Patty Pringle Bloom, M.D.
@BloomPringle
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Following
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Transplant Hepatologist @michiganliver | Alum of @MGHMedicine and @MGH_GI | Hepatic encephalopathy, microbiome | AE @HepCommJournal | Tweets are my own
Ann Arbor, MI
Joined November 2018
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What can I say? Last day
I count my lucky stars for matching
@MGHMedicine
7 years ago
I’ll carry with me my fave MGH-isms: “never worry alone”, “no one ever died of note-openia”, and MANY more
Most importantly, I’ll take the friendships w me
Thanks for one HECK of a ride
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Here we GO.
Only took 27 years of school/training to get here!
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Check out our latest work in
@AmJGastro
📞We recorded cirrhosis pts
🎤Analyzed speech
➡️SLOOOOW speech was associated with HE and low cognitive test scores!
🧐could speech be used to predict overt HE? Monitor HE and treatment remotely?
We are now working to answer these ?s
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No time like the present to announce that I’ve accepted a transplant hepatology faculty position
@UMichGIHep
starting in July!
Thrilled to join the amazing team
@umichmedicine
and do some great research with Dr Anna Lok
@ebtapper
@a2binny
and more!
& THANK you
@AmCollegeGastro
ACG & The ACG Institute for Clinical Research & Education proudly announce the 2020
#ClinicalResearch
Awards.
(4) Jr Faculty Development Grants in 2020, funding the
#FutureofGI
!
1/4: Dr. Patricia
@BloomPringle
of
@UMich
➡️ See all 2020 Awardees:
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My grandpa was admitted to the hospital today with COVID19.
As I walk into work to start a COVID night shift, serves as a reminder to take care of everyone like they’re your own family.
#WeGotThis
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2 weeks on service and still smiling 😁
I’m no longer shy when med students ask about choosing a field
Hepatology and GI are the best
We have effective treatments. Great patients. Wonderful colleagues.
What more do you need?
#livertwitter
#GITwitter
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We’re coming for you COVID-19!
@MGH_GI
takes to the medicine floors in FULL force.
We got this!
Also, mastering the
#SocialDistancing
selfie.
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5
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Feels weird to celebrate right now, but VERY honored to receive the
@AmCollegeGastro
Junior Faculty Award
This is a 💡 for me at a dark time
Thank you to my
@MGH_GI
mentorship team and, most of all, the patients who support my work
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Ok let me brag for a second.
This week my brilliant mom became a Chief Product Officer! 💪🏻
She immigrated from Brazil at 18 years old (alone), had me at 21 (then 3 more), and has accomplished so much personally and professionally since.
Give her a hand! 👏🏻
#BossLady
🇧🇷 🇺🇸
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Perfect way to kick off
@AASLDtweets
#TLM22
With a 10 hour transplant hepatology board exam!
See y’all in DC on the other side 🥴
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Fascinating
@UMichGIHep
grand rounds on HRS by
@VelezNephHepato
Validated everyone’s feeling that diagnosing HRS is harder than the criteria make it seem
And so interested in using POC US for IVC measurement in mgmt
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How did I get SO lucky to get the ☝️ and only
@allie_schulman
as my new office mate?
Does this mean I’ll learn how to do ERCP this year by osmosis?
Stop on by for a healthy dose of
#coffee
and
#WomenInGI
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Pop quiz.
How long ago did my dental office last update their past medical history forms?
#livertwitter
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New pic!
Thanks to a WONDERFUL event with
@UMichGIHep
women in GI, where we took professional photos (among other very important activities)
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When your Apple Watch congratulates you for standing, you realize you’re capable of being proud of anything.
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Just finished a computer and email-free TWO-WEEK vacation.
Read 5 books, watched many sunsets and zero sunrises, and fully re-charged.
HIGHLY recommend ⭐️⭐️⭐️⭐️⭐️
Hope you all have a chance to do the same soon.
Back to
#livertwitter
!
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NEW data on FMT 💩 for Hepatic Encephalopathy
FMT improved cognitive test scores!
But there’s more:
1️⃣Not all FMT donors are created equal (to treat HE)
2️⃣Recipient microbiome influenced FMT efficacy
3️⃣More FMT may be better
1/X
🔥NEW PUB ALERT🔥
FMT💩 capsules to treat hepatic encephalopathy
Read to find out👉
1️⃣Which FMT donor is best
2️⃣Recipient factors influence FMT efficacy
3️⃣Effect of additional FMT doses
#livertwitter
#VisualAbstract
#openaccess
@AASLDtweets
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The research I do isn’t just sitting at a computer (there’s a lot of that)
It’s a million calls, biopsies, stool samples, cognitive tests
It’s taken these 3 years on faculty to find a dream team, one I can trust
Honored every day that they chose to work with me
#BloomLab
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@RatickM
@DougDrachmanMD
@NilayPatelMD
@DrDarshanDoshi
@MGHHeartHealth
@MGHCVFellows
This is the content I’m here for.
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Today has been an amazing confirmation of why I love academic medicine ❤️
Spent all day meeting the amazing faculty of
@WCM_GI
, talking abt livers, research passions, and possible collaborations
And they call this work?!
I hope you love what you do the way I do
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Incredibly grateful to the mentors, co-fellows, and especially the patients who taught me gastroenterology for the last 3 years. Thank you
@MGHMedicine
! Now on to the next fellowship!
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Never thought I’d be tweeting about this BUT
Anyone tried proning a FLOOR patient with COVID?
I just did it with dramatic improvement
Believer with n=1
@NinoNJ
@MGHHMU
@MGHMedicine
@MLaszkowskaMD
@dankirsh
@KathleenCoreyMD
@katrinarmstrong
@mgh_id
@jehanalladina
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✔️excellent figure on approach to elev ferritin for
#gitwitter
and
#livertwitter
🔑many pts with elev ferritin do not actually have iron overload
🔑make sure blood drawn fasting
🔑non-HH liver dz causes elev ferritin too!
➡️ also, used higher TS% than
@AASLDtweets
guidelines
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GI friends are the BEST friends
Starting this year’s
@AmerGastroAssn
and
@AASLDtweets
Academic Skills Workshop off RIGHT
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In 2020 I reached out to
#livertwitter
about diagnostics for post-transplant ascites
It led to this two center collaboration, informing us about the natural history and incidence
See, Twitter isn’t only a procrastination tool😅
#Liver
#transplant
friends:
Is anyone using SAAG to analyze post-transplant ascites?
Seen a mix of > and < 1.1 as a liver transplant fellow, and doesn’t seem to correlate well with etiology/prognosis!
@rrosenblattmd
@AniKardashianMD
@liverazzi
@ebtapper
@AndrewMMoon
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New uniform!
I’m torn between which is hardest part:
1️⃣constantly fogged glasses
2️⃣🚫coffee
3️⃣my iPhone no longer recognizes my face and I’m always entering that darn password
Taking advice.
#wegotthis
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Do you ever feel like someone is right behind you, but you turn around and it’s a mirror?
Welcome to
#LiverMtg19
!!
#LiverSnaps
@AASLDtweets
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Can’t think of a better place (
#twitter
) to announce I’m joining the
@AASLDtweets
communications and technology committee! Can’t wait to get started.
Task 1️⃣: we need a liver emoji! Right now closest we have is a potato 🍠
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This morning I listened to voice memos from March & April, recorded on empty subway trips to and from COVID shifts
I hardly recognize myself on the recordings. I have never been more uncertain in my life
Was the perfect tribute to what happened later
#thankyouscience
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Happiest (early) birthday to the one and only Anna Lok
❤️
@MichiganLiver
Ps yes I made a liver piñata
Pps yes
@ebtapper
brought it down
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Thank you
@JHepatology
and coauthors
@a2binny
@ebtapper
Anna Lok!
Lots of promise 🌟 for Microbiome-targeted therapies for HE
We’ve scratched the surface, but there’s more to do
Several potential targets/pathways (see fig)
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Was thrilled to participate in this tribute to the one and only Dr Anna Lok! 🌟
I’m unbelievably lucky to call her my mentor.
@umichmedicine
@MichiganLiver
@ebtapper
@pummy92
@AASLDtweets
@AASLDFoundation
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THE Dr Anna Lok - my mentor, living legend, delivering the
@AmerGastroAssn
presidential address at
#DDW2023
on breakthroughs and challenges in hepatology
She lays out marching orders for the next generation of hepatology research
Let’s get to work!
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Thank you SO much to the
@AmerGastroAssn
for their support of our work investigating speech as a biomarker of hepatic encephalopathy!
Congratulations to our 2023
#AGAResearchFoundation
awards class! This year we are granting over $2.6 million in funding to 71 gifted researchers working on impactful GI research projects.
@schwoerersimon
@DoctorSharad
@EnriqueSoto8
@laura_targownik
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Wouldn’t spent my Sunday morning any other way:
Coffee, snow outside my window, and learning about Microbiome treatments in cirrhosis!
Ok wish we were in Cali so I could have missed this snow…
Thanks
@CyriacAbby
for a great talk!
#LiverMtg21
@AASLDtweets
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In the last 48 hours: bumper fell off my car, air co in car stopped working on an 85 degree 4-hr car ride, locked keys in my car, AND my dog was sprayed by a skunk and smeared the skunk oil all over our house.
Did I mention my K grant is due this week?
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Thrilled to scoot on over to
#ILC2023
this morning!
Can’t wait to hear about the latest hepatology research and catch up with friends across the pond.
(Ps: this video is me learning to scoot last night. I have hopefully improved for this mornings commute)
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I’d like to dedicate this SNOW ❄️ DAY to
My husband who trudged out at 7am to bribe plows to clear our drive way
And our neighbor with the snowblower who made it possible for me to drive to work when the bribes weren’t enough
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Now in
@HEP_Journal
COVID LFTs in an inpatient US sample
AST or ALT above ULN is COMMON: 93% at some point
Almost 1 in 5 w peak AST or ALT > 5x ULN
AST>ALT most of time
On admit AST correlated with CPK, but not over admit -> AST may not be from muscle
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Case of COVID-19 diagnosed after
#liver
#transplant
!
Interesting: diagnosed day 19 of admission, COVID PCR fluctuated +/-, no organ failure, and abnormal LFTs assumed to be rejection
IMPT to keep in 🧠 as we continue this life saving procedure!
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After a day to reflect, what I found most impressive about
@AASLDtweets
@EASLnews
Masterclass:
AASLD, EASL, and senior leadership have made a ENORMOUS investment in the next gen of liver researchers
Not paying lip service to mentorship
They care about the future and it shows
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Loved presenting our data on speech as a novel biomarker in HE at
@ISHENliver
And the beautiful setting in northern Germany doesn’t hurt!
It is always a pleasure listening to
@BloomPringle
present! Today she spoke about HE audio recording to detect mHE (« HEAR-MHE »): speech identifies mHE!
#ishen2023
Patricia is also an active committee member of the
@ISHENtranslatio
!
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1/3 We report 2 cases of ESBL producing Ecoli bacteremia following FMT in 2 separate clinical trials, linked to the same stool donor by genomic sequencing. Donor was healthy, no risk factors for MDRO, and passed FDA-approved screening procedures.
@DrZackDeFilipp
@raychungmd
Fecal microbiota transplantation is an emerging therapy. In this report, an ESBL-producing Escherichia coli was shown to have been transmitted from donor stool to several clinical trial patients, causing sepsis in two and death in one.
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Almost daily I ask myself (of transplant patients with mild ALT elevations): Is this fatty liver or rejection?
Glad to see this data: Fibroscan CAP > 270 w/ AUROC 0.88 for any steatosis.
Anyone routinely using elastography post transplant?
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#livertwitter
If you KNOW your patient has NAFLD advanced fibrosis, do you ever recheck liver stiffness?
I haven’t routinely.
Change in liver stiffness predicts outcomes, even if you start with advanced fibrosis!
@AGA_CGH
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Congratulations to
@NnekaUfereMD
for this incredibly well deserved award🍾🎊
Join me in celebrating this brilliant researcher, passionate patient advocate, and overall excellent human!!
@MGH_GI
@MGHMedicine
Huge congratulations to
@NnekaUfereMD
for her
@AASLDFoundation
Advanced Hepatology Fellow Award! Heralding great things to come!
@mghliver
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Getting a mini EEG before my morning coffee with
@SathishK0611
Barely passing!
Testing this machine to possibly add to some of my HE studies.
@MontagneseSara
tell me if I have HE!
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Bariatric surgery in cirrhosis or liver transplant: TIMING matters.
1️⃣ largely safe & effective in compensated cirrhosis (but check for high risk varices)
2️⃣ may not be safe and effective in decompensated cirrhosis
3️⃣ early data supporting gastric sleeve AT transplant
DEBATE: Bariatric surgery for
#cirrhosis
: To Be or not To Be?
To be:
@kymwatt
Not to be:
@serperm
When: March 22, 730 AM EST
Where:
#livertwitter
Join us!
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Brilliant presentation from
@DrLAEdwards
on FMT in cirrhosis.
Again, FMT appears to be improving HE, through multiple possible microbial-mediated mechanisms.
We will learn so much from this study.
@DebbieShawcros1
#ILC2023
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While ID, crit care, and medicine are in the trenches, there is MUCH GI/liver docs can be doing to pitch in!
Esp w all the abnormal LFTs in
#COVID2019
—> we can help discern true liver injury, severity, and how much work-up is really needed
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First collab of what will be MANY with the one and only
@ebtapper
Using administrative data to study hepatic encephalopathy
#Cirrhosis
please enjoy our review article!
🔓open-access
😎1st PPB/EBT collab
📣highlights the promise/pitfalls of large data in HE
🙏thanks to Riggio and Ridola for the invitation
#livertwitter
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Excited to have this data out in the world!
#livertwitter
We found 8 gut bacterial species linked to prior overt HE, but none predicted future HE 🧐
Short chain fatty acids (made by gut bacteria) appear to be part of the gut-liver-brain story
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My
#1
favorite
@MGHMedicine
tradition: Chief resident 👋🏻talks. Today, friend
@NinoNJ
spoke about UNCERTAINTY - from starting intern year to 1st year attending to his family immigrating from Croatia. As July 1st approaches: you are NOT alone in worrying abt your new role! 👏🏻Nino!
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So honored to accept the
@AASLDFoundation
Advanced/Transplant Hepatology Award to support my investigation of the gut
#microbiome
in hepatic encephalopathy! And enormous thanks to my mentor
@raychungmd
for his un-ending support. Thank you
@AASLDtweets
!
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Does the USMLE know they’ve ruined potato salad for me?
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✈️Flying home from Vienna after a very fulfilling
#EASL2023
Feeling lucky to be in a field with such smart and passionate colleagues 🍀
Until we meet again in Boston!
#livertwitter
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HUGE THANK YOU to our friends in the emergency room and primary care.
You’re on the front lines of this
#COVD19
epidemic and we have your back.
@MGHMedicine
@MassGeneralEM
@mgh_id
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Join me and
@adegottardi
tomorrow morning 9am!
For ☕️ and discussion about the microbiome and portal hypertension.
Find out why the microbiome is so 🔥 🔥 🔥 right now
We’ll discuss recent developments and highlights from
#LiverMtg21
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The future is BRIGHT 💡 for hepatic encephalopathy treatments
Wonderful
#TLMdX
panel discussion led by one and only
@JasmohanBajaj
@DebbieShawcros1
and
@DrLAEdwards
discuss their upcoming PROMISE trial
300 patients w cirrhosis will receive FMT capsules!
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First of hopefully many collaborations with
@seth_waits
and
@UMichSurgery
!
It would be great to use a checklist to speed up discharge and compare outcomes after
#livertransplant
, but several layers of heterogeneity stand in the way.
@MichiganLiver
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How do we shrink liver waitlist mortality? Turn borderline organs➡️life saving organs?
Tune in this upcoming Tuesday 7:30am ET to hear from the one and only
@KrisCroome
.
Join us at
@UMichGIHep
Grand Rounds:
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Once a week I get a predatory journal email that fools me for a solid 5 seconds.
This one is my favorite.
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UMich Liver Transplant journal club
Fantastic discussion last night about timing and nuances of living donation
Sparked by this great piece:
Wouldn’t want to do this work with any other team
#GoBlue
〽️
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You always have time for the things you put FIRST
We all have the same 24 hours in a day
How are you using yours?
Please talk to
@NeenaSAbrahamMD
about how to manage your ⏰ and prevent burn out
@AmCollegeGastro
#CRLP
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Highlighting this investigational 💊 drug (VE303) for
#livertwitter
We are 1/2 thru an RCT of VE303 to treat HE!
Contains 8 strains w 💪🏻 robust secondary bile acid & short chain fatty acid production
Lasts a year after taking for 2 weeks
Keep your 👀 peeled for our results!
Today we published at
@cellhostmicrobe
the results of a Phase 1 study of
@vedantabio
‘s lead candidate VE303 (for C. difficile infection), with a focus one studying pharmacokinetics (PK) and pharmacodynamics (PD) of this defined bacterial consortium. 🧵 /1
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Little plug:
We NEED to keep TLM an exciting place for trainees, to maintain the pipeline 💪🏻
We need more
@LizzieAbyMD
@jlouissaint89
&
@doctornikkid
To that end: join me in donating to
@AASLDFoundation
for travel awards to junior folks
Link here⬇️🙏
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Phenomenal Starzl lecture from
@AsraniSumeet
right now
Showing us the rise in alcohol even in google search!
We’re going to have more work to do for ALD…
#TLM23
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Don’t usually post on vacation BUT
Met these 2 at an outdoor concert in Austria
Performing free point of care HCV testing!
We chatted, they’ve helped diagnose and treat many this way.
Never know where you’ll run into another liver fan! Keep up the great work!
#LiverTwitter
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If you read ☝️ paper on PPIs in cirrhosis, read this ☝️
Out in
@AGA_Gastro
this month
❤️ the methods
2 main take aways
1️⃣If you’re using PPI for PUD 👉🏻mortality benefit
2️⃣If not 👉🏻increased risk of infection and decompensation
@serperm
@nadimmahmud
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Autoimmune hepatitis pts have ⬇️ post-transplant survival compared to PBC & PSC
HUGE AIH cohort (2515 pts): ⬆️death from infection (esp fungal) & graft loss
#livertwitter
: Should we ⬇️IS in pre-transplant AIH? ⬆️after? Change fungal ppx? What do you do?
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As a “liver person”, best part of
#DDW2023
is hearing about the things I study (gut permeability, microbes etc) from a non-liver point of view - namely IBS and functional bowel disease
Learned a ton from excellent talks at the
@AmerGastroAssn
@RomeFoundation
lectureship
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Just got off an inspiring call with
@Arthur_Kim_ID
’s team at
@MassGeneralNews
Teamwork in action: ID, cards, liver, medicine, pharmacy - working together to write treatment protocols for
#COVID
#livertwitter
we can help by managing liver tox of potential treatments!
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@MichiganLiver
@NDP1001
@ebtapper
😂 I swear this video is about cirrhosis even though it looks like I’m about to report the evening news
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Ever ? why you’re always checking for flapping tremor in cirrhotic patients? Well, wonder no longer. At
@ishen2019
Dr Formentin shares that ASTERIXIS 👋🏻 correlates with ammonia, MELD, neuro tests and predicts future HE! So keep telling patients to 🛑 traffic!
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Just when you thought we knew everything about ammonia
Great paper in
@HEP_Journal
this month from
@RajivJalan1
’s group
Animal model of NAFLD ⬇️urea cycle fxn and ⬆️ammonia
Ammonia led to ⬆️fibrosis
AND the kicker: an ammonia scavenger prevented progression of fibrosis!
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NERD 🚨! Nothing (at work) I love more than analyzing my data for the first time.
Today I am sitting on a couch with a warm cup of coffee and analyzing fresh data from TWO projects! It’s like Christmas came early!
Told you it would be nerdy...
#epitwitter
#livertwitter
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Honored to be invited. Looks to be a fantastic program! Thank you
@AmCollegeGastro
Introducing the inaugural cohort of the ACG Clinical Research Leadership Program!
These emerging leaders will receive training to support skills in clinical research management through The Center for Leadership, Ethics & Equity and the
#ACGInstitute
. Congratulations!
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People are asking... what’s up with LFTs in
#COVID19
?
Many observational studies can tell us a lot now.
Read more in my review for
@MGHMedicine
FLARE:
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@LizzieAbyMD
@AmCollegeGastro
@MichiganLiver
Are you kidding? I immediately told 3 people I had won the lottery! Who will be mentoring WHO?!?
🥳🥳🥳
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Thanks
@UMIntMed
for the shout out! Love this hospital, department, division and colleagues! Can’t believe I’ve already been here 2 years❤️
Waiting to see how long it takes my mom, who Twitter stalks me, to read the last part 😉
Behind the Scenes is back with hepatologist, Dr.
@BloomPringle
, from the Division of GI & Hepatology! Learn about Dr. Bloom and her clinical and research work.
#WomenInGI
#cirrhosis
#gutbacteria
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To follow on great
#livertwitter
convo in the last few weeks:
Telemedicine will STAY impt post COVID
Patients with early readmission for cirrhosis (
@MGH_GI
): 1️⃣most have smartphones and 2️⃣are willing to use an app to manage their disease
(Work accepted to
@BMJ_innovations
)
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6
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The science has been outstanding but the reunions even better
#TLM22
Great seeing
@BloomPringle
,
@traceyg_md
,
@NnekaUfereMD
and Brian Lee at this
@AASLDFoundation
event!
@AASLDtweets
#TLM22
#LiverMtg22
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Thrilled to present my work on hepatic
#encephalopathy
outcomes at
@ishen2019
! Shaping up to be a highly educational conference with incredible line up of experts
@JasmohanBajaj
@DebbieShawcros1
@ebtapper
and more. Let’s move
#HE
care forward! Thanks for support
@AASLDtweets
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FINAL
I designed this trial as a first year fellow, > 5 years ago
There is nothing like (for a newbie like me) seeing my "research baby" finally be OUT!
THANK YOU co-authors and mentors; you know it would not have happened without you
@MGH_GI
@raychungmd
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1
29
Woke up to ☕️ and
@ISHENliver
conference!
Interesting: people with even early/minimal HE have ⬇️ability to sense cold 🥶(and other sensations), especially in their limbs.
This may be contributing to risk of injury in this group!
0
9
29
There are gender disparities in
#livertransplant
.
At
#ControversiesInTransplantation
, Dr Jayme Locke shows 2 people with = eGFR, TB, INR, and Na
➡️ 👨🏻has a MELD of 25 and 👩🏻has a MELD of 22!
OH and 👩🏻is 4x more likely to be passed over for small size.
Time for change.
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5
26
AST dominance of COVID LFTs is a clue for etiology, we have some guesses:
Mitochondrial injury?
Hypoxia?
Microthrombi?
Thank you
@raychungmd
@eaks790
@EricMeyerowitz
@Arthur_Kim_ID
@MGH_GI
@mgh_id
@AASLDtweets
For more see:
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7
27
My liver family
#TLM22
Great seeing
@BloomPringle
,
@traceyg_md
,
@NnekaUfereMD
and Brian Lee at this
@AASLDFoundation
event!
@AASLDtweets
#TLM22
#LiverMtg22
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0
1
26
I’ll admit it. Got a bit behind on my summer reading since starting liver transplant fellowship.
Enjoying this beautiful fall day with a 🎃 spice latte (don’t hate) and catching up on the journals
@HEP_Journal
@AmCollegeGastro
Yes, puppy may need to help... wish me luck!
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