Kevin Cesa

Husband, Girl Dad , Peds GI fellow

[Kevin Cesa @KTCesa]

For Halloween I am going dressed as Maryland Physicians Care - I could not think of anything scarier

[NASPGHAN @NASPGHAN]

NASPGHAN member advocates on Capitol Hill asking lawmakers to protect pediatric GI patients from insurance company tactics like #FailFirst protocols and non-medical switching that delay or deny access to prescribed biologic therapy. Calling on Congress to pass the #SafeStepAct!

[Golden State Warriors @warriors]

Steve Kerr on today's tragic shooting in Uvalde, Texas.

[Waseem Ahmed @Waseem_AhmedMD]

Happy Friday!!! Here is today's algorithm for Monday's fantastic @MondayNightIBD discussion by @KTCesa & @SCKimCHP on the cardiac manifestations of IBD. My take home point: keep your stethoscope handy :). @DCharabaty @Empoweringpts9 #IBDalgorithm.

[Kevin Cesa @KTCesa]

@MondayNightIBD @Waseem_AhmedMD @SCKimCHP @DCharabaty @Empoweringpts9 4) Reoccurrence 10-40% pt
Colchine/Anakinra reduces reoccurrence 50%-70% in RCT (non IBD pts)

Case Reports of EIM myocarditis resolving with control GI disease
UC pt developed fulminant myocarditis requiring ECMO➡��Started IFX ➡️Cardiac/GI disease improved

[Kevin Cesa @KTCesa]

@MondayNightIBD @Waseem_AhmedMD @SCKimCHP @DCharabaty @Empoweringpts9 3) Myocarditis/Pericarditis EIM diagnosis of exclusion (R/O infection, hypersensitivity reaction, toxins)
EIM carditis occur during active/quiescent disease

Treat for relief of symptoms, ⬇️ ❤️🔥, and ⬇️ recurrence
Steroids #1
NSAIDs often insufficient

[#MondayNightIBD @MondayNightIBD]

#ThursdayThanks to

🥇@KTCesa @SCKimCHP for putting the 🫀on the #IBD map!

🔦As an #EIM site
🔦Potentially affected by 💊 Side effects

🥇#MondayNightIBD🏘 for sharing their expertise on #myocarditis #pericarditis in IBD, & for keeping our patients at the 🎯💜 of what we do!

[Kevin Cesa @KTCesa]

@doctorboletoh @MondayNightIBD @SCKimCHP @DCharabaty Interesting thought. Tofacitinib has been used in immune-mediated myocarditis with no increase in adverse CV outcomes in IBD pts seen

https://t.co/xOWPktaNDX
https://t.co/ho4BuKa9Nf

[Kevin Cesa @KTCesa]

@JVG_GIMD @DCharabaty @P_DeepakIBDMD @SchairerIBDMD @MondayNightIBD @SCKimCHP @sabpeds @IBD_Houston Myocarditis presenting as an #EIM of IBD is a diagnosis of exclusion. Agree that biopsy to evaluate other etiologies, including covid, could be helpful
https://t.co/lr1GOxzunZ

[Kevin Cesa @KTCesa]

@P_DeepakIBDMD @DCharabaty @SchairerIBDMD @MondayNightIBD @SCKimCHP @sabpeds @IBD_Houston Also monitor cardiac status: systolic function with echos, cardiac biomarkers (CK-MB, Troponin), EGGs

[Kevin Cesa @KTCesa]

@ibdtweets @DCharabaty @SCKimCHP @MondayNightIBD @moss_md @EdwardLoftus2 @IBDMD @Kpmollen @SunandaKaneMD @DarrellPardi @DavidHudesmanMD @sang_hyoung @theng_gan @ErinMichos @SaraElOualiMD @MRegueiroMD Current pt differs from ATTACH trial cohort where pts had pre-existing NYHA III/IV HF. That trial also showed modest increase in ejection fraction in low dose IFX (5 mg/kg) group #mondaynightIBD

https://t.co/SHi08GGWD9

[Kevin Cesa @KTCesa]

In pediatric Acute Covid myocarditis, pt have higher CRP, but prompt recovery of ❤️ function and 🔻adverse outcomes (including death) compared to covid unrelated myocarditis
https://t.co/8uI1Ou3o5n

[Kevin Cesa @KTCesa]

@DCharabaty @SchairerIBDMD @MondayNightIBD @SCKimCHP @sabpeds @IBD_Houston @P_DeepakIBDMD Very true! Both peri- and myocarditis may develop independently of IBD activity. Some case of carditis also occur pre-IBD diagnosis. This adds to the difficulty of diagnosis/management in these cases!
https://t.co/4Pzj1FxdMq

[Kevin Cesa @KTCesa]

@P_DeepakIBDMD @DCharabaty @SchairerIBDMD @MondayNightIBD @SCKimCHP @sabpeds @IBD_Houston Great Thought! It was ruled out in the above case. Also no pediatric cases of #covid, #myocarditis, #IBD reported

[Kevin Cesa @KTCesa]

@MondayNightIBD @SCKimCHP @DCharabaty Anakinra shown to reduce the risk of #recurrent pericarditis compared to placebo in RCT. No impact on #IBD inflammation. No case reports in the literature for #IBD EIM myocarditis or pericarditis

https://t.co/L4n8WZiUv1

[Kevin Cesa @KTCesa]

@MondayNightIBD @SCKimCHP @DCharabaty https://t.co/SBRpBpP7Xv
https://t.co/k524Z1htot

[Kevin Cesa @KTCesa]

@MondayNightIBD @SCKimCHP @DCharabaty Treatment of #EIM Myocarditis/Pericarditis based on the relief of symptoms, decreasing inflammation, and the prevention of recurrence. Steroids are most common first line treatment. NSAIDS used rarely, since often insufficient and associated with IBD flares.