{"title":"Colonic bleeding induced by a solitary juvenile polyp","authors":"Yun-Ping Sun, Wei Liu","doi":"10.46439/gastro.3.017","DOIUrl":"https://doi.org/10.46439/gastro.3.017","url":null,"abstract":"","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"82 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123022","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}
{"title":"Severe Olmesartan related enteropathy - a case report and literature review","authors":"R. Gason, I. Ould-Nana, PM. Honoré, P. Lacremans","doi":"10.46439/gastro.3.016","DOIUrl":"https://doi.org/10.46439/gastro.3.016","url":null,"abstract":"","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"15 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122382","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}
Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus, solid organ, or stem cell transplantation, underlying hematologic malignancy, and major trauma. Abdominal pain, hematemesis, and melena are common presenting symptoms. Diagnosis of gastric mucormycosis can be overlooked due to the rarity of the disease. A high index of suspicion is required for early diagnosis and management of the disease, particularly in immunocompromised patients. Radiological imaging findings are nonspecific to establish the diagnosis, and gastric biopsy is essential for histological confirmation of mucormycosis. Prompt treatment with antifungal therapy is the mainstay of treatment with surgical resection reserved in cases of extensive disease burden or clinical deterioration. We presented a case of acute gastric mucormycosis involving the body of stomach in a patient with no comorbidity, however he had post COVID status, admitted with hematemesis. Complete resolution of lesion was noted with medical treatment with intravenous amphotericin B.
{"title":"Primary gastric mucormycosis","authors":"Deepanshu Khanna, Jata Shankar, Ayush Jasrotia, Pabitra Sahu","doi":"10.46439/gastro.2.015","DOIUrl":"https://doi.org/10.46439/gastro.2.015","url":null,"abstract":"Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus, solid organ, or stem cell transplantation, underlying hematologic malignancy, and major trauma. Abdominal pain, hematemesis, and melena are common presenting symptoms. Diagnosis of gastric mucormycosis can be overlooked due to the rarity of the disease. A high index of suspicion is required for early diagnosis and management of the disease, particularly in immunocompromised patients. Radiological imaging findings are nonspecific to establish the diagnosis, and gastric biopsy is essential for histological confirmation of mucormycosis. Prompt treatment with antifungal therapy is the mainstay of treatment with surgical resection reserved in cases of extensive disease burden or clinical deterioration. We presented a case of acute gastric mucormycosis involving the body of stomach in a patient with no comorbidity, however he had post COVID status, admitted with hematemesis. Complete resolution of lesion was noted with medical treatment with intravenous amphotericin B.","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135739079","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}
H. Nour, Abdul Malik Magsi, H. Abdalla, Alexandra Mcwhirter, Ahmed Gadoura, M. Sajid
Background: Pain is a very important factor in patient recovery and satisfaction. Following incision and drainage of perianal abscess, wound packing has been found to be very painful. The aim of this study is to compare packing the wound and not packing the wound after incision and drainage (I&D) of perianal abscess, taking into account recurrence rate, rate of occurrence of perianal fistula as well as post-operative pain. Materials and Method: Standard medical electronic databases were searched with the help of a local librarian and relevant published randomised controlled trials (RCT) were shortlisted according to the inclusion criteria. The summated outcome of post-operative pain score, recurrence rate, and rate of occurrence of perianal fistula was evaluated using the principles of meta-analysis on RevMan 5 statistical software. Result: Three RCTs on 490 patients undergoing I&D of perianal abscess were found suitable for this meta-analysis. In the random effects model analysis, the post operative pain score was statistically lower in NPG [risk ratio 0.66, 95%, CI (0.36, 0.97), Z=4.25, P=0.0001]. There was no heterogeneity [Tau2=0.15; chi2=9.32; df=6; I2=36 %; p=0.16] between the studies, however, statistically it was not significant. In addition, there was no statistical difference between the 2 groups in terms of recurrence of perianal abscess or the occurrence of perianal fistula [risk ratio 0.64, 95%, CI (0.31, 1.31), Z=1.23, P=0.22], [risk ratio 1.41, 95%, CI (0.89, 2.23), Z=1.47, P=0.14] respectively. Conclusion: Not packing the wound post I&D of perianal abscess is associated with significantly reduced VAS pain scores, which may result in improved recovery and patient satisfaction and has no effect on recurrence rate or the occurrence of perianal fistula. However, more RCTs recruiting a greater number of patients are required to endorse these findings.
{"title":"Comparing packing and non-packing of the abscess cavity post incision and drainage of perianal abscess: A meta-analysis","authors":"H. Nour, Abdul Malik Magsi, H. Abdalla, Alexandra Mcwhirter, Ahmed Gadoura, M. Sajid","doi":"10.46439/gastro.2.012","DOIUrl":"https://doi.org/10.46439/gastro.2.012","url":null,"abstract":"Background: Pain is a very important factor in patient recovery and satisfaction. Following incision and drainage of perianal abscess, wound packing has been found to be very painful. The aim of this study is to compare packing the wound and not packing the wound after incision and drainage (I&D) of perianal abscess, taking into account recurrence rate, rate of occurrence of perianal fistula as well as post-operative pain.\u0000\u0000Materials and Method: Standard medical electronic databases were searched with the help of a local librarian and relevant published randomised controlled trials (RCT) were shortlisted according to the inclusion criteria. The summated outcome of post-operative pain score, recurrence rate, and rate of occurrence of perianal fistula was evaluated using the principles of meta-analysis on RevMan 5 statistical software.\u0000\u0000Result: Three RCTs on 490 patients undergoing I&D of perianal abscess were found suitable for this meta-analysis. In the random effects model analysis, the post operative pain score was statistically lower in NPG [risk ratio 0.66, 95%, CI (0.36, 0.97), Z=4.25, P=0.0001]. There was no heterogeneity [Tau2=0.15; chi2=9.32; df=6; I2=36 %; p=0.16] between the studies, however, statistically it was not significant. In addition, there was no statistical difference between the 2 groups in terms of recurrence of perianal abscess or the occurrence of perianal fistula [risk ratio 0.64, 95%, CI (0.31, 1.31), Z=1.23, P=0.22], [risk ratio 1.41, 95%, CI (0.89, 2.23), Z=1.47, P=0.14] respectively.\u0000\u0000Conclusion: Not packing the wound post I&D of perianal abscess is associated with significantly reduced VAS pain scores, which may result in improved recovery and patient satisfaction and has no effect on recurrence rate or the occurrence of perianal fistula. However, more RCTs recruiting a greater number of patients are required to endorse these findings.","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77103217","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}
Prabhat Kumar, A. Almomani, Somtochukwu Onwuzo, A. Boustany, Eduard Krishtopaytis, Dana Alshaikh, Almaza a. Albakri, M. Alkhayyat, Tareq Kiwan, Imad Asaad
Background and Aim: Non-Alcoholic Fatty Liver Disease (NAFLD) is the commonest cause of chronic liver disease and is a leading cause of liver transplantation in the United States, with no approved medication to halt or reverse its progression. Recent animal-model prospective trial-suggested that drug Vedolizumab leads to improvement and reversal in the NAFLD-related metabolic derangements. Vedolizumab is an α4β7 integrin-inhibitor that is approved for use in IBD patients. Our study aims to understand Vedolizumab's impact on the course of NAFLD in inflammatory bowel disease (IBD) patients. Methods: We conducted a retrospective cohort analysis of 158 subjects with NAFLD who received Vedolizumab at Cleveland Clinic Foundation (CCF). One cohort of 79 patients with NAFLD who received Vedolizumab were matched with control group of 79 patients. We determined the primary outcome as the response to Vedolizumab measured as Fibrosis-4 (Fib-4) regression to <1.3 points after one year of treatment. Results: We observed that there was no statistically significant difference response (p= 0.576), progression of the disease (p= 1.000) or change in the number of cirrhosis decompensation episodes (in those with NAFLD cirrhosis) among Vedolizumab recipients. Conclusions: In this retrospective cohort analysis, and unlike in the previous animal model, Vedolizumab was not associated with statistically significant improvement or progression in the Fib-4 score after one year of treatment, and among those with NAFLD-cirrhosis, there was no statistical difference in the complication rates.
{"title":"Vedolizumab has no effect on the course of non-alcoholic fatty liver disease: A retrospective cohort analysis","authors":"Prabhat Kumar, A. Almomani, Somtochukwu Onwuzo, A. Boustany, Eduard Krishtopaytis, Dana Alshaikh, Almaza a. Albakri, M. Alkhayyat, Tareq Kiwan, Imad Asaad","doi":"10.46439/gastro.2.013","DOIUrl":"https://doi.org/10.46439/gastro.2.013","url":null,"abstract":"Background and Aim: Non-Alcoholic Fatty Liver Disease (NAFLD) is the commonest cause of chronic liver disease and is a leading cause of liver transplantation in the United States, with no approved medication to halt or reverse its progression. Recent animal-model prospective trial-suggested that drug Vedolizumab leads to improvement and reversal in the NAFLD-related metabolic derangements. Vedolizumab is an α4β7 integrin-inhibitor that is approved for use in IBD patients. Our study aims to understand Vedolizumab's impact on the course of NAFLD in inflammatory bowel disease (IBD) patients.\u0000\u0000Methods: We conducted a retrospective cohort analysis of 158 subjects with NAFLD who received Vedolizumab at Cleveland Clinic Foundation (CCF). One cohort of 79 patients with NAFLD who received Vedolizumab were matched with control group of 79 patients. We determined the primary outcome as the response to Vedolizumab measured as Fibrosis-4 (Fib-4) regression to <1.3 points after one year of treatment.\u0000\u0000Results: We observed that there was no statistically significant difference response (p= 0.576), progression of the disease (p= 1.000) or change in the number of cirrhosis decompensation episodes (in those with NAFLD cirrhosis) among Vedolizumab recipients.\u0000\u0000Conclusions: In this retrospective cohort analysis, and unlike in the previous animal model, Vedolizumab was not associated with statistically significant improvement or progression in the Fib-4 score after one year of treatment, and among those with NAFLD-cirrhosis, there was no statistical difference in the complication rates.","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"353 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89280929","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}
Objective: This manuscript is a mini review of the outpatient management of non-complicated acute appendicitis. We reviewed the literature supporting the safety and efficacy of outpatient management of laparoscopic appendectomy in adult patients with uncomplicated acute appendicitis. Background Data: Outpatient laparoscopic appendectomy is feasible and safe in selected patients in observational studies. Benefits include reduced length of stay (LOS) and postoperative complications. Data reported in 17 studies (mainly retrospective) suggested that outpatient appendectomy might be feasible. Several observational studies have shown that outpatient surgery is not associated with increased readmissions, increased morbidity rates, or reoperation. Until 2022, international guidelines supported the clinical efficacy and safety of outpatient appendectomy. However, the strength of the evidence is weak and recommendations cannot be given. In November 2022, the first randomized controlled trial (RCT) of outpatient treatment according to the ERAS protocol was published. In this study, the length of stay was significantly shorter. There were no differences in readmission rates. No further emergency consultations or complications were observed. The outpatient management had presented an economic saving. Conclusion: Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.
{"title":"Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy","authors":"Jordi Elvira López","doi":"10.46439/gastro.2.011","DOIUrl":"https://doi.org/10.46439/gastro.2.011","url":null,"abstract":"Objective: This manuscript is a mini review of the outpatient management of non-complicated acute appendicitis. We reviewed the literature supporting the safety and efficacy of outpatient management of laparoscopic appendectomy in adult patients with uncomplicated acute appendicitis.\u0000\u0000Background Data: Outpatient laparoscopic appendectomy is feasible and safe in selected patients in observational studies. Benefits include reduced length of stay (LOS) and postoperative complications.\u0000\u0000Data reported in 17 studies (mainly retrospective) suggested that outpatient appendectomy might be feasible. Several observational studies have shown that outpatient surgery is not associated with increased readmissions, increased morbidity rates, or reoperation. Until 2022, international guidelines supported the clinical efficacy and safety of outpatient appendectomy. However, the strength of the evidence is weak and recommendations cannot be given. In November 2022, the first randomized controlled trial (RCT) of outpatient treatment according to the ERAS protocol was published. In this study, the length of stay was significantly shorter. There were no differences in readmission rates. No further emergency consultations or complications were observed. The outpatient management had presented an economic saving.\u0000\u0000Conclusion: Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86936409","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}
Pediatric Functional Gastrointestinal Disorders (p-FGID) comprise one of the most common chronic conditions impacting global health. Conceptualized as gut-brain communication disorders, p-FGID are often exacerbated by and contribute to significant anxiety as well as functional impairment. Cognitive behavioral therapy is the gold standard psychosocial treatment for anxiety spectrum disorders. Prior research demonstrates a bidirectional link between p-FGID and anxiety symptoms, recommending CBT as the first line of treatment for both. While exposure is the potent ingredient for anxiety treatment, exposure is under-investigated in the treatment of p-FGID. The present brief systematic review synthesizes existent literature to describe the impact of CBT on p-FGID and anxiety symptoms in youth. The researchers systematically screened articles (n=23) located via Embase, Medline, and PsychINFO search. Eight studies meeting inclusion criteria were included for the final review. Three themes characterized the selected articles: (1) the impact of CBT on p-FGID symptoms, (2) the impact of CBT on health-related disability in youth with p-FGID, and (3) the impact of CBT on concurrent anxiety symptoms in youth with p-FGID. Key findings are summarized and implications for treatment are identified.
{"title":"Cognitive behavioral therapy for comorbid pediatric functional gastrointestinal disorders and anxiety: Systematic review and clinical applications","authors":"Ciera Korte, R. Friedberg","doi":"10.46439/gastro.2.014","DOIUrl":"https://doi.org/10.46439/gastro.2.014","url":null,"abstract":"Pediatric Functional Gastrointestinal Disorders (p-FGID) comprise one of the most common chronic conditions impacting global health. Conceptualized as gut-brain communication disorders, p-FGID are often exacerbated by and contribute to significant anxiety as well as functional impairment. Cognitive behavioral therapy is the gold standard psychosocial treatment for anxiety spectrum disorders. Prior research demonstrates a bidirectional link between p-FGID and anxiety symptoms, recommending CBT as the first line of treatment for both. While exposure is the potent ingredient for anxiety treatment, exposure is under-investigated in the treatment of p-FGID. The present brief systematic review synthesizes existent literature to describe the impact of CBT on p-FGID and anxiety symptoms in youth. The researchers systematically screened articles (n=23) located via Embase, Medline, and PsychINFO search. Eight studies meeting inclusion criteria were included for the final review. Three themes characterized the selected articles: (1) the impact of CBT on p-FGID symptoms, (2) the impact of CBT on health-related disability in youth with p-FGID, and (3) the impact of CBT on concurrent anxiety symptoms in youth with p-FGID. Key findings are summarized and implications for treatment are identified.","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81436730","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}
Gastrointestinal stromal tumors are mesenchymal tumors which predominantly originate from the interstitial cells of Cajal in the intestinal lining. Around ~85% of malignant GISTs possess activating mutations in the tyrosine kinase receptors KIT or PDGFRA. The driver mutations in genes other than KIT or PDGFRA account for around 15% GISTs and belong to highly heterogeneous groups called wild-type GISTs. Around 20–40% of WT-GISTS are deficient for the succinate dehydrogenase complex (SDHA, SDHB, SDHC, SDHD). Mutations in SDH cause the accumulation of oncometabolite succinate that increases the level of HIF1α which enhances the transcription of several genes including IGF1, IGF2, and VEGF inducing the proliferation of the cancer cells. The remaining WT-GISTS are associated with mutations in BRAF, loss-of-function of NF1, hyperactivation FGFR, inactivation of tumor suppressor genes (p53 and dystrophin), and mutations in DNA damage response genes such as RAD51 and BRCA2 which results in the activation of the PI3K/mTOR or RAS/RAF/MAPK signaling cascade. Therefore, understanding the mutational status and molecular characterization of GIST plays a very crucial role in the overall management of GIST.
{"title":"Genetic mutations in the molecular pathogenesis of gastrointestinal stromal tumor","authors":"D. Saravanan, Monisha Mohan","doi":"10.46439/gastro.1.008","DOIUrl":"https://doi.org/10.46439/gastro.1.008","url":null,"abstract":"Gastrointestinal stromal tumors are mesenchymal tumors which predominantly originate from the interstitial cells of Cajal in the intestinal lining. Around ~85% of malignant GISTs possess activating mutations in the tyrosine kinase receptors KIT or PDGFRA. The driver mutations in genes other than KIT or PDGFRA account for around 15% GISTs and belong to highly heterogeneous groups called wild-type GISTs. Around 20–40% of WT-GISTS are deficient for the succinate dehydrogenase complex (SDHA, SDHB, SDHC, SDHD). Mutations in SDH cause the accumulation of oncometabolite succinate that increases the level of HIF1α which enhances the transcription of several genes including IGF1, IGF2, and VEGF inducing the proliferation of the cancer cells. The remaining WT-GISTS are associated with mutations in BRAF, loss-of-function of NF1, hyperactivation FGFR, inactivation of tumor suppressor genes (p53 and dystrophin), and mutations in DNA damage response genes such as RAD51 and BRCA2 which results in the activation of the PI3K/mTOR or RAS/RAF/MAPK signaling cascade. Therefore, understanding the mutational status and molecular characterization of GIST plays a very crucial role in the overall management of GIST.","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77974713","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}
{"title":"Tubercular appendicitis","authors":"Rajaram Sharma","doi":"10.46439/gastro.1.007","DOIUrl":"https://doi.org/10.46439/gastro.1.007","url":null,"abstract":"","PeriodicalId":91025,"journal":{"name":"Journal of clinical and experimental gastroenterology","volume":"248 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91104162","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}
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