Barrett’s esophagus (BE), a complication of long-term gastroesophageal reflux disease (GERD), has been reported to affect 6–8% of those with heartburn. Most patients are males, Caucasians and middle aged. However, there are no recent demographic studies that evaluated the proportion trends of BE. We aimed to assess proportion trends of BE over an 11-year period, using a very large national dataset. This was a population-based analysis of the national Explorys dataset. Explorys is an aggregate of electronic medical record database representing over 54 million patients. Proportions of BE’s variables such as age, gender, race, BMI, and treatment with PPI were recorded during an 11-year period. BE patients were classified into seven age groups (15–19, 20–29, 30–39, 40–49, 50–59, 60–69, ≥ 70 years old). Secular trends of the proportion of BE were assessed over time for each age group. The majority of patients diagnosed with BE were ≥ 70 years old across all calendar years. However, the proportion of BE patients who were ≥ 70 years old has significantly decreased between 2006 and 2016 (− 19.9%, p < 0.001). The proportion of patients with BE increased in all age groups but most prominently in the age groups, 30–39: 2.07%, 40–49: 3.64%, 50–59: 6.89%, 60–69: 6.18%, p < 0.001. BE was significantly more common in those who were Caucasian and male. PPI usage fell significantly in those who were ≥ 70 years old (− 20.8%, p < 0.001), but increased in the other remaining age groups. The proportion of BE patients who are 70 years and older has significantly dropped. Younger patients’ groups have demonstrated the highest increase in the proportion of BE patients, especially those in the age group of 30–39 years old.

INTRODUCTION: Choledochoduodenal fistulas (CDFs) are abnormal connections that form between the common bile duct and the duodenum. CDFs are rare and result from biliary tract diseases like biliary tract stones and/or infections, peptic ulcer disease, Crohn's disease and surgery. They are more common in elderly patients. CDFs may present with cholangitis-like symptoms and the diagnosis is confirmed with endoscopic retrograde cholangiopancreatography (ERCP). Treatment include therapeutic ERCP or surgery. CASE DESCRIPTION/METHODS: Our patient was a 31 year-old Hispanic female who immigrated recently from El Salvador. The patient presented with symptoms of right upper quadrant pain along with nausea/vomiting and low grade fever. Initial laboratories results were remarkable for white blood cell count (WBC) 14.3 × 109 L, acetate aminotransferase (AST) 493 U/L, alanine aminotransferase (ALT) 438 U/L, total bilirubin 2.4 mg/dl, direct bilirubin 0.56 mg/dl, and Alkaline phosphatase 192 U/L. Abdominal ultrasonography showed non-specific gallbladder wall thickening with dilation of the intrahepatic and extrahepatic bile duct (common bile duct diameter of 1.2 cm), and no gallbladder stones (Figure 1). The patient was admitted to the floor and started on broad-spectrum intravenous antibiotics. An urgent ERCP demonstrated a 3 mm choledochoduodenal fistula seen superior to the major papilla. The fistula was draining purulent materials (Figure 2). The common bile duct (CBD) was dilated to 12 mm with no filling defects (Figure 3). The biliary tree was drained and no stones were found (Figure 3). To ensure adequate biliary drainage, a 10 Fr × 5 cm plastic stent was placed into the CBD (Figure 3). Soon, patient clinical and laboratory profile dramatically improved and was discharged two days later with plan for outpatient follow-up. DISCUSSION: We are reporting a unique case of CDF that developed spontaneously in a patient who has no significant past medical history. No underlying pathology like biliary tract stones was found during the ERCP. This case may raise a question that CDFs could be sometimes idiopathic with no predisposing factors. Spontaneous CDFs are uncommon especially in young population. Only few cases in young patients had been reported in literature. The youngest patient reported in literature was a 6-year-old female who had an unusual case of recurrent cholangitis due to CDF.

INTRODUCTION: Vedolizumab (VDZ), a humanized monoclonal antibody, binds to the alpha4beta7 integrin and blocks the interaction of mucosal cell adhesion molecule-1 thus inhibiting the migration of memory T-lymphocytes into inflamed GI parenchymal tissue. This interaction is a hallmark of Ulcerative colitis (UC) and Crohn's disease (CD). It has been used as an alternative therapy to anti-tumor necrosis factor (anti-TNF) agents for Induction and maintenance in patients with moderate to severe inflammatory bowel diseases (IBD). Due to its immunosuppressive effects, VDZ maybe associated with increased risks of infections. Therefore, it is imperative to study the infection rate in this population, particularly during the perioperative period. Our objective is to identify perioperative infection rates in patients with Inflammatory Bowel Disease (IBD). METHODS: A retrospective multi-center case-control study was conducted. Patients with IBD in the period from May 2014 to Dec 2017 were included. Two groups were studied (Pt with IBD and on VDZ, Pt with IBD and not on VDZ). The perioperative period was identified as up to 30 days post-index surgery. ICD-10 codes for intra-abdominal surgeries and infections were used to identify population. Patients developing only new infections were included. Data were classified into two cohorts for the purpose of comparison: Cohort 1 included all-infections and Cohort 2 included only intra-abdominal infection. Different models of logistic regression data analysis were performed. RESULTS: Logistic regression data analysis was performed including simple, multiple and mixed model for both cohorts. The mixed model included multiple encounters per person, age, gender, ethnicity, and race. Results of Cohort 1 showed odds ratio (OR) = 1.332 (CI 0.599-2.965, P = 0.4821). Results of Cohort 2: OR = 1.286 (CI 0.426-3.882, P = 0.6551). These findings indicated that there was no statistical significance between increased rates of peri-operative infection rates and VDZ use. CONCLUSION: Our findings suggested that VDZ is relatively safe to use during the perioperative period. There are a few small studies indicating similar results, however, a unique aspect of our study was to include broad-spectrum infection types (sepsis from any source such as pneumonia, UTI) and not only intra-abdominal or surgery-related infections. We do recommend further investigations with more controlled study and larger population coverage to further solidify our findings.