Kayal Jram (Kayalvizhi Jayaraman)

Gastroenterologist. Interested in EUS, pancreas and life . Working at Prashanth hospitals, Chennai.

[Anand V Kulkarni @AnandVKulkarni2]

The global ACLF consensus @hepinternation1 now online.
@APASL_AARC @APASLnews @AASLDtweets @EASL_ilf @EASLnews @CLEARED_liver
https://t.co/0oNBAwpIot

[Keith Siau @drkeithsiau]

AGA 2025 clinical practice guidelines for Crohn’s disease 📌🆕

📸: https://t.co/9bG9hwxzAK

[VideoGIE Journal @videogie]

Radhika Chavan, MD, DNB, FISG, FASGE, et al present liver anatomy on linear EUS. https://t.co/IePFqvs9ny

#GITwitter

[Dr Aditya Gudheniya @Gastronaut___]

Dietary Patterns in LIVER CIRRHOSIS
Reference - ACG guidelines 2025

[Dr Aditya Gudheniya @Gastronaut___]

Few Key Points on Management of Acute Variceal Bleed (APASL 2025)

•Time-Zero (T0) redefined : T0 = time of first hematemesis, not hospital arrival, to capture the entire pre-hospital course.
•AVB episode duration = 48 hours from T0 (not 5 days as in Baveno VII). Any bleed within these 48 h = same episode.

•“Home-to-Door” time :- ideally 2 hours (acceptable up to 4h in mild cases). Delay >4–6h increases mortality.

•CT scan recommended as a non-invasive diagnostic tool to assess esophageal varices; CECT superior to LSM/MRI for high-risk varices.

•Pre-ER (ambulance) management :- Terlipressin 2 mg bolus can be administered during transport in suspected AVB.

•ER: Start vasoactive agent early : terlipressin/somatostatin/octreotide within 30 min of index bleed (“door-to-needle” time).

•All vasoconstrictors have comparable efficacy in initial control of variceal bleeding. Choice based on availability and comorbidities.

•Prefer terlipressin in AKI :- physiologic benefit and better renal outcomes.

•Continuous terlipressin infusion (4 mg/24h) preferred over intermittent bolus :- higher success, lower dose, fewer complications.

•Tranexamic acid :- may reduce post-EVL ulcer bleeding but does not reduce mortality and carries risk of portal vein thrombosis.

•After endoscopic control, vasoactive drugs may be stopped after 48 h, and NSBB started thereafter.

•Antibiotics : Ceftriaxone preferred; duration can be shortened to 2 days if endoscopic hemostasis is successful (vs 5 days).

•If both EV and GV present, obliterate gastric varices first even if no stigmata of recent bleed on GV.

•Gastric varices bleed less often but more severely; can bleed even when HVPG <12 mmHg due to large blood flow causing rapid and profuse bleeding.

•Key TIPS points :-
•Rescue option for failure to control bleeding.
•Consider early TIPS in high-risk patients (hemodynamic and endoscopic predictors).
•Preferred rescue therapy for refractory GV or PHG bleeding when endoscopic or radiologic options fail.

•Antibiotics are not recommended for acute variceal bleed in non-cirrhotic portal hypertension :- no evidence available.

#GITwitter

[Supriya Sahu IAS @supriyasahuias]

Here is an update - All three satellite-tagged Amur Falcons Apapang (male), Alang (young female) and Ahu (female) are now undertaking their daring Arabian Sea crossing. Apapang has already flown nonstop for 76 hours, covering 3100 km at an average of 1000 km per day, aided by strong easterly tailwinds. From here, the journey becomes even more extraordinary as they head towards Somalia on their epic 3000 km oceanic flight @sureshwii @wii_india #Amurfalcons

[John Damianos, M.D. @john_damianosMD]

Perianal fistulae in Crohn disease

#ACG2025

[Erman Akkus @Erman_Akkus]

🟠HCC guideline updates from @BCLC_group and @BritSocGastro

👉https://t.co/gYQ8EdBGcZ
👉https://t.co/xyI864VRWR

#cancer #oncology #MedX #liver #HCC @OncoAlert @OncBrothers @SuyogCancer

[John Damianos, M.D. @john_damianosMD]

Precancerous gastric lesions

#ACG2025

[John Damianos, M.D. @john_damianosMD]

Acute pancreatitis with @LuisLaraMD1

#ACG2025

[Kayal Jram (Kayalvizhi Jayaraman) @kayal_jram]

@JingWangMD Thanks for sharing . In the diverticulitis slide, it has been mentioned to avoid Fluoroquinolones. Did the speaker give the reason ? Was it for concern over C.difficle ?

[Frontline Gastro @FrontGastro_BMJ]

🩸 The new BSG HCC guidelines demand attention.

This Frontline Gastroenterology review distils what matters most for frontline clinicians:
🔹 Pragmatic, NHS-based treatment algorithm
🔹 Surveillance clarity — who to scan, who not to
🔹 Integration of systemic + local therapies
🔹 Managing bleeding risk in immunotherapy

The message? Current UK HCC outcomes can be improved — prevention, surveillance & access must be optimised.

🔓 Read the full review: https://t.co/LW0jD8d3ya

@basl_events @heppharm @livernursing @LiverAHPs @Liver4Lifeuk @f4liverresearch @IQILS_Liver @LiverTrust @EASLedu @EASLnews @BritSocGastro @BavenoCoop @BCLC_group @ILCAnews @APASLnews @liverfellow @my_ueg @UKCPAGastro
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @drkeithsiau @ebtapper @DrLChina @acv69cardenas @GeriKeane @jamesbmaurice @ClinicLiver

#Hepatology #HCC #LiverCancer #FGJournal #MedTwitter

[The Better India @thebetterindia]

We Have Won! No one can use ‘ORS’ on their label unless it’s a WHO-recommended formula.

This is the story of Dr. Sivaranjani Santosh, a braveheart paediatrician from Hyderabad, who fought for 8 years against sugar-rich drinks falsely marketed as ORS.

Her persistence led to FSSAI’s landmark order, protecting children and patients from misleading claims.

“These drinks had 10x the sugar WHO recommends, worsening diarrhoea and complications in millions of kids,” she explains.

This victory is not just hers, but belongs to everyone who stood with her — doctors, advocates, parents, and citizens demanding truth in labeling.

Scroll down to see how her 8-year battle changed the game for public health and children across India.

Credits : drsivaranjanionline on IG

#HealthVictory #PublicHealthIndia #ChildSafety #TruthInLabelling #FSSAI #DoctorsForChange #IndiaFightsBack

[ORS Ban India, Dr Sivaranjani Santosh, FSSAI Order, Public Health Victory, Sugar Drinks Misleading Labels]

[Kayal Jram (Kayalvizhi Jayaraman) @kayal_jram]

@jalpa_devi @WashUMedIBD @CiorbaGI @P_DeepakIBDMD @UNMC_GIHEP @kehutchins77 @IBDimmunology @DCharabaty @AmerGastroAssn @AmCollegeGastro @ACG_EBGI @JosephHabibi_MD @ScrubsNHeels @saia_ibd @ibdseb Congratulations Jalpa ! Great news!

[Kayal Jram (Kayalvizhi Jayaraman) @kayal_jram]

@SiddikiGI Is the stent being placed in a spontaneous colopancreatic fistula ?

[Jalpa Devi @jalpa_devi]

🥙 recipe for ASUC 🩺! By @Marylandibddoc

[Tom Tielleman, MD @TomTielleman]

Gen GI Fellow Teaching: Do you know the different ways to know how many bands are left on the @bsc_endoscopy banding kit? Fellows are often taught the second to last band is white, but did you know that if you lose track that you can count the knots on the bander at any time?

[Ali Rezaie MD MSc @AliRezaieMD]

IBD/IBS overlap is common and challenging. Here is a practical guide for the evaluation and diagnosis led by @GIJANE_MD
https://t.co/xdiefz684s
#IBSawarenessmonth

[Kayal Jram (Kayalvizhi Jayaraman) @kayal_jram]

@EndoCollabcom Could you share video of inverted diverticulum and the differentiating features from a sessile polyp?

[Kayal Jram (Kayalvizhi Jayaraman) @kayal_jram]

@GerlyEdson @EndoCollabcom @KMonkemuller @ASGEendoscopy @DHgua @EndoscopiaH @ESGE_news @RevGastroPeru @SEEDendoscopia @sepdigestiva @WorldGastroOrg @sied_noticias Thanks for sharing . Tough case . Was the splanchnic vein thrombosis recent or chronic ? Portal biliopathy could be the reason for bleed I think .