictures: pathognomonic of NSAID injury

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat 6/Chronic Variable Immune Disease Enteropathy #CVID
📌Loss of B-cell function with ↓ serum IgG level & serum IgA or IgM
📌↑ GI infections: Giardia, Campylobacter, Salmonella, Norovirus
📌Diarrhea; protein-losing enteropathy, SIBO
🚨↑risk of NH B-cell lymphoma , gastric CA
#B2B

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat 7/CVID Dx: EGD/C-scope
📌Biopsy even if mucosa is normal
🔬Villous atrophy, ↑IEL; IHC: CD8+ T cell
🔬lack/absence of plasma cells (differentiate from celiac disease)
💊Rx: budesonide; case reports AZA, TNFi

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez 8/#Behcet disease:
🎯Intestinal BD in 3-60% of pts
🎯⬆️GI involvement w BD in East Asian countries (Korea, Japan) vs Western or Middle Eastern countries
🔦C-scope: GI ulcers; 🌋volcano shaped ulcer in ileocecum
🚨Rarely intestinal perforation
🤔of BD in pt w oral/genital ulcers

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD @PriSantiagoMD 9/Segmental Colitis Associated with diverticulosis (SCAD)
🔹Men>60
🔹BRBPR, Diarrhea
🔹🔥 spares diverticular orifices & rectum
🔹Bx: Architecture distortion
🔹Self-limited, course of 5-ASA, abx, budesonide
🔹If chronic: Biologic➡️Surgery
✅#IBDAlgorithm👇

https://twitter.com/Waseem_AhmedMD/status/1383151585237348356?s=20

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD @PriSantiagoMD 10/Ischemic colitis:
🔹Abdo pain then 🩸 w/in 24h
🔹⬆️after 50 but often women<40
🔹L colon/splenic flexure ++,rectum,R colon
🔹Cause: Systemic hypoTA,nonocclusive small vessel disease➡️Local hypoperfusion & reperfusion injury
#MondayNightIBD #B2B

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD @PriSantiagoMD 10/Ischemic colitis:
🔹Dx: CT IV/PO contrast
🔹C-scope to confirm dx + prognosis
🔹Tx: supportive+AB. Consult surgery, watch for peritoneal signs
🔹Urgent surgery if transmural necrosis
🔹Self-limited
⚠️Isolated right ischemic colitis associated with worse outcomes

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD @PriSantiagoMD 11/Radiation injury:
🔹Acute proctitis w/in 6 wk
🔹Radiation-associated vascular ectasias #RAVE:9 m-30 y after ☢️
🔹🩸mucus, tenesmus, urgency, incontinence
🔹Stricture, Fistula to GU tract or SB
🔹Tx: acute: topical steroids; RAVE: hyperbaric O2, APC/RFA
doi.org/10.1053/j.gast…

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD @PriSantiagoMD 12/Malignancy: adenoCA, Lymphoma
🔹Can look like Inflammatory changes, or present as strictures
🔹Maintain high level of suspicion, specially in #IBD pts
🔹Biopsy ++
#MondayNightIBD #B2B

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD 13/Summary
⚠️Not all non-infectious enterocolitis are IBD ! Follow the clues of
🔑History
🔑Endo findings
⚠️Biopsy even if mucosa nml
🔑Histological findings

✅Post-B2B #CME #IBDPolls👇
🗓️Join us April 24 for a #MondayNightIBD convo 🎯 on #MicroscopicColitis w @EugeneYenMD

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD 14/#PostConvo #IBDPoll 1️⃣
CME bit.ly/3L2LZ2t

65M presents w loose BM x4/d x2wks, no Abdo pain, no blood in stool, no fever. Stool studies Neg.
🔦CLN: sigmoid diverticulosis. Erythema+aphthous ulcers around the diverticuli. Rectum+rest of colon mucosa nml
Most likely dx?

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD 15/#PostConvo #IBDPoll 2️⃣
#CME👉🏼bit.ly/3L2LZ2t

32F presents to ER for rectal bleeding after experiencing severe abdo pain that started after a long run. Takes decongestant for seasonal allergies, o/w healthy. CT: thickened left colon. What’s the most likely dx?