Kostas Sideridis

Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis.

Background Multifactor prognostic scoring systems have been developed for acute pancreatitis to identify those patients with a potentially poor prognosis. A similar system for patients with acute cholangitis is still lacking. Goals To identify common clinical, biochemical, and etiologic variables that can be used to predict mortality and the need for early endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute cholangitis. Study A retrospective study of 108 patients with acute cholangitis was performed at a single center. Univariate analysis and logistic regression were used to identify variables that were significantly associated and predictive of mortality and need for early ERCP. Results Univariate analysis identified 18 variables significantly associated with mortality and 15 variables that predicted the need for early ERCP. Through logistic regression total bilirubin (P<0.01), partial prothrombin time (P<0.01), and presence of a liver abscess (P<0.01) were found to be significant in predicting mortality. Alanine aminotransferase (P<0.01) and white blood cell count (P<0.01) were determined to be predictive of a need for early ERCP. The scoring systems for predicting mortality (93.9%, 80.7%) and early ERCP (98%, 91%) were both highly sensitive and specific, respectively. Conclusions Acute cholangitis is a disease that presents with varying severity. We report a scoring system that can be used to identify patients at high risk of early mortality and those that may benefit from earlier ERCP.

Protracted hiccups due to severe erosive esophagitis : A case series

Background Hiccups although a common annoyance of life, have been linked with significant morbidity and even death. There are numerous causes of prolonged hiccups, including diseases of the gastrointestinal tract. Hiccups are reported to represent an atypical manifestation of gastroesophageal reflux disease. Cases We report 4 cases of prolonged hiccups in patients who failed to respond to initial treatment with abortive neurologic medications and who subsequently improved on proton-pump inhibitors. Endoscopic examination revealed severe reflux esophagitis. Conclusion Hiccups are an atypical manifestation and may represent a more severe course of gastroesophageal reflux disease.

Buried Barrett's Esophagus Presenting as a Subepithelial Nodule.

A 52-year-old man with no prior history of Barrett’s esophagus was referred for endoscopic evaluation of gastrointestinal reflux. Small islands of Barrett’s were seen with a subepithelial nodule (a). Volumetric laser endomicroscopy for evaluation of Barrett’s esophagus showed glands (b, yellow arrow) below the epithelial layer (b, red arrow) and lamina propria (b, green arrow) at the area of the nodule consistent with buried Barrett’s esophagus. Endoscopic mucosal resection confirmed the buried Barrett’s on histology (c). (Informed consent was obtained from the patient to publish these images.)