✳️ Iron deficiency anemia (IDA) is the type of anemia typically seen in chronic blood loss from gastric ulcers, duodenal ulcers, or colonic polyps.This anemia is characteristically microcytic and hypochromic due to depleted iron stores from ongoing blood loss.
▶️ Chronic gastrointestinal bleeding is the most important cause of iron deficiency in men and postmenopausal women. Each mL of blood contains 0.4–0.5 mg of iron, so even occult bleeding from these lesions progressively depletes iron stores.
▶️ In patients with IDA referred for endoscopy, potentially bleeding lesions are identified in 62% of cases, including peptic ulceration in 19%.
▶️ Common upper gastrointestinal causes include erosions or ulcers related to aspirin and NSAIDs, as well as peptic ulcer disease, while lower gastrointestinal causes include colorectal cancer, angiodysplasia, and colonic polyps.
▶️ Recurrent blood loss accounts for up to 94% of IDA cases in adults. The diagnosis is established by a serum ferritin level less than 45 ng/mL (or less than 100 ng/mL in the presence of inflammation) along with anemia.
▶️ In men and postmenopausal women presenting with IDA, bidirectional endoscopy should be performed to identify the bleeding source.
▶️ Chronic gastrointestinal bleeding is the most important cause of iron deficiency in men and postmenopausal women. Each mL of blood contains 0.4–0.5 mg of iron, so even occult bleeding from these lesions progressively depletes iron stores.
▶️ In patients with IDA referred for endoscopy, potentially bleeding lesions are identified in 62% of cases, including peptic ulceration in 19%.
▶️ Common upper gastrointestinal causes include erosions or ulcers related to aspirin and NSAIDs, as well as peptic ulcer disease, while lower gastrointestinal causes include colorectal cancer, angiodysplasia, and colonic polyps.
▶️ Recurrent blood loss accounts for up to 94% of IDA cases in adults. The diagnosis is established by a serum ferritin level less than 45 ng/mL (or less than 100 ng/mL in the presence of inflammation) along with anemia.
▶️ In men and postmenopausal women presenting with IDA, bidirectional endoscopy should be performed to identify the bleeding source.
Refractory Constipation__CGH2026.pdf
3.6 MB
AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review
AGA jan 2026
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PIIS1538783626000073.pdf
1.8 MB
Prevention and treatment of thrombosis in patients with decompensated cirrhosis.
Journal of Thrombosis and Haemostasis 31 December 2025
Management_of_colorectal_polyps_update_and_future_directions 2025.pdf
7.6 MB
Management of colorectal polyps: update and future directions.
BMJ December 2025
✳️ Low molecular weight heparin (LMWH) is the preferred anticoagulant for treating acute deep vein thrombosis in patients with decompensated cirrhosis, regardless of the elevated INR.
▶️ The elevated INR should not be considered an absolute contraindication to anticoagulation, as it reflects impaired hepatic synthetic function rather than true anticoagulation status in cirrhosis.
✳️ Direct oral anticoagulants (DOACs) are contraindicated in decompensated cirrhosis, particularly in Child-Pugh class C patients and critically ill individuals, due to hepatic metabolism and unpredictable drug levels.
▶️ While DOACs may be considered in compensated cirrhosis (Child-Pugh class A or B), they should be avoided in decompensated disease.
▶️ LMWH has demonstrated superior outcomes in cirrhotic patients with venous thromboembolism, achieving higher recanalization rates (71% vs 42% without treatment) and lower variceal bleeding risk compared to no anticoagulation. Meta-analyses confirm that LMWH produces more complete recanalization than warfarin and reduces all-cause mortality.
✳️ Warfarin may be considered as an alternative if LMWH is contraindicated, though INR monitoring is problematic in cirrhosis due to baseline coagulopathy and uncertain target ranges. Historical studies have used INR targets of 2-3, but this approach requires careful individualization.
▶️ The decision to anticoagulate should be individualized based on extent of thrombosis, bleeding risk, platelet count (generally safe if >50,000/μL), and fall risk rather than INR alone.
▶️ Active bleeding would be a contraindication, but thrombocytopenia and prolonged INR should not automatically preclude treatment.
▶️ The elevated INR should not be considered an absolute contraindication to anticoagulation, as it reflects impaired hepatic synthetic function rather than true anticoagulation status in cirrhosis.
✳️ Direct oral anticoagulants (DOACs) are contraindicated in decompensated cirrhosis, particularly in Child-Pugh class C patients and critically ill individuals, due to hepatic metabolism and unpredictable drug levels.
▶️ While DOACs may be considered in compensated cirrhosis (Child-Pugh class A or B), they should be avoided in decompensated disease.
▶️ LMWH has demonstrated superior outcomes in cirrhotic patients with venous thromboembolism, achieving higher recanalization rates (71% vs 42% without treatment) and lower variceal bleeding risk compared to no anticoagulation. Meta-analyses confirm that LMWH produces more complete recanalization than warfarin and reduces all-cause mortality.
✳️ Warfarin may be considered as an alternative if LMWH is contraindicated, though INR monitoring is problematic in cirrhosis due to baseline coagulopathy and uncertain target ranges. Historical studies have used INR targets of 2-3, but this approach requires careful individualization.
▶️ The decision to anticoagulate should be individualized based on extent of thrombosis, bleeding risk, platelet count (generally safe if >50,000/μL), and fall risk rather than INR alone.
▶️ Active bleeding would be a contraindication, but thrombocytopenia and prolonged INR should not automatically preclude treatment.
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✳️ Navigating the Maze of Functional Dyspepsia: Emergence of a New Entity, Postprandial Epigastric Pain Syndrome.
▶️ Conclusion: In contrast to earlier characterization of EPS symptoms as purely meal-unrelated, we identied a relevant patient cohort with postprandial epigastric pain in the absence of PDS symptoms in 4 different cohorts. Further research is needed to determine the underlying pathophysiology and the response to different treatment approaches in these newly de ned patient cohorts.
PDF 👇
▶️ Conclusion: In contrast to earlier characterization of EPS symptoms as purely meal-unrelated, we identied a relevant patient cohort with postprandial epigastric pain in the absence of PDS symptoms in 4 different cohorts. Further research is needed to determine the underlying pathophysiology and the response to different treatment approaches in these newly de ned patient cohorts.
PDF 👇
CGH 2025
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