GiT Updates and More

❇️ Prague C & M Criteria For Barrett’s Esophagus: ▪️C (Circumferential) : length of circumferential columnar mucosa . ▪️M (Maximal) : maximal extent of columnar mucosa . 🔆 Method to describe Barrett’s . 🔹Example : C2M5 = 2 cm circumferential , 5 cm maximal extent. Both should be documented.

❇️ Los Angeles (LA) Classification – (GERD): ▪️Grade A : One or more mucosal breaks ≤5 mm , not between tops of 2 mucosal folds . ▪️Grade B : >5 mm , not continuous between folds. ▪️Grade C : Continuous between ≥2 folds , <75% of circumference . ▪️Grade D : ≥75% of circumference .

Causes , Signs and Symptoms of Budd-Chairi syndrome For more details press comment

Breaking! The FDA has approved Wegovy semaglutide to treat MASH in adults with moderate-to-advanced fibrosis.

✳️The main drug classes used to manage hypertension in patients with hepatic disease are nonselective beta blockers (NSBBs), calcium channel blockers (CCBs), and, with caution, renin-angiotensin system inhibitors (ACE inhibitors and ARBs). The choice and safety of antihypertensive agents are highly dependent on the severity of liver dysfunction as classified by the Child-Pugh score. 🔸In compensated cirrhosis (Child-Pugh A): • NSBBs (e.g., carvedilol, propranolol) are preferred, especially in patients with portal hypertension and esophageal varices, as they reduce portal pressure and provide both antihypertensive and portal pressure-lowering effects. Carvedilol is recommended at lower doses (starting at 6.25 mg/day, titrating to 12.5 mg/day if tolerated) due to hepatic metabolism, with further up-titration possible for blood pressure control in hypertensive patients with compensated cirrhosis. The American Association for the Study of Liver Diseases (AASLD) recommends carvedilol as the optimal NSBB for portal hypertension in this population. 🔸ACE inhibitors and ARBs may be considered in Child-Pugh A patients, as they can reduce portal pressure without significant adverse events in this group. However, they should be used with caution and close monitoring of renal function and blood pressure, as adverse hemodynamic effects are more likely in advanced disease. 🔸CCBs are generally safe and can be used for blood pressure control, but do not affect portal pressure. ✳️ In decompensated cirrhosis (Child-Pugh B/C): 🔸NSBBs should be used with extreme caution or avoided in patients with refractory ascites, hypotension, hepatorenal syndrome, or spontaneous bacterial peritonitis, as they may worsen survival and hemodynamics. Lower starting doses are recommended if NSBBs are used at all. 🔸ACE inhibitors and ARBs are generally contraindicated in patients with ascites or advanced decompensation due to the risk of precipitating renal failure and hypotension. The American Association for the Study of Liver Diseases and the European Association for the Study of the Liver both recommend avoiding these agents in patients with ascites. 🔸CCBs remain an option for blood pressure control, but their use should be individualized and closely monitored due to altered drug metabolism and potential for hypotension. ✳️ Diuretics are primarily used for ascites management rather than hypertension in cirrhosis, and thiazides are generally avoided due to risk of hyponatremia and worsening renal function in advanced liver disease. 🔅Summary, NSBBs (especially carvedilol) are preferred in compensated cirrhosis, while ACE inhibitors and ARBs should be avoided in decompensated cirrhosis. CCBs may be used across all stages, but with careful monitoring. The severity of liver dysfunction (Child-Pugh score) directly influences the safety and choice of antihypertensive agents.

💡TiPs in Hepatic Encephalopathy : 1- Potassium and HE 1⃣K-wasting diuretics can trigger HE 2⃣K-wasting diuretics can increase ammonia(Nh3) 3⃣K repletion can decrease Nh3 Why? Renal recapture of K+ by H+/K+ exchange needs glutamine's Nh4+ which gives h+ AND nh3 So, if HE: 1⃣fluids 2⃣replete K 2- Avoid giving bicarbonate to patients with history of overt HE. Bicarb removes H+ so free NH3+ (freely reabsorbed in the kidney & gut) cannot be converted to NH4+ which cannot easily be reabsorbed.

Recommended biopsies in diagnostic upper gastrointestinal endoscopy.

Current Management Options of Complications of Cirrhosis

Secondary Causes of Fatty Liver

Management of Extra intestinal ( EiS ) manifestations in IBD patients

🌟 Schatzki ring and Plummer-Vinson syndrome both cause dysphagia. - Schatzki ring is often caused by acid reflux - Associated with hiatal hernia, a type of scarring or tightening (peptic stricture) of the distal esophagus 🌟Plummer-Vinson syndrome is associated with classic triad ( iron deficiency anemia- dysphagia - Esophageal webs ) - Can rarely transform into squamous cell cancer. - Associated with intermittent dysphagia. - Iron deficiency not caused by blood loss. - More proximal than Schatzki. - Rings are easily detected on barium studies of esophagus. 🔹Treatment is as follows: Schatzki ring: pneumatic dilation in an endoscopic procedure. Plummer-Vinson syndrome: iron replacement at first, which may lead to resolution of the lesion.