Natalya Iorio

Review article: the biology, diagnosis and management of gastrointestinal stromal tumours

Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract with an increasing incidence.

Profile of rifaximin and its potential in the treatment of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain and abnormal bowel patterns. Alteration in gut flora, visceral hypersensitivity, and abnormal bowel motility are among numerous factors in the complex pathophysiology of IBS. Antibiotics have been used adjunctively to treat IBS for many years but are associated with various systemic side effects. Rifaximin is a nonabsorbable, broad-spectrum antimicrobial that inhibits bacterial RNA synthesis by binding the β-subunit of microbial RNA polymerase. It targets the gastrointestinal tract and works by reducing the quantity of gas-producing bacteria and altering the predominant species of bacteria present. In vivo animal studies suggest additional beneficial mechanisms of rifaximin, including reducing mucosal inflammation and visceral hypersensitivity. Clinical studies have demonstrated that rifaximin improves symptoms associated with IBS, such as bloating, flatulence, stool consistency, and abdominal pain, and has a side-effect profile similar to placebo. Although additional investigation into optimal dosing, treatment duration, and potential resistance is required, rifaximin presents as a safe and beneficial addition to the current management options for IBS.

Acute Esophageal Necrosis Presenting With Henoch-Schönlein Purpura.

A 63-year-old woman with abdominal pain and melena developed a palpable, purpuric rash and acute kidney injury. Skin and kidney biopsy confirmed Henoch-Schönlein purpura. Upper endoscopy revealed diffuse, circumferential, black-appearing mucosa of the esophagus consistent with acute esophageal necrosis (AEN), also known as black esophagus. AEN is a very rare cause of gastrointestinal hemorrhage with a high mortality risk. To our knowledge, there have been no prior reports of AEN associated with Henoch-Schonlein purpura or other vasculitis.

La motilidad esofágica en la esofagitis eosinofílica

BACKGROUND Eosinophilic esophagitis (EoE) is characterized by eosinophilic infiltration of the esophagus and is a potential cause of dysphagia and food impaction, most commonly affecting young men. Esophageal manometry findings vary from normal motility to aperistalsis, simultaneous contractions, diffuse esophageal spasm, nutcracker esophagus or hypotonic lower esophageal sphincter (LES). It remains unclear whether esophageal dysmotility plays a significant role in the clinical symptoms of EoE. AIM Our aim is to review the pathogenesis, diagnosis, and effect of treatment on esophageal dysmotility in EoE. METHODS A literature search utilizing the PubMed database was performed using keywords: eosinophilic esophagitis, esophageal dysmotility, motility, manometry, impedance planimetry, barium esophagogram, endoscopic ultrasound, and dysphagia. RESULTS Fifteen studies, totaling 387 patients with eosinophilic esophagitis were identified as keeping in accordance with the aim of this study and included in this review. The occurrence of abnormal esophageal manometry was reported to be between 4 and 87% among patients with EoE. Esophageal motility studies have shown reduced distensibility, abnormal peristalsis, and hypotonicity of the LES in patients with EoE, which may also mimic other esophageal motility disorders such as achalasia or nutcracker esophagus. Studies have shown conflicting results regarding the presence of esophageal dysmotility and symptoms with some reports suggesting a higher rate of food impaction, while others report no correlation between motor function and dysphagia. CONCLUSIONS Motility dysfunction of the esophagus in EoE has not been well reported in the literature and studies have reported conflicting evidence regarding the clinical significance of dysmotility seen in EoE. The correlation between esophageal dysmotility and symptoms of EoE remains unclear. Larger studies are needed to investigate the incidence of esophageal dysmotility, clinical implications, and effect of treatment on patients with EoE.

Mo1174 Age Is a Predictor of Recurrent Gastrointestinal Bleeding in Patients With Left Ventricular Assist Devices: Results From an Urban Tertiary Care Center

Background: Re-bleeding after initial hemostasis in peptic ulcer bleeding can be life threatening. Identifying factors associated with re-bleeding in patient with peptic ulcer bleeding is important. The aims of our study was to evaluate factors related with re-bleeding and to identify incidence rate of rebleeding in patients with high risk peptic ulcer bleeding. Method: Among patients diagnosed as upper gastrointestinal hemorrhage at seven hospitals in DaeguGyeongbuk, and one hospital in Gyeongnam, South korea, from Feb 2011 to Dec 2013, 699 patients diagnosed as high risk peptic ulcer bleeding with Forrest classification above llb were included. The data were obtained in a prospective manner. Results: Among 699 patients, 500 (71.5%) patients had gastric ulcer, 199 (28.5%), duodenal ulcer. Re-bleeding of high risk peptic ulcer occurred in 64 (9.2%) patients. Age, sex, ulcer type, Forrest classification and treatment modalities were not significantly different between re-bleeding and non-rebleeding group. Second look endoscopy was significantly more performed in non-rebleeding group than rebleeding group (81.8% vs 62.5%, P=<0.001). Transfusion volume was significantly higher in rebleeding group than non-rebleeding group (7.9 vs 3.1, p=<0.001). On multivariate analysis, performance of transfusion, larger transfusion volume and non-performance of second look endoscopy were found as risk factors for rebleeding in high risk peptic ulcer bleeding. Conclusion: In our study, incidence rate of rebleeding was 9.2% and non-performance of second look endoscopy, performance of transfusion and larger transfusion volume were found as risk factors for rebleeding in patients with high risk peptic ulcer bleeding.