She/Her,
#IBD
-Gastro, numbers geek, Prev. Chair of EDI at CAG; Div. Head
@UofTGastroHep
, mom of 3, π³οΈββ§οΈ-doc and allyβ¦.
I have Financial and Cognitive
#COIs
@DougJBalloon
Sure, cannibalism is wrong. I guess.
But there is something transcendent about the essence of a fellow traveller entering every cell of your body, he and you becoming one.
Who can argue. The heart wants what the heart wants.
And in this case, itβs more delicious heart.
ππIs UPAdacitinib the most important drug development since anti-TNFs?
πIs it even any different than existing JAK inhibitors?
πLet's breakdown this paper, and see if the promise matches the premise
What is VOROPRAZAN???
Is it going be your treatment of choice for erosive esophagitis?
Should it?
...a π§΅where I break down (and take-down) the following article
I am the director of a major medical division at Canadaβs largest medical school, a mother to 3 amazing boys, a former jeopardy champ, and Iβm trans
god forbid your child should someday grow up to be like me..
@BrynnTannehill
The right is using the Nashville shooting as a pretense to a Kristallnacht against trans people
For those of you less familiar with the history of scapegoating a people for the acts of an individual, read about Herschel
Grynszpan
85% of gastroscopies for dyspepsia are completely normal
Another 14% have findings that respond to empiric therapy
100% of you are going to keep on doing gastroscopies for dyspepsia like youβre making a difference
Congratulations to our successful Senior Promotion candidates for 2021
Dr. Jordan Feld - Promoted to Full Professor on Excellence in Research
Dr. Hemant Shah - Promoted to Associate Professor on Excellence in Creative Professional Activity
@UofTDoMChair
@UHN
@UofTGastroHep
#TDOV
#
To everyone out there who is struggling with making the step
That, although it may seem impossible right now, let me tell you thisβ¦..
That you can have this
1/
Although I didn't make it to πΈπͺπΈπͺ for
#ECCO2024
, I could still feel the seismic waves from the
@ProfileCrohn
(PROFILE) study back in π¨π¦π¨π¦
So will this article change the face of medical management of Crohn's Disease
Let's dive right in
a π§΅π§΅
Starting feb 1, Ontario IBD patients will no longer require months of ineffective therapy prior to starting certain biolΓ³gics!
Probably a decade too late but an important step in the right direction for
@ontario_gastros
and their patients!
Got a moment or two to SPARE??
Let's breakdown this high impact paper on the benefits and drawbacks of discontinuing anti-TNFs or antimetabolites in Crohn's Disease!
I am a physician. I am an academic researcher. Someone put me in charge of a University Division for some reason. I am a mother of 3. I am funnier than I look, which says a lot. I like to sweat and I really like to swear.
And
#IAmAlsoTrans
I am a parent. I am a writer. I am a software engineer. I am a musician. I am a wife and cat mom. I love to read and go for long walks. I love my friends. Iβm bad at math. Iβm great at making puns. I am also trans.
Who are you, in addition to being trans?
#IAmAlsoTrans
ππCAN WE REALLY PREVENT IBD BY ADOPTING A HEALTHY LIFESTYLE ππ
ππSHOULD WE BE COUNSELLING ARE HIGH RISK PATIENTS ππ
Let's break down this week's article by
@LopesScopes
@khalili_MD
and colleagues!
a π§΅
#GIPubBreakdown
ππ
#GIPaperBreakdown
#4
β£
Today we breakdown whether DUPILUMAB is the best treatment currently available for Adults and Adolescents with Eosinophilic Esophagitis
Is it...
β‘οΈ DUP! There it is!
OR
β‘οΈ Have we been DUPed?
It's TACOS Thursday!!!!
Do JAK-Inhibitors have a role as an adjunct to corticosteroids in Acute Severe Ulcerative Colitis?
Let's review this important paper changes should change how we manage our highest risk UC patients!dya
Don't look now but X (formerly Twitter) quietly restored their ban on misgendering and deadnaming trans people - as long as it's reported by the target.
When I was 10, My sister and I had a science fair project where we raced a female hamster vs a male hamster in a maze to see who was smarter.
The male won, and we took the gold medal
Later we learned both hamsters were female
We published it in American Journal of EmergMed
1/ As promised, and as inspired by
@UofTGastroHep
superβοΈ residents
@youstinahanna13
and Dr. R. Khan
Is UPADACITINIB effective in the treatment of CD??
Where does UPADACITINIB fit in the treatment landscape in CD?
a new Tweetorial/X-position! (taggin' the AIBD Stars)
π§΅π§΅π§΅
1/ Would a GI Doc (or IBD patient) consider surgical management for early ileal IBD instead of med management?
What level of evidence will be necessary to change practice?
lets look at the recent work by Agrawal et al π§΅π§΅
#GITwitter
Thanks to
@UofT_DoM
and
@UofTMed_OID
for providing me with this platform on
#TDoR2022
While I was honored to be asked, I want to be clear that my experiences are my own, and doesn't represent or encompass the diversity of trans experiences, struggles, and triumphs....
Office of Inclusion & Diversity (OID), Temerty Med
#TransgenderDayOfRemembrance
is held each year on November 20.
Clinician-scientist Laura Targownik (she/her) speaks with us about the importance of
#TDoR
, trans justice, and her own experiences as one member of the transgender community β‘οΈ
HUGE NEWS!!!!
Phase III RCT OF RISANKIZUMAB to USTEKINUMAB IN CD!
βοΈNONINFERIOR OF RIS VS UST AT WEEK 24 FOR CLIN REMISSION (59% RIS VS 40%UST)βοΈ
βοΈ ENDO REMISSION AT WEEK 48 (32% RIS VS 16% UST (p <0.0001) βοΈ
FULL STUDY NOT YET PUBLISHED, BUT POTENTIALLY PRACTICE CHANGING!
π’ SEQUENCE, a Phase 3 head-to-head study (study drug open-label and efficacy assessment blinded), compared risankizumab to ustekinumab for the Rx of adult patients with moderately to severely active Crohn's disease who have failed one or more anti-TNF.
π£ Risankizumab met bothβ¦
Are we Excited about ETRASIMOD?
Or is it more Eh..trasimod??
Let's take a close look at the recently published paper evaluating the effectiveness of the Sphingosine-1-Phosphate Receptor Modulator ETRASIMOD in patients with ulcerative colitis
π§΅π§΅π§΅
News from GI trials today
NORDICC: colonoscopy only works when you have one
REACT-2: treating to target for Crohnβs disease only works if you need treatmentβ¦.
Dupilumab (DUP) is FDA approved for persons 40kg or greater with eosinophilic esophagitis, and is on path to approval in the EU!
This week, I break down the evidence supporting its use.
But first, how does the GI world think DUP will impact our care of EoE?
βοΈβοΈ POLL BELOWβοΈβοΈ
On this yearβs
#TransDayOfVisibility
, itβs especially important to show the world that trans lives can be joyful, powerful, and world-changing
This year, Iβm choosing to
#BlendOut
#TDOV
#
To everyone out there who is struggling with making the step
That, although it may seem impossible right now, let me tell you thisβ¦..
That you can have this
In non GI related news, my people are making more people!
Welcoming this little pitseleh in April 2024 and myself into undeniable grand-adulthoodβ¦.
And a big congrats to my eldest Jonah and soon-to-be daughter in law Racheal!
Itβs never too early to find happiness
Itβs never too late to find happiness
Whether it was years ago, today, or TBD
π³οΈββ§οΈ π³οΈβππ happy
#NationalComingOutDay
π³οΈβππ³οΈββ§οΈπ
ππNO MORE MEDICAL CONFERENCES IN FLORIDAππ
ππNO MORE MEDICAL CONFERENCES IN TEXASππ
ππNO MORE MEDICAL CONFERENCES IN TENNESSEEππ
As long as these states continue to criminalize and endanger our trans patients and careproviders, we should be withholding our patronage!
@AriDrennen
Basically, she is saying
βif you are looking for a woman who will root out and eliminate defectives and undesirables, and look good doing it, Iβm your gal, Americaβ
hey everyone! I'll be the guest host this week on
@MondayNightIBD
with
@DCharabaty
This Monday's theme:
"When is good enough, good enough"
Join me for a discussion about sunk costs, risk aversion and shared decision making!
We recently told you about Chris McNaughton, the college student who had to sue UnitedHealthcare to get his ulcerative colitis treatment covered.
Now hear Chrisβ story in his own words π§΅π
On
#TDOV
2020, I came out as
#trans
after having lived for almost 2 decades without ever publicly acknowledging having transitioned.
My story is far from unique, you can be happy, have success, find love, and grow old, all while being
#trans
....
Happy
#TDOV2024
!
#TDOV
#
To everyone out there who is struggling with making the step
That, although it may seem impossible right now, let me tell you thisβ¦..
That you can have this
Important Announcement from
@getgutsycanada
COVID-19 Task Force
2nd dose of COVID19 VAX should NOT be delayed in persons with IBD
All persons with IBD SHOULD get their VAX
Details:
And just like that, it has been a year for me here at
@UofTGastro
...
1/Thanks to all of my colleagues across the division for making me feel welcome, for providing kind redirection when needed, for having an appetite for taking on difficult change.....
@DavidJuurlink
The physical exam is like any other diagnostic test, in that
β‘οΈ they have a sensitivity and specificity
β‘οΈ the sens/spec vary with operator skill
β‘οΈ PPV + NPV are affected by the pre-test probability of pathology
β‘οΈ false positives lead to further diagnostic misadventure..
So What Is the Importance of the EARNEST Study?
Should we be more confident in prescribing Vedolizumab for patients with chronic antibiotic dependent and refractory pouchitis?
The Upshot: Not all high-quality evidence is of equally high quality....
Let's see why.....
Things Iβm learning....
1) most of us are quickly realizing how inessential much of what we did all day really was....
2) we probably donβt need all this stuff.....
#ashleypatel
is here to tell you that IBD patients sure wouldnβt mind if you asked them about their mental health for once in your lifeβ¦..
π at you, gastroenterologistsβ¦..
#cddwclm2023
π§΅π§΅π§΅GI PAPER BREAKDOWN
#7
π§΅π§΅π§΅
1/n
Who is the better couple?
πππElvis and Ann Margaret πππ
OR
πππIL-23s and Anti-TNFs πππ
Join me to learn whether IBD Biologics go better together!!!
@assignedmedia
Also, when there is increased societal recognition of any medical issue, we see more health care utilization for that issue
This is not a phenomenon unique to gender incongruence
Welcome to Dr. Natalia Calo (
@natalia_calo
), the
@UofTGastroHep
's newest faculty member!
Dr. Calo will be at
@SMH_GI
, where her clinical focus will be on hepatobiliary disease and advanced endoscopy.
and a research focus on the epidemiology and QoL in chronic pancreatitis.
Pls read our new paper, published in
@AGA_CGH
Why is this important?
1) Mental Health not often assessed by IBD docs
2) Unrecognized anxiety/depression --> less adherence
3) limited options for effective Tx --> more limited if we ignore mental health !
Thanks to
@KiraNewmanMDPhD
for an excellent takedown on the flaws in the methodology of this study.
The greater concern I have (and I'm looking at you, Editorial Board of
@Gut_BMJ
!) is about an apparent failure to apply extended medical ethics (1.n)
I want to thank the folks at
@HealioGastro
and
@RainbowinGastro
for helping me highlight the impact of transphobic legislation on gastroenterologists, GI education, and people living with GI disease
sorry, but these conclusions are completely misattributed
The AI is **NOT** actually differentiating IBS from normal controls, but is only accurately identifying images which are part of a set of images
lemme explain with some rompecabezas.....!
aπ§΅for puzzle fans!
π’π₯AI is coming to
#FGIDs
! Using the image
#AI
model, colonoscopy images of
#IBS
could be discriminated from healthy subjects at AUC 0.95.
Now, can you see what AI sees? (Answer Rightπ½corner)
π Study by Uni. Toyama π―π΅
#gitwitter
#medtwitter
#DGBIs
Like I've been saying for years, there is no such thing as diabetic gastroparesis, only diabetes related functional upper gut syndromes
Stop ordering gastric emptying stdies, and while you're at it stop ordering gastric emptying studies
@assignedmedia
And from the Cass Report, a majority of kids whose parents were concerned enough to be referred for assessment never received any medical intervention
Kids were certainly not being rushed and it sounds as though the process was if anything, too deliberative.
PUBLICATION ALERT
@AGA_CGH
@SinaiHealth
@UM_RadyFHS
@
In a real world cohort of persons with
#Crohns
disease
Early Anti-TNF use (within 2y of Diagnosis) showed
- significant reduction in π₯ stays for IBD
- lower rates of going under theπͺ
****ANNOUNCING***
GI Paper Breakdown
#9
βοΈβοΈ Is VDZ EFFECTIVE FOR TREATMENT OF CHRONIC POUCHITIS βοΈβοΈ
β‘οΈβ‘οΈ Does it improve symptoms???
β‘οΈβ‘οΈ Does it improve endoscopic appearance??
β‘οΈβ‘οΈ Does it improve quality of life???
Full Review Coming Today!!!
PPIs DONβT CAUSE DEMENTIA
PPIs DONβT CAUSE DEMENTIA
PPIs DONβT CAUSE DEMENTIA
PPIs DONβT CAUSE DEMENTIA
(Wait a sec, what was I saying???)
Oh yeah, PPIs DONβT CAUSE DEMENTIA!!
Do PPIs lead to dementia? The answer in this multinational study of 18K+ older adults is NO. Over 6+ years of in-person cognitive testing and medication assessments, there was no association between regular PPI use with any cognition outcome β‘οΈ
πππGame changer?πππ
β‘οΈORs of ~ 10 for colesevelam vs placebo for Bile Acid Diarrhea!
β‘οΈserum levels of Plasma 7Ξ±-hydroxy-4-cholesten-3-one (C4) predict response!
β‘οΈNext tweetorial???
just got off the phone after passing my congradulations (thats congrats PLUS adulation!) to the incomparable
#florencewong
, for her publication in this weeks
@NEJM
Proud to have you in the Division of
@UofTGastro
and Hep!
Thanks
@TakedaPharma
for their support of this program, and for sharing why sex and gender DO matter in studying IBD, and caring for people with IBD....
π’π₯AI is coming to
#FGIDs
! Using the image
#AI
model, colonoscopy images of
#IBS
could be discriminated from healthy subjects at AUC 0.95.
Now, can you see what AI sees? (Answer Rightπ½corner)
π Study by Uni. Toyama π―π΅
#gitwitter
#medtwitter
#DGBIs
@moss_md
There is no colonoscopy study that will be sufficiently negative as to make gastroenterologist stop performing colonoscopy
we all have a huge COI here
ππPOLL IN THREAD!
Is there a preferred 1st option when counselling patients with IBS?
β‘οΈ antispasmodics?
β‘οΈ dietary advice?
β‘οΈ something else?
Join me this week for
#GIPaperBreakdown
#5
to see if the 1st DOMINO has fallen in IBS management!
On this International Women's Day, a shout out to all my female GI colleagues in Canada, who now make up 32% of all Canadian GIs!
So priveleged to be able to work with
#GIWomenCAN
! to increase opportunities for growth for women in GI in Canada (and for our female pts, too!)
In the US, more than half the states are passing laws which restrict the access of trans youth to sports, and to health care.
On this
#TDOV
, let's remember that being trans is not an adverse outcome
#TDOV
#
To everyone out there who is struggling with making the step
That, although it may seem impossible right now, let me tell you thisβ¦..
That you can have this
Itβs not billing, Women have lower billing velocity in fee-for-service settings
Why?
βοΈ Longer time spent per patient for same pay
βοΈ Less up-coding for procedures
βοΈ More referrals to see low paying non-interventional issues
π My Take Home Message
β‘οΈ UPA should be your preferred JAK for UC, all other factors being equal (access, price)
β‘οΈjury is still out on safety, but likely not worse than TOFA
β‘οΈ need more data on dose optimization in maintenance phase
β‘οΈ looking forward to real world data!
.
@RainbowinGastro
:
π³οΈβπWe recognize your call to action & are discussing next steps
π³οΈββ§οΈWe support transgender & gender non-conforming members & patients
π³οΈβπWe want you to feel safe @ meetings + welcome in GI & liver communities
#DiversityinGI
#EquityinGI
#GITwitter
#LiverTwitter