Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org/discussions) 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. Perianal fistula found in UC patient (http://ow.ly/S8bJ30okWuO)
A 20-year-old male patient with no previous medical history was seen and treated last year for pancolitis. His physician solicits drug therapy preferences from the GI community, given the age of the patient and a newly discovered perianal fistula.
2. IBD patient with risk of cancer (http://ow.ly/KoGz30oHdjG)
A 62-year-old female patient with a long history of Crohn’s disease developed acute hepatitis. She had a colectomy in 2011 where a one-stage ileo rectal anastomosis was performed instead of a J-pouch. She was in remission under surveillance and mesalamine, until recently. She also has primary sclerosing cholangitis (PSC) and multifocal dysplasia, a combination that raised concern among the GI community about the patient’s risk of cancer.
3. Significant daily pain in Crohn’s patient (http://ow.ly/FHUI30oHdI8)
A recent colonoscopy for a 39-year-old man with Crohn’s disease revealed active disease in the ileum and sigmoid colon with narrowing at the recto-sigmoid colon. The MRE revealed active inflammation at the ileo-colonic anastomosis and of the sigmoid and descending colon, with no noted fistulas. His physician solicits advice in the forum on next steps for the patient, who was experiencing significant pain daily, despite being on a low residue diet and consistent drug therapy.
Other popular clinical discussions:
• WATS imaging in Barrett’s esophagus (http://ow.ly/PrJ330oHdCN)
Members share their opinions and experiences with Wide-Area Transepithelial Sampling (WATS) in Barrett’s esophagus (BE) after mention of recent data demonstrating its promising potential for surveillance in BE patients, despite not yet being approved by the FDA.
• Positive FIT with negative colonoscopy (http://ow.ly/zSxC30oHcZM)
A physician solicits advice on next steps in managing average-risk patients with a positive FIT and negative colonoscopy screening, and asks colleagues if their actions would change after discovering a patient also had non-bleeding hemorrhoids on exam.
More clinical cases and discussions are at https://community.gastro.org/discussions.