Gastroenterology   

Would you send a CMV DNA PCR in blood, and if you elect to treat with anti-CMV medication, how long would you treat and what parameters would you use,...

Would you recommend repeat POEM, Heller myotomy, or pneumatic dilation?

How do you practically approach a tailored elimination diet in young patients with numerous food impactions and esophageal strictures who are intermit...

Do you discontinue the use of certain medications that have been associated with microscopic colitis (ie, PPIs, SSRIs)?

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies? 

Vasculitis involving aorta, subclavian, common carotid, SMA, IMA, renal artery, and celiac artery.

When do you determine SSRI therapy is unsafe to pursue in such situations?

How do you counsel patients in this scenario? 

I have a patient with recently diagnosed primary biliary cholangitis/cirrhosis (PBC) with SSc. Her laboratory values are within normal limits, but end...

Would chemoRT be preferred over surgery if there is LVI or PNI?

Do you extend the course of fidaxomicin past initial 10 days to at least 3-7 days after completion of antibiotics?

HFE gene mutations in C282Y and H63D are negative.

Is there a role for oral vancomycin in these patients, or is oral vancomycin redundant if other routes of administration are being used (i.e intracolo...

Does histology (radioresistant or radiosensitive) play into this decision?

Would portal hypertensive gastropathy or colopathy sway you away from using it?

And if delayed, should chemotherapy be started?

Since the COVID-19 pandemic, increasingly we see management of acute cholecystitis with cholecystostomy tubes as opposed to surgery, even amongst pati...

IgG4 manifestations include autoimmune pancreatitis and periaortic soft tissue mass.

From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...

How has this impacted your counseling and management?

Would you start with a baseline ultrasound and then pursue further workup such as fibroscan if fatty liver is present, or other?

For example, in patients who are HbSAg negative, anti-HBc positive and HbSAb negative, does vaccination reduce reactivation risk?

Or offer resection followed by adjuvant therapy? 

The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...

Is liquid biopsy helpful? Would you treat if this shows somatic mutation?

Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...

How do you approach de-escalation or justify therapy maintenance? Do you have tiers of medications that you attempt to de-escalate first? In one parti...

A female in her 50s with iatrogenic Cushing's Syndrome presenting for management of SLE with low disease activity (but not remission) in the setting o...

(Patient with active RA despite hydroxychloroquine)

Would the etiology of the thrombocytosis play a role in your decision-making?

 Should they be placed on routine EGD surveillance and if yes at what intervals?

Is radiation effective in this case and if so, what dose would you use? Is there potential for perforation?

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave150 and HIMALAYA? When do you in...

If the patient is outpatient and coming into clinic each day, at what point would you initiate a C. diff workup?

Have you noted significant diarrhea until the ileostomy is reversed?

Are there any medications that you can prescribe? Diet changes? Does this typically resolve on its own after time?

Is there a specific brand or formulation you prefer? The literature supporting the use of probiotics does not standardize the type or dose of probiot...

The patient already received PLADO+sorafenib, Y90, and Atezolizumab/Bevacizumab complicated by recurrent episodes of bleeding from esophageal varices....

Multiple lesions on PET

If so, what agent(s) do you prefer?

Would you offer liver transplant in the setting of metastatic disease? 

The case I am considering involves a patient with biopsy-proven fibrosing dacryoadenitis. 

Would you offer low dose or standard dose aspirin instead?

If so, how would positive levels guide your management?

Would you try atezolizumab/bevacizumab or switch to a TKI?

Would you reduce dose, e.g. from 30 Gy in 10 fractions to 20 Gy in 5 fractions, or hyperfractionate, e.g. 1.5 Gy bid to 20-30 Gy?

For example in a patient with a history of PE?

i.e. EGD surveillance for varices?

ex. VEGFR2 expression, inflammatory signature, PDL1, etc.

Do you continue atezolizumab alone? Would you avoid anticoagulation?

In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?

Do you screen even asymptomatic patients?

In a patient with a large primary and a negative PET/CT for nodal disease, would you push for EUS for radiation planning? Or would this be an unnecess...

This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet

Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT?  What if the size is >5 cm?

Would your recommendations change if you were treating a GI primary (e.g. rectal or anal cancer) vs non-GI primary? 

If so, for what platelet count threshold and do you have a preference as to which agent?

Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...

Do you have any preferred dose fractionation schedules? What kind of margins do you use?

Arterial events have clear instructions to permanently discontinue on the FDA label.  Especially in HCC without many other treatment options, giv...

Would you ever considering re-starting immunotherapy before completing the taper? According to the new guildelines on managing immunotherapy related ...

Are there any indications to choose one over the other?