An Investigation Into What Factors Influence Patterns of Clinical Presentation in Adult-Onset Celiac Disease.

Introduction Anxiety and depression are common in patients with celiac disease (CD), and many psychosocial explanations have been considered. However, as the gut-brain axis is becoming increasingly understood, biological mechanisms have been proposed, including vitamin or mineral deficiencies and gut inflammation. Aim To investigate associations between anxiety/depression and symptom severity, vitamin status, and gut inflammation in untreated adult patients presenting with a serologic indication of celiac disease.

Management of minor upper gastrointestinal haemorrhage in the community using the Glasgow Blatchford Score.

Background: The Glasgow Blatchford Score (GBS) is a validated risk assessment tool in primary upper gastrointestinal haemorrhage, which accurately predicts the need for intervention (endoscopic therapy, blood transfusion or surgery) or death.

Aims: To identify the GBS that predicts lack of intervention or death and to apply this to clinical practice by managing low-risk patients in the community.

Methods: GBSs prospectively calculated on 232 patients with upper gastrointestinal haemorrhage to identify low-risk score.

Stomal varices: a rare cause of stomal hemorrhage. A report of three cases.

Stomal varices secondary to portal hypertension are a rare but potentially fatal cause of hemorrhage. Management, determined by the site of the bleeding, centers on preventing additional bleeds and may include providing local pressure, applying silver nitrate, injection sclerotherapy, suture ligation of the bleeding point, and/or the placement of transjugular intrahepatic portosystemic shunts and refashioning the stoma. Two patients (60- and 69-year-old women) had panproctocolectomy for inflammatory bowel disease and presented at the authors' hospital with bleeding from the ileostomy 1 and 19 years, respectively, following the creation of their stomas.

Insertion of expandable metallic stents in esophageal cancer without fluoroscopy is safe and effective: a 5-year experience.

Background: Self-expanding metallic stent (SEMS) placement is an important method of dysphagia palliation for patients with inoperable esophageal cancer. In most institutions, it is performed with fluoroscopic guidance; however, in 2001, we described a novel, direct-vision approach to SEMS placement, which does not require fluoroscopy. Here we report an audit of our experience over the last 5 years when using this methodology.