ACG Case Reports Journal最新文献

We report a case of significant clinical improvement after starting odevixibat in a 27-year-old patient with refractory pruritus due to progressive familial intrahepatic cholestasis type 1. He had poor response to multiple therapies and experienced profound decline in quality of life, describing his symptoms as emotionally exhausting and difficult to endure. He was evaluated for liver transplantation in March 2020 but was denied due to preserved liver function. Odevixibat was started in November 2021, resulting in biochemical improvement and dramatic sustained resolution of pruritus. He resumed normal activities, achieving excellent quality of life.

Noncirrhotic portal hypertension (NCPH) as a complication of systemic lupus erythematosus (SLE) is rare. We present the case of a young woman with SLE and refractory ascites, with biopsy-confirmed NCPH. The clinical course was complicated by the development of hepatic microabscesses and severe hepatic ischemic injury following transjugular intrahepatic portosystemic shunt (TIPS) placement. Bacterial seeding of the TIPS stent, followed by showering of the liver parenchyma, is the proposed culprit mechanism. This case highlights a novel infectious complication of TIPS in the setting of SLE-associated NCPH, thereby enhancing our understanding of hepatic manifestations in patients with lupus.

We present a series of pediatric and adult cases in which intestinal ultrasound (IUS) visualized benign and malignant intestinal polyps. These cases demonstrate the potential of IUS as a rapid, noninvasive bedside modality for evaluating abdominal pain. IUS has a role in recognizing structural abnormalities and associated complications such as intraluminal masses and intussusception. Although not a diagnostic standard for polyp detection, IUS can complement endoscopy in selected cases. These findings highlight an emerging, broader application of IUS beyond inflammatory bowel disease assessment.

Microscopic colitis is an inflammatory disease diagnosed via histopathology, often presenting with chronic nonbloody diarrhea. A 64-year-old woman was initially diagnosed in 2016 and received multiple standard treatments, which were ineffective and poorly tolerated. Trial of the Janus kinase inhibitor upadacitinib led to resolution of symptoms and improvement of treatment-resistant eczema. Although not FDA-approved for microscopic colitis, this case highlights potential benefit of Janus kinase inhibition in refractory cases and supports further investigation into its safety and efficacy.

Esophageal Crohn's disease (CD) is poorly studied despite being a significant predictor of intestinal CD progression and recurrence. Management has historically focused on steroids and acid suppression, with some success from immunosuppressants and biologics like antitumor necrosis factor-α agents. However, no specific guidelines exist for treating esophageal CD. Risankizumab, a human monoclonal antibody of interleukin-23, has shown promise in treating both induction and maintenance of remission in CD. This case series represents the first reported use of risankizumab in esophageal CD. Despite the absence of guidelines for esophageal CD management, these cases suggest that risankizumab may offer a valuable treatment option and should be strongly considered for managing esophageal CD.

We report a case of life-threatening malnutrition and liver injury in a post-Roux-en-Y gastric bypass patient after initiation of semaglutide, who subsequently developed profound micronutrient deficiencies and acute liver injury requiring ICU care, parenteral nutrition, and endoscopic bypass reversal. This case highlights the potential "dual-hit" risk of GLP-1 receptor agonists in patients with altered gastrointestinal anatomy. Clinicians should closely monitor nutritional status and liver function in postbariatric patients on GLP-1 therapy. Future research should explore safe prescribing practices, risk stratification, and the role of endoscopic interventions in managing severe complications.

Sleeve gastrectomy-transit bipartition is an effective metabolic surgery for obesity, offering significant weight loss and comorbidity resolution. Although generally safe, complications such as fistula, bleeding, or abscess may occur. Fistula remains a major challenge, often requiring endoscopic management. Endoscopic internal drainage using double-pigtail plastic stents has emerged as a minimally invasive and effective option, although stent-related adverse events, including migration or intestinal perforation, can occur. Colonic perforation from plastic stents is extremely rare, with only 59 cases reported. This case describes a late colonic perforation successfully managed endoscopically using a metallic clip, avoiding surgical intervention and achieving complete recovery.

Gastroesophageal reflux disease (GERD) frequently develops or worsens after sleeve gastrectomy (SG), and symptoms may persist despite optimal proton pump inhibitor (PPI) therapy due to postsurgical anatomical changes. Endoscopic full-thickness plication (eFTP) is a minimally invasive approach used to reinforce the gastroesophageal junction barrier. However, its feasibility after SG remains unclear given restricted retroflexion and reduced gastric compliance. This case represents the first reported use, to our knowledge, of GERDx eFTP in a post-SG patient with refractory GERD. The patient, a 40-year-old woman, had experienced severe GERD symptoms for 6 years after her SG and failed maximal PPI therapy. Evaluation revealed a 2-cm sliding hiatal hernia and pathological acid exposure. She underwent eFTP without any complications and had complete symptom resolution by 1 week, with successful discontinuation of PPIs at 3 months. This case demonstrates the technical feasibility of GERDx eFTP in a carefully selected post-SG patient with refractory GERD.

Extensive pseudopolyposis in ulcerative colitis (UC) is rare and can lead to protein-losing enteropathy (PLE) with severe hypoalbuminemia. We report an 18-year-old male with steroid-dependent UC complicated by extensive colonic pseudopolyposis causing PLE. This represents one of the few reported cases of PLE secondary to extensive colonic pseudopolyposis in UC. He presented with profound hypoalbuminemia reaching a nadir of 1.0-1.5 g/dL, malnutrition, iron-deficiency anemia, and deep-vein thrombosis. Colonoscopy and imaging revealed dense pseudopolyps from the proximal sigmoid to the cecum, with minimal inflammation. Renal and hepatic causes of protein loss were excluded through routine urinalysis, the absence of proteinuria, normal creatinine levels, normal liver enzymes, and unremarkable renal and hepatic imaging. Although formal quantitative PLE testing, such as α-1 antitrypsin clearance, was unavailable at our center, the persistent severe hypoalbuminemia, minimal inflammatory activity, and exclusion of alternative etiologies strongly supported a diagnosis of pseudopolyposis-associated PLE. Management included multiple biologics, steroid tapering, total parenteral nutrition, and anticoagulation; colectomy was declined. Clinicians should maintain a high index of suspicion for PLE in UC patients with extensive pseudopolyposis and hypoalbuminemia disproportionate to the degree of inflammation.