Duodenal Varices Presenting as Lower Gastrointestinal Bleeding.

Duodenal varices pose a significant clinical challenge due to their association with severe gastrointestinal bleeding. This condition requires attention because of its acute severity, high morbidity, and mortality rates. The presented case underscores the importance of advancing both knowledge and treatment approaches for duodenal varices. This pursuit is aimed not only at improving immediate clinical outcomes but also at deepening our understanding of complications related to portal hypertension.

Applicability of Online Chat-Based Artificial Intelligence Models to Colorectal Cancer Screening.

BACKGROUND: Over the past year, studies have shown potential in the applicability of ChatGPT in various medical specialties including cardiology and oncology. However, the application of ChatGPT and other online chat-based AI models to patient education and patient-physician communication on colorectal cancer screening has not been critically evaluated which is what we aimed to do in this study. METHODS: We posed 15 questions on important colorectal cancer screening concepts and 5 common questions asked by patients to the 3 most commonly used freely available artificial intelligence (AI) models. The responses provided by the AI models were graded for appropriateness and reliability using American College of Gastroenterology guidelines. The responses to each question provided by an AI model were graded as reliably appropriate (RA), reliably inappropriate (RI) and unreliable. Grader assessments were validated by the joint probability of agreement for two raters. RESULTS: ChatGPT and YouChat™ provided RA responses to the questions posed more often than BingChat. There were two questions that > 1 AI model provided unreliable responses to. ChatGPT did not provide references. BingChat misinterpreted some of the information it referenced. The age of CRC screening provided by YouChat™ was not consistently up-to-date. Inter-rater reliability for 2 raters was 89.2%. CONCLUSION: Most responses provided by AI models on CRC screening were appropriate. Some limitations exist in their ability to correctly interpret medical literature and provide updated information in answering queries. Patients should consult their physicians for context on the recommendations made by these AI models.

Physician-scientists or celebrities? Kardashian-index of gastroenterologists.

BACKGROUND: The coronavirus disease 2019 pandemic unleashed a flood of untrustworthy information on social media platforms, resulting in the unfortunate consequence of expert scientists' opinions getting lost amidst the chaotic sea of misinformation. The question of how much influence these esteemed scientists hold on social media platforms remains elusive. To address this scientific quandary, we sought to explore the concept of the Kardashian index (K-index), a term introduced by Hall in 2014. This metric provides a rudimentary means of evaluating whether a physician scientist's popularity on social media aligns with their significant scientific contributions. AIM: To evaluate if a Gastroenterologist physician's popularity on social media is at par with their scientific contributions (research articles and publications). METHODS: We conducted an extensive search to identify all gastroenterologists actively practicing and associated with the top 100 hospitals as reported by the United States News. We collected specific data on a sub-group including their names, affiliations, degrees, and sub-specializations. To gauge their social media popularity, we utilized the K-index calculation which is determined by dividing the actual number of Twitter followers by the number of researcher's citations. The expected number of followers (F) is calculated using the formula F = 43.3 C ^ 0.32, where C represents the number of citations. RESULTS: Physicians affiliated with the Mayo Clinic emerged as the most prominent presence on Twitter, constituting 16% of the total. They were followed closely by physicians from Mount Sinai Hospital (9%) and the University of Michigan Hospital (9%). Surprisingly, 76% of the physicians evaluated exhibited a low K-index, falling within the range of 0 to less than 2. This suggests that a significant number of highly influential physician-scientists are not receiving due recognition, as indicated by their relatively low number of followers. On the other hand, 24% of the physicians had an inflated K-index, exceeding 5, which positioned them as the "Kardashians". These individuals enjoyed greater social media popularity than their actual scientific contributions. Interestingly, our analysis revealed no discernible association between sex and K-index (P value of 0.92). CONCLUSION: In the gastroenterology field, our study estimated that a majority (76%) of highly researched physicians are undervalued despite their significant scientific contributions.

The Current Status of the Liver Liquid Biopsy in MASH Related HCC: Overview and Future Directions.

Metabolic dysfunction-associated steatohepatitis (MASH) is one of the major risk factors for chronic liver disease and hepatocellular carcinoma (HCC). The incidence of MASH in Western countries continues to rise, driving HCC as the third cause of cancer-related death worldwide. HCC has become a major global health challenge, partly from the obesity epidemic promoting metabolic cellular disturbances but also from the paucity of biomarkers for its early detection. Over 50% of HCC cases are clinically present at a late stage, where curative measures are no longer beneficial. Currently, there is a paucity of both specific and sensitive biological markers for the early-stage detection of HCC. The search for biological markers in the diagnosis of early HCC in high-risk populations is intense. We described the potential role of surrogates for a liver biopsy in the screening and monitoring of patients at risk for nesting HCC.

A Masking Effect: A Case of Initial Presentation of Ulcerative Colitis After Discontinuing Growth Hormone Therapy.

Background: The inflammation and repair of the intestinal mucosa in inflammatory bowel disease (IBD) involve a complex interplay between innate, adaptive immune responses, and hormones. This may explain the relapsing clinical course of the disease. Methods: We present the first reported case of a patient presenting their initial flare of ulcerative colitis immediately after discontinuing growth hormone (GH) therapy, suggesting treatment with GH or growth factors may prevent the development of IBD. Results: This is a case of a 13-year-old female with a history of GH deficiency, presenting with an 8-week history of abdominal pain, blood-stained diarrhea, and fecal calprotectin greater than 8000 mcg/g, 2 weeks after discontinuing GH therapy. The patient subsequently underwent an esophagoduodenoscopy and colonoscopy with biopsies showing histological features consistent with ulcerative colitis. Conclusions: The finding of withdrawing GH or growth factors therapy potentially unmasking IBD in this patient raises a question of whether growth factors can inhibit the development of IBD and suggests beneficial effects of treatment with GH or growth factors as adjuvant therapy for IBD.

Autoimmune Hepatitis Disguised as Iron Overload Syndrome: Diagnostic Dilemma in a Nigerian Man.

Autoimmune hepatitis (AIH) is an extremely rare cause of chronic liver disease (CLD) in sub-Saharan Africa-there have only been 3 reported cases of AIH in Nigeria, a country of about 200 million people. We report the first case of AIH in a male patient in Nigeria and highlight its unusual presentation. A 41-year-old man with jaundice and malaise for 3 months was referred for evaluation after investigations revealed deranged liver enzymes and a cirrhotic liver. Laboratory evaluation revealed high serum immunoglobulin G, but there was also marked elevation of serum ferritin and transferrin saturation, resulting in a diagnostic dilemma between AIH and an iron overload condition such as hemochromatosis. A liver biopsy was crucial in providing a definitive diagnosis of AIH. Despite its rarity, clinicians should maintain a high index of suspicion for AIH in sub-Saharan Africa and should proceed to a liver biopsy when the cause of CLD is unclear.

Failure to Thrive in a Middle-Aged Female: A Case of Congenital Incomplete Pancreas From a Rare Genetic Defect.

Hepatocyte nuclear factor-1 beta (HNF1B) gene is predominantly expressed in the liver, kidney, lung, genitourinary tract, and pancreas. It is an important transcription factor that regulates pancreas development. Mutation or absence of this gene is rare and can cause incomplete pancreatic development known as the agenesis of the dorsal pancreas. This rare genetic abnormality is associated with other disorders like maturity-onset diabetes of the young, abnormal liver function tests, genitourinary tract malformation, pancreatitis, and renal cysts. Diagnosing this genetic abnormality is difficult, especially in patients presenting with symptoms specific to only one system. Management is based on disease manifestation and involves a multidisciplinary approach. Our case describes a 51-year-old female with poorly controlled diabetes mellitus and Mullerian duct anomalies who presented with abdominal pain, fatigue, dizziness, and electrolyte derangement. Contrast-enhanced computed tomography (CECT) of the abdomen showed a multicystic kidney and a pancreatic head with a missing body and tail. Further workup revealed an HNF1B mutation.

An Unusual Case of Hepatocellular Carcinoma in a Healthy Teenager.

Hepatocellular carcinoma (HCC) is a primary liver malignancy known to occur majorly in patients with liver cirrhosis or those with a harbinger of risk factors like viral hepatitis, autoimmune liver disease, alpha-1 antitrypsin deficiency, alcoholic liver disease, and nonalcoholic fatty liver disease. The incidence of HCC has risen in the past 2 decades and currently ranks as the sixth most common cause of cancer-related death worldwide. Most cases are seen in adulthood, and only a very small percentage have been reported in adolescents with risk factors. The 2 pathologic subtypes of pediatric HCC are classic and fibrolamellar. Here, we discussed a very interesting rare case of a healthy male teenager with no apparent liver disease or risk factor who presented with right-upper-quadrant pain, normal alpha-fetoprotein level, and abdominal ultrasound showing a large hepatic mass. A liver biopsy was positive for HCC with fluorescent in situ hybridization showing a PRKACA complex gene pattern, favoring the fibrolamellar type.

A Busted Sac: A Case of Spontaneous Bladder Rupture Secondary to Acute Urinary Retention in a Healthy Middle-Aged Male.

Spontaneous bladder rupture is a relatively rare medical emergency that can be easily misdiagnosed. Although spontaneous bladder rupture is more common in those with previously diagnosed bladder conditions, this phenomenon may also occur in patients with an otherwise insignificant past medical history. Early diagnosis and treatment are critical to avoid fatal complications. Here, we present a 49-year-old male with insignificant past medical history who was diagnosed with spontaneous bladder rupture after the attempted placement of a Foley catheter.

A Rare Metastatic Primary Rectal Melanoma in a Geriatric Male.

Primary rectal melanoma (PRM) is an uncommon malignancy whose etiology remains unknown. Most patients present with rectal bleeding. Distant metastasis is commonly seen in the lung and liver. The incidence rates for locoregional lymph node metastases on initial presentation are almost 60%. Histology and immunochemistry are useful and are the gold standard for diagnosis. The prognosis is very poor due to the late presentation of patients. Optimum surgical treatment remains controversial. Abdominoperineal resection was considered traditionally but over time, has been found to have no survival benefit. Current literature and studies, therefore, recommend wide local excision. The beneficial effects of chemotherapy versus radiotherapy use are still debatable. Herein, we discuss a case of a 72-year-old Caucasian male with rectal bleeding found to have metastasized PRM.

Two Patients With Difficulty in Swallowing due to Dysphagia Lusoria.

Dysphagia lusoria (DL) is a rare clinical entity caused by compression of the esophagus by an aberrant right subclavian artery. It is coined from the Latin word meaning freak or jest of nature, with an estimated prevalence of approximately 0.5%. Before the term DL was known, the artery abnormality was referred to as luxus nature. Most patients are asymptomatic. In 30-40% of cases, DL results in tracheoesophageal symptoms like dysphagia to solid foods, chest pain, cough, and Horner's syndrome. Symptoms presenting later in life have been linked to arteriosclerosis and diminishing esophageal compliance resulting in compression. Another reason why people become symptomatic is due to Kommerell's diverticulum, a disorder that was first described by Kommerell, a German radiologist in 1936. It is also known as lusoria diverticulum, remnant diverticulum or lusoria root. This disorder represents a remnant of the left dorsal arch which forms a vascular ring behind the esophagus, leading to external compression. The key to diagnosis of DL is a barium esophagogram which may show extrinsic compression. Computed tomography or magnetic resonance imaging can be used for definite delineation of the vascular anatomy. Treatment approach is dietary modification or surgical intervention for unresponsive cases. Here, we present cases of dysphagia in two middle-aged women caused by compression effect on the esophagus by an aberrant right subclavian artery who did not respond to dietary modification.

The Tale of a Bleeding Tree: A Rare Case of Peripancreatic Variceal Hemorrhage Causing Hemosuccus Pancreaticus.

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. It was described by Lawal and Farrel in 1931. This disorder has also been referred to as pseudohemobilia or wirsungorrhagia, caused by bleeding into the pancreatic duct. The rarity of this condition can pose a diagnostic challenge. HP is life-threatening and requires immediate attention. The commonly used treatment modality is coil embolization. Surgery is considered in the case of failed embolization or uncontrolled bleeding. Described below, is a case of a 72-year-old female with a history of chronic pancreatitis who presented with anemia secondary to bleeding peripancreatic varices.

Diagnosed by Reversibility: Unmasking Propofol-Related Infusion Syndrome in a Critically-Ill Elderly Male.

Propofol-related infusion syndrome (PRIS) is an uncommon complication resulting from prolonged propofol use. Common clinical presentations include metabolic acidosis, cardiac arrhythmias, and renal complications. The mortality rate is high if it is not recognized in time. There is no antidote to propofol. Initial treatment involves discontinuing ongoing propofol use and providing supportive measures. The reversal of clinical and laboratory features upon discontinuation of propofol provides a basis for retrospective diagnosis or PRIS. In severe cases, ultrafiltration may be utilized.

Imaging Negative Hepatic Lesions: A Rare Case of Infiltrative Hepatocellular Carcinoma Diagnosed With Endoscopic Ultrasound.

Hepatocellular carcinoma is a common malignancy with male predominance. It is further classified into different subtypes, among which the infiltrative subtype is the most difficult to diagnose with imaging because of its inherently ill-defined micro nodules involving a segment or entire hepatic parenchyma without a distinguishable mass. Owing to the aggressive nature and decreased survival expectations in most patients with infiltrative hepatocellular carcinoma, liver transplants and surgical resections are not recommended. Our case describes a middle-aged woman presenting with alpha-fetoprotein >20,000 and imagings negative for hepatic mass, thereby necessitating the use of endoscopic ultrasound with fine-needle aspiration.

The Destabilized Artery: A Case of Spontaneous Coronary Artery Dissection Presenting as Unstable Angina.

Spontaneous coronary artery dissection (SCAD) is increasingly being recognized as a cause of acute coronary syndrome (ACS). This increased recognition of SCAD has been noted in patients with and without traditional cardiovascular risk factors such as diabetes mellitus, hyperlipidemia, and cigarette smoking. The increasing incidence is believed to be due to recent advances in diagnostic and coronary imaging modalities. The most common presenting feature is chest pain or discomfort. Normal troponin level does not rule out SCAD as the definitive diagnosis is made on coronary angiography. Percutaneous intervention (PCI) for SCAD has been associated with lower success rates compared to PCI for atherosclerotic coronary artery disease. Medical management is, therefore, the initial treatment of choice.