🚨Recap of today's @AmCollegeGastro Virtual Grand Rounds on small bowel malabsorption and #IBS mimics from the amazing @BMoshiree and @DrRitaKnotts! 🧵
#GITwitter #GI #gut #MedEd #microbiome
#GITwitter #GI #gut #MedEd #microbiome
Differential diagnosis of #IBS-D
While #IBS should be a positive diagnosis from the @RomeFoundation Rome IV criteria, appropriate workup to rule out specific IBS mimics should be undertaken depending on the presenting symptom(s)
Giardiasis is actually very common! 🦠
⚠️ Consider especially in individuals with the listed risk factors!
⚠️ Consider especially in individuals with the listed risk factors!
Bile acid diarrhea (BAD) is also very common and under-diagnosed. It may mimic #IBS and/or contribute to IBS pathophysiology.
In carbohydrate malabsorption, undigested and fermented carbs in the colon ▶️ gas, bloating, and diarrhea
The low-FODMAP diet does not eliminate sucrose, so consider congenital sucrase-isomaltase deficiency (CSID) in patients refractory to the low-FODMAP diet.
SID is common in patients with chronic #GI symptoms, though abdominal pain is less frequent.
Disaccharidase assay is the 🥇 standard diagnostic test
What about high sucrase levels...?
After diagnosing CSID, refer to RD for assistance in dietary modification!
CF is associated with small bowel dysmotility (delayed transit)
Small intestinal dysmotility can be caused by many different things, and can manifest as accelerated or delayed transit.
Causes of #CIPO
Who should get antroduodenal manometry testing?
Small bowel #motility studies
Histopathologic correlates of motility disorders
Testing for suspected #CIPO or small bowel dysmotility
There is poor symptom correlation with small bowel dysmotility
Could blue dye muffins help us learn more about transit time in specific disease states?
#Bluepoo
#Bluepoo
Best practices in workup up #SIBO
The #SIBO testing debate rages on 🔥
Treating small bowel dysmotility
#SIBO treatment
Prokinetics for #CIPO and small bowel dysmotility
Specific agents and their effect on #motility
Algorithm and treatments for #CIPO and small bowel dysmotility
Collaboration is key when it comes to small bowel dysmotility!
@BMoshiree: The "C" in CSID is congenital, so is it true that these patients should have been having symptoms from childhood? And if not, when should we suspect for deficiencies (apart from lactase) in adults, and should we look for underlying causes?
@BMoshiree who is at risk for fungal overgrowth, when do we consider, and how do we work up and treat?
@BMoshiree: I know these dietary modifications for #SIBO are commonly recommended, but are there data to support this or it is more theoretical?
@BMoshiree: If the underlying pathophysiology relates to ICCs and genes pertaining to neuromuscular function of the small bowel, would #FMT really be expected to help?
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