Gastroenterology Commons^™

From Villi To Alveoli: Lung Involvement In Celiac Disease – A Narrative Review, Mateusz Marzec, Patrycja Cecha

Journal of Community Hospital Internal Medicine Perspectives

Background:

Celiac disease (CD) is a chronic, immune-mediated enteropathy triggered by gluten that affects about 1% of the population and may present with extraintestinal manifestations. Pulmonary complications are considered rare and are poorly characterized. Lane-Hamilton syndrome is the best described lung manifestation, but data suggests a broader spectrum of respiratory involvement.

Methods:

We performed a narrative review with structured search strategy of PubMed and Embase (January 1, 1970 – December 1, 2025) using the terms celiac/coeliac and lung, pulmonary, respiratory, hemoptysis, hemosiderosis, alveolar hemorrhage, interstitial lung disease, alveolitis, bronchiectasis …

Navigating Complex Esophageal Perforations: A Case-Specific Approach To Successful Outcomes, Harsimran Kalsi, Anushree Rai, Kobina Essilfie-Quaye, Neeka Akhavan, Yaseen Perbtani, Tony S. Brar

HCA Healthcare Journal of Medicine

Esophageal perforation is a life-threatening condition requiring prompt diagnosis and effective management. While self-expanding metal stents (SEMS) are a first-line treatment, persistent leaks often necessitate adjunctive endoscopic interventions. A structured, multimodal approach is critical for optimizing outcomes and avoiding surgical intervention. A 44-year-old man developed an iatrogenic esophageal perforation following surgical leiomyoma enucleation. Initial treatment with overlapping fully covered self-expanding metal stents (FC-SEMS) failed to achieve closure, necessitating endoscopic suturing for defect reinforcement. Despite suturing, persistent leakage required placement of a larger-diameter FC-SEMS, secured with an endoscopic fixation system to prevent migration. Serial imaging confirmed successful defect closure, allowing the …

Faktor Risiko Perdarahan Gastrointestinal Pada Pasien Dengan Sindrom Koroner Akut: Sebuah Tinjauan Sistematis, Assyadilla Kirana Setyobudi, Amie Vidyani, Jonathan Christianto Sutadji, Lady Aqnes Kurniawati, Kevin Fernando Suhardi

Jurnal Penyakit Dalam Indonesia

Introduction. Gastrointestinal bleeding (GIB) is a serious but potentially preventable condition. Its symptoms include hematemesis, hematochezia, and melena. Risk factors for GIB include medications such as antiplatelets and anticoagulants, which are standard treatments for acute coronary syndrome (ACS). GIB is strongly associated with ACS and represents the most common bleeding complication in these patients. This study aimed to systematically review the factors contributing to GIB in patients with ACS.

Methods. Relevant articles were retrieved from PubMed, ScienceDirect, Springer, and EBSCO databases, covering studies on GIB risk factors in ACS patients published between March 31, 2003, and March 31, …

Benign Transient Hyperphosphatasemia In Adults: Case Report And Literature Review, Jose L. Rodriguez Castro, Grettel Gonzalez Garcia, Daniel Heller, Bernardo J. Reyes

HCA Healthcare Journal of Medicine

Background

Benign transient hyperphosphatasemia (BTH) in children is characterized by temporary highly elevated serum alkaline phosphatase (ALP) activity in the absence of liver or bone disease and a return to normal within 3 to 4 months. Since its first description in the 1950s, several cases of BTH in infants and children have been reported. Although there is no known etiology for this illness, it has been associated with viral infections. This condition has rarely been seen in the adult population, and there is scarce available information. The sialylation of the ALP isoenzymes decreases their renal clearance from the circulation; however, …

Literally Heartburn: A Case Report Exploring Potential Preventive Measures Of Esophageal Injury After Radiofrequency Ablation For Atrial Fibrillation, Venkat Arutla, Chengu Niu, Prajjwol Bhatta, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Esophageal injury (EI) after radiofrequency ablation (RF) for atrial fibrillation (AF) is a feared complication due to its extreme variability in presentation and very high mortality rate. The incidence of EI after RF ablation also varies widely among the literature. The diagnosis and management of EI is a combination of swift clinical recognition, confirmatory computed tomography (CT) imaging, and prompt surgical repair. This case discusses a 56-year-old male with past medical history of AF who presented to the hospital with complaints of chest pain, shortness of breath and nausea after undergoing recent RF ablation for AF. Imaging revealed an esophageal …

A Case Of Listeria Monocytogenes Bacteremia In A Middle-Aged Woman With A History Of Primary Biliary Cholangitis, Caleb Smack, Jared T. Lausen, Aaron Mills

Eastern Virginia Medical Journal

In this report, we discuss the case of a patient with Listeria monocytogenes bacteremia likely resulting from primary biliary cholangitis (PBC) induced cirrhosis. We aim to bolster the body of literature on Listeria bacteremia and establish PBC as a risk factor for this rare complication. Our patient, who presented with sepsis, was subsequently found to have Listeria bacteremia and received intravenous antibiotic treatment of ampicillin for 3 total weeks with complete resolution of her disease. This is the first case suggesting that cirrhosis as a result of PBC may be an independent risk factor for Listeria bacteremia. In patients at …

Oral N-Acetylcysteine In Hepatitis C - Induced Acute Liver Injury: A Case Report, Mohammed Irfan Khan, Shuchita Jhaveri, Renu Thomas, Kevin Garnepudi, Galvin Dhaliwal, Ahmed Ouni, Shane P. Sweeney, Julian Nguyen

Gulf Coast Division GME Research Day 2026

No abstract provided.

Colonic Perforation In A Patient On Glp-1 Agonist Therapy: A Case Report, Mohammed Irfan Khan, Shuchita Jhaveri, Azad Patel, Bilal Ashraf, Ahmed Ouni, John Paek, Sivatej Sarva

Gulf Coast Division GME Research Day 2026

No abstract provided.

Negative Imaging, Ongoing Hemorrhage: An Ulcerated Jejunal Avm Requiring Advanced Endoscopic Intervention, Joel Mathews, Trina Lewis, John Mathew, Long Hoang

North Texas GME Research Forum 2026

Small bowel bleeding is relatively uncommon, accounting for less than 10% of all gastrointestinal (GI) bleeds. Small bowel angiodysplasias are the most common cause of small bowel bleeding. These lesions can often be difficult to identify on radiographic imaging or endoscopy and tend to rebleed after intervention. Our case centers on an 86-year-old patient who presented with an acute GI bleed from an obscure ulcerated jejunal arteriovenous malformation (AVM); his past medical history includes an undisclosed prior upper GI bleed treated with endoscopic clipping, paroxysmal atrial fibrillation, type 2 diabetes, prostate cancer with prostatectomy, and other chronic conditions. He presented …

Salvage Percutaneous Spyglass-Assisted Lithotripsy Via A Cholecystostomy Tract After Failed Ercp: A Case Report, Nicholas Gerden, Tiffany Hong, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

IR-driven percutaneous cholangioscopy with SpyGlass-assisted lithotripsy is an emerging salvage technique for biliary stone disease in patients with failed or contraindicated endoscopic retrograde cholangiopancreatography (ERCP) due to complex anatomy. We report an 85-year-old patient with an indwelling cholecystostomy tube and biliary stent who presented with recurrent obstructive jaundice, with cholangiography demonstrating occlusion of the common bile duct stent due to choledocholithiasis. Conventional ERCP was unsuccessful because of complex biliary and gastrointestinal anatomy. A multidisciplinary interventional radiology–gastroenterology approach was therefore pursued, utilizing antegrade percutaneous choledochoscopy through an existing cholecystostomy tract with SpyGlass-assisted lithotripsy, followed by cholecystostomy tube exchange. The procedure resulted …

Extra-Intestinal Clostridioides Difficile Abscess In A Small Bowel Gist: A Rare Tumor-Associated Complication, Nicholas Gerden, Pradip Gautam, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

Extra-intestinal infections caused by Clostridioides difficile are exceedingly rare and typically occur in settings that disrupt the gastrointestinal barrier, including recent gastrointestinal surgery, bowel perforation or microperforation, and severe colonic disease.

We present the case of a 75-year-old man with abdominal pain and hemoperitoneum in the setting of a suspected small bowel leak secondary to an intestinal mass. Computed tomography angiography revealed an 11.0 × 9.6 cm pelvic fluid collection, prompting exploratory laparotomy with drainage of a pelvic abscess and evacuation of hemoperitoneum. Intraoperatively, a small bowel perforation caused by a 4.4 cm gastrointestinal stromal tumor (GIST) was identified. Operative …

Sudden Onset Idiopathic Necrotizing Pancreatitis Unmasking Undiagnosed Advanced Cirrhosis, Maikel Tawadrous, Mohammad Mahfouz, Aradhana Pandey, Namin Farid

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Multifocal Gastrointestinal Diffuse Large B-Cell Lymphoma Initially Resembling Crohn’S Disease, Mary Moussa, Durga A. Kumar, Vikas Sethi, Alvin Boyd Newman-Caro, Christopher Halleman, Michael Schulman

West Florida Division GME Research Day 2026

No abstract provided.

Gastrointestinal Ebv In Immunosuppressed Hosts: A Case Of Ptld After Kidney Transplant, Mary Moussa, Baylen Shoemaker, Vikas Sethi, Alvin Boyd Newman-Caro, Rakhee Shah, Patricia Chun, Michael Schulman

West Florida Division GME Research Day 2026

No abstract provided.

A Lethal Connection Uncovered: Direct Endoscopic Evidence Of A Primary Aortoenteric Fistula, Joel Mathews, Trina Lewis, Munazzah Kaleem, Long Hoang

North Texas GME Research Forum 2026

BACKGROUND: Primary Aortoenteric Fistulas (PAEFs) are a rare condition that occurs when the native aorta develops an abnormal connection with the gastrointestinal lumen. PAEFs tend to develop within the duodenum, specifically the distal region of the third part of the duodenum, which is retroperitoneal and is anterior to the aorta. Duodenal PAEFs can be difficult to diagnose and are often lethal, given their non-specific presenting symptoms and rapid progression to hemorrhagic shock.

CASE PRESENTATION: This case focuses on a 70-year-old male with a history of T4N2 colon adenocarcinoma with hemicolectomy, active smoking, and abdominal aortic aneurysm (AAA) who was transferred …

A Not So Typical Case Of Alcoholic Pancreatitis, Wendy Phillips, Kaleem Munazzah, Asad Rehman, Robert Keller

North Texas GME Research Forum 2026

BACKGROUND Acute pancreatitis (AP) has become one of the leading gastrointestinal diagnoses resulting in inpatient hospitalization¹. AP is diagnosed by meeting two of three criteria: characteristic clinical presentation, biochemical evidence (elevated lipase or amylase levels), and imaging findings with pancreatic inflammation. Gallstones and heavy alcohol use account for most cases (40%–70% and 25%–35%, respectively). Hypertriglyceride induced AP (HTG-AP) accounts for only about 7-10% of AP cases³ and often tends to present in younger, male, obese, patients with a higher rate of diabetes¹. Below we present a unique case of a coinciding alcoholic and HTG - AP in an otherwise healthy …

Wilson’S Disease Psychosis In A Young Man With Autism Spectrum Disorder: A Case Report And Focus On Management, Landon C. Sowell, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction

Wilson's disease is a rare autosomal recessive disorder, affecting approximately 1 in 30 000 individuals and is characterized by abnormal copper accumulation in the body, primarily affecting the liver and brain. Psychiatric manifestations as a first presentation, particularly psychosis, are less commonly recognized resulting in failure to begin treatment early in the course of the disease. This case report highlights a patient that presented to the hospital with psychosis, who was later diagnosed with Wilson’s disease. This case underscores the importance of considering organic causes in first-episode psychosis.

Case Presentation

An 18-year-old man with a history of autism spectrum …

Hepatocellular Carcinoma Surveillance In Patients With Cirrhosis, Identifying Gaps In Clinical Practice, Abdullah Orakzai, Muhammad Hammad Sharif, Basil George Verghese, Shiamak Cooper, Venkat Arutla, Purva Shah, Himal Kharel, Aditya Sanjeevi, Aniket-Vijay Rao

Advances in Clinical Medical Research and Healthcare Delivery

Background:Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide, with rising mortality rates in the United States. Early detection of HCC through routine screening significantly improves survival rates in patients with cirrhosis. Current guidelines recommend bi-annual screening using abdominal ultrasound with or without serum AFP levels; however, adherence to these guidelines is suboptimal in clinical practice.

Methods:We conducted a retrospective study of 320 adult patients diagnosed with HCC at our institution between January 1, 2023, and July 31, 2023. Patients aged >22 years were included, and their medical records were reviewed to evaluate routine surveillance …

Fluid Resuscitation Choice And Its Effect On Plasma Chloride And Acute Kidney Injury In Severe Acute Pancreatitis: A Randomized Study Of Normal Saline Vs. Balanced Crystalloids (Physiomax), Mandip Singh Bhatia, Ritu Attri, Ashok Kumar Pannu, Atul Saroch, Saurabh C Sharda, Neeraj Singla, Sakshi Mehta

Journal of Community Hospital Internal Medicine Perspectives

Background: Acute pancreatitis (AP) is a potentially fatal gastrointestinal condition, often associated with organ failure and acute kidney injury (AKI). Early fluid resuscitation with Normal saline (NS) may lead to hyperchloremia and AKI, which prompted interest in using balanced crystalloids. However, the optimal choice of crystalloid fluid remains uncertain. This study aimed to compare the effects of NS versus Physiomax on plasma chloride levels and AKI incidence during early resuscitation in patients with predicted severe AP (pSAP).

Methods: A single-center, prospective, randomized study was conducted between November 2022 and December 2023 at PGIMER, Chandigarh, India. 112 patients with pSAP were …

Can Anemia Be A Prognostic Indicator To Scope For Gastroesophageal Junction Adenocarcinoma?, Ryan Tam, Neha Narayanan, Evan Basha, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Gastroesophageal junction adenocarcinoma is a rapidly progressive disease that has a poor prognosis with a 5-year survival rate of 20%. It commonly presents with major symptoms of dysphagia and weight loss in addition to a long-standing history of reflux. As of now, screening for esophageal adenocarcinoma (EAC) is dependent on identifying risk factors which include a family history of Barrett’s esophagus and esophageal adenocarcinoma or patients with gastroesophageal reflux disease and at least one other risk factory for EAC such as age greater than 50 years, obesity or central adiposity, history of smoking, or male gender. Here, we present a …

Mirizzi Syndrome: A Case Report, Elizabeth Barr, Keng Moua, Kavitha Vemuri

Advances in Clinical Medical Research and Healthcare Delivery

Mirizzi syndrome is a rare complication of chronic gallstone disease that occurs when an impacted gallstone at the gallbladder infundibulum or cystic duct causes common extrinsic hepatic or common bile duct obstruction. Contrary to other gallstone pathologies where gallstones affect the respective location in which they are lodged, Mirizzi syndrome is unique in that it is characterized by extrinsic gallstone compression. Chronic gallstone disease most commonly leads to acute cholecystitis, acute cholangitis, or acute pancreatitis. The extrinsic compression of the common hepatic or common bile duct may lead to eventual erosion which increases the risk for a cholecystocholedochal or cholecystohepatic …

Hiding In The Midgut: A Case Of Small Bowel Diverticular Bleeding In An Elderly Female, Aagamjit Singh, Nishant Aggarwal, Faid Odish

Conference Presentation Abstracts

Introduction Diverticulosis in the colon is a common cause of lower gastrointestinal (GI) bleeding. Non-Meckel diverticula in the small bowel have been reported in the literature; however, they rarely cause significant bleeding. We present a case of an 88-year-old woman with a bleeding jejunal diverticulum that was diagnosed and treated with a push enteroscopy. Case Description An 88-year-old African-American female with a past medical history of colonic diverticulosis and atrial fibrillation on rivaroxaban presented with a 4-day history of melena. She reported having soft, black stools 2–3 times a day, associated with persistent epigastric discomfort and nausea. Her last dose …

Marathon Miles And Melena: Unmasking Acute Gastrointestinal Bleeding In An Endurance Athlete, Usman Bin Hameed, Mujtaba Moazzam, Nathanial Bartosek, Fady Banno, Naveen Reddy

Conference Presentation Abstracts

Gastrointestinal bleeding (GIB) is a recognized complication of endurance sports, particularly long-distance running. While most cases are mild and self-limited, studies indicate that up to 12% of ultramarathon participants experience occult bleeding. Severe or life-threatening GIB, such as ischemic colitis requiring surgery, has been reported but remains rare. Despite its potential significance, exercise-induced GIB remains poorly understood, with limited organized data on its prevalence and mechanisms. A 38-year-old male presented with a three-day history of melena following a recent marathon. Symptoms began with loose stools, progressing to tarry stools, accompanied by fatigue, exertional dyspnea, dizziness, and mild generalized abdominal discomfort. …

A Complex Case Of Tracheoesophageal Fistula Following Chemoradiation And Esophagectomy, Mujtaba Moazzam, Usman Bin Hameed, Fady Banno, Rocco Sbrocca, Ramona M. Berghea

Conference Presentation Abstracts

Tracheoesophageal fistula (TEF) is a pathological connection between the trachea and esophagus. It is a rare but serious complication following esophagectomy, particularly in patients who have undergone concurrent radiation therapy, with rates of 5-15%. TEFs often manifest with severe complications such as malnutrition, infections, and life-threatening bleeding, making them exceptionally difficult to manage. This case report highlights a rare presentation of TEF in a patient with esophageal adenocarcinoma treated with multimodal therapy. A 45-year-old male with stage III esophageal adenocarcinoma underwent concurrent chemoradiation, esophagectomy, and immunotherapy. Subsequent oligometastatic disease required further treatment, including radiofrequency ablation and Keytruda maintenance. The patient …

Clinical Outcomes For Smokers With Early-Onset Colorectal Cancer: An Analysis Of The National Inpatient Sample, Matthew Ebrahim, Tony Elias, Sonika Vatsa, Yarin Trabelsi, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

We sought to examine the national inpatient sample database to describe in-hospital outcomes among smokers with EOCRC. The NIS was searched for hospitalizations of adult patients with EOCRC, defined as all-cause colorectal cancer in patients 50 years old or younger. In this nationally representative population‐based retrospective cohort study, hyperlipidemia was associated with higher mortality.

The Role Of Heart Rate Variability In The Management Of Inflammatory Bowel Disease: A Scoping Review, Zarif A. Ladak, Krisha Patel, Dylan Bagley, Jeffery Powers

Rowan-Virtua Research Day

Complications associated with Inflammatory Bowel Disease (IBD) have an unclear pathophysiology. Heart Rate Variability (HRV) is a potent modality for monitoring autonomic nervous system function and may give insight into the timing of flares and complication development. Existing literature suggests a link between IBD complications and inflammation as well as inflammation and HRV. However, research directly exploring the relationship between HRV and IBD complications is limited. This review aims to examine the state of the science as it pertains to the relationship between HRV and IBD complications highlighting current knowledge gaps to guide future research. A search was conducted using …

The Presence Of Cardiac Arrhythmias Impacts Hospitalized Patients With Celiac Disease, Rahul Patel, Tirth Patel, Darshan Patel, Trinava Roy, Sachin Prasad, Paul Gill, Rafail Beshai, Joshua Soliman, Brian Blair, C. Jonathan Foster

Rowan-Virtua Research Day

Background

Celiac disease has links to inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and sarcoidosis. The latter 3 also have cardiovascular manifestations associated with them. However, there are limited studies on the in-hospital outcomes of Celiac disease with cardiac manifestations. Therefore, the aim of this study was to evaluate the hospital outcomes of Celiac disease with concomitant arrhythmias.

Methods

Patients aged 18 years with Celiac disease and arrhythmias (atrial fibrillation, atrial flutter, ventricular tachycardia, and supraventricular tachycardia) versus Celiac Disease alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2019-2020. ICD 10 codes were utilized. Multivariate …

Intracolonic Migration Of A Dislocated Acetabular Cup Prosthesis, Jack R. Lubka, Cyrus Tamboli, Philip Brunetti, Sarosh Tamboli, Alex Davis, Hamish Patel, Olugbenga Oyesanmi, Michael Strobbe, Shaival Thakore, Subhasis Misra, Jeffrey Mino

HCA Healthcare Journal of Medicine

Background

Acetabular cup migration is a rare complication of hip replacement surgery. If the acetabular socket of the ilium is weak, the prosthesis can erode or pass through it. There have been multiple reports of acetabular cup prosthesis migration to the colon, creating a coloarticular fistula between the hip joint and the cecum, sigmoid colon, or rectum. We report a rare presentation of a complete intracolonic migration of a prosthetic acetabular cup without creating a fistula.

Case Presentation

A 53-year-old female patient with a remote history of a total right hip replacement presented with abdominal pain and rectal bleeding. Computed …

A Peculiar Pancreatitis: Investigating The Adverse Effects Of Mesalamine, Elias Arellano Villanueva, Miguel Lopez, Alhasan Asaad, Jose Campo Maldonado

Research Symposium

Background: Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations in the United States, accounting for approximately 300,000 emergency department visits annually. It is characterized by parenchymal and peripancreatic fat necrosis accompanied by inflammation. The clinical diagnosis of AP is based on elevated serum amylase and lipase levels, characteristic imaging findings, and epigastric pain often radiating to the back. While gallstones and alcohol use are the most common causes of AP, drug-induced pancreatitis (DIP) is a rare but increasingly recognized etiology, contributing to 0.1–5% of cases. DIP is typically diagnosed by excluding other causes and is often associated with …

Transcranial Magnetic Stimulation As A Treatment Modality For Functional Bowel Disorder And Irritable Bowel Syndrome And Possible Correlations With The Gut-Brain Axis: A Review, Lauren Draper, Devin Pfister, Ethan Zaugg

Annual Research Symposium

Functional Bowel Disorders (FBD), including Irritable Bowel Syndrome (IBS), are highly prevalent gastrointestinal conditions classified as Disorders of Gut-Brain Interactions (DGBIs) under the Rome IV criteria. These conditions, marked by abdominal pain, altered bowel habits, and significant psychological comorbidities, present substantial challenges in both diagnosis and treatment. Conventional therapies primarily target gut-centric mechanisms but often yield limited efficacy, underscoring the need for approaches that account for the complex interplay of the gut-brain axis in DGBI pathophysiology.