Chathruckan Rajendra MD

@JeanFredericCo1 discusses long-term LUCENT extension data showing durable clinical, endoscopic, & histologic outcomes w/ mirikizumab in moderately to severely active UC. hcplive.com/view/mirikizum… @MSHS_IBDCenter @mountsinaiIBD @IcahnMountSinai #gastro #colitis #IBD @HCPLiveNews

Mostafavi et al: Manual #disimpaction not enough? 👀 This case shows how IV #neostigmine unlocked massive stool passage in severe refractory #constipation—no bradycardia, no surgery. 💥 Could this be the missing adjunct in complex motility cases? #PedsGI #Motility #GITwitter

The day after #WorldIBDDay, join @NASPGHAN for a FREE webinar on Management of Anemia in #IBD 🩸 📅 May 20 | 8 PM ET 🌟 Fantastic pediatric faculty: Drs. Ali, Pasternak, Goyal, Grossman, Vissa & Walters 🎓 1.5 CME/MOC credits Join me in registering 👉 learnonline.naspghan.org/products/manag… @sabpeds @DrPasternak_IBD @askIBDdoc @andrewbgrossman #tomWalters @mvissa

Advanced therapies for Crohn’s disease can yield different results according primary location. Interestingly, JAK inhibitors may be better for colonic vs ileal disease. 📸: pmc.ncbi.nlm.nih.gov/articles/PMC12…

Refractory DGBI needs more than a single-clinic solution. 🧩🧠🏥 In @FrontGastro_BMJ, a neurogastroenterology centre shares practical experience creating a multidisciplinary team to manage refractory disorders of gut–brain interaction. 💬🤝 A useful blueprint for services thinking about integrated care, complex symptoms and joined-up support. Read more: fg.bmj.com/content/early/… #DGBI #GutBrainAxis #Neurogastroenterology #MDT #IBS #FrontlineGastro #GItwitter #Gastroenterology #IntegratedCare #ClinicalService @BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @ESGE_news @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman

🚨 ¡NUEVO ESTUDIO REVELADOR sobre Poliposis Adenomatosa Familiar (PAF)! Investigadores holandeses analizaron 50 años de datos para entender cómo ha cambiado el riesgo de cáncer en pacientes con PAF. Los resultados son clave para la vigilancia. Publicado en @AGA_Gastro gastrojournal.org/article/S0016-… #PAF #Cáncer #Salud @AmerGastroAssn @gastromx @sage_gastro @FAGEgastro @aegastro @sepdigestiva @ESmecuol74087 @DeMadaria @MoreiraR_Leti @OPGEgastro @gastrocol @pepebandera1 @OxytocinLau @VerduLab

Guideline Monday - 📋 AGA 2025 Gastroparesis Dx: 4-hr gastric emptying study (not 2-hr) Rx: metoclopramide or erythromycin ❌ Domperidone, prucalopride, G-POEM: not first-line Reserve endoscopy/GES for refractory Sx #GITwitter #GIfellows gastrojournal.org/article/S0016-…

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad @IBD_DrEMF @Gastro4Kids @BenjamminGold @DrRosenIBD @jlightdale @raghu_vikram @JenniferLeeLee1 @GutMD_ @sabpeds @JonathanMoses77 @johnmrosen @dr_rdvenkatesh @PLLU @vaibhav_manu @malloc_doc @hilarykmichel @JKurowskiMD @pedsGI_Japan @PedsGIChat @pedsgidoctora @pedsIBDdoc @PedsMamaDoc @SamPaglinco @NASPGHAN @rafeeq_rm @ConradCole10 @ManuelLaraMart @dziring @ankurchugh02 @MichaelKappel12 @GIGIPedsGI @bowelsounds @temarahajjat 12/ #VEOIBD #IBD Summary: 🧬 15-20% monogenic 🔬 Fecal calprotectin is best biomarker 💉 Anti-TNF needs BSA dosing + TDM 🏥 HSCT = 92% remission + 100% survival in monogenic disease 👥 GI+immunology team essential. Refer early to a specialized center!

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad @IBD_DrEMF @Gastro4Kids @BenjamminGold @DrRosenIBD @jlightdale @raghu_vikram @JenniferLeeLee1 @GutMD_ @sabpeds @JonathanMoses77 @johnmrosen @dr_rdvenkatesh @PLLU @vaibhav_manu @malloc_doc @hilarykmichel @JKurowskiMD @pedsGI_Japan @PedsGIChat @pedsgidoctora @pedsIBDdoc @PedsMamaDoc @SamPaglinco @NASPGHAN @rafeeq_rm @ConradCole10 @ManuelLaraMart @dziring @ankurchugh02 @MichaelKappel12 11/ #VEOIBD Prognosis Overall: 👍 74–86% steroid-free remission ✂️ 11% colectomy rate 🚨 More severe course if 👶🧬infantile-onset and/or monogenic ⬇️ Response to 1st-line induction ⬆️ Steroid dependence ⬆️ Risk of surgery & 🏥

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad @IBD_DrEMF @Gastro4Kids @BenjamminGold @DrRosenIBD @jlightdale @raghu_vikram @JenniferLeeLee1 @GutMD_ @sabpeds @JonathanMoses77 @johnmrosen @dr_rdvenkatesh @PLLU @vaibhav_manu @malloc_doc @hilarykmichel @JKurowskiMD @pedsGI_Japan @PedsGIChat @pedsgidoctora @pedsIBDdoc @PedsMamaDoc @SamPaglinco @NASPGHAN @rafeeq_rm 10/ #Monogenic #VEOIBD 💎#HSCT is potentially curative!📸👇CHOP data & IL-10RA deficiency cohort 💎 Indications: ✅ IL-10/IL-10R deficiency (landmark) ✅ XIAP, FOXP3 (IPEX), CGD, DOCK8, RAG1/2, SCID and other 🚨💎 For select patients, it's not a last resort — it is THE therapy

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad @IBD_DrEMF @Gastro4Kids @BenjamminGold @DrRosenIBD @jlightdale @raghu_vikram @JenniferLeeLee1 @GutMD_ @sabpeds @JonathanMoses77 @johnmrosen @dr_rdvenkatesh @PLLU @vaibhav_manu @malloc_doc @hilarykmichel @JKurowskiMD @pedsGI_Japan @PedsGIChat @pedsgidoctora @pedsIBDdoc 9/#Monogenic #VEOIBD management 💎 Genetic mutation guides targeted therapy, identify CI to drugs ✅ Abatacept for CTLA4/LRBA deficiency ✅ Anti-IL18 for NLRC4 ✅ Rapamycin for FOXP3/PIK3CD before HSCT ✅ Hematopoietic stem cell transplant 🚨💎Critical: AVOID TNFi in CGD

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad @IBD_DrEMF @Gastro4Kids @BenjamminGold @DrRosenIBD @jlightdale @raghu_vikram @JenniferLeeLee1 @GutMD_ @sabpeds @JonathanMoses77 @johnmrosen @dr_rdvenkatesh @PLLU @vaibhav_manu @malloc_doc @hilarykmichel @JKurowskiMD 8/ #TNFi in #VEOIBD ⏰⬇️ Response to TNFi in VEOIBD vs in older kids ✅ IFX 3-yr maintenance 12% VEOIBD vs 67% in REACH trial 💎 Recommendations to ⬆️reponse: ✅ Body Surface Area-based dosing (200 mg/m²) + tight #TDM ✅🎯 IFX levels: >23 before 2nd infusion, >10 @ maintenance

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad @IBD_DrEMF @Gastro4Kids @BenjamminGold @DrRosenIBD @jlightdale @raghu_vikram @JenniferLeeLee1 @GutMD_ @sabpeds @JonathanMoses77 @johnmrosen @dr_rdvenkatesh @PLLU 7/#VEOIBD 💎Multidisciplinary GI + immunology team is essential — not optional #PedsIBD Conventional therapies 💎1st line steroid-sparing induction: EEN 🔺5-ASA if mild-mod UC 🔺IMM: MTX preferred over AZA 🔺Subset requires escalated dosing or alternative approaches #PedsGI

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad @IBD_DrEMF @Gastro4Kids @BenjamminGold @DrRosenIBD @jlightdale @raghu_vikram @JenniferLeeLee1 6/ 🪜 Pathways in #VEOIBD 🛠️ Remodeling of junctional complexes in the epithelium 👩‍💻 Effects on processing & presentation of antigens on MHCs and subsequent T-Cell activation 📶 Inflammatory signaling pathway disruption @GutMD_ @sabpeds

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad @IBD_DrEMF @Gastro4Kids @BenjamminGold 5/ Dx workup #VEOIBD ⏰💎All pts should get genetic evaluation 🧬 Basic immunologic screen: Igs, vaccine titers, DHR test for CGD & XIAP flow cytometry. WES or targeted gene panels (IL-10/IL-10R, XIAP, FOXP3, TTC7A, CGD) 🔺highest yield in infantile-onset (onset<age 2)

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD @ibdgijami @BenClickMD @Siyan_Cao @SuhaAbushamma @DrJordanAxelrad 4/Dx workup in #VEOIBD 🔦 Full colonoscopy + exam ileum 💎 Dz location: Colon ++ (94%); isolated ileal disease rare ⏰💎🔬 Histology clues — eosinophilic infiltrates, ⬆️apoptosis; villous blunting/atrophy, ⬆️IEL — can point to monogenic disease 💩 FCP & standard labs more👇

@MondayNightIBD @ericbenchimol @DrChrisMoran @ibdtweets @MRegueiroMD 3/ #VEOIBD Presentation, phenotype ✅ GI symp ✅ Failure to thrive 44% ✅ EIMs 28% ✅ Pancolitis 90% ✅ IBD-U 11–22% vs 4–10% in older kids ⏰💎IBD + recurrent infections or perianal fistulas as infant or refractory or strong FH ➡️Genetic/Immunologic eval at a specialized center

@MondayNightIBD 2/ #VEO-IBD = IBD diagnosed before age 6 🔺Make up 15% of all #PedsIBD 🧬~15-20% having a monogenic cause — especially infants <age 2 📈 VEO-IBD is on the rise, ⬆️Incidence by 7.2 %/year 🚩 May have distinct phenotype & Rx response vs adult-IBD ⏰ Early recognition matters

@MondayNightIBD 1/ Welcome to #Back2basic #MondayNightIBD Today’s Topic is Very Early Onset #VEO #IBD ✅ Definition, Epidemiology ✅ Presentation ✅ Workup ✅ Monogenic Causes ✅ Management ✅ Prognosis 🏎️ Let’s start !

We need to think about better approaches to trials in #IBD particularly in often neglected areas such as CD perianal fistula (#CD_pAF ) Dr Nuru Noor led our work on Bayesian prior elicitation to determine efficacies of therapies #CD_pAF Free to access here academic.oup.com/ecco-jcc/artic… I 📖 a lot while doing this Welcome comments