Gastrointestinal Causes Research Articles

Pancreatitis Aguda: Articulo de Revisión

La pancreatitis aguda es una de las principales causas gastrointestinales por la cual se acude al cuarto de urgencias, y es una causa importante de morbimortalidad a nivel mundial. Se caracteriza por la activación desmedida de la tripsina en las células acinares del páncreas, provocando la autodigestión enzimática del tejido pancreático. La primera descripción de esta entidad fue realizada en el año 1652 por el médico danés Nicholaes Tulp. Sus principales etiologías son la litiasis biliar y el consumo excesivo de alcohol. Para establecer el diagnóstico de pancreatitis aguda se requieren al menos 2 de sus 3 criterios diagnósticos: dolor abdominal típico de pancreatitis, niveles de amilasa y/o lipasa séricos con elevación superior a 3 veces el límite de lo normal, hallazgos típicos de pancreatitis aguda por imagenología del abdomen. La hidratación, nutrición temprana y el manejo del dolor son los pilares en el manejo de una pancreatitis aguda

S3086 Predicting Gallstone Pancreatitis: A Pilot Study

INTRODUCTION: Acute pancreatitis, a life-threatening disease with increasing incidence worldwide, is the most common gastrointestinal cause of hospitalization in the United States. Gallstone Pancreatitis (GP) makes up for about 40%-70% of cases. Distinguishing GP from other causes is of clinical importance as it can change the management, primarily whether the patient should undergo cholecystectomy. METHODS: This retrospective, cross-sectional chart review examined patients ≥18 years old with a diagnosis of pancreatitis at a single hospital in South Texas between September 2014 and December 2019. Cases were included if two of three criteria were met: 1) acute abdominal pain; 2) serum lipase ≥3 times the upper limit of normal (920 units/L); and/or 3) findings of acute pancreatitis on CT scan. Patients with post-ERCP pancreatitis were excluded from analyses. Differences in descriptive statistics between GP and non-GP were evaluated using t-test and chi-square. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the diagnosis of GP were calculated separately for ALT, AST, lipase, alkaline phosphatase (AP) and total bilirubin (T Bili). Statistical analyses were conducted using R version 4.0.0. RESULTS: After chart-review, 405 patients met the inclusion criteria for this study. We found that 37.8% had a diagnosis of GP. The mean age of included patients was 53.1 years (SD = 18.8). No significant difference in Body Mass Index was found between GP and non-GP (GP: 31.5 vs non-GP: 30.7, P = 0.325). The Female:Male ratio was significantly higher in GP than non-GP (GP: 1.83 vs non-GP: 1.1, P = 0.020). AST, ALT, lipase, AP, and T Bili were also significantly higher in GP than non-GP (Table 1). The PPV for ALT >150 units/L to diagnose GP was 88% (range: 81-93). AST, lipase, AP, and T Bili findings are shown in Table 2 and Figure 1. CONCLUSION: The majority of cases were attributed to GP. Moreover, in 35.5% of the cases, the underlying etiology was not identified. In patients with acute pancreatitis we determined that ALT >150 units/L has a PPV of 88% of diagnosing GP. Lipase, AP, AST and T Bili did not show the same potential as a single laboratory value; however, they were all significantly higher in GP compared to non-GP. Further research combining laboratory values and risk factors would help pave the way to the creation of a predictive scoring system for GP, thus decreasing unnecessary studies and diagnoses of ‘idiopathic’ acute pancreatitis.Table 1.: Descriptive StatisticsTable 2.: Sensitivity, Specificity, PPV and NPV for Diagnosing Gallstone PancreatitisFigure 1.: Laboratory Values ROC Curves.

S0021 Cannabis-Induced Acute Pancreatitis: A Systematic Review

INTRODUCTION: Acute pancreatitis (AP) is a leading gastrointestinal cause of hospitalization in the United States, and 20% of AP is considered idiopathic. Cannabis has now become the most commonly used illicit drug with increasing prevalence as well as legalization. Cannabis has been reported in several case reports as a possible etiology of idiopathic AP. The aim of this critical analysis is to systematically review the literature and analyze cannabis as an etiology of idiopathic and recurrent AP. Another aim is to identify any risk factors or demographics associated with this population and a correlation with the severity of AP. METHODS: Case reports with cannabis induced acute pancreatitis, as well as retrospective and prospective reviews, were identified systematically through a detailed PubMed search. For each case report, the Naranjo Adverse Drug Reaction (ADR) score as well as severity of the pancreatitis were calculated, the latter with scores such as modified CT severity index (CTSI) and revised Atlanta classification (RAC) among others. RESULTS: Eighteen case reports were included along two large studies. Fourteen of the cases (77.78%), 87.5% (Culetto et al) and 71.7% (Simons-Linares et al) of the study patients were male. Fourteen of the cases (77.78%), and 80% (Culetto et al, Simons-Linares et al) of the study patients were under the age of 35. Eight of the cases (44.44%) and 100% (Simons-Linares et al) of study patients had recurrent cannabis induced acute pancreatitis. None of the patients who were followed up with experienced recurrent pancreatitis after stopping cannabis use. In the cases, as severity worsened using both CTSI and RAC scores, the proportion of males increased from 76.92% to 100% and from 71.43% to 100% respectively. There was also an increase in proportion of patients under 35 years with increase in severity, from 69.23% to 100% and from 71.43% to 100% respectively. CONCLUSION: This study demonstrates a higher proportion of cannabis induced pancreatitis cases were males. In addition, there was an increase in the proportion of males and proportion of patients under 35 years with an increase in severity. In all followup cases, no patients had recurrent pancreatitis after stopping cannabis. Since widespread cannabis use is becoming steadily more prevalent, especially in a younger population, and may be an etiology in idiopathic acute pancreatitis, cannabis use should be documented in acute pancreatitis for future analysis and any new treatment.

S3071 Type of Pain Medication Used in Acute Pancreatitis Is Related to Diagnostic Patterns and Outcomes

INTRODUCTION: Acute Pancreatitis (AP) is a leading gastrointestinal cause for hospital admissions in the United States. Supportive care including analgesia remains a cornerstone of treatment although data is lacking regarding optimal type and dose of pain medications in AP. Given known systemic effects of opioids including known anti-inflammatory properties, we examined trends of pain medication use and their related factors in AP. METHODS: We used ICD 10 code for AP to retrieve 4043 charts of patients presenting to emergency rooms within the MedStar Health system (a nine hospital regional health management organization) from March 2015 to June 2019. We assimilated data including relevant history, laboratory markers, imaging, in-patient management and readmissions. We used Revised Atlanta criteria to define the diagnosis of AP. Pertinent to pain management, we recorded if an analgesic was prescribed, what type was used and if the patient received opioids within 24, 48 hours from admissions and at discharge. Statistical analyses were performed including T-test, ANOVA using GraphPad PRISM for Mac OS (Version 8). RESULTS: 2541 complete patient charts were used in our retrospective study. 81% of patients who met the Revised Atlanta criteria received pain medications (P < 0.0001). There was a significant difference between tertiary & non tertiary care centers in the use of pain medications, both between groups of patients who met the criteria (P = 0.0018) and those who did not (P = 0.0135) (Figure 1). Significant differences were noted for length of stay (LOS) (P = 0.0001), with opioid medications associated with a prolonged hospital course (Figure 2). Significant differences were also seen in patients with respect to ICU admission rate (P = 0.04) as well as complications of AP (P = 0.0001). CONCLUSION: Our results show differences in pain management regimens between different tiers of hospitals, location of care (e.g. ICU). Variation in these management plans was associated with differences in LOS and complications related to AP. These differences may be attributed to severity of symptoms with contribution from individual/ group clinical practices by physicians at these hospitals. By understanding these differences, we can design rational prospective trials to assess optimal pain management in AP.Figure 1.: Trends of using pain medications in tertiary & non-tertiary care centers in patients with Acute Pancreatitis who met the Revised Atlanta’s criteria.Figure 2.: Graph depicting relationship between the types of pain medications used and the length of hospital stay in patients with Acute Pancreatitis.

S0104 Diagnostic Trends and Clinical Course of Non-Gallstone Non-Alcohol-Associated Acute Pancreatitis Within a Large Health System

INTRODUCTION: Acute pancreatitis (AP) is a leading gastrointestinal cause of hospitalization in the United States. Up to two-thirds of cases are related to alcohol use (AAP) or gallstones (GAP). There is limited data on the prevalence, patient characteristics and severity of non-biliary-non-alcohol-associated AP (NNAP). We analyzed and contrasted real-world diagnostic trends and clinical outcomes of NNAP with AAP and GAP within a large multi-state health system. METHODS: ICD-10 codes for AP were used to identify adult patients presenting to emergency departments (ED) within the MedStar Health system between March 2015 and June 2019. These included ED visits and inpatient admissions. Manual review yielded 2542 charts with complete clinical information, 1212 of which have AP as defined by Revised Atlanta Classification (RAC) and documented etiologies as either GAP, AAP or NNAP. Charts with unknown etiology or idiopathic were excluded. GAP, AAP and NNAP groups were then compared for the following characteristics and outcomes: patient age, lipase, presenting symptoms, imaging received, workup of etiology, treatment variables, complication rate, readmission rate and length of stay. Statistical analysis was performed using GraphPad PRISM. RESULTS: A total of 1903 patients met RAC for AP and 690 patients were excluded due to having unknown or idiopathic etiology in documentation. The prevalence of NNAP was 10.7% and these patients were more likely to have elevated lipase (OR 1.65, P < 0.02) and AP defined by RAC (OR 2.01, P < 0.0001) compared to patients with GAP and AAP. Incidence of workup was higher in the NNAP group (OR 4.81, P < 0.0001). Drug-induced (DI, 37.6%), hypertriglyceridemia (TG, 21.7%) and anatomic abnormality (14.3%) were the 3 most common etiologies in patients with NNAP (Figure 1). Compared to GAP and AAP, the NNAP group was more likely to require ICU level of care (OR 1.88, P = 0.02), experience complications (OR 1.57, P = 0.02) and be readmitted within 30 days (OR 2.02, P = 0.0025). Length of stay was significantly longer for patients with NNAP compared to GAP and AAP (6.1 vs. 4.6 vs. 3.8 days, P = 0.0001; Figure 2). CONCLUSION: Patients with NNAP experienced higher morbidity, readmission rate and longer hospital stay. DI, TG and anatomic abnormality were the most common causes. This is an unique subset of patients who require closer monitoring and appropriate targeted therapies.Figure 1.: Etiologies of patients with acute pancreatitis other than gallstone or alcohol.Figure 2.: The average length of stay of patients with NNAP was significantly longer than that of patients with GAP and AAP (P < NNAP = non-gallstone-non-alcohol-associated acute pancreatitis GAP = gallstone-associated acute pancreatitis AAP = alcohol-associate acute pancreatitis.

S0084 Epidemiology, Etiology, and Outcomes of Acute Pancreatitis in a Predominantly Hispanic Patient Population: A Retrospective Study

INTRODUCTION: Acute pancreatitis (AP) is the most frequent gastrointestinal cause for hospital admission in the United States with over 130,000 cases per year (0.8% of all inpatient admissions). Epidemiology and outcomes data influence health care resource allocation and clinical decision-making, which are particularly important for county and safety net institutions. Nevertheless, there are limited data on AP in minority populations. This study assessed the burden of disease of AP and its associated clinical characteristics and outcomes in a large, predominantly Hispanic, county population. METHODS: Patients from the three county hospitals comprising the Los Angeles Department of Health Services (LADHS), the second largest municipal healthcare system in the country, were considered for inclusion. Using a combination of International Classification of Disease (ICD) codes and lipase values, patients admitted with AP in LADHS between January and December 2016 were identified. Electronic medical records were individually abstracted for pertinent data and to exclude patients without AP. The primary outcomes were all cause mortality and readmission. Statistical analyses were performed with student’s t and chi-squared tests, as well as general linear model and logistic regression. RESULTS: During the study period, 356 patients were admitted to a LADHS hospital with AP, representing 1.2% of all hospital admissions. Of these 356 patients, 78% of patients self-identified as Hispanic. The majority of patients were men (56.2%), with mean age of 43.9 years and body mass index of 32.4 kg/m2. and 21% reported a prior history of AP. The median hematocrit and BISAP score on admission were 40.6% and 2 (mortality <2% predicted), respectively. The most common etiologies of AP were gallstones (40.2%) and alcohol (22.8%). Median length of stay was 5 days. All-cause mortality rate at 30 days and 1 year were 3.9% and 4.7%, respectively. Notably, 19.4% of patients required re-admission within 30 days, 39% of which were for AP. CONCLUSION: Based on this study of a large, predominantly Hispanic population, there appears to be a 50% higher rate of hospital admission for AP as compared to national data (1.2% vs 0.8%). Obesity was a prominent feature, and gallstones were the most common etiology, similar to national statistics. Mortality and length of stay were comparable to those in the published literature, though nearly 20% of patients experienced re-admission, a rate higher than expected based on national data (11.9%–16.2%).

Vomiting in Pediatric Patients.

This classic team-based learning activity is specifically designed for emergency medicine bound medical students and junior residents; however, general pediatrics residents and general medical students may also benefit from this activity. Senior residents and fellows felt that the cases were too basic for them but enjoyed acting as facilitators. Vomiting is a common chief complaint in pediatric patients seen in the Emergency Department. 1-3 Presentations include acute, chronic, and cyclic vomiting, with underlying etiologies such as toxin injection, emotional disturbances, and movement disequilibrium. 1 By understanding these various pathways, it is helpful for physicians to distinguish between gastrointestinal and non-gastrointestinal causes of vomiting. 1 Most cases of vomiting in the pediatric population are self-limiting and require only supportive treatment; however, physicians must be able to recognize red flags associated with vomiting that warrant further evaluation. 1,3 This task may be challenging for medical students and residents in emergency medicine and those with infrequent exposure to pediatric patients. Therefore, this team-based learning activity was developed to help junior learners in differentiating non-emergent and emergent cases of pediatric vomiting. This activity aids learners in formulating a differential based on age, history, and characteristics of vomiting. We also review specific causes of pediatric vomiting that physicians cannot miss including intussusception, pyloric stenosis, malrotation, intestinal atresia, and intracranial pathology. By the end of this TBL session, learners should be able to:Identify red flag symptoms that should prompt referral for urgent intervention by GI or surgical specialists.Recognize how chronicity of the vomiting can alter the differential diagnosisDescribe the varying pathways that can cause nausea and vomiting.Determine the necessity of imaging tests to confirm and possibly treat various causes of vomiting.Interpret imaging studies associated with specific causes of vomiting. Classic Team Based Learning (cTBL). Learners and instructors provided verbal feedback after the session in a large group format. Learners were specifically asked if they felt the session was education, relevant, high-yield and level appropriate. One instructor provided written feedback to the cases as well. Overall learners and instructors found the session to be engaging, informative and educational. Learners felt that the session was level appropriate for medical students and junior residents. As a result of feedback from the session, several of the iRAT/gRAT questions were adjusted and the group application cases were re-written and implemented. Overall, the educational content and delivery was effective. This session was presented to a group of emergency medicine students, interns and residents. Learners were divided into smaller groups, and each group had a variety of level of learners, including pediatric emergency medicine fellows, present. The fellows, while not necessary to the delivery of the TBL, were extremely helpful in aiding the residents during the session. The final debriefing and answer review were essential to ensure that learners met all educational objectives and fully understood the materials. Pediatric vomiting, intussusception, pyloric stenosis, intestinal atresia, malrotation, gastroesophageal reflux disease, superior mesenteric artery (SMA) syndrome, hyperemesis.

Trends in Costs and Risk Factors of 30-Day Readmissions for Transcatheter Aortic Valve Implantation

As transcatheter aortic valve implantation (TAVI) continues its rapid growth as a treatment approach for aortic stenosis, costs associated with TAVI, and its burden to healthcare systems will assume greater importance. Patients undergoing TAVI between January 2012 and November 2017 in the Nationwide Readmission Database were identified. Trends in cause-specific readmissions were assessed using Poisson regression. Thirty-day TAVI cost burden (cost of index TAVI hospitalization plus total 30-day readmissions cost) was adjusted to 2017 U.S. dollars and trended over year from 2012 to 2017. Overall, 47,255 TAVI were included and 30-day readmissions declined from 20% to 12% (p <0.0001). Most common causes of readmission (heart failure, infection/sepsis, gastrointestinal causes, and respiratory) declined as well, except arrhythmia/heart block which increased (1.0% to 1.4%, p <0.0001). Cost of TAVI hospitalization ($52,024 to $44,110, p <0.0001) and 30-day cost burden ($54,122 to $45,252, p <0.0001) declined. Whereas costs of an average readmission did not change ($9,734 to $10,068, p = 0.06), cost burden of readmissions (per every TAVI performed) declined ($4,061 to $1,883, p <0.0001), including reductions in each of the top 5 causes except arrhythmia/heart block ($171 to $263, p = 0.04). Index TAVI hospitalizations complicated by acute kidney injury, length of stay ≥5 days, low hospital procedural volume, and skilled nursing facility discharge were associated with increased odds of 30-day readmissions. In conclusion, the costs of index hospitalizations and 30-day cost burden for TAVI in the U.S. significantly declined from 2012 to 2017. However, readmissions due to arrhythmia/heart block and their associated costs increased. Continued strategies to prevent readmissions, especially those for conduction disturbances, are crucial in the efforts to optimize outcomes and costs with the ongoing expansion of TAVI.

Clinical Outcomes of Acute Pancreatitis in Patients With Coronavirus Disease 2019

Acute pancreatitis (AP) is one of the most common gastrointestinal causes of hospitalization, with a reported annual incidence ranging from 4.9 to 35 per 100,000 individuals in the United States.1 The diagnosis is established with at least 2 of the following criteria: abdominal pain consistent with AP; elevation in serum amylase and/or lipase greater than 3 times the upper limit of normal; and suggestive findings of AP in cross-sectional abdominal imaging. It may range from a mild acute interstitial pancreatitis to a more severe necrotizing pancreatitis with substantial associated morbidity and mortality.

Risk factors for critical care admission in acute pancreatitis

Background: Acute pancreatitis is one of the most common gastrointestinal causes of emergency hospital admissions. One in four patients will develop severe acute pancreatitis requiring critical care admission (CCA) frequently for a prolonged period leading to a considerable burden on health care resources. The main objective of this study was to analyse factors that may predict the need for CCA in patients diagnosed with acute pancreatitis.Methods: In this study, authors analyzed the health records of all patients (154 patients) admitted to Salmaniya Medical Complex (SMC) with the diagnosis of acute pancreatitis.Results: A total of 10 (6.5%) and 24 (15.6%) patients were admitted to the intensive care unit (ICU) and surgical high dependency unit (SHDU) respectively. There were no differences between different admission locations when it came to age, gender, comorbidities, frequency of attacks and number of computed tomography (CT) scans. After adjusting for all covariates in a multivariate binary logistic regression, the following factors were found to predict CCA: Nationality OR (95% CI): 7.64 (1.14-51.29), dyslipidaemia etiology OR (95% CI): 0.025 (0.001-0.755) and CT severity index - CTSI (95% CI): 1.463 (1.014-2.111). CCA was associated with higher length of stay (6 days vs. 9 day) OR (95% CI): 0.79 (0.015-0.413) and higher in-hospital mortality (1.7% versus 17.6%) OR (95% CI): 5.58 (3.38-7.78).Conclusions: This study results indicate that nationality, dyslipidaemia etiology and CTSI were associated with higher CCA. ICU admission was associated with longer length of hospital stay and higher mortality rates.

Abdominal Pain in Primary Care

Abdominal pain is among the top 20 - reasons for primary care office visits. Causes of abdominal pain range from self-limiting to life-threatening. Complaints of abdominal pain present providers with a number of potential differential diagnoses and options for evaluation and management because the source of abdominal pain may include respiratory, gastrointestinal, genitourinary, gynecologic, or musculoskeletal causes. Because the physical examination may be normal despite the underlying pathology, it is important for providers to carefully review the history of the complaint. This case study presents a middle-aged man presenting with abdominal pain for several months that warranted a comprehensive approach to differential diagnosis.

Investigating Associated Factors Between Admission to Pediatric Emergency and Referral to Intensive Care Unit: A Retrospective Cohort Study

Aim: We aimed to evaluate the patients who were admitted to Pediatric Emergency Department regarding the ratio of referral to Intensive Care Unit (ICU), and the relationship between the time of waiting in Emergency Department and the length of stay in Intensive Care Unit between January 2013 and December 2018. Methods: The patients’ records who were admitted to our Pediatric Emergency Department between January 2013 and December 2018 were evaluated retrospectively. The referrals to Neonatal and Pediatric ICU were evaluated. Due to the absence of an Intensive Care Unit in our hospital, we compared the duration of referral to ICU and length of stay in ICU. Results: The total number of patients who were admitted to Emergency Service was 673023, the number of the patients referred to ICU was 1327, 302 of these patients were referred to the Pediatric ICU (PICU), and the rest of them were referred to Neonatal ICU (NICU). While 47.35% of the patients who were referred to the PICU presented with respiratory tract diseases, 19.86% had neurological causes, 13.9% were intoxications, and 7.8% were gastrointestinal causes. 28.78% of the patients who were referred to the PICU had an accompanying chronic disease at the time of admission. Mean duration of referral to the PICU was 8.4 ± 6.3 hours. The length of stay of in PICU in 2017 and 2018 was investigated by asking on the phone (n = 122), and the mean length of stay of the patients in the PICU was 5.18 ± 2.1 days. There was no statistically significant correlation between the duration of referral to the ICU and the length of stay in the PICU (p; 0.089), whereas in 54 patients who presented to the emergency department due to respiratory distress and had no underlying chronic disease, there was a statistically significant correlation between the duration of referral to ICU and the length of stay in ICU (p: 0.012). Conclusion: The number of Pediatric Emergency Department admissions is very high in our country and most of these patients present with respiratory complaints. 0.19% of the patients who were admitted to the emergency service were in need of intensive care. Patients who had no underlying disease and who needed intensive care for respiratory distress were shown to have a shorter length of stay, and their referrals were faster. These patients should be referred to intensive care units without delay in the emergency service. As a conclusion, there is a need for more PICU in our country.

Ever-increasing diversity of drug-induced pancreatitis.

With over 100000 hospital admissions per annum, acute pancreatitis remains the leading gastrointestinal cause of hospitalization in the United States and has far-reaching impact well beyond. It has become increasingly recognized that drug-induced pancreatitis (DIP), despite accounting for less than 3% of all cases, represents an important and growing though often inconspicuous cause of acute pancreatitis. Nevertheless, knowledge of DIP is often curtailed by the limited availability of evidence needed to implicate given agents, especially for non-prescription medications. Indeed, the majority of available data is derived from case reports, case series, or case control studies. Furthermore, the mechanism of injury and causality for many of these drugs remain elusive as a definitive correlation is generally not established (< 10% of cases). Several classification systems have been proposed, but no single system has been widely adopted, and periodic updates are required in light of ongoing pharmacologic expansion. Moreover, infrequently prescribed medications or those available over-the-counter (including herbal and other alternative remedies) are often overlooked as a potential culprit of acute pancreatitis. Herein, we review the ever-increasing diversity of DIP and the potential mechanisms of injury with the goal of raising awareness regarding the nature and magnitude of this entity. We believe this manuscript will aid in increasing both primary and secondary prevention of DIP, thus ultimately facilitating more expedient diagnosis and a decrease in DIP-related morbidity.

962 AN NON-INFERIORITY RANDOMIZED CONTROLLED TRIAL TO COMPARE HEMOSTATIC POWDER TC325 AND STANDARD THERAPY IN BLEEDING FROM NON-VARICEAL UPPER GASTROINTESTINAL CAUSES

Observational studies suggest that endoscopic application of TC-325, a hemostatic powder can control active bleeding from non-variceal upper gastrointestinal causes. TC-325, as a monotherapy, has not been compared to standard treatment in a randomized controlled trial with adequate sample size. In this multicenter non-inferiority randomized controlled trial, we assigned patients actively bleeding from a non-variceal cause during esophago-gastro-duodenoscopy to receive either spraying with TC-325 or standard treatment. They were followed up for 30 days for further bleeding. A total of 224 patients were randomized (TC-325 N=111, standard treatment N=113). These include 130 gastroduodenal ulcers (58%), 32 tumors (14.3%) and 62 other causes (27.7%). With intention-to-treat analysis, the re-bleeding free probability over 30 days was 89.8% in the TC-325 group and 81.1% in the standard treatment group (difference in proportions, 95%CI; 8.7%, -1.3%, 18,7%). There were fewer failures in the control of bleeding during index endoscopy with the use of TC-325 (3 vs. 11, OR, 95%CI, 3.88, 1.05-14.32). Recurrent bleeding was similar between groups (9 vs. 10). There were 14 deaths to each group (P=0.96). Further interventions were similar (endoscopic treatment; 8 vs. 13, angiography 1 vs. 3) In patients with bleeding gastroduodenal ulcers, further bleeds occurred in 8 of 65, 12.5% in the TC-325 group and 10 of 65, 15.4% in the standard treatment group. The hemostatic powder, TC-325, is not inferior to standard treatment in the control of bleeding from non-variceal upper gastrointestinal causes. [Funded by the University Grant Council, the Hong Kong SAR Government]

Gastrointestinal Disorders and the Nervous System.

This article describes the neurologic sequelae of various nutritional micronutrient deficiencies, celiac disease, inflammatory bowel disease, and liver disease. Where relevant, appropriate treatments for these conditions are also discussed. The developing field of the microbiome and nervous system interaction is also outlined. Pathology in the gastrointestinal system can affect the nervous system when it causes micronutrient deficiency, when immune responses created by the gastrointestinal system affect the nervous system, when toxins caused by gastrointestinal organ failure harm the nervous system, and when treatments aimed at a gastrointestinal medical condition cause damage to the nervous system as a side effect. This article addresses familiar concepts and new developments in the treatment and understanding of diseases that affect the gut and nervous system simultaneously.

Animal models to study the role of pulmonary intravascular macrophages in spontaneous and induced acute pancreatitis.

Acute necrotizing pancreatitis (ANP) is a common gastrointestinal cause of emergency admissions in dogs and humans and can lead to a systemic inflammatory response syndrome resulting in multiple organ dysfunction syndrome. Among the various complications associated with ANP, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) is a major contributor leading to high mortality rates associated with severe acute pancreatitis (AP) in human patients. The incidence of ALI/ARDS in ANP dogs is not well-characterized in spontaneous AP and there are no models to study it in rodent models. Most of the data related to AP comes from rodent models of AP, which may not always represent the true mechanisms occurring in the lungs of dogs or humans with ANP. Therefore, this manuscript provides a review of current and potential models to study the role of pulmonary intravascular macrophages (PIMs) in acute pancreatitis. Recently, we characterized lung inflammation in clinical cases of AP in dogs and found significant recruitment of PIMs which have been credited as pro-inflammatory cells in species such as cattle, horse, pigs, and sheep that normally have them. Considering the pro-inflammatory roles of constitutive or induced PIMs, we investigated whether a well-established mouse model of ANP has induced PIMs. We found induced PIMs in L-arginine-induced ANP in mouse and that MCP-1 is important in PIM induction in this model. Taken together, now we summarize information on spontaneous ANP in dog and a mouse model of induced ANP to study mechanisms of lung dysfunction and the role of PIMs during ANP.

Two cases of agenesis of the dorsal pancreas and a review of the literature

BackgroundAgenesis of the dorsal pancreas (ADP) is a very rare disease with no specific symptoms, and the pathogenesis is not clear. Some patients will be accompanied by other diseases, such as pancreatic tumor or pancreatitis. But most cases are very atypical and difficult to distinguish. Some syndromes of pancreatic exocrine insufficiency are common in patients with ADP. Here, we report two cases of ADP and summarize the clinical features, diagnosis, and treatment of ADP.Case presentationCase A is a 65-year-old Chinese woman who presented with abdominal pain accompanied by nausea, bloating and acid reflux. The enhanced abdominal CT scan found nothing meaningful except the absence of the body and tail of the pancreas. The diagnosis was considered as gastrointestinal dysfunction cause by exocrine pancreatic insufficiency and recovered after symptomatic treatment. Case B is a 61-year-old Chinese woman who presented with abdominal pain accompanied by fever, vomiting and bloating. The abdominal CT showed multiple stones in the gallbladder, and the body and tail of the patient’s pancreas were absent. She was diagnosed with cholelithiasis and recovered after laparoscopic cholecystectomy.ConclusionAgenesis of the dorsal pancreas (ADP) is a rare congenital disease with an unclear pathogenesis that presents multiple symptoms. It should be considered when the patients have non-specific, persistent and unexplained symptoms such as bloating or uncontrolled blood sugar. Imaging examination is helpful for diagnosis. And it does not require surgical intervention unless it accompanies other diseases, EPI need to be considered when the non-specific gastrointestinal symptoms appear.

Protocolo diagnóstico del dolor en fosa ilíaca izquierda

Anamnesis and clinical examinations are essential for the proper diagnosis of left iliac fossa pain. Gastrointestinal causes are the most common, especially acute diverticulitis. The use of simple radiology is being relegated to the initial assessment of obstructive processes and to suspected hollow viscus perforation. In the hands of experts, abdomen ultrasonography can provide significant information; however, computed tomography is the reference diagnostic test, with a sensitivity and specificity of 90-100% for diagnosing acute diverticulitis and its complications.

Esophageal granular cell tumour: A case report and review of literature

Granular cell tumours (GCTs) are uncommon tumours of neurogenic origin, thought to originate from Schwann cells. They are most commonly seen in skin, subcutaneous tissues and oral cavity, and are rarely found in gastrointestinal tract (8-10% of cases). Esophageal involvement is seen only in 2% cases. They are slow growing in nature, usually are asymptomatic and detected incidentally during investigation for other gastrointestinal causes. Because of the rarity of GCTs in clinical practice, proper workup and management are essential to avoid the potential morbidity and mortality. Endoscopic submucosal resection is the primary treatment which is done in most cases. Herein, we report a case of 85 year old female who was worked up for dyspepsia and dysphagia and was diagnosed as a case of Granular cell tumour on histopathology.

Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea.

Many anti-nausea treatments are available for chronic gastrointestinal syndromes, but data on efficacy and comparative effectiveness are sparse. To conduct a sectional survey study of patients with chronic nausea to assess comparative effectiveness of commonly used anti-nausea treatments. Outpatients at a single center presenting for gastroenterology evaluation were asked to rate anti-nausea efficacy on a scale of 0 (no efficacy) to 5 (very effective) of 29 commonly used anti-nausea treatments and provide other information about their symptoms. Additional information was collected from the patients' chart. The primary outcome was to determine which treatments were better or worse than average using a t test. The secondary outcome was to assess differential response by individual patient characteristics using multiple linear regression. One hundred and fifty-three patients completed the survey. The mean efficacy score of all anti-nausea treatments evaluated was 1.73. After adjustment, three treatments had scores statically higher than the mean, including marijuana (2.75, p < 0.0001), ondansetron (2.64, p < 0.0001), and promethazine (2.46, p < 0.0001). Several treatments, including many neuromodulators, complementary and alternative treatments, erythromycin, and diphenhydramine had scores statistically below average. Patients with more severe nausea responded better to marijuana (p = 0.036) and diphenhydramine (p < 0.001) and less so to metoclopramide (p = 0.020). There was otherwise no significant differential response by age, gender, nausea localization, underlying gastrointestinal cause of nausea, and GCSI. When treating nausea in patients with chronic gastrointestinal syndromes, clinicians may consider trying higher performing treatments first, and forgoing lower performing treatments. Further prospective research is needed, particularly with respect to highly effective treatments.