Marcia Mitre

Schatzki ring and Barrett's esophagus: do they occur together?

Our purpose was to determine the prevalence of Barretts esophagus in the presence of Schatzki ring. We performed a retrospective case–control study with an endoscopic database. Barretts esophagus was present in 3 of 409 (0.73%) patients with Schatzki ring and in 16 of 888 (1.80%) patients without Schatzki ring. Short segment Barretts esophagus was present in 3 cases and 10 controls. Long segment Barretts esophagus was present in no cases and six controls. Logistic regression models adjusting for the presence of a hiatal hernia revealed a significant decrease in the odds of Barretts esophagus in cases compared to controls (OR, 0.24; 95% CI, 0.07–0.87; P = 0.029). Barretts esophagus is less prevalent in patients with Schatzki ring compared to patients without Schatzki ring. Long segment Barretts esophagus was not observed in patients with Schatzki ring. A responsible protective effect or mutually exclusive pathophysiology should be considered.

Mantle cell lymphoma: a rare cause of a solitary duodenal mass.

Mantle cell lymphoma is a very aggressive lymphoma with a very poor prognosis. It commonly involves the gastrointestinal tract but rarely presents as primary gastrointestinal lymphoma. The most notable cases of primary gastrointestinal mantle cell lymphomas have been described as multiple lymphomatous polyposis and have a very poor prognosis. We report a case of primary gastrointestinal mantle cell lymphoma that was discovered by endoscopic biopsy of a single duodenal polyp in a 70-year-old woman who was previously treated for Helicobacter pylori gastritis. She presented with a 6-month history of indigestion, heartburn and abdominal bloating. A subsequent workup revealed one extranodal site of involvement, lymphatic involvement below the diaphragm and a normal bone marrow biopsy. We followed a wait-and-watch approach including serial CT scans and blood tests. Two years later, her symptoms have not progressed and her disease has remained stable.

Fecal microbiota transplantation in recurrent Clostridium difficile infection: A retrospective single-center chart review: Fecal transplantation in Clostridium difficile

Fecal microbiota transplantation (FMT) has been proposed as a treatment option for patients with recurrent Clostridium difficile (C. difficile) infection but remains a novel option. We examined if FMT is an effective means of treating recurrent C. difficile infection.

Mo1228 Deflating the Pipes: A New Way of Colonic Decompression

Introduction The standard endoscopic treatment of a symptomatic colonic pseudo-obstruction is by placing a 14Fr, 175cm long colonic decompression tube. We wanted to assess the effect of large bore orogastric Ewald stomach evacuator tubes (32Fr) placed rectally for decompression due to its large size, easy accessibility, and obviating the need for proximal colonic intubation. Methods This is a retrospective case series assessing the effectiveness, safety and outcomes of rectally placed orogastric tubes used for decompression of colonic pseudo-obstruction, ileus and volvulus from 2013 to 2014 at a single institution. Clinical outcomes were measured by symptom resolution with >50% reduction of distention on imaging. Results Twenty one patients with colonic pseudo-obstruction, ileus and volvulus were evaluated. The average age was 68.7 ± 12.2 (SD) years of which 13 (59%) were men. Eleven patients had medical etiologies causing distention while 6 patients were postoperative. Seventeen patients (81%) had associated comorbidities including cardiovascular (80%), pulmonary (28%), sepsis (14%), and were ventilator dependent (19%). Twelve patients (57%) failed medical therapy including neostigmine, erythromycin and metoclopramide. Eighteen (85.71%) patients were taking medication including narcotics, benzodiazepines and calcium channel blockers, either alone or in combination. The mean distention diameter was 9.2 ± 3 (SD) cm. Fifteen (71%) patients had improvement after the first procedure while 2 (9.5%) patients had improvement after more than one procedure. Three (17.6%) had a recurrence while 4 (19%) patients had no improvement. Overall success rate was 80.9%. The average time for improvement was 1.58 days with no procedure related complications. Conclusion Large bore gastric tubes placed rectally provide an alternative to the conventional colonic decompression tubes with good initial successful decompression without any complications.

Diarrhoea, weight loss and polyposis: think Cronkhite-Canada syndrome.

A 71-year-old male presented with nausea, diarrhoea and weight loss. He had mild to moderate alopecia, paucity of eyebrow hair, erythematous non-pruritic nodular rash on the wrists, toenail onychomychosis and scalp hyperpigmentation. A colonoscopy revealed an irregular, haemorrhagic 5 cm rectosigmoid mass. Biopsies revealed mucin distended glands and focal ischemic changes. A CT scan showed numerous polypoid-like lesions in the stomach. Upper endoscopy showed mucosal erythema and nodularity with polypoid-like lesions. Biopsies showed cystic glandular dilatation, lamina propria oedema and chronic inflammation consistent with Cronkhite-Canada syndrome (CCS). The patient was started on nutrition supplementation. His skin manifestations were treated topically and with mineral supplements. He improved within 10 weeks and is currently asymptomatic. A high index of suspicion for CCS should exist in patients who present with weight loss, diarrhoea and polyposis. If diagnosed early, the disease can be treated with the goal of clinical remission.