Shows
Dr GI JoeA Gastroenterologist's Guide to UC ManagementUlcerative Colitis: The Modern Therapy Ladder from First-Line to RescueIntroduction: A Practical Framework for UC ManagementWelcome to our deep dive into the management of Ulcerative Colitis. In today's episode, we're going to build a clear, step-by-step, and evidence-based guide for managing UC across the full spectrum of disease, from mild proctitis that you might see in clinic to an acute severe flare requiring hospital admission. We know that guidelines can be dense and trial data complex, so our objective is to translate all of that information into an actionable "zero-to-go" plan...
2025-11-0418 minDr GI JoeA Gastroenterologist's Guide to Crohn's ManagementTreat-to-Target Approach to Crohn's Disease Management1.0 Introduction: The Treat-to-Target Paradigm in Crohn's DiseaseThe management of Crohn's disease has undergone a fundamental transformation. We have moved beyond the limited goal of simple symptom control and embraced a more ambitious objective: achieving deep, durable, and steroid-free remission. This modern approach is guided by the "Treat-to-Target" (T2T) philosophy, which now serves as the central framework for providing optimal care.The core principles of T2T are straightforward yet powerful. First, we establish clear, objective targets for each patient, such as the normalization...
2025-11-0317 minDr GI JoeA Gastroenterologist's Guide to IBD Diagnosis and SurveillancePodcast Show Notes: Decoding IBD - A Gastroenterologist's Guide to Diagnosis, Management, and SurveillanceIntroduction: Navigating the Overlap Between Crohn's and Ulcerative ColitisThe clinical overlap between Ulcerative Colitis (UC) and Crohn's Disease (CD) can be significant, often making diagnosis based on symptoms alone a formidable challenge. While both fall under the umbrella of Inflammatory Bowel Disease, their natural history, complications, and therapeutic pathways can differ substantially. This guide provides a clear, evidence-based framework for clinicians to systematically differentiate, manage, and monitor these complex conditions, moving from initial clinical suspicion to long-term surveillance with confidence.
2025-11-0317 minDr GI JoeCDIClostridioides difficile Infection (CDI) Treatment Protocol1.0 Purpose and ScopeThis protocol establishes a standardized, evidence-based framework for the diagnosis and management of Clostridioides difficile infection (CDI). Its strategic importance lies in unifying our clinical approach to improve patient outcomes, reduce the incidence of recurrence, and ensure the appropriate stewardship of antimicrobial and biologic therapies. By adhering to this protocol, we aim to optimize care from the initial diagnosis through the management of complex, recurrent disease.The scope of this document applies to the diagnosis, severity assessment, and staged treatment of initial and recurrent...
2025-10-1414 minDr GI JoeInpatient IBD FlareInpatient Management of Inflammatory Bowel Disease Flares with Bloody Stools1.0 Purpose and ScopeThis protocol provides a standardized, evidence-based framework for the systematic management of hospitalized patients presenting with inflammatory bowel disease (IBD) flares accompanied by bloody stools. Its strategic importance lies in ensuring timely, appropriate interventions and systematic risk stratification to improve patient outcomes while minimizing complications associated with both the disease and its treatments. This document outlines the critical first steps of patient evaluation upon hospital arrival, guiding clinicians through a structured pathway from initial stabilization to definitive therapy.
2025-09-3015 minDr GI JoeNETs and GISTNeuroendocrine Tumors (NETs) and Gastrointestinal Stromal Tumors (GISTs)1.0 Foundational Principles of Neuroendocrine and Mesenchymal Tumors1.1 IntroductionThe diagnosis of a gastrointestinal mass prompts a critical evaluation to determine its cellular origin and biological drivers. While neuroendocrine neoplasms (NENs) and gastrointestinal stromal tumors (GISTs) can both present in this manner, they represent fundamentally distinct disease entities. NENs arise from the diffuse neuroendocrine system, while GISTs originate from mesenchymal pacemaker cells within the gut wall. This divergence in their fundamental biology dictates entirely separate diagnostic and management paradigms. An...
2025-09-2819 minDr GI JoeEsophagogastric MalignanciesClinical Pathway for Upper GI Malignancies: A Guide for Gastroenterology FellowsIntroductionThis document provides a comprehensive, evidence-based clinical pathway for the diagnosis, staging, treatment, and surveillance of the three primary upper GI malignancies encountered in our practice: esophageal cancer, gastric adenocarcinoma, and gastric lymphoma. The goal of this guide is to establish a clear, logical framework for clinical decision-making, offering a structured approach suitable for a fellow-in-training. By mastering these pathways, you will be equipped to navigate the complexities of upper GI oncology, from initial presentation to long-term follow-up, ensuring optimal...
2025-09-2515 minDr GI JoeGastric Polyps and Metaplasia, and Hypersecretory DisordersGastric Metaplasia, Hypertrophic and Hypersecretory Disorders1.0 Hypertrophic & Hypersecretory GastropathiesDisorders of gastric mucosal growth and acid secretion, while individually rare, present unique diagnostic and management challenges in clinical gastroenterology. A strategic approach is crucial for differentiating between these conditions, as their underlying pathophysiology, clinical trajectories, and therapeutic needs are starkly different. This section provides a framework for understanding and managing two classic, yet frequently contrasted, gastropathies: Ménétrier disease and Zollinger-Ellison syndrome.1.1 Ménétrier DiseaseOverview and PathophysiologyMénétrier diseas...
2025-09-2517 minDr GI JoeUpper GI InfectionsDiagnosis and Management of Key Gastrointestinal Infections1.0 Helicobacter pylori Infection: A Comprehensive ProtocolThe effective management of Helicobacter pylori infection represents a critical competency for gastroenterologists in training. A systematic approach, from accurate diagnosis through confirmed eradication, is essential for preventing the long-term sequelae of this common infection, including peptic ulcer disease and gastric neoplasia. This protocol outlines an evidence-based framework for the diagnosis, treatment, and long-term management of H. pylori.1.1 Diagnostic Workup and StrategyThe selection of an appropriate diagnostic test is a crucial...
2025-09-2516 minDr GI JoeUpper GI Motility DisordersDiagnostic and Management Pathways for Gastric Motility and Vomiting Disorders1.0 Initial Patient Assessment: Symptom-Based Triage1.1. Introduction to Symptom-Directed DiagnosisA meticulous clinical history is the cornerstone of an accurate diagnosis for upper gastrointestinal disorders. While imaging and physiological tests are essential, the patient's own description of their symptoms provides the critical initial roadmap. After a structural evaluation has ruled out obvious anatomical issues, the specific cluster of symptoms—what the patient feels, when they feel it, and what makes it better or worse—becomes the primary guide for...
2025-09-2514 minDr GI JoeManometry in Motility DisordersDiagnosis and Management of Esophageal Motility DisordersIntroductionThis protocol provides a standardized, evidence-based framework for the diagnosis and management of esophageal motility disorders, grounded in the Chicago Classification v4.0. Its purpose is to equip gastroenterology fellows with a systematic approach to patient care, beginning with initial symptom evaluation and progressing through advanced diagnostic interpretation and therapeutic decision-making. By following this structured pathway, fellows can build the clinical reasoning necessary to navigate this complex field with confidence and precision.1.0 Initial Patient Evaluation and Diagnostic Sequencing...
2025-09-2414 minDr GI JoeManometry in Motility DisordersDiagnosis and Management of Esophageal Motility DisordersIntroductionThis protocol provides a standardized, evidence-based framework for the diagnosis and management of esophageal motility disorders, grounded in the Chicago Classification v4.0. Its purpose is to equip gastroenterology fellows with a systematic approach to patient care, beginning with initial symptom evaluation and progressing through advanced diagnostic interpretation and therapeutic decision-making. By following this structured pathway, fellows can build the clinical reasoning necessary to navigate this complex field with confidence and precision.1.0 Initial Patient Evaluation and Diagnostic Sequencing...
2025-09-2414 minDr GI JoeEsophagogastric Functional DisordersDiagnosis and Management of Esophagogastric Functional Disorders1.0 Introduction to Esophagogastric Disorders of Gut-Brain Interaction (DGBI)Patients presenting with upper gastrointestinal symptoms such as heartburn, chest pain, and dyspepsia represent a common and complex clinical challenge. This protocol provides a structured, evidence-based pathway for the clinician to differentiate between structural diseases like gastroesophageal reflux disease (GERD) and a group of conditions defined by the Rome IV criteria as Disorders of Gut-Brain Interaction (DGBI). A core principle of this protocol is that a functional diagnosis is a positive diagnosis, established through a systematic workup that identifies...
2025-09-2418 minDr GI JoeCrohn's Treatment GuidelinesA Phenotype-Driven Guide to Biologic Selection in Crohn's DiseaseThe management of Crohn's disease has undergone a paradigm shift, moving away from a reactive model focused on symptom control towards a proactive, treat-to-target strategy. This modern approach aims to alter the natural history of the disease by achieving deep, objective remission, thereby preventing complications like strictures, fistulas, and the need for surgery. A systematic, evidence-based approach is paramount, beginning with accurate disease classification and risk stratification to tailor the selection of advanced therapies to the individual patient's disease phenotype.1.0 Foundational Principles of...
2025-09-2436 minDr GI JoeBarrett's and other Esophageal DisordersDiagnosis and Management of Common Esophageal Disorders1.0 Initial Patient Assessment and TriageThe initial triage of a patient presenting with esophageal symptoms is a critical determinant of clinical outcomes. A systematic approach, predicated on recognizing distinct symptom patterns and alarm features, is essential for directing the urgency and nature of subsequent investigations. This initial assessment allows for the rapid identification of high-risk scenarios, distinguishing between patients who require immediate intervention and those who can be managed on an outpatient basis.Symptom-Based Triggers for...
2025-09-2217 minDr GI JoeGERDDiagnosis and Management of Gastroesophageal Reflux Disease (GERD)1.0 Initial Patient Assessment and TriageThe initial patient encounter is a critical triage point for determining the urgency and direction of the diagnostic workup. The primary objective is to stratify patients based on the presence or absence of "alarm features." These features may indicate underlying complications or alternative diagnoses that require immediate endoscopic investigation to ensure patient safety and guide the subsequent clinical path.Dysphagia (Difficulty Swallowing)Clinical Significance: May indicate a peptic stricture, eosinophilic esophagitis (EoE), or malignancy.Required...
2025-09-2217 minDr GI JoePeptic Ulcer DiseaseManagement of Peptic Ulcer Disease (PUD) and Ulcer Bleeding1.0 Introduction and Scope1.1 Purpose and Definition of PUDThe strategic management of Peptic Ulcer Disease (PUD) is critical to ensuring optimal patient outcomes and efficient resource utilization. This protocol establishes a standardized, evidence-based framework for the diagnosis, risk stratification, and treatment of PUD. Adherence to this protocol is intended to reduce recurrence rates, minimize complications, and promote consistent care across all clinical settings.Peptic Ulcer Disease is defined as a discrete break in the gastric or...
2025-09-2216 minDr GI JoeDyspepsiaClinical Practice Guideline: Diagnosis and Management of Dyspepsia and Peptic Ulcer Disease1.0 Introduction and ScopeDyspepsia represents one of the most common and complex symptom presentations encountered in both primary care and gastroenterology. Its management requires a nuanced understanding of a broad differential diagnosis, ranging from benign functional disorders to life-threatening malignancies. This clinical practice guideline is designed to provide healthcare professionals with a clear, evidence-based, and systematic framework for the evaluation and management of patients presenting with dyspeptic symptoms.The term "dyspepsia" is derived from its Greek etymology: dys...
2025-09-2215 min