This ulcer was identified in a 26 year old and determined to be due to Strongyloides stercoralis infection. From Clin Gastroenterol Hepatol Nov 2016; DOI: http://dx.doi.org/10.1016/j.cgh.2016.04.019 “This case also highlights the importance of including strongyloidiasis in the differential diagnosis when a patient presents with ulcer bleeding and eosinophilia.”
Related blog post: Foreign Bodies in Children -Expert Guidance | gutsandgrowth
In their introduction (KP Quinn et al. Clin Gastroenterol Hepatol 2016; 14: 1296-1301), the authors state the following: “Despite the widely held notion that pouchitis is a rare complication in FAP following IPAA, clinical experience at our institution suggests [it]…is underestimated.”
Methods: retrospective cohort study of all FAP patients who underwent IPAA (ileal ouch-anal anastomosis) from 1992-2015 at their institution (Mayo clinic), n=113.
Key findings:
My take: While pouchitis does occur more commonly in IBD following IPAA, it does occur with FAP more frequently than previously described.
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I’m not sure this will take off, but a recent study (Z Liao et al. Clin Gastroenterol Hepatol 2016; 14: 1266-73) showed the feasibility and accuracy of using a magnetically controlled capsule endoscopy (MCE) to detect diseases in the stomach with a high rate of accuracy.
This was a multicenter blinded study comparing MCE with conventional gastroscopy in 350 patients (mean age 46.6 years). Technique: MCE system relied on a guidance robot with a C-arm. The capsule could also be manipulated manually with a joystick. Examinations took no longer than 30 minutes and required no sedation. To improve visualization, a defoaming agent and pronase granules (to remove mucus) were given. Also, if visualization was not adequate, the patient was instructed to infest water.
Key findings:
In patients capable of swallowing the capsule, MCE could allow very good inspection of the stomach without sedation and at much lower cost. In adults, nearly a third would still need conventional gastroscopy to obtain biopsies and MCE would not be ideal for detecting duodenal diseases like celiac disease.
My take: I doubt MCE will be used much in this country anytime soon.
this is art?
Briefly noted: RM Navari et al. NEJM 2016; 375: 134-42. Olanzapine (marketed as Zyprexa), compared with placebo, in combination with dexamethasone, aprepitant (or fosaprepitant) and a 5-hydroxytryptomaine type 3 antagonist (eg palonosetron, ondansetron, or granisetron) helped reduced nausea/vomiting. Among a total of 380 patients, 74% in the olanzapine group had no nausea/vomiting compared with 45% in the placebo group in the first 24 hours. In the 1st 120 hours, the rates of no nausea/vomiting were 37% vs. 22%. A “complete response,” defined as no emesis episodes and no rescue medications, occurred in 64% vs 41% in the 1st 120 hours. The most concerning side effect reported was severe sedation which was reported in 5%.
Arthur Ravenel Jr Bridge
From Gastroenterology & Endoscopy News July 2016: Tofacitinib Effective in Refractory and Severe UC
An excerpt:
Tofacitinib (Pfizer), an oral agent already approved for certain patients with rheumatoid arthritis, can induce clinical remission in up to 25% of individuals with moderate to severe, refractory ulcerative colitis (UC) and clinical response in as many as 60% of these patients.
The results, based on two placebo-controlled trials involving more than 1,100 patients, showed the drug also increased the risk for serum lipid elevations but was otherwise safe. Researchers presented the data at the 2016 annual meeting of the European Crohn’s and Colitis Organization (ECCO; oral presentation 019)…
The new data are from the OCTAVE Induction 1 and Induction 2 trials, identically designed, randomized, double-blind and placebo-controlled Phase III studies…In the OCTAVE 1 trial, 476 patients received 10 mg of tofacitinib orally twice daily for eight weeks and 122 received an oral placebo. In OCTAVE 2, 429 and 112 patients were randomized to receive the two regimens, respectively.
Screenshot from gastroendonews.com
Also from Gastroenterology & Endoscopy News August 2016: Update on Diagnosis and Treatment for Ulcerative Colitis This article provides a succinct summary regarding diagnosis and treatments of ulcerative colitis; treatments discussed include emerging therapies like tofacitinib.
A recent review elaborates on the newest methods for endoscopic control of bleeding. Topics included caplock clips, endoscopic suturing, and hemostatic sprays.
Full text: New Endoscopic Technologies and Procedureal Advances for Endoscopic Hemostasis (from Clinical Gastroenterology and Hepatology)
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Briefly noted:
Editorial: MH Nathanson, N Terrault Hepatology 2016; 64: 328-29. This very unusual editorial explains a published erratum of 2010 paper reversing a claim that patients with Hepatitis B who had achieved HBsAg clearance had markedly decreased rates of hepatocellular carcinoma (37 cases per 100,000 person-years). After correction of the arithmetic error, the rate of HCC in this population was actually 442 cases per 100,000 person-years. The editorial does reiterate that studies have shown lower HCC among those with low HBV DNA which is a prerequisite for HBsAg clearance. Exact risk is difficult in this population due to infrequent development of HBsAg loss and infrequent development of HCC. The message: While loss of HBsAg may lower HCC risk, there remains a need for HCC surveillance.
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Thanks to Ben Gold for this reference: Y. Zhulina et al. Aliment Pharm Ther 2016; 44: 495-504.
Methods:
Key finding:
My take: Another study showing that stool calprotectin is quite useful. How long will it be until I will not need to write letters to insurance companies to get this test covered?
Also noted in the same issue:
“The safety of autologous and metabolically fit bone marrow mesenchymal stromal cells in medically refractory Crohn’s disease – a phase 1 trial with three doses” (pages 471–481) T. Dhere, I. Copland, M. Garcia, K. Y. Chiang, R. Chinnadurai, M. Prasad, J. Galipeau and S. Kugathasan. Aliment Pharm Ther 2016; 44: 471-81. This study examined the use of mesenchymal stromal cells in 12 patients.
In conclusion, a single infusion of fresh autologous bone marrow-derived mesenchymal stromal cells propagated ex vivo using a non xenogeneic human platelet lysate growth supplement at doses ranging 2–10 million cell/kg BW was well tolerated in patients with medically refractory moderate to severe Crohn’s disease in this preliminary study. Our data neither addressed long-term safety nor sustained efficacy. However, this study informs that a future phase 2 study
A previous study of mesenchymal stromal cells was briefly discussed in a previous blog: Sanjay Gupta is Wrong…about Stem Cell Therapy
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