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Retirement of Dr. Denis McCarthy from the Editorial Board
Henry C. Lin
doi : 10.1007/s10620-024-08700-6
Volume 69, pages 4317–4318, (2024)
It is with gratitude that Digestive Disease and Sciences (DDS) announces the retirement of Professor Denis McCarthy, MD, PhD from the Editorial Board. Dr. McCarthy served previously as Chief, Division of Gastroenterology and Hepatology at the University of New Mexico (UNM) and Chief, Section of Gastroenterology at the New Mexico VA Health Care System, Albuquerque, NM. At UNM, he played a major role in developing the Fellowship Program in Gastroenterology. During his time of service on our Editorial Board, Dr. McCarthy extended his educational efforts to the much larger audience of DDS readership by editing/co-writing 77 articles for the monthly “UNM Clinical Case Conferences”. Almost all these articles began as divisional case-based teaching at UNM where the diagnosis was unknown to all but the presenting fellow. Dr. McCarthy would moderate the case discussion involving fellows and faculty, charge the presenting fellow with writing up the case for publication, work with them in reviewing the literature on all aspects of the case, particularly those relating to pathogenesis and differential diagnosis, and mentor the fellows on their writing to include a comprehensive, critical discussion. Dr. McCarthy was fully active, both clinically and educationally, until retiring at age 82, after 60 years in medicine. He still attends today UNM’s GI and liver conferences, shares his wealth of GI knowledge, and is still everyone’s favorite teacher!
A Case of Imaging-Negative Distal Cholangiocarcinoma Diagnosed by Novel Spyglass Transoral Cholangioscope
Jun-li Shi, Ping Li, Yang Liu, Fan Zhou, Bing-qing Li & Lei Wang
doi : 10.1007/s10620-024-08713-1
Volume 69, pages 4319–4320, (2024)
A 56-year-old male was admitted for abdominal pain, fever, and jaundice. MRCP imaging showed dilation of extrahepatic bile ducts (Fig. 1A). Endoscopic retrograde cholangiopancreatography confirmed bile duct dilation (Fig. 1B). The Spyglass® direct visualization system was used to examine the duct lumen, which revealed villous tumors in the distal bile duct (Fig. 1C) that were biopsied, revealing adenocarcinoma (Fig. 1D). Following a multidisciplinary consultation, a pancreaticoduodenectomy was performed. While commonly used diagnostic methods for cholangiocarcinoma often have low sensitivity [1], Spyglass® examination can enhance sensitivity up to 99% [2], revealing features such as tumor vessels, invasive stenosis, finger-like and papillary processes, villous masses covering the surface, concentric round stenosis, granular mucosa, irregular mucosal nodules, [3]. In this case, villous and nodular masses were noted. We hope that this case may encourage clinicians to consider Spyglass® as a diagnostic tool for patients with dilated extrahepatic bile ducts with no other evidence of tumor.
Prostatic Adenocarcinoma Taking an Unusual Route: Rare Case of Pancreatic Metastasis
Shubham Kumar, Reetu Kundu, Sachin Hosahally Jayanna, Piyush Aggarwal, Ashwani Sood & Surinder Singh Rana
doi : 10.1007/s10620-024-08706-0
Volume 69, pages 4321–4324, (2024)
A 56-year-old man was diagnosed with prostate adenocarcinoma in 2023. He received six cycles of chemotherapy followed by maintenance hormonal therapy. The patient presented with intermittent epigastric pain for 3 months. His prostate-specific antigen (PSA) level was elevated (48 ng/mL). 68 Ga-PSMA-11 Positron emission tomography-computed tomography (Fig. 1) demonstrated a mass in the head of the pancreas measuring 5.7?×?4.5?×?4.8 cm along with a second lesion in the distal body measuring 2.1?×?1.5?×?2 cm. Endoscopic ultrasound (EUS) performed confirmed the presence of pancreatic masses and identified an additional lesion in the left adrenal gland (Fig. 2). He underwent EUS-guided fine needle aspiration of all three lesions. Histopathological examination revealed metastatic adenocarcinoma (Fig. 3). Immunohistochemistry (IHC) was performed, which showed prostate-specific antigen (PSA) positivity (Fig. 4) and confirmed metastasis from prostate adenocarcinoma
Endoscopic Ultrasound-Guided Coil and Glue Injection for Bleeding Duodenal Varix Using a Forward Viewing Echoendoscope
Beenal Dhooria, Sachin Hosahally Jayanna, Ajay Gulati, Gaurav Agrawal, Rajesh Gupta & Surinder Singh Rana
doi : 10.1007/s10620-024-08709-x
Volume 69, pages 4325–4327, (2024)
A 58-year-old female presented with melena. She was diagnosed with metabolic dysfunction-associated steatotic liver disease 2 years ago. Physical examination of patient revealed pallor, tachycardia and splenomegaly. At admission she had pancytopenia with hemoglobin of 6 gm/dl, and received 2 units of packed red blood cells, pantoprazole, terlipressin and antibiotics. Endoscopy performed elsewhere revealed an isolated duodenal varix (DV) in second part of the duodenum with stigmata of recent bleeding (Fig. 1) and the patient was referred to our tertiary care center. Computed tomography (CT) splenoportovenography showed DV with prominent retroperitoneal venous collaterals in relation to the C loop of the duodenum (Fig. 2). Patient was planned for Endoscopic ultrasound (EUS) guided obliteration of the DV but the varix could not be well visualized on linear echoendoscope. Therefore, forward forward-viewing echoendoscope (FVE) (Olympus TGF-UC180J) was used and patent DV with venous flow pattern was visualized (Fig. 3). The DV was successfully obliterated using EUS-guided coil (Nester, Cook Medical, Bloomington, Ind, USA) and glue injection (Fig. 3). Post-procedure CT abdomen showed coils and glue in DV causing beam hardening artifacts and no filling of DV confirming its eradication (Fig. 4).
Hepatic Amyloidosis Without Hepatomegaly
Shichuan Tang, Lanlan He, Tingfeng Huang, Yongyi Zeng & Liqing Zheng
doi : 10.1007/s10620-024-08731-z
Volume 69, pages 4328–4329, (2024)
A 63-year-old man presented with abdominal pain for 2 months. Initial laboratory tests showed elevated ?-glutamyltransferase, alkaline phosphatase, and a positive urine protein. A contrast-enhanced computed tomography (CT) scan of the upper abdomen showed no hepatomegaly. However, the hepatic parenchyma showed inhomogeneous enhancement in the arterial and portal phases and multiple patchy slightly hypodense shadows in the delayed phase (Fig. 1A). A liver biopsy was performed. H&E staining showed deposition of eosinophilic material in the hepatic sinusoids (Fig. 1B) and Congo red staining was positive (Fig. 1C). A diagnosis of hepatic amyloidosis (HA) was made.
A Case of Mysterious Multiple Liver Masses in a CD40 Ligand Deficiency Child
Youhong Fang, Yang Liu & Jie Chen
doi : 10.1007/s10620-024-08711-3
Volume 69, pages 4330–4332, (2024)
A nine-year-old boy, diagnosed with CD40 ligand deficiency at six months of age, presented with mild diarrhea for one year and recent-onset fever of unknown origin. High-throughput sequencing of blood and bone marrow identified Penicillium marneffei infection; imaging revealed hepatomegaly with multiple liver masses (Fig. 1A). Liver biopsy revealed hepatocellular steatosis with local fibrous tissue hyperplasia and hyaline degeneration. Despite treatment with linazolamide, piperacillin, and voriconazole, his condition worsened; he developed bloody ascites and severe anemia. Colonoscopy revealed a phyllodes tumor in the transverse colon (Fig. 1B); pathology is shown in Fig. 2. The boy ultimately died from liver rupture and sepsis, complicated by liver neuroendocrine carcinoma with colon metastasis. CD40L deficiency is associated with a high risk of liver, pancreatic, and biliary malignancies, often metastatic and carrying a poor prognosis [1, 2]. Previous literature has documented ten cases of CD40L deficiency patients who developed neuroendocrine carcinoma (Supplement Table 1)
From Fragmented Data to Actionable Insights: Predicting HCC in Fontan Patients—A Call for Collaboration
Moira Hilscher & Sudhakar Venkatesh
doi : 10.1007/s10620-024-08678-1
Volume 69, pages 4333–4335, (2024)
Fontan-associated liver disease (FALD), a condition that occurs in nearly all patients who have undergone Fontan palliative repair for single ventricle congenital heart defects, can lead to devastating complications including cardiac cirrhosis and portal hypertension. Retrospective histologic studies identify sinusoidal fibrosis in all patients within 10 years of surgical repair [1], and other studies suggest that approximately 40% of patients with Fontan physiology develop cirrhosis within 30 years of Fontan repair [2]. Hepatocellular carcinoma (HCC), the most feared complication, is associated with a poor prognosis [3]. Though HCC in FALD is rare, its incidence and prevalence are expected to increase in the coming years since advances in medical care have enabled many patients with Fontan physiology to survive well into adulthood, often reaching their third or fourth decades of life [4, 5].
Chronic Abdominal Pain in Patients with Inflammatory Bowel Disease in Remission: A Continuing Challenge for Clinicians
Natasha Klemm & Sarvee Moosavi
doi : 10.1007/s10620-024-08716-y
Volume 69, pages 4336–4346, (2024)
Inflammatory bowel disease (IBD) is a chronic condition that includes ulcerative colitis and Crohn’s disease. It is characterized by a relapsing and remitting pattern that negatively impacts quality of life (QoL). Current goals of treatment involve symptomatic, biochemical, and endoscopic remission in a treat-to-target approach. Despite effective treatment and remission of IBD, many patients report frequent and isolated abdominal pain. A wide range of etiologies exist, including surgery-related, infections, pelvic conditions, immune-related, and systemic illnesses. Disorders of the gut–brain interaction (DGBI), frequently characterized by abdominal pain, are increasingly recognized in IBD patients, including those with quiescent disease. Various mechanisms are involved and numerous non-pharmacologic and pharmacologic therapies have been proposed. Hereby, we outline the pertinent findings of the literature on management of chronic abdominal pain, focusing on quiescent IBD
Predictors of Unplanned Health Care Utilization Among Children with Inflammatory Bowel Disease in a Rural Region of the Southeastern US
Catherine Gray BS, Reeda Shakir DO, Dmitry Tumin PhD & Chetan Mandelia MD
doi : 10.1007/s10620-024-08619-y
Volume 69, pages 4347–4354, (2024)
Pediatric Inflammatory Bowel Disease (IBD) imposes significant healthcare costs and strains emergency services. This study aimed to identify factors associated with unplanned healthcare usage among children with IBD in a rural, medically underserved region in the southeastern United States
Country Comfort? Risk Factors for Unplanned Healthcare Visits in Rural America in Children with IBD
Kelly Sandberg
doi : 10.1007/s10620-024-08687-0
Volume 69, pages 4355–4356, (2024)
Unplanned healthcare visits, defined as hospital readmissions and excess outpatient or emergency department visits, are seen across a variety of chronic conditions in pediatric patients [1,2,3]. In patients with inflammatory bowel disease (IBD), a condition that requires specialized knowledge to manage, access to providers with appropriate expertise may be limited in rural areas leading to more hospitalizations and greater emergency department utilization [4]. There is a dearth of health services research addressing chronic gastrointestinal diseases in the US, with the most recent substantial study over a decade old [5]; rural areas are typically underrepresented in health services research, which often focuses on large urban centers and uses secondary analyses of large data sets; and few studies address healthcare utilization in people with IBD. In this issue of Digestive Diseases and Sciences, Mandelia and colleagues [6] identify risk factors for unplanned healthcare visits in a rural region of the Southeastern United States among children with IBD
Extended Monitoring for Transition to Oral Corticosteroids in Acute Severe Ulcerative Colitis May Be Unnecessarily Prolonging Length of Stay
Sapphire Ear, James Cordero, Ryan McConnell, Fernando Velayos, Uma Mahadevan & Sara Lewin
doi : 10.1007/s10620-024-08679-0
Volume 69, pages 4357–4363, (2024)
There is no guideline regarding whether patients treated with intravenous corticosteroids for acute severe ulcerative colitis (ASUC) should be monitored in the hospital after transitioning to oral steroids. Our study aimed to: (1) compare rates of oral steroid transition failure and 30-day readmission between ASUC hospitalizations with extended inpatient monitoring compared to accelerated inpatient monitoring, and (2) identify predictors of oral steroid transition failure
Multimedia-Based Education Led to Improvement in Disease Knowledge Among Patients with Cirrhosis
Manisha Verma, Matthew Chan, Seyed Toroghi, Mark Gallagher, Kevin Lo & Victor Navarro
doi : 10.1007/s10620-024-08704-2
Volume 69, pages 4364–4372, (2024)
Current evidence shows limited patient understanding of liver disease, coupled with no standard guidelines or methods to offer patient education in a busy clinical environment. We developed multimedia-based education (MBE) for those with cirrhosis & tested its effectiveness in improving patient knowledge from baseline to 1 month
Integrative Analyses of Genes of Pediatric Non-alcoholic Fatty Liver Disease Associated with Energy Metabolism
Yijun Lin, Hong Ye, Yan Chen, Rui Zhang, Yuyun Chen & Weijie Ou
doi : 10.1007/s10620-024-08702-4
Volume 69, pages 4373–4391, (2024)
Pediatric non-alcoholic fatty liver disease (NAFLD) is a chronic steatosis of the liver associated with energy metabolism in children and adolescents, failure to intervene promptly can elevate the risk of developing hepatocellular carcinoma. Therefore, this study aimed to understand the underlying mechanism of pediatric NAFLD and investigate potential biomarkers and therapeutic targets.
Predicting Portal Pressure Gradient in Patients with Decompensated Cirrhosis: A Non-invasive Deep Learning Model
Zi-wen Liu, Tao Song, Zhong-hua Wang, Lin-lin Sun, Shuai Zhang, Yuan-zi Yu, Wen-wen Wang, Kun Li, Tao Li & Jin-hua Hu
doi : 10.1007/s10620-024-08701-5
Volume 69, pages 4392–4404, (2024)
A high portal pressure gradient (PPG) is associated with an increased risk of failure to control esophagogastric variceal hemorrhage and refractory ascites in patients with decompensated cirrhosis. However, direct measurement of PPG is invasive, limiting its routine use in clinical practice. Consequently, there is an urgent need for non-invasive techniques to assess PPG
Abnormal Autonomic Nervous Regulation in Patients with Globus Pharyngeus
Peter Liptak, Zuzana Visnovcova, Nikola Ferencova, Martin Duricek, Peter Banovcin & Ingrid Tonhajzerova
doi : 10.1007/s10620-024-08694-1
Volume 69, pages 4405–4415, (2024)
Globus pharyngeus could be described as a benign sensation of lump or foreign object in the throat. The etiology of the globus as a solitary syndrome is still unknown, but it is proposed that stress could have an important role in symptom emergence.
Association of Heterotopic Gastric Mucosa in the Upper Esophagus (HGMUE) with Pharyngolaryngeal Symptoms: A Systematic Review and Meta-Analysis
Xuanran Chen, Shunhai Zhou, Chaoyi Shi, Mingzhi Feng, GeSang ZhuoMa, Diyun Shen, Tianyue Wang & Jun Zhang
doi : 10.1007/s10620-024-08699-w
Volume 69, pages 4416–4429, (2024)
Heterotopic gastric mucosa in the upper esophagus (HGMUE) is considered to be accompanied by pharyngolaryngeal symptoms, whereas the association strength between HGMUE and pharyngolaryngeal symptoms remains controversial. This study assessed the strength of the association between HGMUE and pharyngolaryngeal symptoms using a meta-analytic approach.
Validation of a Hand-Held Point-of-Care Device to Measure Breath Hydrogen and Its Utility in Detecting Response to Antibiotic Treatment
Guillermo Barahona, Barry Mc Bride, Áine Moran, Ricky Harrison, Luisa Villatoro, Robert Burns, Bo Konings, Robert Bulat, Megan McKnight, Glenn Treisman & Pankaj J. Pasricha
doi : 10.1007/s10620-024-08583-7
Volume 69, pages 4430–4436, (2024)
Breath testing for small intestinal bacterial overgrowth (SIBO) is typically performed using clinic-based equipment or single-use test kits.
Efficacy and Safety of GLP-1 Agonists on Metabolic Parameters in Non-diabetic Patients with Inflammatory Bowel Disease
Joëlle St-Pierre, Jeremy Klein, Natalie K. Choi, Evan Fear, Silvana Pannain & David T. Rubin
doi : 10.1007/s10620-024-08720-2
Volume 69, pages 4437–4445, (2024)
Obesity in patients with IBD is increasing, accompanied by an increase in metabolic comorbidities. Although GLP-1 agonists have shown promise in weight reduction, their efficacy and safety in patients with IBD are underexplored. This study evaluated the impact of GLP-1-based therapies on weight loss and metabolic parameters in non-diabetic patients with IBD
Comparing Environmental Risk Factors at Diagnosis in Faroese and Danish Patients with Inflammatory Bowel Disease
Kári Rubek Nielsen, Frederikke Agerbo Modin, Jóngerð Midjord, Amanda Vang, Marjun á Fríðriksmørk Berbisá, Herborg Líggjasardóttir Johannesen, Jens Frederik Dahlerup, Vibeke Andersen, Anders Neumann, Jens Kjeldsen, Natalia Pedersen, Ebbe Langholz, Pia Munkholm, Turid Hammer & Johan Burisch
doi : 10.1007/s10620-024-08721-1
Volume 69, pages 4446–4457, (2024)
The incidence and prevalence of inflammatory bowel disease (IBD) in the Faroe Islands have increased drastically during the past 60 years, presumably due to changing environmental risk factors in a genetically susceptible population
Transition to Subcutaneous Infliximab vs Vedolizumab in Inflammatory Bowel Disease: A Prospective Multicenter Study
Mariabeatrice Principi, Irene Vita Brescia, Elisa Stasi, Silvia Mazzuoli, Angela Maria D’Uggento, Elena Equatore, Ilaria Lacavalla & Alfredo Di Leo
doi : 10.1007/s10620-024-08631-2
Volume 69, pages 4458–4466, (2024)
Transition from intravenous (IV) to subcutaneous (SC) administration is an option in inflammatory bowel disease (IBD) with Infliximab (IFX) or Vedolizumab (VDZ). The aim was to compare the adherence, the persistence in therapy, and quality of life (QoL) at baseline, at 6, at 12 months of SC IFX versus SC VDZ.
A Meta-Analysis of Cumulative Incidence of Hepatocellular Carcinoma After the Fontan Operation
Sophie Hansen, Richard Gilroy, Ian Lindsay, John R. Doty, Ross A. Butschek & Christopher J. Danford
doi : 10.1007/s10620-024-08470-1
Volume 69, pages 4467–4475, (2024)
Hepatic complications are increasingly recognized after the Fontan operation. The development of hepatocellular carcinoma (HCC) is associated with high mortality when diagnosed, but its incidence and risk factors are poorly understood. We conducted a systematic review and meta-analysis of the cumulative incidence of HCC after Fontan and associated risk factors
Preventive Measures and Risk Factors for Post-ERCP Pancreatitis: A Systematic Review and Individual Patient Data Meta-Analysis
Christina J. Sperna Weiland, Venkata S. Akshintala, Anmol Singh, James Buxbaum, Jun-Ho Choi, Badih J. Elmunzer, Evan S. Fogel, Jian-Han Lai, John M. Levenick, Timothy B. Gardner, Guan W. Lua, Hui Luo, Mike de Jong, Shaffer R. S. Mok, Veit Phillip, Vikesh Singh, Peter D. Siersema, Joost P. H. Drenth & Erwin J. M. van Geenen
doi : 10.1007/s10620-024-08693-2
Volume 69, pages 4476–4488, (2024)
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP, with limited studies comparing combined prophylactic measures and their efficacy relative to individual patient risk profiles.
IBD Knowledge Differs Among HCPs: Education Matters
Liqi Li
doi : 10.1007/s10620-024-08646-9
Volume 69, pages 4489–4490, (2024)
The study carried out by Vernon-Roberts et al. [1] examines the knowledge levels of various healthcare professional (HCP) groups in relation to Inflammatory Bowel Disease (IBD). A validated assessment tool called the IBD-KID2 survey was utilized to assess the knowledge of medical students, nurses, pharmacists, and dietitians. Although the study offers valuable perspectives on the differences in IBD knowledge among different HCP groups, there are certain aspects that could be enhanced or require further elaboration.
Inflammatory Bowel Disease Knowledge and Education Among Healthcare Professional Groups
Angharad Vernon-Roberts, Lucy Blay & Andrew S. Day
doi : 10.1007/s10620-024-08719-9
Volume 69, pages 4491–4492, (2024)
We were pleased to see that our previous research on the levels of inflammatory bowel disease (IBD)-specific knowledge in health care professional groups (HCP) [1] has prompted commentary [2, 3]. This work has built upon the development and validation of the IBD-knowledge inventory device (IBD-KID)-2 tool, as cited in our original HCP paper [1].
Neoplastic Pseudocirrhosis Pathophysiological Deepening
Antonio Manenti, Stefania Caramaschi, Gianrocco Manco & Luca Reggiani Bonetti
doi : 10.1007/s10620-024-08669-2
Volume 69, pages 4493–4494, (2024)
Neoplastic pseudocirrhosis (NPC), the clinical aspects of which have been comprehensively reported by Sadlik et al., deserves to be studied in depth from a pathophysiological point of view to understand it better and learn from it, given its increasing relevance in the current era of long-term anti-neoplastic chemotherapy and precise diagnostic imaging [1]. It usually represents the most advanced stage of a liver metastatic disease, the diagnosis of which is essentially clinical-radiological, rarely needing to be supported by histopathological data. We investigated its pathophysiology by correlating specific clinical-radiological signs with inherent histopathological observations, validated in the light of known features of common metastatic liver diseases. Neoplastic cells can reach the liver parenchyma by various routes, mainly vascular, represented by branches of the hepatic artery or portal vein, easily ‘capillarise’ or directly obstruct the hepatic sinusoids [2, 3]. This process, typical but not exclusive of hematological neoplasms, can also complicate carcinomas of various organs, especially if highly aggressive and undifferentiated [4]. Its widespread diffusion may increase intrahepatic portal resistance, leading to a general portal hypertension with secondary porto-systemic collaterals, splenomegaly and ascites. This abnormal hemodynamics may be mitigated by efficient collaterals developed between portal branches and hepatic vein roots within the liver parenchyma or sub-glissonian space, or by directing part of portal blood to the caudate lobe and its retro-hepatic veins, which inflow directly into the inferior vena cava [5,6,7,8]. Alternatively, portal hypertension may be pre-sinusoidal when intrahepatic portal branches are subject to neoplastic thrombosis or external compression by metastatic masses. Finally, neoplastic cells can reach the liver parenchyma, transported by blood flow refluxing from the superior or inferior vena cava into the hepatic veins and downstream into the central lobular veins. Hemodynamic damage is proportional to the area of congested liver parenchyma and ranges from a ‘limited’ Budd-Chiari syndrome with little or no effect on overall portal hemodynamics in the case of a single hepatic vein involvement, to a zone of congested liver lobules. This may complicate with an accelerated necro-apoptosis, followed by an interstitial fibrosis. The diagnostic contribution of radiological imaging is essential in all cases.
