Daniel Conde

Internal Medicine resident UAMS-Northwest 🇺🇸🇪🇨🇲🇽 🐗 Universidad Autónoma de Guadalajara

[Beatriz Gros @Bealoquebea]

Health literacy is not “just education”

In inflammatory arthritis, lower ability to find, understand &use health information is linked to worse physical, mental, treatment &work outcomes

This matters in IBD too

Evidence-based online education can empower patients and support better shared decision-making

https://t.co/ohNKKzJDmi

@TheLancet @LancetGastroHep

[JAMA @JAMA_current]

💬 Perspective: Bayesian methodology supports efficient, flexible clinical trial designs; FDA guidance encourages prespecification and sensitivity analysis of priors.

https://t.co/lmMitu7aYY

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🩺 Cirrhosis is no longer just a “liver disease.”

This review summarizes how inpatient cirrhosis management has fundamentally evolved from static “end stage liver disease care” into dynamic risk stratification and organ support.

One of the most important modern concepts highlighted:

⚠️ “Cirrhosis” is increasingly being replaced by the concept of compensated advanced chronic liver disease (cACLD).

A particularly important ICU and ward management point:

🩸 Variceal bleeding management has changed.

Modern evidence supports:
• restrictive transfusion strategy
• early vasoactive therapy
• early antibiotics
• rapid endoscopy
• selective early TIPS in high risk patients

One major physiological misconception continues to harm patients:

❌ Elevated INR in cirrhosis does NOT equal auto anticoagulation.

Cirrhosis creates a “rebalanced” coagulation state where patients can simultaneously:
• bleed
AND
• thrombosis

This explains why routine FFP correction before paracentesis is no longer recommended and why portal vein thrombosis remains common.

Another critical update:

💧 Ascites management is not simply “give diuretics.”

The review reinforces that:
• sodium restriction is foundational
• albumin remains physiologically crucial
• aggressive fluid shifts can precipitate renal collapse
• diagnostic paracentesis should be routine in hospitalized patients with ascites, even without symptoms

Perhaps one of the most important modern concepts:

🧠 Hepatic encephalopathy is not merely “high ammonia.”

The article emphasizes:
• systemic inflammation
• infection triggers
• electrolyte disturbances
• medications
• renal dysfunction
• gut microbiome interactions

as central drivers of encephalopathy.

And importantly:

🍖 Protein restriction is now contraindicated.

This is a major paradigm shift from older teaching.

Patients with cirrhosis require:
• aggressive nutritional support
• high protein intake
• sarcopenia prevention
• late night protein supplementation

One of the strongest messages of the paper:

⚠️ Every hospitalization for decompensated cirrhosis should trigger transplant thinking.

Not “end stage management.”
Not passive stabilization.

But active reassessment of:
• prognosis
• reversibility
• candidacy
• goals of care
• frailty
• transplant referral timing

For intensivists and hospitalists, cirrhosis management is increasingly becoming a discipline of: • hemodynamic physiology
• renal protection
• inflammation control
• nutritional optimization
• procedural timing
• multidisciplinary coordination

rather than isolated hepatology alone.

📖 Rogal S. Inpatient Management of Patients With Cirrhosis. Annals of Internal Medicine. 2026. doi:10.7326/ANNALS-26-00513

[Beatriz Gros @Bealoquebea]

Thank you @ShahidaDin1 @ross_j_porter @eathar_s for this great time discussing colorectal cancer surveillance in IBD

And thank you @FrontGastro_BMJ for the support

[United European Gastroenterology @my_ueg]

PEI is common, frequently unrecognised – and not a 'pancreas-only problem.' New 'Mistakes in…' article unpacks the key clinical pitfalls: from overinterpreting faecal elastase results to insufficient nutritional assessment.

Full article on Gutflix 🔗 https://t.co/j3uvPrRWko

[JAMA @JAMA_current]

📊 JAMA Clinical Guidelines Synopsis: #CrohnDisease guidelines recommend fecal calprotectin for screening and monitoring, routine colonoscopy for colorectal cancer, and oral budesonide for induction in mild to moderate ileocecal disease.

https://t.co/s9czp8Szkn

[American Gastroenterological Association (AGA) @AmerGastroAssn]

Join us for a live, patient-centered recap of #CCC2026! Hear insights from patient reporters Ian Goldstein & Victoria Tyler, and IBD experts @KrugCleveland & @AdamFayeMD.

Presented in partnership with @CrohnsColitisFn.

📅 Feb. 26, 2026
⏰ 8–9 p.m. ET
🔗 https://t.co/Th07B6TWtG

[Tauseef Ali MD, FACG AGAF FACP @ibdtweets]

IBD Journal Scan 📚
New nationwide data (>54,000 pts) in Clinical Gastroenterology & Hepatology (Feb 2026) shows:
No dysplasia → ~2.3% progression
Indefinite → ~5.3%
Low-grade → ~8.3%
High-grade → ~40% CRC (often within 1 year)
Dysplasia grade = risk signal.
Personalized surveillance prevents advanced CRN.
DOI: 10.1016/j.cgh.2026.01.043

Great work by @DrJordanAxelrad
@AdamFayeMD and the team

https://t.co/J3iCvd9hzx

[Beatriz Gros @Bealoquebea]

Great initiative! It takes less than 5 mins please help @edyta_tul

[Therapeutic Advances in Gastroenterology @TAGastroenterol]

This review highlights the expanding role of JAK inhibitors in managing extra‑intestinal manifestations of IBD, including joint and skin involvement, while noting the need for more targeted evidence. #JAKinhibitors #IBDEIMs #GIResearch #Clinicalresearch https://t.co/YafeVRenBB

[Beatriz Gros @Bealoquebea]

🧵 Can past response to steroids predict future response in patients with UC?

We tried to answer a question clinicians face every day—but that has surprisingly little data behind it

[Frontline Gastro @FrontGastro_BMJ]

👀 Missed this last month?

This paper distils the BSG IBD colorectal surveillance guidelines into a sharp, usable summary for everyday GI practice.

https://t.co/vTLxNLJKgq

@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @JonnyBlackwell @alenkabrooks @DCharabaty @jennie_clough @rachelcooney7 @DisneyBen @bealoquebea @jklimdi @wingyanjoyce @jonathansegal85

#IBD #Colitis #Crohns #ColorectalCancer #Surveillance #Endoscopy #GIEndoscopy #ClinicalGuidelines #PatientSafety #MedEd

[Frontline Gastro @FrontGastro_BMJ]

🚨 ⚠️ IBD SYSTEMATIC REVIEW 🚨 ⚠️

📄 14 articles
✏️ 11 different tools to measure health literacy
🌏 Marked geographical variation was observed in the prevalence of limited HL:
- highest rates in China (31–86%)
- lowest rates in the USA (4–40%)
🏥 Limited HL was associated with reduced QoL, patient knowledge and self-management skills, but no association was found with adverse clinical IBD outcomes.

With thanks to Dr Robertus JB Pierik and co-authors for this fantastic contribution to the journal! @LauranneDerikx

Read the full paper here 👇 👇 👇

https://t.co/5ijt254Mf2

@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @JonnyBlackwell @alenkabrooks @DCharabaty @jennie_clough @rachelcooney7 @DisneyBen @bealoquebea @jklimdi @wingyanjoyce @jonathansegal85

#IBD #CrohnsDisease #UlcerativeColitis #IBDResearch #IBDAwareness #IBDLife #IBDCommunity #GutHealth #DigestiveHealth #ChronicIllness #IMID #Gastroenterology #MedTwitter #MedEd #AcademicTwitter

[The Lancet Gastroenterology & Hepatology @LancetGastroHep]

New research - Efficacy and safety of subcutaneous guselkumab induction therapy in participants with moderately to severely active ulcerative colitis (ASTRO): a double-blind, treat-through, randomised, placebo-controlled, phase 3 trial

https://t.co/WhBmg8MWfW

#GITwitter

[John Damianos, M.D. @john_damianosMD]

❗️Appendectomy was found to be superior to switching to a JAK inhibitor among patients with active ulcerative colitis exposed to advanced therapies. Higher clinical response, clinical remission, steroid-free remission, and endoscopic response.

https://t.co/xVGOAyV3Nj

[EndoCollab™ | GI Endoscopy Community @EndoCollabcom]

Recommendations for Endoscopic Removal of Colorectal Lesions

via @ASGEendoscopy

[Enveda @lifeschemistry]

One more thing.

We have received another FDA IND clearance and have initiated Phase 1 for ENV-6946, bringing our total to three first-in-class, novel, nature-inspired molecules in the clinic.

ENV-6946 is an oral small molecule engineered for the potential to treat inflammatory bowel disease, designed as a “multi-biologic in a pill.” It simultaneously targets TNFα, IL-23, and TL1A signaling in the gut without requiring separate injectable therapies.

Millions of people live with IBD, with far too few efficacious, safe, durable, and convenient options available. ENV-6946 represents a new path forward – one designed for efficacy, safety, and simplicity.

With ENV-294, ENV-308, and now ENV-6946 in clinical development, we continue to demonstrate:

• The ingenuity of nature
• The power of our platform
• The pace and commitment of our team

Onward.

Read more: https://t.co/GH04ifkwyb

[EndoCollab™ | GI Endoscopy Community @EndoCollabcom]

Finally: a global consensus on defining small bowel strictures in Crohn's disease

By Dr Miguel Regueiro

[Duke GI @Duke_GI_]

This week is Crohn’s & Colitis Awareness Week.
🟣 Nearly 3M Americans live with IBD conditions, often invisible but certainly life-changing.
🟣Join Duke GI in raising awareness & supporting all affected.
💜 #IBDAwareness #IBDLooksLike #CrohnsAndColitisAwarenessWeek #IBDVisible

[Beatriz Gros @Bealoquebea]

Pregnancy and the post pregnancy period
Fantastic talk by @UmaMahadevanIBD
#womeninIBD @_MDEducation