- |||||||||| Gastroenterological Manifestations in a Patient With Common Variable Immunodeficiency (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3666;
Non-cirrhotic portal hypertension was managed with furosemide and spironolactone...Recognition of this complication allowed for symptom resolution within two days of starting lactulose therapy. NRH in CVID represents an autoimmune-like liver disease that might be driven by a local vasculopathy, and thus severe cases can warrant a trial of immunosuppression.
- |||||||||| Veramyst (fluticasone furoate nasal spray) / GSK
Extraintestinal Manifestations of Ulcerative Colitis Presenting as Tracheobronchitis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3632;
On examination, the patient had extensive wheezing and thus was instructed to utilize an albuterol inhaler and was prescribed a 10-day prednisone taper...The patient was therefore started on Fluticasone Furoate-Vilanteril 100-25 mcg/inhalation and sent for chest imaging...Figure: Image 1 A-F: Moderate concentric thickening of the wall of the trachea and diffuse thickening of the walls of the bronchi and bronchioles. Overall findings highly suspicious for airway involvement of ulcerative colitis.
- |||||||||| hydroxychloroquine / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Enterocolitis as the Initial Presentation of Systemic Lupus Erythematosus (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3600;
Her symptoms progressively improved, after which steroids were tapered and she was transitioned to hydroxychloroquine therapy...Early suspicion and prompt management is essential to prevent complications such as bowel ischemia or perforation. Figure: Computerized tomography of the abdomen & pelvis in coronal [A] and sagittal views [B] demonstrated diffuse mural thickening of the jejunum and ileum in a “target sign” pattern.
- |||||||||| budesonide / Generic mfg., lansoprazole / Generic mfg.
Dysphagia, Rings and Furrows, Oh My! A Rare Cause of Benign Esophageal Stenosis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3567;
Repeat EGD off of lansoprazole demonstrated benign stenosis in the distal esophagus that was dilated and mucosal changes suspicious for EoE...Stent was removed and she was started on swallowed budesonide to treat lichen planus of the esophagus...D. Esophageal biopsy pathology- necrotic, esosinophilic keratinocytes (Civatte bodies).
- |||||||||| leflunomide / Generic mfg.
Drug-Induced Colitis Secondary to Leflunomide (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3556;
This case highlights both the importance of keeping leflunomide-induced colitis in the differential and the potential adverse effects of delay in diagnosis. Figure: Figure 1 (a) erythema and congestion, (b) ulceration, (c) erosions with exudates
- |||||||||| Cryoglobulinemic Vasculitis After 6 Years of Sustained Virologic Response in a Post-Liver Transplant Patient (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3514;
MRI orbits revealed lacrimal gland adenititis treated with topical medications including erythromycin and systemic acetazolamide...Notably, she was treated with ledipasvir/sofosbuvir and ribavirin which was completed 7/2015 with SVR achieved 12/2015...She was treated with pulse dose solumedrol and plasmapheresis...Her creatinine returned to baseline and she was started on prednisone 60mg daily...Moreover, multiple modalities of diagnosis may need to be pursued if initial biopsies are not conclusive to establish effective treatment plans. Overall, CV should remain on the differential in patients with a treated HCV and SVR.
- |||||||||| budesonide / Generic mfg.
Crohn's Disease Presenting as Diffuse Granulomatous Mesenteric Adenitis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3512;
Given uncertainty regarding the underlying diagnosis, she was trialed on 2 months of budesonide...B. Endoscopic findings of inflamed terminal ileum with congested, erythematous, and ulcerated mucosa.
- |||||||||| budesonide / Generic mfg.
Complete Colonoscopy vs Flexible Sigmoidoscopy to Diagnose Microscopic Colitis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3504;
This frequency indicates 53.8% of the diagnoses for MC could be missed by performing left sided biopsies alone. The Kappa coefficient of -0.7896 indicates no agreement between obtaining a pathologic diagnosis from left sided biopsy compared to random with a ( p < .0001).
- |||||||||| dexamethasone / Generic mfg.
Colonic Mucormycosis as a Complication of COVID Pneumonia: A Case Report (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3487;
He was treated with dexamethasone...Figure: Left, Right: punched out, deep ulcerations of the sigmoid colon Middle: PAS 400X. Fungal organisms present, consistent with mucormycosis in a background of acute inflammation, ulceration, and focal necrosis.
- |||||||||| Kenalog-40 (triamcinolone acetonide injection suspension) / BMS
Chronic Tracheoesophageal Fistula Successfully Treated Using an Amplatzer Closure Device Under Endoscopic Visualization (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3466;
Home medications include famotidine...The patient had undergone numerous esophagogastroduodenoscopies (EGD) since 2017 for recurrent strictures requiring TTS balloon dilations, intralesional triamcinolone acetonide injections and esophageal stenting complicated by formation of a tracheoesophageal fistula (TEF) at the anastomotic site...In the setting of large or difficult to manage TEFs and patients who are not surgical candidates, Amplatzer septal occluder devices can be used to successfully treat complicated TEFs. Figure: Amplatzer device deployed with successful tracheoesophageal fistula closure.
- |||||||||| Stelara (ustekinumab) / J&J
Adrenal Crisis in a Patient With Crohn’s Disease: A Legacy of the Corticosteroid Treatment Era (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3357;
Case Description/ A 73-year-old female with Crohn’s disease diagnosed at the age of 18, complicated by short bowel syndrome and esophageal involvement, who had been steroid dependent for 15 years though stable on ustekinumab and no steroids for more than 8 years, presented to the emergency department with an acute onset of abdominal pain, diarrhea with incontinence, profound weakness, disorientation, and possible syncope, one hour after IV iron sucrose therapy...Because of the severity of this response, the possibility of adrenal crisis was raised: serum cortisol was 15.5 ug/dL (nl 6.2-29) despite the stressful situation and the patient responded clinically to 100 mg of hydrocortisone IV...Important hints are the patient’s age and GI history, which includes extent of exposure to corticosteroids. Effective diagnosis requires maintaining a high index of suspicion.
- |||||||||| A Rare Cause of Dysphagia: Esophageal Stricture Due to Lichen Planus (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3314;
He was started on pantoprazole 40 mg twice daily...He had Candida esophagitis 1 month after initiation of budesonide which was treated with fluconazole...Successful use of immunomodulators such as cyclosporine, mycophenolate has been described...Figure: Esophageal biopsy showing esophageal squamous mucosa with basal cell hyperplasia, intraepithelial lymphocytes, and two apoptotic keratinocytes (Civatte or colloid bodies). Findings are compatible with esophageal lichen planus.
- |||||||||| dexamethasone / Generic mfg.
A Rare Case of Colonic Adenocarcinoma Presenting With Right Upper Extremity Weakness (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3278;
Dexamethasone was initiated and patient underwent right craniotomy with tumor resection...Lastly, neurological deficit, as seen in our patient, is an uncommon presentation for CRC. Increased awareness of BM and OM in mCRC is crucial for early diagnosis and intervention.
- |||||||||| Cytovene (ganciclovir) / Roche
A Case of EBV Hepatitis Complicated by Hemolytic Anemia (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3208;
Due to the high global prevalence of Epstein-Barr virus, healthcare professionals should be aware of the diagnosis, management and complications of hepatic manifestations. Table: Liver Injury and Cholestasis Lab Trend From Hospital Day (HD) 1-7
- |||||||||| budesonide / Generic mfg., tetracycline / Generic mfg., dicyclomine / Generic mfg.
Vibrio Species Infection Followed by New Onset Lymphocytic Colitis: Cause or Coincidence? (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3163;
He was treated with tetracycline, though his symptoms did not completely relent...Postinfectious IBD was suspected, and he was started on a FODMAP diet and dicyclomine...Treatment was initiated with oral budesonide and tapered...While the exact mechanism of post-infectious LC is unknown, upregulation of nitric oxide synthase is seen in both infection with Vibrio and LC. Further metabolic clarification and investigation are yet required to define the pathogenesis of this disorder.
- |||||||||| ceftriaxone / Generic mfg., methotrexate / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
The Great Masquerader: Whipple’s Disease Presenting as Sarcoid-Like Granulomas (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2955;
She improved with steroids and methotrexate...IV solumedrol was initiated for presumed flare with plans to initiate outpatient TNF inhibitor therapy...She was started on IV ceftriaxone with symptomatic improvement...Prompt diagnosis and treatment of WD is necessary to prevent endocarditis, CNS manifestations, and death. WD should be considered in the differential diagnosis of sarcoidosis, particularly in steroid-unresponsive disease.
- |||||||||| Olumiant (baricitinib) / Incyte, Eli Lilly
Superior Mesenteric Artery Thrombosis and Intestinal Ischemia as a Consequence of Sars-Cov-2 Infection (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2876;
Subsequently, he was on BIPAP and baricitinib in the ICU...Also, Future research is needed to better understand the role of coagulopathy and anticoagulation treatment in managing patients with COVID-19 infection. Figure: Axial image of CTA of the abdomen shows thrombus with complete occlusion of the superior mesenteric artery at its origin.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
Severe Nausea and Hyperemesis Are Not Always Gastrointestinal: Non-GI Immune-Related Adverse Events Presenting as Upper GI Symptoms (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2792;
Case Description/ A 61-year-old male with metastatic RCC status post right nephrectomy on Nivolumab and Ipilimumab was admitted due to 2-months of progressive generalized weakness and persistent nausea and vomiting...Hydrocortisone and levothyroxine therapy were immediately instituted...This process can also result in autoimmune responses to various systems in the body, including gastrointestinal, endocrine, hepatic, pulmonary, dermatologic, and renal systems. With the increased utility of ICI in treating various malignancies, it is of the upmost importance to recognize different irAE to avoid delay in starting lifesaving treatments and to avoid unnecessary procedures like this particular case.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
Severe Dysphasia With Eosinophilic Esophagitis Pattern of Injury and Autoimmune Gastritis Related to Pembrolizumab Therapy (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2789;
Topical glucocorticoid therapy with budesonide was then started...Pembrolizumab was discontinued and docetaxel with ramucirumab was started, which resulted in a complete resolution of his dysphagia symptoms...Refractory cases may require systemic immunosuppression with corticosteroids or biologic therapy. Figure: Figure 1A – Mid-esophageal narrowing on barium swallow study Figure 1B – Intraepithelial eosinophilia consistent with EoE
- |||||||||| methylprednisolone sodium succinate / Generic mfg., enoxaparin sodium / Generic mfg., apixaban / Generic mfg.
Saddle PE in an IBD Patient (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2738;
He received enoxaparin injection for VTE prophylaxis...He remained hemodynamically stable and was ultimately discharged on apixaban...Despite this clear association, VTE prophylaxis is underutilized in this population. Figure: Large saddle embolism at the bifurcation of the pulmonary artery
- |||||||||| dexamethasone / Generic mfg., sorafenib / Generic mfg.
Refractory Hypoglycemia From Hepatocellular Carcinoma: How Low Can You Go? (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2677;
He suffered hypoglycemia-induced seizures requiring debulking therapy with transarterial bland embolization (TAE) and dexamethasone...Sorafenib was considered for palliation, but the patient opted for comfort-directed care and died one month after admission...Table: Table 1. Laboratory Data
- |||||||||| budesonide / Generic mfg.
Olmesartan-Induced Enteropathy With Associated Anti-Enterocyte Antibody (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2349;
Four months after discharge, she reported complete resolution of her diarrhea while on Budesonide and significant weight gain with both enteral feeds and PO intake...Panel B - There were scattered epithelial apoptotic bodies in the crypts (black arrow) and focal increase in intraepithelial lymphocytes (white arrows). (Hematoxylin & eosin stain, 400x original magnification).
- |||||||||| Taltz (ixekizumab) / Eli Lilly, Japan Tobacco
New-Onset Inflammatory Bowel Disease After Ixekizumab Initiation for Psoriatic Arthritis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2300;
While on IV methylprednisolone 20 mg every 8 hours for 1-week, symptoms persisted with repeat labs: fecal calprotectin 725 mcg/g, ESR 11 mm/hr, CRP 1.72 mg/L...Days later, he improved and was discharged with outpatient follow-up on oral prednisone 40 mg...Patient was initiated on Adalimumab shortly after and is now feeling significantly better as he tapers off his steroid regimen...(C) Repeat colonoscope view of transverse colon; colitis with altered vascularity, congestion and pseudopolyps in a continuous circumferential pattern from transverse colon to the cecum. (D) Final colonoscope view of transverse colon; mild to severe pancolitis from rectum to cecum, with superficial ulcerations and friability of mucosa, Mayo Score 3.
- |||||||||| mycophenolate mofetil / Generic mfg., mycophenolate sodium / Generic mfg.
Mycophenolate Mofetil (MMF)-Induced Hemorrhagic Colitis with Safe Reintroduction of Alternative Low Dose Enteric-Coated Mycophenolate Sodium (EC-MPS) (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2277;
Case Description/ A 36 y/o M with kidney transplant in 2015 on tacrolimus, prednisone, and oral MMF 500 mg twice a day presented with hematochezia, loose stools, and abdominal discomfort...MMF was discontinued in favor of Azathioprine (AZA) 100 mg daily...For this, he received high dose IV methylprednisolone, IVIG, and plasmapheresis...Still, this may lead to acute graft rejection as seen in our case. Our case suggests that EC-MPS may be a safe alternative in instances of MMF-induced colitis given the reduced association with GI related toxicities.
- |||||||||| dexamethasone / Generic mfg., valacyclovir / Generic mfg., acyclovir / Generic mfg.
Mind the Steroids: Herpes Esophagitis in an Immunocompetent Patient After Steroid Therapy (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2235;
Given persistent symptoms he underwent laryngoscopy which demonstrated bilateral tonsillar exudates and normal pharyngeal mucosa, prompting admission and initiation of IV antibiotics and dexamethasone...His symptoms abated while on IV acyclovir allowing transition to oral valacyclovir...C: (x200): IHC study using antibodies against HSV-1. Numerous intranuclear viral inclusions are positive with HSV-1 within the infected cells.
- |||||||||| Campath (alemtuzumab) / Sanofi
Microscopic Enteritis: A Rare Manifestation of T-cell Promyelocytic Leukemia (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2229;
He was empirically treated with intravenous methylprednisolone with resolution of fevers...He was treated with alemtuzumab; however developed worsening disease and disseminating opportunistic infections (cytomegalovirus and aspergillosis)...Prompt, timely evaluation should be prioritized to improve outcomes. T-PLL is a rare leukemia due to abnormal growth of T-lymphocytes and typically presents with leukocytosis, weight loss, and infection; however, gastrointestinal symptoms may be a presenting symptom.
- |||||||||| Mesalamine-Induced Interstitial Lung Disease in a Crohn’s Patient With COVID-19 (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2202;
Latent interstitial pulmonary involvement is seen in around 20%-55% of patients with IBD, with the most common manifestation being drug-induced lung disease, due to sulfasalazine, mesalamine, methotrexate, or anti-TNF agents...Figure: A: Portable Chest X-ray showing multifocal pneumonia, low lung volumes with bilateral patchy airspace disease; B, C: CT-Chest showing peripherally distributed ground-glass opacities, distributed in upper and lower lobes. There were superimposed early diffuse lung fibrotic changes, without any evidence of pulmonary thromboembolism; D: CT Chest, 5 months post-discharge, showing improvement in opacities.
- |||||||||| Linzess (linaclotide) / Astellas, Ironwood Pharma, AbbVie
Longstanding Proctocolitis Secondary to Chronic Inferior Mesenteric Vein (IMV) Occlusion (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2145;
Case Description/ A 43-year-old male with a past medical history of DM, HTN, renal transplant on immunosuppression, prothrombin gene mutation and DVT on apixaban initially presented with rectal pain and diarrhea of one month duration...He was started on linaclotide, mesalamine enemas, and hydrocortisone enemas...Early detection of IMVT can decrease both morbidity and mortality while effectively guiding therapy. Figure: A) Diffuse severe inflammation with mucosal friability and granularity of the descending colon B) Diffuse severe inflammation with mucosal friability and erosions in sigmoid colon C) Diffuse severe inflammation with congestion, friability, and shallow ulcerations in rectum with oozing
- |||||||||| Tepezza (teprotumumab) / Horizon Therapeutics, Roche
Insulin-Like Growth Factor I Receptor Inhibitor-Induced Inflammatory Bowel Disease (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2062;
This case highlights a potentially detrimental side effect and appropriate discussions with patients should be held prior to this medications usage. Ideally the gastroenterologist should be kept abreast of the decision to initiate such therapy to allow for careful monitoring.
- |||||||||| Taltz (ixekizumab) / Eli Lilly, Japan Tobacco, Simponi (golimumab) / Merck (MSD), Mitsubishi Tanabe, J&J
Induction of Inflammatory Bowel Disease by Interleukin-17 Inhibitor (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2038;
Introduction: Ixekizumab is a monoclonal antibody targeting interleukin-17 (IL-17) approved for treating psoriasis...Patient’s medications included topical betamethasone-calcipotriene, methotrexate weekly, folic acid, golimumab monthly, and piroxicam...Hydrocortisone and mesalamine were started...It reminds us to be cognizant and monitor for IBD symptoms in patients taking such medications. Figure: Figure 1: Colonoscopy demonstrated a contiguous area of bleeding ulcerated mucosa in the rectum (1A) and sigmoid colon (1B).
- |||||||||| Dupixent (dupilumab) / Sanofi, Regeneron
Iatrogenic Cushing’s Syndrome in Eosinophilic Esophagitis: A Rare Complication of Swallowed Topical Corticosteroids (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1916;
Case Description/ A 27-year-old woman with a seven-year history of EoE refractory to proton pump inhibitor, 6-food elimination diet, and swallowed fluticasone (FP) achieved disease remission with high-dose oral viscous budesonide (OVB) 4mg...Given known exposure to exogenous steroids, features consistent with iatrogenic Cushing’s syndrome, and assumed hypothalamic-pituitary-adrenal axis (HPAA) suppression, the patient began a taper of OVB and steroid-sparing treatment was initiated with dupilumab 300mg weekly...Figure: FIGURE 1. Endoscopic evidence of (B) active disease on FP (B) disease remission on OVB 4mg daily; (C) Cushingoid features of abdominal striae and dorsocervical hump.
- |||||||||| prednisone / Generic mfg., methylprednisolone sodium succinate / Generic mfg., azathioprine / Generic mfg.
Gastrointestinal Hemorrhage With Gastritis and Pancolitis as Sole Presentation for Granulomatosis With Polyangiitis Flare (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1754;
He was discharged on a prednisone taper and later transitioned to azathioprine therapy...The gastric oxyntic-type and colonic mucosa revealed an unusual pattern of chronic active gastritis and colitis with neutrophilic mediated epithelial injury in the form of glandular micro abscesses, cryptitis, crypt abscesses and vasculitis. No granulomas are identified. A Helicobacter pylori immunostaining was performed on the gastric biopsy, and it was negative.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS
Gastritis Secondary to Nivolumab in a Patient With Metastatic Melanoma (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1740;
Intravenous (IV) pantoprazole and oral sucralfate were started, along with IV methylprednisolone, which was later transitioned to oral prednisone...The hospital course was complicated by severe oropharyngeal candidiasis treated with nystatin and fluconazole, dysphagia requiring temporary nasogastric (NG) tube placement, hypotension, delirium, QTc prolongation requiring cessation of oral fluconazole, pulmonary embolism requiring anticoagulation, and bacteremia of unknown origin requiring ceftriaxone...Infliximab is often used for refractory disease. Figure: Upper endoscopy revealing diffuse sloughing of the gastric mucosa
- |||||||||| sofosbuvir/velpatasvir / Generic mfg., methylprednisolone sodium succinate / Generic mfg., ursodeoxycholic acid / Generic mfg.
Fibrosing Cholestatic Hepatitis Masquerading Acute Cellular Rejection in HCV-Positive Donor Liver Graft (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1687;
Considering the donor was HCV+, Hepatitis C RNA, PCR was done on 3/1/22 which was >100000000 IU/mL, at this point patient was started on EPCLUSA (sofosbuvir-velpatasvir)...B: Arrow pointing towards pigment deposition showing intrahepatic cholestasis. Table: Table-1: Trend in LFTs and HCV RNA viral load over hospital course following deceased donor HCV+ OLT
- |||||||||| Xeljanz (tofacitinib) / Pfizer
Failed Tofacitinib Rescue Therapy in Acute Severe Ulcerative Colitis Refractory to Steroids and Anti-TNF Therapy (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1669;
Case Description/ A 60-year-old Indian man with a three-year history of ulcerative proctitis on mesalamine therapy was admitted to the hospital for diarrhea, abdominal pain, and hematochezia after failing outpatient oral prednisone and rectal budesonide foam...The patient was started on IV methylprednisolone 60 mg/daily...Due to the unavailability of inpatient Infliximab use in our hospital at the time, he was started on Adalimumab and received 160 mg dose, followed by another 160 mg injection in 9 days due to the lack of significant improvement after first dose...Clinicians should be cautious delaying a definitive surgical intervention until more robust data supports tofacitinib rescue therapy for this sick population. Fortunately, this patient had an uncomplicated post-op course and was discharged to rehab in ten days.
- |||||||||| methylprednisolone sodium succinate / Generic mfg.
Factors Associated With Cannabis Use Among Inpatients With Inflammatory Bowel Disease Exacerbation (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1659;
Pre-admission cannabis use was reported by 7.25% of patients and was mostly (63%) for recreational use. On multivariable analysis, younger age was associated with cannabis use, as was male gender, African American race, tobacco and alcohol use, and a diagnosis of anxiety and/or depression, table 1.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
Esophageal Manifestations of Paraneoplastic Pemphigus Vulgaris Associated With Gastric Neuroendocrine Tumor (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1593;
She also received a loading dose of rituximab...Clinicians should have a low threshold for endoscopic examination of patients for whom there is suspicion of immunobullous disease to facilitate rapid diagnosis and initiation of appropriate therapy. Figure: Figure 1: Endoscopic images demonstrating tongue ulceration and extensive desquamation in the distal esophagus appearing similar to a pseudomembrane in addition to subepithelial hemorrhages.
- |||||||||| triamcinolone acetonide / Generic mfg., carvedilol / Generic mfg., apixaban / Generic mfg.
Endoscopic Balloon Dilation of Recurrent Peptic Stricture in a Patient With Portal Hypertension (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1508;
He was then started on apixaban for afib and transitioned from nadolol to carvedilol...The stricture was injected with 4 ml of triamcinolone acetonide distributed in 1 cm increments across four quadrants...(B) There was scant bleeding after dilation, otherwise no significant bleeding or complication. (C) Retroflexion was performed in the stomach and revealed moderate gastric varies in the cardia.
- |||||||||| Efficacy and Safety of Biologic Medications in Refractory Microscopic Colitis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1476;
98 (5%) of those patients had been exposed to biologics, and only 12 (< 1%) total patients were started on a biologic medication primarily for MC (as opposed to other concomitant conditions). The average length of diagnosis prior to biologic was 1.7 +/- 1.6 years (Table 1).
- |||||||||| Actemra SC (tocilizumab SC) / Roche, Halozyme
Early Use of Tocilizumab as an Effective Steroid-Sparing Strategy for the Treatment of Immune Checkpoint Inhibitor-Mediated Cholangiopathy: Building Foundations for Personalized Management (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1447;
Five days later, subcutaneous tocilizumab 162 mg was administered without complication...Ursodiol was administered long-term in an attempt to address and to mitigate further cholangiopathic consequences. Abbreviations: EUS, endoscopic ultrasound; CCY, cholecystectomy; SC, subcutaneous; toci, tocilizumab; MRI/MRCP, magnetic resonance imaging/magnetic resonance cholangiopancreatography; ERCP, endoscopic retrograde cholangiopancreatography; CBD, common bile duct; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, gamma-glutamyl transferase.
- |||||||||| budesonide / Generic mfg.
Dysphagia in the Setting of Absent Esophageal Contractility: A Case for Ruling out Eosinophilic Esophagitis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1432;
He began a budesonide slurry with dramatic improvement in symptoms, and complete resolution of symptoms with dairy elimination...Clinicians should have an awareness of the association between EoE and motility disorders when evaluating either entity, as EoE requires a high index of suspicion and assurance of adequate biopsies for diagnosis. Several biopsies from two or more esophageal levels are recommended to increase sensitivity of testing.
- |||||||||| Carafate (sucralfate) / AbbVie
Disease Activity Evaluation in Collagenous Gastritis: A Case Report (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1368;
Figure 2 Histological section of gastric body showing nonspecific chronic inflammatory infiltrate with a thickened subepithelial collagen deposit on hematoxylin and eosin stain. Figure 3 Followup EGD with diffuse several mucosa changes characterized by congestion, erythema, erosion, friability with contact bleeding and nodularity in the gastric body.
- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J, Valcyte (valganciclovir) / Roche, Mitsubishi Tanabe, Cytovene (ganciclovir) / Roche
Cytomegalovirus Colitis in an Immunocompetent Patient Presenting With New Onset Ulcerative Colitis: A Clinical Vignette (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1300;
On discharge at hospital day 12, patient was transitioned to twice daily oral valganciclovir 900 mg for a 3-week course and an oral prednisone taper...H&E Stain (20x) demonstrating active chronic colitis (left). Immunohistochemical staining (40x) showing CMV immunoreactivity (right).
- |||||||||| Collagenous Sprue and POEMS Syndrome: Association or Coincidence? (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1204;
His medications included losartan and aspirin...Remission was achieved with melphalan and dexamethasone...Figure B. Repeat proximal duodenal biopsy under low-power view demonstrating villous atrophy. Figure C. Repeat proximal duodenal biopsy under high-power view demonstrating intraepithelial lymphocytosis (arrow) and 32.2um subepithelial collagen band (bracket).
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma, Cytovene (ganciclovir) / Roche
CMV-Induced Small Bowel Bleeding Complicating Severe COVID-19 Respiratory Failure (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1192;
Hematoxylin and eosin stain (x40 magnification) showing CMV inclusion bodies (Fig 1b) and immunohistochemistry stain showing CMV immunoreactivity (Fig 1c). Table: Decline of cytomegalovirus viral load (based on serum PCR) after treatment started with intravenous ganciclovir on ‘Day 0’.
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