Acute Hemorrhagic Rectal Ulcer Presenting With Severe Lower Gastrointestinal Bleeding: A Case Report of an Emerging Entity.

Acute hemorrhagic rectal ulcer (AHRU) is a rare but potentially life-threatening condition. We present the case of a 74-year-old man who developed sudden massive hematochezia and hypotension during hospitalization for fever of unknown origin. He was known to have alcohol-related liver cirrhosis, hypoalbuminemia and coronary artery disease (CAD) and was on daily aspirin.

Pancreaticopleural fistula: Case report and review of the literature.

A pancreatic fistula is defined as the leakage of pancreatic fluid into another organ or compartment because of pancreatic duct disruption or pseudocyst formation. It is most often seen in middle-aged men between 40 and 50, particularly in patients who have a history of chronic alcoholism and pancreatitis. The tract may fistulae into the pleura, creating a pancreaticopleural fistula, an exceedingly rare condition presenting as a recurrent pleural effusion and extremely high amylase levels, a key distinguishing factor in diagnosis.

Non-cirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and management.

Since the Asian Pacific Association for the Study of the Liver (APASL) published guidelines on non-cirrhotic portal fibrosis/idiopathic portal hypertension in 2007, there has been a surge in new information, especially with the introduction of the term porto-sinusoidal vascular disorder (PSVD). Non-cirrhotic intra-hepatic causes of portal hypertension include disorders with a clearly identifiable etiology, such as schistosomiasis, as well as disorders with an unclear etiology such as non-cirrhotic portal fibrosis (NCPF), also termed idiopathic portal hypertension (IPH). This entity is being increasingly recognized as being associated with systemic disease and drug therapy, especially cancer therapy.

The Utility of Multitarget Stool DNA Testing for Colorectal Cancer Screening After a Normal Colonoscopy.

Background: Multitarget stool DNA (MT-sDNA) tests (here, Cologuard®) are currently used in average-risk patients as a primary method of screening for colorectal cancer. However, MT-sDNA testing has also been used in patients who previously underwent colonoscopy who wish to avoid repeat colonoscopy. Here, in a large primary care practice setting, our aim was to evaluate the diagnostic performance of MT-sDNA testing in patients with a previously normal colonoscopy.

Incidence of Idiosyncratic Drug-Induced Liver Injury Caused by Prescription Drugs.

Background: The incidence of drug-induced liver injury (DILI) is not known for most prescription medications. We aimed to estimate the incidence of DILI for commonly prescribed outpatient drugs.

Methods: To establish a baseline estimate of DILI incidence, we used the estimated incidence (EI) of amoxicillin/clavulanate DILI from a previous population-based study in Iceland.

Review article: Recommendations for detection, assessment and management of suspected drug-induced liver injury during clinical trials in oncology patients.

Background: Drug-induced liver injury (DILI) is a major concern for oncology drugs in clinical practice and under development. Monitoring cancer patients for hepatotoxicity is challenging as these patients may have abnormal liver tests pre-treatment or on-study for many reasons including liver injury due to past oncology treatments, hepatic metastases, medical co-morbidities such as heart failure, and concomitant medications. At present, there are no regulatory guidelines or position papers that systematically address best practices pertaining to DILI detection, assessment and management in oncology patients.

Safety of Endoscopy in Cirrhosis.

Background: Endoscopic procedures are among the most commonly performed medical procedures and the serious adverse event rate is reported to be 1-3 adverse events per 1000 procedures.

Aims: Here, we have examined the safety of endoscopy specifically in cirrhotic populations.

Methods: We conducted a retrospective case (cirrhosis)-control (non-cirrhosis) study of the outcomes of patients undergoing endoscopy in a large academic medical center.

CT135 mediates the resistance of to primate interferon gamma stimulated immune defenses.

Evading host innate immune defenses is a critical feature of infections, and the mechanisms used by to subvert these pathways are incompletely understood. We screened a library of chimeric mutants for genetic factors important for interference with cell-autonomous immune defenses. Mutant strains with predicted truncations of the inclusion membrane protein CT135 were susceptible to interferon gamma-activated immunity in human cells.

AGA Clinical Practice Update on Management of Iron Deficiency Anemia: Expert Review.

Description: In this Clinical Practice Update (CPU), we will Best Practice Advice (BPA) guidance on the appropriate management of iron deficiency anemia.

Methods: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice (BPA) statements were drawn from a review of the published literature and from expert opinion.

Overt gastrointestinal bleeding in patients with cancer: Clinical characteristics and outcomes.

Background: The aim of this study was to compare the clinical characteristics and outcomes of gastrointestinal bleeding (GIB) between cancer patients (CP) and non-cancer patients (NCP).

Methods: This was a prospective study of patients admitted with overt GIB between 2013 and 2021. GIB etiology, management and outcomes including rebleeding and mortality, were compared between CP and NCP, and among patients with different types of cancer.

Impact of blood transfusion on mortality and rebleeding in gastrointestinal bleeding: an 8-year cohort from a tertiary care center.

Background: The aim of this study was to investigate the impact of blood transfusion (BT) on mortality and rebleeding in patients with gastrointestinal bleeding (GIB) and whether BT at a threshold of ≤7 g/dL may improve these outcomes.

Methods: A prospective study was conducted in patients admitted with GIB between 2013 and 2021. Antithrombotic (AT) use and clinical outcomes were compared between transfused and non-transfused patients, and between those transfused at a threshold of ≤7 vs.

Is it time to reduce the length of postgraduate training for physician-scientists in internal medicine?

Physician-scientists play a crucial role in advancing medical knowledge and patient care, yet the long periods of time required to complete training may impede expansion of this workforce. We examined the relationship between postgraduate training and time to receipt of NIH or Veterans Affairs career development awards (CDAs) for physician-scientists in internal medicine. Data from NIH RePORTER were analyzed for internal medicine residency graduates who received specific CDAs (K08, K23, K99, or IK2) in 2022.

Long-term outcomes of patients with autoimmune hepatitis induced cirrhosis after immunosuppressive treatment.

Introduction: Autoimmune hepatitis is an immune-mediated liver disease that results in hepatic inflammation and subsequent fibrosis. We aimed to assess the natural history of autoimmune hepatitis in patients who had cirrhosis at the time of diagnosis.

Methods: We examined consecutive patients with autoimmune hepatitis (based on the revised International Autoimmune Hepatitis Group criteria) and cirrhosis who had long-term follow-up between 2012 and 2018.

Noninvasive assessment of liver fibrosis and portal hypertension.

Purpose Of Review: The result of ongoing liver injury - and disease, regardless of cause - is fibrosis, and fibrosis appears to be a critically important result of ongoing injury. Further, in a number of different liver diseases, the presence of fibrosis has prognostic value. Therefore, the assessment of fibrosis is of critical clinical importance.