Strongyloides Hyperinfection Presenting as a Gastric Outlet Obstruction.

Strongyloides is a unique nematode in its ability to cause a secondary hyperinfection and disseminated disease several years following initial contact. The prevalence of Strongyloides infection has been rising; it is currently considered a global disease, which presents with a broad spectrum of clinical signs and symptoms among patients. This case report focuses on a 67-year-old Caribbean female presenting with severe weight loss, vomiting, early satiety, and mild anemia who was subsequently diagnosed with strongyloidiasis on the basis of a duodenal biopsy pathology report obtained via esophagogastroduodenoscopy (EGD).

Strongyloidiasis: a diagnosis more common than we think.

Strongyloides stercoralis is endemic to many tropical regions; however, there is limited knowledge concerning the clinical implication of this helminth, particularly in urban medical centers. We report a case series of strongyloidiasis in our urban medical center in New York City. Patients over the age of 18 years who were examined in our institution from January 1998 to May 2011 were identified by electronic medical record search using International Classification of Diseases, 9th Revision codes. We identified 22 cases of S. stercoralis. Eleven patients were men and 11 were women, with the average age at diagnosis being 62.4 years. Fourteen patients emigrated from the Caribbean, one from Nepal, five were blacks born in the USA, and two did not have their birthplace documented. The main presenting complaints were diarrhea (9/22), abdominal pain (6/22), vomiting (7/22), and weight loss (8/22). Seventeen patients demonstrated eosinophilia. Four patients were positive for human T-lymphotropic virus-1 antibodies, and three patients were infected with HIV. Diagnosis was made with stool examination (19/22), bronchoalveolar lavage (1/22), gastric biopsy (1/22), and duodenal biopsy (3/22). Among six patients who had upper endoscopy performed, the findings commonly included gastritis and gastric and duodenal ulcers. After treatment, 12/22 showed resolution of symptoms. Although a diagnostic approach tends to start with stool collections, consideration of upper endoscopy with biopsy in symptomatic patients is advisable. The absence of eosinophilia should not deter the clinician from seeking a diagnosis. Although often not done, ascertaining HIV and human T-lymphotropic virus-1 status should be part of the work-up.

An isolated neurofibromal polyp of the colon.

Solitary neurofibromal colonic polyps are a rare entity, particularly outside the setting of neurofibromatosis type 1. The clinical significance of such lesions has not yet been established. Though typically benign tumors, neurofibromas have been reported to undergo malignant transformation, with an increased risk of malignancy when associated with neurofibromatosis. In this case report, we present the rare case of a man found to have an isolated colonic neurofibroma without any personal/family history or clinical features of neurofibromatosis. A 59-year-old man with a history of dyslipidemia and degenerative joint disease presented for a routine screening colonoscopy. The colonoscopy revealed no abnormalities except a 3 mm transverse colon polyp and another 4 mm polyp in the descending colon. Biopsy results showed the descending colonic polyp to be a tubular adenoma; however, multiple levels of the 3 mm transverse colon polyp revealed interlacing bundles of spindle cells extending into the lamina propria with comma-shaped nuclei consistent with findings seen in neurofibroma. Isolated colonic neurofibromas are rare and understudied. While they are usually benign, they may undergo malignant transformation, especially when associated with neurofibromatosis. Thus, patients presenting with isolated neurofibromas should be followed for development of neurofibromatosis and malignancies.

A comprehensive review of esophageal stents.

Esophageal stents are important tools for palliative treatment of inoperable esophageal malignancies. With the development of multiple self-expandable stents, there are now several therapeutic options for managing benign and malignant esophageal diseases. This paper discusses the various types of esophageal stents currently available, indications for their placement, challenges and complications that gastroenterologists face when placing these stents, and some of the innovations that will become available in the near future.