John Haydek, MD MS

🚨AGA New Guideline Alert🚨 🔗#msdynmkt_trackingcontext=8534adf0-8e34-46ef-b49c-86f0fc90a0ea" target="_blank" rel="nofollow noopener">gastrojournal.org/article/S0016-… ▶️AGA Living Guideline: Pharmacological Management of Moderate-Severe Ulcerative Colitis I’ll break down its 14 recommendations down over the next 7 tweets 🧵 👇 #AGA #GI #UC #IBD #MedTwitter 1/9

@UmaMahadevanIBD I think this is a great point and one of the downsides of network meta-analysis and relying on indirect analysis. Are the high 🪣 > med 🪣 and we just don't have enough data so far to say so? Or given heterogenous data is there just artificial signal there?

@JHaydek Thank you for the breakdown. This is where it gets confusing from clinical standpoint. Why have 🪣if high not > med? particularly confusing for UST being med for adv naive but high for adv tx exposed.

🚨AGA New Guideline Alert🚨 🔗#msdynmkt_trackingcontext=8534adf0-8e34-46ef-b49c-86f0fc90a0ea" target="_blank" rel="nofollow noopener">gastrojournal.org/article/S0016-… ▶️AGA Living Guideline: Pharmacological Management of Moderate-Severe Ulcerative Colitis I’ll break down its 14 recommendations down over the next 7 tweets 🧵 👇 #AGA #GI #UC #IBD #MedTwitter 1/9

@DhereMdEmory Thank you!

Thank you @JHaydek for the great summary points!

@Bealoquebea Thank you!

@JHaydek Fantastic summary Looking forward to reading it in detail tomorrow 🤩

🌟 Our first-ever living guideline for managing moderate-to-severe #UlcerativeColitis led by @berkeleydoc, @manasiagrawalmd, @Jhaydek, @ashwinmdibd, @FrankIScottMD, @EdwardLoftus2 prioritizes early use of advanced therapies over a step-up approach. ow.ly/t2Ru50UahEi

@AGA_Gastro , @AshwinMDIBD , @EdwardLoftus2 , @berkeleydoc , @ManasiAgrawalMD , @FrankIScottMD @BenClickMD , @KatarinaGreer2 , @MLaszkowskaMD , @David_LeimanMD , @JenniferKMaratt , @BabuPMohan2 @tareksawas, @GauravsyalMD @Jarshah4 , @margaretzhou , @SultanShazi

Last, what are living guidelines? 🧑‍🍼 🔹With how quick drug-development 💊 and treatment strategies ♟️ change, AGA will review new lit. 📄and update recommendations 📝 as needed every 6 months. Stay tuned for updates in the future! 9/9

✳️11-12 . For TNF + IMM therapy, when should you stop? ❌ stop TNF if combo 🤷‍♂️Knowledge gap: no recommendation on continuing IMM or when to stop 🗓️ ✳️13. For patients w/ mod-severe disease: 👍Early advanced therapy ❌No step-up 🪜therapy ✳️14 If now on advanced 💊, stop 5-ASAs

✳️8, ✳️9, ✳️10 Combo therapy 💊+💊 🔹 TNF + immunomodulator > TNF or IMM alone 🤷‍♂️Knowledge gap: no recommendation about whether IMM + non-TNF biologic is helpful 7/9

✳️5, ✳️6, ✳️7. Immunomodulators 💊 ❌ Thiopurines for induction 👍 Okay to use thiopurines for maintenance ❌ Methotrexate for induction or maintenance 6/9

Some Monday ACG moments ✨🩵Happy to reunite with my big friend/mentor @VictorChedidMD 🩵 and so happy to meet again with @JHaydek and @L_Sahyoun and share experiences from our first months as IBD attendings! 😀grateful for those @MilestoneIBD friendships !!!

.@JHaydek is at Poster P2674 to tell you why you should consider primary prophylaxis in patients with #PSC to prevent #pouchitis. Come learn more. #ACG2024 @UNCGastro @UNCGIFellowship @LauraRaffalsMD @PriSantiagoMD @shannonchangmd @JHashashMD @tqaziMD @HorstIBDDoc @MLongMD

Ever wonder if you should biopsy normal neoTI after resection in CD? ▶️Normal (i0) endoscopy ▶️Active inflammation ⬆️POR risk More evidence that active 🔬 disease can risk stratify IBD clinical risk. @RavShahMD @IBDBen @DrJordanAxelrad @EdBarnesMD journals.lww.com/ajg/abstract/9…

I profoundly disagree with this. Asking questions - particularly those that prompt the learner to think & not simply recall information - is a GREAT teaching method. If you create a safe learning environment it isn’t “toxic quizzing” but the Socratic method at its best.

What it’s like to be in healthcare right now: “We will pay you $2 for that pie” “But it costs me $4 in pie ingredients and $2 in human labor to make a pie. We need $6 to break even” “Sorry, we’ll only pay you $2 for that pie. We suggest you make many more pies that you also sell for $2/pie. New requirement is 6 pies/day” “But then we are still losing $4 per pie. How does making more pies help us?” “We just found out flour is on shortage so you’ll have to buy more expensive imported flour and will lose $5 per pie. Or you can consider making pies without flour.” “But I can’t make pies if we keep losing money on pies. And I can’t make pies without flour” “We suggest you ditch rolling pins and remove any fruit filling as a cost saving measure. And consider limiting how much time you bake the pie for to use less oven time” “But then how can I even make a pie that resembles a pie?” “We appreciate the question and have no response. We empower YOU to solve this problem. We have scheduled 4 meetings to discuss how you can make more pies with less ingredients and less oven time and less labor” “But it seems the root of the problem here is actually that we don’t get reimbursed fairly for our pies…” “Don’t say that out loud. Please get back to making pies with no filling and no flour and no rolling pins and be sure to attend the meetings.” #medtwitter #Pediatrics #insurance