Joshua M. Steinberg, MD

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Joshua M. Steinberg, MD

Joshua M. Steinberg, MD

@joshsteinbergMD

Dir. of IBD @gastrorockies | Clinical Instructor @CUMedicalSchool | @UChicagoIBD @Georgetown GI trained | @ABC @AmCollegeGastro #YPLSP alum |tweets ≠ med advice

Denver, CO Katılım Nisan 2019
852 Takip Edilen2.8K Takipçiler
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Joshua M. Steinberg, MD
Joshua M. Steinberg, MD@joshsteinbergMD·
My advanced IBD fellowship @UChicagoIBD prepared me for a fulfilling and dynamic career as an #IBD specialist. If you’re interested in pursuing an IBD fellowship, check out our @MondayNightIBD webinar 👇🏻
#MondayNightIBD@MondayNightIBD

🌟Interested in #IBD? 🌟Considering an #IBDFellowship? 🎥This 🔥#MNIBDWebinar w PDs @GlassnerKerri @tqaziMD & IBD specialist @joshsteinbergMD is for you ! 🎯Define your goals & find the right fit 🎯Leverage your network/CV 🎯Opportunities in academia & private practice & more

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Joshua M. Steinberg, MD retweetledi
Aimen Farooq
Aimen Farooq@AimenKhanMD·
@MondayNightIBD @joshsteinbergMD @ibddoctor @LoriPlung @berinsj @DrRosenIBD @IBDGastroDocSg @rogeriosparra @ibdseb @JamesHaddadMD @puentesfabi @fgomollon @Youcantmakethi4 @srmbeauroy #IBDAlgorithm 🧠 #ASUC 🚨 📍Day0️⃣: R/o 🦠CDI/CMV ➕scope early 💉IV steroids ➕DVT prophylaxis 📊Reassess daily (PRO + CRP) ⏳Day3️⃣: No response ➡️Rescue w IFX/ CsA/ JAKi 🎯Day6️⃣: Response? ✔️ Transition & maintain ❌ Don’t delay surgery Rx choice🟰availability➕💰➕access
Aimen Farooq tweet media
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Joshua M. Steinberg, MD retweetledi
#MondayNightIBD
#MondayNightIBD@MondayNightIBD·
📣 People living with #IBD & caregivers, join the #PatientExperience convo led by @LoriPlung Whether you had IBD #surgery already or, you think that surgery might be needed at some point, What can help you in that journey? 🗳️👇🏽& share your thoughts 💬w us ! #StrongerTogether
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Joshua M. Steinberg, MD retweetledi
Ildiko ☕️
Ildiko ☕️@IldikoMe·
I know this is going to be very controversial but we need to consider the possibility that maybe, just maybe, colonoscopy prep, which is massively disruptive to the microbiome and significantly increases calprotectin, is itself a risk for, or exacerbates, flares. I have one rule in IBD: never mess with whatever is working.
Joshua M. Steinberg, MD@joshsteinbergMD

@MondayNightIBD @DCharabaty @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @IBDPharmD @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH 46M w UC, was in remission on IFX+AZA x5 yrs, off all tx & managing w diet x2 yrs 🔦Outpt colon: Mayo 2 2 wks later: 20+ bloody BM/d, wt loss. Alb 3, CRP 37, FCP 2670, C diff - Admitted 🏥, no response day 3 of IVCS. AXR w mild colon distention What is your rescue therapy?

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Joshua M. Steinberg, MD retweetledi
Fernando Gomollón
Fernando Gomollón@fgomollon·
Good point, but at least for the first five days of a severe AUC situation hospital care is the most adequate election. Hospitalization costs are irrationally high at #USA much more rational in most European countries. For myself I would clearly prefer hospital for a few days.
Joshua M. Steinberg, MD@joshsteinbergMD

@IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro Great point. Hospitalizations remain a major cost driver in UC accounting for a large proportion of total healthcare expenditures. Mean cost per UC admit exceeds $13K–$28K, so JAKi could be an excellent option. Do you think about cost when tx’ing ASUC? @IBDAPN @BaldeepPablaMD

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Joshua M. Steinberg, MD
Joshua M. Steinberg, MD@joshsteinbergMD·
@JamesHaddadMD @IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro Great point. Access to samples can be a literal lifesaver, but unfortunately many practices/institutions may not have that option. Perhaps getting our small molecule therapies on inpatient formulary will help alleviate this challenge.
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Joshua M. Steinberg, MD
Joshua M. Steinberg, MD@joshsteinbergMD·
@MondayNightIBD @DCharabaty @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @IBDPharmD @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH 46M w UC, was in remission on IFX+AZA x5 yrs, off all tx & managing w diet x2 yrs 🔦Outpt colon: Mayo 2 2 wks later: 20+ bloody BM/d, wt loss. Alb 3, CRP 37, FCP 2670, C diff - Admitted 🏥, no response day 3 of IVCS. AXR w mild colon distention What is your rescue therapy?
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Jeffrey Berinstein
Jeffrey Berinstein@berinsj·
@joshsteinbergMD @IBDAPN @IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro @BaldeepPablaMD @ericarosecohen @AmyStewartNP @IBDimmunology @drsusankais @yusukemiya73 ASUC pts need maintenance tx regardless to avoid long-term colect (waiting until Day 3 for AT = outdated- but need RCTs) 5-ASA/AZA vs AT maintenance: 2-4 higher risk of progression pubmed.ncbi.nlm.nih.gov/39586616/ No maintenance: 88% colectomy at 7 years. pubmed.ncbi.nlm.nih.gov/16716758/
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Jeffrey Berinstein
Jeffrey Berinstein@berinsj·
@joshsteinbergMD @IBDAPN @IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro @BaldeepPablaMD @ericarosecohen @AmyStewartNP @IBDimmunology @drsusankais @yusukemiya73 Speaking of early intervention: ✅CRS EARLY (⁉️DAY 1)- No question But why are we waiting until Day 3 to "consider" rescue therapy? We know who is high-risk 1. Multiple TWs Criteria 2. Multiple 🏥 3. ADMIT-ASUC (CRP>100mg/L, Alb <25g/L, UCEIS>6) 4. Deep ulcers 🤔 Missing 🪟
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Joshua M. Steinberg, MD
Joshua M. Steinberg, MD@joshsteinbergMD·
@berinsj @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @IBDPharmD @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH The JAKi guru has spoken! There is emerging data for upadacitinib in #ASUC from @berinsj et al. Multicenter study (AJG 2024): • UPA + IVCS • ~83% steroid-free remission (non-colectomy pts) • 24% colectomy at 90 days 📄 doi.org/10.14309/ajg.0… Why not TOFA? JAK-1 >> ?
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Marita Kametas
Marita Kametas@IBDAPN·
@joshsteinbergMD @IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro @BaldeepPablaMD @ericarosecohen @AmyStewartNP @IBDimmunology @drsusankais @yusukemiya73 Salvage therapy and CRS consult with comprehensive ostomy education happening concurrently! Big emphasis on surgery positive language and avoiding “patient failed xyz” language to improve post op self efficacy
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Aline Charabaty, MD, FACG, AGAF
Aline Charabaty, MD, FACG, AGAF@DCharabaty·
@ibddoctor @joshsteinbergMD @IBDPharmD @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @askIBDdoc @ibddocalex @AGA_Gastro @IBDAPN @BaldeepPablaMD & on the topic of cost, how does that affect the choice between JAKi (TOFA vs UPA) for ASUC in different parts of the world ? @DrRupaBanerjee1 @elrets @datadriven_tdoc @puentesfabi @drvishal82 @KaazanPatricia @Bealoquebea @drsumitbhatia
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Erica R Cohen MD
Erica R Cohen MD@ericarosecohen·
@joshsteinbergMD @MondayNightIBD @IBDAPN @IBDPharmD @DCharabaty @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro @BaldeepPablaMD @AmyStewartNP @IBDimmunology @drsusankais @yusukemiya73 Its never too early!! I engage on admission, counsel pt we hope for the best but need to plan for the worst and want everyone to be educated and informed in the event of a decompensation.
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Jeffrey Berinstein
Jeffrey Berinstein@berinsj·
@DCharabaty @joshsteinbergMD @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @IBDPharmD @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH Agree! 💪 response IFX prev--> reinduce with IFX However, reinduction with ineffective agent =>delays ASUC delays ==Not good (Narrow 🪟 to stop🔥) 🤔 Put out fire🧯with UPA as 🌉 to other Tx Personal RCT: ASUC Pts IFX gap -->choose IFX ASUC Pts clear IFX fail --> choose UPA
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Joshua M. Steinberg, MD
Joshua M. Steinberg, MD@joshsteinbergMD·
@IBDAPN @IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro @BaldeepPablaMD Early & effective tx always! Speaking of early intervention, how soon are you engaging our colorectal surg colleagues in this pt with ASUC w mild colonic distention? At what point is colectomy on the table? @ericarosecohen @AmyStewartNP @IBDimmunology @drsusankais @yusukemiya73
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Marita Kametas
Marita Kametas@IBDAPN·
@joshsteinbergMD @IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro @BaldeepPablaMD The cost of care on the patient and population level needs to be considered when thinking about being able to sustainably provide care. We should also be thinking of the cost of repeated need for admission in terms of colectomy risk. Early and effective treatment!
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David Choi, PharmD
David Choi, PharmD@IBDPharmD·
@DCharabaty @joshsteinbergMD @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro Another consideration is thinking about the cost effectiveness of inpatient IFX 10MG/KG vs 2-3 days of Rinvoq 45 mg daily to discharge. With more scrutiny of minimizing inpatient cost, and increased pressure for minimizing LOS, should JAKi be used more often?
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Haley Mertens
Haley Mertens@halesj126·
👀 @berinsj
Joshua M. Steinberg, MD@joshsteinbergMD

@MondayNightIBD @DCharabaty @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @IBDPharmD @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH 46M w UC, was in remission on IFX+AZA x5 yrs, off all tx & managing w diet x2 yrs 🔦Outpt colon: Mayo 2 2 wks later: 20+ bloody BM/d, wt loss. Alb 3, CRP 37, FCP 2670, C diff - Admitted 🏥, no response day 3 of IVCS. AXR w mild colon distention What is your rescue therapy?

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@MondayNightIBD @ibddoctor @LoriPlung @berinsj @DrRosenIBD @IBDGastroDocSg @rogeriosparra @ibdseb