@MondayNightIBD @DCharabaty 1/ Thiopurines are associated with an increased risk of NMSC (non-melanoma skin cancer)

Which of the following is true about this risk relative to non-exposed IBD pts, duration of thiopurine use , and after thiopurine cessation 🛑#Back2Basics #MondayNightIBD @MondayNightIBD @DCharabaty 32 y/o M with UC here for f/u. In remission x7 yrs on AZA 75mg/d. He is here to discuss his concerns about his risk of lymphoma associated w/ AZA. (HSTCL= hepatosplenic T cell; EBV-L= EBV assoc lymphoma) Which statement is true?
#Back2Basics #MondayNightIBD

@MondayNightIBD @SobiaMujtabaMD @JasonHouMD @DCharabaty 1/ 65 y/o M new dx #Crohns ileitis after he presented w abdo pain,diarrhea, wt loss, anemia. CLN: deep linear ulcers in TI. He has an active lifestyle,stable CAD. Symptoms recur when prednisone<15 mg. What is the LEAST effective strategy to keep this pt in remission? #Back2Basics @MondayNightIBD @SobiaMujtabaMD @JasonHouMD @DCharabaty 2/ #IBD is not only a disease of the young !

♦️ Typical dx age 20-39, w a second smaller peak >50

♦️ Recently ⬆️ prevalence in elderly> age 60, due to:

🔺Aging of adults w #IBD

🔺⬆️elderly onset IBD > age 60 #EOIBD:
🔹⬆️awareness & dx
🔹Environment/ microbiome changes

@MondayNightIBD @ibdnaik @SobiaMujtabaMD @ibdleuven @DCharabaty 1/29 yo M, smoker, presents with RLQ abscess w fistula to the TI; he undergoes abscess drainage & then ileocecal✂️w primary ileocolonic anastomosis. Path c/w #Crohns, margins free of disease. You see him for f/up 2 weeks post-op, What's the next ? #MondayNightIBD #Back2Basics @MondayNightIBD @ibdnaik @SobiaMujtabaMD @ibdleuven @DCharabaty 2/ Let’s talk #Crohn’s intestinal complications
CD can present w stricturing/perforating complications
50-60% CD will develop strictures, fistulas or abscesses over time
70% require surgical✂️by 15yrs of dx
Surgery not curative, most pts will have endo recurrence 1 yr post-IC✂️

@MondayNightIBD @SobiaMujtabaMD @NabilQuraishi @CholestasisDoc @DCharabaty 1/ 35 y/o M presents with fatigue & generalized pruritus x 6weeks. No skin rash, No abdo pain, diarrhea or 🩸 in stool. AST 62 ALT 64 ALP 435 Tbili 1.3. MRI/MRCP: multifocal strictures & areas of dilatation of intra +extra hepatic ducts. What’s the next step?💡 #Back2Basics #B2B @MondayNightIBD @SobiaMujtabaMD @NabilQuraishi @CholestasisDoc @DCharabaty 2/ What’s #PSC & phenotypes?

🧩Idiopathic chronic inflam dis. of the biliary tree

🧩90%: Large ducts (LD): "Beads on string appearance” on ERCP/MRCP (pt👆)

🧩5% Small IHD only: nml MRCP, dx by liver bx, slide👇

🧩5% PSC w AIH overlap: abnl MRCP+liver bx w⬆️AST/ALT or IgG

@MondayNightIBD @SobiaMujtabaMD @FezaRemziMD @DCharabaty 1/ 35 yo F panUC on IFX 10mg q4wk, admitted with abdo pain, hematochezia, malaise. T 39 BP 95/63 HR 110 FCP 900 mcg/g. Abdo distended, TTP; CT: colonic wall thickening+edematous mucosa. Cdiff neg; WBC 15, Hb 6. No improvement despite IVCS+Abx. Which surgery is indicated #B2BPoll @MondayNightIBD @SobiaMujtabaMD @FezaRemziMD @DCharabaty 2/ Indications for colectomy in UC:

📌Elective:

📍UC refractory to medical Rx

📍Steroid-dependant UC

📍Unresectable dysplasia, CA

📍Complications from medical Rx

📌Emergency:

📍Toxic megacolon

📍Fulminant colitis

📍Perforation

📍Severe Bleeding

@MondayNightIBD @SobiaMujtabaMD @SchwartzbergMD @DCharabaty 1/ 27 yo F, crohns colitis on AZA, presents w 2wk perianal pain. One week ago a “boil” developed adjacent to the anus, painful to touch and draining cloudy fluid. PE: Perianal fistulous opening tender & draining pus on palpation. What is the next best step ? #B2B @MondayNightIBD @SobiaMujtabaMD @SchwartzbergMD @DCharabaty 2/Recap #Crohns:
📌Transmural inflammation involving any part of GIT
📌B for Phenotypes: inflammatory/stricturing/penetrating
📌L for location: UGI,SB,Colon
📌Penetrating Behaviors:
Fistulae
Perforations
Intra-abdominal abscesses(IAA)

recall this #B2B MTL classification table👇🏼

@MondayNightIBD @SobiaMujtabaMD @DuekerJeffrey @DCharabaty 25y/oM quit🚬3 mos ago, now 3🩸loose BM/day,mild abdo cramps;Cousin w Crohns;Stool➖for infection;CLN: erythematous granular mucosa rectum+sigmoid, superficial ulcers;BX:Acute cryptitis,crypt abscess,crypt architecture distortion. What helps most dx UC vs Crohn’s?
#B2B #IBDPoll @MondayNightIBD @SobiaMujtabaMD @DuekerJeffrey @DCharabaty UC and CD:

🔻Chronic inflammation of the GI tract

🔻Affects all ages: Typically starts between age 20-39

🔻Second peak of incidence age >50

🔻Flares of GI symptoms +/-systemic symptoms +/- EIM

Endotherapy of postcholecystectomy biliary strictures (PCBS) with multiple plastic stents (MPSs): Long-term results in a large cohort of patients @GIE_Journal sciencedirect.com/science/articl… Methods & Design: 196 pts with benign biliary stricture (BBS) treated with endoscopic MPS identified retrospectively from ERCP database with a 7 year follow-up period.

Addressing gender in GI, important catalysts for change: open communication b/w attendings & fellows about comfort w/ physical contact when teaching endoscopy, equal representation of M/F endosocpists in industry and new device marketing #WIM #WomenInGI sciencedirect.com/science/articl… More visible presence of women in conference leadership- research shows female conference attendees are better engaged and more encouraged to ask questions when speaker or panelist is a woman

super proud of my mom for finally getting her screening colonoscopy today after a lot of back and forth, and came across some interesting papers that delve into cultural barriers towards #CRCscreening amongst some immigrant communities 👇🏼 [thread] 🔸Common cultural barriers reported that were not directly associated with healthcare access:

- mistrust in Western Medicine
- religious beliefs
- cancer fatalism
- low level of health literacy
- fear or shame of procedure itself

In honor of #WomenInMedicine month I want to start a thread acknowledging all the amazing #WomeninGI & invite them to a discussion:

What is one bias about being a woman in this field that frustrates you? How do you overcome it? What do you wish patients and male colleagues knew? @DCharabaty @VaNiPaLeTi @LindaNguyenMD @AdjoaGIMD @AparnaGoelMD @DrRitaKnotts @FergaGleeson @GutGirlMD @ibdgijami @DJodorkovskyMD @RKosowiczMD @AmyOxentenkoMD @NayantaraCoelho @SumeraRizviMD @ManasiAgrawalMD @KellyHathornMD @AngladeMDMBA @PriyaVijayMD @JeanFoxMD @AkshataMoghe

I was at a family gathering talking to some recent medical grads/med students and I’m still in disbelief that some of these future docs are limiting their options by primitive constructs like a “bad rep” in choosing a specialty 1/6 Burnout or “moral injury” has become so entrenched in medical culture that choosing a specialty with the least amount of Doctor-patient interaction and highest compensation has become an aspirational topic of debate amongst professionals ad nauseam 2/6