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The yield for CAF with APCT in the ED was high for CD patients but minimal for those with UC and was not improved by the use of contrast. Elevated CRP, low BMI, Black race and previous history of IBD surgery predicted CAF in CD but no variables were predictive of CAF in UC.

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

Clostridium difficile infection (CDI) is a leading cause of nosocomial infection and isassociated with significant morbidity and mortality. Immunocompromised (IC) patients are particularly at higher risk. Recurrence rates of up to 60 % have been reported after the third episode despite treatment with antibiotics. Recent published reports of fecal microbiota transplantation (FMT) in the IC population have shed light that the procedure proves to be effective and safe. No studies that compare the efficacy and adverse event rate of FMT between IC and non-IC patients currently exist The aim of our study is to compare the response and serious adverse event (SAE) rates of FMT for recurrent or refractory CDI (RCDI) between IC patients and non-IC patients.We performed a single-center retrospective study on patients who received FMT for RCDI in a single tertiary care center. Donor stool was obtained from a universal donor, friend, or relative. We used a standardized protocol for preparation of stool used for FMT. Patients received FMT through the upper gastrointestinal route or by colonoscopy. Those who failed initial FMT were eligible to receive additional FMT.Patients were considered IC as a result of one or more of the following: HIV infection (any CD4 count), AIDS-defining diagnosis or CD4<200/mm 3 , inherited or primary immune disorders, active malignancy, and immunodeficient or immunosuppressed from a medical condition/medication including current or recent (<3 months) treatment with anti-neoplastic

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The patient, a 64-year-old woman, presented with a history of systemic lupus erythematosus characterized by antinuclear antibody and anti-double-stranded DNA positivity, chronic hypocomplementemia, polyarthritis, pericarditis, and lupus nephritis complicated by endstage renal disease. She had been receiving hemodialysis for ;3 years and peritoneal dialysis for many years prior to that. She also had a history of antiphospholipid syndrome (APS) characterized by persistently positive lupus anticoagulant, high-titer IgG and IgM anti-b 2glycoprotein I, and high-titer IgG and IgM anticardiolipin. She was receiving anticoagulation therapy for an episode of deep venous thrombosis complicated by pulmonary embolism. She was admitted for cachexia and found to have evidence suggestive of smoldering disseminated intravascular coagulation (DIC) (low fibrinogen and elevated D-dimer levels, prolonged prothrombin and partial thromboplastin times, low hemoglobin [Hgb] level, and low platelet count). While hospitalized, she developed coffee ground emesis, hypotension, and an acute drop in her Hgb concentration of 3 gm/dl. Upper gastrointestinal endoscopy revealed "black esophagus" involving the middle and lower portions of the esophagus (A and B) (lower third of the esophagus and gastroesophageal junction, respectively). Extensive thrombosis (arrows) and acute esophageal necrosis were confirmed by histopathologic examination (C and D [original magnification 3 10 and 3 20, respectively]). Acute esophageal necrosis appears black, circumferential, and can affect any portion of the esophagus. Risk factors include hypertension, diabetes, hyperlipidemia, and chronic kidney disease. Alcohol abuse, malnourishment, hypoalbuminemia, and history of vascular and thromboembolic disease are other risk factors. In this patient, a prothrombotic state due to APS and DIC likely contributed. Extensive evaluation did not reveal evidence of infection or malignancy. We suspect the DIC was due at least in part to APS. Evaluation of 8 cases suggests that acute esophageal necrosis is multifactorial in most patients (as in this patient) and has multiple risk factors for ischemic insult and decreased gastric mucosal defenses (1). Gastrointestinal ischemia involving the small bowel or colon has been reported in APS (2). To our knowledge, this is only the second reported case of acute esophageal necrosis in a patient with APS (3).

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