Vomiting-induced gastric emphysema: a rare self-limiting condition.

Radiological evidence of presence of air or gas within the stomach wall is termed "gastric pneumatosis" and is considered an ominous sign. However, the etiological associations range from benign self-limiting causes to life-threatening emergencies. The authors report the case of gastric pneumatosis in a 34-year-old man who presented to the emergency department with severe abdominal pain after multiple episodes of vomiting. The authors also review the clinical associations of this uncommon condition and discuss risk stratification and management strategies.

A multicenter retrospective experience of infliximab in Crohn's disease patients: infusion reaction rates and treatment persistency.

BACKGROUND: Infusion reactions have been associated with infliximab therapy, but no study has assessed how physicians treat and manage this common adverse event. GOALS: To determine how gastroenterologists manage infusion reactions, identify prophylactic pretreatment protocols, and determine infliximab treatment persistence in the presence of infusion reactions. METHOD: This retrospective multicenter chart review analyzed data from adults younger than 90 years at the time of their first infliximab infusion from 9 academic or community-based gastroenterology practices. Infusion reaction rates were compared using a Chi-square test with Yates' correction. Kaplan-Meier methods assessed infliximab treatment persistency. RESULTS: Among 6,468 infusions with known infusion reaction status administered to 447 patients, 3.5% (226/6,468) of infusions resulted in an infusion reaction, and less than 0.1% (2/6,468) were associated with a serious infusion reaction. Among all patients, 19.7% (88/447) experienced at least 1 infusion reaction, whereas 0.4% (2/447) experienced a serious infusion reaction. Patients receiving concomitant immunosuppressives had fewer infusion reactions compared to patients not receiving them (57/322 patients, 17.7% vs 31/125 patients, 24.8%; P=.118). The cumulative proportion of patients continuing infliximab therapy at 2, 4, and 5 years was 73%, 58%, and 54%, respectively. CONCLUSIONS: The incidence of serious infusion reactions was low. In the overall experience observed in this clinical practice retrospective cohort, no conclusions can be drawn regarding the effectiveness of specific infusion reaction prophylactic measures. In spite of infusion reactions, the long-term infliximab treatment persistence rate was high.