#MondayNightIBD

Thought-provoking Q w #ASUC convo @joshsteinbergMD ?Why wait for CS failure to start effectiveRx ?Will JAKi replace TNFi: lower💰, easier access🏥 & out ?Can we manage select pts outside🏥 @ibddoctor 🌟#PatientExperience of surgical journey @LoriPlung 💎#IBDAlgo @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

@MondayNightIBD @joshsteinbergMD @ibddoctor @LoriPlung @berinsj @DrRosenIBD @IBDGastroDocSg @rogeriosparra @ibdseb @JamesHaddadMD @puentesfabi @fgomollon @Youcantmakethi4 @srmbeauroy @DuekerJeffrey @AmyStewartNP @MariannySulb @DrRupaBanerjee1 @IBDPharmD @IBDAPN @ericarosecohen @elrets @ibdtweets @GI_PharmD #MondayNightIBD
#PostConvo #IBDPoll 2️⃣
🆓#CME👉🏼mnibd.short.gy/SteinbergPost

22y/o admitted for #ASUC, no response to IV solumedrol x 3 days & a dose of IFX 10mg/kg. CRP 35, alb 3.2

If you're considering ✂️colectomy next, what is best timing for surgery to optimize outcomes?

@MondayNightIBD @joshsteinbergMD @ibddoctor @LoriPlung @berinsj @DrRosenIBD @IBDGastroDocSg @rogeriosparra @ibdseb @JamesHaddadMD @puentesfabi @fgomollon @Youcantmakethi4 @srmbeauroy @DuekerJeffrey @AmyStewartNP @MariannySulb @DrRupaBanerjee1 @IBDPharmD @IBDAPN @ericarosecohen @elrets @ibdtweets @GI_PharmD #MondayNightIBD
#PostConvo #IBDPoll 1️⃣
🆓#CME👉🏼mnibd.short.gy/SteinbergPost

56y/o 🏥 for acute severe UC, 10 bloody BM/d, T 38.2C, mildly dehydrated, CRP 40, alb 2.3, flex sig Mayo 3
In addition to IVF + 60mg IV solumedrol, & CRS consult, What other therapies should be started?

@MondayNightIBD If you're living w #IBD or a caregiver & had ✂️IBD surgery or it’s a future possibility What would make the decision to have✂️ & the journey easier 🗣️ Discuss w GI+✂️team early & several times 🔮Understand recovery+QoL post✂️ 🤝Talk to a pt who had same✂️ 🚫Other options failed

@MondayNightIBD Have you needed surgery? If so, what helped you make the decision, and why? @ownyourcrohns @aboutIBD @nataliesparacio

@MondayNightIBD @ownyourcrohns @aboutIBD @nataliesparacio Living with IBD is hard enough-- then you throw a possible surgery in the mix. How best do you handle those conversations? @GutlessGlamour @Youcantmakethi4

@MondayNightIBD @ownyourcrohns @aboutIBD @nataliesparacio @GutlessGlamour @Youcantmakethi4 I believe communication with your team is key! Adding a surgeon to your team and getting to know one another can take the anxiety down a notch. What do you think @SchwartzbergMD?

@MondayNightIBD @ownyourcrohns @aboutIBD @nataliesparacio @GutlessGlamour @Youcantmakethi4 @SchwartzbergMD I find that peer-to-peer support can be very powerful when preparing for surgery. Talking to someone who has experienced it firsthand is helpful and comforting. Knowing what to expect helps you cope ahead. #PatientExperience #MondayNightIBD

@MondayNightIBD @ownyourcrohns @aboutIBD @nataliesparacio @GutlessGlamour @Youcantmakethi4 @SchwartzbergMD Where would you go for information and support if you required surgery? #PatientExperience #MondayNightIBD @srmbeauroy @keepingmyshitTG @rebelliousgut @NoaErlitzki

📣 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

@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?

@fgomollon @ibddoctor @MondayNightIBD @joshsteinbergMD @IBDPharmD @DCharabaty @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @askIBDdoc @ibddocalex @AGA_Gastro @IBDAPN @BaldeepPablaMD @fgomollon - thoughts? Building on @ibdseb's COVID work, started RCT for outpatients w/ ASUC (TWs). Randomized to 5 days: 1) Pred 75mg +Upa 45mg 2) Pred 75mg (+ Upa PLB) Shipped to 🏘️<24 hrs Goal: Keep pts home Daily 5 min 📞 + day 5 🏥 + Rescue PRN 🤔Crazy? Maybe

@ibddoctor @joshsteinbergMD @IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @askIBDdoc @ibddocalex @AGA_Gastro @IBDAPN @BaldeepPablaMD This is really forward thinking Peter and team. Congrats! This is what patients want and I’m sure it can be done safely in appropriately selected patients with the right resources and personnel. Once upon a time people were anxious about giving infliximab at home.

@ibddoctor @fgomollon @MondayNightIBD @joshsteinbergMD @IBDPharmD @DCharabaty @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @askIBDdoc @ibddocalex @AGA_Gastro @IBDAPN @BaldeepPablaMD I've had some success managing "milder" ASUC in an ambulatory setting. 1. Singapore is small, commuting is convenient 2. Patient must be willing to travel, ready communication with team 3. JAK-inh (instead of IFX) 4. IUS (instead of flexisig) 5. Low threshold to admit if needed

@joshsteinbergMD @MondayNightIBD @DCharabaty @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @IBDPharmD @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH High risk of colectomy! Surgeon must be close to the gastroenterologist in this case! Always !

@DCharabaty @joshsteinbergMD @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @IBDPharmD @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro Enclosed a peer reviewed SR if helpful These are useful but I do feel without individual patient level data we can only infer potential use for now We are doing the definitive study @ACESO_ASUC cghjournal.org/article/S1542-…

@IBDPharmD @DCharabaty @joshsteinbergMD @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro Not just cost effectiveness - availability/timing with respect to how sick the pt is. One of the hospitals I work at needed 2-3 days to stock the IFX dose I needed. I have JAKi samples in my office.

@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.

@joshsteinbergMD @IBDPharmD @DCharabaty @MondayNightIBD @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @ibddoctor @askIBDdoc @ibddocalex @AGA_Gastro It's hard to see the disadvantage of maintaining a small supply of a rescue medication.