Common causes of marked alanine aminotransferase derangement include liver ischemia, drugs/toxins, biliary obstruction, and viral hepatitis. Determination of etiology and outcomes of patients with severe liver injury can be guided by clinical and biochemical parameters.

Esophageal malignancy presenting as smooth esophageal stricture with a negative biopsy for malignancy is not uncommon. We retrospectively analyzed the data of 11 such patients who appeared to have malignant esophageal stricture otherwise but had negative repetitive biopsies. Linear endosonography provided a safe and effective modality for diagnosis in such patients.

A number of recent studies have been published evaluating the chemopreventive effect of aspirin against gastric cancer, and an updated meta-analysis is required to evaluate this relationship further. Of 463 studies, we analyzed 33 studies with a total of 1 927 971 patients. The pooled risk ratios for gastric cancer incidence were 0.890 (95% confidence interval, 0.871–0.909) and 0.826 (0.740–0.922) in the fixed- and random-effects models, respectively. The pooled risk ratios for gastric cancer death in the fixed- and random-effects models were 0.798 (0.749–0.850) and 0.894 (0.780–1.024), respectively. Aspirin use may reduce the risk of gastric cancer incidence and death.

Our findings provide preliminary evidence to suggest that small intestinal contrast ultrasonography (SICUS) offers a comparable diagnostic yield to that of magnetic resonance enterography (MRE) and ileocolonoscopy (IC) and performed better than transabdominal ultrasound (TUS) in a paediatric cohort with suspected or established Crohn's disease (CD). Our work comparing SICUS and MRE in routine clinical practice adds to the existing, albeit very limited, evidence that SICUS offers a radiation-free alternative to MRE for the evaluation of CD in children and adolescents.

In this study, we evaluated the performance of newly developed prognostic models, the United Kingdom-primary biliary cholangitis and global primary biliary cholangitis group scores, to predict long-term outcomes in patients with primary biliary cholangitis treated with ursodeoxycholic acid, adding to the expanding corpus of literature that discusses the reliability and accuracy of using those models outside Europe. Our findings suggest that advanced prognostic models are reliable and reasonably accurate to predict adverse events and can thus be generalized to the U.S. population.

This is a retrospective cohort study that compared the rates of colectomy for severe ulcerative colitis over a 15-year period before and after the introduction of Infliximab therapy at our institution. We found a significant decrease in the rates of colectomy for severe ulcerative colitis over the study period, as well as a reduction in the rates of complications.

Tumor volume and density assessment using automated lesion measurements may be an objective method of evaluating the responses of advanced hepatocellular carcinoma to treatment with sorafenib.

Functional bowel disorders (FBD) in children are becoming increasingly more common where there are data. The low FODMAP (LFD) diet is used as a successful dietary therapy for treating irritable bowel syndrome in adults; however, a paucity of data exists examining the use of this diet in children. This retrospective clinical case note review showed that the LFD is a useful dietary treatment strategy in children and adolescents with FBD and adds to the small body of evidence supporting LFD interventions in children.

This study is the first to investigate the association between the horizontal margin (HM) status and local recurrence in patients with esophageal squamous cell carcinoma, and we suggest that the pathological HM status may be a useful predictor of local recurrence.

This large Australian survey shows that the integrated biopsychosocial model of health care, with regular mental health screening and good access to mental health professionals, is requested by people living with inflammatory bowel disease to improve their outcomes.

Cold snare polypectomy of 10–20 mm sessile polyps is safe, and no complications were seen when compared with hot snare.

Depth estimation of 211 superficial esophageal squamous cell carcinomas (SCCs) (171 epithelial [EP] or lamina propria [LPM] cancers, 31 muscularis mucosa [MM] or shallow submucosal [SM1] cancers, and 9 deep submucosal [SM2] cancers) was performed independently by five evaluators (A, B, C, D, and E) using the numerical depth estimation scale (0 = EP/LPM, 1 = EP/LPM > MM/SM1, 2 = MM/SM1 > EP/LPM, 3 = MM/SM1, 4 = MM/SM1 > SM2, 5 = SM2 > MM/SM1, 6 = SM2), using primarily white light endoscopy (WLE) images (step 1) and, subsequently, both WLE and magnifying narrow-band imaging (M-NBI) images (step 2). The mean difference between the estimated score (from 0 to 6) and pathological score (0 for histologically proven EP/LPM, 3 for MM/SM1, and 6 for SM2) was significantly decreased in step 2 compared with that in step 1 for all five evaluators (A, 1.03 in step 1 and 0.63 in step 2, P < 0.001; B, 0.83 and 0.56, P < 0.001; C, 0.72 and 0.50, P < 0.001; D, 0.82 and 0.62, P < 0.001; E, 0.55 and 0.34, P < 0.001). This indicated that M-NBI has an additive value for estimating the invasion depth of superficial esophageal SCCs.

In cases of colorectal endoscopic submucosal dissection with poor maneuverability, the use of balloon-assisted endoscopy (BAE) contributed to improvement in the R0 resection rate. In addition, BAE contributed to quicker dissection speed for lesions located in the cecum/ascending colon. This is an important point for deciding which to select, BAE or conventional endoscopy.

Assessment of health-related quality of life is an essential component of chronic disease management, yet this is not routinely performed in clinical practice. To meet this need, we previously performed a translation and adaptation of the Chronic Liver Disease Questionnaire for the Mandarin-speaking Chinese population in Singapore. This study aims to validate this Chronic Liver Disease Questionnaire (Singapore version) by demonstrating its internal consistency and validity in a population of chronic liver disease patients. By sharing the results of our validation study, we hope to encourage physicians to use this health-related quality of life tool in routine clinical practice in the management of patients with chronic liver disease.

Breath testing is used to identify carbohydrate malabsorption and small intestine bacterial overgrowth. Measuring methane alongside hydrogen is advocated to reduce false-negative studies, but the variability of methane production is unknown. The validity of including an increase of ≥20 ppm methane to identify carbohydrate malabsorption or small intestine bacterial overgrowth should be questioned due to the variability of readings during testing.

Optimizing runway time plays a critical role in adequate bowel preparation for colonoscopy. Identifying methods of good bowel preparation in patients is ideal to prevent repeat procedures.

A triad of abdominal pain, fever, and weight loss is suggestive of abdominal tuberculosis in children. Multiple intra-abdominal sites are frequently involved. Microbiological confirmation is possible in only a third of the cases.

Although the review showed the roles of general practitioners (GPs), pharmacists, dietitians, and psychologists in inflammatory bowel disease (IBD) management, nurses and gastroenterologists were the key drivers delivering specialized care to IBD patients. Many key services are accessible only for hospital inpatients (tertiary care) or through outpatient clinics (secondary care) with an absence of a multidisciplinary approach including GPs and pharmacists. The available evidence shows opportunities for primary care providers to play a more active role in the management of IBD patients.

The introduction of gastric endoscopic submucosal dissection at a regional hospital is possible. Furthermore, with careful patient selection, favorable results can be obtained and procedural safety ensured.

Enhanced recovery after surgery (ERAS) programs are used to improve postoperative outcomes such as lengths of stay and complications after hepatobiliopancreatic surgery. Logistic barriers in program implementation, as well as postoperative complications, are cited as the main reasons for noncompliance with ERAS. In our study, only postoperative complications were the main reason for noncompliance with the ERAS protocol.

Our study showed no adverse cardiac outcomes in patients with implantable cardiac devices receiving capsule endoscopy. Data quality from capsule endoscopy is not compromised in patients with implantable cardiac devices.

Non-alcoholic fatty liver disease (NAFLD) with significant fibrosis (transient elastography > 8 kPa) is prevalent in asymptomatic populations. The predictors of significant fibrosis in NAFLD were male gender and history of dyslipidemia. Screening for NAFLD using CAP/TE in asymptomatic population should be considered in hospitals with available facilities.

Esophageal endoscopic submucosal dissection (ESD) is often technically difficult due to intraoperative body movements. Esophageal ESD using the lidocaine injection method (LIM) did not cause body movements that disturbed the procedure in our study. LIM may help create a stable conscious sedation method for esophageal ESD.

Enteric tube placement in patients with esophageal varices (EV) is associated with low risk of bleeding. Elevated MELD-Na and lower EV location conferred a higher risk of bleeding.

Exclusive enteral nutrition (EEN) is an alternative therapeutic option to corticosteroids for patients with Crohn's disease (CD). This study aimed to develop an optimal care pathway for using EEN in adults with active CD. Six key consensus statements regarding the practical application of EEN in adults with active CD were developed based on available evidence and expert opinion to assist clinicians in delivering this therapy.

Gastrointestinal ultrasound (GIUS) is being increasingly used for disease monitoring in inflammatory bowel disease; however, patient perceptions of the different modalities available are sparse. This article evaluates patient perceptions, finding that GIUS was preferred to other modalities, and it was also found to have an impact on disease-related knowledge.

Point of care ultrasound is incorporated into routine IBD assessment in many European centers, however uptake in Australia has been slow. This article evaluates the accuracy of point of care ultrasound in monitoring disease activity in a local cohort of IBD patients. Point of care ultrasound was found to be accurate for monitoring disease activity and extent in IBD compared to the gold standard, ileocolonoscopy.

Bilharziasis is an endemic helminthic disease in Egypt. Huge colonic polyps may be of bilharzial origin, and it may be the lone pathology of this disease. Furthermore, it may mimic colon cancer.

Endoscopic diagnoses of human Fasciolopsis buski mostly come as a surprise, especially in the absence of intense peripheral eosinophilia. Although F. buski infections are not uncommon in Southeast Asia, endoscopic diagnosis of parasite has been described in a few case reports. Here, we describe and illustrate the endoscopic removal of F. buski from the stomach and duodenum.

This is a case report of a young female presenting with abnormal liver function and ascites secondary to hypervitaminosis A. The patient was ordering vitamin A online to self-treat her acne.

Amyloidosis can occur as a consequence of inflammatory bowel disease or can mimic inflammatory bowel disease. Hereditary transthyretin (TTR) amyloidosis is hardly ever recognised in the Indian subcontinent. We report a case of TTR amyloidosis occurring in a young Indian girl who also had ulcerative colitis.

We describe the case of a 56-year-old female who presented with a 2-month history of painless jaundice and constitutional symptoms. Computed tomography scan showed massive hepatosplenomegaly with abdominal lymphadenopathy. Liver biopsy and a strongly positive antimitochondrial antibody titer confirmed the diagnosis of primary biliary cholangitis.

We present the case of a fecaloma presenting as a huge abdominal mass.

This study presents the case of a 70-year-old man who underwent total gastrectomy with Roux-en-Y anatomy. It was difficult to adjust the catheter in the direction of the bile duct despite using double-guidewire technique. We placed a 5Fr-5cm pancreatic duct (PD) stent to assist biliary cannulation. We inserted a catheter crossing the PD stent. By doing so, selective biliary cannulation was successful.

We present a 37-year-old male who had upper gastrointestinal bleed and was found to have non cirrhotic portal hypertension. His examination revealed typical raindrop pigmentation of the palms and soles, which led us to the diagnosis of chronic arsenicosis as the cause of portal hypertension.

Effect of carbon-ion radiotherapy on unresectable intrahepatic cholangiocarcinoma

Many diseases can cause intestinal granulomas like Crohn's disease and tuberculosis. Behcet's disease is an uncommon cause of intestinal granulomas. Here, we present the case of intestinal Behcet's that closely mimicked Crohn's disease.

Here, we report the case of a 24-year-old pregnant women with incidentally discovered low-grade appendiceal mucinous neoplasm (AMN) during cesarean section. To the best of our knowledge, there is a preoperatively diagnosed AMN complicating pregnancy. Previous reports suggested that AMN is detected during an operation performed for incidental reasons, such as acute abdomen, in all cases.

In achalasia patients, Lugol-voiding areas (LVAs) are modified by inflammation and appear wider than their actual size. Moreover, some parts of LVAs in achalasia patients might be reversible by treatments that improve delayed emptying.

Multiple liver tumors due to hypereosinophilia caused by interleukin (IL)-5 disappeared mainly on steroid therapy. IL-5 elevation that induced hypereosinophilia was due to the potent hidden T-cell malignant lymphoma.