Background:Inflammatory bowel disease (IBD) manifests systemically, yet most comorbidity studies rely on predominantly European populations. The All of Us Research Program enables investigation across demographically diverse groups. Methods:We matched 5,094 IBD patients 1:4 with controls by age, gender, and race, analyzing comorbidities using logistic regression with Mantel-Haenszel adjustment. Multiple testing correction used false discovery rate (FDR) with significance thresholds of OR >1.5 or <0.5 and FDR <0.05. Results:Our cohort included 29.2% non-White participants versus 10-15% in traditional studies. We identified 22 significant associations across seven organ systems. Three novel discoveries included delayed postmyocardial infarction pericarditis (adjusted OR = 4.80), contact dermatitis (adjusted OR = 1.84), and carotid artery aneurysm (adjusted OR = 2.21). Other significant associations included drug-induced lupus (adjusted OR = 4.32), autoimmune hepatitis (adjusted OR = 2.43), and restricting-type eating disorders (adjusted OR = 4.00). IBD patients showed decreased obesity-related conditions. Conclusion:This demographically diverse study discovered novel IBD comorbidities and confirmed established associations across racial groups. Findings support reconceptualizing IBD as a multisystem disorder requiring comprehensive management and demonstrate the importance of diverse research populations.

Esophageal food impaction (EFI) resulting in obstruction is a gastrointestinal emergency requiring disimpaction by upper endoscopy. Current guidelines recommend emergent intervention within 24 h to reduce risk of complications. However, limited data exist regarding specific factors affecting practice patterns, including timing and setting of endoscopic intervention for EFI. We conducted a retrospective review of 684 patients who presented with EFI to the emergency department (ED) at three hospitals from 2015–2021. 447 patients met inclusion criteria. We compared hospitalization rates, ED triage-to-endoscopy time, sedation type, endoscopy setting [ED/intensive care unit (ICU), operating room (OR), or endoscopy unit (EU)], and complications for “business hours” (between 8AM and 5PM) and “after hours” procedures (weekends or before 8AM/after 5PM). Among 509 EFI cases, 67.2

Background and Aims: Rectal variceal bleeding is a rare life-threatening cause of lower gastrointestinal bleeding. We present the first case series to our knowledge of successful hemostasis achieved with combination of endoscopic ultrasound (EUS)-guided coil embolization and absorbable gelatin sponge (AGS) for bleeding rectal varices. Methods: We performed a retrospective review of 6 patients with active rectal variceal bleeding. All patients underwent EUS-guided coil embolization with AGS therapy. Procedural details, technical success, adverse events, and rebleeding rates were measured. Results: We achieved 100% technical success (6 of 6 patients) with successful sonographic rectal varices decompression. A range of 1 to 4 coils with a total length of 7 to 20 cm was injected along with AGS. There were no adverse events or rebleeding from recurrent rectal varices. Median follow-up period was 190 days. Conclusions: EUS-guided coiling coupled with AGS therapy appears to be a potentially safe and efficacious alternative for patients with bleeding rectal varices.

Patients with Ehlers-Danlos syndrome (EDS) suffer from gastroparesis, constipation, and gut dysmotility. We present a case of histopathological assessment of the enteric nervous system from an EDS patient with severe gut dysmotility. Full-thickness small bowel biopsies with immunostains for c-kit and S-100 within the myenteric plexus revealed no significant abnormality. Using the method by Boschetti et al of Neuronal Specific Enolase-based immunostaining, we found that interganglionic distance in the myenteric plexus (∼800 um) exceeded the normal range (380-570 µm). This clinical experience provides rationale for pursuing histopathology in patients with EDS.

Background/Aims: Given the limited head-to-head trials comparing the outcomes of pre-endoscopy erythromycin and metoclopramide for upper gastrointestinal bleeding (UGIB), a network meta-analysis (NMA) and component NMA were conducted. Methods: A comprehensive review of the Medline, Embase, and Cochrane databases was conducted for randomized controlled trials comparing pre-endoscopy erythromycin or metoclopramide for UGIB with or without gastric lavage (GL) to placebo and/or GL. The primary outcome was the adequate visualization of the mucosa. The secondary outcomes were endoscopy visualization score, endoscopy duration, diagnosis established at initial endoscopy, second-look endoscopy, blood transfusions, mortality, and duration of hospitalization. Results: A total of 16 studies (1,447 patients) were included. No significant differences were observed between erythromycin and metoclopramide in all the outcomes, but erythromycin had significantly better outcomes than the control group in terms of endoscopic visualization score (standardized mean difference, 0.58; 95% confidence interval [CI], 0.26–0.91), adequate mucosal visualization (risk ratio, 1.55; 95% CI, 1.18–2.04), second-look endoscopy, transfusion requirements, and duration of hospitalization. Component network meta-analysis revealed that erythromycin, but not metoclopramide or GL, provided significantly better endoscopic visualization than the placebo. Conclusions: Erythromycin should be considered before UGIB endoscopy. The current data do not support the use of metoclopramide or GL.

BACKGROUND:Tofacitinib is an oral Janus kinase inhibitor for the treatment of ulcerative colitis (UC). Real-world data comparing the effectiveness of tofacitinib to ustekinumab are limited. We compared 52-week outcomes of tofacitinib vs ustekinumab for UC after antitumor necrosis factor (anti-TNF) failure. METHODS:In this retrospective cohort study, adults initiated tofacitinib or ustekinumab for UC after anti-TNF failure May 1, 2018 to April 1, 2021, at a US academic medical center. The primary outcome was steroid-free clinical remission (SFCR) at 12 and 52 weeks. The secondary outcome was drug survival (ie, time to drug discontinuation due to nonresponse). Adverse events (AEs) were also assessed. RESULTS:Sixty-nine patients initiated tofacitinib, and 97 patients initiated ustekinumab with median follow-up of 88.0 and 62.0 weeks, respectively. After inverse probability of treatment-weighted logistic and Cox regression, there was no association of tofacitinib vs ustekinumab with SFCR at 12 weeks (odds ratio, 1.65; 95% CI, 0.79-3.41), SFCR at 52 weeks (odds ratio, 1.14; 95% CI, 0.55-2.34), or drug survival (hazard ratio, 1.37; 95% CI, 0.78-2.37). Kaplan-Meier analysis demonstrated no separation in drug survival curves. Regression results were similar after excluding patients with prior tofacitinib or ustekinumab exposure. During available follow-up, 17 AEs were reported for tofacitinib (most commonly shingles, n = 4), and 10 AEs were reported for ustekinumab (most commonly arthralgia and rash, each n = 2). Two patients discontinued treatment due to AEs (1 tofacitinib for elevated liver enzymes, 1 ustekinumab for arthralgia). CONCLUSIONS:In a real-world UC cohort, tofacitinib and ustekinumab demonstrated similar effectiveness at 52 weeks. Adverse events were consistent with the known safety profiles of these agents.

Objectives The study aimed to compare the risk of gastrointestinal infections among patients with and without metabolic dysfunction-associated fatty liver disease (MAFLD).Methods This was a population-based, retrospective, observational study using data from the National Inpatient Sample (NIS), the largest all-payer US inpatient care database.Setting Hospitalisation of adults aged ≥18 years old admitted in 2020 was identified using the NIS. Patients were stratified by the presence and absence of MAFLD.Participants 26.4 million adults aged ≥18 years old were included in the study. Patients younger than 18 and those with missing demographic or mortality data were excluded.Primary and secondary outcomes Primary outcome was to assess the overall risk of gastrointestinal infections in patients with and without MAFLD. Secondary outcomes were demographics and comorbidities stratified by the presence or absence of gastrointestinal infection, and the risk of specific gastrointestinal pathogens.Results Of 26.4 million patients admitted in 2020, 755 910 (2.85%) had the presence of MAFLD. There was a higher prevalence of bacterial gastrointestinal infections in patients with MAFLD than those without (1.6% vs 0.9%, p<0.001). The incidence of Clostridioides difficile (1.3% vs 0.8%, p<0.001), Escherichia coli (0.3% vs 0.01%, p<0.001), and Salmonella (0.07% vs 0.03%, p<0.001) was higher in patients with MAFLD. The presence of MAFLD was associated with higher odds of developing gastrointestinal infections (adjusted OR (aOR) −1.75, 95% CI −1.68 to 1.83, p<0.001). After adjusting for confounders, results remained statistically significant (aOR −1.36, 95% CI - 1.30-1.42, p<0.001).Conclusion Even after adjusting for confounding factors, our study demonstrates an increased risk of gastrointestinal infections in patients with MAFLD, specifically of C. difficile, E. coli, and Salmonella. The immune and microbiota changes seen within MAFLD potentially contribute to the increased risk of gastrointestinal infections.

In this retrospective cohort study, tofacitinib was associated with higher adjusted odds of steroid-free clinical remission at 52 weeks and endoscopic remission within 52 weeks compared with vedolizumab. Adverse events were consistent with the known safety profiles of these agents.

Summary Despite advancing treatment methods, esophageal cancer (EC) maintains a high mortality rate and poor prognosis. Through various mechanisms, aspirin has been suggested to have a chemopreventive effect on EC. However, the long-term impact, particularly regarding the rate of metastasis, needs to be further elucidated. NIS 2016–2020 was used to identify adult patients (age > 18 years) with EC using ICD-10 codes. Patients with missing demographics and mortality were excluded. Patients were stratified into two groups based on aspirin use. Data were collected on patient demographics, Elixhauser Comorbidity Index (ECI), and comorbidities (hypertension, chronic pulmonary disease, coronary artery disease (CAD), chronic kidney disease (CKD), congestive heart failure (CHF), coagulopathy, alcohol use, smoking, and obesity). The outcomes studied were rates of total metastasis, gastrointestinal (GI) metastasis, non-GI metastasis, and lymphoid metastasis. Multivariate logistic regression analysis was performed to evaluate the impact of aspirin use on various metastases after adjusting for patient demographics, comorbidities, and ECI. Out of 190,655 patients, 20,650 (10.8%) patients were aspirin users. Majority of the patients in the aspirin group were aged > 65 years (74.7%), males (82.1%), White race (84%), and had medicare insurance (71%). There was a higher incidence of diabetes, hypertension, chronic pulmonary disease, CAD, CKD, CHF, and smoking in aspirin users than non-aspirin users. Patients with aspirin users had a lower incidence of metastasis (28.9% vs. 38.7%, P < 0.001), GI metastasis (14.2% vs. 20.6%, P < 0.001), non-GI metastasis (15.1% vs. 22%, P < 0.001), and lymphoid metastasis (8.9% vs. 11.3%, P < 0.001) than non-aspirin users. After adjusting for confounding factors, patients with aspirin use had lower odds of having metastasis (aOR-0.73, 95% CI-0.70-0.77, P < 0.001). Our study noted that aspirin use is associated with a reduction in the rate of metastasis in patients with EC. These studies support the use of aspirin in patients with EC and suggest the need for further studies to understand the mechanism by which aspirin use reduces metastasis in patients with EC.