Dr John O'Donohue

Gastroenterologist. Shining a light on bowel cancer. Inspector of endoscopy units, stomachs & bile ducts too. Some tweets my own.

[David Beaton @davidbeaton87]

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🚨 New from the British Society of Gastroenterology:
We analysed all UK colonoscopies from the National Endoscopy Database (2019–2020). That’s over 592,000 procedures. Findings below 👇

(📄 Free article link (limited time): https://t.co/Cp1UmqB0ru)

[Dr John O'Donohue @TheBottomDoc]

@goldstone_tony @HeldinEU @nhs_pensions But it might make sense atk wait a year for the recent pay increase of 8% to be ‘baked in’ to final salary calculation. which is ‘best of three’ last years. You’d have to live 12 years after retirement to see the gains, though!

[Dr John O'Donohue @TheBottomDoc]

Well, what sort of farewell cake did you expect at an upper GI surgeon’s retirement party? @LG_NHS
Saying happy retirement to Mr Alek Uzkalnis!

[Dr John O'Donohue @TheBottomDoc]

A very promising start to a @JAG_Endoscopy accreditation visit, right here!

[Dr John O'Donohue @TheBottomDoc]

How to identify the ‘sensory phenotype’ in bloating, and how to treat it:

Duloxetine, not SSRI, is best if diet and diaphragmatic breathing isn’t enough and pharmaceutical treatment needed

Kyle Staller, Mass General @DDWMeeting

[Dr John O'Donohue @TheBottomDoc]

Practical guide to management of bloating - all in one slide

- Kyle Staller, Mass General Hosptial @DDWMeeting

[Dr John O'Donohue @TheBottomDoc]

The major gas/bloat producers in the gut:

[Dr John O'Donohue @TheBottomDoc]

IBS microbiome subtypes in types of IBS:

Mike Pimentel, Cedars-Sina @DDWMeeting

IBS-C: methanogens
IBS-D: hydrogen sulfide

[Dr John O'Donohue @TheBottomDoc]

SIBO due to just two bacteria: E. coli and klebsiella

[Dr John O'Donohue @TheBottomDoc]

Bloating is equivocal:

[Dr John O'Donohue @TheBottomDoc]

What’s different between patients with bloating & normal controls?

Fernando Azpiroz, Hspital Val d’Hebron @DDWMeeting

Not amount of gas, or biomass.

It’s sensitivity to distension.

Perceived distension can be obesity, or descent of diaphragm (abdominophrenic dyssynergia)

[Dr John O'Donohue @TheBottomDoc]

Management of reflux @DDWMeeting
- hierarchy of management
- where to use PCABS for PPI-refractory reflux
-who are good candidates for an anti-reflux procedure

[Dr John O'Donohue @TheBottomDoc]

Not all FODMAPs are equal! Can we simplify FODMAP restriction in IBS-D?

Prashant Singh, Un of Michigan @DDWMeeting

FODMAP restriction difficult and can result in micronutrient malnutrition

In reintroduction phase, most symptoms due to fructans & galacto-oligosaccharides

[Dr John O'Donohue @TheBottomDoc]

Heather Patton, VA San Diego, CA @DDWMeeting

All patients with compensated cirrhosis should be subclassified as with or without Clinically Significant Portal Hypertension (CSPH)

- and pharmacotherapy used (eg carvedilol) to lower portal pressure

Note NEW terminology!

[Dr John O'Donohue @TheBottomDoc]

However, 40% of patients do not respond adequately to UDCA. Pruritus can be exacerbated by Obeticholic Acid - which can’t be used with decompensated cirrhosis. Elafibrinor, a PPAR agonist, shows promise and improves pruritus.

[Dr John O'Donohue @TheBottomDoc]

New treatment paradigm for PBC (Primary Biliary Cholangitis) - Dr Willscott Naugler, Portland, Oregon

[Dr John O'Donohue @TheBottomDoc]

Don’t need endoscopy to screen for varices in patients with cirrhosis any more - Dr Willscott Naugler, Portland, ON @DDWMeeting

Concept of ‘Clinically significant Portal Hypertension’ - if > 10 mm Hg elevation is present, start on beta blockers to prevent varices, ascites

[Dr John O'Donohue @TheBottomDoc]

EIGHT mistakes doctors make in treating IBD - AVOID THESE!

David T Rubin, University of Chicago @DDWMeeting

[Dr John O'Donohue @TheBottomDoc]

And contraindications:

[Dr John O'Donohue @TheBottomDoc]

Choice of immunomodulatory therapies in IBD:
The story in 2024, summarised in just three slides

David T Rubin (University of Chicago) @DDWMeeting