Gastrointestinal Tract Involvement Research Articles

Characteristics of cutaneous manifestations in immunoglobulin a vasculitis and their relationships with system involvement and treatment needs.

The characteristics of cutaneous manifestations in IgAV patients may be helpful in predicting the course of the disease. The skin lesion type, distribution and persistence of cutaneous manifestations in IgAV are associated with system involvement. In addition, the need for intensive therapy increases in the presence of vesicles/bullae, necrosis/ulcer, rash spreading over the buttocks and persistent rash in IgAV. • Palpable purpura localized to the lower extremities is the expected cutaneous manifestation of immunoglobulin A vasculitis. • The type, distribution and duration of rash in IgAV have effects on theimmunoglobulin A vasculitis disease course. • Genital tract involvement is more common in patients with necrosis/ulcers. • Gastrointestinal tract involvement and genital tract involvement are more commonin patients with rash spreading above the buttocks. • Renal involvement is more common in patients with persistent rash.

Can the affected intestinal segment visualized on abdominal ultrasound predict gastrointestinal tract bleeding in immunoglobulin A vasculitis?

To evaluate immunoglobulin A vasculitis (IgAV) patients with gastrointestinal (GI) tract involvement and to reveal the relationship between the location and extent of the affected intestinal segment detected on the initial abdominal ultrasound (US) and GI tract bleeding. This medical record review study was conducted on 117 IgAV patients with GI tract involvement between January 2016- June 2023. Patients were divided into two groups as those with (n=28) and without (n=89) GI tract bleeding. Predictors of GI tract bleeding were investigated by comparing demographic, clinical characteristics and laboratory findings. Gender, age at diagnosis, symptoms at admission, rash distribution, GI tract complaints, and the elapsed time until the development of GI tract symptoms were similar in both groups. There was no difference between small intestinal, large intestinal or small+large intestinal involvement (p=0.89). The ileum was the most commonly affected intestinal segment in patients with and without GI tract bleeding (p=0.37). Jejunal wall thickening (p=0.04) and the number of affected intestinal segments (p=0.008) were higher in patients with GI tract bleeding. In IgAV patients, jejunum involvement and affected multiple intestinal segments shown by abdominal US are associated with GI tract bleeding.

Clinical characteristics of Behçet's disease in an Egyptian cohort

Background: Behçet's disease is a multi-systemic vasculitis characterized by recurring lesions in the skin mucosa and sight-threatening uveitis. The aim of the research: This research aimed to investigate the clinical features of Behçet's disease (BD) in individuals residing in Egypt. Patients and methods: 150 individuals with BD were recruited, examined, and put through a skin allergy test, musculoskeletal assessment, laboratory tests, and comprehensive medical history. The disease's activity was evaluated using the Behçet Disease Current Activity Form (BDCAF). Complete ophthalmological evaluation and imaging studies were performed according to the organ involved. Results: Cases were 116 men (77.3%) and 34 women (22.7%) (M: F 3.4:1). Their mean age was 34.05 ± 9.28 years, and the disease duration range was 1–20 years. Oral and genital aphthosis were reported in 86.7% and 82.0%, respectively. Eye affection was observed in 68.7%, mainly in anterior uveitis (35.3%). Vascular manifestations occurred in 58.7%, affecting primarily the venous side (31.3%) in the form of deep venous thrombosis (DVT). 32.7% had joint affection, and the pathergy test was positive for 28%. Central nervous system (CNS), skin lesions, and gastrointestinal tract involvement were the slightest common manifestations observed in 26%, 25.3%, and 7.3%, respectively. Articular manifestations were markedly linked to skin lesions (P = 0.002), and there was a significant predominance of articular manifestations among females (P = 0.042). BDCAF score was significantly related to male gender (P = 0.037), smokers (P < 0.000), those with older age (P = 0.028), delayed age of disease onset (P = 0.025), and additionally those with the eye (P = 0.000) and CNS involvement (P = 0.003). Conclusion: The clinical features of Egyptian Behçet's patients were significantly dominated by mucocutaneous involvement, followed by ocular affection. Articular manifestations were markedly more significant in women. The disease activity score was more remarkable in males, smokers, those of older age, and those with a delayed age of disease onset.

S3789 Melena as the Initial Presentation of Diffuse Large B-Cell Lymphoma with Gastrointestinal Tract Involvement

S3789 Melena as the Initial Presentation of Diffuse Large B-Cell Lymphoma with Gastrointestinal Tract Involvement

Efficacy assessment of intravenous immunoglobulin for gastrointestinal involvement in systemic sclerosis using UCLA SCTC GIT: Case-based review.

To summarize the published evidence in the literature on the use of intravenous immunoglobulin in gastrointestinal tract involvement in systemic sclerosis patients and report the experience of our department. A systematic literature review was performed; and a literature search was conducted in MEDLINE and Embase until 1/5/2024, using the participants, intervention, comparator and outcomes framework. Only full-text articles involving systemic sclerosis adults, submitted to intravenous immunoglobulin (at least one administration) to treat primary gastrointestinal tract manifestations. The outcome was the University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 score to evaluate response to treatment. Two reviewers performed the assessment of data extraction and synthesis, independently. Four papers (two case reports and two retrospective studies) out of 35 references were included. In addition, we added two systemic sclerosis patients from our department in this review. In 25 systemic sclerosis patients, with various gastrointestinal tract manifestations, the intravenous immunoglobulin therapy was found to improve digestive tract symptoms in SSc patients, as shown by the decrease in the scores of University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0. No adverse events were reported, except for one case of low-grade fever post-administration. The results from this systematic literature review based on case series suggest that intravenous immunoglobulin may improve gastrointestinal tract symptoms assessed by the University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 scale, with only minor reported adverse events, suggestive of an acceptable safety profile. We believe that this systematic literature review will contribute to shed light on the efficacy and safety aspects of intravenous immunoglobulin treatment in the management of gastrointestinal tract symptoms; and multicenter randomized placebo-controlled trials are urgently needed to foster progress in this field.

Dynamic endoscopic progression of gastrointestinal tract involvement in Langerhans cell histiocytosis: A pediatric case report.

Gastrointestinal tract involvement in Langerhans cell histiocytosis (LCH) is extremely rare, with limited documentation of endoscopic manifestations. We report a 19-month-old girl who presented with repeated diarrhea and bloody stools, accompanied by recurrent pulmonary infections, anemia, hypoproteinemia, thrombocytopenia, coagulopathy, and hepatosplenomegaly with lymphadenopathy. Initial treatment with antibacterial agents, mesalazine, thalidomide, and prednisone led to temporary improvement; however, the symptoms repeatedly relapsed. She underwent three digestive endoscopies, but until the third endoscopy, a definitive diagnosis of Langerhans cell histiocytosiswas established through biopsy. While upper gastrointestinal tract findings were not significant, notable changes were observed in the colorectal region. A colonoscopy revealed progression from erythema to diffuse hyperemia and edema, with erythema, erosion, and superficial ulcers extending into the distal ileal mucosa. Genetic analysis identified a BRAF-V600E mutation. Following treatment with chemotherapy (vincristine and prednisone) and the BRAF inhibitor dabrafenib, the patient demonstrated significant clinical improvement within days. At the 1-year follow-up, the patient had normal bowel movements and a weight gain of 2.5 kg. Early gastrointestinal endoscopy with multiple biopsies in suspected children can facilitate early detection. Dabrafenib is a viable treatment option for Langerhans cell histiocytosis.

Atypical manifestation of immunoglobin A vasculitis, with skin, gastrointestinal tract, joint and scrotal involvement, in an eight-year-old boy

Atypical manifestation of immunoglobin A vasculitis, with skin, gastrointestinal tract, joint and scrotal involvement, in an eight-year-old boy

Species distribution, antifungal susceptibility pattern and associated factors of Candida blood stream infections in Sri Lanka from 2018 to 2022

Introduction: Candidemia can be life-threatening in immunocompromised individuals thus, prompt diag-nosis and treatment with antifungal agents is mandatory for successful outcome.Surveillance data on species distribution, antifungal susceptibility and associated factors of candidemia is utmost important to decide on empiric antifungal therapy, to impose infection control measures as well to promote antifungal stewardship in a country.Therefore, this study was aimed at retrospective review of data on candidemia at Mycology Reference Laboratory in Sri Lanka for 5 years duration to identify the species causing candidemia, their antifungal susceptibility pattern and associated factors.Results: A twofold rise in candidemia cases were seen during this 5-year duration compared to previous 7 years (2011-2017). Predominant species causing candidemia was C. tropicalis (35%) followed by C. parapsilosis (33%). C. albicans was the 3rd commonest species causing candidemia in Sri Lanka.There were 3% C. glabrata cases, 2% C. guilliermondii and 1% C. famata and C. krusei cases. Importantly two sequencing confirmed C. auris cases were identified for the first time in Sri Lanka in 2021.Overall good antifungal susceptibility was seen for both fluconazole and amphotericin B and there were only 7%and 1.6% resistance respectively.Long term hospital stay (47%) was commonly seen in this study group followed by use of broad-spectrum antibiotics (24%) and involvement of gastro-intestinal tract (21%).Conclusion: Candida tropicalis is the commonest species causing candidemia in Sri Lanka. Common Candida species had good susceptibility to antifungals. Long term hospital stay was associated with candidemia in majority of patients.

Serum markers of microbial translocation and intestinal damage in assessment of gastrointestinal tract involvement in systemic sclerosis

Gastrointestinal (GI) tract involvement affects up to 90% of Systemic sclerosis (SSc) patients. The presence of GI symptoms is assessed by the University of California, Los Angeles, and Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT 2.0). Microbial translocation (MT) is reported in SSc patients consequently to increased intestinal permeability due to intestinal damage (ID) and dysbiosis. Aim of this study was to assess circulating levels of LBP and EndoCab IgM (markers of MT), IL-6 (marker of inflammation), I-FABP and Zonulin (markers of ID) in a cohort of SSc patients and healthy controls (HC). Moreover, we aimed to correlate these parameters with severity of GI symptoms. UCLA SCTC GIT 2.0 questionnaire was administered to 60 consecutive SSc patients. Markers of MT, inflammation and ID were evaluated in SSc patients and HC. SSc patients had higher median value of markers of MT, inflammation and ID than HC. The logistic regression analysis showed LBP as the only variable associated with an UCLA total score “moderate-to-very severe” [OR 1.001 (CI 95%: 1.001–1.002), p < 0.001]. The logistic regression analysis showed LBP [OR 1.002 (CI 95%: 1.001–1.003), p < 0.01] and disease duration [OR 1.242 (CI 95%: 1.023–1.506), p < 0.05] as variables associated with UCLA distension/bloating “moderate-to-very severe”. The logistic regression analysis showed LBP as the only variable associated with UCLA diarrhea “moderate-to-very severe” [OR 1.002 (CI 95%: 1.001–1.003), p < 0.01]. SSc patients with dysregulation gut mucosal integrity expressed by high levels of MT and ID biomarkers had more severe GI symptoms.

Polypoid Kaposi Sarcoma Involving the Lower Gastrointestinal Tract: Clinicopathologic Study of 15 Cases.

Gastrointestinal manifestations of Kaposi sarcoma are rare but may cause morbidity. Lower gastrointestinal involvement is particularly rare and lesions may resemble conventional bowel polyps. To study 15 patients who presented with lower gastrointestinal tract Kaposi sarcoma with polypoid architecture. The surgical pathology files of the departments of pathology at multiple institutions were searched for cases of Kaposi sarcoma forming polyps in the lower gastrointestinal tract (jejunum, colon, rectum); 15 cases with such features were identified. Clinicopathologic information was extracted from the medical record and documented by reviewing individual hematoxylin-eosin stained slides. The patients were 13 men and 2 women aged 26-80 years (median = 44 years). Gastrointestinal tract involvement was multifocal in 11 cases and unifocal in 4. The tumors involved the rectum, recto-sigmoid junction, cecum, ascending colon, transverse colon, and descending colon and presented as polypoid lesions measuring 0.2-2.1 cm. Six patients had upper gastrointestinal tract involvement in addition to lower gastrointestinal lesions. Histologically the tumors were characterized in 6 cases by a dense spindle cell proliferation in the lamina propria; however, the remaining cases showed only a subtle fascicular spindle cell proliferation in the lamina propria that did not form an expansile mass. Biopsies of gastrointestinal polyps showing absence of the common features of hyperplastic or adenomatous polyps, particularly in immunocompromised patients, should be carefully examined for the presence of a stromal spindle cell proliferation. Use of immunohistochemical stains, particularly human herpesvirus-8, can help in establishing the correct diagnosis.

A case of mantle cell lymphoma with involvement of the entire gastrointestinal tract - Multiple endoscopic findings.

Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma that occurs in some patients with gastric and intestinal involvement, but esophageal involvement is rare, and involvement of the entire gastrointestinal (GI) tract is even rarer. The endoscopic manifestations of MCL are mainly nodular or polypoid lesions. We report a rare case of MCL containing esophageal involvement of the entire GI tract with multiple endoscopic findings.

Gastrointestinal disorders in systemic sclerosis: cluster analysis and prognosis from a French prospective cohort.

The gastrointestinal tract (GIT) is frequently involved in systemic sclerosis (SSc) and is responsible for alteration of quality of life. Many complications can occur, including chronic intestinal pseudo-obstruction, digestive haemorrhage and small-intestinal bacterial overgrowth. Since early development of organ failure is associated with poor prognosis, we need to identify risk factors associated with severe GIT involvement to prevent severe forms of the disease. We conducted an observational prospective study, which included 90 SSc patients from December 2019 to September 2021. We collected questionnaires about digestive manifestations and quality of life, blood and stool samples, and performed imaging. At inclusion and throughout the study we assessed the occurrence of malnutrition and severe GIT disorders. We performed statistical analysis to highlight eventual risk factors associated with digestive manifestations, including hierarchical cluster analysis. A majority of our patients had gastro-oesophageal manifestations (93.3%), followed by intestinal manifestations (67.8%) and anorectal manifestations (18.9%). We found a correlation between anorectal disorders and cardiac disease, and between gastro-oesophageal involvement and impaired pulmonary function tests. Smoking was significantly associated with occurrence of severe GIT disorders. Malnutrition was frequent and associated with more cardiac and pulmonary disease. Cluster analysis identified three groups of patients, including one cluster with cardiac and digestive involvement. GIT manifestations are frequent and severe in SSc. Smoking appears to be associated with severe disease. Anorectal manifestations may be associated with cardiac disease, but we need more studies to validate these results.

Splenic infarction may be the first sign of granulomatosis with polyangiitis: case reports

Granulamatous polyangiitis (GPA) is a rare systemic vasculitis that makes up most of the antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The disease is more likely to affect the upper and lower respiratory tract, kidney and skin. The gastrointestinal tract involvement is more rare. In the general population, spleen infarction is a rare condition. Most spleen infarcts are asymptomatic, and most patients receive a diagnosis by chance during the evaluation. The most common causes of non-traumatic spleen infarction in the general population include cardiac causes such as atrial fibrillation, infections, thrombophilic conditions, and malignancies. In rheumatic diseases, various spleen involvement has been identified, such as splenomegaly, spleen rupture, spleen abscess, asplenia and spleen infarction. The development of spleen infarct in antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) is well known. It is not well known whether GPA is a risk factor for spleen infarction. However, publications including cases of developing spleen infarction due to GPA are increasing. This review highlights the occurrence of spleen infarction in patients with GPA, by presenting two GPA cases with splenic infarction. It also emphasizes that spleen infarction can occur in GPA and may frequently be without symptoms.

The role of upper gastrointestinal endoscopy in the diagnosis of pediatric inflammatory bowel disease.

Upper gastrointestinal (UGI) tract involvement is frequently reported in pediatric Crohn disease (CD) and ulcerative colitis (UC). Aside from granulomas, most findings are nonspecific. The aims of this study were to review the prevalence of UGI tract findings in pediatric patients with CD or UC at diagnosis and to describe differences in endoscopic and histologic features. Patients with CD and UC aged 2 to 17 years diagnosed between 2000 and 2015 who had upper and lower endoscopy at diagnosis were randomly chosen from the BC Children's Hospital inflammatory bowel disease (IBD) registry. Pathology review of the UGI biopsy specimens was blinded to IBD diagnosis. Of the 198 patients, 102 with CD and 96 with UC were included, with a mean age of 11.7 years (range, 2.3-17 years). Patients with CD were more likely to have aphthous ulcers (20.4% vs 3.5%, P = .002) and erosions (16.3% vs 3.5%, P =.018), most commonly affecting the antrum. Macroscopically normal UGI endoscopy was present in 60% of patients. Microscopic disease was reported in 100% of patients with CD and 87% of patients with UC. In both groups, nonspecific inflammation was the most common finding. Chronic deep, superficial, and diffuse inflammation were more frequent among patients with CD than UC (42% vs 4%, P < .001; 60% vs 17%, P < .001; 50% vs 34%, P = .04, respectively). The UGI tract macroscopic changes were common in pediatric IBD, especially in CD. Despite macroscopically normal endoscopy, histologic abnormalities were frequent. Although chronic inflammation was more often reported in patients with CD, aside from granulomas there were no unique histologic abnormalities unique to CD.

Clinicopathologic Features of Gastrointestinal Tract Langerhans Cell Histiocytosis

Gastrointestinal (GI) tract involvement by Langerhans cell histiocytosis (LCH) is rare and its clinicopathologic characteristics have only been described in case reports and small series. We reviewed hematoxylin and eosin and CD1a, S100, and Langerin immunohistochemical–stained slides from 47 patients with well-documented demographic and clinical findings. Our cases included 8 children and 39 adults, with a mean follow-up of 63 months. All pediatric patients had concurrent multisystem LCH, presented with GI symptoms, and showed nonpolypoid lesions. Seven (88%) showed multifocal GI disease, including 5 with multiple GI organ involvement. All sampled lesions from children exhibited infiltrative growth. More than half had died of the disease or manifested persistent LCH at last follow-up. Twenty-five of 39 (64%) adults had LCH involving only the GI tract (single system), with the remaining 14 (36%) exhibiting multisystem disease. Adult single-system GI LCH was typically encountered incidentally on screening/surveillance endoscopy (72%). Most exhibited isolated colorectal involvement (88%) as a solitary polyp (92%), with a well-demarcated/noninfiltrative growth pattern (70%), and excellent prognosis (100%). In comparison, adult patients with multisystem LCH more frequently presented with GI symptoms (92%, P < .001), noncolorectal GI site involvement (50%, P = .02), multifocal GI lesions (43%, P = .005), nonpolypoid lesions (71%, P < .001), infiltrative histologic growth pattern (78%, P = .04), and persistent disease (57%, P < .001). Adult patients with multisystem LCH appear to exhibit similar clinicopathologic features to those of pediatric patients. These results demonstrated that adults with single-system LCH involving the GI tract have an excellent prognosis, whereas multisystem LCH occurring at any age carries an unfavorable prognosis. High-risk features of GI LCH include pediatric age, GI symptomatology, noncolorectal GI involvement, multifocal GI disease, nonpolypoid lesions, and infiltrative growth pattern.

Gastrointestinal involvement in neuromuscular disorders.

Although not often discussed, many of the neuromuscular disorders (NMDs) affect the gastrointestinal tract (GIT). Depending on the type of NMD, the prevalence of GIT involvement ranges from <5% (e.g. hereditary neuropathies, myofibrillar myopathies) to 100% (e.g. MNGIE, OPMD). Particularly in NMDs with multisystem affection, involvement of the GIT can dominate the clinical presentation or at least make up a significant part of the clinical picture. The most prominent representatives of NMDs with multisystem involvement are the mitochondrial disorders (MIDs) and the myotonic dystrophies. The best known syndromic MIDs with GIT involvement are MNGIE, MELAS, Leigh, and Pearson syndromes. Among neuropathies, GIT involvement is most commonly found in ALS and GBS. GIT involvement may also be a feature of myasthenia. The clinical manifestations of GIT involvement are diverse and can affect the entire GIT, from the teeth to the rectum, including the liver and pancreas. The most well-known clinical manifestations of GIT involvement are dysphagia, nausea, vomiting, reflux, hollow organ dysmotility, hepatopathy, diabetes, diarrhea, constipation, and fecal incontinence. Even if treatment can usually only be symptomatic, the therapeutic options are diverse, are often effective, and can significantly and beneficially influence the course of the underlying NMD.

A Case of Hereditary Hemorrhagic Telangiectasia With Gastrointestinal Tract Involvement

A Case of Hereditary Hemorrhagic Telangiectasia With Gastrointestinal Tract Involvement

Fistulising skin metastases in Crohn’s disease: a case report and review of the literature

BackgroundMetastatic Crohn’s disease is a rare disorder characterized by various granulomatous skin lesions that occur independently of gastrointestinal tract involvement. However, currently there is no standardized care or specific treatment. Therapeutic approaches include immunosuppressive agents, such as corticosteroids, azathioprine, and monoclonal antibodies targeting inflammatory cytokines like tumor necrosis factor (TNF).Case presentationWe present a case of a 29-year-old western European woman with significant blind ending abdominal subcutaneous fistulas and abscesses, who sought evaluation in the dermatology department. Histological examination revealed multiple epithelioid cell granulomas. There was no evidence of infectious or rheumatologic diseases such as sarcoidosis. The tentative diagnosis was metastatic Crohn’s disease, which was not related to an intestinal manifestation of the disease. The patient responded to infliximab but had to discontinue it due to an allergic reaction. Subsequent adalimumab treatment failed to induce clinical remission; thus, therapy was switched to ustekinumab, resulting in a positive response. Written informed consent for publication of their clinical details and clinical images was obtained from the patient.For our study more than 1600 publications were screened for cases of metastatic Crohn’s disease on PubMed database. 59 case reports with 171 patients were included in the analysis and evaluated for localization, diagnostic and therapeutic approaches, and complications and were summarized in this review.ConclusionThe successful ustekinumab treatment of a patient with metastatic Crohn's disease underscores the potential of this minimally investigated therapeutic option, highlighting the need for future treatment guidelines given the increasing prevalence of such cases.

Abstract PO5-13-12: Personalized circulating tumor DNA testing for recurrence detection and treatment response monitoring in patients with metastatic invasive lobular carcinoma

Abstract Introduction Metastatic invasive lobular carcinoma (mILC) presents unique challenges during treatment response monitoring. A higher frequency of metastases to the bone, gastrointestinal tract, uterus, meninges, ovary, and diffuse serosal involvement is observed in mILC. The challenge with mILC is that they can be difficult to detect clinically and radiographically, and consequently clinical progression can be difficult to determine with conventional imaging modalities like CT Scans, thus precluding many patients with mILC from enrolling into clinical trials. Therefore more accurate biomarkers are needed to better assess response to treatment in real time. In this study, we demonstrate the feasibility of longitudinal ctDNA testing for treatment response monitoring in patients with mILC. Methods In this real-world study, longitudinal plasma samples (n=219) from 60 patients with mILC, treated across 52 independent clinics between 7/22/21 and 6/15/23, were analyzed. A personalized, tumor-informed ctDNA assay (SignateraTM bespoke, mPCR-NGS assay) was used for detection and quantification of ctDNA in plasma samples. Results In this cohort, the median patient age at diagnosis of metastatic disease (baseline) was 62.9 years (range: 32.2-79.7). Of the 60 patients, 41 (68%) had ER+PR+HER2-, 7 (12%) ER+PR-HER2-, 4 (7%) ER+PR+HER2+, 2 (3%) ER+PR-HER2+, 1 (2%) triple negative breast cancer; receptor status was not available for 5 (8%) patients. CDH1 (75%) and PIK3CA (42%) were observed to be the top two genes with somatic, nonsynonymous mutations. Mutations in TP53 and TBX3 were observed in 13% of patients, mutations in AKAP9, IGFN1, RBM26, and RFC3 in 10% of patients, and mutations in ESR1 in 6.7% of patients. At variant level, PIK3CA p.H1047R (22%) and RBM26 p.Q701Tfs*23 (10%) were the top two somatic variants identified. The most common CDH1 variant, p.Q23*, was found in 5% of the cases. Of the 60 patients, 37 (61.7%) were ctDNA-positive at all time points while on treatment (chemotherapy/endocrine therapy/targeted therapy) with the first time point collected at a median of 6.7 months (range: 2.5-2307 months) from baseline. Of these 37, imaging/biopsy results after baseline were available for 32 patients, 86% (27/32) of whom progressed. Thirty-two of 37 persistently ctDNA-positive patients had serial ctDNA measurements available, of which 14 (43%) had significant increase in ctDNA levels (average: 47-fold increase, standard deviation: 98) from first to last time points. At some point during their care ctDNA was detectable in all (n=51) patients with evidence of clinical progression. Of the 60 patients, 14 (23.3%) were ctDNA-negative at all time points tested. None of the 14 persistently ctDNA-negative patients had evidence of disease recurrence or progression at the time of initial testing or throughout ctDNA monitoring. The first ctDNA time point was collected at a median of 33.1 months (range: 0.68-92 months) from baseline for these patients,a median of 3 time points was tested per patient (1-12). Of the remaining 9/60 patients, 3 (33%) had sustained ctDNA clearance for a median of 46 days (range: 0-224 days) in response to treatment, and 2 (22%) were initially ctDNA-negative but turned positive 105 and 156 days later, indicating potential resistance to treatment and molecular progression. Additional 4/9 (44%) had ctDNA levels consistently low levels (average: 0.42 mean tumor molecules/mL) while on treatment for a median of 260 days (range: 217-442) and showed no evidence of progression. Conclusions ctDNA status and dynamics correlate well with clinical status of patients with mILC, as determined by conventional monitoring tools such as imaging and biopsy. Our results indicate that personalized, tumor-informed, longitudinal ctDNA testing may serve as a useful tool for detection of progression and monitoring treatment response in mILC patients. Citation Format: Steffi Oesterreich, Antony Tin, Samuel Rivero-Hinojosa, Janie Fielder, Jenifer Ferguson, Ekaterina Kalashnikova, Angel Rodriguez, Minetta Liu, Adrian Lee. Personalized circulating tumor DNA testing for recurrence detection and treatment response monitoring in patients with metastatic invasive lobular carcinoma [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-13-12.

Gastrointestinal Tract and Kidney Injury Pathogenesis in Post-COVID-19 Syndrome.

COVID-19 is a global health emergency that requires worldwide collaboration to control its spread. The scientific community is working to understand the different aspects of the post-COVID-19 syndrome and potential treatment strategies. Interestingly, there have been reports of gastrointestinal tract (GIT) involvement in the post-COVID-19 syndrome, suggesting the presence of both severe and mild GIT disorders. The development of the post-COVID-19- GIT syndrome involves various factors, such as impaired GIT mucosa cells, disruptions in the feeling of satiety, reduced blood supply due to the formation of small blood clots, and increased prostaglandin secretion caused by an excessive immune response. GIT symptoms have been observed in around 16% of COVID-19 patients. Other complications include kidney damage and prolonged impairment in the filtration and excretion functions of the glomeruli and tubules. The pathogenesis of post-COVID-19 renal syndrome involves factors, like an overactive immune response, reduced lung perfusion and oxygenation, viral infection in kidney tissues, endothelial dysfunction, and decreased blood volume. Roughly 20% of hospitalized patients experience renal manifestations after recovering from COVID-19.