History Of Peptic Ulcer Disease Research Articles

S1871 A Case of Ketamine-Induced Cholangiopathy: A Novel Diagnosis Associated With Chronic Recreational Ketamine Use

Introduction: Ketamine, an analgesic commonly used for procedural sedation, has become a popular agent for recreational use among young adults. The diagnosis of ketamine-induced cholangiopathy is uncommon. We report a case of a young adult with clinical and radiological features consistent with cholangiopathy induced by chronic ketamine use. Case Description/Methods: A 19-year-old female with past medical history of peptic ulcer disease presented to emergency department (ED) with one year history of severe epigastric abdominal pain. On further questioning, patient reported chronic recreational ketamine use. Physical exam revealed mild epigastric and RUQ tenderness. Liver function test demonstrated elevated alkaline phosphatase of 174 U/L, AST of 237 U/L and ALT of 224 U/L. All other hematology and chemistry results were within normal limits. RUQ ultrasound showed minimally dilated common bile duct (CBD). An MRCP was obtained, showing mild-to-moderate dilatation of intra-/extra-hepatic bile ducts and dilated cystic duct (CD) without obvious intraductal calculi (Figure A). Endoscopic ultrasonography (EUS) was performed showing dilatation of CBD, minimal dilatation of common hepatic duct, and minimal dilatation of CD, once again without obvious calculi (Figure B). These imaging findings are compatible with ketamine-induced cholangiopathy. After being admitted for 6 days, the patient demonstrated significant improvement in her abdominal pain, with gradually improving liver test values. She was discharged with the recommendation to abstain from ketamine use and outpatient gastroenterology follow-up. Discussion: Chronic exposure to ketamine has been known to cause urologic injury, referred to as ketamine-induced ulcerative cystitis. In comparison to the urologic complications of chronic ketamine use, its effects on the biliary system have been less commonly reported. Existing reports have mostly come from regions of Asia where recreational ketamine use is more prevalent. The nonspecific gastrointestinal symptoms that are typically reported by patients with ketamine-induced cholangiopathy may make the diagnosis more challenging to recognize. Due to increasing recreational ketamine use among young adults in recent years, cases of ketamine-induced cholangiopathy are likely to rise. Therefore, a better understanding of the clinical and radiological features of this condition are needed to allow for prompt recognition of ketamine-induced cholangiopathy.Figure 1.: A. MRCP image showing mild-to-moderate dilatation of the intrahepatic and extrahepatic bile ducts and dilatation of the cystic duct. There are no visible stones or evidence of other etiology for the dilatation. B. EUS image displaying CBD dilatation measuring up to 10.6 mm in the head region, with smooth tapering to the ampulla where it measured 2.7 mm.

The relationship between helicobacter pylori infection and nodular antral gastritis in pediatric patients

Helicobacter pylori (H. pylori) is a spiral-shaped gram-negative bacterium that colonizes the gastric mucosa. It is a common infectious agent in children. In this study, we aim to evaluate the demographic data, and the clinical and histopathological findings of pediatric patients that underwent upper gastrointestinal endoscopy (UGSE) in our clinic. Between July 2017 and February 2019, 636 patients applied to the Selcuk University Faculty of Medicine, Pediatric Gastroenterology outpatient clinic with complaints of epigastric abdominal pain and/or dyspeptic complaints. Patients who underwent upper gastrointestinal endoscopy were evaluated retrospectively. Data on age, gender, family history of peptic ulcer disease, and family history of H. pylori were recorded. Endoscopic and histopathological findings were collected from medical records. 235 (36.9%) of the patients participating in the study were male, and 401 (63.1%) were female. H. pylori infection was detected in 277 (43.6%) patients as a result of histopathological examination of H. Pylori, urea breath tests and H. Pylori antigen tests in the stools of patients are included in the study. Nodular antral gastritis was detected in 282 (44.3%) of our patients endoscopically. H. pylori was detected in 83.7% (n: 236) of the 282 patients with nodular antral gastritis. Nodular antral gastritis was observed to be significantly higher in H. pylori-positive patients than in H. pylori-negative cases (odds ratio (OR), 39.16; 95% confidence interval (CI), 24.88-61.64; p: <0.001). Nodular antral gastritis is caused by chronic H. pylori infection. It is predicted that early detection of H. pylori infection in children is important and may decrease complications later in life. Our study shows that all the markers evaluated are very good predictors of H. pylori infection. Positive significant association was found between the prevalence of H. pylori infection and nodular antral gastritis.

Drug-induced duodenal perforation in the paediatric patient with thalassemia major, an unreported side effect of iron- chelating agent- a case report

Duodenal ulcer disease is uncommon in paediatric age group. Its perforation is even rarer. However, it should be kept in mind when examining children with acute abdomen especially if there are signs of shock or possibility of upper gastrointestinal bleed. We report a case of a 6 years old female child, a known case of thalassemia major and taking oral Deferasirox since two years of age. She had atypical presentation as there was no previous history of peptic ulcer disease and she only suffered epigastric pain and vomiting for a week but due to lack of proper diagnosis at a local clinic developed duodenal ulcer perforation, which was ultimately diagnosed at a tertiary care hospital and managed with Graham Patch Closure.

Clinical outcomes of fast-track total knee arthroplasty for patients aged >80 years.

Because of the ageing population in Hong Kong, there is an increasing incidence of total knee arthroplasties (TKA) conducted in patients aged >80 years. This retrospective case-control study enrolled all patients who were aged >80 years and underwent fast-track primary TKA between 2011 and 2015. Their outcomes were compared with the outcomes of a matched control group of younger patients who underwent fast-track TKA in the same period. In total, 220 patients were included in this study with a follow-up period of at least 2 years (mean=3.2 years; range, 2-5 years); 112 (51%) were octogenarians and 108 (49%) were non-octogenarians. Greater improvement in Knee Society Score was found in the octogenarian group at 1 year after surgery (46 ± 19 vs 39 ± 16, P=0.018). The incidence of complications was higher in the octogenarian group (15.2% vs 4.6%, P=0.009). There were no significant differences in the incidence of major complications, the rate of intensive care unit admission, or the 1-year mortality rate between the two groups. After adjustment for confounding factors, Charlson Comorbidity Index >5, history of major cerebrovascular accident, and history of peptic ulcer disease were predictive of complications after fast-track TKA (P=0.039, P=0.016, and P=0.007, respectively); octogenarian status was not predictive of complications. Octogenarians had greater improvement in Knee Society Score at 1 year after fast-track TKA, compared with non-octogenarians, but there were no significant differences in the incidences of mortality or major complications.

Appendicular Mucocele: About a Case Observed in Bamako

It is a globally rare condition that can present in a variety of clinical syndromes or can occur as an incidental surgical finding. It poses the double problem of its possible malignancy and the risk of gelatinous disease of the peritoneum in the event of perforation. We report a case treated in the “A” Surgery Department of the Point-G University Hospital Center (CHU) in Mali in 2022. It was a 62-year-old woman, a housewife who presented to the department. “A” surgery at the Point G University Hospital Center for pain in the iliac fossa. As a medical history, she was hypertensive on atenolol and a known diabetic on diet and metformin-based treatment, as well as symptomatic sickle cell disease (AS) and an undocumented history of peptic ulcer disease. The biological assessments revealed hyperleukocyte with granulocyte predominance. C-reactive protein was positive at 32 mg/l. Ultrasound revealed a 27 mm cystic dilation of the appendicitis in favor of appendicular mucocele. We proceeded with the appendix. The surgical specimen containing gelatinous fluid was removed and histological examination was in favor of a mucinous adenocarcinoma of the appendix.

Rethinking the history of peptic ulcer disease and its relevance for network epistemology

The history of the research on peptic ulcer disease (PUD) is characterized by a premature abandonment of the bacterial hypothesis, which subsequently had its comeback, leading to the discovery of Helicobacter pylori—the major cause of the disease. In this paper we examine the received view on this case, according to which the primary reason for the abandonment of the bacterial hypothesis in the mid-twentieth century was a large-scale study by a prominent gastroenterologist Palmer, which suggested no bacteria could be found in the human stomach. To this end, we employ the method of digital textual analysis and study the literature on the etiology of PUD published in the decade prior to Palmer’s article. Our findings suggest that the bacterial hypothesis had already been abandoned before the publication of Palmer’s paper, which challenges the widely held view that his study played a crucial role in the development of this episode. In view of this result, we argue that the PUD case does not illustrate harmful effects of a high degree of information flow, as it has frequently been claimed in the literature on network epistemology. Moreover, we argue that alternative examples of harmful effects of a high degree of information flow may be hard to find in the history of science.

Non-steroidal anti-inflammatory drugs in the elderly. Agreement with safe prescription recommendations according to cardiovascular and gastrointestinal risks

Introduction/objectiveNon-Steroidal Anti-Inflammatory Drugs are the cornerstone in the treatment of acute and chronic pain due to inflammation in musculoskeletal conditions. Even though adverse side-effects are associated, their use is common in the elderly patients. Our aim is to determine the prescription trend of NSAIDs, the evaluation for gastrointestinal (GI) and cardiovascular (CV) risks, and the level of agreement with prescription guidelines. MethodsWe conducted an observation and descriptive study in a general hospital geriatrics consultation. ResultsFrom the 231 patients only 59 patients had a NSAIDs prescription. The most frequently prescribed was Acetaminophen, in 29(49.1%) patients, Celecoxib was prescribed in 11(18.6%) patients, Piroxicam in 5(8.4%) patients, Acetaminophen plus Celecoxib plus Omeprazole in 4 (6.7%), Acetaminophen plus Piroxicam in 2 (0.3%) patients, and Acetaminophen plus Diclofenac plus Celecoxib in 1 patient (1.6%). In the Framingham risk classification there were 160/231 (69.3%) patients in Very High Risk and 71/231 (30.7%) patients in High Risk. There were no patients in Low Risk. GI Risk: 79 patients (34.1%) had a peptic ulcer disease history. There were 55/231 (23.8%) in the High GI Risk classification, 102/231 (44.1%) in Intermediate GI Risk and 74/231 (32%) in the Low Risk. The level of agreement between the prescribed versus recommended NSAIDs according the CV and GI risks was measured with a contingence table and the kappa statistic of 0.37 p=0.001. ConclusionThere is a low level of agreement between prescribed and recommended NSAID in elderly population.

GASTROPROTECTION IN PATIENTS ON ANTITHROMBOTIC THERAPY: A QUALITY IMPROVEMENT STUDY

GASTROPROTECTION IN PATIENTS ON ANTITHROMBOTIC THERAPY: A QUALITY IMPROVEMENT STUDY

An incidental concurrence causing gastric outlet obstruction

Phytobezoar which is described as an undigested or incompletely digested food. It is an odd cause of gastric outlet obstruction (GOO). The aim of this study is to present and discuss a case of GOO caused by cicatrised duodenal ulcer with a phytobezoar. 71-year-old male, presented with abdominal pain and vomiting (non-bilious) since 3days with peptic ulcer disease for 4 years. Examination and investigations revealed a bezoar requiring emergency surgical intervention. An exploratory laparotomy was conducted. A bezoar was palpated in the stomach and removed through posterior gastrotomy. Vagotomy with Posterior Gastrojejunostomy was done as drainage procedure for cicatrised Duodenal ulcer. GOO caused by phytobezoar can co-exist in patients with previous history of peptic ulcer disease and cicatrised duodenal ulcer. Urgent laparotomy may be indicated.

Abstract 628: Ophtalmological manifestations of acute leukemias at university hospital center Yalgado Ouedrago

Abstract Acute leukaemias constitute 9.04% of malignant hemopathies (Burkina Faso, 2015). Their manifestations are mainly haematological, however other less frequent attacks are possible. We report here for the first time in Burkina Faso, three cases of ocular localizations in young adults. Observation 1: S.I, male, 17-year-old patient, student living in Ouagadougou with a history of recurrent sore throat and ear infections. He was admitted for asthenia and pallor in the context of polytransfusion. The myelogram showed a rich marrow marked by the presence of 15% blast cells. Ophthalmologic examination reported visual acuity of 1/10, stage II proptosis and lower chemosis, and massive retinal and macular hemorrhage. Chemotherapy could not be performed. he died a week later. Observation 2: TB, male, 23-year-old patient, welder, suffering from acute lymphoblastic leukemia diagnosed in front of a severe recurrent anemia and confirmed by a myelogram, showing a rich marrow infiltrated by lymphoblasts representing 47% of the medullary cells. The ophthalmologic examination revealed conjunctival-palpebral infiltration by acute leukemia with myogenic ptosis. The evolution was marked by an improvement in symptoms after a cure according to the Vincristine-Prednisone protocol and he was discharged from hospital weeks later. He was subsequently lost to follow-up. Observation 3: KK male, 25-year-old patient, artisanal miner residing in Ouagadougou with a history of peptic ulcer disease, carrier of acute myeloid leukemia (AML) confirmed by a myelogram. The ophthalmologic examination concludes with a bilateral inflammatory orthopathy with an exposure keratitis on site of AML. He received transfusion of concentrates of red blood cells and platelets, as well as corticosteroid therapy for 04 days. The following was marked by a rapid worsening of the symptoms and the death of the patient a week later. Conclusion: The extra-haematological manifestations of acute leukemia are rare. They are associated with a pejorative prognosis. This series of 03 cases that we report is the first described to date in our context. Citation Format: Kalo Roland Millogo, Delphine Kabore, Solo Traore. Ophtalmological manifestations of acute leukemias at university hospital center Yalgado Ouedrago [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 628.

The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty

BackgroundAnticoagulation after total joint arthroplasty has been demonstrated to reduce venous thromboembolism. However, anticoagulation can lead to adverse bleeding events. The purpose of this study was to assess if an association exists between specific anticoagulation modalities, such as clopidogrel, and postoperative gastrointestinal (GI) bleeding. MethodsA prospective cohort of Medicare patients undergoing total joint arthroplasty from 2017 to 2019 (3535 patients) was retrospectively reviewed. The baseline characteristics and anticoagulation methods were compared between the “GI bleed” cohort and the “non-GI bleed cohort.” Independent t-tests were conducted for continuous variables, while chi-squared analysis was conducted for dichotomous variables. ResultsThirteen patients (0.42%) sustained a postoperative complication of a GI bleed. The mean age for patients sustaining a GI bleed was 69.23 years compared with 72.30 years for the non-GI bleed cohort (P = .11). Six patients who sustained a GI bleed (46%) were on an anticoagulation therapy other than aspirin, and this trended toward significance (P = .09). Five patients who sustained a GI bleed (38%) were on clopidogrel (P < .01). Seven percent of patients on clopidogrel sustained a postoperative GI bleed (P < .01). None of the patients who sustained a postoperative GI bleed had a history of peptic ulcer disease. ConclusionPatients on clopidogrel in the acute perioperative period demonstrated a strong association with the complication of postoperative GI bleeding. Arthroplasty surgeons should be aware of this association to educate and monitor patients on clopidogrel therapy and to work as part of interdisciplinary teams to assess the risks vs benefits of perioperative clopidogrel.

Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: A retrospective cohort.

Immunosuppression and comorbidities might place solid organ transplant (SOT) recipients at higher risk from COVID-19, as suggested by recent case series. We compared 45 SOT vs. 2427 non-SOT patients who were admitted with COVID-19 to our health-care system (March 1, 2020 - August 21, 2020), evaluating hospital length-of-stay and inpatient mortality using competing-risks regression. We compared trajectories of WHO COVID-19 severity scale using mixed-effects ordinal logistic regression, adjusting for severity score at admission. SOT and non-SOT patients had comparable age, sex, and race, but SOT recipients were more likely to have diabetes (60% vs. 34%, p<.001), hypertension (69% vs. 44%, p=.001), HIV (7% vs. 1.4%, p=.024), and peripheral vascular disorders (19% vs. 8%, p=.018). There were no statistically significant differences between SOT and non-SOT in maximum illness severity score (p=.13), length-of-stay (sHR: 0.9 1.11.4 , p=.5), or mortality (sHR: 0.1 0.41.6 , p=.19), although the severity score on admission was slightly lower for SOT (median [IQR] 3 [3, 4]) than for non-SOT (median [IQR] 4 [3-4]) (p=.042) Despite a higher risk profile, SOT recipients had a faster decline in disease severity over time (OR = 0.76 0.810.86 , p<.001) compared with non-SOT patients. These findings have implications for transplant decision-making during the COVID-19 pandemic, and insights about the impact of SARS-CoV-2 on immunosuppressed patients.

Undernutrition and Associated Factors among Pregnant Women in Kacha Birra District, Southern Ethiopia

Background: Worldwide, malnutrition is a public health concern with noteworthy consequence especially in pregnant women. Maternal undernutrition may dispose mothers to poor wellbeing including infection, preeclampsia/ eclampsia, and adverse pregnancy outcomes such as preterm birth and intrauterine growth retardation. Pregnant women are exposed to nutritional deficiency because of increased metabolic needs as a result the usually end up in undernutrition. There is lack of updated information in the study area regarding nutritional status and factors among pregnant women. Objective: To assess undernutrition and associated factors among pregnant womenin Kacha Birra district, Southern Ethiopia in 2019. Methods: An institution-based cross-sectional study was conducted among 344 pregnant women attending antenatal care in public health facilities from February 21-March 20, 2019. A systematic sampling technique was employed. Data were collected using a structured questionnaire and analyzed by a statistical package for social science version 22 software. Both bivariate and multivariate logistic regression analyses were undergone to identify factors associated with the nutritional status of pregnant women. Result: Among 344 pregnant women who participated in the study, 52.6% were undernourished. On the multivariable analysis; having a history of peptic ulcer disease [(AOR=1.97 (1.23-3.17)], husband’s educational status with Illiterate to elementary [AOR=0.589 (0.369-0.940), medium dietary diversity score [AOR=2.931 (1.106-7.766)], high dietary diversity score [AOR=2.485 (0.915-6.747)], intestinal parasite infection [AOR=1.725 (1.086-2.742)], second trimester gestational age [AOR=0.338 (0.159-0.718)] had shown statistically significant association with maternal undernutrition. Conclusion: Over half of pregnant women were in undernurition. Multisectorial collaboration and coordination among related sectors and strengthening programs targeted on adult’s educational status, improved drinking water and sanitation against pregnant women’s, counseling on Antenatal clinic and prevention and treatment of chronic disease during pregnancy.

A Study of Proton Pump Inhibitors and Other Risk Factors in Warfarin-Associated Gastrointestinal Bleeding.

BackgroundWarfarin users are at increased risk for gastrointestinal bleeding (GIB). History of GIB, stroke, cardiovascular or chronic kidney disease, age greater than 65 years, and drug interaction with proton pump inhibitors (PPI) have previously been identified as risk factors for GIB in warfarin users. We hypothesized that concomitant use of warfarin and PPI would increase the incidence of GIB relative to warfarin use alone.MethodsWe did a retrospective review of medical records of 626 patients taking warfarin for at least two weeks. Parameters including age, concomitant medication use (non-steroidal anti-inflammatory drugs (NSAID), aspirin, selective serotonin reuptake inhibitors (SSRIs), PPI, and anti-platelet drug), history of GIB, chronic renal failure (CRF), and peptic ulcer disease (PUD) prior to warfarin use were analyzed.ResultsVariables that increase the likelihood of bleeding in warfarin users included aspirin, PPI, history of PUD, history of previous GIB, CRF, and elevated prothrombin time (PT)/international normalized ratio (INR) values. Concomitant antiplatelet use showed a slight increase in GIB but this was not statistically significant (p=0.082). NSAID use and SSRI use were not associated with a higher risk of GIB among warfarin users. Patients who are on PPI and warfarin simultaneously are more likely to be on acetylsalicylic acid (ASA) or have a history of PUD, GIB, or CRF, all of which are associated with increased incidences of GIB.ConclusionsAlthough concomitant use of warfarin and PPI appears to be associated with an increased incidence of GIB, these patients are more likely to have other risk factors that also increase the risk of a GIB outcome. Therefore, the interaction between PPI and warfarin is clinically insignificant.

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review.

Background and Objective:Liver penetration by a confined perforation of peptic ulcer is a rare but severe event. Its clinical and pathological features are unclear.Methods:In total, 41 qualified English publications were identified using the PubMed database and one in-house case.Results:Among the 42 patients, 20 patients had liver involvement by a perforated duodenal ulcer and 22 by a gastric ulcer. Among the 23 cases of known ulcer histology, 2 ulcers were malignant and were adenocarcinomas in the gastric remnant and the remaining 21 ulcers were confirmed as histologically benign (for frequency of malignancy in duodenal versus gastric ulcers, p = 0.48). The presence of hepatocytes was the clue of diagnosis for 19 cases. The median ages of the patients were 64.5 years (95% Confidence Intervals [CI] 53.40–71.90) for duodenal ulcer and 65.5 years (95% CI: 59.23–70.95) for gastric ulcer, respectively. The male to female ratio was 1.5:1 for duodenal ulcers and 2:1 for gastric ulcers. Patients with liver involvement of a perforated gastric ulcer were more likely to have a larger ulcer (median largest dimension, 4.75 cm versus 2.5 cm, p = 0.014). Female patients with liver involvement of a gastric ulcer were older than male patients (median age 72 versus 60 years, p = 0.045). There were no differences in gender, region (Asia, Europe, America versus others), use of non-steroidal anti-inflammatory drugs (n = 15), H. Pylori positivity (n = 10), possible history of peptic ulcer disease (n = 19) or mortality (n = 32) between duodenal and gastric ulcers.Conclusions:Careful histologic examination, clinicopathological correlation, and immunohistochemistry are critical to establish the diagnosis and avoid misdiagnosing liver involvement as malignancy.

Annals for Educators - 20 October 2020

Annals for Educators - 20 October 2020

Upper gastrointestinal bleeding: Causes and patient outcomes.

Background:Upper gastrointestinal bleeding (UGIB) remains a healthcare burden and is associated with considerable morbidity and mortality. We aim to describe the presentation, clinical, and laboratory characteristics of patients presenting with UGIB as well as important patient outcomes.Methods:This is a retrospective study performed at a tertiary care university hospital in Riyadh. Electronic endoscopic reports of patients undergoing gastroscopies for the indication of UGIB from January 2006 to January 2015 were included. Demographic data, past medical conditions, medications used, symptoms on presentation, as well as the patients' hemodynamic status, laboratory investigations on presentations, the need for blood products, the need for admission to an intensive care unit, rebleeding, and in-hospital mortality rates were retrieved from medical records.Results:Two hundred fifty-nine patients were included with a mean age of 57.1 years and males constituted 66.8% of the study cohort. At least one comorbidity was present in 88.2%, while 20.7% had a history of prior UGIB, 12.6% had a history of peptic ulcer disease, and 9.2% had known esophageal varices. A nonvariceal source represented 80.1% of the causes (95% CI: 75.4 to 85.3%), 15.5% required admission to the intensive care unit (ICU), the rebleeding rate was 8.9% (95% CI; 5.7% to 12.2%) while the in-hospital mortality was 4.4% (95% CI; 2.4% to 6.9%). The mean pre-endoscopic Rockall score was 2.6 (range: 0 to 5), while the total Rockall score was 4.4 (range: 1 to 9). There was no association between the pre-endoscopic Rockall score and rebleeding (3.0 vs. 2.5, P = 0.27) or need for ICU admission (3.2 vs. 2.4, P = 0.08), the total Rockall score and rebleeding (5.0 vs. 4.4, P = 0.58) or need for ICU admission (5.0 vs. 4.3, P = 0.36).Conclusion:Causes of UGIB in this patient population were predominantly nonvariceal and the rebleeding and mortality rates resembled those of other studies.

S3454 Dieulafoy Lesion Masquerading as Diverticular Bleeding

INTRODUCTION: Dieulafoy lesion (DL) is an aberrant submucosal artery which protrudes from a small mucosal defect presenting with massive painless gastrointestinal bleeding (GIB) in the form of melena, hematemesis or hematochezia (Hcz), depending on its location. DLs are most commonly found in the proximal stomach within 6 cm of the gastro-esophageal junction along the lesser curvature, however, can occur anywhere along the GI tract to a lesser degree. DLs in the small intestine are rare, mostly seen in the jejunum, with DLs in terminal ileum occurring even rarer. CASE DESCRIPTION/METHODS: A 49-year-old woman with hypertension and history of peptic ulcer disease presented to emergency department complaining of maroon colored stools. She denied epigastric pain, nausea, constipation or weight loss. Her last colonoscopy (CF) was at 48 years of age with finding of “benign” polyps. Patient’s family history was significant for colon cancer in her father. Physical exam was positive for maroon colored stool on rectal exam. Laboratory tests revealed hemoglobin (Hgb) of 9.7 mg/dL, blood urea nitrogen (BUN) of 14 mg/dL and creatinine of 1 mg/dL. Endoscopic evaluation was started with esophagogastroduodenoscopy (EGD), which revealed no source of active or stigmata of recent bleeding. During EGD, patient had a large bloody bowel movement and decision was made to proceed with unprepped CF, which revealed small internal hemorrhoids, pan-diverticulosis and maroon colored blood clots in terminal ileum, which were felt to be secondary to incompetent ileocecal valve. Hcz was thought to be secondary to diverticular bleed, however, over the course of the day patient was noted to have a significant drop in Hgb to 5.7 mg/dL and continued to have Hcz. Blood transfusion was initiated and computed tomography (CT) angiography ordered, which was found to be negative for active bleeding. Repeat CF after bowel prep revealed a 0.3 cm ulcer with visible non-bleeding vessel in the terminal ileum, and was treated with epinephrine injections and two endoclips. Patients remained hemodynamically stable and was ultimately discharged home. DISCUSSION: DLs can cause life threatening hemorrhages and account for 1–2% of overt GIBs. They can be difficult to differentiate from other sources of bleeding, such as diverticular bleeds or bleeding due to arterio-venous malformations. Multidisciplinary approach is necessary for quick diagnosis and proper treatment as multiple endoscopies and imaging studies may be necessary to localize the site of bleeding.Figure 1.: Terminal Ileum filled with blood from first colonoscopy.Figure 2.: 0.3 cm ulcer with visible vessel in terminal Ileum.Figure 3.: Status post injection of epinephrine and placement of 2 endoclips.

Response to the Time

Response to the Time

S0467 Functional Gastroduodenal Disorders in a Predominantly Hispanic Population: A Cross-Sectional Study

INTRODUCTION: The epidemiology of functional gastroduodenal disorders (FGDs) has been recently studied in the Rome IV Global Study. The prevalence of functional dyspepsia varied significantly across countries, such as 10.1% in the USA vs. 6.6% in Mexico (Sperber et al. 2020). The global study did not sufficiently explore the prevalence among specific sub-populations within those countries, such as those residing on the US-Mexico border, a population composed primarily of Hispanics with high rates of acculturation. The aim of this study was to characterize the prevalence of FGDs in this unique population. METHODS: This cross-sectional study recruited subjects from various community centers throughout El Paso, Texas—a city on the US-Mexico border, from 2019 to 2020. Validated paper-based English or Spanish versions of the Rome IV Questionnaire were used according to subjects' preference. Those with a history of peptic ulcer disease, gastrointestinal cancer, celiac disease, or inflammatory bowel disease were excluded. Subjects’ perception of their health status was rated as: poor, fair, good, very good, and excellent. Collected data is presented as prevalence (95% confidence interval (CI)) and compared using Chi-square test/Fisher's exact test. RESULTS: A total of 216 adult subjects (54.6% female; 66.2% Hispanic) completed the questionnaire. After excluding the patients with history of organic gastrointestinal disorders, 197 subjects were included in the study. The overall prevalence of FGDs was 6% (95% CI: 3%–10%) and they were more prevalent in females than in males (7.4% vs. 4.5%, P < 0.05). The most common FGDs were functional dyspepsia and rumination syndrome, both observed in 2.5% (0.8%–6%); followed by belching disorders in 2% (0.6%–5%). Chronic nausea and vomiting syndrome and cyclic vomiting syndrome were detected in 1.5% (0.3%–4%) and 1% (0.1%–4%), respectively. More subjects with FGDs rated their health status as poor/fair compared to those without FGDs (50% vs. 12.4%, P < 0.001). CONCLUSION: In this study on the US-Mexico border, we found that FGDs were relatively common. The prevalence of functional dyspepsia was lower than the worldwide prevalence, including that of the US and Mexico. The prevalence of belching disorders and vomiting disorders were statistically similar to the worldwide prevalence. In our population, the prevalence of rumination syndrome was similar to functional dyspepsia.