Gastronomer

Short tweetorials 🧵 on Gastroenterology and hepatology.
Making learning fun for IM residents and GI Fellows 🔫.
Account run by a GI fellow :)

[Gastroenterology @AGA_Gastro]

ADMIRE CD II, a global phase 3 randomized trial, found no significant difference between darvadstrocel and placebo for combined remission in patients with #CrohnsDisease and complex perianal fistulas. Furthermore, no new safety signals were identified.
🔗 https://t.co/63Fl6wfIbe

[Indian Journal of Gastroenterology @IJG_Journal]

PRESIDENT PROFILE

Dr. Pramod Kumar Garg: President, Indian Society of Gastroenterology- 2026
by @UshaPGIMER

https://t.co/Qxd7gCyL0w

[Gastronomer @Middle_class_xo]

TDF & TAF are best taken with meals 🍽️
Entecavir should be taken on an empty stomach ⏳
#MedTwitter #Gastrotwitter #GastroX

[Gastronomer @Middle_class_xo]

@Gastronaut___ @pgholam Why propranolol when you have carvedilol?

[Gastronomer @Middle_class_xo]

💧 Cirrhosis + ascites + normal Na?
👉 No free water restriction — only salt restriction is needed.
Fluid restriction only if Na <125 mmol/L.
Otherwise, it worsens nutrition & QoL.

(AASLD 2021, EASL 2018)
#Cirrhosis #MedTwitter

[Gastronomer @Middle_class_xo]

Upper GI involvement in Crohn’s disease🧵

1. Upper GI involvement in CD: 3–16%.

2. Adults: Routine UGIE is not recommended, except when upper GI symptoms are present.

3. Children <17 years: Routine UGIE is recommended at diagnosis to screen for upper GI involvement.

#IBD #CD

[Gastronomer @Middle_class_xo]

8/ Clinical Pearl 💡
Always combine LS with clinical (CDAI/HBI), biomarkers (CRP, fecal calprotectin), and imaging (MRE/CTE) before treatment changes.
Have you ever used LS?

[Gastronomer @Middle_class_xo]

Lewis Score in Crohn’s disease (CD) with Capsule Endoscopy 🧵

Capsule endoscopy allows direct visualization of small bowel mucosa in IBD.
But how do we quantify inflammation? 🔍
➡️ Lewis Score (LS) is the most widely used index.

#MedTwitter #Gastrotwitter #GastroX #IBD

[Gastronomer @Middle_class_xo]

7/ Limitations

Cannot distinguish IBD from NSAID enteropathy

Only mucosal (not transmural)

Inter-observer variability

Stricture = risk of capsule retention

[Gastronomer @Middle_class_xo]

Takeaway 📝

Vienna: first, simple

Montreal: Adult, standard

Paris: pediatric, most detailed

BSG IBD guidelines 2025 recommends using Montreal for adults and Paris for children.

[Gastronomer @Middle_class_xo]

Classifications of Crohn’s Disease 📚
🧵 Vienna ➡️ Montreal ➡️ Paris — let’s compare!
#MedTwitter #Gastrotwitter #GastroX #IBD

[Gastronomer @Middle_class_xo]

3️⃣ Paris (2011, Pediatric)

Age: A1a <10, A1b 10–17, A2 ≥17

Location: L1 ileal, L2 colonic, L3 ileocolonic, L4a proximal, L4b distal small bowel

Behaviour: B1 inflammatory, B2 stricturing, B3 penetrating, B2B3 both

Modifiers: G0/G1 growth, +p perianal

Adds growth -for kids.