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Objective: Assessing the relationship of body mass index (BMI) on acute pancreatitis (AP) hospitalization in the United States (US)., Methods: The National Inpatient Sample utilized to capture normal weight, overweight, and obese AP hospitalization in the US during 2020 based on BMI. Patients, hospitalization characteristics, and outcomes were compared., Results: In 2020, there were 53,000 (20%) obese, 3980 (2.6%) overweight, and 210,000 (77.4%) normal weight AP hospitalizations. All-cause inpatient mortality was similar for obese, and overweight compared to normal weight AP hospitalizations, respectively (0.65% vs 0.63% vs 0.6%). Furthermore, obese AP hospitalization had a higher chance of developing systemic [odds ratio (OR): 1.7, confidence interval (CI) (1.35-2.12)], and needing intubation or vasopressor requirement OR: 1.75, CI (1.14-2.68), compared to normal AP patients. However, overweight AP hospitalizations had similar chance of developing systemic OR: 1.1, CI (0.83-1.38) and local complication OR: 1.14, CI (0.88-1.5), needing intubation or vasopressor requirements OR: 1.27, CI (0.73-2.23) except use of jejunostomy tube was higher OR: 1.74, CI (1.1-2.75) compared to normal weight AP hospitalizations. The mean length-of-stay and mean total healthcare costs were higher among obese by 2.14 days (CI 0.9-3.37), p = 0.001 and by US$ 21,626, CI (4379-38,872), p = 0.014 compared to normal weight AP hospitalizations., Conclusions: Obese and overnight AP hospitalizations had similar inpatient mortality compared to normal weight hospitalizations. Obese AP hospitalizations have higher complications and healthcare utilization compared to normal weight hospitalizations., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. Consent to participate: Not applicable., (© 2025. The Author(s).)

Hepatic artery pseudoaneurysm (HAP) is a serious rare life-threatening complication of Gastrointestinal surgeries that is often overlooked in diagnostic evaluation due to its rarity. We present a case of 71 years female, with a surgical history of gastric sleeve surgery, Roux-en-Y gastric bypass, and cholecystectomy, presenting with features of upper GI bleeding. Multiple diagnostic modalities were used and finally Magnetic Resonance Mesenteric Angiogram was able to pinpoint the location of the GI bleed as a hepatic artery pseudoaneurysm. Primary surgical repair used to be the mainstay treatment option for managing visceral aneurysms. However, due to advances in technology, embolization as well as implantation of covered stent grafts have become the preferred treatment for such lesions., Competing Interests: No conflict of interest., (© The Author(s) 2024. Published by Oxford University Press.)

Background/aims: Studies have varied results regarding the impact of the teaching and non-teaching status of hospitals on the outcomes for hospitalized patients with upper gastrointestinal bleeding (UGIB). To evaluate these outcomes, we conducted a retrospective cohort study using the 2014 National Inpatient Sample (NIS) database., Methods: We included all adult patients who were admitted with the principal diagnosis of UGIB. Patients admitted to rural and urban non-teaching hospitals were classified as non-teaching, whereas those admitted to urban teaching hospitals were classified as teaching. The main outcomes of interest were in-hospital mortality, percentage of patients requiring inpatient endoscopy, and endoscopic therapy, packed red blood cell (PRBC) transfusion, length of stay (LOS), and total hospitalization charges., Results: The study included 132,085 (97%) with nonvariceal UGIB (NVUGIB) and 4,200 (3%) with variceal UGIB (VUGIB). Of them, 62% were managed at teaching hospitals. Compared with admitted patients at non-teaching hospitals, patients with nonvariceal UGIB admitted at teaching hospitals had similar adjusted in-hospital mortality rates (adjusted odds ratio (OR): 0.97, 95% confidence interval (CI): 0.79-1.19), inpatient endoscopy rates (OR: 0.98, 95% CI: 0.91-1.1), and early endoscopy rates (within 24 hours) (OR: 0.98, 95% CI: 0.91-1.1) and lower PRBC transfusion rates (OR: 0.87, 95% CI: 0.79-0.97) but higher endoscopic therapy rates (OR: 1.3, 95% CI: 1.2-1.4), length of stay (mean increase of 0.43 days) (P<0.01), and total hospital charges (mean increase of $4,369) (P<0.01). Patients with variceal UGIB had similar adjusted in-hospital mortality rates (OR: 1.2, 95% CI: 0.61-2.3), inpatient endoscopy rates (OR: 0.97, 95% CI: 0.67-1.4), early endoscopy rates (within 24 hours) (OR: 0.97, 95% CI: 0.67-1.4), endoscopic therapy rates (OR: 2.5, 95% CI: 0.54- 11.2), and total hospital charges (P=0.45), and lower PRBC transfusion rates (OR: 0.63, 95% CI: 0.45-0.88) but higher length of stay (mean increase of 0.69 days) (P=0.02)., Conclusions: Patients with nonvariceal UGIB treated at US teaching hospitals and non-teaching hospitals have similar mortality, rates of in-hospital endoscopy, and early endoscopy, but teaching hospitals have higher rates of in-hospital therapeutic endoscopy, length of stay, and total hospital charges. There was no difference in any of the outcomes for variceal gastrointestinal (GI) bleeding treated at teaching hospitals compared with those treated at non-teaching hospitals, except for length of stay, which was higher among patients admitted to teaching hospitals compared to those admitted to non-teaching hospitals., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sharbatji et al.)

Breast cancer is the most common malignancy affecting women and has a high mortality rate. It commonly metastasizes to the skeletal and pulmonary systems. Rare reports have described breast cancer spreading to the gastrointestinal tract. We present a female patient diagnosed with and treated for primary lobular-type breast cancer, who developed recurrent bowel obstruction due to metastasis., (© 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Pyoderma gangrenosum (PG) is a rare non-infectious skin disease of undetermined origin. It is characterized by a single or multiple painful, necrotic ulcers. Formerly, PG was assumed to be infectious, but eventually, it was established to be an inflammatory disorder that is commonly associated with autoimmune and neoplastic diseases. We report a case of PG in a 70-year-old female who presented on the pretibial area as a single non-healing ulcer. It started as a small induration that worsened over the course of two weeks despite being on antibiotics. We started the patient on corticosteroids and high potency topical steroids that resulted in healing of the ulcer. PG can prove to be a diagnostic dilemma and can be inappropriately treated with antibiotics or even something radical like an amputation if misdiagnosed. Hence, physicians need to think of this entity even in the absence of any predisposing conditions., Competing Interests: The authors have declared that no competing interests exist.

A giant coronary artery aneurysm (CAA) associated with a coronary cameral fistula is an extremely rare finding. Most cases of CAAs are asymptomatic. The incidence of CAA varies between 0.3% to 5.3%. Due to advancements in diagnostic technologies, the incidence of CAA is on the rise. Even in the modern days of medical science, the clinical course of CAA is still unpredictable and the suitable timing for the treatment of CAA is still open to debate. We reported a case of a giant coronary artery aneurysm in a 38-year-old female, which was 9.4 x 9.7 x 9.2cm in size, arising from the left coronary artery, extending into the proximal circumflex, and draining into the right atrium, forming a fistula tract. The patient was diagnosed with the help of coronary computed tomography (CT) and cardiac catheterization after which surgery was performed to repair the aneurysm and fistula. Postoperatively, the patient recovered without any complication., Competing Interests: The authors have declared that no competing interests exist.

Background: Glasgow-Blatchford score (GBS) has been developed for risk stratification in management of acute upper gastrointestinal (GI) bleeding. However, the performance of GBS in patients with lower GI bleeding is unknown., Aim: To evaluate the performance of full or modified GBS and modified GBS in prediction of major clinical outcomes in patients with lower GI bleeding., Methods: A retrospective study of patients admitted to a tertiary care center with either non-variceal upper GI bleeding or lower GI bleeding was conducted. The full and modified GBS were calculated for all patients. The primary outcome was a combined outcome of inpatient mortality, need for endoscopic, surgical, or radiologic procedure to control the bleed or treat the underlying source, and need for blood transfusion., Results: A total of 1026 patients (562 cases for upper GI and 464 cases for lower GI) were included in the study. Hospital-based interventions and mortality were significantly higher in upper GI bleeding group. The performance of the full GBS in lower GI bleeding (area under the receiver operating curve (AUROC) 0.78, 95% CI 0.74-0.82) was comparable to full GBS in upper GI bleeding (AUROC 0.77, 95% CI 0.73-0.81) in predicting the primary outcome. Similarly, the performance of modified GBS in lower GI bleeding was shown to be comparable to modified GBS in upper GI bleeding (AUROC 0.78, 95% CI 0.74-0.83 vs. AUROC 0.76 95% CI 0.72-0.80)., Conclusion: In patients with lower GI bleeding, both full GBS and modified GBS can predict the need for hospital-based interventions and mortality.

Hemangiomas of the small intestine are rare and very difficult to diagnose preoperatively. Clinical presentations may include occult or massive gastrointestinal (GI) bleeding, obstruction, intussusception, and perforation. We report a 66-year-old Caucasian male patient with severe anemia secondary to occult GI bleeding from a cavernous hemangioma in the jejunum. A double balloon enteroscopy following capsule endoscopy was performed to obtain biopsy samples, which established the final diagnosis., Competing Interests: The authors have declared that no competing interests exist.

Pancreatic pseudocyst is a complication that can arise in both acute and chronic pancreatitis. Overtime, this encapsulated enzyme-rich fluid collection may erode into surrounding vasculature and result in the formation of a pseudoaneurysm. Pseudoaneurysms can rupture into the gastrointestinal tract and present as upper, lower, and biliary bleeding. Evaluation of pancreatic pseudocysts involves computed tomography imaging or magnetic resonance imaging for both identification and monitoring. Esophagogastroduodenoscopy (EGD) and endoscopic ultrasound (EUS) can be done to further visualize the lesion. In the presence of gastrointestinal bleed, management involves the combination of interventional radiology and surgery., Competing Interests: The authors have declared that no competing interests exist.