Gastroenterology Commons^™

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson

Marshall Journal of Medicine

Ogilvie's syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms …

Acute Upper Gastrointestinal Bleeding–Impact Of Timing Of Endoscopy On Patient Outcomes: Impact Of Timing Of Endoscopy On Patient Outcomes, Abdullah Abbasi, Shima Ghavimi, Louis H. Lau, Cosmos Liutao Guo, Rashid Lui

Internal Medicine

Acute upper gastrointestinal bleeding (AUGIB) is one of the most common emergencies encountered by gastroenterologists across the world. Various medical and endoscopic therapies have evolved over time to improve patient outcomes. However, controversy still exists around the optimal time of endoscopy for patients with AUGIB. Recently, several studies have been published to answer this clinical question and we have reviewed one of these articles.

On 13th October 2021, @Gijournal, we discussed the latest high-impact article published to answer this clinical question. We critically appraised, ‘’Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study’’ which was published in …

Potential Counter Regulatory Effects Of A Gut Microbiota Metabolite In Alleviating Down-Regulation Krüppel-Like Factor 4 In Intestinal Inflammation, Ylva Forslund

Theses, Dissertations and Capstones

Inflammatory bowel disease (IBD) is a medical condition characterized by chronic inflammation of the intestinal epithelium. Krüppel-like factor 4 (KLF4), a zinc finger transcription factor, is vital for maintaining intestinal epithelial homeostasis. KLF4 promotes differentiation of goblet cells that generate the protective mucus layer. Reduced goblet cell number and defective mucus layer are associated with IBD. Shortchain fatty acids (SCFA) are known to play an important role in the maintenance of a strong and healthy intestinal epithelial layer and also in goblet cell differentiation. However, whether the positive effects of SCFAs on goblet cells are mediated, at least partly, via …

Eradication Of Stage Iv Gastric Cancer: Case Report, Ibrahim Mohammed, Cherishma Nagisetty, Arslan Iqbal, Michael Abdelmasseh, Doreen Griswold, Muhammad Omer Jamil, Juan R. Sanabria

Marshall Journal of Medicine

Background. Gastric cancer has a low overall survival rate worldwide, and surgery still remains the intent to cure option on early stages of disease. HER-2 positive cancers may have a survival advantage. We present a patient with stage IV gastric cancer HER-2 positive responsive to Herceptin, free of detectable disease two years after surgery.

Patient Presentation. 70 years old Caucasian male complained of left-sided chest pain. Upon evaluation, he was diagnosed with HER-2 positive adenocarcinoma of the stomach at the pylorus with two liver metastases. Near complete response was observed with Herceptin and Cis-platinum based chemotherapy followed by 80% distal …

Duodenal Variceal Bleeding With Large Spss Treated With Transjugular Intrahepatic Portosystemic Shunt And Embolization: A Case Report, Rohit Anand, Saad Emhmed Ali, Driss Raissi, Wesam M. Frandah

Internal Medicine

Background: Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is located distal to the second part of duodenum. The pre- transjugular intrahepatic portosystemic shunt (TIPS) presence of SPSS was found to be associated with an increased risk of early morbidity and mortality after TIPS placement. Case Summary: A 43-year-old cirrhotic male presented with melena for three days. Upper endoscopy was performed and showed active blood oozing from the distal duodenum concerning for ectopic duodenal varix. …

Exploring The Excluded Stomach: A Case Series Of Novel Endoscopic Techniques To Diagnose Gastric Cancer In The Excluded Stomach After Roux-En-Y Gastric Bypass Surgery, Saeed Ali, Abdelkader Chaar, Wesam Frandah, Rola Altoos, Zeeshan Sattar, Muhammad Hasan

Internal Medicine

Gastric cancer is the fifth most common malignancy worldwide and the fourth leading cause of cancer-related deaths. The diagnosis is usually made by direct visualization with supporting histopathology. However, patients with gastric bypass surgery pose a challenge in diagnosis due to the difficulty in the evaluation of the excluded stomach. We present two cases of gastric cancer in the excluded stomach after Roux-en-Y gastric bypass (RYGB) surgery was diagnosed using two different endoscopic approaches.

Restoration Of Completely Transected Common Bile Duct Continuity Using Single Operator Cholangioscopy, Saad Emhmed Ali, Houssam Mardini, Mohsin Salih, Steven J. Krohmer, Wesam M. Frandah

Internal Medicine

Common bile duct (CBD) injury, ranging from a partial tear to a complete transection, is a major surgical complication of cholecystectomy with significant morbidity and mortality. Proper management of these complex injuries depends on the type and extent of injury and time of recognition. Identifying and repairing injuries during cholecystectomy can prevent development of complications, but this only occurs in about one-third of cases. We report a novel technique to reconnect a transected CBD with assistance of single-operator cholangioscopy.

Complete Esophageal Obstruction After Endoscopic Variceal Band Ligation In A Patient With A Sliding Hiatal Hernia, Munthir Mansour Md, Yousef Abdel-Aziz Md, Hesham Awadh, Nihar Shah Md, Akash Ajmera

Gastroenterology

Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia.

A Rare Case Report Of Spontaneous Resolution Of Hepatic Portal Venous Gas Associated With Cocaine‑Induced Intestinal Ischemia, H. Patel, H. Shaaban, Nihar Shah Md, W. Baddoura

Gastroenterology

Hepatic portal venous gas (HPVG) is a rare disease entity. It is an ominous finding, usually, associated with intraabdominal ischemic necrosis. It frequently requires emergent surgical intervention. Herein, we present a case of a patient who complained of intense abdominal pain, with radiographic findings of HPVG as a result of cocaine-induced vascular insufficiency. After 5 h of nonoperative and conservative management, the HPVG spontaneously resolved. The patient clinically improved and was discharged home in a stable condition.

Thrombotic Thrombocytopenic Purpura Induced By Acute Pancreatitis, Socrates G. Roedan Md, Nihar Shah Md, Robert Spira Md

Gastroenterology

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder characterized by clotting in small blood vessels of the body (microthrombi), resulting in a low platelet count. The disease consists of the pentad of microangiopathic hemolytic anemia, thrombocytopenic purpura, neurologic abnormalities, fever and renal disease. Many symptoms could develop with acute pancreatitis but being able to differentiate when it is associated with any hematological conditions such as TTP is crucial to initiate a proper medical treatment. We present a rare case of a thirty-eight years old African American female, who presented to the Emergency department with an abdominal pain associated with …

Recurrent Hepatocellular Carcinoma In Patient With Crohn’S Disease: Incidental Or Expected Outcome Of Azathioprine?, Youssef Botros, Mary Mathews, Hiren Patel, Nihar Shah Md, Walid Baddoura, Andrew De La Torre

Gastroenterology

Hepatocellular carcinoma (HCC) usually occurs in patients with underlying risk factors such as liver cirrhosis and chronic hepatitis B. Although patients with Crohn's disease (CD) are at an increased risk to develop malignancies such as colon cancer, the incidence of HCC in this population is extremely rare. We report a case of 62-year-old male with long history of CD treated with azathioprine (AZA) and aminosalicylic acid (ASA) who was incidentally diagnosed with HCC, for which left hepatectomy was done. Four years later during routine follow-up, patient had another hepatic lesion and underwent resection of the mass. The mechanism of occurrence …

Recurrent Hepatocellular Carcinoma In Patient With Crohn's Disease: Incidental Or Expected Outcome Of Azathioprine?, Youssef Botros, Mary Mathews, Hiren Patel, Nihar Shah Md, Walid Baddoura, Andrew De La Torre

Gastroenterology

Hepatocellular carcinoma (HCC) usually occurs in patients with underlying risk factors such as liver cirrhosis and chronic hepatitis B. Although patients with Crohn’s disease (CD) are at an increased risk to develop malignancies such as colon cancer, the incidence of HCC in this population is extremely rare. We report a case of 62-year-old male with long history of CD treated with azathioprine (AZA) and aminosalicylic acid (ASA) who was incidentally diagnosed with HCC, for which left hepatectomy was done. Four years later during routine follow-up, patient had another hepatic lesion and underwent resection of the mass. The mechanism of occurrence …

Multiple Intussusceptions Associated With Polycythemia In An Anabolic Steroid Abuser , A Case Report And Literature Review, Y. Cavanagh, Nihar Shah Md, A. B. Thomas, A. Gupta

Gastroenterology

Intussusceptions are generally associated with mechanical lead points or localized inflammation that function as foci for intestinal telescoping. We present the case of a patient whose abuse of anabolic steroids resulted in the development of multiple simultaneous intussusceptions. Our patient had no additional identifiable risk factors for intussusception. Consistent with previous reports, corticosteroid induced polycythemia and its consequent hyperviscosity led to intravascular sludging and mesenteric ischemia with associated bowel wall thickening. The localized intestinal induration then served as mechanical foci for intussusception. Due to the illicit nature of anabolic androgenic steroid (AAS) abuse, the physiologic effects of supraphysiologic doses are …

Proton Pump Inhibitors And Corticosteroids As Synergistic Risk Factors For Candida Esophagitis, Nihar Shah Md, Yana Cavanagh, Oleg Shulik, Pooja Patel, Vincent A. Debari, Walid Baddoura

Gastroenterology

Abstract:

Introduction: Inhaled & systemic steroids are one of the well-documented risks factors for Candida esophagitis. However, the role of gastric acid suppression remains controversial.

Methods:

We conducted a retrospective case-control study of 420 patients consisting of 84 cases of Candida esophagitis and 336 matched controls. Our cohort was gathered from subjects evaluated from 2001 to 2012. The diagnosis of Candida esophagitis was based on endoscopic and/or histological criteria.

Results:

On univariate analysis, proton pump inhibitors were associated with higher risk (OR = 2.14; 95 % CI: 1.30 to 3.54); steroid use also increased the risk (OR = 3.55; 95% …

Development Of Hyperplastic Polyps Following Argon Plasma Coagulation Of Gastric Antral Vascular Ectasia, Nihar Shah Md, Yana Cavanagh, Dharmesh H. Kaswal, Sohail Shaikh

Gastroenterology

The etiology of gastric antral vascular ectasia (GAVE) syndrome or gastric hyperplastic polyps (HPs) is not fully understood. We report a case of gastric HP arising in a patient treated with argon plasma coagulation (APC) for GAVE syndrome. Despite unclear etiologic progression, this and previously reported cases suggest a temporal relationship between the treatment of GAVE and HP. A 68-year-old male with a history of coronary artery disease, congestive heart failure and diabetes type II who initially presented with symptomatic anemia 2 weeks after starting aspirin and clopidogrel therapy. Diagnostic esophagogastroduodenoscopy (EGD) demonstrated diffuse GAVE. He was treated with 5 …

Role Of Non-Selective Beta Blockers In Hepatocellular Carcinoma: An Analysis In Patients With Cirrhosis And Portal Hypertension, Hiren Patel, Abhishek Kumar, Nihar Shah Md, Ela Eris, Michael Maroules, Walid J. Baddoura, Vincent A. Debari

Gastroenterology

There are many different biochemical processes responsible for the hepatocelluar carcinoma (HCC) development that can be targeted for the prevention or halt progression of the HCC. Non-selective betablockers (NSBB) affects a multitude of intracellular biochemical and signaling pathways involved in carcinogenesis. Aim: To determine if NSBB may be protective for HCC in patients with cirrhosis and portal hypertension. Methods: We retrospectively enrolled 200 patients from medical records diagnosed with cirrhosis and portal hypertension between January 2001 and December 2013. Eighteen patients were excluded (taking selective beta-blocker and/or unavailable medical records). The etiology of cirrhosis, use of NSBB, demographics and the …

Cecal Bascule After Colonoscopy - Case Report And Review Of Literature, Nihar Shah Md, Hiren Patel Md, Varun Patel Md, Robert Spira

Gastroenterology

Cecal bascule is a rare disease variant of a cecal volvulus. It consists of upward and anterior folding of the ascending colon, forming a flap valve, and occluding the bowel lumen resulting in proximal cecal dilatation. Herein, we present a case of a patient who developed persistent abdominal pain few hours after a colonoscopy. CT scan of the abdomen revealed an upward and anterior folding of the cecum. Subsequently the patient was taken to the operating room for a right hemi-colectomy. This case emphasizes the importance to consider cecal bascule as a differential diagnosis in patients with persistent abdominal pain …

An Unusual Initial Presentation Of Hepatocellular Carcinoma As A Sellar Mass, Nihar Shah Md, Yana Cavanagh, Hamid Shaaban, Beth Stein, Sohail N. Shaikh, Dharmesh H. Kaswala, Walid Baddoura

Gastroenterology

Sellar masses are frequently adenomatous pituitary tumors. Metastatic disease is unusual, often mimicking the presentations of adenomas. Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy but unusual to have a pituitary metastasis (PM). A 65-year-old man presented with headache, diplopia, ptosis, decreased vision in the right eye and unintentional weight loss of 32lbs. Preliminary out-patient work-up revealed a mass in the pituitary region. Cranial imaging showed 3.1 cm × 3.2 cm × 4.4 cm lesion. Abdominal imaging (computed tomography and magnetic resonance imaging) demonstrated a lobulated, nodular and heterogeneous right lobe of the liver. Trans-sphenoidal resection of the …

Enterogenous Cyst Of The Small Bowel Causing Intussusception In An Adult: Case Report And Review Of Literature, Nihar Shah Md, Therese Lizardo-Escaño, Hamid Shaaban, Gautamy Dhadham, Arya Karki, Robert Spira

Gastroenterology

Small bowel intussusception is a rare congenital disease entity, mostly manifesting before the age of two with abdominal pain and acute intestinal obstruction. In adults, colon intussusception is a rare event causing approximately 1% of all acute intestinal obstructions and they can occur idiopathically in adults or due to an intraluminal tumor mass. We report a case of an enterogenous cyst causing intussusception and iron deficiency anemia in an adult treated by surgical excision and resection of the small bowel.

Hemophagocytic Lymphohistiocytosis: A Series Of Five Clinical Cases In Adult Patients At A Single Institution With A Review Of The Literature, David Thomas, Nihar Shah Md, Hiren Patel, Tapan Pandya, Dron Gauchan, Michael Maroules

Gastroenterology

Context: Hemophagocytic Lymphohistiocytosis or the “Hemophagocytic Syndrome” is a spectrum of disorders of regulatory immunomodulatory pathways inciting phagocytosis of hematopoietic cells resulting in end-organ damage. The condition appears in both heritable and non-heritable forms from a multitude of possible environmental triggers, most notably infection. The condition often results in a fatal outcome without prompt diagnosis and treatment. Cases in children have been reported much more frequently and classically than in adult patients.

Case Report: In this case series we examined fi ve such cases in adult patients that were found at our institution in a window as small at 2 …

Safety Of Infliximab In Children With Ibd: The Experience Of An Academic Center In Wv, Michael Northcutt Md, Awni Al-Subu Md, Brooke Bella Rn, Yoram Elitsur Md

Biochemistry and Microbiology

BACKGROUND: The immune-modulating drug, infliximab, is approved for Inflammatory Bowel Disease (IBD) treatment in children. Chronic therapy with infliximab is associated with the development of early and delayed infusion reactions. We reviewed our experience with infliximab treatment and its side effects in a cohort of children diagnosed with IBD who were treated in our clinic.

METHODS: A retrospective analysis of all IBD children treated with infliximab in our center from 2006-2011 was performed. The demographic, chronological and clinical data were recorded. The infliximab infusion was given at 5mg/ kg according to a standard protocol after pre-treatment with low dose …

Intravenous Immunoglobulin In The Treatment Of Severe Clostridium Difficile Colitis, Nihar Shah Md

Gastroenterology

Intravenous immunoglobulin (IVIG) has been utilized in patients with recurrent and refractory Clostridium difficile colitis. It is increasingly being used in patients with initial clinical presentation of severe colitis. Herein, we report a case of severe C. Difficile colitis successfully treated with IVIG with a review of the medical literature to identify the optimal timing and clinical characteristics for this treatment strategy.

Lactobacillus Acidophilus Alleviates Platelet-Activating Factor-Induced Inflammatory Responses In Human Intestinal Epithelial Cells, Alip Borthakur, Sumit Bhattacharyya, Anoop Kumar, Arivarasu Natarajan Anbazhagan, Joanne K. Tobacman, Pradeep K. Dudeja

Clinical & Translational Sciences

Probiotics have been used as alternative prevention and therapy modalities in intestinal inflammatory disorders including inflammatory bowel diseases (IBD) and necrotizing enterocolitis (NEC). Pathophysiology of IBD and NEC includes the production of diverse lipid mediators, including platelet-activating factor (PAF) that mediate inflammatory responses in the disease. PAF is known to activate NF-kB, however, the mechanisms of PAF-induced inflammation are not fully defined. We have recently described a novel PAF-triggered pathway of NF-κB activation and IL-8 production in intestinal epithelial cells (IECs), requiring the pivotal role of the adaptor protein Bcl10 and its interactions with CARMA3 and MALT1. The current studies …

Replacement Gastrostomy Tube Causing Acute Pancreatitis: Case Series With Review Of Literature, Anish M. Shah, Nihar Shah Md, Joseph R. Depasquale

Gastroenterology

Context Percutaneous endoscopic gastrostomy (PEG) feedings are generally considered safe with few serious complications. Acute pancreatitis is a rare complication associated with replacement percutaneous endoscopic gastrostomy tubes.

Case report We report two cases of acute pancreatitis induced by migrated replacement percutaneous endoscopic gastrostomy tubes.

Conclusions Migration of a balloon into the duodenum can result in external manipulation of the ampulla of Vater thereby disturbing the flow of pancreatic secretions leading to acute pancreatitis. Recognition of this complication is important and should be included as potential etiology of acute pancreatitis in patients receiving percutaneous endoscopic gastrostomy feedings. Periodic examination and documentation …

Helicobacter Pylori Infection Rate Decreases In Symptomatic Children: A Retrospective Analysis Of 13 Years (1993-2005) From A Gastroenterology Clinic In West Virginia, Yoram Elitsur, Yulia Dementieva, Mary Rewalt, Zanda Lawrence

Pediatrics

Background: The rate of Helicobacter pylori is decreasing in the developed countries, but few long-term studies are available from the United States. We retrospectively assessed the annual H. pylori infection rate in symptomatic children seen in our clinic over a 13-year study period.

Study: A retrospective analysis of all children who had histologic diagnosis of H. pylori infection between January 1993 and December 2005 in our pediatric gastroenterology clinic was performed. The annual infection rate and the overall infection rate were calculated.

Results: A total of 1743 upper endoscopy reports were reviewed, of which 212 (12.1%) were diagnosed with H. …