News from the AGA

Top AGA Community patient cases


Physicians with difficult patient scenarios regularly bring their questions to the AGA Community ( to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.

In case you missed it, here are the most popular clinical discussions shared in the forum recently:

1. Ileoclonic Crohn’s in VA patient

A 77-year-old patient with chronic kidney disease, dementia and congestive heart failure was seen to evaluate chronic diarrhea. His colonoscopy revealed active inflammation and a stricture at the anastomosis, which prevented the physician from bypassing with a pediatric colonoscope. The patient’s diarrhea improved once he was started on budesonide. The discussion in the AGA Community forum outlined next steps and the best course of treatment for this complicated patient.

2. H. pylori in a penicillin allergic patient

A patient diagnosed with H. pylori during an endoscopy has a history of a severe penicillin allergy and has used clarithromycin in the past year. Antibiotic resistance testing revealed genetic pattern suggesting resistance to clarithromycin, fluoroquinolones and metronidazole. Recommendations from GIs included combination therapy with proton pump inhibitors (PPIs), antacids and antibiotics.

3. Reintroduction of azathioprine after moderate leukopenia

This 48-year-old patient has a history of ulcerative colitis pancolitis and developed antibodies to Humira monotherapy. Her GI is adjusting her azathioprine dose and repeating lab work to recover her white blood cell counts and is soliciting advice from the practice community on using methotrexate for combination therapy.

More clinical cases and discussions are at

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