ResearchPad - Gastroenterology https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Influence of Besifovir Dipivoxil Maleate Combined with L-Carnitine on Hepatic Steatosis in Patients with Chronic Hepatitis B]]> https://www.researchpad.co/product?articleinfo=N9ea6741d-e264-47dc-befd-90a0488102c5 <![CDATA[Cardiovascular Risk in Individuals with Inflammatory Bowel Disease]]> https://www.researchpad.co/product?articleinfo=N13a39035-8a2a-4ce9-a02d-84eaacf8aef4

Background

Inflammatory bowel disease (IBD) patients present a higher risk of developing cardiovascular diseases due to the presence of chronic inflammation, which plays an essential role in atherogenesis. Therefore, the aim of the study was to evaluate the cardiovascular risk between patients with IBD and healthy control individuals.

Materials and Methods

A total of 52 consecutive IBD outpatients from a tertiary hospital and 37 healthy controls were enrolled. Data collected included age, sex, smoking status, presence of comorbidities, disease activity, ongoing medical treatment, body mass index, arterial blood pressure, and cardiovascular risk. The cardiovascular risk was based on the Framingham risk score and ultrasonography variables, such as the carotid intima-media thickness and the presence of atherosclerotic plaque in the carotid. Multivariate logistic regression or multiple linear regression analysis was performed at a significance level of 5%.

Results

No differences were observed between groups with regard to age, sex, smoking status, comorbidities, blood pressure, body mass index, lipid profile, and Framingham risk score. In the IBD group, fasting glucose [95 (86.2–107.3) mg/dL vs 86 (79–100) mg/dL, p=0.041], carotid intima-media thickness (0.69±0.12 mm vs 0.63±0.12 mm, p=0.031), and atherosclerotic carotid plaque (25% vs 5.4%, p=0.032) were higher compared with those in the control group. Multivariate logistic regression analysis showed that patients with IBD presented a 6.45-fold higher risk of carotid atherosclerotic plaque (odds ratio: 6.45; 95% confidence interval: 1.035–40.216; p<0.046).

Conclusion

Patients with IBD are at an increased risk of atherosclerosis and, consequently, an increased risk for cardiovascular diseases.

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<![CDATA[Amino Acid-Responsive Crohn’s Disease: A Case Study [Expression of Concern]]]> https://www.researchpad.co/product?articleinfo=N739012ae-2b9e-4403-b56a-06a8dbe12b2a ]]> <![CDATA[Multicentre prospective observational study protocol for radiation exposure from gastrointestinal fluoroscopic procedures (REX-GI study)]]> https://www.researchpad.co/product?articleinfo=N6e40113f-39ef-4bd4-9268-97d309e1f1da

Introduction

Recently, the use of various endoscopic procedures under X-ray fluoroscopic guidance, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasonography (EUS), enteral endoscopy and stenting, has been rapidly increasing because of the minimally invasive nature of these procedures compared with that of surgical intervention. With the spread of CT and fluoroscopic interventions, including endoscopic procedures under X-ray guidance, high levels of radiation exposure (RE) from medical imaging have led to major concerns throughout society. However, information about RE related to these image-guided procedures in gastrointestinal endoscopy is scarce, and the RE reference levels have not been established. The aim of this study is to prospectively collect the actual RE dose and to help establish diagnostic reference levels (DRLs) in the field of gastroenterology in Japan.

Methods and analysis

This is a multicentre, prospective observational study that is being conducted to collect the actual RE from treatments and diagnostic procedures, including ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement and enteral tube placement. We will measure the total fluoroscopy time (min), the total dose–area product (Gycm2) and air-kerma (mGy) of those procedures. Because we are collecting the actual RE data and identifying the influential factors through a prospective, nationwide design, this study will provide guidance regarding the DRLs of ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement and enteral tube placement.

Ethics and dissemination

Approval was obtained from the Institutional Review Board of Toyonaka Municipal Hospital (25 April 2019). The need for informed consent will be waived via the opt-out method of each hospital website.

Trial registration number

The UMIN Clinical Trials Registry, UMIN000036525.

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<![CDATA[Amyand's Hernia: Perforated Appendix in an Incarcerated Inguinal Hernia]]> https://www.researchpad.co/product?articleinfo=N31b20b0f-ac31-4b5b-bd19-c9905ef10a6c

Amyand’s hernia is an unusual condition characterized by the presence of a normal or inflamed appendix located within an inguinal hernia. We present a rare situation wherein a 56-year-old male patient presented with an incarcerated inflamed appendix in a right inguinal hernia. He was emergently taken to the operating room, with diagnostic laparoscopy changed to open, due to incarcerated cecum and terminal ileum. The incarcerated segment had to be resected with primary anastomosis. The inflamed and purulent contents were washed out, and the hernia defect was left unrepaired due to the presence of abscess in the inguinal canal. 

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<![CDATA[Lymph Node Ratio as a Prognostic Marker in Rectal Cancer Survival: A Systematic Review and Meta-Analysis]]> https://www.researchpad.co/product?articleinfo=N08d338b4-8574-4584-8ccc-60d1d7fd307c

Introduction 

The lymph node ratio (LNR) is defined as the ratio of the number of positive lymph nodes to the total number of nodes retrieved. LNR has recently emerged as a prognostic factor in rectal cancer. The objective of our study was to pool eligible studies to elucidate the prognostic role of LNR on overall survival (OS) and disease-free survival (DFS) in rectal cancer patients using a meta-analysis.

Methods

A systematic database search was performed in MEDLINE and Embase for relevant studies that reported LNR in rectal cancer. Two authors independently screened the relevant articles for selection and data extraction. As a result, a list of such studies and references, published in English up to December 2019, was obtained, and a total of 4,486 node-positive patients in 18 studies were included in this meta-analysis. RevMan software 5.3 (Cochrane Collaboration, the Nordic Cochrane Centre, Copenhagen) was used for conducting all statistical analyses.

Results

A higher LNR was significantly correlated with worse OS [hazard ratio (HR): 2.60; 95% confidence interval (CI): 2.21-3.06; p≤.00001] and DFS (HR: 2.43; 95% CI: 2.11-2.80; p≤.00001) in node-positive rectal cancer patients. Besides, LNR is an independent predictive and prognostic marker of OS and DFS (HR: 2.52; 95% CI: 2.17-2.94; p≤.00001 with I2=0%; p=.32 and HR: 2.63; 95% CI: 2.17-3.18; p≤.00001 with I2=0%; p=.63 respectively, irrespective of lymph nodal harvest).

Conclusions

Our present study demonstrates that LNR is an independent predictor of survival in rectal cancer. LNR should be considered as a parameter in future oncological staging systems. Further well-designed randomized control trials to prospectively assess LNR as an independent predictor of rectal cancer survival are necessary before its application in daily practice.

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<![CDATA[An Interesting Case of Congenital Intrahepatic Porto-hepatic Shunt as a Cause of Unexplained Encephalopathy]]> https://www.researchpad.co/product?articleinfo=Nf42d1eb4-bf94-4ab6-9557-939d935370fd

Congenital portosystemic shunts can be divided into two types: intrahepatic shunts in which there is an abnormal connection between the branches of the portal vein and either the inferior vena cava or the hepatic veins and less commonly the extrahepatic type in which the portal system is connected to one of the branches of the mesenteric veins. Here we describe a 73-year-old woman who was admitted to the hospital with clinical evidence of encephalopathy and was found to have hyperammonemia. Abdominal computed tomography angiography was performed and revealed a dilated portal vein measuring up to 1.8 cm at the porta-hepatis along with dilated superior mesenteric and splenic veins. Multiple dilated vascular channels were identified within the right hepatic lobe. An intrahepatic portosystemic shunt between an enlarged middle hepatic vein and two separate branches of the right portal vein was demonstrated. A liver biopsy showed normal architecture with no evidence of inflammation or fibrosis. Portosystemic shunts are rare and often detected in adulthood but should be considered as an important cause of unexplained encephalopathy in the absence of cirrhotic liver disease or hepatic trauma. Given that the size of such shunts increases with age, older persons are more prone to the effect of toxic metabolites.This age-associated increase in shunt size may help explain why some patients remain asymptomatic until later in their life which may account for the late presentation in our patient.

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<![CDATA[Aberrant expression of two miRNAs promotes proliferation, hepatitis B virus amplification, migration and invasion of hepatocellular carcinoma cells: evidence from bioinformatic analysis and experimental validation]]> https://www.researchpad.co/product?articleinfo=N8f756cb8-5957-4c43-a86e-a428dcc762c2

Background

As key negative regulators of gene expression, microRNAs (miRNAs) play an important role in the onset and progression of hepatocellular carcinoma (HCC). This study aimed to identify the miRNAs involved in HCC carcinogenesis and their regulated genes.

Methods

The Gene Expression Omnibus (GEO) dataset (GSE108724) was chosen and explored to identify differentially expressed miRNAs using GEO2R. For the prediction of potential miRNA target genes, the miRTarBase was explored. Enrichment analysis of Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) was performed by the DAVID online tool. The hub genes were screened out using the CytoHubba plug-in ranked by degrees. The networks between miRNAs and hub genes were constructed by Cytoscape software. MiRNA mimics and negative control were transfected into HCC cell lines and their effects on proliferation, hepatitis B virus DNA (HBV-DNA) replication, TP53 expression, migration, and invasion were investigated. The following methods were employed: MTT assay, quantitative PCR (qPCR) assay, western blotting, wound healing assay, and transwell assay.

Results

A total of 50 differentially expressed miRNAs were identified, including 20 upregulated and 30 downregulated miRNAs, in HCC tumor tissues compared to matched adjacent tumor-free tissues. The top three upregulated (miR-221-3p, miR-222-3p, and miR-18-5p) and downregulated (miR-375, miR-214-3p and miR-378d) miRNAs, ranked by |log2 fold change (log2FC)|, were chosen and their potential target genes were predicted. Two gene sets, targeted by the upregulated and the downregulated miRNAs, were identified respectively. GO and KEGG pathway analysis showed that the predicted target genes of upregulated and downregulated miRNAs were mainly enriched in the cell cycle and cancer-related pathways. The top ten hub nodes of gene sets ranked by degrees were identified as hub genes. Analysis of miRNA-hub gene network showed that miR-221-3p and miR-375 modulated most of the hub genes, especially involving regulation of TP53. The q-PCR results showed that miR-221-3p and miR-375 were markedly upregulated and downregulated, respectively, in HCC cells and HCC clinical tissue samples compared to non-tumoral tissues. Furthermore, miR-221-3p overexpression significantly enhanced proliferation, HBV-DNA replication, as well as the migration and invasion of HCC cells, whereas miR-375 overexpression resulted in opposite effects. Western blotting analysis showed that the overexpression of miR-221-3p and miR-375 reduced and increased TP53 expression, respectively.

Conclusion

The present study revealed that miR-211-3p and miR-375 may exert vital effects on cell proliferation, HBV-DNA replication, cell migration, and invasion through the regulation of TP53 expression in HCC.

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<![CDATA[Recurrence Rate in a Patient Treated with Colon Resection Followed by Chemotherapy in Comparison to a Patient Treated with Colon Resection without Chemotherapy]]> https://www.researchpad.co/product?articleinfo=N65f38e97-728c-4c50-87ba-2e1f37abee04

Given that colon cancer is one of the most prevalent cancers worldwide, it is essential to employ strategies to try to reduce its incidence and recurrence rate. Though colon cancer is a sporadic disease in the vast majority of cases, multiple risk factors are linked to this disease, namely, obesity and cigarette smoking. Additionally, not many studies have been done in Saudi Arabia studying the recurrence rate of colon cancer. Therefore, we conducted a retrospective cohort study at King Khalid Hospital, King Abdulaziz Medical City, National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia to investigate the recurrence rate of colon cancer in patients treated with complete colon resection followed by chemotherapy versus patients treated with colon resection alone via electronic and paper medical records. A total of 120 patients were included in this study; 61 were males (50.8%) and 59 were females (49.2%). According to our findings, the recurrence rate in patients who underwent surgical resection with adjuvant chemotherapy was 15.6% (n = 10), while the recurrence rate in patients with surgery alone was 21.4% (n = 12). Cancer recurrence is associated with significant morbidity and mortality. Therefore, further studies should be done to investigate the recurrence rate in patients with risk factors to identify and deal with the causes of recurrence.

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<![CDATA[A Rare Cause of Intestinal Pseudo-obstruction: Gastrointestinal Amyloid]]> https://www.researchpad.co/product?articleinfo=N02f46774-587f-4285-a260-12e476d7c1e8

Amyloidosis is characterized by extracellular deposition of the amyloid protein. It can affect multiple organ systems but it most commonly affects the heart, kidney and gastrointestinal (GI) tract. It can occur sporadically or in association with other conditions like multiple myeloma, chronic inflammatory diseases, infections etc. Its involvement of the gastrointestinal tract is rare and diffuse. It has variable manifestations in GI tract from involving the stomach to the large bowel including liver. We present a case of 55 year old Caucasian male with recent diagnosis of multiple myeloma who presented with recurrent episodes of small bowel obstruction which was later found to be caused by amyloid deposition.

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<![CDATA[A Common Medication with an Uncommon Adverse Event: A Case of Doxycycline-induced Pancreatitis]]> https://www.researchpad.co/product?articleinfo=N7593e528-58b0-474c-ac26-763cce1e0ec1

Drug-induced pancreatitis is a rare entity. The diagnostic criteria for drug-induced pancreatitis include the development of pancreatitis during drug therapy, elimination of all other possible causes, resolution with discontinuation of the offending drug, and reappearance on using the same drug. Several drugs have been implicated in having an association with pancreatitis. Tetracyclines are considered to be a Class I medication (medications implicated in greater than 20 reported cases of acute pancreatitis). However, there are very few reported cases of doxycycline-induced acute pancreatitis. We report the case of a 55-year old male who presented to the emergency department (ED) with three days of progressively severe and constant mid-epigastric abdominal pain. On evaluation, he was found to have elevated lipase levels. Computed tomography (CT) scan of his abdomen revealed findings consistent with pancreatitis without any evidence of gallstones or common bile duct dilation. He denied alcohol use, trauma, and insect bites or stings. His calcium and triglyceride levels were within normal limits. His blood cultures did not show any bacterial growth. He had recently been initiated on doxycycline for concerns of cellulitis and had begun to develop abdominal pain seven days after the initiation of doxycycline. He had completed his antibiotic course on the day of presentation to the ED. He had no other recent medication changes. He had subsequent improvement of symptoms off of the doxycycline and with supportive care. Given that all other causes of pancreatitis had been excluded and that he had been initiated on doxycycline prior to presentation, the etiology was attributed to being likely secondary to doxycycline use. Our case highlights the importance of reviewing outpatient medications by the hospital medicine team and awareness of rare triggers for acute pancreatitis.

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<![CDATA[A Case of Intussusception in a Patient with Marijuana Use: Coincidence or Possible Correlation?]]> https://www.researchpad.co/product?articleinfo=N8fb2c578-cb8a-4914-9bf9-9971012e4b7f

'Intussusception' means invaginating or telescoping and is caused by any condition that disrupts the normal physiological mechanism of intestinal peristalsis. Intussusception is rare in adults with an incidence of two to three cases per population of 1,000,000 annually. The most common cause of intussusception in adults is a neoplasm. In this case report, we are describing the case of a 22-year-old female with a past medical history of chronic constipation and a 60-pound unintentional weight loss who presented with the sudden onset of progressively worsening, severe abdominal pain associated with nausea, episodes of non-bloody, non-bilious emesis, and dark-colored loose stools. The patient’s social history was significant for extensive marijuana use for more than one year. Upon presentation, vitals were significant for mild bradycardia and examination was remarkable for diffuse abdominal pain. Initial laboratory testing was positive only for lactic acidosis. A computed tomography (CT) scan of the abdomen and pelvis revealed small bowel intussusception in the left hemiabdomen, along with periportal edema, and a small amount of pericholecystic fluid. The patient underwent both upper endoscopy and colonoscopy but no lead points for the intussusception could be identified. The patient responded to conservative management, including bowel rest, which resulted in the resolution of the intussusception on a follow-up small bowel series. Intraluminal irritants as the possible etiology of intussusception should be considered in the absence of a pathological lead point. Marijuana has been shown to act on various bowel segments and disrupts gastrointestinal motility through inhibition of cholinergic mechanisms. We believe the chronic use of marijuana could be the possible etiology of intussusception observed in our patient. Therefore, this case brings attention to the adverse effects of marijuana in light of increasing legalization and the increasing therapeutic use of marijuana and its derivatives.

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<![CDATA[Association of Hepatitis B Virus DNA Level and Follow-up Interval With Hepatocellular Carcinoma Recurrence]]> https://www.researchpad.co/product?articleinfo=Ndaf115ef-b64b-4924-b46a-0c6f0b85ef0e

This prognostic study evaluates the feasibility and availability of a novel hepatitis B virus DNA index to assess the prognosis of patients with hepatitis B virus–related hepatocellular carcinoma.

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<![CDATA[Identification of exosomal miRNAs associated with the anthracycline-induced liver injury in postoperative breast cancer patients by small RNA sequencing]]> https://www.researchpad.co/product?articleinfo=Ne200efd1-a76e-4a00-891e-33814e709835

Background

Anthracycline-induced liver injury (AILI) is one of the serious complications of anthracycline-based adjuvant chemotherapy for postoperative breast cancer patients. Exosomal miRNAs, as signaling molecules in intercellular communication, play the essential roles in drug-induced liver injury (DILI). However, the expression profiles of them in patients with AILI remains unknown.

Methods

Seven post-chemotherapy patients were recruited in this study. After isolated plasma-derived exosomes, small RNA sequencing revealed exosomal miRNA profiles and differentially expressed miRNAs (DE-miRNAs) were identified between the liver injury group and non-liver injury group. miRTarBase and miRDB were used to predict the potential target genes of DE-miRNAs. DILI-related genes were downloaded from the CTD Database. The intersection of predicted genes and DILI-related genes were identified as the AILI-related target genes of the DE-miRNAs. GO annotation and KEGG pathway enrichment analysis were performed by the DAVID database. Furthermore, the protein-protein interaction (PPI) network was established by the STRING database and essential exosomal miRNAs were identified via Cytoscape software.

Results

A total of 30 DE-miRNAs and 79 AILI-related target genes were identified. AILI-related target genes of the DE-miRNAs are significantly enriched in NOD-like receptor signaling pathway, the HIF-1 signaling pathway, and the FoxO signaling pathway. Then, the hub genes were screened and we discovered that IL-6 and SOD2 are the most critical genes that may be involved in the development of AILI through the activation of immune response and the occurrence of oxidative stress, respectively. In addition, we found that miR-1-3p could potentially regulate most of the hub genes in the miRNA-hub gene network.

Conclusion

We explored the potential functions of DE-miRNAs and suggested exosomal miR-1-3p might be the essential exosomal miRNA in the pathogenesis of AILI. Moreover, our study provided an experimental basis for experimental verification to reveal the actual function and mechanism of miRNAs in AILI.

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<![CDATA[Ursolic acid improves the bacterial community mapping of the intestinal tract in liver fibrosis mice]]> https://www.researchpad.co/product?articleinfo=N8beab16a-fc77-4bbe-9676-10e62a380b31

Liver fibrosis often appears in chronic liver disease, with extracellular matrix (ECM) deposition as the main feature. Due to the presence of the liver-gut axis, the destruction of intestinal homeostasis is often accompanied by the development of liver fibrosis. The inconsistent ecological environment of different intestinal sites may lead to differences in the microbiota. The traditional Chinese medicine ursolic acid (UA) has been proven to protect the liver from fibrosis. We investigated the changes in the microbiota of different parts of the intestine during liver fibrosis and the effect of UA on these changes based on high-throughput sequencing technology. Sequencing results suggest that the diversity and abundance of intestinal microbiota decline and the composition of the microbiota is disordered, the potentially beneficial Firmicutes bacteria are reduced, and the pathways for functional prediction are changed in the ilea and anal faeces of liver fibrosis mice compared with normal mice. However, in UA-treated liver fibrosis mice, these disorders improved. It is worth noting that the bacterial changes in the ilea and anal faeces are not consistent. In conclusion, in liver fibrosis, the microbiota of different parts of the intestines have different degrees of disorder, and UA can improve this disorder. This may be a potential mechanism for UA to achieve anti-fibrosis. This study provides theoretical guidance for the UA targeting of intestinal microbiota for the treatment of liver fibrosis.

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<![CDATA[A Mysterious Case of Recurrent Acute Hyperammonemic Encephalopathy]]> https://www.researchpad.co/product?articleinfo=N3ec571c8-5898-446e-a0ef-a6433bd88d55

Ammonia is a well-recognized neurotoxin. Awareness about hyperammonemia, in the absence of liver cirrhosis, may help in lifesaving, prompt diagnosis, and treatment. We present a case of a 53-year-old male who presented to the emergency department (ED) with altered mental status (AMS). He was unresponsive with occasional eye opening. Initial labs were normal except for mildly elevated blood alcohol level. Serum ammonia levels were very high (305 umol/L). He improved with lactulose. He had similar admissions later on. Urine orotic acid levels were high confirming ornithine transcarbamylase (OTC) deficiency. Noncirrhotic hyperammonemia as a cause of AMS remains a diagnosis of exclusion requiring high index suspicion. Very few cases of late inborn errors of urea cycle disorders (UCDs) have been reported in the literature. Our case highlights the importance of early diagnosis of UCDs and that outcome can be excellent if treated aggressively. Once identified, adult-onset forms of the UCDs have a good prognosis-largely due to the initiation of preventative measures and earlier recognition of exacerbations.

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<![CDATA[Chronic Abdominal Pain: A Case of Giant Fecalith in the Distal Jejunum]]> https://www.researchpad.co/product?articleinfo=N435bcd89-1765-4534-92c7-a634c2247911

A fecalith is a mass of an accumulation of hardened fecal matter that is seen in patients with Chagas disease, Hirschsprung’s disease, and inflammatory bowel disease. In this article, we report a case of a 53-year-old female with chronic abdominal pain who was admitted with progressive weight loss, near syncope episode, and serum potassium of 2.6 mg/dL. An abdominal computed tomography (CT) scan revealed a left lower quadrant complex mass measuring 10.3 cm, with asymmetrical wall thickening and inflammatory stranding, non-discarding the compromise of the small bowel and consequent mild small bowel distention. A fecalith of 10.3 x 10.9 x 8.7 cm was found during an exploratory laparotomy in the small intestine. We report this rare case of distal jejunum fecalith accompanied by chronic pain.

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<![CDATA[Mucosa-associated Lymphoid Tissue Lymphoma of Colon: A Case Report and Literature Review of Rare Entity]]> https://www.researchpad.co/product?articleinfo=N4b18df2b-15c8-4dcf-9195-c803b8fe43af

Mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) accounts for approximately 5% of non-Hodgkin lymphomas, and the gastrointestinal (GI) tract is the most common site of involvement. The stomach and small intestine are the most common sites of involvement in the GI tract. Colonic MALT lymphoma is a rare condition that comprises only 2.5% of MALT lymphomas and less than 0.5% of all colon cancers. They usually present as colon mass or polyps. In this case report, we present a case of colonic MALT lymphoma diagnosed on random colon biopsies which is very rare.

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<![CDATA[Recent Anti-platelet Therapy Revealing Underlying Undiagnosed Gastrointestinal Stromal Tumor in Otherwise Healthy Patient]]> https://www.researchpad.co/product?articleinfo=Nef2631f4-4595-40dc-9f12-6ad7390c5bd0

Gastrointestinal stromal tumors (GIST) are uncommon tumors of the gastrointestinal (GI) tract that arise from primitive mesenchymal cells. Usually, GIST presents as chronic gastrointestinal symptoms or obscure gastrointestinal bleed. Not many cases have been reported in the literature with acute symptoms in the setting of recent aspirin use. We report a case of 70-year-old male otherwise healthy who presented to the hospital with the complaint of black tarry stool for the past two days after taking one tablet of aspirin once a day for two days. The patient underwent upper endoscopy which showed a moderate size polypoid mass in the gastric fundus. Initially, standard endoscopic biopsy was negative for malignancy, due to high suspicion for GIST, later the patient underwent upper endoscopic ultrasound with fine-needle aspiration which confirmed low-grade GIST.

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<![CDATA[Hemorrhoidal disease and chronic venous insufficiency: Concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research)]]> https://www.researchpad.co/product?articleinfo=Nfe171234-9ec3-4822-a310-daef5ab6bce4

Abstract

Background and Aim

The CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was conducted to provide data on patients presenting with hemorrhoidal disease (HD) in clinical practice and to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk factors.

Methods

This international, noninterventional study enrolled adult patients attending a consultation for hemorrhoidal complaints. The questionnaire completed by physicians established the subjects' demographic and lifestyle characteristics and collected information on HD grade and symptoms and signs of CVD.

Results

A total of 5617 patients were analyzed. Symptoms commonly reported were bleeding (71.8%), pain (67.4%), swelling (55.0%), itching (44.1%), and prolapse (36.2%). Multivariate analysis revealed the variables with the strongest association with HD severity were older age, higher CVD CEAP (Clinical manifestations, Etiologic factors, Anatomic distribution of disease, and underlying Pathophysiology) class, constipation, and male gender (all P < 0.0001). Elevated BMI was a risk factor for HD recurrence. Among women, number of births had a significant association with both HD grade and recurrence. The presence of CVD, reported in approximately half the patients (51.2%), was strongly associated with advanced grade of HD (P < 0.0001). Treatments most commonly prescribed were venoactive drugs (94.3%), dietary fiber (71.4%), topical treatment (70.3%), analgesics (26.3%), and surgery (23.5%).

Conclusions

CHORUS provides a snap shot of current profiles, risk factors, and treatments of patients with HD across the globe. The coexistence of HD and CVD in more than half the study population highlights the importance of examining for CVD among patients with a hemorrhoid diagnosis, particularly when shared risk factors are present.

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