Gastroenterologist & obesity medicine physician. Trained at @bcm_gihep, @BCM_InternalMed, @TJUHospital. Views are my own.
Houston, TX
Joined June 2019
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Frederick Peng, MD, FACP, DABOM retweeted
#ASGE has updated its variceal bleeding guidelines, now published in @GIE_Journal, with several MAJOR changes from 2014:
1. Endoscopy within 24 hours for acute variceal bleeding, rather than 12 hours, with greater emphasis on resuscitation.
2. Esophageal stents are now formally recognized as a salvage/temporizing option for refractory variceal bleeding.
3. In COMPENSATED cirrhosis w/ clinically significant PHTN, start a NSBB and CONTINUE annual EGD surveillance (a key difference from prior guidance and current national societies guidelines recommending NSBB alone without routine EGD follow up).
4. In compensated cirrhosis already on an NSBB, growing varices (~20% of cases) should be banded for primary prophylaxis (first guidelines to recommend COMBINATION therapy).
5. For gastric varices, EUS-guided cyanoacrylate PLUS coil therapy is now the preferred endoscopic approach.
#MedTwitter #Hepatology #GITwitter #MedEd @ASGEendoscopy
Frederick Peng, MD, FACP, DABOM retweeted
Highlights from our 25th Annual GI & Hep Course - exploring advances and nuances in GI care through energizing talks and engaging panels - thank you to all who made this year another success! Already brainstorming for next year! 💪🏻🤓@bcm_gihep
Frederick Peng, MD, FACP, DABOM retweeted
What an amazing first session for our 🌟25th Annual GI & Hepatology Course💩 featuring our own LEGENDS, and internal and external ROCK STARS in GI! 🔥🔥🔥 @bcm_gihep @WasAbiDoc @EndoscopyOthman @SeragHashem
Frederick Peng, MD, FACP, DABOM retweeted
BLEEDING FROM PHG AND GAVE
=> Portal hypertensive bleeding: first line NSBB, definitive treatment TIPS
=> GAVE: EBL is superior to APC
#BavenoVIII
Frederick Peng, MD, FACP, DABOM retweeted
🚨 New head-to-head RCT in @NEJM: apixaban vs rivaroxaban 🥊
🏆 Apixaban emerges as the safe winner, with half the risk of bleeding complications
💡 For patients at high risk of GI bleeding, apixaban may be preferrable to rivaroxaban
nejm.org/doi/full/10.1056/NE…
Frederick Peng, MD, FACP, DABOM retweeted
Chicago Classification v4.0 (HRM)
▪️Dx = sx + metrics + provocation
▪️IRP → EGJ outflow
▪️DCI/DL/breaks → peristaltic vigor & pattern
▪️IBP → pressurization phenotype
▪️MRS/RDC required → assess LES relaxation & contractile reserve
@ebmedgi
Frederick Peng, MD, FACP, DABOM retweeted
The natural history of MASH. @DrLoomba
thelancet.com/journals/langa…
Frederick Peng, MD, FACP, DABOM retweeted
Obesity is a chronic, relapsing disease, and effective medication use requires high-quality, evidence-based care.
Our new quality indicators define best practices.
Read more here: ow.ly/6V1450XpGZy
@AGA_Gastro @CNewberryMD @FPengMD @JenniferKMaratt
Frederick Peng, MD, FACP, DABOM retweeted
📚 Functional GI Disorders – High-Yield Pearls (Dr. Rawan Dayah)
🧠 Hirschsprung Disease
•❌ Absent RAIR (Rectoanal Inhibitory Reflex) → 🔍 Suggests Hirschsprung
🚽 Constipation
•🌀 Colonic Inertia → ❌ No HAPCs (High-Amplitude Propagating Contractions) on manometry
•🎈 Balloon Expulsion Test >60 sec → ⚠️ Pelvic floor dysfunction
•📡 Wireless Motility Capsule → Differentiates 🐢 Slow transit vs. 📍Regional delay
•🍽️ Postprandial HAPCs = ✅ Normal
◦❌ Absence → Abnormal motility
🧘 Pelvic Floor Dyssynergia
•🥇 Biofeedback therapy = Gold standard treatment
💢 Irritable Bowel Syndrome (IBS)
•✅ Symptom-based, positive diagnosis (not a diagnosis of exclusion)
•⚡ Pain is required for diagnosis (Rome IV)
•🚨 Alarm features (e.g., weight loss, bleeding, anemia) → Investigate for organic disease
•🧪 Fecal Calprotectin → Helps rule out IBD
•🔑 Key management tools:
◦🥦 Low FODMAP diet
◦🌾 Fiber supplementation
◦💊 Neuromodulators (e.g., TCAs, SSRIs)
•💊 Rifaximin = ✅ Only FDA-approved antibiotic for IBS-D
•🚫 Tegaserod = Restricted use (approved for IBS-C in women <65 without CVD)
@bcm_gihep #GITwitter #medtwitter
Frederick Peng, MD, FACP, DABOM retweeted
ACG guidelines on atrophic gastritis and gastric intestinal metaplasia 💡
Frederick Peng, MD, FACP, DABOM retweeted
🚨 Big milestone in MASLD/MASH!
We now have two FDA-approved drugs:
🔸 Resmetirom (oral, THR-β agonist)
🔹 Semaglutide (weekly SC, GLP-1 RA)
I made this simple side-by-side comparison 👇
Frederick Peng, MD, FACP, DABOM retweeted
Who better to kick off the Esophagus / Potpourri section than the motility maestro @WalterChanMD discussing “Updates in Management of EOE”
🔹 PPI therapy in EoE
- BID dosing > QD for histologic response
- 10–12 weeks improves remission rates
- Approx 68% maintain remission on lowest effective dose
- Genotype (CYP2C19 rapid metabolizer) + allergic comorbidities predict relapse
💊Topical steroids
- Induce remission + reduce remodeling
- Once vs BID dosing = similar outcomes
- Relapse common when stopped → maintenance needed
- Response rate: 50–70%
#GIHepUpdates2025 @AdventHealthCFL
Frederick Peng, MD, FACP, DABOM retweeted
When we say GI is a small world, having the opportunity to invite #AhnNguyen my co-fellow from @UTSWGastroHep
📊 Acid control (Day 7 pH ≥4 time):
•Vonoprazan: 85–94%
•Esomeprazole: 61%
•Rabeprazole: 65%
•Lansoprazole: 42%
➡️ PCABs deliver faster, more potent acid suppression.
⚖️ PCAB potency vs PPI equivalents:
- Vonoprazan 20 mg ≈ Omeprazole 60 mg BID
- Vonoprazan 10 mg ≈ Omeprazole 60 mg QD
🩺 Erosive esophagitis maintenance (24 wks):
- PCABs = non-inferior to PPIs overall
- PCABs > PPIs in LA Grade C/D disease
🔥 Non-erosive reflux disease (NERD):
- Vonoprazan 10–20 mg → ~45% heartburn-free days
1 Placebo: 28%
➡️ Significant benefit, but symptom resolution still incomplete.
- Monitor in patients with Tacrolimus
- Long term safety: VISION study (5 year PCAB vs PPI) - similar AEs rate, higher gastrin level in PCABs
Takeaway:
✅ PCABs = faster, stronger acid suppression
✅ Superior in severe esophagitis
✅ Useful in NERD, though room to improve
#GIHepUpdates2025
Frederick Peng, MD, FACP, DABOM retweeted
Proud to share the new @C5NYC PSA on colorectal cancer screening in Mandarin Chinese: bcove.video/4oz9Lot
Hope this is will help our Chinese-speaking patients get screened!
@nyulangone @MSKCancerCenter @AmCollegeGastro @AmerGastroAssn @ASGEendoscopy
Frederick Peng, MD, FACP, DABOM retweeted
A must-read review in the @NEJM on the most common cause of chronic liver disease: MASLD.
All you need to know: trends, pathogenesis, early detection, co-morbidities, lifestyle changes and novel and future drugs…..
Https://shorturl.at/N88Ed
Frederick Peng, MD, FACP, DABOM retweeted
🔑ACG 2025 Preventive Care in IBD.Key Points:
✅ Vaccinations:
- PCV20 or PCV21 instead of older schedules
- Shingrix (2-dose recombinant) for all ≥50 yrs and ≥19 yrs if on immunosuppression
- RSV vaccine for all ≥75 yrs & for 50–74 yrs w additional chronic conditions
- Annual influenza: high-dose if ≥65 yrs; avoid live intranasal version in immunosuppressed
- COVID-19: follow national guidelines
✅ Skin & Cervical Cancer Screening:
- Annual cervical screening if on immunosuppressants for 3 years then every 3yrs
- Annual melanoma screening for all IBD patients
- Annual non-melanoma skin cancer screening if on thiopurines, methotrexate, JAK inhibitors or S1P modulators, especially if >50.
✅ Bone Health:
- Bone mineral density check at diagnosis if risk factors, repeat as needed.
✅ Mental Health & Smoking:
- Annual screening for depression and anxiety.
- Systematic smoking cessation counseling
✅ Household contacts:
- Should be up to date with vaccines; some precautions for live vaccines like varicella and rotavirus.
journals.lww.com/ajg/fulltex…
Frederick Peng, MD, FACP, DABOM retweeted
🚨 New Data on Risankizumab in Crohn’s Disease!
Even initial nonresponders to IV induction saw benefits with extended treatment 💉
📈 At Week 24:
✅ Clinical Response:
– 76% (180 mg SC)
– 64% (360 mg SC)
– 62% (1200 mg IV)
✅ Clinical Remission: Up to 45%
✅ Endoscopic Remission: Up to 25%
🔁 At Week 52 (FORTIFY)
➡️ Most SC responders maintained remission & response
💪 360 mg SC showed numerically better results than 180 mg SC
🛡️ Safety? No new risks.
📚 Trials: MOTIVATE, ADVANCE, FORTIFY
👉 Extended risankizumab may rescue and maintain response in Crohn’s patients who don’t respond initially.
Extended Risankizumab Treatment in Patients With Crohn’s Disease Who Did Not Achieve Clinical Response to Induction Treatment -
@AGA_CGH
cghjournal.org/article/S1542…
Frederick Peng, MD, FACP, DABOM retweeted
Summary of REDEFINE 1 and REDEFINE 2 trials with CagriSema, presented this week at #ADA2025 and published in NEJM:
REDEFINE 1:
• 👥 3,417 participants with obesity or overweight (without diabetes) treated with CagriSema achieved a 22.7% weight loss after 68 weeks, compared to 2.3% with placebo ⚖️
• 🎯 40.4% of participants on CagriSema achieved a weight loss of 25% or more
• 📉 The weight loss was slightly below the company's initial expectations of at least 25%
REDEFINE 2:
• 👥 1,206 participants with obesity or overweight and type 2 diabetes treated with CagriSema achieved a 15.7% weight loss after 68 weeks, best in the category thus far 🥇, compared to 3.1% with placebo ⚖️
• ✅ 89.7% of participants achieved a weight loss of 5% or more
• 💉 Mean HbA1c reduction of 2.07%
Article links:
nejm.org/doi/full/10.1056/NE…
nejm.org/doi/full/10.1056/NE…
Frederick Peng, MD, FACP, DABOM retweeted
Evaluation of Symptoms Suspicious for GERD - Value of Endoscopy
⭐️Assess integrity of EGJ ⭐️
Several pitfalls of Hill classification!
Consider using 🆕 AFS Endoscopic Classification of the Esophagogastric Junction Integrity!
🔗 journals.sagepub.com/doi/ful…
🙏Dr Gyawali
#EBMed
Frederick Peng, MD, FACP, DABOM retweeted
GLP-1RAs were associated with an increased risk of GERD and cholelithiasis but did not significantly increase the risk of pancreatitis, cholecystitis, intestinal obstruction, or other serious gastrointestinal or biliary events.
GLP-1 RAs were associated with increased the risk cholelithiasis (RR [risk ratio], 1.46 [95% CI, 1.09 to 1.97]; two more cases per 1,000) and GERD (RR, 2.19 [95% CI, 1.48 to 3.25]; four more cases per 1,000) compared to placebo
Recent meta analysis of 55 placebo-controlled, randomized controlled trials involving 106,395 participants
gastrojournal.org/article/S0…
