Practice of gastroenterologists in treating flaring inflammatory bowel disease patients with clostridium difficile: antibiotics alone or combined antibiotics/immunomodulators?

Background: The optimal management of Clostridium difficile infection (CDI) in flaring inflammatory bowel disease (IBD) patients has not been defined. Limited data suggest that coadministration of immunomodulators (IM) with antibiotics (AB) results in a worse outcome. We investigated the prevalent practice among North American gastroenterologists in this scenario.

Improvement of Pyoderma gangrenosum and psoriasis associated with Crohn disease with anti-tumor necrosis factor alpha monoclonal antibody.

Background: Infliximab is an anti-tumor necrosis factor alpha monoclonal antibody IgG effective in the treatment and maintenance of remission of active refractory Crohn disease and associated draining enterocutaneous fistulae. Multiple infusions of infliximab show promising results in patients with rheumatoid arthritis. Currently, there is limited clinical experience with infliximab, and no published reports exist on its use in cutaneous disorders.

Gastric sarcoidosis.

Sarcoidosis of the gastrointestinal tract is uncommon even though involvement of the liver, spleen, and adenopathy are becoming recognizable entities on computed tomography (CT). Involvement of the stomach, the most common site of sarcoidosis of the gastrointestinal tract, is usually associated with pulmonary disease. The radiologic appearances of gastric involvement are variable.

Esophageal dysmotility from a small esophageal granular cell tumor.

Although typically small and submucosal, esophageal granular cell tumors frequently produce dysphagia. Esophageal manometry and a cine-esophagram in a patient with a 7-mm-wide esophageal granular cell tumor and dysphagia showed esophageal aperistalsis and a hypertensive lower esophageal sphincter that relaxed normally with swallowing. This finding suggests that dysmotility may contribute to the dysphagia frequently attributed to this tumor.

Cessation of recurrent bleeding from gastrointestinal angiodysplasias after aortic valve replacement.

Recurrent bleeding from gastrointestinal angiodysplasias associated with aortic stenosis ceased after aortic valve replacement in two patients. In one patient numerous gastrointestinal angiodysplasias disappeared, as shown by endoscopy, after aortic valve replacement. Valve replacement may be adequate treatment for gastrointestinal bleeding from angiodysplasia associated with aortic stenosis.

Adenosquamous carcinoma of the liver arising in biliary cystadenocarcinoma: clinical, radiologic, and pathologic features with review of the literature.

Primary biliary cystadenoma, cystadenocarcinoma, squamous carcinoma, and adenosquamous carcinoma of the liver are rare tumors. We describe a middle-aged woman with recurrent fever and a clinical diagnosis of hepatic abscess who proved at laparotomy to have adenosquamous carcinoma of the liver arising in a biliary cystadenocarcinoma. The pathologic features of the tumor and findings on ultrasonography, angiography, and computed tomography are described in detail.

Colonoscopy as an adjunctive technique in evaluating acquired colonic narrowing.

Fiberoptic colonscopy is a useful adjunct to the barium enema in establishing the nature of colonic narrowing for which surgical intervention is being considered in patients who are not clinically obstructed. When the mucosa can be demonstrated to be free of disease, celiotomy and resection can be avoided. Even without significant narrowing, it is sometimes possible to limit the extent of resection by proving the process to be benign.

The endoscopy corner: reversible ischemic colitis--correlation of colonoscopic and pathologic changes.

Ischemic colitis is a well described complication following distal aortic replacement. The diagnosis is typically made by correlating clinical signs such as the occurrence of abdominal pain and bloody diarrhea with supporting radiographic changes. In this report, the diagnosis of ischemic colitis was confirmed on the basis of colonoscopic and associated histopathological findings.

Antibodies to ribosomes in chronic active hepatitis.

A recently developed Farr-type radioimmunoassay for the detection of antibodies to tritium-labeled HeLa cell cytoplasmic ribosomes was evaluated as a serologic test in a variety of liver diseases. Ribosomal antibodies were detected in the sera of 31.4% of 70 patients with chronic active hepatitis (CAH) and primary biliary cirrhosis compared with only 4.

Hyperviscosity syndrome attributable to hyperglobulinemia in chronic active hepatitis.

A young women with clinical and histological features of chronic active hepatitis was noted to have extremely high levels of immunoglobulin (14.6 g per dl). This was associated with the hyperviscosity syndrome, diffuse coagulation abnormalities, and renal insufficiency in the absence of severe liver disease.

Serum lysozyme, serum proteins, and immunoglobulin determinations in nonspecific inflammatory bowel disease.

The serum levels of lysozyme, serum electrophoresis, and serum immunoglobulins were determined prospectively in 101 patients with ulcerative colitis, ulcerative proctitis, Crohn's disease, or nonclassifiable nonspecific inflammatory bowel disease. Although the mean serum lysozyme concentration of patients with Crohn's disease (10.5 +/- 6.

Ulcerative esophagitis and colitis in a pediatric pantient with Behcet's syndrome. Response to steroid therapy.

The gastrointestinal manifestations of Behcet's syndrome including colitis and esophageal ulceration have been recognized in recent years. In the present case, a girl with Behcet's syndrome was followed since age 11 for oral, vaginal, perianal ulcers and neurological involvement. At age 16 she developed esophageal ulceration and colitis, was treated with steroids and improved.