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Paul Farkas @gastropaul.bsky.social · 13/08/2026

Crohn's and E-Cigs; Heat-Not-Burn Tobacco Tobacco (smoking) 🔼risk of post op recur 🤔Study: Recurrence higher in all smoking groups vs. nonsmoking Heat-not-burn significant increased risk e-cigs increased risk, not stat sig in multivariable analysis Beware #IMsky #Medsky #GIsky

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Paul Farkas @gastropaul.bsky.social · 24/07/2026

Go Ahead...have another cup. AHA OK's Coffee...in moderation 🤔Full disclosure: I am a caffeine addict 👍American Heart Association 3-5 drinks/day may even be cardioprotective. Still beware of "power drinks" Medscape summary below... Pour one for me too.... #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 23/07/2026

Supragastric Belching: Time to hit the Karaoke. Miserable: Uncontrolled continuous belching 🤔Meds available, diaphragmatic breathing 😀Study shows that singing can help. Mostly in older pts 😀Cheap, easy, no meds, but warn neighbors and friends Ear plugs anyone??? #IMsky #Gisky #medsky

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Paul Farkas @gastropaul.bsky.social · 02/07/2026

To Cut or not to cut...that is the ?: Acute Appendicitis 🤔Vignette: NEJM 7/2 🤔Uncomplicated A/P in young pt. 🤔Unclear, patient choice. Op Rate after Abs is 46% at 2 years, higher if appendicolith. (lower if none) 🤔Risk of surgery low, but risks with Ab use 👍You get to vote:) #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 17/06/2026

Carvedilol a winner in Cirrhosis + Ascites 🤔New ascites with minimal or no varices. Carvediolol vs standard Rx. 👍Was safe, reduced mortality, fewer ascites related comps, higher HVPG response. Even better control of ascites. A small study, but encouraging. #IMSky #GISKY #Medsky

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Paul Farkas @gastropaul.bsky.social · 12/06/2026

Potassium competitive acid blockers...nice review 🤔Faster onset of action, not meal depend, avoids CPY2C19 issues, longer half life 🤔Useful in GERD, NERD, and H pylori Rx regimens 🤔Good safety profile 😟Problem is cost, insurance approval Chart below for dosing #GIsky #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 06/06/2026

Sore throat after EGD? ?Uvular necrosis 🤔Pressure from scope, or suction, Beware of Yankauer suction (Have seen this once) 🤔Can present hours to 2 days after 🤔Quite painful, dysphagia 🤔Easy dx (if you look for it) 👍Conservative Rx only.

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Paul Farkas @gastropaul.bsky.social · 05/06/2026

Need to do better at Rx'ing Alcohol Use Disorder 🤔VA study shows Rx for AUD in 30.8% inpatients 🤔Most common med used: Naltrexone (oral) followed by Acamprosate. 29 Million with AUD in US We know this Rx is not a cure-all. But it is a start...we should all likely adopt. #GIsky #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 04/06/2026

Case Report: Hepatopulmonary Syndrome in CLD 🤔Pulse ox is only 28% sensitive 🤔Classic symptoms: Platypnea (dyspnea worse upright) and orthodeoxia (O2 sat drops upright) 🤔Agitated saline with TEE reasonable for confirmation 👍No specific Rx (?garlic) other than Txp #IMsky #GIsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 03/06/2026

Nice Review of Hepatitis B in JAMA 🤔Reminder of the importance of vaccinating newborns 👍Useful reviews of the mysteries of serologic testing, and when to treat, and when to screen for Hepatoma We can't yet cure it, but we can prevent it, and treat it Vaccination is key. #IMsky #medsky

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Paul Farkas @gastropaul.bsky.social · 11/05/2026

Never a fan of KCL pills, now report of colon bezoar? 🤔Reports of nausea/vomiting; esophageal ulcers; gastritis and ulcers etc 🤔New report (sort of felt the CT was cool) of gigantic colon bezoar in patient with colonic stricture #Imsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 05/05/2026

Coffee: The cure-all..Even Constipation? 🤔AM Coffee (8-12) ⬇️risk of constipation Study DDW '26; Morning coffee with lower risk for constipation, 0.73; Stronger link with 2-3 cups/day Not definitive, but I like my coffee www.gastroenterologyadvisor.com/reports/morn... #IMsky #MEDsky #GIsky

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Paul Farkas @gastropaul.bsky.social · 04/05/2026

Do things really go better with Coke? ?impactions 🤔Challenging. Large fecalomas 🤔Pt with fecaloma (12.2x10.5cm) failed with conservative Rx 🤔A 1 liter classic Coca-Cola enema given. 50% improvement, second days later with resolution #IMSky #Medsky #gisky www.cureus.com/articles/424...

cureus.com

Massive Fecaloma Dissolved by Coca-Cola: A Case Report

Fecalomas are hardened masses of fecal material that are a rare complication of chronic constipation and require surgical resection when conservative measures fail. Recent reports suggest that Coca-Co...

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Paul Farkas @gastropaul.bsky.social · 30/04/2026

Elevated Ferritin common in MASLD, perhaps useful in risk stratification 🤔Meta analysis 16 studies 🔼Ferritin in 26% MASLD pts 🤔Suggests more severe disease, increased liver-related events ?Role for risk stratification Also a reminder: not all high ferritin is Hemochromatosis #medsky #IMsky

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Paul Farkas @gastropaul.bsky.social · 25/04/2026

Hepatic Encephalopathy....???a new idea 🤔Standard Rx's not always tolerated or work 🤔Tenapanor useful for PSE with added benefit of decreasing Na absorption SMALL case series: But seemed effective and also Sx recurred after withdrawal in 3 pts To consider with combination of IBS-C and PSE

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Paul Farkas @gastropaul.bsky.social · 20/04/2026

Nothing dramatic...just a nice concise review of chronic diarrhea in JAMA. 🤔 Usually IBS-D/Chronic diarrhea, but remember to consider OTC/Rx'd meds, Celiac, Microscopic colitis, lactose or other disaccharidase deficiencies, etc Useful article/charts for review or teaching.

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Paul Farkas @gastropaul.bsky.social · 09/04/2026

Celiac??? It's OK.... just go ahead and kiss 'em 🤔Patients checked after kissing partner who just ate crackers. 🤔Apparently safe 5 minutes after the crackers, perhaps safer if the partner drinks 4 oz water. So...go ahead.

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Paul Farkas @gastropaul.bsky.social · 27/03/2026

Excellent review Evaluating LFT's 🤔Gastro (in Press) 🤔Link to abstract: www.gastrojournal.org/article/S001... 👍Good for teaching materials, or useful quick review. #IMsky #Medsky #GIsky

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Paul Farkas @gastropaul.bsky.social · 21/03/2026

H.pylori...What is to be done? 🤔Common, perhaps up to 50% in >60 yo's 🤔Associated with Gastric Ca 🤔So many drugs...so many regimes...&still controversy re who to treat 👍JAMA nice two page review of treatment guidelines. Still favor Bis. Quadruple Therapy #medsky #IMsky

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Paul Farkas @gastropaul.bsky.social · 19/03/2026

Coming to a pt near you...Alpha-gal 🤔thought was geographically limited..but spreading 🤔Lone star tic leads to sensitivity to sugar molecule in most red meat or dairy products 🤔Reactions 2-10 hr p ingestion can range from urticaria/angioedema to N+V; abd pain 🤔Beware #GIsky #IMsky #mdsky

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Paul Farkas @gastropaul.bsky.social · 15/03/2026

Tonsillectomy & IBD? 🤔In the 60's 1 million/year in US, Recent 500K 🤔Now many for sleep disordered breathing 🤔Retrospective study, 1.4 million matched, suggests increased risk of developing IBD (HR 1.37 Crohn's; 1.29 UC) 🤔Interesting to consider Doubt will change decisions #IMSky #MedSky

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Paul Farkas @gastropaul.bsky.social · 12/03/2026

Cdiff Review: dx and mgmt. 🤔w/u PCR or GDH. If positive EIA 🤔Fidaxomicin may be clear next step as generic ⬇️cost 🤔If cured and needs another antibiotic, Vanco 125/d continue 5 days after antibiotic. 🤔FMT after 2nd recur, after 10 day of anti-CDI Rx and a washout of 48-72 hrs. #Medsky #IMSky

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Paul Farkas @gastropaul.bsky.social · 11/03/2026

Short review of post op ileus (POI), acute colon pseudo-obstruction(ACPO) 🤔POI: review MEDS; labs; ambulation 🤔Enteral feeding of benefit (POI) 🤔? SC methylnaltrexone for ACPO 🤔? prucalopride for POI & ACPO 🤔? value of chewing gum to prevent POI 🤔Does coffee prevent POI? #Medsky #IMsky #GISky

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Paul Farkas @gastropaul.bsky.social · 08/03/2026

cALD in US: Common; 85% of pts unaware they have it 🤔Compensated ALD in asymptomatic pts. 🤔Weighted preval of cALD in us 2.4%; possible cALD 3.46% 🤔85% unaware (This surprised me) Another reminder to screen with FIB-4 and/or Elastography #IMSky #GISky #Medsky

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Paul Farkas @gastropaul.bsky.social · 06/03/2026

Add Statins to our Water? Statins associated with lower risk of HCC and Hepatic decompensation in cirrhosis 🤔Umbrella review ( EASL) 168 studies, 10 mil pts 🤔Reduced risk of HCC (HR 0.53)and decompensation (HR 0.54) Continue statins in these patients Food for thought? #IMsky #GIsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 04/03/2026

Hep Encephalopathy Guidelines...AJGastro3/26 🤔HN4 not useful, recommend "single test strategy" ie Stroop 🤔Do endorse consider 4l PEG 🤔Acute HE, adding rifaximin to lactulose 🤔Consider zinc levels and supplementation if not resp 🤔Protein 1.2-1.5 g/kg/d, no restrictions 🤔night snack #Imsky #medsky

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Paul Farkas @gastropaul.bsky.social · 27/02/2026

1/5 of US Adolescents have MASLD; a tenth have related fibrosis. 🤔Presented at EASL-SLD (ref below) 🤔Associated with male sex, overweight, obesity, higher waist circumferences MASLD is potentially treatable. We need to look for it, evaluate it, and treat it to prevent its evolution to cirrhosis.

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Paul Farkas @gastropaul.bsky.social · 26/02/2026

For non ICU pts with HRS/AKI ...Terlipressin seems best option 🤔Another article supporting Terlipressin vs. Octerotide plus Midodrine for hepatorenal syndrome/AKI 🤔For non ICU patients (those on general wards) (and most will be in ICU where nor epi preferred), ) a useful suggestion.

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Paul Farkas @gastropaul.bsky.social · 23/02/2026

Coffee Barrett's and Gerd 🤔Review/meta-analysis 🤔Coffee associated with marginal 🔼 Gerd, but not Barrett's. "routine avoidance/reduction of coffee intake ...needs further evaluation" 👍Perhaps restrict in pts who identify it as a trigger, or improve with cessation. Not routinely #medsky #GIsky

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Paul Farkas @gastropaul.bsky.social · 20/02/2026

Screen heavy drinkers for liver disease 🤔 CCJM 2/14/26 notes this is not yet standard in primary care 🤔Modifiable risk factor. Mort rates doubled 1999-2022 👍Consider for men 5/d or 15/week. or Audit-C 4 or more; Women with 4/d or 8/ week, Audit 3 or more. Audit-C on Medscape #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 14/02/2026

Weight Loss in MASLD...Maybe better compliance with lower expectations? 🤔Weight Loss is the cornerstone of rx of MASLD 🤔While more weight loss is almost definitely better, article suggests that even 3% may be of real benefit Sort of encouraging in real world practices #IMSky #Medsky

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Reposted by Paul Farkas

josh farkas 💊 @pulmcrit.bsky.social · 10/02/2026

are you using a DEFCON-based strategy to manage bowel motility in hospitalized patients? having a clear, evidence-based treatment strategy improves efficacy & saves time you don't need to redesign the wheel for every patient & helpful to avert thermonuclear war emcrit.org/ibcc/constip... #EMIMCC

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Paul Farkas @gastropaul.bsky.social · 09/02/2026

I'll admit it...I'm a caffeine addict. Not to prevent dementia...but it is a good justification. 🤔JAMA article suggests lower rates of dementia and cognitive decline with greater consumption of caffeinated coffee/tea 👍2-3 cups a day coffee; 1-2 of tea seems optimal Bring it on #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 05/02/2026

Let's hear it for short sleeves 🤔Long Sleeves cultured. 280 samples. 81% bacterial growth, 20.7% with potential pathogens. Fleece most likely to be contaminated. No evidence of spread. Even so lets hear it for "bare below the elbows." #IMsky #Medsky #GIsky

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Paul Farkas @gastropaul.bsky.social · 05/02/2026

Will PPI's ever be vindicated? 🤔Duru in BMJ - No association between PPI and Gastric Adenocarcinoma. 🤔Ed (see below): Recognizing the conflicting and uncertain evidence base on PPI ...harms, suggest concern about adverse effects alone...not a reason to avoid prescribing. #IMsky #GIsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 29/01/2026

Alfapump....? Interesting idea for refractory ascites 🤔Pumps ascitic fluid into badder 🤔Role unclear; ? if not candidates for Liver Txp, or TIPS ?Preferable to repeated large vol taps Interesting article reviewing selection of pts and how it is placed. #IMsky #GIsky #Medsky

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Reposted by Paul Farkas

josh farkas 💊 @pulmcrit.bsky.social · 24/01/2026

reminder to liberally check carbon monoxide levels during snowmageddon CO levels can be measured on venous blood along with routine labs (no need for a separate arterial puncture) emcrit.org/ibcc/co/ #EMIMCC

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Paul Farkas @gastropaul.bsky.social · 23/01/2026

AGA Update on Inpatient Mgmt of Adults with IBD 🤔Good summary, with nice graphics (see below) 🤔Another reminder re prophylactic anticoags 🤔Early use of IV steroids, and if no response consider additional meds. 🤔Review on dealing with abscesses and peri-rectal disease. #IMsky #Medsky #GIsky

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Paul Farkas @gastropaul.bsky.social · 19/01/2026

Cannabis in Gastroporesis (GP)??? Likely not a great idea 🤔Perhaps 18% of pop uses Cannabis 🤔Use also increasing in GP. We know it can be anti-emetic, 🔼 appetite... 😟Study shows 🔼ED visits, hospitalizations, malnutrition, need for enteral feeding in GP on Cannabis #GIsky #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 15/01/2026

The Things We Carry 🤔In our clinical world we do carry many things, including memories, many of which trouble us 🤔Somehow we more easily recall the troublesome, disturbing than the rewarding and fulfilling Rory Spiegel perspective in NEJM. Excellent. #IMsky #GIsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 09/01/2026

Celiac Disease in pts with IBS. 🤔Increased risk of CD in IBS (Odds ratio vs control 4.42 for + serologies. 🤔Always interested that odds were similar across gender and IBS Subtypes. (had thought would be higher in IBS-D) Lets keep on testing... #Medsky #IMsky

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Paul Farkas @gastropaul.bsky.social · 07/01/2026

CLEANSE your liver? 🤔Top 20 liver cleanse supplements on Amazon 😐1.4 mil sold, revenue 38 mil 😟Much hype, little evidence, and some risk Up to 41% CLD pts on complement meds Limited Scientific Evidence Unlike Canada/EU not much supervision Good editorial, last image #GIsky #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 06/01/2026

Hugging make you uncomfortable??? 🤔16 yo severe abd pain after "bear hug" 🤔Prior abdominal fullness, rash 🤔CT (below) irreg cystic mass, free fluid 👍Ruptured Echinococcal Cyst in dog owner. 🤔Uncommon in US. High prev in some regions. Nice review Medscape #IMsky #Medsky #GIsky

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Paul Farkas @gastropaul.bsky.social · 02/01/2026

Like IBD, ?🔼risk of thromboembolism in Microscopic Colitis 🤔Over 10 years of follow-up: VTE events in 6% with MC and 4.8% in reference pts 🤔Higher risks of PE, DVT, other VTE events 21% higher risk of VTE. Should we follow same prophylaxis guidelines as with IBD? #GIsky #IMsky #Medsky

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Reposted by Paul Farkas

josh farkas 💊 @pulmcrit.bsky.social · 28/11/2024

how to quickly set up a useful MedSky account! 🦋 Mix of basic & more advanced stuff (eg designing user-curated hashtag feeds) 🦋 Take a look & add any useful tips you have in the comments section blog: emcrit.org/pulmcrit/blu... #MedSky

emcrit.org

PulmCrit: How to quickly create a useful professional account in BlueSky

I discussed the reasons for migrating to BlueSky here. I've received positive feedback from several FOAMed expats who migrated to Bluesky and enjoy it

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Reposted by Paul Farkas

josh farkas 💊 @pulmcrit.bsky.social · 24/12/2025

Holiday gift for ya: the IBCC chatbot app 😁 Free AI chatbot searches IBCC contents Answers seem pretty good & it links to relevent chapters for additional info Works as an Ebook index on steroids Created by emergency med folks at Columbia (credit to Joshua Farber & David Fisher) #EMIMCC

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Paul Farkas @gastropaul.bsky.social · 23/12/2025

New-Onset DM and risk of Pancreatic Cancer 🤔Large prospective study: 6-fold increased risk (at 3yr) 🤔Median lead time 8 months 🤔Not ready to recommend screening, but perhaps looking into other frisk factors (mostly family, hereditary syndromes etc) higher yield in this group #IMsky #MEDsky

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Paul Farkas @gastropaul.bsky.social · 22/12/2025

IBD, AIH, EoE, etc... ✔️MMR status 🤔With 🔼Measles, consider MMR status, ideally before starting immunotherapy 👍 Immune if: IgG+, Born before 1957, 2MMR shots, doc history infection 👍Nice review, with good flow sheet 👍They also suggested checking out household members. #IMsky #GISky #Medsky

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Paul Farkas @gastropaul.bsky.social · 19/12/2025

Risk of Cervical Cancer in IBD... 🤔? risk of CC in IBD actually ⬇️, BUT 🔼 in pts on immunosuppression 🤔Not powered to differentiate among immunosupp meds 👍A reminder to screen for Cerv Ca while pts on immunosuppressives, and to re-consider use of HPV vaccine #GIsky #IMsky #Medsky

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Paul Farkas @gastropaul.bsky.social · 17/12/2025

Indef dysplasia in Barrett's ?What to do 🤔Treat, recheck. What's next? 🤔223 with f/u EGD in one year, 9.87% with neoplasia of any grade. Of those with just IND, repeat f/u 22% incident neoplasia, Risk🔼 with length and smoking 🤔?F/u as LGD, and consider Endo Rx #GIsky #IMSky #Medsky

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