Clinical Case Summary

A 21-years old male developed a perianal abscess and he undertook an ileocolonoscopy which showed right colon substenosis with ulcerations and deformation of the ileo-cecal valve. Stenosis histological samples were compatible with IBD-U (granulation tissue, chronic inflammatory infiltration and some cryptes with lowered mucous secretion). The MRI-enterography, showed thickening of distal ileum, ileo-cecal valve and cecum. A diagnosis of Crohn’s disease was made and the patient started adalimumab. The patient experienced recurring subocclusive crisis, thus another ileocolonoscopy was performed showing a scarring stenosis of proximal right colon, which could not be overcome by paediatric instrument. The patient underwent ileo-colonic resection. The surgical sample showed ileo-cecal valve circumferential stenosis and an occluding diaphragm between cecum and ascendent colon. Histologically the valve and the colonic wall had thickening and raising of only submucous membrane; mucosa was characterized by linfoplasmacellular inflammation with eosinophils granulocytes, architecture distortion and Paneth metaplasia. These features were compatible with colopathy with formation of fibrosus intraluminal diaphragm, namely diaphragm disease. The use of NSAIDs was investigated, but the patient took them just occasionally. Therefore, there was not a clear correlation between the use of NSAIDs and the diaphragm formation. At the ileocolonscopy performed six months after surgery, the ileal-colonic anastomosis appeared wide, slightly hyperaemic and without lesions. No more subocclusive crisis occurred.
Diaphragm disease is a rare colopathy associated with a long-term use of NSAIDs with a range of presentations and symptoms as abdominal pain, anemia, diarrhea, weight loss and constipation. The treatment is based on discontinuation of NSAIDs and eventually surgery. This clinical case shows a rare and challenging differential diagnosis of IBD.

Introduction

There is conflicting data on the risk factors linked to Gastroesophageal Reflux Disease (GERD) and Functional Dyspepsia (FD). Studies that explore the association between anxiety/depression and GERD phenotypes (Esophagitis/EE and Non-Erosive Reflux Disease/NERD), FD, and Rome-IV syndromes are scarce.

Aims & Methods

The aim was to evaluate the association between epidemiological factors and comorbidities with GERD phenotypes, FD, and Rome-IV syndromes, as well as the relationship of these processes with anxiety/depression.
338 participants were selected from 357 patients referred to three tertiary centers in Granada (Spain) for endoscopic assessment. A gastroenterologist individually interviewed each participant prior to the procedure and administered three validated questionnaires (GERD-Q, Rome-IV, and HADS) to detect the presence of GERD, FD, and anxiety/depression, respectively.

Results

45/338 patients were controls, 198/58.6% were classified as GERD, 81/24.0% EE (49/14.5% symptomatic, and 32/9.5% asymptomatic), 117/34.6% NERD, 176/52.1% FD (43/12.7% epigastric pain syndrome, 36/10.7% postprandial distress syndrome, and 97/28.7% overlapping syndrome). 81 patients were mixed GERD-FD. Multivariate analysis found significant independent associations: age in NERD and FD; sex in EE, asymptomatic EE and FD; body mass index in NERD and FD; alcohol in EE; anxiety/depression in FD; use of calcium channel antagonists in EE; and inhalers in FD. We compared controls vs different groups/subgroups finding significantly more anxiety in NERD, FD, all Rome-IV syndromes, and mixed GERD-FD; more depression in FD, overlapping syndrome, and mixed GERD-FD; and higher levels of anxiety+depression in NERD, FD, overlapping syndrome, and mixed GERD-FD.

Table: Multivariate analysis (logistic regression) of factors associated with different groups and subgroups of GERD and FD

Conclusion

The existence of shared demographic and psychopathological risk factors in Non-Erosive Reflux Disease (NERD) and Functional Dyspepsia (FD) implies that they could be part of the same pathophysiological spectrum. The prevalence of anxiety was higher in NERD, while anxiety and depression were more frequent in FD. These results suggest that psychological therapy could be a supportive strategy for both conditions.

Introduction

Recently, a novel self-assembling peptide hemostatic gel has become available in Japan. However, the safety and efficacy of this novel self-assembling peptide hemostatic gel remain unclear for bleeding after EST.

Aims & Methods

The aim of this study was to evaluate the safety and efficacy of a novel self-assembling peptide hemostatic gel for bleeding after EST, and compared to conventional endoscopic hemostasis technique.
This retrospective study was carried out between January 2019 and October 2022. Patients who developed bleeding associated with EST were enrolled. The patients were divided into two groups based on the hemostasis techniqueused: a conventional hemostasis technique (Group A) or a novel self-assembling peptide hemostatic gel hemostasis technique (Group B).

Results

A total of 62 patients (Group A, n=36; Group B, n=26)were included. Endoscopic hemostasis was initially obtained in 72.2% (26/32) of patients in Group A and in 88.4% (23/26) of patients in Group B, with no significant difference (P=0.1211). However, the procedure time was significantly shorter in Group B (mean, 9.38 min) compared with Group A (mean, 15.4 min) (P=0.0103).There were no significant differences in the severity of bleeding between the two groups (P=0.4468). post-EST bleeding was observed in 6 patients (Group A, n=4; Group B, n=2). although there was no significant difference (P=0.6532), adverse events were more frequently observed in Group A (n=12) than in Group B (n=1).

Conclusion

PuraStat application for EST bleeding might be safe and effective, and comparable to the conventional endoscopichemostasis technique, although further prospectiverandomized trial is needed.