Tranexamic Acid as a Successful Therapy in Turner Syndrome With Recurrent Overt Gastrointestinal Bleeding due to Small Intestinal Venous Anomalies.

Small intestinal venous abnormalities are an underrecognized condition as an etiology of overt gastrointestinal (GI) bleeding in patients with Turner syndrome. Evidence-based therapeutic options for these lesions are lacking in the published literature. A 47-year-old woman with Turner syndrome with a 30-year course of recurrent GI bleeding was found to harbor diffuse small intestinal venous ectasias through endoscopic imaging. Achievement of a 21-month clinical remission (elimination of hospitalizations for overt GI bleeding and normalization of hemoglobin concentration) was reached after initiation of tranexamic acid titrated to 2,600 mg daily.

Bedside Live-View Capsule Endoscopy in Evaluation of Overt Obscure Gastrointestinal Bleeding: A Pilot Point-of-Care Study.

BACKGROUND: Capsule endoscopy (CE) is an emerging tool in the diagnosis and management of occult bleeding and overt obscure gastrointestinal bleeding (OOGIB). Maximizing the efficiency of CE can lead to rapid bleeding localization and shorter time to therapy. We investigated whether a trained registered nurse (RN) can accurately interpret bleeding by observing the CE findings in real time by measuring inter-observer agreement between RN and physician interpretation. METHODS: We conducted a prospective study of patients admitted for OOGIB who underwent live-view capsule endoscopy (LVCE) between December 2016 and November 2017. A matched control group who underwent standard CE was obtained through retrospective review. An RN received a 2-day training program for CE interpretation. RN bedside interpretation for bleeding was followed by interpretation by 2 gastrointestinal physicians blinded to LVCE findings. Outcomes were compared between groups using t-tests and χ2 tests. Cohen's kappa measured the agreement between the physicians and the RN. RESULTS: Ten subjects were in the LVCE group, and 12 subjects were in the standard-of-care group. The agreement between the physicians and the RN was 9/10 (90%), with a kappa of 0.73 (95% CI: 0.26-1.00; p = 0.016). Patients in the LVCE group had shorter duration to physician interpretation (0.6 vs. 0.7 days [p = 0.50]), shorter duration to endoscopy (1.8 days vs. 3 days [p = 0.240]), and shorter length of stay (8.1 vs. 11.4 days [p = 0.26]) compared to the standard-of-care group. CONCLUSION: This study utilizing an RN for LVCE interpretation found inter-observer agreement between RN and physician findings. Larger studies are needed to assess whether this RN-physician team approach can translate to improved outcomes.

Vedolizumab Therapy in Refractory Microscopic Colitis: A Single Center Case Series.

Microscopic colitis (MC) is a disease characterized by chronic watery diarrhea secondary to colonic inflammation. Endoscopically, the mucosa is usually normal but biopsies show characteristic histologic findings.1.

A Single-Center Randomized Controlled Trial Evaluating Timing of Preparation for Capsule Enteroscopy.

BACKGROUND/AIMS: Intestinal lavage (IL) administration immediately before capsule enteroscopy (CE) is superior to lavage the day before the procedure. We aimed to determine the effect of IL timing on CE diagnostic yield. METHODS: Patients referred for CE were randomized prospectively into two equal groups according to the timing of IL with 2 L of polyethylene glycol solution. Group A and B underwent IL over 2 hours beginning 14 and 4 hours, respectively, before the scheduled CE. The primary outcome measure was preparation quality, measured with a predetermined validated grading scale. RESULTS: A total of 34 patients were randomized. The frequency of mucosal abnormalities (77% vs. 82%, p=not significant [NS]) and diagnostic yield (47% vs. 53%, p=NS) were similar between the two groups. Moreover, no significant association between the quality of small bowel preparation and the timing at which the purgative for IL was administered was observed (overall fluid transparency, p=0.936; overall mucosal invisibility, p=0.091). CONCLUSIONS: Day-before IL is equivalent to same-day IL in terms of overall preparation quality, proportion of complete studies to cecum, small bowel transit time, frequency of identified mucosal abnormalities, and overall diagnostic yield.

A case of sclerosing mesenteritis with spontaneous resolution with steroid therapy.

We present the case of a 59-year-old male who presented with sudden onset of severe epigastric pain and laboratory studies consistent with acute pancreatitis. Imaging showed a dramatic interval increase in mesenteric edema with a normal pancreas, and a diagnosis of acute-onset sclerosing mesenteritis was made. Corticosteroids were initiated, and the patient demonstrated a dramatic improvement in symptoms and laboratory abnormalities overnight. Subsequent imaging after 4 and 8 months revealed continued improvement of mesenteric abnormalities consistent with consolidative sclerosing mesenteritis with a radiographic picture more typical of this unusual disorder. The abrupt onset of symptoms with acute dramatic development of mesenteric edema and dramatic resolution of symptoms has not been previously described.