John Damianos, M.D.
@john_damianosMD
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@MayoClinicGIHep Gastroenterology & Hepatology Fellow. Yale Internal Medicine, Dartmouth Med. 🦠Microbiome, brain-gut axis, diet, IBS, IBD, motility, #MedEd 🇬🇷
Joined August 2015
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Buckle up! This 🧵 is a deep dive into the
#physiology
of defecation, the mechanics of pooping! 🧰 🚽 💩
#medicine
#MedEd
#science
#GITwitter
#GI
#gut
#motility
#constipation
#IBS
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Silver stools (Thomas's sign): pathognomonic of carcinoma of the ampulla of Vater. This case was metastatic colon
#cancer
.
#MedTwitter
#GITwitter
#surgery
#oncology
#coloncancer
21
481
3K
Ultraprocessed foods have contributed to the global burden of chronic inflammatory diseases such as inflammatory bowel disease in part via detrimental effects on the gut microbiota. 🍕🦠🔥
#MedTwitter
#diet
#nutrition
#IBD
#microbiome
#health
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989
3K
I gave a talk on inpatient bowel regimens today for the
@YaleMed
@YaleIMed
residents and students, with additional 💎s on outpatient
#constipation
. Here are the slides!
💩 💩 💩
#MedTwitter
#GITwitter
#motility
#MedEd
@YaleIM_Chiefs
@MayoClinicGIHep
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205
1K
3
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598
The microbiota contribute to weight management, and we can target the microbiota to achieve weight loss
#MedTwitter
#microbiome
#obesity
#diet
#probiotics
3
186
575
Kombucha-induced acute liver injury with massive hepatic necrosis
#MedTwitter
#LiverTwitter
#Liver
#GITwitter
#microbiome
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550
GLP-1 receptor agonist lixisenatide slows the progression of Parkinson disease.
#MedTwitter
#GITwitter
#Neurology
#NeuroTwitter
#Parkinsons
@NEJM
11
87
499
73
53
489
I am thrilled beyond words to have matched at
@MayoClinic
for my Gastroenterology and Hepatology fellowship! 🤩🤩🤩
#MedTwitter
#GITwitter
We are thrilled to welcome these residents who just Matched into Mayo Clinic Gastroenterology Fellowship in Rochester, Minnesota's Class of 2026!
@DougSimonetto
@rjw_styk2it
@DarrellPardi
@LauraRaffalsMD
@hmalhi
@LewisRobertsMD
@KashyapPurna
#MatchDay
#FellowshipMatch
#GITwitter
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Food additives may contribute to the development of inflammatory bowel disease via pro-inflammatory modulation of the gut microbiota.
#MedTwitter
#medicine
#GITwitter
#IBD
#microbiome
5
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388
Aggressive fluid resuscitation in acute pancreatitis does NOT improve clinical outcomes, and it ⬆️ the risk of fluid overload. 💧
#MedTwitter
#GITwitter
#MedEd
#pancreas
7
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7
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356
4
99
316
Amazing
@NEJM
case of intrapericardial colon. Patient with palpitations relieved passing gas or having a bowel movement.
#GITwitter
#GI
#gut
#cardiotwitter
#cardiology
20
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A master class on prokinetics from
@NGMJournal
! Here is a summary! 🧵👇
⚡️🎈〽️🪠🫀💩🚄🧠✳️🗯️💊📰🚽🔌🧪💡🧲📊🔎
#MedTwitter
#GITwitter
#motility
#pharmacology
4
98
288
The effects of
#diabetes
on the gastrointestinal system and functioning.
#MedTwitter
#GITwitter
#motility
#endocrinology
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8
70
271
3
100
268
Abdominal distension in patients with disorders of gut-brain interaction is most commonly due to abdominophrenic dyssynergia (diaphragmatic contraction & anterior abdominal wall relaxation),not to ⬆️intestinal gas. Can detect with EMG or CT (⬇️sensitive)🎈
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267
Very excited to share our review on abdomino-phrenic dyssynergia!
🎈This physiology is an important contributor to bloating and distension in disorders of gut-brain interaction!
#MedTwitter
#GITwitter
#DGBI
#FGID
#IBS
@AmJGastro
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🥥Coconut water induces clinical remission in mild-to-moderate ulcerative colitis
#MedTwitter
#GITwitter
#IBD
#diet
#nutrition
@AmerGastroAssn
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258
Up to 2/3 of diagnosed diarrhea-predominant irritable bowel syndrome is actually attributable to
1️⃣food intolerances
🍞disaccharide deficiencies
🥦FODMAPs
🔥allergies (alpha-gal, eosinophilic disorders)
2️⃣bile acid malabsorption
3️⃣dysbiosis
#GITwitter
6
82
254
Effects of ultra-processed foods and food additives (emulsifiers, artificial sweeteners, colorants, nanoparticles) on gastrointestinal health.
#MedTwitter
#GITwitter
#diet
#nutrition
5
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Enormous news in the
#microbiome
world: the FDA has approved the first ever live biotherapeutic product, Reybota (RBX2660), a healthy donor 💩 microbiota suspension for the treatment of recurrent Clostridioides difficile infection.
#MedTwitter
#GITwitter
4
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Intestinal barrier dysfunction has been implicated in several neurologic and psychiatric disorders. 🧠
#MedTwitter
#Neurology
#NeuroTwitter
#Neuroscience
#GITwitter
#microbiome
#braingut
9
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3
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The
#gut
microbiota play a 🔑 role in heath and disease. Modulation of the microbiota can potentially prevent and treat certain diseases. However, there is still a lot which is unknown.
#MedTwitter
#medicine
#science
#health
#microbiome
#probiotics
#diet
6
71
213
Healthy plant-based diets are associated with ⬇️ body fat, and are an effective intervention for weight management.
#MedTwitter
#diet
#nutrition
#obesity
#plantbased
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1
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@ENirenberg
@acweyand
Not to mention the strong link between infections and immune-mediated diseases.
Epstein-Barr virus is a likely cause of multiple sclerosis, as EBV infection is associated with a whooping 3️⃣2️⃣x ⬆️ risk of
#MS
. 🦠 🧠
#MedTwitter
#medicine
#science
#neurology
#NeuroTwitter
#neuroscience
#autoimmune
0
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A multi-strain
#probiotic
co-administered with metformin leads to a greater reduction in hemoglobin A1c compared to metformin alone, via ⬆️short-chain fatty acid-producing bacteria and ⬆️ certain bile acids.
#MedTwitter
#diabetes
#microbiome
#probiotics
3
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The Mediterranean
#diet
⬇️ intestinal inflammation and favorably modulates the gut microbiota, including ⬆️ short-chain fatty acids in patients with ulcerative colitis.
#MedTwitter
#GITwitter
#IBD
#nutrition
5
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Dietary fiber influences gut mucosal immunity via microbial-derived short-chain fatty acids.
#MedTwitter
#diet
#nutrition
#GITwitter
#SCFA
#microbiome
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Let's talk about something common, hard to treat, and often misunderstood: CHRONIC BLOATING AND DISTENSION!
A 🧵 summarizing from the excellent
@AGA_CGH
article
#GI
#GITwitter
#motility
#IBS
#DGBI
#FGID
#microbiome
#health
#MedEd
2
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Eating 20 g of almonds 30 min before each meal may prevent post-meal hyperglycemia and improve body weight, waist circumference, and insulin resistance in individuals with pre-diabetes.
#MedTwitter
#diabetes
#diet
#nutrition
4
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Kiwi is more effective than psyllium to ⬆️ bowel movement frequency and and ⬇️ gastrointestinal discomfort in patients with constipation-predominant irritable bowel syndrome or functional
#constipation
. 🥝
#MedTwitter
#GITwitter
#IBS
#diet
#DGBI
5
40
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Nice review on what we know about
#diet
and inflammatory bowel disease. 🔥
#MedTwitter
#GITwitter
#IBD
#nutrition
#microbiome
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Therapeutic targets for the treatment of pain in irritable bowel syndrome.
#MedTwitter
#GITwitter
#IBS
#DGBI
#FGID
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Anticoagulants and antiplatelets during GI bleed🩸with the 👸 of
#CardioGI
herself,
@NeenaSAbrahamMD
!
#MedTwitter
#GITwitter
#ACG2022
#hematology
#hemetwitter
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58
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The bidirectional microbiota-gut-brain axis contributes to sleep disorders. 😴
#MedTwitter
#microbiome
#psychiatry
#neurology
#sleepmedicine
1
54
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New
@AmerGastroAssn
guidance on
#diet
in inflammatory bowel disease
🥇Mediterranean diet
✅EEN & CDED in CD
✅screen for malnutrition and vitamin deficiencies
✅collaborate with RD
✅breastfeeding is protective
#MedTwitter
#GITwitter
#IBD
5
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0
52
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How does alcohol affect the gastrointestinal tract? 🍺 🍷 🥃
#MedTwitter
#GITwitter
#microbiome
#health
2
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Alterations of the gut-brain-immune axis contribute to the pathogenesis of headache disorders.
#MedTwitter
#GITwitter
#Neurology
#neurotwitter
#migraine
3
54
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🚨 Here are the ⭐️ new ⭐️
@AmCollegeGastro
guidelines on the Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections! I'll summarize in 🧵 below!
🦠 ▶️ 💩 💩 💩 ▶️ 😷
#GITwitter
#GI
#gut
#Cdiff
#microbiome
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The small intestine and colon differ in ecology and physiology. This is important when studying interventions such as
#diet
and
#probiotics
.
#MedTwitter
#GITwitter
#microbiome
0
52
170
5
67
172
Dysbiosis of the oral microbiota may contribute to the development of autoimmune diseases. 👄 🦠 🔥
#MedTwitter
#diet
#nutrition
#microbiome
#autoimmune
3
52
168
Excellent paper on the immunopathogenesis and environmental triggers of
#celiac
disease. 🌾 🦠 💩 🔥
#MedTwitter
#medicine
#GITwitter
#autoimmune
@Gut_BMJ
3
40
161
Rifaximin has an anti-inflammatory effect in the gut
👄⬇️oralization of the gut
#microbiome
🦠⬇️mucin-degrading species eg Streptococcus & Veillonella
🦠⬇️susceptibility to pathogens and ⬆️gut barrier repair
#medtwitter
#medicine
#LiverTwitter
#GITwitter
0
61
162
Role of epigenetics in the pathogenesis of irritable bowel syndrome.
#MedTwitter
#GITwitter
#IBS
#DGBI
0
54
160
Dysbiosis contributes to the development of diverticular disease. Targeting the microbiota may be able to improve outcomes.
#MedTwitter
#GITwitter
#microbiome
2
41
158
Summarizing today's very useful
@AmCollegeGastro
Virtual Grand Rounds on feeding tube management!🧶
#medtwitter
#medicine
#GITwitter
#GI
#nutrition
5
47
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5
53
157
Thank you so much to
@DrPraegers
for having me to discuss the effects of plant-based diets on the
#gut
#microbiome
! Here are my slides for all to see! 😃
🍅🥑🧅🍑🥦🍒🫑🍊🌶️🍎🍆🍊🫒🍓🥒🍉🥗🥝🦠
#medicine
#medtwitter
#diet
#nutrition
#GITwitter
#GI
#guthealth
#health
17
46
156
Fecal microbiota transplantation combined with anti-inflammatory
#diet
induced deep remission in mild-moderate ulcerative colitis more effectively than standard medical therapy, with a sustained response at one year.
#MedTwitter
#GITwitter
#IBD
#FMT
2
45
155
🔮Targeting mucosal healing in inflammatory bowel disease without immunosuppression. 🔥
#MedTwitter
#GITwitter
#IBD
#microbiome
1
33
153
Dupilumab (anti IL-4 & IL-13 mAb) is effective in the treatment of eosinophilic esophagitis. 🔥
#MedTwitter
#GITwitter
#motility
#autoimmune
#esophagus
@NEJM
2
51
153
Long-chain omega-3 polyunsaturated fatty acids
🫀⬇️triglycerides
🫀⬇️inflammation
🫀improve vascular endothelial function
🫀⬇️platelet activation
🫀⬇️CV death, heart attacks
🫀⬆️risk of new atrial fibrillation
#MedTwitter
#cardiology
#diet
#nutrition
3
53
150
Here are the new
@BritSocGastro
guidelines for
#IBS
in
@Gut_BMJ
! I'll summarize in 🧵 ⬇️⬇️⬇️!
😖💩🦠🧠🥦🍞💊
#GITwitter
#GI
#gut
#braingut
#motility
#DGBI
#FGID
#microbiome
#probiotics
#MedTwitter
#MedEd
5
54
148
A multi-strain
#probiotic
(9 Lactobacillus strains ➕ 5 Bifidobacterium strains) successfully induced remission in mild-moderate ulcerative colitis, and also ⬇️CRP, ⬆️hemoglobin, ⬇️IgA, and ⬆️IL-10.
#MedTwitter
#GITwitter
#IBD
#microbiome
#probiotics
4
44
146
Kombucha-induced liver injury
#medtwitter
#medicine
#LiverTwitter
#liver
#GITwitter
#microbiome
#diet
#nutrition
#DILI
#kombucha
11
36
143
The
#microbiome
is an important mediator of nutrition’s impact on the gut-brain axis.
#MedTwitter
#diet
#nutrition
#neuroscience
#GITwitter
4
54
143
Dark chocolate 🍫 is a prebiotic that improves gut microbial diversity and composition (⬆️Blautia obeum levels, ⬇️Faecalibacterium prausnitzii). Furthermore, it is associated with improved mood. 🧠
#MedTwitter
#medicine
#mentalhealth
#diet
#microbiome
3
28
144
⭐️ New
@AmerGastroAssn
guideline on pouchitis.
#Probiotics
(De Simone formulation) are recommended for the prevention of recurrent pouchitis.
#MedTwitter
#GITwitter
#IBD
#microbiome
3
42
145
A combination of curcumin and QingDai in ulcerative colitis:
🌱86% clinical response
🌱46% ⬇️ fecal calprotectin by 50%
🌱75% endoscopic improvement
🌱⬇️ aryl-hydrocarbon receptor pathway activation
#MedTwitter
#GITwitter
#IBD
#diet
#nutrition
12
33
142
Diets high in fiber are associated with 23%⬇️all-cause mortality, 26% ⬇️ cardiovascular disease-related mortality, and 22% ⬇️ cancer-related mortality.
Insoluble fiber has a greater effect.
Nuts and seeds have 43%⬇️ CVD death risk.
#MedTwitter
#diet
4
46
142
Are disorders of gut-brain interaction disorders of neuro-immune interactions?
#MedTwitter
#GITwitter
#motility
#DGBI
#FGID
3
46
140
The gut microbiota contribute to heart failure.
Consumption of prebiotics and fermented foods and avoidance of red meat favorably modulate the microbiota in a cardioprotective fashion.🫀
#MedTwitter
#Cardiology
#heartfailure
#microbiome
#diet
#nutrition
0
44
141
Fermented foods and how they support gastrointestinal health.
#MedTwitter
#GITwitter
#diet
#nutrition
#microbiome
4
47
141
2
37
141
Small intestinal bacterial overgrowth is present in 37% of patients with irritable bowel syndrome (10% H2, 27% CH4). CH4 associated with constipation, H2 with diarrhea.
#IBS
severity did not correlate with
#SIBO
. H2 correlated with depression.
#GITwitter
3
34
141
Which diets are best and worst for the heart? 🫀
🥇DASH and Mediterranean diets
🥈vegan and low-fat diets
🥉very low-fat and low-carb diets
👎keto and paleo
#MedTwitter
#cardiology
#hearthealth
#diet
#nutrition
8
53
139
Consumption of ultra-processed foods for 2 weeks ⬆️ weight and body fat.
A home-cooked food diet for 2 weeks ⬇️ weight and cholesterol, and ⬆️ appetite-suppressing hormone PYY.
#MedTwitter
#health
#diet
#nutrition
#obesity
4
48
138
Artificial sweeteners, elumsifiers, food colorants, and other food additives adversely impact the gut microbiota, contributing to a pro-inflammatory state that may predispose to or worsen
#IBD
.
#MedTwitter
#medicine
#GITwitter
#GI
#diet
#nutrition
5
45
138
@YazanAbdullahMD
Oversimplified, stigmatizing, and wrong.
This neglects, among other things:
🧬polymorphisms in serotonin pathway genes
🦠post-infectious
#IBS
🟢altered bile acid metabolism
⚡️dysautonomia and dysmotility
🧠anxiety/depression often develops *AFTER* IBS diagnosis
#GITwitter
2
7
136
🚨New
@AmCollegeGastro
guidelines for the treatment of irritable bowel syndrome! I will summarize in this🧵 ⬇️⬇️⬇️
Authors:
#BrianLacy
,
@MarkPimentelMD
,
@dbrennerGIMD
,
@umfoodoc
,
@drlauriekeefer
,
@MLongMD
,
@BMoshiree
#GITwitter
#GI
#IBS
#gut
#MedEd
8
47
139
Cranberry supplementation improves the gut microbiota including ⬆️ short-chain fatty acid-producing bacteria.
#MedTwitter
#GITwitter
#microbiome
#diet
#nutrition
3
32
135
Thalidomide ⬇️ recurrent bleeding from small intestinal angiodysplasia 🩸
#MedTwitter
#GITwitter
#GIbleed
0
41
129
Abnormal bile acid metabolism contributes to irritable bowel syndrome, especially
#IBS
-D.
#MedTwitter
#GITwitter
#microbiome
3
39
133
1
37
132
Consumption of herbs and spices high in polyphenols such as black pepper, onion, garlic, cinnamon, ginger, and turmeric is associated a more favorable gut
#microbiome
with ⬆️ diversity, ⬆️ beneficial bacteria, & ⬇️ pathogenic bacteria.
#MedTwitter
#diet
3
37
129
@KK_medicine
Not even joking here- close family friend was choosing between Melanie and Elena and wanted to combine into… Melena. I vetoed that pretty quickly 😬
13
1
125
38% of patients diagnosed with irritable bowel syndrome have fructose malabsorption and 49% have fructan malabsorption.
#MedTwitter
#GITwitter
#IBS
8
34
128
Cross-talk between the microbiota and microglia contribute to the pathogenesis of disorders of gut-brain interaction.
#MedTwitter
#GITwitter
#DGBI
#FGID
1
35
126
Clinical practice update on exocrine pancreatic insufficiency
#MedTwitter
#GITwitter
#EPI
#pancreas
@AmerGastroAssn
1
52
128
The appendix plays a role in the pathogenesis of ulcerative colitis.
Appendectomy ⬇️ the risk of ulcerative colitis.
#MedTwitter
#GITwitter
#IBD
2
34
125
@BadMedicalTakes
Imaging their surprise reading this article from the British Medical Journal in 1861!
2
4
119
Consumption of two gold kiwis per day is as effective as psyllium (7.5 g/d) in the treatment of
#constipation
. 🥝
#MedTwitter
#GITwitter
#diet
#nutrition
#motility
3
28
122
One beer per day (either alcoholic or non-alcoholic) ⬆️ diversity of the gut microbiota and strengthened the intestinal epithelial barrier. This is likely mediated by polyphenols. 🍻
#MedTwitter
#GITwitter
#microbiome
#diet
#nutrition
#guthealth
12
22
122
The viscous cycle of inflammation and malnutrition in inflammatory bowel disease. 🔄
#MedTwitter
#GITwitter
#IBD
#diet
#nutrition
3
39
122
Why is colon cancer occurring in younger individuals?
☢️early life environmental exposures/toxins
⚖️obesity ad metabolic disorders
📺sedentary behavior
🥤refined sugars and sweetened beverages
🥩 red and processed meats
💊antibiotics
✂️C-section
10
38
121
Officially starting as a GI FELLOW tomorrow, surrounded and supported by the BEST co-fellows and attendings ever! 🤩 💩 🩸 🚽 🔦 🦠 🏥
#MedTwitter
#GITwitter
#futureofGI
Welcome 1st year
@MayoClinicGIHep
fellows to the wonderful world of GI and Hepatology!!
Good luck on your 1st day tomorrow!! You got this!!! 🌟
2
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11
1
121
1
46
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The Mediterranean
#diet
is associated with a more favorable gut microbiota profile and ⬇️ intestinal inflammation. 🍓🥦🍇🧄🍠🥝🍆🥑🫘🍉🧅
#MedTwitter
#GITwitter
#nutrition
#health
#microbiome
1
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