Rasha Abou Jaoudeh, MD

Thrilled to have couples matched with my other half @rashajaoudeh at @EmoryUniversity !! Thankful for our family, friends, and mentors! @EmoryGastroHep #GIFellowship #PedsGIFellowship #Match2025

Reflux Esophagitis - Los Angeles Classification 🔹Grade A: ≤5mm mucosal breaks, not bridging folds 🔹Grade B: >5mm mucosal breaks, not bridging folds 🔸Grade C: Breaks bridging folds, <75% circumference 🔸Grade D: Breaks bridging folds, ≥75% circumference @EndoscopyCampus #MEDTwitter #MedX #MedEd #GITwitter

#WedGastroGuide 💩 Role of Endoscopy in Enteral Feeding - @ASGEendoscopy 2011 Guideline PEG Indications⁉️ 🔸Impaired swallowing due to neurologic or cancer-related conditions when oral nutrition is not expected to resume within 30 days 🔸Intact GI tract but insufficient calorie intake 🔸Gastric decompression (e.g. peritoneal carcinomatosis) 🔸PEG-J if concomitant severe GERD, gastroparesis, or repeated-tube feeding-related aspirations 🔸Others PEG Contraindications⁉️ 🔸Absolute 1⃣Inability to bring the anterior gastric wall in apposition with the abdominal wall 2⃣Pharyngeal/esophageal obstruction 3⃣Significant coagulopathy 🔸Relative: ascites, neoplastic/inflammatory/infiltrative diseases of the gastric or abdominal walls 🔸Others When to start tube feeds⁉️ 🔸Can safely start tube feeds in most patients within 4 hours of PEG placement PEG Complications⁉️ 🔸Infection (administer a dose of IV antibiotics pre-op) 🔸Tube clogging (flush with 30-60 cc of water with nutrition/medication) 🔸Tube dislodgment (a mature tract is required for non-endoscopic tube replacement) 🔸Buried bumper syndrome (prevent by leaving external bolster 1-2 cm from the abdominal wall and regular tube rotation/advancement) 🔸Others Procedure Steps & Technique‼️ 🔸Amazing video by Dr. Gottumukkala S. Raju youtube.com/watch?v=QHOqzx… ASGE Guideline in @GIE_Journal giejournal.org/article/S0016-… Abbreviations: PEG (percutaneous endoscopic gastrostomy); PEG-J (percutaneous endoscopic gastrostojejunostomy) #MedEd #MedTwitter #MedX #GITwitter

#WedGastroGuide💩 Transjugular Intrahepatic Portosystemic Shunt (TIPS) - @AASLD 2023 Guidance TIPS Main Indications⁉️ 🔸Variceal bleed refractory to 💊or endoscopic management 🔸Ascites refractory to Na-restriction and 💊 (Spironolactone 400 mg/day + Furosemide 160 mg/day) 🔸Budd-Chiarri 🔸Others TIPS Contraindications⁉️ 🔸Absolute: congestive HF, severe TR, severe pulmonary HTN, severe uncontrolled HE, systemic infection ‼️Higher MELD score -> higher mortality with TIPS. No clear cutoff but ~18 Pre-TIPS Workup⁉️ 🔸CT scan (for mapping), TTE, MELD score, and others Hepatic venous-portal gradient (HPVG)⁉️ 🔸1-5 mm Hg➡️Normal✅ 🔸> 5 mm Hg ➡️ portal hypertension 🔸> 10 mm Hg ➡️clinically significant portal hypertension 🔸> 12 mm Hg ➡️increased risk of variceal bleeding🩸 TIPS for Variceal Bleeding⁉️ ‼️Variceal bleeding ➡️ goal HVPG < 12 mm Hg or >50% reduction from baseline. ‼️Dilate stent starting at 8 mm and up to 10 mm to achieve gradient goals ‼️If unable to reach HVPG <12 mm Hg➡️add non-selective beta blockers Complications⁉️ 🔸Procedure-related (e.g. vessel injury) 🔸TIPS dysfunction 🔸Hepatic Encephalopathy (higher risk with lower post-TIPS HVPG) 🔸Worsening of liver function 🔸Cardiac overload AASLD Guideline journals.lww.com/hep/fulltext/2… TIPS Liver Fellow Network @LiverFellow aasld.org/liver-fellow-n… #MedTwitter #MedEd #GITwitter #LiverTwitter

#WedGastroGuide💩 Management of Acute Colonic Pseudo-Obstruction (ACPO ~ Ogilvie Syndrome) - @ASGEendoscopy 2020 Guideline Uncomplicated ACPO‼️ 🔹No ischemia or peritonitis, cecal diameter<12 cm, no significant abdominal pain 🔹NPO, NGT,✅electrolytes & fluids, 💊infection, ❌narcotics, ✅ambulation Persistent ACPO (48-72h)‼️ 🔸Neostigmine (2 mg over 3-5 minutes; can be given x2) 🔸❌Relative C/I in recent MI, bradycardia, asthma, renal insufficiency 🔸📈cardiopulmonary parameters (mainly bradycardia). Immediate access to Atropine‼️ 🔸If failed or C/I neostigmine➡️colonic decompression with decompression tube 🔸If perforation or peritonitis➡️surgical management ASGE Guideline in @GIE_journal giejournal.org/article/S0016-… #GITwitter #MedTwitter #MedEd

Great work by @CleClinicKids Drs. Meenal Karuvannur and @rashajaoudeh presenting on complex clinical issues and #IBD at the #MWGC2024! #womeninmedicine #FutureLeaders

#WedGastroGuide💩 IBS-C Pharmacotherapy - @AmerGastroAssn 2022 Guideline 1⃣First-line therapy 🔸Constipation➡️Osmotic laxatives (e.g. PEG) 🔸Abdominal pain➡️Antispasmodics (e.g. dicyclomine, hyoscyamine) 2⃣Second-line therapy➡️Secretagogues 🔸Linaclotide (Linzess)✅290 microgram once daily 🔸Lubiprostone (Amitiza)✅8 microgram twice daily 🔸Plecanatide (Trulance)✅3 mg once daily 🔸Tenapanor (Ibsrela)✅50 mg BID 3⃣Third-line therapy 🔸Tegaserod (Zelnorm)✅6 mg BID, only for women<65 without a history of cardiovascular ischemic events MUST READ - AGA IBS Spotlight ‼️gastrojournal.org/action/showPdf… AGA IBS-C Guideline gastrojournal.org/article/S0016-… AGA IBS Clinical Decision Support Tool gastrojournal.org/article/S0016-… #GITwitter #MedTwitter #MedEd

@SaraHassanMD @Rabihghazi_95 Thank you so much Dr. Hassan!! I am so grateful to have you as my mentor! And we miss Torta SO much! ❤️

@Rabihghazi_95 @rashajaoudeh I am so excited for what the future will hold ❤️ you guys are amazing ! PS Tortilla misses you both

Incredibly excited to be applying for #GIFellowship💩 Thrilled to be sharing this journey with my amazing fiancée and future #PedsGI star @rashajaoudeh🌟 #GIfellowship #PedsGIfellowship #match2025

@SCKimIBDMD @Rabihghazi_95 Thank you for your kind words Dr. Kim! I truly appreciate all your support and guidance on this journey! ❤️

@Rabihghazi_95 @rashajaoudeh Good luck to the two of you!! And yes… Rasha IS a #PedsGI rockstar ❤️

#WedGastroGuide💩 Post-ERCP Pancreatitis Prevention Strategies - @ASGEendoscopy 2023 Guideline Rectal NSAIDs‼️ 🔸Indomethacin 100 mg 🔸>30 min before or during procedure 🔸❌in recent PUD or renal insufficiency Wire-guided✅> Contrast-guided cannulation‼️ Pancreatic duct stent placement‼️ 🔸In high-risk patients (sphincter of oddi dysfunction, difficult/prolonged/traumatic cannulation, extensive contrast injection, etc.) 🔸3-5 Fr stent, without internal flange (to allow spontaneous migration) 🔸Abdominal X-ray in 2-4 weeks to confirm migration. If still present➡️endoscopic removal ASGE guideline asge.org/docs/default-s… Great Podcast with Dr. @ChahalPrabhleen youtube.com/watch?v=Pcvz1O… #MedTwitter #GITwitter #Endoscopy #ERCP

#WedGastroGuide 💩 Management of ingested foreign bodies and food impactions - @ASGEendoscopy 2011 Guideline 💠Avoid contrast imaging ❌❌ 💠Determine timing of endoscopy⏲️(table below) 💠Endoscopic removal‼️ 🔸Disk batteries or sharp objects in esophagus 🔸Esophageal food impaction or foreign body with complete obstruction 🔸All magnets within endoscopic reach 🔸All objects with diameter > 2.5 cm in stomach 🔸Sharp pointed objects or objects with length >6 cm in proximal duodenum 💠Consider observation 🔸Coins🪙in esophagus (can observe for 12-24h before removal) 🔸Batteries🪫in the stomach without signs of GI injury (can observe for 48h before removal) ‼️Great review on devices for foreign bodies extraction by @clivejmiranda @stevenbollipo gastroendonews.com/Review-Article… ‼️Amazing video on foreign bodies in GI tract in @videogie videogie.org/article/S2212-… @ASGEendoscopy Guideline in @GIE_Journal asge.org/docs/default-s… #GITwitter #MedTwitter #MedEd #Endoscopy

#WedGastroGuide💩 Small Intestinal Bacterial Overgrowth (SIBO) - @AmCollegeGastro 2020 Guideline Symptoms⁉️ 🔸Bloating, pain, dissension, flatuence, diarrhea Risk factors⁉️ 🔸Any condition affecting mechanisms in Table 3 🔸Motility disorders (diabetes, scleroderma), prior luminal abdominal surgeries, bowel strictures, chronic PPI, etc. Diagnosis⁉️ 🔸Hydrogen breath test is diagnostic (with lactulose or glucose). Hold antibiotics 4 weeks prior and promotility agents/laxatives 1 week prior 🔸Duodenal/Jejnual aspirate and culture: ≥10^3 CFU/mL Treatment⁉️ 🔸Antibiotics course (Rifaxmin commonly used) ACG SIBO Guideline in @AmJGastro journals.lww.com/ajg/fulltext/2… SIBO Guideline Podcast with Dr. @MarkPimentelMD gi.org/journals-publi… #MedTwitter #MedEd

#WedGastroGuide💩 Endoscopic Eradication Therapy of Barrett's Esophagus and Related Neoplasia @AmerGastroAssn 2024 Guideline High-grade dysplasia (HGD)‼️ 🔸Recommends complete EET 🔸Surveillance at 3, 6, and 12 months➡️annually Low-grade dysplasia (LGD)‼️ 🔸Recommends EET > surveillance 🔸Complete EET➡️surveillance at 1 & 3 years➡️resume surveillance interval used in NDBE Non-dysplastic Barrett's esophagus (NDBE)‼️ 🔸Recommends against EET 🔸Surveillance 3-5 years Visible lesions‼️ 🔸Non-bulky tumors + no concern for T1b➡️EMR>ESD 🔸Bulky tumors or concern for T1b or failed EMD➡️ESD AGA Guideline gastro.org/press-releases… AGA Clinical Practice Update (CPU) gastrojournal.org/article/S0016-… Abbreviations: EET (endoscopic eradication therapy); EMR (endoscopic mucosal resection), ESD (endoscopic submucosal dissection) #GITwitter #MedTwitter #MedEd #Barrett

#WedGastroGuide 💩 Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma - @AASLDtweets 2023 Guideline ‼️Part 2: HCC Diagnosis Diagnostic modality⁉️ 💠Multiphase CT or MRI with LI-RADS classification. Sufficient for diagnosis without biopsy in 🔼risk patients: 🔸Cirrhotic: any etiology except vascular (cardiogenic) 🔸Chronic HBV + PAGE-B score ≥ 10 🔸History of HCC Biopsy Indications⁉️ 🔸"Not at🔼risk" patients 🔸LR-4 (considered), LR-M, LR-TIV LI-RADS ‼️ 💠Excellent LI-RADS review by @LiverFellow (picture). Assess for: 🔸Arterial phase hyperenhancement (APHE) 🔸Lesion size 🔸# of additional major features: 1⃣ enhancing capsule, 2⃣ non-peripheral washout, 3⃣ lesion growth (≥50% in <6M) ‼️Part 3: HCC Treatment ➡️Next Wednesday @AASLDtweets HCC Guidance @HEP_Journal journals.lww.com/hep/fulltext/2… @LiverFellow Podcast with Dr. Amit Singal aasld.org/liver-fellow-n… @LiverFellow LI-RADS Review aasld.org/liver-fellow-n… Abbreviations: LI-RADS (liver imaging reporting & data system); LR-TIV (LI-RADS tumor in vein); PAGE-B (platelet-age-gender HBV score) #GITwitter #MedTwitter #MedEd #Hepatology #HCC

#WedGastroGuide💩 Management of Anticoagulants & Antiplatelets in Acute GI Bleeding & Periendoscopic Period - @AmCollegeGastro 2022 Guideline 🔑 Key points: 1⃣ Determine if life-threatening🩸 2⃣ Life-threatening🩸on Warfarin➡️ PCC>FFP. No clear benefit for vitamin K 3⃣ Life-threatening🩸on DOAC➡️can consider🔁 agent (andexanet alfa for Xa inhibitors & Idarucizumab for direct thrombin inhibitors) 4⃣ ASA & acute GI🩸 - Do not❌if used for secondary prevention - Can consider❌if high-risk procedure (see table) - If ASA was❌, resume on day of endoscopic hemostasis 5⃣ Warfarin & planned💩procedure - Do not❌unless high-risk procedure - If high-risk procedure->❌5 days prior -❌bridge unless ⬆️ VTE risk (mechanical valve; Afib + CHADS2 >5; prior VTE while❌VKA) 6⃣ DOAC & planned💩procedure➡️❌medication 1-2 days prior 7⃣ DAPT & planned💩procedure➡️❌P2Y12 & continue ASA ‼️Guideline dissemination tool ‼️ journals.lww.com/ajg/citation/2… @AmCollegeGastro Guideline published in @AmJGastro: journals.lww.com/ajg/fulltext/2… @AmJGastro Podcast with Dr. Neena Abraham gi.org/journals-publi… Abbreviations: PCC (prothrombin complex concentrate); FFP (fresh frozen plasma); DOAC (direct oral anticoagulants); ASA (aspirin); VTE (venous thromboembolism); DAPT (dual antiplatelet therapy) #GITwitter #MedTwitter #MedEd #GIBleed

#WedGastroGuide💩 Management of Celiac Disease @AmCollegeGastro 2023 Guideline 👉 Key Points: 1⃣ ❌ Screen all patients 2⃣ Consider testing if clinical picture suggestive of possible CD❓(e.g. diarrhea, weight loss, abdominal pain, bloating, chronic IDA, etc). 3⃣ Initial serologic testing: TTG IgA while on a regular, gluten-containing diet (+ total IgA if not previously tested for deficiency). 4⃣ Definitive diagnosis✅: - EGD + duodenal biopsies (1 or 2 from bulb + 4 from distal duodenum). - Perform EGD if positive serology, or if negative serology but high pretest probability. 5⃣Lymphocytic infiltration (≥25 intraepithelial lymphocytes per 100 epithelial cells), crypt hyperplasia, villous atrophy. 6⃣ Treatment🧑‍🍳: gluten free diet.➡️Dietitian. Adherence is🔑. 7⃣ Monitoring📉 - Treatment goal is mucosal healing -> discuss with patient and consider EGD after 2 years of starting GFD. - Close follow-up in clinic to monitor for clinical response, serologic conversion, and other comorbidities (e.g. Vit D deficiency, IDA, autoimmune diseases) @AmCollegeGastro guideline published in @AmJGastro: journals.lww.com/ajg/Fulltext/2… @AmJGastro podcast with Dr. Alberto Rubio-Tapia: gi.org/journals-publi… Abbreviations: CD (celiac disease), IDA (iron deficiency anemia), TTG (tissue transglutaminase), GFD (gluten-free diet) #GITwitter #MedTwitter #MedEd #celiacdisease

#WedGastroGuide 💩 Follow-up after Colonoscopy and Polypectomy - @AmerGastroAssn Guideline 👉 Key Points: 1⃣ Algorithm for average risk population who had a high-quality colonoscopy 2⃣ Average risk population: ❌ IBD, ❌personal or FH of CRC, ❌hereditary syndromes that ⬆️risk of CRC, ❌serrated polyposis syndrome, ❌personal history of CRC 3⃣ High quality colonoscopy ✅: examination complete to cecum + 👍 bowel prep (to detect > 5mm polyp) + colonoscopist with 👍 ADR (≥30% in 👨& ≥20% in 👩) + complete polyp resection 4⃣ Adenoma characteristics: number, size (cutoff 10 mm), histology (e.g. hyperplastic vs dysplastic; low vs high grade dysplasia; tubular vs villous vs tubulovillous, etc.) @AmerGastroAssn Guideline: gastro.org/clinical-guida… Abbreviations: CRC (Colorectal Cancer), IBD (Inflammatory Bowel Disease), FH (Family History), ADR (Adenoma Detection Rate) #GITwitter #MedEd #MedTwitter

#WedGastroGuide 💩 Gastroparesis - @AmCollegeGastro Guideline 👉 Key Points: 1⃣ R/O mechanical obstruction 2⃣ Assess for 💊-induced delayed GE (e.g. opioids) 3⃣ SGE (solid meal emptying ≥ 3h). ❌opioids, prokinetics, and other💊that can affect GE for at least 48 hours prior to testing 4⃣ 🧑‍🍳 small particle, low fat, low non-digestible food 5⃣ ‼️Diabetes control, avoid opioids 6⃣ Prokinetics: Metoclopramide (‼️EPS), erythromycin (1-4 weeks due to tachyphylaxis), Domperidone (❌FDA-approved in 🇺🇸) 7⃣ EndoFLIP characterizes pyloric function ➡️ role in predicting outcomes after G-POEM and potentially botulinum 💉 @AmCollegeGastro Guideline: journals.lww.com/ajg/Fulltext/2… Abbreviations: SGE (scintigraphic gastric emptying), GE (gastric emptying), EPS (extrapyramidal symptoms), G-POEM (gastric peroral endoscopic myotomy) #MedTwitter #MedEd #GITwitter #Gastroparesis

#WedGastroGuide💩 Chronic Idiopathic Constipation - Joint @AmerGastroAssn & @ACG Guideline 👉 Key Points: 1⃣ Hydration & ⬆️fibers 2⃣ Osmotic laxatives (e.g. PEG, Mg Oxide) 3⃣ Stimulants as short-term or rescue therapy (e.g. Bisacodyl, Senna) 4⃣ Secretagogue (e.g. Lubiprostone, Linaclotide, Plecanatide) or Prokinetics (Prucalopride) 5⃣ Consider evaluation for pelvic floor dysfunction (e.g. anorectal manometry, balloon expulsion testing) AGA-ACG Guidelines: gastrojournal.org/article/S0016-… AGA-ACG Clinical Decision Support Tool: gastrojournal.org/article/S0016-…