Sameer Islam

Left ventricular assist devices and gastrointestinal bleeding: a narrative review of case reports and case series.

The use of left ventricular assist devices (LVADs) has become a state‐of‐the‐art therapy for advanced cardiac heart failure; however, multiple reports in the literature describe an increased risk for gastrointestinal (GI) bleeding in these patients. We characterized this association by reviewing recent studies on this topic.

Presentation, Diagnosis, and Management of Esophageal Lichen Planus: A Series of Six Cases

Lichen planus (LP) is an idiopathic disorder that presents with cutaneous and genital manifestations. Esophageal LP (ELP) was first described by Al-Shihabi and Jackson [J Laryngol Otol 1982;96:567-571] in 1982. Only approximately 80 cases have been documented in the literature since. It is a rare and underrecognized disorder, leading to a delay in diagnosis and a lack of standardized management. We describe the presentation, diagnosis, and management of 6 cases of ELP, at a tertiary institution, because we believe that an increasing awareness of this condition can help identify more cases and increase our understanding of this interesting condition.

Endoscopic Retrograde Cholangiopancreatography in the Elderly

Background The use of gastrointestinal endoscopy in geriatric patients is rising as an increasing proportion of the population is reaching an advanced age. Most studies of endoscopic retrograde cholangiopancreatography (ERCP) in the elderly have been done in tertiary care or referral centers. Methods We analyzed the clinical and endoscopic data on all ERCPs in patients aged 65 years and older in a retrospective review of medical records of patients at the county hospitals in El Paso and Lubbock, Texas between 2004 and 2008. ERCP data in patients aged 75 years and older were compared with those who were 65–74 years. Results There were 125 ERCPs performed in 89 patients (74 procedures in 54 patients older than 75 years, 51 procedures in 35 patients younger than 75 years). The average age was 76.0 (range: 65‐94), 62.4% were female and 79.2% were Hispanic. Indications were similar between groups: jaundice (66.9%), abnormal liver tests (87.2%), abdominal pain (79.2%), cholangitis (24.0%), pancreatitis (32.8%) and stent change (12.9%). Concomitant illnesses were also similar. Lower doses of midazolam and meperidine were used for moderate sedation in the older group (P < 0.01). ERCP findings were similar in both groups: stones (40.8%), stricture (18.4%) and stent placement (30.4%). Complications occurred in 6.4%. Conclusions This study of ERCP in elderly predominantly Hispanic patients found similar indications, efficacy and safety in patients 75 years and older compared with those 65–74 years old. Advanced age is not a contraindication to ERCP, but issues related to sedation and the use of antithrombotic therapy need to be addressed in the elderly.

Endoscopic removal of multiple duodenum foreign bodies: An unusual occurrence

Deliberate single foreign body ingestion is a scenario that many gastroenterologists commonly see in psychiatric units and prisons. However, multiple foreign body ingestions, especially located in the duodenum, provide the endoscopist with unique challenges for management and treatment. Although most foreign objects pass spontaneously, one should have a low threshold of intervention for multiple objects, especially those that are wide, sharp and at risk of perforation. Diagnosis is typically made when there is a history of ingestion coupled with corresponding radiographic verification. The symptoms tend to be non-specific although some patients are able to delineate where the discomfort level is, correlating with the site of impaction. Most foreign bodies pass spontaneously; however when multiple sharp objects are ingested, the gastroenterologist should perform endoscopic procedures to minimize the risks of bowel perforation. We describe here a successful case of multiple ingested foreign bodies retrieved across the C-loop of the duodenum and the pharynges-esophageal curve via endoscopy and review the literature of multiple foreign body ingestion.

Sigmoid plasmacytoma mimicking colon cancer in a patient with multiple myeloma: case report and review of literature

Congenital duodenal occlusion presenting as a neonatal emergency may be caused by a diaphragm or a complete obliteration of the duodenal lumen. Complete obliteration may result from vascular occlusion in utero. A diaphragm may represent incomplete vacuolation of the proliferating epithelial lining of the duodenum between the sixth and eighth weeks of gestation. 1 If the occlusion caused by the diaphragm is complete, symptoms appear from birth. In some cases, a lumen persists in the diaphragm, and presentation is delayed. The lumen is rarely wide enough to avoid symptoms or for symptomstobedelayeduntiladultlife.Thehistoryinadults isusuallyoneofpersistent vomitingandweightloss.Twenty adult patients with duodenal web were reported in a large series of congenital duodenal anomalies from one center in the United States. 3 The onset of symptoms in adult life seems to be the effect of progressive decompensation of the peristaltic force of the stomach and proximal duodenum.

Aortic stenosis and angiodysplastic gastrointestinal bleeding: Heyde's disease.

Obscure gastrointestinal (GI) bleeding can be a perplexing and difficult problem in elderly patients, especially if they are hemodynamically unstable. If aortic stenosis is also present, the cause of the GI bleeding may be explained. We present a 66-year-old man with a medical history of coronary artery disease who presented with acute GI bleeding. During his hospital course, the patient had a colonoscopy showing diffuse angiodysplasia and an echocardiogram showing severe aortic stenosis. This combination of angiodysplasia and aortic stenosis is known as Heydes syndrome. It has been hypothesized that the aortic stenosis causes an acquired von Willebrand factor deficiency that leads to GI bleeding. Aortic valve replacement, when possible, can prevent recurrent GI bleeding in these cases, but medical decisions in these cases are complex and difficult.

The use of DNA fingerprinting to resolve conflicting results in patients with suspected gastrointestinal malignancy.

Goals: To underscore the utility of DNA fingerprinting for clarifying disparate results from endoscopic pathologic specimens. Background: Occasionally, serially obtained gastrointestinal biopsies may yield inconsistent results. These discrepancies pose a dilemma for gastroenterologists and their patients, especially when malignancy is a consideration. Study: Patients referred to our tertiary care center from outside institutions had undergone endoscopically obtained esophageal biopsies showing malignancy, verified by pathologists at both our site and from the referring center. Repeat endoscopic biopsies at our center did not show malignancy. To verify that different sets of biopsies came from the same patient, we performed a polymerase chain reaction–based analysis comparing the 2 specimens. This analysis, called DNA fingerprinting, can show a high degree of certainty whether 2 specimens came from the same patient. Results: In each case, DNA fingerprinting verified a match, laying the groundwork for intervention. One patient underwent endoscopic radiofrequency ablation to the esophageal mucosa involved. Another underwent esophagectomy with partial gastrectomy. Both are doing well clinically and remain cancer-free on follow-up. Conclusions: DNA fingerprinting is a powerful and a relatively inexpensive tool. Usually, only small amounts of tissue are required, and even degraded or archival tissue is adequate. DNA fingerprinting can be an important tool in the gastroenterologist’s arsenal to help clarify conflicting results, allowing the patient and physician to move forward with the management.

Pulmonary valve stenosis causing massive pulmonary artery aneurysm: a conservative approach.

To the Editor Pulmonary artery aneurysms are a rare clinical entity, and their clinical management guidelines are not well established, especially for older patients. We present the case of a 70-year-old woman with a significant pulmonary artery aneurysm treated conservatively with medical management. The aim of this report is to draw attention to possible conservative management and treatment options for elderly patients with pulmonary artery aneurysms.

Congenital hypertrophy retinal pigment epithelium as a manifestation of colon cancer.

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An Unusual Number of Self-ingested Foreign Bodies

Foreign body ingestion is a common gastrointestinal (GI) emergency, which usually occurs accidentally in children. Most ingested foreign bodies pass spontaneously; however, serious complications such as bowel obstruction or perforation can occur and require intervention. We are reporting an unusual case of an adult patient who ingested multiple spoons that caused abdominal pain and required endoscopic interventions for retrieval. A 34-year-old male inmate with a history of schizophrenia presented to the emergency department complaining of acute worsening epigastric pain for the preceding 7 days. The pain was localized, dull and there was no association with nausea, vomiting, constipation