Need for a More Objective, Inclusive, and Equitable Selection Process for Gastroenterology Fellowships.

Diseases related to the digestive system account for a significant proportion of the diseases burden in the United States and result in 36.8 million ambulatory visits, 3.8 million hospital admissions, and 22.

The Unmasking of Cytomegalovirus as an Accomplice to -Induced Severe Acute Gastroenteritis in a Healthy Host.

Cytomegalovirus (CMV) belongs to the family, and it is considered the largest virus to infect humans. Primary CMV infection frequently targets immunodeficient patients and is often symptomatic. However, it may remain latent or clinically unapparent for years in immunocompetent individuals.

A Novel Approach to Percutaneous Endoscopic Gastrostomy Tube Replacement: Can You Save the Site?

Inadvertent removal or dislodgement is the most commonly encountered complication in patients with percutaneous endoscopic gastrostomy (PEG) tube. Once the gastrocutaneous fistula is formed, bedside tube replacement can be performed at the same site, within 24 hours of dislodgement. Usually, after this timeframe, the tract closes; hence, it is recommended to perform a replacement at a different site.

Upper GI Bleeding Secondary to Radiation Gastritis in a Patient with Preexisting Portal Hypertensive Gastropathy.

We commonly see patients presenting with either portal hypertensive gastropathy (PHG) or radiation gastritis. Radiation-induced hemorrhagic gastritis is an unusual lethal complication postradiation. Patients with preexisting PHG have very friable mucosa that can easily bleed after radiation for cancer treatment.

infection in liver cirrhosis patients: A population-based study in United States.

Background: (formerly ) infection (CDI) is an increasingly frequent cause of morbidity and mortality in hospitalized patients. Multiple risk factors are documented in the literature that includes, but are not limited to, antibiotics use, advanced age, and gastric acid suppression. Several epidemiological studies have reported an increased incidence of CDI in advanced liver disease patients.

Esophageal Food Impaction: A Retrospective Chart Review.

Background: Esophageal food impaction (EFI) is the third most common non-biliary emergency in gastroenterology, with an annual incidence rate of 13 episodes per 100,000 person-years and 1,500 deaths per year. Patients presenting with food impaction often have underlying esophageal pathology. We evaluated the possible risk factors for EFI in our study.

Gastropancreatic Fistula: A Rare Complication of Peptic Ulcer Disease.

Peptic ulcer disease (PUD) has a significant health burden. Penetration is a rare complication of PUD, where an ulcer erodes into another organ. To the best of our knowledge, we present the fourth case in the literature where a gastric ulcer has penetrated the pancreas.

A Comprehensive Review of Infectious Granulomatous Diseases of the Gastrointestinal Tract.

A granuloma is defined as a localized inflammatory reaction or a hypersensitive response to a nondegradable product leading to an organized collection of epithelioid histiocytes. Etiologies of granulomatous disorders can be divided into two broad categories: infectious and noninfectious (autoimmune conditions, toxins, etc.) causes.

Fidaxomicin Use for Clostridium Difficile Infection Probably Decreases the Effect of Coumadin® in Elderly.

The incidence of infection (CDI) has been decreasing in the last decade, though the incidence of community-acquired CDI has remained stable. In an elderly patient on Coumadin®, we report an unexpected decrease in international normalized ratio (INR) during the treatment of second recurrence of CDI treated with fidaxomicin. According to the available information, fidaxomicin does not interfere with warfarin.

An Emphasis on Screening to Detect Liver Cirrhosis and Hepatocellular Carcinoma in Patients Having Undergone the Fontan Procedure in Early Childhood.

The Fontan procedure is a surgical procedure for patients with single-ventricle anatomy that results in the flow of systemic venous blood to the lungs without passing through a ventricle. Before the 1970s, most children with single-ventricle anatomy failed to survive into adulthood. With the introduction of the Fontan procedure, and its many modifications, the survival rate of these patients improved exponentially.

A Case of Acute Esophageal Necrosis from Unruptured Thoracic Aortic Aneurysm.

Acute esophageal necrosis (AEN), also known as black esophagus due to its appearance on endoscopy, classically involves the distal esophagus (97% of cases). AEN affecting the midesophagus with sparing of the distal esophagus is rare and usually occurs in patients with thoracic aortic aneurysmal (TAA) rupture or aortic dissection. Herein, we report a unique case of AEN in the midesophagus in a patient with an unruptured and undissected TAA.

Spontaneous Perforation of an Acalculous Hydropic Gallbladder in a Diabetic Patient With Neuropathy: An Underdiagnosed Entity.

Gallbladder hydrops (HGB) is often under-diagnosed due to the various diagnostic criteria used throughout the globe. It can be described as a progressive increase in the volume of the gallbladder in the absence of inflammation, or bacterial infection. The underlying mechanism involves biliary ductal obstruction due to gallstones.

Pancreatic Pseudoaneurysm from a Gastroduodenal Artery.

Pancreatic pseudoaneurysm is a rare vascular complication of pancreatitis, resulting from erosion of the pancreatic or peripancreatic artery into a pseudocyst. However, it may happen after pancreatic or gastric bypass surgery or trauma. It may lead to fatal complications if left untreated.

Severe de novo Ulcerative Colitis following Ixekizumab Therapy.

Ixekizumab is a selective monoclonal antibody targeting interleukin-17A, approved for the treatment of chronic plaque psoriasis. It has rarely been associated with inflammatory bowel disease (IBD) in randomized trials only. We report a unique case of severe new-onset ulcerative colitis in a young male complicated by cytomegalovirus infection who was on ixekizumab therapy for plaque psoriasis.

Systematic Review and Meta-analysis: Adalimumab Monotherapy Versus Combination Therapy with Immunomodulators for Induction and Maintenance of Remission and Response in Patients with Crohn's Disease.

Background: It is unclear whether the combination of adalimumab (ADA) and immunomodulators is superior to ADA monotherapy in patients with Crohn's disease.

Methods: PubMed, Medline, Embase, Web of Science, and other databases were searched. Randomized controlled trials, open-label, prospective cohort, and retrospective studies, and pooled analyses were included.

Solitary Polypoid Angiodysplastic Lesion Mimicking a Tumor in the Jejunum.

Small bowel bleeding should be considered in patients with overt or occult gastrointestinal hemorrhage after normal upper and lower endoscopic examination. Angiodysplasia appearing as multiple flat vascular tufts is the most common cause of small bowel bleeding in patients over 40 years old. Polypoid angiodysplasia, however, is extremely rare.

Gastrointestinal Anisakidosis - Watch What You Eat.

Gastrointestinal anisakidosis is an under-reported and often misdiagnosed parasitic infection caused by the larvae of a nematode anisakis. The majority of cases are seen in Japan due to the consumption of raw and undercooked seafood; however, the incidence is likely to rise in the United States given the rising popularity of Japanese cuisine like sashimi or sushi. This unique report highlights the importance of considering anisakiasis in the differential diagnoses for patients with nonspecific abdominal symptoms with a recent history of raw or undercooked fish consumption.

ASGE guidelines result in cost-saving in the management of choledocholithiasis.

Background: The goal of this study was to determine whether utilization of the ASGE guidelines for the evaluation of bile duct stones (BDS) would result in fewer imaging studies and in turn lead to a lower healthcare expenditure.

Methods: This was a retrospective study set in an urban Teaching Hospital. Patients undergoing evaluation for BDS and who had their gallbladders in situ were included in the study.

Factors predicting early discharge and mortality in post-percutaneous endoscopic gastrostomy patients.

Background: The aim of our study was to ascertain factors that favor early discharge and predict mortality in post-percutaneous endoscopic gastrostomy (PEG) patients.

Methods: Successive patients who underwent successful PEG placement during a 10-year period in a single New York City hospital were included in the study. Data was retrospectively extracted from hospital electronic medical records.

The Blatchford score is an useful index in the management of Mallory-Weiss tear and gastrointestinal bleeding: experience from an urban community hospital.

Objectives: The purpose of this study was to determine the utility of individual clinical parameters as well as a composite index like the Blatchford score in predicting the need for endoscopic intervention and prognosticating the out come in patients with Mallory Weiss tear presenting with gastrointestinal bleeding.

Methods: We retrospectively reviewed our endoscopy database and our EMR system to identify patients with Mallory Weiss tear and collect relevant data.

Results: A total of 38 cases with Mallory-Weiss tear were identified at our center over a 5 year period.

An unusual cause of upper gastrointestinal bleeding: duodenal GIST. A case report and literature review.

A duodenal GIST is an unusual cause of upper gastrointestinal bleeding. Duodenal GISTs are rare and constitute 5% of all GISTs. A significant percentage of duodenal GISTs are located in the third and fourth portion of the duodenum and may not be detected on routine upper endoscopy.

Diabetes is not an independent predictor of gastroparesis in symptomatic patients referred for gastric emptying studies.

Background: It is commonly presumed that diabetics are more prone to gastroparesis when compared to non-diabetics.

Objective: To ascertain whether diabetes is an independent predictor of gastroparesis in symptomatic patients who are referred for gastric emptying studies.

Methods: This was a cross sectional observational study.

Pseudocyst management: endoscopic drainage and other emerging techniques.

Pseudocyst formation is a well known complication of pancreatitis. Not all pancreatic pseudocysts require intervention. Selected patients who are asymptomatic can be subject to expectant management.

Treatment of gastroparesis: an update.

Gastroparesis is a chronic disorder of gastric motility that is characterized by delayed emptying of either solids or liquids from the stomach in the absence of any mechanical obstruction. Nausea, vomiting, early satiety and bloating are some of the manifestations of gastroparesis. Idiopathic, diabetes mellitus and postsurgical states account for the majority of cases.