Unusual Upper Gastrointestinal Bleeding Due to a Neuroendocrine Tumor Arising in Meckel Diverticulum.

Meckel diverticulum is the most common congenital variation of the gastrointestinal tract arising from incomplete obliteration of the vitelline duct during gestation. In most cases, individuals are asymptomatic. This is a case of a 38-year-old patient with hematochezia in whom Meckel diverticulum was diagnosed. A mass was identified within the diverticulum. Histopathological and immunohistochemical studies revealed a well-differentiated neuroendocrine tumor. The development of tumors in Meckel diverticulum is rare, and when identified, only 0.5%-3.2% of these tumors are found to be malignant. Furthermore, gastrointestinal bleeding is an infrequent clinical feature of neuroendocrine tumors. A unique aspect of this case was that numerous imaging studies and endoscopic procedures were unable to definitively identify the presence of Meckle diverticulum and underlying neuroendocrine tumor. Through a high clinical suspicion and collaboration with surgical colleagues, an exploratory laparotomy was performed, which ultimately led to the identification and diagnosis of the underlying pathology.

Noninvasive Tests Used in Risk Stratification of Patients with Nonalcoholic Fatty Liver Disease.

As the prevalence of obesity and type 2 diabetes increases around the world, the prevalence of nonalcoholic fatty liver disease (NAFLD) has grown proportionately. Although most patients with NAFLD do not experience progressive liver disease, about 15% to 20% of those with nonalcoholic steatohepatitis can and do progress. Because liver biopsy's role in NAFLD has become increasingly limited, efforts have been undertaken to develop non-invasive tests (NITs) to help identify patients at high risk of progression. The following article discusses the NITs that are available to determine the presence of NAFLD as well as high-risk NAFLD.

Vigorous physical activity provides protection against all-cause deaths among adults patients with nonalcoholic fatty liver disease (NAFLD).

BACKGROUND: Mortality benefits of vigorous leisure time physical activity (LTPA) among adults with NAFLD is not known. AIM: To investigate association between LTPA and reduction in all-cause mortality among adults with NAFLD. METHODS: We used NHANES (1999-2006) self-reported PA data for adults (≥40 years) with mortality follow-up through December 31, 2015. US-Fatty Liver Index in absence of secondary causes identified NAFLD. Moderate and vigorous LTPA were calculated by the 2018 PA Guidelines for Americans. RESULTS: NAFLD prevalence among 5211 adults (46.2% male; 75.8% white; mean age 53.2 years) was 32.7%. Adults with NAFLD were less likely to report the recommended minimal PA (≥ 150 min/week, 55.5% vs 64.8%) or highly active PA (≥300 min/week, 39.2% vs 48.5%) compared to adults without NAFLD. Over a median follow-up of 12.3 years, 355 deaths among adults with NAFLD and 510 deaths among adults without NAFLD were registered. In the metabolic comorbidities-adjusted model, adults with NAFLD who reported ≥50% of their total PA as vigorous activity had a 56% reduction in all-cause mortality risk (HR:0.44, 95%CI: 0.25-0.76) and cancer-specific mortality risk (HR: 0.21, 0.06-0.66) but not cardiac-specific mortality (p > 0.05) compared to adults with NAFLD who did not report any LTPA. This association remained significant even among adults with NAFLD who met the recommended minimal PA, among adults with NAFLD who reported any LTPA, and among adults with NAFLD who had metabolic abnormalities and in sensitivity analysis. CONCLUSIONS: Engaging in vigorous activity is beneficial for adults with NAFLD - especially those with metabolic abnormalities.