Gastroenterol. Insights, Volume 6, Issue 1 (December 2015) – 4 articles

We present a case of an 83-year-old woman with end-stage renal disease and hyperphosphatemia treated with sevelamer carbonate, who underwent subtotal colectomy for diffuse bowel necrosis and two perforations in the transverse colon. Histologic examination revealed ischemic colitis with crystals consistent with sevelamer carbonate embedded in ulcer debris and within the colonic wall in areas of transmural necrosis. This is a novel cause of drug-induced ischemic colitis with subsequent perforation that has not yet been reported in the literature. Clinicians and pathologists should be aware of the potential complications of sevelamer use and the histologic features of sevelamer-induced colonic injury. Full article

A 35-year-old male with no prior medical history presented for evaluation of multi-year history of dysphagia to both solids and liquids. He underwent esophagogastroduodenoscopy revealing linear furrows with ring-like esophagus. Pathology of biopsies showed findings consistent with eosinophilic esophagitis (EoE). This is a newly recognized disease entity with a rapidly increasing prevalence that cannot be entirely accounted for by the increasing awareness in medicine. All patients with clinical suspicion of EoE should undergo esophageal biopsies regardless of endoscopic findings, as normal endoscopy can be seen in up to 17% of cases. Numerous non-specific endoscopic findings have been described, including trachealization, felinization, linear furrows, crepe paper mucosa, and longitudinal shearing. We present a unique and neverbefore seen image of EoE that accentuates the findings that may be seen endoscopically Full article

Anemia with occult gastrointestinal bleeding (OGIB) is a common reason for inpatient gastroenterology consultation and endoscopy. However, the utility of inpatient endoscopy in this setting is unclear. The aim of this paper is to determine variables that predict positive endoscopic examinations for inpatients presenting with anemia and OGIB. We performed a prospective observational study of consecutive hospitalized patients between March 2013 and April 2014 with anemia and OGIB. For patients undergoing inpatient endoscopic evaluation, logistic regression was used to determine which variables were associated with detecting etiology of OGIB. An occult bleeding score (OBS) was created using receiver operating characteristics and area under the curve (AUC) analysis to predict detection of bleeding source and need for endoscopic intervention. Of the 74 patients identified, 55 (74%) underwent endoscopic evaluation, of whom 28 patients had a source of OGIB identified. Patients with malignancy (OR 7.25, 95%CI 1.06-144) were more likely to have a bleeding source identified on endoscopy, whereas patients with higher admission hemoglobin levels were less likely to have a detected source (OR 0.62, 95%CI 0.41-0.86). The OBS was constructed by assigning a point each for malignancy and admission hemoglobin <8.2 g/dL. The OBS predicted detection of etiology of bleeding and endoscopic intervention with an AUC of 0.79 and 0.75. The yield of endoscopy in determining a bleeding source in patients with OGIB is significant particularly in patients with malignancy or a low hemoglobin level. A simple score can assist in determining whether inpatient endoscopy is warranted in this population. Full article