Gastroenterology Commons^™

Juvenile Polyp And Lymphoid Hyperplasia “Leads” To Intussusception, Rasheed Ansari, Kirby Lampe, Ding-You Li

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OP is an 8-year-old female who presented to the ED with 1 day of NBNB emesis and abdominal pain. • The CT abdomen showed colocolonic intussusception at the hepatic flexure with a possible polypoid lesion serving as a lead point. • Radiology did not recommend air enema for reduction given atypical age, atypical location, and visualization of lead point. • GI consulted for a possible colonoscopy to reduce intussusception. Colonoscopy contraindicated due to polypoid mass causing obstruction and inability for patient to tolerate cleanout. • Diagnostic laparoscopy performed. Noted Intussusception in the distal ascending colon/proximal transverse colon. Chronic inflammatory changes …

Unclear Source Of Gastrointestinal Bleeding: Utilizing Small Bowel Capsule To Detect An Enteric Duplication Cyst, Victoria Sarata, Kirby Lampe, Kathryn Clarkston

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Introduction Enteric duplication cysts (EDCs) are rare congenital malformation formed during embryonic development of the gastrointestinal tract. Symptoms may include vomiting, abdominal distension, palpable abdominal mass, or bleeding but may vary based on location of the lesion [1]. We present a case of a 9-year-old-male with presented with recurrent rectal bleeding and had abnormalities on small bowel capsule which were diagnosed as enteric duplication cyst on exploratory laparoscopy. Case This is a 9 year old male with a history of persistent iron deficiency anemia, gallstones s/p cholecystectomy and recurrent hematochezia. Patient was initially admitted for recurrent red bloody stools and …

Symptomatic Severe Hyponatremia: A Rare Complication Of Double Balloon Enteroscopy, Victoria Sarata, Kirby Lampe, Thomas M. Attard

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Previously healthy 11-year-old female, newly diagnosed Peutz-Jeghers Syndrome (PJS) confirmed by genetic testing STK11 PV (c.464+1dupG) underwent double balloon enteroscopy (DBE) after small bowel capsule showed multiple small intestinal polyps including >1.5 cms diameter. Pre-procedure, she completed a two-day MiraLAX clean out with >10 x 17g doses of MiraLAX each mixed in 6-8oz of water and other clear liquids. DBE completed with resection of 17 total small intestinal (SI), jejunal and ileal polyps. Procedure lasted approximately 4hrs and 5L of sterile water was used for underwater technique and irrigation.Sterile water was used for copious irrigation needed for direct visualization, and …

Refractory Benign Esophageal Strictures Complicated By Esophageal Perforation And Treated With Serial Dilations And Stent Placement In A Pediatric Patient, Kirby Lampe, Victoria Sarata, Nadia Ibrahimi

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Patient is a 2-year-old male who was originally referred to GI for failure to thrive and recurrent vomiting following feeds. Upper GI showed long-segment stricture with mid-thoracic tapering and initial EGD revealed 2mmx5cm distal esophageal stricture that was balloon dilated with serial dilations and triamcinolone injections. He presented one week after his 3rd dilation with fever, vomiting and respiratory distress and was found to have cardiac tamponade, left pleural effusion, septic shock and esophageal perforation. He was transferred to the ICU and started on broad-spectrum antibiotics, IV fluids and chest tube placement. He required intubation and vasopressors. After stabilization, esophogram …

A Rare Case Of Ogilvie’S Syndrome In A Pediatric Patient With A Complex Medical History, Kirby Lampe, Victoria Sarata, Aileen Har

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Acute colonic pseudo-obstruction (ACPO) or Ogilvie’s syndrome is an acute dilatation of the small or large bowel without an obstructive lesion. Symptoms include abdominal distension, nausea and vomiting, constipation and occasional dyspnea. The disorder most commonly involves the cecum and right colon and is most frequently seen in male patients above the age of 60 (1). It is rare for Ogilvie’s to occur in the pediatric population though some infrequent instances have been reported. Here, we report a case of a patient with significant abdominal distension and gaseous distension seen on x-ray, which was diagnosed and treated as Ogilvie’s syndrome. …

A Case Report: Ansa Pancreatica As A Cause Of Recurrent Pancreatitis, Chase Branstetter, Elizaveta Khenner, Victoria Sarata, Nadia Ibrahimi

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No abstract provided.

Rising Use Of Immune Checkpoint Inhibitors And The Escalating Burden Of Gastrointestinal And Hepatic Toxicities: A Nine-Year Analysis, Donghyun Ko, Do Han Kim Md, Pedro Palacios Argueta Md, Wilhelm S. Basegoda Md, Jose A. Porres, Francis F. Fadi, Jana G. Hashash, Francis A. Farraye, Paul T. Kroner Md

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The advent of immune checkpoint inhibitors (ICIs), including programmed death 1 (PD-1), PD-L1, and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitors, has revolutionized cancer therapeutics, markedly improving survival in various malignancies. However, their expanding utilization has been paralleled by the emergence of immune-related adverse events (irAEs), particularly gastrointestinal (GI) and hepatic toxicities, which pose significant challenges in clinical practice. These toxicities can manifest as a spectrum of conditions, from mild transient symptoms to severe, life-threatening complications, necessitating a better understanding of their prevalence and trends. This study aims to evaluate the temporal changes in ICI use and associated GI and hepatic …

Low Dose Aspirin Is Associated With Improved 30-And 92-Day Outcomes In Patients With Acute Pancreatitis: A Multinational Multicenter Analysis, Do Han Kim Md, Donghyun Ko Md, Pedro Palacios Argueta Md, Wilhelm S. Basegoda Md, Jose A. Porres, Frank J. Lukens Md, Paul T. Kroner Md

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Currently, no medications are known to formally treat or prevent acute pancreatitis (AP). Significant attention has been devoted to aspirin (ASA), with rodent models showing that it is associated with decreased inflammatory cytokine levels and protects against acinar cell necrosis. Current human studies, which are limited to retrospective inpatient outcomes only on the index hospitalization for AP, do suggest that patients on ASA have improved outcomes. The aim of our study was to explore de 30- and 90- day outcomes of patients with AP on long-term ASA use.

Long-Term Use Of Oral Factor X(A) Inhibitors Is Associated With Increased Rates Of Pancreatic Necrosis At 30- And 90-Days In Patients With Acute Pancreatitis: A Multinational Multicenter Analysis, Do Han Kim Md, Donghyun Ko, Pedro Palacios Argueta Md, Wilhelm S. Basegoda Md, Jose A. Porres, Frank J. Lukens Md, Paul T. Kroner Md

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The aim of this study is to explore the association between use of long-term anticoagulation with FXaI and the odds of pancreatic necrosis in patients with AP using a large multinational database.

Chronic Antiplatelet Agent Use Is Associated With Decreased 90-Day Morbidity And Mortality In Patients With Acute Pancreatitis, Do Han Kim Md, Donghyun Ko, Pedro Palacios Argueta Md, Wilhelm S. Basegoda Md, Jose A. Porres, Frank J. Lukens Md, Paul T. Kroner Md

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The aim of this study is to explore the association between the use of antiplatelets and outcomes of patients with AP using a large multinational database.

Acute Pancreatitis With Acute Kidney Injury Is Associated With Worse 30 And 90-Day Outcomes: A Multinational Multicenter Analysis, Donghyun Ko, Do Han Kim Md, Pedro Palacios Argueta Md, Wilhelm S. Basegoda Md, Frank J. Lukens Md, Paul T. Kroner Md

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Acute kidney injury (AKI) in patients with acute pancreatitis (AP) has been consistently shown to impact clinical outcomes and is a marker of organ dysfunction, being a primary indicator and driver of disease severity. The cornerstone of management of AP is aggressive intravenous fluid administration, and AKI has traditionally been a surrogate measure of the adequacy of volume repletion and is even recommended by the current ACG guidelines to be monitored in 6-hour intervals for 24-48 hours from presentation. While having been proven to be a factor of paramount importance on prior studies, the aim of our study is to …

Evolocumab Is Associated With Lower Mortality When Compared To Statin In Masld/Mash Patients: A Multinational Analysis, Donghyun Ko, Do Han Kim Md, Wilhelm S. Basegoda Md, Jose A. Porres, Cristina H. Makarian, Luis M. Nieto Md, Pedro Palacios Argueta Md, Paul T. Kroner Md, Frank J. Lukens Md

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Evolocumab is typically used as an add-on or replacement therapy for patients with dyslipidemia who are already on the maximum tolerated dose of statins or are intolerant to statins. While statins are effective in lowering lipid levels and have been shown to improve liver-related outcomes and reduce major adverse cardiovascular events (MACE), statin intolerance is increasingly encountered with their widespread use. The aim of our study is to compare the benefits of using evolocumab as monotherapy versus statins as monotherapy in patients with metabolic-dysfunction-associated steatotic liver disease (MASLD) and metabolic-dysfunction-associated steatohepatitis (MASH).

Rectal Indomethacin Decreases Post-Ercp Pancreatitis In Elderly Patients Without Increasing The Risk Of Acute Kidney Injury, Do Han Kim Md, Donghyun Ko Md, Jose A. Porres, Wilhelm S. Basegoda Md, Carlos Eilzondo-Alatorre Md, Luis M. Nieto Md, Miguel Salazar Md, Paul T. Kroner Md, Pedro Palacios Argueta Md, Frank J. Lukens Md

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This study examines the association of use of rectal indomethacin with clinical outcomes in elderly patients undergoing ERCP using a large population-based multinational database.

History Of Bariatric Surgery Is Not Associated With Worse Clinical Outcomes At 5 Years In Patients Who Undergo Liver Transplantation, Do Han Kim Md, Donghyun Ko, Pedro Palacios Argueta Md, Wilhelm S. Basegoda Md, Jose A. Porres, Klaus E. Monkemuller, Paul T. Kroner Md

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This study explores and compares outcomes of LT alone with LT in patients with a prior history of RYGB or SG, using a large multinational database.

Sglt-2 Inhibitor Use Is Associated With Lower Mortality In Patients With Alcoholic Cirrhosis And Type 2 Diabetes Mellitus: A Multinational Analysis, Do Han Kim Md, Donghyun Ko, Jose A. Porres, Wilhelm S. Basegoda Md, Cristina H. Makarian, Luis M. Nieto Md, Pedro Palacios Argueta Md, Paul T. Kroner Md, Frank J. Lukens Md

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In our study, we aimed to investigate whether SGLT2 inhibitors are associated with a reduced risk of all-cause mortality, liver-related events, and cardiovascular outcomes in patients with alcoholic cirrhosis and T2DM.

Immune-Related Adverse Events Associated With Pembrolizumab In Dmmr/Msi-H Colorectal Cancer: A Single Arm Safety Meta-Analysis, Joshi Simran, Saman Javid, Gaurav Sharma, Corinne Caissie, Armando Dominguez-Diaz

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Pembrolizumab, a PD-1 checkpoint inhibitor, enhances immune response and has proven effective against various cancers, including melanoma, non-small cell lung cancer, and head and neck squamous cell carcinoma.

Clinical trials have also shown its efficacy in treating various types of cancers with different mismatch-repair statuses. However, the spectrum and frequency of immune-related adverse events (irAEs) in the dMMR (deficient mismatch repair) / MSI-H (microsatellite instability-high) colorectal cancer remain underexplored.

Therefore, this meta-analysis aims to evaluate pembrolizumab's safety profile in this colorectal cancer subset.

Glp-1ra Use Is Not Associated With Immediate Worse Outcomes In Patients Undergoing Ercp: A Multinational Analysis, Donghyun Ko, Do Han Kim Md, Wilhelm S. Basegoda Md, Jose A. Porres, Carolos Elizondo Altorre, Luis M. Nieto Md, Miguel Salazar Md, Paul T. Kroner Md, Pedro Palacios Argueta Md, Frank J. Lukens Md

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Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to treat biliary and pancreatic conditions with increased therapeutic utilization over recent decades. Limited evidence exists regarding the potential impact of glucagon-like peptide-1 receptor agonists (GLP-1RA) on post-ERCP pulmonary outcomes. Increasing concern for retention of gastric contents has led to recent recommendations on holding these agents prior to upper endoscopic intervention. The aim of this study is to assess if use of GLP-1RA prior to ERCP leads to worse cardiopulmonary outcomes.

Untreated Subclinical Hypothyroidism Is Associated With Higher Mortality And Hepatic Decompensation In Patients With Masld/Mash: A Multinational Analysis, Do Han Kim Md, Donghyun Ko Md, Jose A. Porres, Wilhelm S. Basegoda Md, Cristina H. Makarian, Luis M. Nieto Md, Pedro Palacios Argueta Md, Paul T. Kroner Md, Frank J. Lukens Md

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This study aims to explore whether subclinical hypothyroidism contributes to the progression of MASLD/MASH, reflected as an increased risk of liver-related outcomes.

Key Diagnostic Factors In Steatotic Liver Disease And Their Longitudinal Impact On Overall Mortality, Do Han Kim Md, Donghyun Ko Md, Pojsakorn Danpanichkul, Meena B. Bensal Md, Mazen Noureddin, Karn Wijarnpreecha, Mark Muthiah

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This study evaluates the effect of diagnostic criteria on overall mortality across the SLD spectrum.

Engineering A Novel Treg Population To Control Autoimmune Diabetes, Sofia Colon Guzman, Elly Puckett, Ryan T. Fischer, Mary Markiewicz

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Purpose Type 1 diabetes (T1D) in an autoimmune disorder where T cells attack  islet cells, which are the pancreatic cells responsible for insulin production. T1D affects about 1 in 500 children in the United States and is one of the most common chronic diseases in pediatrics. Currently, insulin is the most effective treatment for T1D However, it does not change the underlying disease, and patients still experience many complications throughout their lifetimes. With a significant increase in the prevalence of T1D in children and adolescence in the past two decades, it’s important to explore therapies that alter the immune …

Discrepancy Between Hyaluronic Acid Levels And Mri-Based Measurements Of Hepatic Fat And Fibrosis, Daniel Aaron Borman, Rachel Chevalier, Jonathan Wagner, Michele T. Pritchard, Sherwin S. Chan, Nathan S. Artz, Johnston Fite, Yoon Cho, Valentina Shakhnovich, Veronica Williams, Voytek Slowik

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Introduction Metabolic-dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease in children in the United States and, when left untreated, can progress to liver fibrosis. Clinicians currently utilize imaging and biopsy to assess fibrosis in this patient population as there is no validated serum biomarker available for detecting fibrosis. Previous research suggests that serum hyaluronic acid levels are predictive of hepatic fibrosis in children with MASLD. Methods Retrospective data were obtained from the Children’s Mercy Hospital Liver Lab study. Pediatric subjects with both hyaluronic acid (HA) samples and MRI evaluation within a month were identified and included for …

Terminal Ileal Intubation In Retroflexion In A Pediatric Patient, Lakshmi Kunam, Antonia Fernandez Ovalle, Thomas M. Attard

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Background: Terminal ileum (TI) intubation is integral to complete diagnostic ileocolonoscopy in children. It is necessary to determine terminal ileal involvement in patients with a broad spectrum of pathologic processes. In some cases the standard method of intubation does not lead to success and retroflexion is needed. Here we describe the case of terminal ileal intubation in retroflexion on a 14 year old female. Case description: 14 year-old female patient with a past medical history of chronic abdominal pain, NAFLD, anxiety, vulvovaginitis, lichen sclerosus, depression, constipation, delayed menses, and GERD who was admitted for 2 weeks of escalating symptoms and …

Steatotic Mass Secondary To Heterozygous Hemochromatosis, A Rare Case Of Biliary Obstruction, Saddam Zaidi Md, Cheng-Hung Tai, Joanna Gibson Md, Phd, Caroline Loeser

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Heterozygous Hemochromatosis (HH) is a genetic disorder that increases iron absorption. Carriers of the C282Y HFE gene mutation have a higher risk of developing nonalcoholic fatty liver disease (NAFLD). Research indicates a significant association between liver fat accumulation (steatosis) and fibrosis in HH. This case involves a 31-year-old male with HH and an uncommon biliary obstruction caused by focal fat infiltration.

A Rare Case Of Metachronous Gastric Lymphoma And Gastric Adenocarcinoma, Rofinna Johnkennedy Md, Mph, Cheng-Hung Tai, Alexa Plato Md, Department Of Medicine,, Caroline Loeser

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Reports of metachronous primary gastric lymphoma and gastric adenocarcinoma exist in the literature, but it remains a rare entity. We present a rare case of metachronous gastric adenocarcinoma in a patient diagnosed initially with primary gastric lymphoma.

Amyloidosis: A Rare Cause Of Pan-Dysmotility, Rofinna Johnkennedy Md, Mph, Cheng-Hung Tai, Alexa Plato Md, Department Of Medicine,

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Amyloidosis is a rare systemic infiltrative disease, with a prevalence estimated to be 6-10 cases per million person-years. It involves the extracellular deposition of beta-sheet fibrillar protein and can manifest in any organ system in the body. Diagnosis of gastrointestinal involvement of amyloidosis can be difficult, given its nonspecific symptoms including abdominal pain, nausea, dysphagia, and diarrhea.

To Screen Or Not To Screen, That Is The Question, Saddam Zaidi Md, Cheng-Hung Tai, Caroline Loeser

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AASLD and EASL recommend biennial HCC screening for Child-Pugh A and B, but not C. We report a 43-year-old female with alcohol related hepatitis and cirrhosis. Her Fibro test score improved from F4 in 2021 to F2 in 2023 with strict alcohol abstinence. AASLD guidelines for HCC screening in such cases remain unclear.

Outcomes Of Alcohol-Associated Hepatitis In Hospitalized Patients With Prior Bariatric Surgery: A Nationwide Analysis, 2016-2020, Sarpong Boateng, Prince A. Ameyaw, Karthik Mathialagan, Basile Njei

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Alcohol-associated hepatitis (AAH) is a severe liver condition often necessitating hospitalization and has a one-year mortality of 40%. The increasing prevalence of obesity has led to a rise in bariatric surgery (BS), which can alter the outcomes of various comorbid conditions. There are some concerns about possible increased risk and severity of alcohol related disorders in patients with a history of BS due to alteration in alcohol metabolism after surgery.

Sangrado Del Tubo Digestivo Alto Secundario A Infección De Adenovirus, Moises Alatorre-Jimenez, Sarah T. Edwards, Thomas M. Attard

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Titulo: Sangrado del Tubo Digestivo Alto Secundario a Infección de Adenovirus Introducción: El Sangrado del tubo digestivo alto (STDA) es causado por múltiples etiologías incluyendo gastritis, varices, esofagitis, anomalidades vasculares, cuerpos extraños, y ulceras (1). Dentro de estas causas se conoce que infecciones virales pueden producir ulceras causando sangrado los más comunes son el virus de Epstein- Barr, Covid-19, Herpesvirus-6, Herpesvirus-7 y Citomegalovirus (1,2,3,4,5). Presentamos el caso de un paciente con STDA severo a causa de infección por adenovirus. Reporte de Caso: Paciente de 22 meses de edad, previamente sano que se presenta al servicio de Urgencias debido a un …

Rumination Syndrome Diagnosis Supported By Colon Manometry In A Pediatric Patient, Alex Biller, John Rosen, Amornluck Krasaelap

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Introduction: Rumination syndrome is a disorder of gut-brain interaction characterized by effortless repetitive postprandial regurgitation, reswallowing, and/or spitting.(1) This condition is caused by increased intragastric pressure due to abdominal muscle contractions, leading to the opening of the lower esophageal sphincter and the return of gastric content into the esophagus.(1) Rumination is a clinical diagnosis after the exclusion of other etiologies of symptoms. The diagnosis of rumination is clinical, but supportive evidence can be obtained through esophageal or antroduodenal manometry.(2) We present a unique case report of rumination syndrome diagnosis supported by data obtained during colon manometry in a pediatric patient. …

Latency Time From Prior Authorization Submission To Initiation Of Biologic Therapy In Inflammatory Bowel Disease, Shannon Capraro, Janelle R. Noel-Macdonnell Phd, Lauren Disselhoff, Layne Sieve, Rachel Chevalier

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Background For pediatric patients with a diagnosis of inflammatory bowel disease (IBD), initiation of biologic therapy can be essential to attain disease control. Unfortunately, patients often experience delays in receiving the first dose of these medications due to the need for insurance companies to approve medication prior authorizations (PA). Physicians and support staff spend many working hours collating and transferring information regarding urgency to payors. To our knowledge, no studies exist to evaluate the factors that contribute to how quickly a medication is approved in pediatric patients. We set out here to evaluate which demographic and disease factors contribute to …