Pub Date : 2020-10-21DOI: 10.17554/j.issn.2224-3992.2020.09.963
L. Bierle, S. Reddy, Varun Kesar, V. Chitnavis, D. Grider
Synchronous carcinomas in the same patient were first elucidated in the early 1930s. Following this initial recognition, awareness of synchronous carcinomas coupled with advancements in medical technology have made diagnosis of two primary carcinomas from separate sites in the same time interval possible. We present a case of newly diagnosed synchronous primary esophageal and ascending colon adenocarcinomas in a patient presenting with lower gastrointestinal bleed. A 74-year-old female with history of abdominal aortic aneurysm repair on dual-antiplatelet therapy and chronic obstructive pulmonary disease on supplemental oxygen presented with bright red blood per rectum. Initial hemoglobin was 12.5g/dL, down-trending to 9.0g/dL. Esophagogastroduodenoscopy (EGD) revealed a nodule in the proximal esophageal mucosa, a submucosal lesion in the esophageal body 30 centimeters from the entry point, and a hiatal hernia with pathology showing high grade dysplasia in Barrett mucosa (Figure 1). Her hemoglobin stabilized after one transfusion and symptoms resolved. Days later, repeat EGD with endoscopic mucosal resection and colonoscopy showed Barrett’s esophagus, a distal esophageal mass at 30cm (Figure 2), and synchronous colon masses in the ascending colon (Figure 3). Pathology from EGD biopsies revealed Barrett mucosa leading to esophageal adenocarcinoma (Figure 4) with MLH1 and PMS2 mismatch repair (MMR) proteins intact, demonstrating nuclear positivity. Histopathologic analysis of the ascending colon mass revealed BRAF mutation positivity (Figure 5) and loss of MLH1 and PMS2 MMR proteins, confirming a sporadic microsatellite unstable colonic adenocarcinoma. She was staged at T2N0 by endoscopic ultrasound and T2N0 colon adenocarcinoma with recommendations for esophageal resection and hemicolectomy. Given her oxygen requirements and chronic hypercarbia, she was not a candidate for esophagectomy, however underwent hemicolectomy. Colonic neoplasias (up to 20%) are the most common synchronous cancers in patients with primary gastric cancer; the incidence of esophageal and synchronous colon cancers is unknown. Upon discovering multiple primary malignancies, accurate staging along with immunohistochemical analysis is key to distinguish each primary cancer and determine appropriate therapy.
{"title":"Synchronous Esophageal and Colon Adenocarcinomas","authors":"L. Bierle, S. Reddy, Varun Kesar, V. Chitnavis, D. Grider","doi":"10.17554/j.issn.2224-3992.2020.09.963","DOIUrl":"https://doi.org/10.17554/j.issn.2224-3992.2020.09.963","url":null,"abstract":"Synchronous carcinomas in the same patient were first elucidated in the early 1930s. Following this initial recognition, awareness of synchronous carcinomas coupled with advancements in medical technology have made diagnosis of two primary carcinomas from separate sites in the same time interval possible. We present a case of newly diagnosed synchronous primary esophageal and ascending colon adenocarcinomas in a patient presenting with lower gastrointestinal bleed. A 74-year-old female with history of abdominal aortic aneurysm repair on dual-antiplatelet therapy and chronic obstructive pulmonary disease on supplemental oxygen presented with bright red blood per rectum. Initial hemoglobin was 12.5g/dL, down-trending to 9.0g/dL. Esophagogastroduodenoscopy (EGD) revealed a nodule in the proximal esophageal mucosa, a submucosal lesion in the esophageal body 30 centimeters from the entry point, and a hiatal hernia with pathology showing high grade dysplasia in Barrett mucosa (Figure 1). Her hemoglobin stabilized after one transfusion and symptoms resolved. Days later, repeat EGD with endoscopic mucosal resection and colonoscopy showed Barrett’s esophagus, a distal esophageal mass at 30cm (Figure 2), and synchronous colon masses in the ascending colon (Figure 3). Pathology from EGD biopsies revealed Barrett mucosa leading to esophageal adenocarcinoma (Figure 4) with MLH1 and PMS2 mismatch repair (MMR) proteins intact, demonstrating nuclear positivity. Histopathologic analysis of the ascending colon mass revealed BRAF mutation positivity (Figure 5) and loss of MLH1 and PMS2 MMR proteins, confirming a sporadic microsatellite unstable colonic adenocarcinoma. She was staged at T2N0 by endoscopic ultrasound and T2N0 colon adenocarcinoma with recommendations for esophageal resection and hemicolectomy. Given her oxygen requirements and chronic hypercarbia, she was not a candidate for esophagectomy, however underwent hemicolectomy. Colonic neoplasias (up to 20%) are the most common synchronous cancers in patients with primary gastric cancer; the incidence of esophageal and synchronous colon cancers is unknown. Upon discovering multiple primary malignancies, accurate staging along with immunohistochemical analysis is key to distinguish each primary cancer and determine appropriate therapy.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"9 1","pages":"3351-3353"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47860216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-21DOI: 10.17554/j.issn.2224-3992.2020.09.960
Manasi Joshi, E. Godfrey, J. Goss, A. Rana
ALD patients comprise a larger proportion of listings for liver transplant (LT) than in the past, and represent a population undergoing demographic change in the United States. This study examined the OPTN/UNOS transplantation waitlist STAR files from March 2002 - December 2017. All adults listed for LT were included (n=135,956). Yearly demographic trends in ALD-related listings and listing outcomes (transplantation vs. death on waitlist) were explored. Alcoholic cirrhosis has increased from 4.3% of the LT candidates in 2002 to 8.3% in 2017. While alcoholic hepatitis accounted for only 0.64% of listings in 2017, this has doubled since 2004. The proportion of women listed for ALD increased (21.8% in 2002 vs. 28.34% in 2017). Furthermore, proportionally fewer ALD listings are White patients (79.42% in 2002 vs. 75.66% in 2017). While the proportion of Hispanic LT candidates increased (12.87% vs. 15.94% p=0.00), proportionally, Hispanic ALD patients remained constant (15.68%, 15.84%). Since 2015, the percentage of ALD patients on the waitlist receiving transplants increased (from 41% in 2014 to 45% and 49% in 2015 and 2016). This increase is more than the increase for patients transplanted for non-ALD indications (39% to 40% and 41%). Transplant-to-death ratio increased to 7.6 in 2017 in the ALD group but only to 4.3 in the non-ALD group. This descriptive study provides an update on the relative prevalence of ALD in the LT population, demographic changes, and waitlist outcomes.
{"title":"Alcoholic Liver Disease Patients Listed for Liver Transplantation: An Overview from 2002-2017","authors":"Manasi Joshi, E. Godfrey, J. Goss, A. Rana","doi":"10.17554/j.issn.2224-3992.2020.09.960","DOIUrl":"https://doi.org/10.17554/j.issn.2224-3992.2020.09.960","url":null,"abstract":"ALD patients comprise a larger proportion of listings for liver transplant (LT) than in the past, and represent a population undergoing demographic change in the United States. This study examined the OPTN/UNOS transplantation waitlist STAR files from March 2002 - December 2017. All adults listed for LT were included (n=135,956). Yearly demographic trends in ALD-related listings and listing outcomes (transplantation vs. death on waitlist) were explored. Alcoholic cirrhosis has increased from 4.3% of the LT candidates in 2002 to 8.3% in 2017. While alcoholic hepatitis accounted for only 0.64% of listings in 2017, this has doubled since 2004. The proportion of women listed for ALD increased (21.8% in 2002 vs. 28.34% in 2017). Furthermore, proportionally fewer ALD listings are White patients (79.42% in 2002 vs. 75.66% in 2017). While the proportion of Hispanic LT candidates increased (12.87% vs. 15.94% p=0.00), proportionally, Hispanic ALD patients remained constant (15.68%, 15.84%). Since 2015, the percentage of ALD patients on the waitlist receiving transplants increased (from 41% in 2014 to 45% and 49% in 2015 and 2016). This increase is more than the increase for patients transplanted for non-ALD indications (39% to 40% and 41%). Transplant-to-death ratio increased to 7.6 in 2017 in the ALD group but only to 4.3 in the non-ALD group. This descriptive study provides an update on the relative prevalence of ALD in the LT population, demographic changes, and waitlist outcomes.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"9 1","pages":"3309-3312"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46131086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-21DOI: 10.17554/j.issn.2224-3992.2020.09.969
F. Pace, Helena Maria Giordano Valério, Juliano Machado de Oliveira, K. Barbosa, T. Ribeiro, J. Chebli
Clinically significant portal hypertension is a cornerstone in cirrhosis’s natural history, significantly impacting these patients’ morbidity and mortality. Unless adequate preventive measures are implemented, the recurrence rate of bleeding can reach up to 65% of patients and with mortality of 57%. The goals in portal hypertension treatment focus on reducing the hepatic venous portal gradient, both by reducing portal blood flow and intrahepatic resistance. Nonselective beta-blockers and esophageal varices ligation have been the standard of care in esophageal varices’ treatment. Currently, statins and carvedilol’s role in reducing portal pressure, preventing esophageal variceal bleeding, and other advanced liver disease complications seem to be promising.
{"title":"Beta-blockers and Statins: Role in Portal Hypertension and Beyond","authors":"F. Pace, Helena Maria Giordano Valério, Juliano Machado de Oliveira, K. Barbosa, T. Ribeiro, J. Chebli","doi":"10.17554/j.issn.2224-3992.2020.09.969","DOIUrl":"https://doi.org/10.17554/j.issn.2224-3992.2020.09.969","url":null,"abstract":"Clinically significant portal hypertension is a cornerstone in cirrhosis’s natural history, significantly impacting these patients’ morbidity and mortality. Unless adequate preventive measures are implemented, the recurrence rate of bleeding can reach up to 65% of patients and with mortality of 57%. The goals in portal hypertension treatment focus on reducing the hepatic venous portal gradient, both by reducing portal blood flow and intrahepatic resistance. Nonselective beta-blockers and esophageal varices ligation have been the standard of care in esophageal varices’ treatment. Currently, statins and carvedilol’s role in reducing portal pressure, preventing esophageal variceal bleeding, and other advanced liver disease complications seem to be promising.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41891445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-21DOI: 10.17554/j.issn.2224-3992.2020.09.962
I. Yakubu, Ali I. Elgaderi, Charles Andrews, Christophe Persad, E. Burke, J. Farley, Khaled Shaban, Lucy Kelly, Mahmood E. Elkaramany, Megan E. Penrose, M. K. Ansari, Osama Idris, Pamela Ntenezi, Syed Tipu Naqvi, Sylvia C. Mibey
Background In COVID-19 pandemic, hospitals become overwhelmed with acute admissions leading to the suspension of outpatient clinics including gastroenterology and endoscopic services. Similarly available resources are channeled to combat the scourge. These diversions of resources coupled with lockdowns and fear of getting infected prevent patients from accessing routine and life-saving gastroenterology services leading to increased gastrointestinal-related morbidity and mortality in at-risk populations. Often, there are delays in the diagnosis and early treatment of gastrointestinal cancers, and high risks of death from gastrointestinal bleeding. Summary This review discusses COVID-19 risk factors and ways and means of ensuring safe essential gastroenterology services in the setting of COVID-19 pandemic based on available evidence. Telemedicine avoids physical contacts, maximizes safety by reducing the risk of infection to both clinicians and patients, and is conducive to a lockdown, quarantine, or self-isolation environment of COVID-19. It can be used to triage critical cases requiring life-saving endoscopic procedures. The review also explores measures at de-risking endoscopies being high-risk aerosol generating procedures. The emerging technology of non-contact endoscopy in the form of robotic endoscopy raises hope in this direction.
{"title":"Repositioning Gastroenterology Services during COVID-19 Pandemic","authors":"I. Yakubu, Ali I. Elgaderi, Charles Andrews, Christophe Persad, E. Burke, J. Farley, Khaled Shaban, Lucy Kelly, Mahmood E. Elkaramany, Megan E. Penrose, M. K. Ansari, Osama Idris, Pamela Ntenezi, Syed Tipu Naqvi, Sylvia C. Mibey","doi":"10.17554/j.issn.2224-3992.2020.09.962","DOIUrl":"https://doi.org/10.17554/j.issn.2224-3992.2020.09.962","url":null,"abstract":"Background In COVID-19 pandemic, hospitals become overwhelmed with acute admissions leading to the suspension of outpatient clinics including gastroenterology and endoscopic services. Similarly available resources are channeled to combat the scourge. These diversions of resources coupled with lockdowns and fear of getting infected prevent patients from accessing routine and life-saving gastroenterology services leading to increased gastrointestinal-related morbidity and mortality in at-risk populations. Often, there are delays in the diagnosis and early treatment of gastrointestinal cancers, and high risks of death from gastrointestinal bleeding. Summary This review discusses COVID-19 risk factors and ways and means of ensuring safe essential gastroenterology services in the setting of COVID-19 pandemic based on available evidence. Telemedicine avoids physical contacts, maximizes safety by reducing the risk of infection to both clinicians and patients, and is conducive to a lockdown, quarantine, or self-isolation environment of COVID-19. It can be used to triage critical cases requiring life-saving endoscopic procedures. The review also explores measures at de-risking endoscopies being high-risk aerosol generating procedures. The emerging technology of non-contact endoscopy in the form of robotic endoscopy raises hope in this direction.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"9 1","pages":"3303-3308"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43460563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-21DOI: 10.17554/J.ISSN.2224-3992.2020.09.953
H. Suga, Y. Khalid, N. Dasu, G. Holland, K. Dasu, Summar T. Salim, Lucy M. Joo
Gastric adenocarcinoma is the third leading cause of mortality worldwide. Although it is a relatively infrequent neoplasm in North America, it is associated with a high mortality rate. Gastric adenocarcinoma is believed to result from inflammation of gastric cells leading to peptic ulcers which then progresses to cancer. Our case highlights a rare presentation of a rapidly growing gastric adenocarcinoma, originally unseen on endoscopy a month prior, and later appearing as a large circumferential mass. Initially the H. pylori and biopsy results in negative findings for adenocarcinoma, however, a month later the biopsy results were positive for gastric adenocarcinoma. Gastric adenocarcinomas are usually insidious and presents initially as non-specific symptoms such as dyspepsia, nausea, and early satiety. The initial workup consists of an EGD and EUS for localization, tissue biopsy, and determination of tumor size/depth as well as locating regional lymph nodes. Our case highlights the emphasis of frequent surveillance and close follow-up of patients who have increased risk factors for gastric adenocarcinomas as these cancers can often be missed and are fatal.
{"title":"An Unusual and Unfortunate Presentation of a Gastric Adenocarcinoma","authors":"H. Suga, Y. Khalid, N. Dasu, G. Holland, K. Dasu, Summar T. Salim, Lucy M. Joo","doi":"10.17554/J.ISSN.2224-3992.2020.09.953","DOIUrl":"https://doi.org/10.17554/J.ISSN.2224-3992.2020.09.953","url":null,"abstract":"Gastric adenocarcinoma is the third leading cause of mortality worldwide. Although it is a relatively infrequent neoplasm in North America, it is associated with a high mortality rate. Gastric adenocarcinoma is believed to result from inflammation of gastric cells leading to peptic ulcers which then progresses to cancer. Our case highlights a rare presentation of a rapidly growing gastric adenocarcinoma, originally unseen on endoscopy a month prior, and later appearing as a large circumferential mass. Initially the H. pylori and biopsy results in negative findings for adenocarcinoma, however, a month later the biopsy results were positive for gastric adenocarcinoma. Gastric adenocarcinomas are usually insidious and presents initially as non-specific symptoms such as dyspepsia, nausea, and early satiety. The initial workup consists of an EGD and EUS for localization, tissue biopsy, and determination of tumor size/depth as well as locating regional lymph nodes. Our case highlights the emphasis of frequent surveillance and close follow-up of patients who have increased risk factors for gastric adenocarcinomas as these cancers can often be missed and are fatal.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"9 1","pages":"3294-3297"},"PeriodicalIF":0.0,"publicationDate":"2020-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49297862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-21DOI: 10.17554/j.issn.2224-3992.2020.09.930
A. Yagi, M. Hasegawa, S. Ataka
We discussed evident effects of aloe-emodin and aloe polysaccharide on the therapy of viral infections and epigenetic factor butyrate that is involved in latency and reactivation in viral infection. Furthermore we presented eight case reports of Kampo medicine with Aloe vera juice (AVJ) to virus infections. Kampo medicine with AVJ-successive ingestion demonstrates to be suitably personalized medicine for virus infections and improves gut-microbial ecosystem in host. The potential Kampo medicine with AVJ may provide fresh insights as an anti-virus medicine for homeostatic regulation in host.
{"title":"Beneficial Efficacy of Aloe Vera to Viral Infections: Case Reports of Kampo Medicine With Aloe Vera Juice","authors":"A. Yagi, M. Hasegawa, S. Ataka","doi":"10.17554/j.issn.2224-3992.2020.09.930","DOIUrl":"https://doi.org/10.17554/j.issn.2224-3992.2020.09.930","url":null,"abstract":"We discussed evident effects of aloe-emodin and aloe polysaccharide on the therapy of viral infections and epigenetic factor butyrate that is involved in latency and reactivation in viral infection. Furthermore we presented eight case reports of Kampo medicine with Aloe vera juice (AVJ) to virus infections. Kampo medicine with AVJ-successive ingestion demonstrates to be suitably personalized medicine for virus infections and improves gut-microbial ecosystem in host. The potential Kampo medicine with AVJ may provide fresh insights as an anti-virus medicine for homeostatic regulation in host.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"9 1","pages":"3242-3247"},"PeriodicalIF":0.0,"publicationDate":"2020-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48012494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-21DOI: 10.17554/j.issn.2224-3992.2020.09.951
T. Dhere, Sujata Dwadasi, S. Levy, Ruoming Wu, Z. Kazzi, H. Iskandar
Aim: Inflammatory bowel disease (IBD) is a chronic condition becoming increasingly prevalent in the African-American (AA) population. We aimed to compare ED utilization between AA and non-Hispanic Caucasian (C) IBD patients in a large tertiary care referral center. Material and Methods: A retrospective chart view was performed on IBD patients seen in the Emory University Hospital ED after Institutional Review Board approval. Results: Data from 391 patients including 244 C patients and 147 AA patients was available for analysis. There were more AA patients who had ≥ 2 ED visits compared to C patients. When assessing the number of ED visits based on whether the visits were IBD-related vs non-IBD related, more AA patients had ≥ 2 visits for both types of visits. In the multivariable logistic regression analysis, factors associated with IBD related visits included younger age, AA race, male sex, a diagnosis of ulcerative colitis, being a current patient in the Emory GI clinic, and prior history of IBD-related surgery. Conclusion: Our study reveals that AA IBD patients seen in the ED more individuals visited the ED more than once for both IBD and non-IBD related issues compared to C IBD patients.
{"title":"Comparison of Emergency Room Use Between African-American and Caucasian Inflammatory Bowel Disease (IBD) Patients","authors":"T. Dhere, Sujata Dwadasi, S. Levy, Ruoming Wu, Z. Kazzi, H. Iskandar","doi":"10.17554/j.issn.2224-3992.2020.09.951","DOIUrl":"https://doi.org/10.17554/j.issn.2224-3992.2020.09.951","url":null,"abstract":"Aim: Inflammatory bowel disease (IBD) is a chronic condition becoming increasingly prevalent in the African-American (AA) population. We aimed to compare ED utilization between AA and non-Hispanic Caucasian (C) IBD patients in a large tertiary care referral center. Material and Methods: A retrospective chart view was performed on IBD patients seen in the Emory University Hospital ED after Institutional Review Board approval. Results: Data from 391 patients including 244 C patients and 147 AA patients was available for analysis. There were more AA patients who had ≥ 2 ED visits compared to C patients. When assessing the number of ED visits based on whether the visits were IBD-related vs non-IBD related, more AA patients had ≥ 2 visits for both types of visits. In the multivariable logistic regression analysis, factors associated with IBD related visits included younger age, AA race, male sex, a diagnosis of ulcerative colitis, being a current patient in the Emory GI clinic, and prior history of IBD-related surgery. Conclusion: Our study reveals that AA IBD patients seen in the ED more individuals visited the ED more than once for both IBD and non-IBD related issues compared to C IBD patients.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"9 1","pages":"3261-3265"},"PeriodicalIF":0.0,"publicationDate":"2020-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47970897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-21DOI: 10.17554/J.ISSN.2224-3992.2020.09.940
H. Suga, Y. Khalid, N. Dasu, K. Dasu, D. Chiesa, Hui Li
Duodenal lymphomas are considered a rare etiology in the GI tract and are found incidentally in around one out of every 5000 esophagogastroduodenoscopies. These tumors are distinct from nodal follicular lymphomas but share some morphologic, immunochemical, and histological features. Further staging is performed via CT scan, PET scan for classification of the tumor burden of the disease. We present a case report of a healthy 63 year old male who was found to have an indolent variant of the follicular lymphoma classified as stage 1E follicular lymphoma. This disease process is generally benign and usually confers a good overall prognosis. Follicular duodenal lymphomas were further classified in 2016 by the World health organization; as these tumors have increased in incidence due to advancing techniques in endoscopies and determining whether or not treatment options are needed for these tumorswhich have excellent outcomes. Our case highlights that a watchful wait approach can be a good option for patients who do not present with concerns of systemicdisease.
{"title":"A Presentation of a Follicular Lymphoma Incidentally Found in the Duodenum","authors":"H. Suga, Y. Khalid, N. Dasu, K. Dasu, D. Chiesa, Hui Li","doi":"10.17554/J.ISSN.2224-3992.2020.09.940","DOIUrl":"https://doi.org/10.17554/J.ISSN.2224-3992.2020.09.940","url":null,"abstract":"Duodenal lymphomas are considered a rare etiology in the GI tract and are found incidentally in around one out of every 5000 esophagogastroduodenoscopies. These tumors are distinct from nodal follicular lymphomas but share some morphologic, immunochemical, and histological features. Further staging is performed via CT scan, PET scan for classification of the tumor burden of the disease. We present a case report of a healthy 63 year old male who was found to have an indolent variant of the follicular lymphoma classified as stage 1E follicular lymphoma. This disease process is generally benign and usually confers a good overall prognosis. Follicular duodenal lymphomas were further classified in 2016 by the World health organization; as these tumors have increased in incidence due to advancing techniques in endoscopies and determining whether or not treatment options are needed for these tumorswhich have excellent outcomes. Our case highlights that a watchful wait approach can be a good option for patients who do not present with concerns of systemicdisease.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"9 1","pages":"3290-3293"},"PeriodicalIF":0.0,"publicationDate":"2020-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44728899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-21DOI: 10.17554/j.issn.2224-3992.2020.09.945
Gen Maeda, Y. Tagashira, D. Inoue, H. Horike, Shin Namiki
Aim: Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in the management of patients with pancreaticobiliary disorders, including cholangitis. Although complications of ERCP can develop even when skilled physicians perform the procedure, there are few studies on the association between endoscopic stone extraction and post-ERCP cholangitis. Materials and Methods: The present report is of a retrospective cohort study of patients with choledocholithiasis and post-ERCP cholangitis. Clinical, microbiological, and procedural data were collected from the patients’ electronic medical records. The relationship between each clinical feature and post-ERCP cholangitis was analyzed using univariate and multivariate logistic regression analysis. Results: Of 376 patients with acute cholangitis due to choledocholithiasis, 200 consecutive patients meeting the inclusion criteria were identified. Among these, 23 (11.5%) received the diagnosis of post-ERCP cholangitis. In multivariate analysis, a duration of ≥11 days from biliary drainage to endoscopic stone extraction (adjusted odds ratio [aOR]: 8.57; 95% confidence interval [CI], 2.68-27.50) and the use of endoscopic papillary balloon dilation (aOR 6.04; 95% CI, 1.88-19.40) were identified as independent risk factors of post-ERCP cholangitis. Conclusions: The risk of post-ERCP cholangitis can be reduced by performing endoscopic stone extraction as soon as the patient achieves clinical stability after biliary stent insertion and by using endoscopic sphincterotomy instead of endoscopic papillary balloon dilation.
{"title":"Factors Associated With Post-Endoscopic Retrograde Cholangiopancreatography Cholangitis in Patients Undergoing Endoscopic Stone Extraction at a Japanese Tertiary Care Center","authors":"Gen Maeda, Y. Tagashira, D. Inoue, H. Horike, Shin Namiki","doi":"10.17554/j.issn.2224-3992.2020.09.945","DOIUrl":"https://doi.org/10.17554/j.issn.2224-3992.2020.09.945","url":null,"abstract":"Aim: Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in the management of patients with pancreaticobiliary disorders, including cholangitis. Although complications of ERCP can develop even when skilled physicians perform the procedure, there are few studies on the association between endoscopic stone extraction and post-ERCP cholangitis. Materials and Methods: The present report is of a retrospective cohort study of patients with choledocholithiasis and post-ERCP cholangitis. Clinical, microbiological, and procedural data were collected from the patients’ electronic medical records. The relationship between each clinical feature and post-ERCP cholangitis was analyzed using univariate and multivariate logistic regression analysis. Results: Of 376 patients with acute cholangitis due to choledocholithiasis, 200 consecutive patients meeting the inclusion criteria were identified. Among these, 23 (11.5%) received the diagnosis of post-ERCP cholangitis. In multivariate analysis, a duration of ≥11 days from biliary drainage to endoscopic stone extraction (adjusted odds ratio [aOR]: 8.57; 95% confidence interval [CI], 2.68-27.50) and the use of endoscopic papillary balloon dilation (aOR 6.04; 95% CI, 1.88-19.40) were identified as independent risk factors of post-ERCP cholangitis. Conclusions: The risk of post-ERCP cholangitis can be reduced by performing endoscopic stone extraction as soon as the patient achieves clinical stability after biliary stent insertion and by using endoscopic sphincterotomy instead of endoscopic papillary balloon dilation.","PeriodicalId":90217,"journal":{"name":"Journal of gastroenterology and hepatology research","volume":"9 1","pages":"3255-3260"},"PeriodicalIF":0.0,"publicationDate":"2020-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47297290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-21DOI: 10.17554/j.issn.2224-3992.2020.09.944
Tolulope Jolaiya, M. Fowora, C. Onyekwere, R. Ugiagbe, I. Agbo, O. Lesi, D. Ndububa, O. Adekanle, Henry Akum Njom, A. Idowu, I. Adeleye, M. Bamidele, Favour Ngoka, Pia Palamides, Stella I Smith
Introduction Helicobacter pylori is a spiral shaped gram negative bacterium majorly causing peptic ulcers and gastric cancer in humans. The combinations of two or more antibiotics such as amoxicillin, clarithromycin, metronidazole or tetracycline with anti-secretory agents or bismuth have been used successfully for the treatment of H. pylori . Aim Increasing antibiotic resistance has been a contributory factor to treatment failures; as such evaluation of resistance mechanism will improve the management of H. pylori infection. Methodology The antibiotic resistance in H. pylori isolates from Nigeria was determined using E-test strips from Biomerieux SA, France and PCR for the efflux pump gene detection. Results Resistance to metronidazole was found to be 93% (97/104), amoxicillin 42% (44/104), clarithromycin 39% (41/104) and tetracycline 27% (28/104). However 51% (53/104) of the isolates harboured multidrug efflux pump gene hefA (Hp605) and 34% (35/104) hefD (Hp 971). However, hefG (Hp 1327) was absent in all the isolates. There was significant association between clarithromycin resistance and hefA with p-value 0.014, there was also association between amoxicillin resistance and hefD with p-value 0.004. Conclusion The present study revealed that H. pylori antibiotic resistance is on the increase in Nigerian strains and the mechanism of resistance may possibly include the possession of multidrug efflux pump.
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