Upadacitinib in Crohn's disease: real-world experience.

Small molecule therapy in inflammatory bowel disease has recently gained momentum. One such agent that was recently approved for use in Crohn's disease is upadacitinib. Even though clinical trials support the use of this agent and efficacy is impressive, real-world data remains limited and scattered in the current literature. This article aims to summarize the real-world data published so far about using upadacitinib in Crohn's disease.

Metastatic Plasmacytoid Urothelial Carcinoma Masquerading as a Primary Signet Ring Cell Carcinoma of the Duodenum.

Plasmacytoid urothelial carcinoma can histologically mimic gastrointestinal signet ring cell carcinoma, a potential diagnostic pitfall resulting in improper clinical management. We present a rare case of a malignant duodenal ulcer due to metastasis from plasmacytoid urothelial carcinoma. Only by histological and retrospective immunohistochemical comparison with the primary bladder tumor was this revealed as a metastasis from a plasmacytoid urothelial carcinoma. This case report highlights the importance of clinical correlation and comparison with any previous pathology specimens, the limitations of immunohistochemical staining, and the utilization of both old and new immunohistochemical tools when differentiating signet ring cell carcinomas of primary sites versus potential metastases.

Uretero-Jejunal Fistula: A Rare Cause of Acute Pyelonephritis.

Penetrating peptic ulcers often lead to severe complications. The development of uretero-enteric fistulas is rare and can be challenging to diagnose and treat. Here, we present the case of a 41-year-old patient who previously underwent gastrojejunostomy for superior mesenteric artery syndrome and developed a peptic jejunal ulcer, leading to a uretero-jejunal fistula and finally causing acute pyelonephritis. The patient was managed with a multidisciplinary approach including medical therapy and endoscopic and radiologic interventions.

Colonic Lymphangiomatosis.

Lymphangiomas are benign malformations of the lymphatic vessels which can be primary or secondary in etiology. Colonic involvement is rare, and the diagnosis is mostly incidental. Sometimes, the initial endoscopic appearance can be misleading. We present a case of colonic lymphangiomatosis presenting with free air under the diaphragm requiring surgical removal of the involved portion of the colon. The diagnosis was confirmed by the pathology of the resected specimen and its correlation with prior clinical information. The patient recovered well with an uneventful postoperative course and follow-up. This case demonstrates a rare complication of colonic lymphangiomatosis prompting definitive treatment by surgical resection.

Non-cirrhotic portal hypertension in inflammatory bowel disease.

With the increasing incidence and prevalence of inflammatory bowel diseases (IBD), its complications and associated morbidity also continue to rise. One of these is non-cirrhotic portal hypertension. There is an increasing need of recognizing and understanding the pathophysiology of this condition in the clinical setting of IBD, especially in long standing cases. Due to multiple potential factors, patients with IBD appear to be at a higher risk of developing portal hypertension even in the absence of liver cirrhosis. Portal hypertension is usually diagnosed when complications (such as ascites, variceal bleeding) develop, especially when patients have already experienced multiple complications of the disease. Hence, a high level of vigilance for the detection of portal hypertension at an early stage is needed. This review discusses the known epidemiology, clinical characteristics, clinical presentation, modalities of diagnosis and the potential treatments of the different forms of non-cirrhotic portal hypertension associated with IBD. The concomitant presence of portal hypertension can significantly impact the overall clinical picture and disease burden in IBD. Hence, increased awareness of this condition at an early stage might help tailor a comprehensive and individualized therapeutic plan of care for these patients.

Bleeding Gastric Lipoma Resected by Endoscopic Submucosal Dissection.

Gastric lipomas are slow-growing benign lesions of the stomach that are often detected incidentally. Most cases are asymptomatic but larger lesions may become symptomatic, thereby requiring treatment. Multiple endoscopic modalities have been used for resection in the past. We present the case of a 67-year-old patient who presented with upper GI bleeding secondary to a gastric lipoma, which was successfully resected by endoscopic submucosal dissection.