Abhishek Gulati

IBD LIVE Case Series-Case 4: Worms in IBD: Friend or Foe.

LEARNING OBJECTIVES After completing this journal-based activity, physicians should be better able to: 1. Define the “hygiene hypothesis” of autoimmune diseases. 2. Understand the reasoning behind Trichuris suis ova (TSO) therapy for inflammatory bowel disease. 3. Know the key findings of trials using TSO in patients with Crohn’s disease and ulcerative colitis. 4. Be aware of the potential risks regarding helminth therapy. 5. Know the current opinion regarding TSO treatment in inflammatory bowel disease. 6. Be aware of the scope of complementary and alternative medicine (CAM) use in the United States, particularly among individuals with inflammatory bowel disease.

Esophageal Lichen Planus: Understanding a Potentially Severe Stricturing Disease

A 67-year-old woman with a long-standing history of recurrent dysphagia and esophageal strictures failed to respond to aggressive antireflux management. She required multiple dilations for symptomatic strictures that were discovered throughout the esophagus. Intralesional, topical, and systemic glucocorticoid therapies were utilized without resolution in symptoms. Several years after initial presentation, histopathology ultimately demonstrated lichenoid features and a diagnosis of esophageal lichen planus (ELP) was confirmed. However, as her symptoms had already become significantly disabling with severe strictures that carried an increased risk of endoscopic complications with dilation, she ultimately decided to undergo an esophagectomy for definitive treatment. Moreover, ELP may often go unrecognized for several years. Clinicians should consider ELP in the differential for dysphagia in middle- to elderly-aged women with or without a known history of lichen planus (LP) especially for those with findings of multiple or proximal strictures.

Immunoglobulin G4 (IgG4)-associated pouchitis - Part of IgG4 related disease? A case series and review of the literature.

BACKGROUND AND AIMS IgG4-mediated pouchitis was first described in 2011. The aetiology and pathogenesis of IgG4-associated pouchitis is unknown. Over the last four years, less than seventy cases of IgG-associated pouchitis have been reported from a pouchitis clinic in Cleveland. METHODS We report the first two cases of IgG4-associated pouchitis from our inflammatory bowel disease clinic and outside of Cleveland. CONCLUSION This highlights the fact that this entity could be more common than we think. It is important for general gastroenterologists to think about IgG4-mediated disease if the patient has refractory pouchitis, so early diagnosis and referral can be made. This would avoid the cost of expensive therapy and minimize antibiotic use which is what happened in our cases prior to this diagnosis being made.