Evidence-Based GI Doc

@LindaNguyenMD @ScrubsNHeels @DCharabaty @IBD_Afzali @kehutchins77 @MN_GIMD @MccutchenDr @drfolamay @AasmaShaukatMD @JChristieMD …. Is your “husband” part of the package, too 😱

Packed and ready for @ScrubsNHeels. Looking forward to learning & connecting Day wear, evening wear, 👙, 🧘🏻gear & 👠👟to match… all in a carry on #packingmasterclass @DCharabaty @IBD_Afzali @kehutchins77 @MN_GIMD @MccutchenDr @drfolamay @AasmaShaukatMD @JChristieMD

@CarlKayMD @ABIMcert Congrat

Board certified gastroenterologist ✅ @ABIMcert #GITwitter

An award that represents the labour of love for science, perseverance and belief, plus the bonus of a dream team.

In #EBGI: On-Demand Vonoprazan for Non-Erosive Reflux Disease Symptoms: A New Option Reviewer: Christopher Vélez, MD 📖 bit.ly/4fDjtB3 🔊 bit.ly/4fDS3er @AmCollegeGastro @Chris_Velez_MD

@aferoz19 @umer446 @ScopingSundays @ACG_EBGI @CamilleLupianez @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @DavidDiehlMD @SanchezLunaMD @AdamKichlerDO @sachdevmd @SumantInamdar @ShyamTMD @QuinTheLiuMD @KKadkhodayan @MetabolicEndo @AmJGastro @rjsealock @EndoscopyOthman @d21loren @tberzin @Boston_Endo @MSawhneyMD @abdul_kouanda @SriGaddamMD @shailsingh @NorioFukamiMD Other database studies showing that PPIs are "ASSOCIATED" with different disorders (e.g. dementia) are really simply demonstrating that "sicker" people are more likely to be prescribed PPI (for whatever reason) compared to "healthier" people with fewer baseline medical problems

@umer446 @ScopingSundays @ACG_EBGI @CamilleLupianez @EBGIdoc @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @DavidDiehlMD @SanchezLunaMD @AdamKichlerDO @sachdevmd @SumantInamdar @ShyamTMD @QuinTheLiuMD @KKadkhodayan @MetabolicEndo @AmJGastro @rjsealock @EndoscopyOthman @d21loren @tberzin @Boston_Endo @MSawhneyMD @abdul_kouanda @SriGaddamMD @shailsingh @NorioFukamiMD Are there any side effects of vonoprazan that we should be aware of before prescribing? #scopingsundays

📣📣 Not to miss 📣📣 Tomorrow -Join Us- @ACG_EBGI & #ScopingSundays collaboration 🔥🔥 “Potassium - Competitive Acid Blocker: A Niche or Necessity” Moderated by @umer446 & @CamilleLupianez -& our Expert Guest @EBGIdoc!

@aferoz19 @umer446 @ScopingSundays @ACG_EBGI @CamilleLupianez @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @DavidDiehlMD @SanchezLunaMD @AdamKichlerDO @sachdevmd @SumantInamdar @ShyamTMD @QuinTheLiuMD @KKadkhodayan @MetabolicEndo @AmJGastro @rjsealock @EndoscopyOthman @d21loren @tberzin @Boston_Endo @MSawhneyMD @abdul_kouanda @SriGaddamMD @shailsingh @NorioFukamiMD Personally, I rely on the COMPASS RCT, which is the only large (thousands of patients), double-blind, placebo-controlled RCT with 4 year + follow-up. Found that increase in enteric infections (e.coli diarrhea) was only increased adverse event vs placebo with PPIs

@aferoz19 @umer446 @ScopingSundays @ACG_EBGI @CamilleLupianez @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @DavidDiehlMD @SanchezLunaMD @AdamKichlerDO @sachdevmd @SumantInamdar @ShyamTMD @QuinTheLiuMD @KKadkhodayan @MetabolicEndo @AmJGastro @rjsealock @EndoscopyOthman @d21loren @tberzin @Boston_Endo @MSawhneyMD @abdul_kouanda @SriGaddamMD @shailsingh @NorioFukamiMD No increase in side effects vs placebo in RCTs. Per prescribing info provided with meds, the list of POSSIBLE safety concerns is same as PPIs. Important to remember-those PPI safety concerns come from epidemiologic database studies that can't fully account for confounders

@AimenKhanMD @CamilleLupianez @ScopingSundays @ACG_EBGI @umer446 @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @MouhandMD Unfortunately, this varies a LOT. Key is that your faculty should be working with pharmacy to make sure vonoprazan is available. Situation is similar to 1989 when PPIs first became available and some hospitals lagged and only provided H2RAs for a couple of years

@EBGIdoc @CamilleLupianez @ScopingSundays @ACG_EBGI @umer446 @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @MouhandMD Can you comment on availability of Vonoprazan in the hospitals across U.S.?

@CamilleLupianez @umer446 @ScopingSundays @ACG_EBGI @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @DavidDiehlMD @SanchezLunaMD @AdamKichlerDO @sachdevmd @SumantInamdar @ShyamTMD @QuinTheLiuMD @KKadkhodayan @MetabolicEndo @AmJGastro @rjsealock @EndoscopyOthman @d21loren @tberzin @Boston_Endo @MSawhneyMD @abdul_kouanda @SriGaddamMD @shailsingh @NorioFukamiMD @amitbhattMD @SiddikiGI @JohnVargoMD @drsethinyc @ColonDocUMMH @AlysonMJohnson @AnotherPatelMD @NCosgroveMD @DennisYangMD @MItaniMD @clivejmiranda Esophageal testing will definitively distinguish inadequate acid suppression vs functional heartburn, but availability of esophageal testing is limited in many areas of US.

🤔Can Vonoprazan be used in NERD Patients? Check out👇 ICYMI @ACG_EBGI🧵 "Vonoprazan is Efficacious for Non-Erosive Reflux Disease (NERD): An Alternative for PPI-Resistant NERD Patients?" 🙏@MItaniMD & @clivejmiranda 🔗bit.ly/vonoCGH x.com/ACG_EBGI/statu… #ScopingSundays

@CamilleLupianez @umer446 @ScopingSundays @ACG_EBGI @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @DavidDiehlMD @SanchezLunaMD @AdamKichlerDO @sachdevmd @SumantInamdar @ShyamTMD @QuinTheLiuMD @KKadkhodayan @MetabolicEndo @AmJGastro @rjsealock @EndoscopyOthman @d21loren @tberzin @Boston_Endo @MSawhneyMD @abdul_kouanda @SriGaddamMD @shailsingh @NorioFukamiMD @amitbhattMD @SiddikiGI @JohnVargoMD @drsethinyc @ColonDocUMMH @AlysonMJohnson @AnotherPatelMD @NCosgroveMD @DennisYangMD @MItaniMD @clivejmiranda Dilemma is because you differentiate between inadequate acid suppression and functional heartburn with: (a) empiric trial of vonoprazan, which greatly minimizes acid production-much better than PPI bid; or (b) do Bravo/manometry/24hr pH testing?

@CamilleLupianez @umer446 @ScopingSundays @ACG_EBGI @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @DavidDiehlMD @SanchezLunaMD @AdamKichlerDO @sachdevmd @SumantInamdar @ShyamTMD @QuinTheLiuMD @KKadkhodayan @MetabolicEndo @AmJGastro @rjsealock @EndoscopyOthman @d21loren @tberzin @Boston_Endo @MSawhneyMD @abdul_kouanda @SriGaddamMD @shailsingh @NorioFukamiMD @amitbhattMD @SiddikiGI @JohnVargoMD @drsethinyc @ColonDocUMMH @AlysonMJohnson @AnotherPatelMD @NCosgroveMD @DennisYangMD @MItaniMD @clivejmiranda Or is inadequate therapeutic response to PPI because patient has functional heartburn (hypersensitive esophagus due to brain-gut dysfunction) and would be better treated with low-dose tri-cyclic antidepressants?

@CamilleLupianez @umer446 @ScopingSundays @ACG_EBGI @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @DavidDiehlMD @SanchezLunaMD @AdamKichlerDO @sachdevmd @SumantInamdar @ShyamTMD @QuinTheLiuMD @KKadkhodayan @MetabolicEndo @AmJGastro @rjsealock @EndoscopyOthman @d21loren @tberzin @Boston_Endo @MSawhneyMD @abdul_kouanda @SriGaddamMD @shailsingh @NorioFukamiMD @amitbhattMD @SiddikiGI @JohnVargoMD @drsethinyc @ColonDocUMMH @AlysonMJohnson @AnotherPatelMD @NCosgroveMD @DennisYangMD @MItaniMD @clivejmiranda Vonoprazan is FDA-approved for NERD. Presents a very interesting dilemma when patient has heartburn symptoms and EGD shows normal esophagus and patient gets only partial/sub-therapeutic improvement with PPI. Is inadequate response due to inadequate acid suppression?

@CamilleLupianez @ScopingSundays @ACG_EBGI @umer446 @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD This is not FDA-approved use of vonoprazan, but will be much easier (in the future) if we simply give 20mg oral vonoprazan to ED patients with melena as opposed to starting IV PPI bolus + IV PPI continuous infusion

@ScopingSundays @ACG_EBGI @umer446 @EBGIdoc @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD 3️⃣ 45 yo M presents with melena. EGD showed a bleeding gastric ulcer (see 🔦📸 on next post). What would be your post endoscopic hemostasis recommendation❓

@CamilleLupianez @ScopingSundays @ACG_EBGI @umer446 @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD Although no head-to-head comparisons in healthy individuals (much less patients with gi bleeds), 20 mg vonoprazon oral is likely more potent at increasing gastric pH and would do it more rapidly based on pharmacology.

@CamilleLupianez @ScopingSundays @ACG_EBGI @umer446 @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD This raises gastric pH which minimizes conversion of pepsinogen to pepsin and may help platelet function if pH increases enough. Facilitates clot integrity and reduces recurrent bleeding

@CamilleLupianez @ScopingSundays @ACG_EBGI @umer446 @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD At time of EGD, if clean-based ulcer, then stop IV PPI. If adherent clot or visible vessel/active bleeding requiring hemostasis, then continue IV PPI

@CamilleLupianez @ScopingSundays @ACG_EBGI @umer446 @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD When patient presents with melena or hemetemesis (especially if no reason to suspect esophageal varices), standard is to start 80mg pantoprazole iv bolus + 8mg/hr pantoprazole continuous infusion. This reduces recurrent bleeding if adherent clot has already formed.

@umer446 @ScopingSundays @ACG_EBGI @CamilleLupianez @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @lukens_f @LionelSDSouza @PeterDraganov @doumitb @SkipKrafftMD @AliAbbasMD @neilRsharmaMD @sushilahlawat1 @iGUT_Houston @tr_levin @SultanMahmoodMD @KiwanGIDoc @clivejmiranda @HarshitKharaMD @JennPhanMD @drKumarGI @NikhilKumtaMD @waqmd @alhaddad_mo @gastrowala @gurutrikumd @RajeshKris @ReemSharaiha Although this has been helpful in the past, it's now a bit outdated based on new ACG Guideline on H.pylori tx (sept 2024). Clarithromycin-resistance has increased throughout the US. Don't use clarithromycin-based tx unless you have antibiotic sensitivities

@ScopingSundays @ACG_EBGI @CamilleLupianez @EBGIdoc @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD @lukens_f @LionelSDSouza @PeterDraganov @doumitb @SkipKrafftMD @AliAbbasMD @neilRsharmaMD @sushilahlawat1 @iGUT_Houston @tr_levin AGA proposed algorithm for H.pylori Tx: @SultanMahmoodMD, @KiwanGIDoc, @clivejmiranda

@umer446 @ScopingSundays @ACG_EBGI @CamilleLupianez @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD Remember-the new ACG Guideline on H.pylori treatment recommends AGAINST using any clarithromycin-based therapy UNLESS you have PCR of h.pylori strain with specific antibiotic sensitivities (which is rarely done). Bottom Line: stay away from clarithromycin-based tx.

@ScopingSundays @ACG_EBGI @CamilleLupianez @EBGIdoc @AmCollegeGastro @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @vaibhav_manu @rmulkimd @LizzieAbyMD @AdvaniRashmiMD @AimenKhanMD @MouhandMD 2️⃣ 60 yo F with dyspepsia and weight loss. EGD showed non-bleeding gastric ulcer (endoscopy 📸👇). Bx positive for H.pylori. She has never been treated for H.pylori in the past. What is your best choice of treatment? #ScopingSundays