Javier A. Villafuerte Gálvez
@JVG_GIMD
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Gastroenterologist @BIDMC_GI & @harvardmed |🇵🇪 MD @CayetanoHeredia | Interests: C.difficile, celiac disease, IBD, H.pylori, onco-GI
Boston, MA
Joined December 2010
@ibdtweets @IBD_Houston @ibdgijami @ibdseb @Bealoquebea @mchiorean4 @EdwardLoftus2 @GI_PharmD @IBDPharmD @IBDimmunology @IBD_Afzali Maybe reverse causation? Physicians will likely choose the drug perceived as safer / less immunisuppressive in patients who are likelier to have a higher all cause mortality (frailty).
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@hpeureg @AmJGastro @ehmsg @aegastro @Togas_euproject @AIDAeuproject @DiegoCasas8 @alcedo_javier @jp_gisbert Now that needs and RCT! Would be nice if confirmed. Though, the risk of placebo effect for AEs and counfounding by indication for efficacy is substantial.
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@BradSpellberg @DrToddLee Not all GIs are experienced in IBD. Doesn't make them incompetent. Just like not every ID is experienced in HIV or trop med. Didn't mean to offend your GI friend Seen enough TB training in 🇵🇪 to know "anything can be TB" Also to know "it's rarely ONLY TB", esp. when so atypical
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@BradSpellberg @DrToddLee Giving a dissenting opinion is the basis of academic discussion. I find it disappointing of a professor to take such offense at an opinion instead of trying to rebut it. I guess only ID docs can opine on infections in any organ? As well as IBD?
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@BradSpellberg @DrToddLee If TB looks like UC either the scope was not done by someone experienced in IBD or the patient has UC and TB. Ileocecal Crohn's sure can look like TB, imaging and histology can help differentiate. TB has more ascites and lymphadenopathy than Crohns.
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@DrToddLee @ABsteward Agree it's important to think about infectious mimickers. However, bystander infections in severe / fulminant UC are not rare. Holding back on colectomy for + CMV, or random + multiplex panel is vastly more dangerous.
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@laura_tee_mdgi @drkeithsiau I agree. Especially considering how uninformative terminal is vs. distal.
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@AvrahamCooperMD @tony_breu @wwnorton Congrats Avi! Double love the title. Brough the story of William Beaumont to mind.
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@Mo_Shiha @drkeithsiau @CholestasisDoc Agree! Though, ⚠️< 50% of newly dx have tTG IgA >10xULN. ⚠️Getting to >10xULN is not the natural history of many pts. 🔑To see tTG IgA rise, you need substantial ⏫& consistent ↔️ exposure to gluten (PMID=22619366). Not helpful for 'flares', maybe for major lapses.
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@Bealoquebea Thanks for sharing! Hard to draw strong conclusions from M-A when outcomes of combination (efficacy/safety) likely depend a lot on 1⃣which combination (ex: TNFi +JAKi vs. JAKi + VDZ) 2⃣disease-specific pharmacodynamics (💩 loss of mAbs in IBD) 3⃣age, esp. for AE (RA>IBD)
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RT @BIDMC_CancerCtr: 💙We appreciate everyone who came to our #colorectalcancer screening and prevention event last night at BILH Chelsea Pr…
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RT @RainbowinGastro: Does PPI change the serum and urine calcium levels? 🤔 Come check out this 🔥poster (S2299) by our ⭐️member @TulioCorre…
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@IldikoMe @john_damianosMD Biopsies for sure. Important to quantify gluten ingestion. But if biopsies are negative and no symptoms (or symptoms unlikely to be related), you just wait. A good number (50+%) of patients with borderline serologies will normalize and not develop the disease.
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@IBS_Maastricht @AmCollegeGastro Conclusions are based on a subgroup (>2004) of a total n<250. It's a nice study and a good effort. But not enough to change practice.
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@KralJan @my_ueg @AmerGastroAssn @AGA_Gastro @AmCollegeGastro @Y_ECCO_IBD @ESGE_news @Gastro_Advisor @GastroHep @FrontGastro_BMJ @gastrogirl @HealioGastro @gastroendonews @LumirKunovsky Awesome summary. I'd add 2 common scenarios: - PPI failure in GERD due to inability to time 30min before meals (more common than true failure) - The rare patient with a true PPI adverse drug reaction
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@AdamRodmanMD @NEJM @arjunmanrai @liam Why pay for the Whisper API that hallucinates non-stop when you have high-quality transcription in Microsoft Word? I use it for encounter transcription in both Spanish and English. No hallucinations at all. Far better than Dragon too btw.
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