BACKGROUND Gastric cancer significantly contributes to cancer mortality globally. Gastric intestinal metaplasia (GIM) is a stage in the Correa cascade and a premalignant lesion of gastric cancer. The natural history of GIM formation and progression over time is not fully understood. Currently, there are no clear guidelines on GIM surveillance or management in the United States. AIM To investigate factors associated with GIM development over time in African American-predominant study population. METHODS This is a retrospective longitudinal study in a single tertiary hospital in Washington DC. We retrieved upper esophagogastroduodenoscopies (EGDs) with gastric biopsies from the pathology department database from January 2015 to December 2020. Patients included in the study had undergone two or more EGDs with gastric biopsy. Patients with no GIM at baseline were followed up until they developed GIM or until the last available EGD. Exclusion criteria consisted of patients age < 18, pregnancy, previous diagnosis of gastric cancer, and missing data including pathology results or endoscopy reports. The study population was divided into two groups based on GIM status. Univariate and multivariate Cox regression was used to estimate the hazard induced by patient demographics, EGD findings, and Helicobacter pylori (H. pylori) status on the GIM status. RESULTS Of 2375 patients who had at least 1 EGD with gastric biopsy, 579 patients were included in the study. 138 patients developed GIM during the study follow-up period of 1087 d on average, compared to 857 d in patients without GIM (P = 0.247). The average age of GIM group was 64 years compared to 56 years in the non-GIM group (P < 0.001). In the GIM group, adding one year to the age increases the risk for GIM formation by 4% (P < 0.001). Over time, African Americans, Hispanic, and other ethnicities/races had an increased risk of GIM compared to Caucasians with a hazard ratio (HR) of 2.12 (1.16, 3.87), 2.79 (1.09, 7.13), and 3.19 (1.5, 6.76) respectively. No gender difference was observed between the study populations. Gastritis was associated with an increased risk for GIM development with an HR of 1.62 (1.07, 2.44). On the other hand, H. pylori infection did not increase the risk for GIM. CONCLUSION An increase in age and non-Caucasian race/ethnicity are associated with an increased risk of GIM formation. The effect of H. pylori on GIM is limited in low prevalence areas.

BACKGROUND:Sessile serrated adenomas (SSAs) are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition, concealment by mucous caps, and flat appearance. High definition (HD) colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition (SD) colonoscopes. In the absence of existing clinical guidelines to obligate the use of HD colonoscopy for colorectal cancer screening in average-risk patients, demonstrating the benefit of HD colonoscopy on SSA detection rate (SSADR) may help strengthen the evidence to recommend its use in all settings.AIM:To evaluate the benefit of HD colonoscopy compared to SD colonoscopy on SSADR in average-risk patients undergoing screening colonoscopy.METHODS:Data from screening colonoscopies for patients aged 50-76 years two years before and two years after the transition from SD colonoscopy to HD colonoscopy at our large, academic teaching center were collected. Patients with symptoms of colorectal disease, positive occult blood test, history of colon polyps, cancer, polyposis syndrome, inflammatory bowel disease or family history of colon cancer or polyps were excluded. Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded. Differences in individual endoscopist SSADR, average SSADR, and overall SSADR with SD colonoscopy vs HD colonoscopy were also evaluated for significance.RESULTS:A total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period from a pool of 11 endoscopists. Statistically significant improvements of 2.30% in mean SSADR and 2.53% in overall SSADR were noted with HD colonoscopy (P = 0.00028 and P = 0.00849, respectively). On the individual level, three endoscopists experienced statistically significant benefit with HD colonoscopy (+5.74%, P = 0.0056; +4.50%, P = 0.0278; +4.84%, P = 0.03486).CONCLUSION:Our study suggests that HD colonoscopy statistically significantly improves sessile serrated adenoma detection rate in the screening of average risk patients during screening colonoscopy. By improving the detection and removal of these lesions, adoption of HD colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.

We report on a patient with Mollaret’s meningitis to highlight the appropriate diagnostic criteria and benign prognosis without empiric antiviral therapy. An 83-year-old man with a history of aseptic meningitis of unknown etiology followed by full recovery presented with a two-day history of fevers, generalized weakness, and neurologic abnormalities. Cerebral spinal fluid (CSF) analysis demonstrated lymphocytic pleocytosis consistent with aseptic meningitis. Given his prior noninfectious aseptic meningitis and symptom-free interval, Mollaret’s meningitis was suspected and empiric treatment for herpes simplex viruses (HSV) encephalitis with acyclovir was deferred. All CSF studies, including polymerase chain reactions for HSV-1 and HSV-2, returned negative with clinical improvement by the fourth day of admission. For patients suspected to have Mollaret’s meningitis, lumbar puncture should be conducted promptly to facilitate diagnosis. Although several reports describe patients with CSF infection, the diagnosis of Mollaret’s meningitis should be reserved for noninfectious cases. In such cases, empiric antiviral therapy for HSV encephalitis may be deferred and complete recovery is expected.

Introduction: Improved survival of cystic fibrosis (CF) has shifted consideration to non-pulmonary complications of the disease, such as gastrointestinal (GI) complications that require hospitalization. We are presenting the most common GI causes of hospitalization in CF patients. Methods: Patients were included in the study if they had a primary or secondary ICD-10 diagnosis of CF (E84.x). They were captured using major diagnostic categories (MDC06: Diseases and Disorders of the Digestive System, or MDC07: Diseases and Disorders of the Hepatobiliary System and Pancreas). Frequency rank procedures of diagnostic related codes (DRGs) and primary ICD-10 diagnoses identified the most common GI-related reasons for hospitalization in CF patients. Mean age and mortality was determined for the five major GI-related hospitalization causes. Results: Diagnosis: Of the 9085 CF patients hospitalized for GI reasons between 2016-2018, 6700 were hospitalized for complaints related to this study (73.7%) and 2385 CF GI hospitalizations did not fit our 5 major categories (26.3%). 17.9% of the patients were hospitalized for pancreatitis (n=1625), including acute pancreatitis and chronic pancreatitis. 1615 patients were hospitalized for GI inflammation and dysmotility (17.8%), including constipation, gastroenteritis and colitis. 1005 patients were hospitalized for obstruction (11.1%), including: paralytic ileus and intestinal obstruction and postprocedural obstruction. 405 patients were admitted for GI procedures and colorectal malignancy (4.5%) including management of ostomies and intestinal adhesions. 2115 CF hospitalizations were for unspecified GI diagnoses (23.3%). Age: Mean age at hospitalization was 22.0 (SE, 0.8) for unspecified diagnosis, 23.7 (SE, 1.0) for GI inflammation and dysmotility, 27.5 (SE, 1.0) for GI obstruction, 27.8 (SE, 2.4) for GI procedures and 30.1 (SE, 0.8) for pancreatitis. Mortality: GI obstruction was a common cause of inpatient mortality (0.5%), followed by pancreatitis (0.3%). Miscellaneous GI diagnosis had a 0.2% mortality incidence. GI procedures, GI inflammation and dysmotility were not associated with inpatient mortality. Conclusion: Pancreatitis, GI inflammation, and GI obstruction were the three most common causes of GI hospitalization in CF patients. The mean age of these patients ranges from 23 to 30 years old. The mortality rate remains < 1% in CF patients, when hospitalized for GI reasons.Figure 1.: Distribution of most common causes of Gastrointestinal hospitalization in patients with Cystic Fibrosis.Table 1.: Most common causes of Gastrointestinal hospitalization in patients with Cystic Fibrosis.

loss of appetite, abdominal cramping, bloating, and diarrhea were assessed using a daily electronic patient-reported outcome questionnaire to generate weekly TSS. Patients underwent upper endoscopy with biopsy at screening, week 14 of ENIGMA, and 2 timepoints during the OLE study. Histopathologic analyses were performed by a blinded central pathologist; EG and EoD were defined as $30 eos/hpf in $5 gastric hpfs and $30 eos/hpf in $3 duodenal hpfs, respectively. Results: As of March 2021, 13 patients with EG6EoD and 12 patients with EoD without EG received 94 weeks of lirentelimab (ENIGMA1OLE). At week 94, mean TSS was reduced by 70% in patients with EG6EoD and 81% in patients EoD without EG compared with baseline (Table 1). TSS decreased significantly from baseline through week 94 regardless of EG6EoD or EoD without EG (Figure 1). Gastro-duodenal eosinophil counts were significantly reduced. There were no drug-related serious adverse events. The most common adverse events were mild–moderate infusion-related reactions, mostly during the first infusion. Conclusion: In an OLE study, patients with EG6EoD or EoD without EG receiving lirentelimab for up to 94 weeks had sustained and similar reductions in TSS and eosinophil counts in gastric and duodenal biopsies—patients benefited regardless of whether the stomach was involved. Long-term treatment with lirentelimab (AK002) was well tolerated and holds promise for patients with EG and/ or EoD.

Introduction: Sessile serrated adenomas (SSAs) are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition, concealment by mucous caps, and flat appearance. High definition (HD) colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition (SD) colonoscopes. We performed a retrospective study to evaluate the benefit of HD colonoscopy on SSA detection rate (SSADR) in average-risk patients undergoing screening colonoscopy. Methods: Data from screening colonoscopies for patients aged 50-76 years within two years before and two years after the transition from SD colonoscopy to HD colonoscopy were compiled from our large, academic teaching center. Patients with symptoms of colorectal disease, positive occult blood test, history of colon polyps, cancer, polyposis syndrome, inflammatory bowel disease or family history of colon cancer or polyps were excluded. Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded. Differences in individual endoscopist, average, and overall SSADRs with SD colonoscopy vs HD colonoscopy were also evaluated for significance. Results: A total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period. Eleven endoscopists performed colonoscopies both before and after implementation of HD colonoscopy. Significant improvements of 2.30% in mean SSADR and 2.53% in overall SSADR were noted with HD colonoscopy (P = 0.00028 and P = 0.00849, respectively). On the individual level, three endoscopists saw significant benefit with HD colonoscopy (+5.74%, P = 0.0056; +4.50%, P = 0.0278; +4.84%, P = 0.03486). Conclusion: Our study suggests that high definition colonoscopy statistically significantly improves sessile serrated adenoma detection in the screening of average risk patients during screening colonoscopy. By improving the detection and removal of these lesions, adoption of high definition colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.Figure 1:: Endoscopist, overall, and average SSADRs during SD colonoscopy and HD colonoscopy. * denotes statistically significant difference (P <0.05)Table 1.: Endoscopist, overall, and average SSADRs with corresponding colonoscopy volumes during SD colonoscopy and HD colonoscopy.