Dynamic liver test patterns do not predict bile duct stones.

Background: Numerous models have been developed to predict choledocholithiasis. Recent work has shown that these algorithms perform suboptimally. Identification of clinical predictors with high positive and negative predictive value would minimize adverse events associated with unnecessary diagnostic endoscopic retrograde cholangiopancreatography (ERCP) while limiting the use of expensive tests including magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) for indeterminate cases.

High-risk symptoms do not predict gastric cancer precursors.

Background & Study Aims: Gastric intestinal metaplasia (GIM) is the most common precursor of gastric cancer. Our aim is to determine if presenting symptoms predict gastric cancer precursor lesions in a high-risk population.

Patient And Methods: Consecutive unique patients evaluated by endoscopy for upper gastrointestinal symptoms at the Los Angeles County Hospital between 2010 and 2014 were evaluated.

A case of recurrent obscure gastrointestinal bleeding: Heyde's syndrome - case report and review.

Gastrointestinal bleeding from angiodysplasias in patients with aortic stenosis is termed as 'Heyde's syndrome'. We report a case of Heyde's syndrome successfully treated with trans-catheter aortic valve replacement.

Rare cause of gastric outlet obstruction.

Bouveret's syndrome is a rare cause of gastric outlet obstruction. The stones enter the small bowel via cholecysto-enteric fistula. The most common presenting symptoms are abdominal pain, nausea and vomiting.

Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis.

Objectives: Early aggressive intravenous hydration is recommended for acute pancreatitis treatment although randomized trials have not documented benefit. We performed a randomized trial of aggressive vs. standard hydration in the initial management of mild acute pancreatitis.

Autoimmune pancreatitis and cholangitis.

Autoimmune pancreatitis (AIP) is part of a systemic fibrosclerotic process characterized by lymphoplasmacytic infiltrate with immunoglobulin G subtype-4 (IgG4) positive cells. It characteristically presents with biliary obstruction due to mass-like swelling of the pancreas. Frequently AIP is accompanied by extra-pancreatic manifestations including retroperitoneal fibrosis, thyroid disease, and salivary gland involvement.

Validation of a clinical prediction scale for hospital-onset Clostridium difficile infection.

Objective: The aim of this study was to validate a clinical prediction scale for hospital-onset Clostridium difficile infection (CDI).

Methods: The study included a consecutive cohort of patients admitted to the adult medical service over a period of 17 months (June 2011 to October 2012). The clinical prediction scale comprised of new-onset loose stools (5 points), length of hospital stay >7days (4 points), aged 65 years or older (3 points), resides in long-term care facility (2 points), broad spectrum antibiotics use (1 point), and hypoalbuminemia (1 point).

A cohort study for derivation and validation of a clinical prediction scale for hospital-onset Clostridium difficile infection.

Objective: To develop and validate a clinical prediction scale for hospital-onset Clostridium difficile infection (CDI).

Methods: A community-based, 360-bed hospital located in the suburbs of a metropolitan area in the United States served as the setting for the present retrospective cohort study. The cohort consisted of patients admitted to the adult medical service over a six-year period from October 2005 to September 2011.

Hypergastrinemia and recurrent type 1 gastric carcinoid in a young Indian male: necessity for antrectomy?

Carcinoid tumors are the most common neuroendocrine tumors. Gastric carcinoids represent 2% of all carcinoids and 1% of all gastric masses. Due to the widespread use of Esophagogastroduodenoscopy for evaluating a variety of upper gastrointestinal symptoms, the detection of early gastric carcinoids has increased.

Diagnosis and management of cystic lesions of the pancreas.

Pancreatic cysts are challenging lesions to diagnose and to treat. Determining which of the five most common diagnoses-pancreatic pseudocyst, serous cystic neoplasm (SCN), solid pseudopapillary neoplasm (SPN), mucinous cystic neoplasm (MCN), and intraductal mucinous papillary neoplasm (IPMN)-is likely the correct one requires the careful integration of many historical, radiographic, laboratory, and other factors, and management is markedly different depending on the type of cystic lesion of the pancreas. Pseudocysts are generally distinguishable based on historical, clinical and radiographic characteristics, and among the others, the most important differentiation is between the mucin-producing MCN and IPMN (high risk for cancer) versus the serous SCN and SPN (low risk for cancer).

Metastatic Renal Cell Cancer and a Gastric Mass: An Unusual Finding.

Renal cell cancer (RCC) accounts for approximately 3% of all adult malignancies. RCC has a metastasis rate of approximately 25%, which is most commonly to the lungs (>50%). On the contrary, RCC metastasis to the gastrointestinal tract (excluding the liver) is very uncommon and ranges from 0.

Role of endoscopic ultrasound/SpyScope in diagnosis and treatment of choledocholithiasis in pregnancy.

Cholelithiasis and choledocholithiasis occur frequently in pregnancy and their management can be complicated. Traditional endoscopic retrograde cholangiopancreatography (ERCP) is the first line treatment for choledocholithiasis, but in addition to its baseline risks, fluoroscopy poses an additional radiation risk to the fetus. Endoscopic ultrasound (EUS) is an accurate modality for detecting common bile duct stones, but its role has not been defined in pregnancy.

EUS-guided FNA diagnosis of pancreatic endocrine tumors: new trends identified.

Background: Pancreatic endocrine tumors (PETs) are rare (1 per 100,000 population) and are thought to be functioning in up to 85% of cases and are generally less than 2 cm in size. By previous reports, 15% to 50% of PETs are nonfunctioning and are discovered either incidentally or by symptom evaluation from a mass effect. EUS-guided FNA (EUS-FNA) has been shown to accurately diagnose PETs and to localize tumors for surgical resection.

Pancreatic endocrine tumors.

Incidental, nonfunctional pancreatic endocrine tumors (PET) are observed with increasing frequency. Most are insulinomas. Endoscopic ultrasound with fine-needle aspiration plays a significant role in the localization and tissue diagnosis of PET.

Refined genomic localization and ethnic differences observed for the IBD5 association with Crohn's disease.

Although the general association of the inflammatory bowel disease (IBD) 5 region on chromosome 5q31 to Crohn's disease (CD) has been replicated repeatedly, the identity of the precise causal variant within the region remains unknown. A recent report proposed polymorphisms in solute carrier family 22, member 4 (SLC22A4) organic cation transporter 1(OCTN1) and solute carrier family 22, member 5 (SLC22A5) (OCTN2) as responsible for the IBD5 association, but definitive, large-sample comparison of those polymorphisms with others known to be in strong linkage disequilibrium was not performed. We evaluated 1879 affected offspring and parents ascertained by a North American IBD Genetics Consortium for six IBD5 tag single nucleotide polymorphisms (SNPs) to evaluate association localization and ethnic and subphenotypic specificity.

Endoscopic ultrasound-guided fine needle aspirate microsatellite loss analysis and pancreatic endocrine tumor outcome.

Background & Aims: The clinical course of pancreatic endocrine tumor (PET) varies depending on tumor aggressiveness, disease extent, and possibly accumulated molecular alterations. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) results, although accurate in diagnosing PET, correlate poorly with PET outcome. The role of detecting key molecular abnormalities in predicting PET behavior and clinical outcome from EUS-FNA material remains unknown.

Medical therapy for ulcerative colitis.

Although newer therapeutic agents are being developed for the treatment of inflammatory bowel disease, aminosalicylates and corticosteroids remain the mainstay of treatment for UC (Tables 2-5). Patients who do not respond to these agents or become steroid dependent require immunomodulatory therapy or curative surgery. Cyclosporine represents the greatest treatment advance for UC in 10 years.