Dr Adil Hassan Chang, FCPS, MACG, CHPE

Assistant Professor,
Consultant Gastroenterologist & Hepatologist.
Passionate for Advance Endoscopy |
Son, Husband & Father.

[Dr Adil Hassan Chang, FCPS, MACG, CHPE @dradilchang]

#ACG New Guideline on UGIB 📛🔴

Glasgow Baltchford Score (GBS) as a tool to categorize patients in:

1. Very-low risk ❗
(Discharge from ER)

2. Not very-low risk❗
(Admit & Resuscitate)

@AmCollegeGastro @AmJGastro
@drbughio @helpatologist
@sksadiksk
https://t.co/zGkAagcXeY

[Dr Adil Hassan Chang, FCPS, MACG, CHPE @dradilchang]

@DrAshokGastro Excellent

[Frontline Gastro @FrontGastro_BMJ]

Nutrition in cirrhosis: practical, powerful and too often under-prioritised. 🍽️🧡

This @FrontGastro_BMJ review offers a practical approach to nutrition in people with cirrhosis — from screening and sarcopenia to protein targets, late evening snacks and multidisciplinary support. 💪🩺
Essential reading for hepatology teams aiming to make nutrition a core part of liver care.

Read more: https://t.co/zIH44ZGKEv

#Cirrhosis #Nutrition #Sarcopenia #Hepatology #ClinicalNutrition #FrontlineGastro #GItwitter #LiverTwitter #DietitianTwitter #PatientCentredCare @bhmullish @lukelikeslivers @ImperialNHS @imperialcollege @BritSocGastro @my_UEG @AmCollegeGastro @DDWMeeting @EASLnews @AASLDtweets @BAPENUK @DrLChina @acv69cardenas @GeriKeane @jamesbmaurice @drobeirne @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman

[Dr Adil Hassan Chang, FCPS, MACG, CHPE @dradilchang]

Eid Mubarak 2026

[Dr Adil Hassan Chang, FCPS, MACG, CHPE @dradilchang]

https://t.co/yvQEsnxYhy

[Keith Siau @drkeithsiau]

Best abstract award (2 of 2) at #ESGEDays2026 goes to Mike de Jong for the FLUYT2 trial on post ERCP pancreatitis prevention after pancreatic duct cannulation. The study supports routine PD stenting, but ideally NOT with a straight plastic stent 👏🏆

[Ramon Bataller @rabataller]

Alcohol is a carcinogen. Patients with alcohol liver disease (ALD) have higher cancer risk.

A large meta-analysis shows >2x increased risk of de novo malignancies in ALD patients after liver transplantation.

👉 We need systematic, intensified cancer surveillance.

[Dr.Marlon Villanueva™ 🩺 𝕏 @MarlonVFZR]

🧪 𝗙𝗜𝗕-𝟰: 𝗳𝗶𝗯𝗿𝗼𝘀𝗶𝘀 𝗵𝗲𝗽𝗮́𝘁𝗶𝗰𝗮 𝗲𝗻 𝟯𝟬 𝘀𝗲𝗴𝘂𝗻𝗱𝗼𝘀
⬇️⬇️⬇️⬇️

📊 𝙌𝙪𝙚́ 𝙚𝙨
👉 Score no invasivo → estima fibrosis avanzada (F3–F4)

🧮 𝙁𝙤́𝙧𝙢𝙪𝙡𝙖
👉 Edad × AST / (Plaquetas × √ALT)

🎯 𝙄𝙣𝙩𝙚𝙧𝙥𝙧𝙚𝙩𝙖𝙘𝙞𝙤́𝙣

* 🟢 <1.3 → bajo riesgo
* 🟡 1.3–2.67 → zona gris
* 🔴 >2.67 → alto riesgo → derivar

⚠️ 𝘼𝙟𝙪𝙨𝙩𝙚𝙨 𝙘𝙡𝙖𝙫𝙚

* 👴 >65 años → corte bajo riesgo ≈ 2.0
* 🏋️ Ejercicio → ↑AST → falsos positivos

🧠 𝘾𝙪𝙖́𝙣𝙙𝙤 𝙪𝙨𝙖𝙧
👉 Tamizaje en NAFLD, hepatitis crónica, hallazgos incidentales

🔥 𝙈𝙚𝙣𝙨𝙖𝙟𝙚 𝙘𝙡𝙖𝙫𝙚
👉 El FIB-4 no diagnostica fibrosis…
👉 𝙙𝙚𝙘𝙞𝙙𝙚 𝙦𝙪𝙞𝙚́𝙣 𝙉𝙊 𝙣𝙚𝙘𝙚𝙨𝙞𝙩𝙖 𝙢𝙖́𝙨 𝙚𝙨𝙩𝙪𝙙𝙞𝙤𝙨 𝙮 𝙦𝙪𝙞𝙚́𝙣 𝙣𝙤 𝙥𝙪𝙚𝙙𝙚𝙨 𝙙𝙖𝙧𝙩𝙚 𝙚𝙡 𝙡𝙪𝙟𝙤 𝙙𝙚 𝙞𝙜𝙣𝙤𝙧𝙖𝙧

🧠𝙂𝙪𝙖𝙧𝙙𝙖 𝙚𝙨𝙩𝙚 𝙝𝙞𝙡𝙤 𝙥𝙖𝙧𝙖 𝙩𝙪 𝙜𝙪𝙖𝙧𝙙𝙞𝙖 🏥

‼️Si te sirve: ❤️ Me gusta | 🔁 Repost | ➕ Follow para más #MedED en #ClubCrit 😄🧠🫶

👇🏼👇🏼👇🏼👇🏼
📚📖#ClubCrit

#HepaticFibrosis #icu #intensivecare #diagnosis #POCUS #VExUS #management #MedicinaBasadaEnEvidencia #Terapia #MedEd #Medicina #FOAMed #FOAMcc #CuidadoCrítico #MedX #EducaciónMédica #MedIntensiva #MedXCommunity #MedicinaCrítica #MedED #CritCare #ICUManagement #MustRead #LecturaRecomendada

[Razia Aliani @RaziaAliani]

Golden rules for writing research that gets published
Save it for your next manuscript & Retweet to help your network!

— Pick concrete words over abstract ones
— Write for your readers, not yourself
— Use your natural voice, then polish
— Tell a focused story - stay on track
— Own your work and decisions
— Make confident statements
— Cut unnecessary words
— Keep examples simple
— Stay self-aware

𝗪𝗵𝗮𝘁'𝘀 𝘆𝗼𝘂𝗿 𝘁𝗼𝗽 𝘁𝗶𝗽 𝗳𝗼𝗿 𝗰𝗹𝗲𝗮𝗿 𝗿𝗲𝘀𝗲𝗮𝗿𝗰𝗵 𝘄𝗿𝗶𝘁𝗶𝗻𝗴?

----------------
𝗙𝗼𝘂𝗻𝗱 𝗶𝘁 𝘂𝘀𝗲𝗳𝘂𝗹?
🔄 Retweet (& like)

+ follow + 🔔
I test AI tools to simplify your #research & #analysis
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[Dr Adil Hassan Chang, FCPS, MACG, CHPE @dradilchang]

@DeMadaria @EdgardLozada @GIPapachristou @bejjani_joseph @WiqasAhmad8 @DigestivoHRyC @DrCasals @93Ezquerra @DarylRamai @RodriguezGandia @luciamajano12 @digestivoHGUGM @EvitaMM81 @jalpa_devi @gastrochus @NataliaCorzo12 @DCebSan @GuillermoGR87 @Enriqueceamanos congratulations 🎊

[Amitabh Yaduvanshi MD, DM, FACC, FSCAI @IntervnCardio]

1/9
The 2026 ACC/AHA Dyslipidemia Guidelines are officially here!
Replacing the 2018 guidelines, these new updates bring major shifts in risk assessment, novel lipid markers, and cholesterol targets.
Here are the most salient features you need to know. 🧵👇
#Cardiology #MedTwitter

[Al Jazeera English @AJEnglish]

Spain’s PM Pedro Sanchez has condemned the US-Israel war on Iran as a breach of international law, emerging as one of the sole Western leaders to denounce the attacks.

[AJG - The American Journal of Gastroenterology @AmJGastro]

ACG-@ASGEendoscopy Quality Indicators for ERCP
Anderson, et al.

📕 https://t.co/QSOPS63Ocv

@MLongMD @JasmohanBajaj

[CME INDIA @CMEINDIA1]

SGOT (AST) in Liver Function Tests: Clinical Significance
(CME INDIA)
Serum glutamic-oxaloacetic transaminase (SGOT), now termed aminotransferase (AST), is a transaminase enzyme present in both the cytosol and mitochondria of hepatocytes and in high concentrations in cardiac muscle, skeletal muscle, kidney, brain, and red blood cells. Hence, AST is a sensitive but relatively non-specific marker of hepatocellular injury.

AST elevation reflects cellular necrosis or membrane leakage but does not exclusively indicate hepatic origin.

Degree of Elevation – Diagnostic Implications

• Mild elevation (≤2–3 × ULN)
Seen in MASLD, alcohol use, chronic viral hepatitis, hypothyroidism, statin therapy, strenuous exercise, and muscle disorders.

• Moderate elevation (3–10 × ULN)
Suggests acute viral hepatitis, autoimmune hepatitis, evolving ischemic hepatitis, or significant drug-induced liver injury.

• Marked elevation (>10–20 × ULN)
Classically seen in ischemic (shock) liver, acetaminophen toxicity, acute viral hepatitis, severe autoimmune hepatitis, and massive hepatic necrosis.

AST vs ALT – De Ritis Ratio (AST/ALT)

This ratio provides crucial etiologic clues:

• AST/ALT <1 → MASLD, viral hepatitis (ALT predominant)
• AST/ALT >1 → Advanced fibrosis or cirrhosis
• AST/ALT ≥2 → Strongly suggestive of alcohol-associated liver disease (mitochondrial AST release)
• Very high AST with modest ALT → Ischemic injury, muscle breakdown, or hemolysis

Extra-Hepatic Causes of Raised AST (Key Pitfall)

Because AST is widely distributed:

• Myocardial infarction
• Myositis, rhabdomyolysis, strenuous exercise
• Hemolysis
• Hypothyroidism
• Macro-AST (benign persistent elevation)

Always correlate with:

ALT

CK / LDH

Clinical context

Important Clinical Pearls

• AST is less liver-specific than ALT and should never be interpreted in isolation.
• Mitochondrial AST predominance explains high AST in alcoholic liver disease.
• Rising AST with falling ALT may indicate progression to advanced fibrosis or cirrhosis.
• Normal AST does not exclude chronic liver disease.
• Disproportionately high AST with normal bilirubin may point to muscle or cardiac pathology rather than liver disease.

Interpretation in the Present LFT Context

Reported SGOT (AST): 51.6 U/L (mild elevation)

With:

Normal ALT (29.5 U/L)

Predominantly indirect hyperbilirubinaemia

Normal ALP

This pattern suggests: • Mild hepatocellular stress, or
• Non-hepatic AST source, or
• Early/resolving hepatic injury

Alcohol use, muscle injury, hemolysis, or Gilbert’s syndrome with intercurrent stress should be considered.

Take-Home Message

AST is a sensitive but non-specific marker of hepatocellular injury. Its greatest diagnostic value lies in interpretation alongside ALT and the AST/ALT ratio, which provides powerful clues to alcohol-related disease, fibrosis, and ischemic injury.

[Dr Adil Hassan Chang, FCPS, MACG, CHPE @dradilchang]

@DeMadaria Great
Would love to be part of it.

[Dr Adil Hassan Chang, FCPS, MACG, CHPE @dradilchang]

@CUGastroHep @BilalMohammadMD @JChristieMD @vineet_chopra @CUAnschutz @CUDeptMedicine MASHA ALLAH congratulations 🎊

[EndoCollab™ | GI Endoscopy Community @EndoCollabcom]

📊 1 in 7 patients with dysphagia and normal-looking mucosa have EoE.

That's why the 4-14-4 biopsy protocol isn't optional—it's essential:
The Protocol:

Proximal: 4 biopsies at 14 cm above GEJ
Distal: 4 biopsies at 4 cm above GEJ
Keep specimens separate

The Payoff:
Diagnostic yield of 15% in macroscopically normal esophagus

Your endoscopy report might say "normal," but the pathology could tell a different story.

[Ramon Bataller @rabataller]

New insights on assessing LIVER FIBROSIS with NON-INVASIVE TESTS, just released by @NEJM:

- Key techniques &amp; thresholds.
- Practical algorithms &amp; actionable steps.
https://t.co/KkPHLNaLh3

[Aravind Palraj @Rheumat_Aravind]

🧵 A detailed thread 👇
📌 Understanding ESR – Erythrocyte Sedimentation Rate

Tweet 1:
A simple blood test, yet a powerful clue in medicine. But what exactly does it measure? And how do we interpret it correctly? 🩸🔬
@IhabFathiSulima @DrAkhilX @CelestinoGutirr @RACC_UK @Drkhenaizan #MedTwitter #RheumatX

[EndoCollab™ | GI Endoscopy Community @EndoCollabcom]

A 60-year-old man with hypertension, heart disease, and bowel issues was hospitalized for worsening anemia despite taking oral iron supplements.

https://t.co/JOCngeLRY4