Rafeeq

These cakes were brought by my 18 year old patient with #Crohn’s disease. It was his last appointment at the Children’s Hospital.I have looked after him for~5 years,he is in deep remission. #IBD management is team work. Thx to staff @Bham_Childrens @CrohnsColitisUK @CICRAcharity

⚡️Tips to improve lift for resection⚡️ AGA update on lifting agents: doi.org/10.1016/j.cgh.… 1. SSLs: No injection if margins are visible or < 20 mm 2. 10-30 mm lesions: central injection 3. Dominant lesions: start from accessible region 4. >30: inject, cut, repeat Agents:Fig

Management of Eosinophilic Oesophagitis (EoE) - 2026 ASGE guidelines 📸: sciencedirect.com/science/articl…

Number Needed to Treat | New England Journal of Medicine - what a great editorial! nejm.org/doi/full/10.10…

Interested in shaping research funding decisions? We’ve opened a range of opportunities to join our decision-making committees across multiple research programmes. Closing date: 26 May 2026 Learn more about the opportunities available and apply at ⬇️ nihr.ac.uk/get-involved/c…

Advances in the pathophysiology, diagnosis, and management of celiac disease bmj.com/content/391/bm… #GIpath #celiacdisease

In 2018, Stanford professor Matt Abrahams gave a masterclass on why most people fail to communicate well.

@berinsj @fgomollon @ibddoctor @MondayNightIBD @joshsteinbergMD @IBDPharmD @DCharabaty @SchwartzbergMD @ShaziaMSiddique @IBDPharmacist @JohnRTMonsonMD @john_damianosMD @UnivArizonaIBD @fudmanMD @MariannySulb @ShomronH @askIBDdoc @ibddocalex @AGA_Gastro @IBDAPN @BaldeepPablaMD @ibdseb Is the dose of prednisolone (75 mg/day) along with Upadacitinib 45 mg/day too much immunosuppression?

@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

📣 #GI #CRSurgery #PharmD Join us for a convo led by @joshsteinbergMD @DCharabaty What is your rescue therapy in #ASUC? What factors play a role in your choice? 🗳️Take the poll👇🏽, RT & share 💬 your thoughts & experience with us !

The strain that caused the death of two students in Kent has been confirmed to be MenB. The MenB vaccine was first offered to young children in the UK in 2015 at 8 weeks, 12 weeks and one year. Hence, current university students will not generally have received the vaccine.

Part 2 of the European coeliac disease guidelines are now out in @UEGJournal, covering management, follow-up, and complex disease courses 🌾🆕 📸: onlinelibrary.wiley.com/doi/10.1002/ue…

@DrAkshayKapoor @ibddoctor @IBDimmunology @Bealoquebea @AmerGastroAssn @AGA_CGH Most high volume IBD units are already prescribing anti-TNF on the higher dose/frequency. I believe immunomodulators add a degree of durability of Rx with anti-TNF particularly with Infliximab

@ibddoctor @IBDimmunology @rafeeq_rm @Bealoquebea @AmerGastroAssn @AGA_CGH Nice thread. Is combo therapy overrated? Would people still give Aza if one could achieve target trough levels based on higher dosing ?( SONIC; post hoc)

Use IMMs with IFX? I tend not to - maybe I should? ☑️@AmerGastroAssn @AGA_CGH 👇🏾 🟢SC IFX anti-drug antibody (ADA) rate = 57%! 🟢mono-tx ADA OR = 3.29 (c/w combo) (Fig 2) ⚪️most ADA = not neutralizing cghjournal.org/article/S1542-…

Fluid restriction in patients with heart failure: a systematic review heart.bmj.com/content/early/…

@IBDimmunology @Bealoquebea @AmerGastroAssn @AGA_CGH Thank you. I believe that first disease modifying treatment is the best treatment for our patients with IBD. Hence even in this modern era of 5-6 advanced treatments options, it is better to protect the initial effective Rx

@rafeeq_rm @Bealoquebea @AmerGastroAssn @AGA_CGH Good question. 1. LD IMMs for ADA = sometimes. With more agents available - I guess I’m less worried about IFX loss 2. HD IMMs - mod-severe dz - I’m not sure is its better than intensified mono IFX or UPA. SONIC = standard IFX BUT - maybe I’m wrong! I’d love other takes!

In an international, randomized trial involving patients with acute venous thromboembolism, the risk of clinically relevant bleeding was significantly lower with apixaban than with rivaroxaban during the 3-month treatment period. Full COBRRA trial results: nejm.org/doi/full/10.10…

New ileitis - is it intestinal TB or is it Crohn's? estimate the probabilities based on all the available data (and location in the world) at pathology.med.umich.edu/shiny/tbcrohns/ #IBD Find out what adding new data will do to shift the probabilities by toggling other results.

In this @Gut_BMJ case report by @Mo_Shiha, a 72M with transfusion-dependent bleeding from radiation proctopathy (left photo) underwent flexible sigmoidoscopy for treatment with Argon Plasma Coagulation (APC). Despite having a perfectly clean bowel and use of CO2 insufflation, a loud 'bang' was heard echoing in the endoscopy room, as the APC was applied. The patient experienced sudden, severe abdominal pain, and an urgent CT scan revealed a localized perforation and peritoneal free gas (right photo). The diagnosis was a rare colonic gas explosion triggered by APC. Typically, this devastating complication requires urgent surgery. However, the patient's history of an allogeneic stem cell transplant for leukemia left him with severe bone marrow aplasia, making colonic surgery too risky. He was therefore managed medical with a novel, intensive non-operative approach using antibiotics, parenteral nutrition, and G-CSF. The patient successfully recovered, was discharged after three weeks, and remained bleeding free at 6 months. To the authors’ knowledge, this was the first documented instance of a colonic gas explosion successfully treated without surgery. This is also a reminder that residual stool in the colon can lead to combustible amounts of methane and hydrogen, which can explode when introducing oxygen and heat. gut.bmj.com/content/70/3/4…

⚠️ ⚠️ ⚠️ ESSENTIAL READING 🚨 🚨 🚨 The journal is delighted to present the British Society of Gastroenterology, Association of Upper Gastrointestinal Surgery of Great Britain and Ireland and Royal College of Pathologists Delphi consensus guidance on biopsy sampling during upper gastrointestinal endoscopy in adult patients on behalf of the authors. The recommendations have been beautifully summarised in the figure. Full manuscript here 👇 👇 👇 fg.bmj.com/content/early/… With thanks to Dr Amar Srinivasa and co-authors. @srinivasa_amar @Oliver_Bendall @Amira_Babikir @gastro3570 @NJEMCP @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @drkeithsiau @DrOmerAhmad @Dunnepdj @shraddha_gulati @CardiffGastro @DrBuHayee @poodocnisha @Sharm_Sub #Endoscopy #DelphiConsensus #ClinicalGuidelines #BSG #AUGIS #Pathology #GIPathology #EvidenceBasedMedicine #QualityImprovement #ClinicalStandards #Gastroenterology #GI #AcademicMedicine #MedTwitter

How to diagnose coeliac disease: highlights from the updated 2025 guidelines in @UEGJournal 🔗: onlinelibrary.wiley.com/doi/full/10.10…

Delivering bad news as an ICU doctor is one of the harder parts of the job. Here are some lessons I've learned along the way👇 1. Always sit down 2. Don't just jump into it. Spend the first couple of minutes with introductions to yourself, your team (if present), but more importantly who all is in the room (patient, family etc.) 3. If you will be needing consent for something (procedure, palliation etc.) as part of the discussion, ensure you know who the decision maker(s) are. 4. Preface the bad news "I have to share something that might be hard to hear" 5. Clearly in <30 seconds deliver the bad news then STOP TALKING. The biggest mistake I see is people give the news and keep going. It takes time to process what may be the worst news they've ever received. Silence is the solution here. They will talk or ask questions when they are ready... it could be 10 seconds, 1 minute, or 10minutes. Give them the time they need before you proceed. 6. Ask if they have any questions about what you have delivered. 7. Be prepared to answer 'what comes next' .. 8. Ask about spirtual / religious beliefs when appropriate and offer support if that is available. 9. Let them know you or someone from your team will be available to answer questions that might come to mind... often in the moment, questions slip people's mind but come to them minutes after you leave. Make sure they know how they can have them clarified. Just some thoughts here... any others? Bonus: Don't construe family members becoming angry as them being angry at you or the team. Anger when faced with this news is common, normalize it and realize it likely isn't directed at you!

Health systems worldwide face two fundamental and connected challenges: pervasive misinformation and disinformation and eroding public trust. A Viewpoint discusses the paradox of trust in health care in the age of social media: spkl.io/6016AvBw0 spkl.io/6015AvBwL