bluuebunny/crossref_metadata_2025_split huggingface dataset:
2984 The Osteoarthritis of Celiac Disease: Incidence and Risk Factors of Osteoarthritis in Celiac Disease Cohort
Authors: Saleem Saad , Abu-Heija Ahmad , Then Eric O. , Weissman Simcha , Gaduputi Vinaya 
Published: October 2019

INTRODUCTION:
Osteoarthritis has been alluded to be an extra-intestinal manifestation of celiac disease, but definitive data about its association has been lacking. Therefore, we evaluated the association of primary osteoarthritis in celiac disease cohort and determined the risk factors for primary osteoarthritis.

METHODS:
A retrospective analysis was conducted using the de-identified data from the national health database, the Healthcare Cost and Utilization Project (HCUP). We identified the hospital encounters for “history of celiac disease” using international classification of Diseases (ICD-9) diagnostic codes from 2011 to 2014. We assessed the incidence of primary osteoarthritis in celiac disease population and independent predictors of by multivariate analysis. P-values less than 0.05 indicated a statistically significant association. The odds ratio and 95% confidence interval were also calculated. Data were analyzed using SPSS.

RESULTS:
A total of 29,446 history of celiac diease hospital visits were identified - 111 with primary diagnosis of primary osteoarthritis (case group) and 29,335 without osteoarthritis (control group). Comparing study group with control group, age - mean with standard deviation 64.15 + 11.04 yrs vs. 55.15 + 22.10 yrs (P < 0.001), sex - female 88 (79.3%) vs. 20846 (71.1%) (P = 0.057, Odds ratio [OR] = 1.56 (95% Confidence interval (CI) 0.98-2.5), race - Hispanic 7 (6.3%) vs. 1142 (3.9%) (P = 0.19, OR = 1.67, CI; 0.77-3.59), obesity 15 (13.5%) vs. 1454 (5%) (P < 0.0001, OR = 3.0, CI; 1.73-5.18), smoking 4 (3.6%) vs. 2829 (9.6%) (P < 0.03, OR = 0.35, CI; 0.13-0.95), nausea and vomiting 2 (1.8%) vs. 1219 (4.2%) (P = 0.214, OR = 0.42, CI; 0.104-1.716), diarrhea 0 vs. 1353 (4.6%), underweight 0 vs. 63 (0.2%), anemia 21 (19%) vs. 3293 (11.2%) (P = 0.01, OR = 1.85, CI; 1.15-3.0), constipation 11 (10%) vs. 1732 (5.9%) (P = 0.07, OR = 1.75, CI; 0.94-3.27). The odds of developing osteoarthritis among celiac diease population was significantly higher (adjusted odds ratio [aOR] = 1.59, CI; 1.18-2.13, P < 0.001) (shown in Figure 1).

CONCLUSION:
This study concluded up to 59% increased likelihood of primary osteoarthritis in the celiac diease patients. Older age, obesity and celiac diaese showed greater odds of developing primary osteoarthritis. Further studies are needed to determine the association between gluten free diet and its effect on osteoarthritis.
2992 Systematic Review of Gastrointestinal Angiomyolipoma
Authors: Zafar Yousaf , Gondi Keerthi , Muthukumar Varsha , Luke Alex 
Published: October 2019

INTRODUCTION:
Angiomyolipoma (AML) is a rare tumor composed of adipose tissue, smooth muscle, and abnormal blood vessels. Although most commonly, occurring in the liver and kidney, it has been described to occur in the gastrointestinal tract (GI AML). A systematic review has not been performed to investigate its clinical characteristics.

METHODS:
We conducted a systematic review of the literature to identify all published cases of GI AML in the literature between 1980 and 2019. All available cases were analyzed for clinical characteristics and outcomes. Statistical analysis was mainly descriptive.

RESULTS:
16 cases of GI AML were identified. The majority of patients were male (81.3%) and of old age (mean = 61.3 years). GI AML most commonly occurred in the stomach (62.5%) followed by the colon (25%) and duodenum (12.5%). It commonly presented with gastrointestinal bleeding and fatigue. Computed tomography most commonly revealed a submucosal, well-circumscribed lesion with varying intensity in the mass. 100% of cases were benign, with only one case of recurrence following surgical resection.

CONCLUSION:
GI AML is a rare condition which commonly presents in the stomach and colon. Morbidity is minimal, and surgical resection is commonly curative with low recurrence. Future studies are necessary to characterize its etiology and association with other conditions.
3027 Lipase Stands Out: Is It Sufficient to Diagnose Acute Pancreatitis?
Authors: Neupane Sunita , Shrimanker Isha , Sapna Fnu , Bhandari Binita , Nookala Vinod 
Published: October 2019

INTRODUCTION:
Acute pancreatitis is defined when two out of the three diagnostic criteria are present such as abdominal pain often radiating to the back, characteristic imaging findings, and amylase and/or lipase levels that are three times or more the upper limit of normal (ULN). We present the case of an elderly male with abdominal pain and isolated raised lipase concentrations treated as acute pancreatitis.

CASE DESCRIPTION/METHODS:
A 96-year-old male with a history of dementia, coronary artery disease, hyperlipidemia, presented with sudden onset right-sided abdominal pain and six episodes of vomiting that started a few hours prior. He denied constipation, diarrhea, and fever. The patient does not drink alcohol or smoke. On arrival, he had a pulse of 77 beats/minute, blood pressure of 165/88 mm Hg, respiratory rate of 16 breaths/minute and oxygen saturation of 93% on room air. Physical exam revealed bilateral pedal edema along with significant tenderness in the right lower quadrant with mild tenderness in the right upper quadrant with negative Murphy's sign. Laboratory investigations revealed white blood cell count of 13 K/ul, sodium of 131 mmol/l, chloride of 95 mmol/l, calcium of 9.4 mg/dl, triglyceride levels of 60 mg/dl, aspartate aminotransferase of 65 U/l, alanine transaminase of 36 U/l, and alkaline phosphatase of 123 U/l, and lipase of 4450 U/l. Ultrasound of the gall bladder and computed tomography of the abdomen revealed diffuse gallbladder wall thickening with pericholecystic fluid without any significant pancreatic abnormality. A provisional diagnosis of acalculous cholecystitis was made and he was started on intravenous (IV) ceftriaxone one gm, once a day and IV metronidazole 500 mg, thrice a day with IV pantoprazole 40 mg, once a day. Magnetic resonance cholangiopancreatography done after two days revealed the absence of gall bladder wall thickening. Cholecystitis was thus ruled out and the patient was diagnosed with acute pancreatitis owing to the raised levels of lipase. A resolution of abdominal symptoms and a decreasing trend was seen in serum lipase levels on day four of hospitalization but the levels still remained above the ULN (Figure 1). The patient was discharged with surgical follow-up on an outpatient basis.

DISCUSSION:
The cut-off set for lipase levels in acute pancreatitis has a specificity of >99%. Clinicians should have a high suspicion of pancreatitis in patients with abdominal pain and isolated hyperlipasemia but be wary of alternative diagnosis too.
3036 Alcohol Consumption Increases Risk of Pancreatitis in Celiac Disease: A Case Report
Authors: Rashid Mamoon Ur , Khan Muzammil Muhammad , Ullah Waqas , Zafar Hammad , Hussain Ishtiaq , Hasan Badar , Ur Rehman FNU Asad , Hurairah Abu 
Published: October 2019

INTRODUCTION:
Celiac disease is an autoimmune disorder of small intestine that improves significantly with gluten free diet. It is reported that patients with celiac disease are associated with increased risk of hepatobiliary and pancreatic diseases. In patients with celiac disease, alcohol further increases the risk of pancreatitis.

CASE DESCRIPTION/METHODS:
35 year old female with history of celiac disease and alcohol abuse presented to us with abdominal pain, nausea and vomiting for 1 week. Pain was generalized, characterized as sharp and stabbing. She admitted drinking half a bottle of vodka daily for pevious few weeks and has been dealing with alcohol abuse for many years. Initial labs showed hyponatremia 125, Hypokalemia 2.4, Ethanol 280 and lipase 500. CT Abdomen was unremarkable. Patient IGA was elevated with Tissue transglutaminase IgA level more than 250. Patient was diagnosed with acute pancreatitis and was treated with supportive management. Patient previous pathology showed villous blunting and intraepithelial lymphocytes suspected for non-compliance with gluten free diet. Patient symptoms and labs improved significantly during hospitalization and was discharged home. Unfortunately, patient was admitted within a week with similar symptoms of abdominal pain with hyponatremia, hypokalemia, and elevated lipase but Ethanol level was less than 10. Patient was again treated conservatively for recurrent pancreatitis and discharged home with counselling for gluten free diet and alcohol cessation.

DISCUSSION:
Celiac disease is an autoimmune disease with abnormal response of the small intestine to the gluten, widely present in our diet. Patient may present with vomiting, abdominal pain, nausea, flatulence, weight loss or diarrhea. It has been reported that almost 20% of the patients with celiac disease are associated with pancreatitis and pancreatic inflammation. It is believed that impaired release of pancreatic stimulating hormones from the pancreas due to inflammed proximal small bowel may be responsible. However, it has also been reported that papillary stenosis may be responsible for the pancreatic inflammation present in the celiac disease. Alcoholic patients with celiac disease have several fold increased risk of development of pancreatitis and pancreatic inflammation and are counselled to avoid or reduce the alcohol intake.
3038 A Rare Case of Pancreatitis Due to Paraesophageal Hernia
Authors: Al Kateb Mohamad , Leibach John , Calestino Matthew , Bray Christopher 
Published: October 2019

INTRODUCTION:
Pancreratitis due toWe present a rare case of acute pancreatitis due to a large paraesophageal hernia who presented to the emergency department with chief compliant of epigastric pain and dysphagia.

CASE DESCRIPTION/METHODS:
A 65-year- old female presented to our emergency department due to progressively worsening epigastric pain. The pain sharp, intermittent and moderate in severity and radiated to her back associated with nausea and vomiting. She denied fever, shortness of breath, or chest pain. A review of systems was otherwise negative. Physical examination including vital signs was unremarkable with the exception of mild epigastric tenderness on palpation. Seven years prior to admission, patient underwent laparoscopic cholecystectomy for gallstones pancreatitis. Laboratory data was unremarkable. Although her serum lipase was within normal limits (114 U/L), her history and physical were concerning for pancreatic pathology. Therefore, CT scan of the abdomen was obtained and demonstrated trace inflammatory fluid around the pancreatic uncinate process, consistent with mild pancreatitis. Additionally, a massive hiatal hernia was noted causing mild atelectasis in the lung bases. The patient was admitted to our facility and was treated for the presumptive diagnosis of recurrent pancreatitis. Of interest, five months prior to this admission, the patient had presented to the ED with similar symptoms. CT imaging at that time had also demonstrated large paraesophageal hernia. She was evaluated by our general surgery service and was deemed not to be a candidate for surgical intervention. Due to the recurrent nature of her symptoms, she subsequently underwent esophagogastroduodenoscopy during which the paraesophageal hernia was identified with a large amount of food and fluid within it. Thusly she was reevaluated by our general surgery team and ultimately underwent reduction of her stomach, paraesophageal hernia repair, and gastrostomy tube insertion. Patient did well post-operatively with no complication. Patient was discharged to rehab 7 days after surgery.

DISCUSSION:
We believe that the patient's recurrent symptoms were the result of progressive enlargement of the paraesophageal hernia that manifested as a gastric volvulus. There are few cases of pancreatitis due to paraesophageal hernia leading pancreatic herniation1. Serum lipase measurements that are below normal limits can indicate chronic pancreatitis2. Few cases of pancreatitis were reported with low lipase.2
3043 Not All Bumps Are Equal, Mucosal Schwann Cell Hamartoma a Rare Subtype
Authors: Altamimi Barakat Aburajab , Niyazi Fadi , Snow Anthony , El Sayed Amer 
Published: October 2019

INTRODUCTION:
Benign mesenchymal polyps are an interesting group of colonic polyps. There has been a surge in the number of these polyps identified since legislation modified Medicare and began reimbursement for screening colonoscopy in patients at an average risk for colorectal carcinoma. It is important to differentiate between the different types of mesenchymal polyps given that some have correlation with hereditary diseases.

CASE DESCRIPTION/METHODS:
66 year old male patient with history of hypertension presents for routine colorectal cancer screening colonoscopy. He is asymptomatic and has no family history of cancer including colon cancer. During the colonoscopy a small 5 mm polyp was found in the rectosigmoid which was removed using cold forceps polypectomy. The pathology was read as a benign mesenchymal polyp. Further staining with S-100 and CD 68 was done which revealed that this polyp was in fact a Schwann cell hamartoma.

DISCUSSION:
There has been 10 reported cases of mucosal schwann cell hamartoma in literature. Using immunohistochemistry for S100 highlights tissue with neural differentiation expanding the lamina propria of the colonic biopsy and CD68 highlights muciphages. These polyps resemble spindle cell proliferation and other neuronal tumors and are usually limited to the mucosa of the colon with no submucosal extension. They are usually solitary and patients do not have symptoms though a couple of cases reported finding them in the process of workup for diarrhea. Gibson and Hornick supplied the necessary name in 2009 in an attempt to differentiate it from other Schwann cell proliferation which is seen in entities like neurofibroma and ganglioneuroma. The importance of this entity is its lack of association with hereditary cancer syndromes, specifically neurofibromatosis type 1 (NF1) and multiple endocrine neoplasia 2B (RET) which is seen with neurofibromas. Also ganglioneuromatous polyposis and diffuse ganglioneuromatosis are seen in Cowden syndrome, Juvenile polyposis syndrome, MEN2B and NF1 however solitiary ganglioneuroma are not associated with hereditary diseases. It is important to differentiate this entity from others to prevent unnecessary and aggressive testing and treatment. Pathologists should include this differential as part of S 100 positive spindle cell proliferative lesions and gastroenterologists should be aware of the benign nature of this pathology.
3047 A Tale of Two Tumors: Peritoneal Malignancies
Authors: Glover Matthew , Walker Ted , Kang Liang-I , Rood Richard P. 
Published: October 2019

INTRODUCTION:
Pseudomyxoma peritonei (PMP) and malignant peritoneal mesothelioma (MPM) are rare malignancies of the peritoneum that present in similar fashion. We describe one case of each to illustrate the diagnostic and therapeutic challenges associated with these tumors.

CASE DESCRIPTION/METHODS:
Case 1: A 67 year old Ukrainian male presented with a chief compliant of 6 months abdominal pain and fever. Physical exam revealed abdominal distension. A CT scan showed infiltrative densities of the omentum and mesenteric fat suggesting an inflammatory process. CRP and ESR were elevated. Colonoscopy was unremarkable. His abdominal pain continued to worsen. A repeat CT showed progressive omental densities (Figure 2a). An initial percutaneous omental biopsy showed atypical mesothelia cells. Subsequent exploratory laparotomy with targeted biopsies revealed a diagnosis of MPM (Figure 3a). He was initiated on hyperthermic intraperitoneal chemotherapy (HIPEC) with possible future cytoreductive surgery (CRS). Case 2: A 75 year old Nepali male presented with a chief complaint of abdominal pain, distension and weight loss. An outpatient ultrasound several months prior had demonstrated septated ascites. Physical exam revealed a markedly distended abdomen. A CT scan showed diffuse peritoneal and omental thickening (Figure 2b). An Omental biopsy was performed and pathology revealed pseudomyxoma peritonei (PMP) (Figure 3b). A colonoscopy revealed mucinous material at the appendiceal orifice (Figure 1). Following laparoscopy, he was not deemed a candidate for CRS with HIPEC due to burden of disease.

DISCUSSION:
PMP and MPM are rare tumors of the peritoneum that typically present with non-specific signs and symptoms.1,2 As a result, diagnosis is often delayed and occurs late in the progression of disease. Both PMP and MPM defy typical TNM staging as spread is predominately expansive rather than infiltrative. This pattern of spread gives limited extra-abdominal metastatic potential. As a consequence, these tumors tend to remain confined to the abdominal cavity. First line therapy for both PMP and MPM is CRS and HIPEC.3,4 Candidacy is determined by the peritoneal cancer index (PCI), a scoring system based on extent of peritoneal tumor burden visualized on laparoscopy.5 Systemic chemotherapy is an option for patients ineligible for CRS and HIPEC. Ideal chemotherapy regimens remain unclear as no randomized controlled trials exist.1,2 Intraperitoneal mucolytics remain under investigation as a potential therapy unique to PMP.6
3074 In Colon Cancer: Superficial Thrombophlebitis Is a Road to PE
Authors: Vekaria Pratikkumar , Raiyani Chandrika , Robitshek Daniel , Raiyani Tejas 
Published: October 2019

INTRODUCTION:
In general, all cancers associated with developing vascular thromboembolism (VTE). Colorectal cancer (CRC) can also cause VTE, but overall incidences of VTE related to CRC is underestimated. Superficial thrombophlebitis (STP) involves phlebitis and thrombosis of superficial vein of upper or lower extremity. It is broadly known as self-liming condition and requires conservative management. Nonetheless, few case reports suggest that superficial thrombophlebitis can progress into Pulmonary Embolism (PE), especially, with concomitant hypercoagulable state such as cancer, chemotherapy.

CASE DESCRIPTION/METHODS:
56-year-old-Caucasian-female with pertinent history of adenocarcinoma of colon s/p resection, on adjuvant chemotherapy presented to ED with right side chest pain and dyspnea. CT chest showed right upper and lower lobe PEs. Around 2 months prior to this, after her chemotherapy cycle, patient had developed right leg redness and pain along the ankle and lower inner leg. She had developed STP in right Great Saphenous Vein without any DVTs noted on Doppler. She was treated with conservative management with NSAIDs, with resolution of her symptoms in 2 days. However, after her next chemotherapy cycle, she had recurrence of STP and work up was again negative for DVT. Patient was started on low dose Aspirin then. On subsequent cycle, she developed PE as noted on presentation, which was treated successfully with Apixaban and she uneventfully completed her chemotherapy cycles.

DISCUSSION:
Cancer and chemotherapy are major risk factors for developing VTE, and it causes imbalance between coagulation and fibrinolytic system. Study shows that chances of getting CRC related VTE is more during first 6 months after diagnosis and then it falls subsequently. Our patient, developed PE in 4 months after diagnosis. No robust study has been done that shows prospects of developing VTE if CRC patient develops STP. Many factors can play role in such situation, like; age, sex, location (below or above-knee STP), health condition, chemotherapy, and coagulation profile. Few studies have reported that STP should be managed more rigorously when it is associated with cancer and starting anticoagulants (AC) prophylactically can help patient from getting PE. Therefore, from our and other case reports, we suggest that CRC patient on chemotherapy should be considered for prophylactic AC if they develop STP to minimize risk of developing VTE.
3090 Endoscopic Removal of Partially Migrated Gastric Banding
Authors: Boškoski Ivo , Bove Vincenzo , Tringali Andrea , Landi Rosario , Familiari Pietro , Perri Vincenzo , Costamagna Guido 
Published: October 2019

INTRODUCTION:
Intragastric band migrations or dysfunctions are common long-term complications of laparoscopic adjustable gastric banding (Lap-Band) that classically require surgical treatment. In this video case we describe the endoscopic removal of partially eroded Lap-Bands.

CASE DESCRIPTION/METHODS:
We present the case of a 61 years-old female that underwent a Lap-Band in 2002 for morbid obesity (weight 150 Kg, BMI 55.1). In November 2017 she had abdominal pain and an EGD showed erosion of the gastric mucosa and partial intragastric migration of the Lap-Band (>50%). After surgical removal of the subcutaneous reservoir an endoscopic procedure was planned to remove the migrated gastric band. The procedure was performed under general anesthesia, with CO2 insufflation and using a therapeutic gastroscope (GIF-1T 160, Olympus, Japan). The ring was captured with a guidewire (Jagwire, Boston Scientific, Marlborough, MA) under endoscopic control and fluoroscopic control in a "loop shape". The endoscope was then removed, and a mechanical lithotripter (Endobair, London, UK) was placed over the 2 extremities of the wire and a biliary lithotripsy device was used to cut the migrated band. The band was pushed into the stomach, captured with a snare and pulled out. There were no procedure related complications.

DISCUSSION:
Endoscopic removal of intragastric migrated Lap-Band is safe, repeatable and procedure and is a valide alternative over surgery.
Watch the video: http://bit.ly/2LuYDJS