Justin Leong

Consultant Gastroenterologist | Singapore General Hospital | Singapore 🇸🇬

Clinical interests in Inflammatory Bowel Disease (IBD) and endoscopy

[Justin Leong @JustinLeongWH]

A beautifully written piece

In an era where clinical medicine has been relegated to a floor of competency instead of a asymptote of mastery, this is a fitting reminder of the beauty of our craft.

The Thing Itself: Medicine as Craft - Gastroenterology https://t.co/TWkfWIHMYW

[Frontline Gastro @FrontGastro_BMJ]

Subcutaneous infliximab monotherapy in IBD: does it persist in the real world? 💉📊

In @FrontGastro_BMJ, this real-world study examines treatment persistence and efficacy of subcutaneous infliximab monotherapy in patients with inflammatory bowel disease. 🧑‍⚕️🔬

Important data as IBD services consider convenience, adherence, drug levels and long-term treatment strategy.

Read more: https://t.co/gblCM26p3u

#IBD #Infliximab #SubcutaneousInfliximab #CrohnsDisease #UlcerativeColitis #FrontlineGastro #GItwitter #InflammatoryBowelDisease #IBDTreatment #ClinicalResearch @BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman

[Keith Siau @drkeithsiau]

Here are some of the highlights ‼️

1️⃣ Where to take photos
2️⃣ How to describe lesions
3️⃣ Barrett’s assessment
4️⃣ Gastric intestinal metaplasia

📸: @FrontGastro_BMJ
https://t.co/dW3kKoS1p3

[Uma Mahadevan @UmaMahadevanIBD]

Fabulous IBD LATEBREAKERS @DDWMeeting Insight study suggests combination of IUS and calpro may obviate need for post-op colonoscopy @maartenpruijt

[Bishal Gyawali, MD, PhD, FASCO @oncology_bg]

A MUST-READ!

This is probably one of my most important papers where I try to teach how to fish rather than offer fish.

How I Read a Clinical Trial Report?

BG’s primer for Busy Clinicians.

Thank you @JCOOP_ASCO @EthicsdoctorP for the kind invitation. I hope the readers will find this useful.

https://t.co/HJhZlsBpU2

[Justin Leong @JustinLeongWH]

A very evocative piece by @jenna_taglienti
Beautiful writing

"The meaning of my work is profound.
The meaning of my presence at home is irreplaceable."

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

If there was one article you want to read as a clinician?
Read this

Via @jenna_taglienti - an absolutely stunning write in @JAMA_current

"Medicine can have extraordinary meaning. But it cannot substitute for being present in your own life. The world may need us as physicians.

But the people who love us need us as ourselves.

And that is the role no one else can fill."

Brilliant - and much love to you

'Time is Finite"

https://t.co/qPJkmtwxUe

[Justin Leong @JustinLeongWH]

Navigating the Differential Diagnosis of Intestinal Tuberculosis and Crohn's Disease

Great article
https://t.co/cKaIkJP8hP

[Justin Leong @JustinLeongWH]

Differentiating Intestinal Tuberculosis from Crohn's Disease

Challenging to Differentiate ITB from CD
· Microbiological test sensitivity is limited:
o AFB stain: 5.3 – 37.5%
o AFB culture: 23-46%
o PCR: 36.4 – 67.9%
· ITB cannot be confidently excluded even with negative results

[Frontline Gastro @FrontGastro_BMJ]

🩸📉 Is the cancer risk in iron deficiency anaemia still as high as we think?

In this large single centre audit of 1253 consecutive referrals, the prevalence of gastrointestinal malignancy in fully investigated IDA has fallen to 5.6%, reinforcing the case for smarter risk stratification rather than automatic invasive investigation for all.

Prior colonic imaging within 5 years was associated with very low colon cancer yield, and long term proton pump inhibitor exposure showed a strong negative association with GI cancer risk.

🔎 The updated analysis suggests that adding PPI status may improve the predictive performance of the IDIOM score, though prospective validation is needed.

A timely contribution to the risk stratification debate in IDA pathways.

https://t.co/mJ05WrPycI

@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone
@eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman
@BritSocGastro @BSGTrainees @Dukes_Club

[Yuri Gorelik @GorelikYuri]

We probably need to stop ERCPing every bole duct stone

Contrary to current paradigm of "no stome left behind" this @AGA_CGH retrospective propensity matched study shows that older adults with unsymptomatic choledocholithiasis fared better WITHOUT an ERCP

interesting read

[Dr Mark Silverberg @guthealthmd]

So many wonderful insights and observations from Willem Bemelman after a 30 year career doing #IBD surgery at AMC. One of the truly great IBD surgeons that has thought so deeply about IBD pathophysiology.

Some points he made:
1. Fecal stasis is a big clue. We see inflammation in these areas such as the rectum, TI, appendix, blind limbs, etc.
2. Complicated disease is often the result of late diagnosis or suboptimal treatment.
3. High uncontrolled inflammatory burden leads to structural damage which is nearly impossible to reverse currently. Reducing the burden as early and effectively as possible is key. This can be done by surgery or medication.
3. Wound healing/repair is defective in CD as one can observe by anastomotic ulceration that we see much less frequently in other settings.

@mantaj_brar @AnthonydeBuck @SunHoLee15 @ZaneCohenCentre @AntoninoSpin @pakotze

[Dr. Med @DrNikhilMD]

5
💊 Step 1 — Iron therapy comes first

Never start ESAs before correcting iron.

Start iron if:
💉 HD patient → Ferritin ≤500 & TSAT ≤30%
💊 Non-dialysis/PD → Ferritin <100 (TSAT <40%) or Ferritin 100–300 (TSAT <25%)

Why? EPO won’t work without iron substrate.

KDIGO calls this the “Iron First” approach.

[John Damianos, M.D. @john_damianosMD]

Eosinophilic gastrointestinal diseases

#ACG2025

[Justin Leong @JustinLeongWH]

A Long Obedience in the Same Direction

"In a world of scrolls and swipes, where distraction is currency and speed is king, staying faithful to any meaningful path is revolutionary. Because that’s where the gold is buried. That’s where meaning is found."

https://t.co/5El7AQwkiw

[William Aird @WilliamAird4]

1/5

Iron Balance: The Math Behind Dietary Deficiency

Iron balance depends on one thing: how much you absorb vs how much you lose.

Losses ≈ 1 mg/day in men, 1.5–2 mg/day in menstruating women.

Absorption depends on what and how you eat.

[Frontline Gastro @FrontGastro_BMJ]

🩸 Iron deficiency anaemia vs. anaemia of chronic disease — similar symptoms, different stories! 🤔🔍

Both can signal serious underlying pathology 🚨
Getting the diagnosis right early = better outcomes ✅

📚 New review in @FrontGastro_BMJ breaks down how to distinguish & manage these common conditions 👨‍⚕️🧬

Read the fill paper here 👉 https://t.co/ixcIZ768UB

#GItwitter #Anaemia #IronDeficiency #ChronicDisease #DiagnosisMatters #MedTwitter #FrontlineGastroenterology #Hematology #Gastroenterology
@BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @ESGE_news @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman

[Justin Leong @JustinLeongWH]

So proud of our team for winning the ASGE #GoldenScope. Great achievement!

🇸🇬 🇸🇬 🇸🇬

@AndrewOngML

[ASGE GI Endoscopy @ASGEendoscopy]

Congratulations the 2025 #GoldenScope winners! They competed in the semi-finals this past weekend at ASGE IT&amp;T, beating 65 teams. Way to go! Pictured in order: 1st place: Singapore General Hospital, 2nd place: Baylor College of Medicine &amp; 3rd place: Cleveland Clinic. #GIFellows

[Justin Leong @JustinLeongWH]

'Turning stone translucent'. Mesmerising

[Massimo @Rainmaker1973]

The Veiled Lady sculpted in 1869 by Giovanni Battista Lombardi, showcasing his masterful technique of creating a delicate veil effect in marble.

[Justin Leong @JustinLeongWH]

3) Integration of multiple parameters necessary to shift diagnostic probability meaningfully

Model is here for reference
https://t.co/qqFGMvZk85

[Justin Leong @JustinLeongWH]

Differentiating Intestinal Tuberculosis from Crohn's Disease

Challenging to Differentiate ITB from CD
· Microbiological test sensitivity is limited:
o AFB stain: 5.3 – 37.5%
o AFB culture: 23-46%
o PCR: 36.4 – 67.9%
· ITB cannot be confidently excluded even with negative results

[Justin Leong @JustinLeongWH]

Conclusion

1) Common symptoms (e.g. abdo pain, weight loss, anaemia) poorly differentiate ITB from CD
2) Strong predictors (e.g. perianal disease, EIMs, lung lesions, specific endoscopic features) have high diagnostic value but are uncommon (&lt;50% of pts)

cont