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.
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▶️ 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.
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CGH 2025
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✳️ Prevalence and Prognosis of Mild Inflammatory Bowel Disease: A Population-based Cohort Study, 1997–2020.
▶️ Conclusions : Approximately one-fourth of individuals with mild UC within 1 year after diagnosis and one-half of those with mild CD progressed to moderate-severe disease over time. Young age at diagnosis increased the probability of progression, whereas increasing duration of mild disease decreased the probability.
PDF 👇
▶️ Conclusions : Approximately one-fourth of individuals with mild UC within 1 year after diagnosis and one-half of those with mild CD progressed to moderate-severe disease over time. Young age at diagnosis increased the probability of progression, whereas increasing duration of mild disease decreased the probability.
PDF 👇
CGH December 2025