Gastroenterology Commons^™

Frequency And Risk Factors Of Non-Alcoholic Fatty Liver Disease In Helicobacter Pylori-Infected Dyspeptic Patients: A Cross-Sectional Study, Basit Siddiqui, Muhammad Kamran, Shiyam Sunder Tikmani, Rabeea Azmat, Zain Mushtaq, Saad Bin Zafar Mahmood, Muhammad Tahir Khan, Javed Yakoob, Zaigham Abbas

Section of Gastroenterology

Background: In dyspeptic patients with Helicobacter pylori contributes to non-alcoholic fatty liver disease. However, little evidence available from Pakistan.
Objective: The study aims to determine the frequency and risk factors of non-alcoholic fatty liver disease in dyspeptic patients with Helicobacter pylori.
Methods: This cross-sectional study was conducted between 22 November 2016 and 30 June 2018. Adults of age between 18 and 90 years who attended the out-patient department due to abdominal discomfort, pain, fullness, and bloating who underwent upper gastrointestinal tract endoscopy were enrolled after taking informed consent. Patients with celiac disease, inflammatory bowel disease, taking alcohol, pregnant women …

The Discrepancy Between Admission And Discharge Diagnoses: Underlying Factors And Potential Clinical Outcomes In A Low Socioeconomic Country, Samar Fatima, Sara Shamim, Amna Subhan Butt, Safia Awan, Simra Riffat, Muhammed Tariq

Section of Internal Medicine

Objective: The discrepancy between admission and discharge diagnosis can lead to possible adverse patient outcomes. There are gaps in integrated studies, and less is understood about its characteristics and effects. Therefore, this study was conducted to determine the frequency, characteristics, and outcomes of diagnostic discrepancies at admission and discharge.
Design and data sources: This retrospective study reviewed the admitting and discharge diagnoses of adult patients admitted at Aga Khan University Hospital (AKUH), Internal Medicine Department between October 2018 and February 2019. The frequency and outcomes of discrepancies in patient diagnoses were noted among Emergency Department (ED) physician versus admitting physician, …

A Randomized Open-Label Study Of Two Methods Of Proton Pump Inhibitors Discontinuation, Emily Hendricks, Aman Ajmeri, Monider M. Singh, Milliejoan Mongalo, Lynne J. Goebel

Internal Medicine

Background: Proton pump inhibitors (PPIs) are effective in treating gastroesophageal reflux disease (GERD). Unfortunately, they are often inappropriately prescribed and long-term use has potential adverse effects. A single best method for discontinuation of PPIs does not currently exist. The objective of this study was to determine if there is a significant difference in successfully discontinuing PPI use at 12 months between patients discontinuing abruptly or tapering first.

Methodology: We conducted a randomized trial with 38 patients diagnosed with GERD. We collected six weekly and then monthly surveys of symptoms based on the Dyspepsia Symptom Severity Index. Chart review at 12 …

Esophageal Necrosis As An Unexpected Complication Of Diabetic Ketoacidosis, Hayden Smith, Tricia James

Providence Portland Medical Center Internal Medicine 2021

No abstract provided.

Hyperlipasemia Does Not Confer Worse Clinical Outcomes In A Retrospective Cohort Of Novel Coronavirus (Covid-19) Patients, Zaid Imam, Inayat Gill, Bana Antonios, Andrew Aneese, Gaurav Kakked, Faisal Kamal, Bara Al Kurdi, Alexandra Halalau

Conference Presentation Abstracts

Abstract Background Gastrointestinal manifestations and hyperlipasemia commonly occur as part of novel coronavirus infection (COVID-19), while data on acute pancreatitis is limited to case reports. We aimed to study the prevalence of hyperlipasemia and acute pancreatitis in a large inpatient cohort of COVID-19 patients and their impact on clinical outcomes. Methods Retrospective chart review of all hospitalized patients with confirmed COVID-19 at an 8-hospital health system in Michigan, USA was performed between February 1,2020 through April 1,2020 with inclusion of patients with obtained lipase levels. Univariate analyses were performed to evaluate associations between hyperlipasemia and degree of hyperlipasemia and clinical …

Intraluminal Endovascular Coil Migration: A Rare Complication Post-Embolization Of The Gastroduodenal Artery For A Previously Bleeding Duodenal Ulcer, Yassin Naga, Mahendran Jayaraj, Yousif Elmofti, Annie Hong, Gordon Ohning

School of Medicine Faculty Research

Transarterial angiographic embolization is a highly effective, safe treatment for non-variceal upper gastrointestinal bleeding refractory to endoscopic intervention. However, intraluminal coil migration is a possible complication. Coil migration, while usually a self-limiting process, can lead to significant rebleeding. In our case, a patient presented with a life-threatening duodenal ulcer hemorrhage, likely precipitated by intraluminal endovascular coil migration after a recent gastro-duodenal artery embolization. He was successfully managed without endoscopic coil removal and had no additional gastrointestinal bleeding. It is important for endoscopists to be aware of this complication and weigh the risks and benefits of coil removal.

Intestinal Dysbiosis Disguised As A Rectal Fistula Treated With Autologous Fecal Microbiota Transplantation, Nicolina Scibelli, Pratishtha Singh, Kathleen Raynor

South Atlantic Division GME Research Day 2021

No abstract provided.

Hepatic Candidiasis In An Immunocompetent Patient: A Diagnostic Challenge, Zorays Moazzam, Amman Yousaf, Zahid Iqbal, Ahmad Tayyab, Muhammad Hashim Hayat

Medical College Documents

Hepatic candidiasis is a manifestation of disseminated candidiasis, which typically presents in immunocompromised patients. Focal hepatic candidiasis in immunocompetent patients, however, is infrequent/extremely rare. We present the case of an immunocompetent female patient who presented with respiratory distress and right-sided pleural effusion. The pleural fluid tap did not grow anything, and a contrast-enhanced computed tomography (CT) scan revealed a right liver lobe subcapsular collection. CT-guided aspiration and culture resulted in Candida albicans growth. The patient responded to oral fluconazole, and a follow-up CT scan demonstrated resolution of the collection. Although hepatic candidiasis rarely occurs in immunocompetent patients, it should be …

Evaluating The Revised American Society For Gastrointestinal Endoscopy Guidelines For Common Bile Duct Stone Diagnosis, Jake S Jacob, Michelle E Lee, Erin Y Chew, Aaron P Thrift, Robert J Sealock

Faculty, Staff and Students Publications

BACKGROUND/AIMS: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines.

METHODS: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis.

RESULTS: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The …

Self-Expanding Metal Stent (Sems) Placement To Treat Bleeding From Late Radiation Esophagitis, Inayat Gill, Bana Antonios, Zaid Imam, Gahad Ghaith

Articles

Radiation esophagitis is a serious complication occurring in patients receiving radiotherapy for head and neck cancers. Current treatment with proton pump inhibitors and mucosal protectants provides symptomatic relief with few studies showing improvement in erosive esophagitis or ulceration. Use of self-expandable metal stents (SEMS) in cases of erosive radiation esophagitis refractory to medical therapy has not been studied. We report a case of a patient presenting with recurrent hematemesis from late (chronic) radiation esophagitis with bleeding esophageal ulceration successfully treated with SEMS placement after failure of conservative medical management, proposing a possible utility for SEMS in this setting.

Semiautomated Glasgow-Blatchford Bleeding Score Helps Direct Bed Placement For Patients With Upper Gastrointestinal Bleeding., Drew B Schembre, Robson E Ely, Janice M Connolly, Kunjali T Padhya, Rohit Sharda, John J Brandabur

Articles, Abstracts, and Reports

OBJECTIVE: The Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care.

DESIGN: We reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death. …

Type Iii Gastric Neuroendocrine Tumor: Case Report Of A Rare Gastric Carcinoma, Christopher L. Orpiano, Michael Quinn, Gurjeet Kang, Aric Tucker, Aric Tucker, Lakshminarasimhan Venu, Joseph Staffetti

Gastroenterology

No abstract provided.

Intestinal Microbiota – A Possible Contributor To Cardiovascular Diseases?, Roua Iorga, Ovidiu Gabriel Bratu, Nicolae Bacalbasa, Mihnea-Alexandru Gaman, Camelia Cristina Diaconu

Journal of Mind and Medical Sciences

The intestinal microbiota represents an interesting and emergent field of research, with already known implications in metabolic and immunological functions. Recently, there is increasing evidence that specific gut microbial populations are associated with cardiovascular diseases. Numerous completed and ongoing studies aim to evaluate the potential of intestinal microbiota assessment to improve the prevention, diagnosis, and therapeutic arsenal of cardiovascular diseases, considering dysbiosis as a cardiovascular risk factor. There is strong evidence for a correlation between intestinal flora imbalance and metabolic changes secondary to bacterial metabolites. In this minireview, we discuss recent data about the connections between intestinal microbiota and cardiovascular …

Prevalence Of Risk Factors Of Acute Kidney Injury In A Tertiary Care Hospital In Pakistan, Ainan Arshad, Ahmed Ayaz

Section of Internal Medicine

The objective of this study was to determine the prevalence of preventable risk factors of acute kidney injury in a tertiary care hospital in Pakistan. All patients admitted at Aga Khan University Hospital, Karachi with diagnosis of acute kidney injury were included out of which 134 were selected via random sampling. Patients with existing CKD were excluded. Data was then collected retrospectively from medical records of these patients. Mean age was 60±11.7 years while mean serum creatinine on admission was 2.4±1.3 (mg/dl). Sepsis played a role in almost half of the patients [60 (45%)]. Other factors included diarrhoea [23 (17%)], …

A Rare Clinical Presentation Of Metastatic Crohn's Disease, Kaitlyn L Streight, Tara L Braun, Nicholas Lowe, Soo Jung Kim

Faculty, Staff and Students Publications

A 31-year-old female with a history of systemic lupus erythematous, IgA nephropathy, and psoriasis presented with a one-month history of a painful, pruritic rash under the bilateral breasts and in the genital region. Cutaneous examination revealed a large, tender ulcer under the left breast with a shiny erythematous base and peripheral hypertrophic changes. Small ulcers were present on the bilateral inguinal folds, and the labia majora were edematous with multiple erythematous papules. Histological examination of the left breast revealed ulceration with granulomatous dermatitis, consistent with a diagnosis of metastatic Crohn's disease. Metastatic Crohn's disease is a rare cutaneous manifestation of …

A Rare Cause Of Pneumoperitoneum, Robert Zusman, George Michael, Anna E. Augustin, My Myers, Dudith Pierre-Victor

West Florida Division GME Research Day 2020

Pneumoperitoneum is most commonly associated with a perforated viscus. When free air is seen on imaging, the most common course of action is an emergent exploratory laparotomy. However, pneumoperitoneum may not always be indicative of a perforated bowel. In the case described below, we will discuss a patient who developed acute peritonitis and pneumoperitoneum after undergoing chest compressions during cardiopulmonary resuscitation (CPR) and positive pressure mechanical ventilation.

Bradycardia In The Setting Of Gastric Sarcoidosis, Kameron Black Mph, Michelle Levine Do, Rage Geringer Md, Gregory Hicks Md, Oliwier Dziadkowiec

Internal Medicine

No abstract provided.

Recent Advances In The Treatment Of Clostridioides Difficile Infection: The Ever-Changing Guidelines, Shruti Khurana, Alyssa Kahl, Kevin Yu, Andrew W Dupont

Faculty, Staff and Student Publications

No abstract provided.

Pantoprazole Continuous Infusion Versus Intermittent Bolus For Gastrointestinal Bleed Prior To Esophagogastroduodenoscopy (Egd), Vy Dang Pharmd, Mickayla Clark Pharmd, Bcps, Kartika Shetty Md, James Hwang, Pinak Shah, Scott J. Anderson

Gastroenterology

Purpose: Practice guidelines recommend patients with non-variceal upper gastrointestinal (GI) bleeds who have a high risk of active bleeding, nonbleeding visible vessels, and adherent clots should be given proton pump inhibitors (PPIs) intravenous (IV) bolus followed by continuous infusion after esophagogastroduodenoscopy (EGD). The use of PPIs before EGD has shown to reduce the requirement for EGD, however, there are no studies evaluating the difference in outcomes of continuous infusion PPI versus intermittent IV bolus PPI prior to EGD. The objective of this study is to evaluate clinical outcomes of continuous infusion PPI versus intermittent IV bolus PPI prior to EGD. …

Immune-Mediated Colitis From Dual Checkpoint Inhibitors., Nishanth Thalambedu, Yasir Khan, Qian Zhang, Shristi Khanal, Ammar Ashfaq

Abington Jefferson Health Papers

Melanoma is a deadly disease with immunotherapy treatment options that emerged in the last few years and have changed the disease outcome. However, it is associated with immune-related toxic effects despite improving survival. We present the case of a 53-year-old woman who had two weeks of diarrhea after she was treated with dual immunotherapy agents for her advanced melanoma. The final workup revealed pancolitis, possibly due to immunotherapy adverse effects. Initial conservative treatment, unfortunately, did not lead to a clinical improvement until a steroid was introduced. We are reporting this case to alert our fellow physicians about the immune-mediated toxicities …

A Patient With Chronic Lymphocytic Leukemia With Pancreatic Involvement, Rajesh Essrani Md, Matthew J. Sullivan Do, Hiral N. Shah Md

Department of Medicine

A 78-year-old female with a past medical history of hypertension, type 2 diabetes mellitus, and chronic lymphocytic leukemia was hospitalized for poor appetite, weight loss, and night sweats. On physical exam, there was no palpable lymphadenopathy, and her abdomen was soft and nondistended. Laboratory results showed a hemoglobin count of 13.3 g/dl, hematocrit 41.3%, white blood cell 68.4 × 103 μL with lymphocytes 92.0%, total bilirubin 0.4 mg/dL, aspartate transaminase 14 U/L, and alanine transaminase 15 U/L. CT of the chest, abdomen, and pelvis showed hypodense lesions within the pancreatic body (1.4 × 1.4 cm) and medial aspect of …

Bone Metastasis In Appendicular Skeleton: Rare Occurrence In Colorectal Cancer, Pratikkumar Vekaria Md, Chandrika Raiyani Md, Ravis Patel Md, Devin Vaishnani Md, Tejas Raiyani Md

Gastroenterology

Colorectal cancer (CRC) is considered as preventable cancer if diagnosed in the early stage. It is also second leading cause of death from cancer in US. Bone metastases (BM) is uncommon presentation with CRC and if it occurs, it involves axial skeletal more than extremities. Many case studies also reports that survival after BM is considerably poor than without BM. Cancer type and genetic mutations also play an important role in such metastasis.

Gastroenterology, A Guiding Light In Hemophagocytic Lymphohistiocytosis, Sahityan Viswanathan, Jeffrey Capati, Long T. Hoang

Gastroenterology

No abstract provided.

Double Pylorus: Case Report Of Atypical Presentation, Christopher Lozano Orpiano Do, Gurjeet Kang Do, Michael Quinn Do, Lakshminarasimhan Venu Md, Joseph Staffetti Md

Gastroenterology

Introduction: Double pylorus is a rare endoscopic finding that has been reported in 0.001% to 0.4% of upper gastrointestinal endoscopies, consisting of a gastroduodenal fistula extending from the prepyloric gastric antrum to the duodenal bulb through an accessory channel. In the majority of cases, it is a complication when peptic ulcers erode and create a fistula between the duodenal bulb and the distal stomach. It usually presents on the lessor curvature of the gastric antrum and on a superior wall of the duodenal bulb. It is commonly an endoscopic finding, since clinical presentation is similar to other peptic diseases.

Case …

Salivary Gland Choristoma: A Rare Finding At Gastroesophageal Junction, Isin Y. Comba Md, Richard Henriquez Md, Sundeep Kumar Md, Hilda Merino-Chavez Md, Maria Wallis-Crespo Md, Christopher Cooper Md, Lakhinder Bhatia Md

Gastroenterology

Introduction: Choristoma is tumor-like outgrowth of heterotopic and mature tissue located at anatomically unusual sites. Heterotopic salivary gland tissue (HSGT) has been most commonly described in head and neck region but can rarely involve gastrointestinal (GI) tract with a few cases reported in the literature.

Case Description/Methods: An 87-year-old female with past medical history of gastroesophageal reflux disease (GERD), hypertension, and chronic kidney disease was admitted for an acute DVT. Due to worsening anemia, she underwent an upper endoscopy that showed a small nodularity at the GE junction (figure 1a), a large hiatal hernia, and reflux esophagitis in the lower …

Rare Obscure Cause Of Upper Gastrointestinal Bleeding: Bleeding Duodenal Lymphangiectasia, Sufian Sorathia, Rulz Cantave, Vivek Choksi, Kairavee D. Dave, Steven Kaplan

Gastroenterology

Introduction: While ulcerative and erosive mucosal changes are more commonly the culprit lesion of upper gastrointestinal bleeding, bleeding can also occur from traumatic, malignant or vascular lesions. An unusual and infrequent vascular cause of bleeding is from a focal intestinal lymphangiectasia (IL). We describe a patient who presented with bleeding from a duodenal IL.

Case Description/Methods: A 94-year-old female was sent by her nursing home for witnessed melena and new onset normocytic anemia with a hemoglobin of 7 g/dl. She was unable to provide a reliable history due to her advanced dementia. Her medical history was unknown. She was hypotensive …

Extracapsular Hepatocellular Adenoma: A Diagnostic Dilemma, Iisin Y. Comba, Richard Henriquez, Sundeep Kumar, Ruthvik Srinvasa-Murthy, Maria Wallis-Crespo, Olga Karasik, Lakhinder Bhatia, Dong Xu

Gastroenterology

Introduction: Hepatocellular adenoma (HCA) is a benign tumor of the liver and almost always located intracapsular. Bleeding (25%), and malignant transformation (5%) can complicate the disease course if left untreated. Herein, we present a case of extracapsular HCA of ectopic liver in the omentum complicated with intraperitoneal hemorrhage.

Case Description/Methods: A 43-year-old lady with no past medical history presented to emergency department with two-day history of left shoulder pain and epigastric discomfort. Her only medication was an oral contraceptive pill (OCP). On physical exam, the patient had persistent sinus tachycardia, and epigastric tenderness. Initial labs were unremarkable except for mildly …

Poem Perceptions: A Survey Of Gastroenterologists And The Treatment Of Achalasia In The Philadelphia Region, Rebecca Loh, Md, Alexander Schlachterman, Md

Department of Medicine Posters

Introduction

Peroral endoscopic myotomy (POEM) is a relatively new innovate technique that has been shown to be an effective treatment for achalasia. Despite studies demonstrating its effectiveness as a less invasive therapy, POEM is still not as widely implemented as the traditional Heller myotomy for the treatment of achalasia. We aimed to explore the barriers that may impact implementation of POEM and to assess the regional perception of POEM amongst gastroenterologists in an urban setting.

A Hiatal Hernia Causing Atrial Fibrillation Through Direct Mechanical Irritation, Kirolus Sourial, Zaid Yaqoob, Anthony Chahin, Saif Borgan, Ernesto S. Robalino Gonzaga, Aamir Javaid, Olga Karasik

Gastroenterology

Introduction: Hiatal hernia (HH) is anatomically classified into four types according to herniated structures. Giant HH refers to a herniation of > 50% of the stomach. Atrial fibrillation (AF) is a common arrhythmia, frequently seen in association with cardiovascular diseases. We report a case of AF caused by a giant HH compressing the left atrium.

Case Description/Methods: A 90+ year-old female with a past medical history of gastroesophageal reflux disease (GERD), was admitted for surgical evaluation of symptomatic HH. During hospital stay the patient developed AF with rapid ventricular response, became hypotensive and lightheaded. EKG (Figure 1) confirmed new onset AF …

Iron Pill-Induced Gastropathy In Elderly Patients: A Case Series Report, Isin Y. Comba Md, Richard Henriquez, Sundeep Kumar, Ruthvik Srinvasa-Murthy, Maria Wallis-Crespo, Lakhinder Bhatia Md, Joshua Shultz

Gastroenterology

Introduction: Iron deficiency anemia is a global health problem with an estimated two billion cases worldwide. Oral iron supplementation is considered the first line treatment. However, recent studies favor the use of short-term IV iron especially in patients with drug tolerance and efficacy concerns. In this report, we present three cases of iron pill gastropathy in patient's whose clinical courses were complicated by gastric erosion, ulcer or gastrointestinal (GI) bleeding. All of our patients had a history of iron deficiency anemia and were being treated with oral ferrous sulfate.

Case Description/Methods: The first case involved a 72-year-old male with multiple …