Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admission worldwide, and has a mortality rate of between 2% and 15%. 1 Recent guidelines have recommended stratifying patients with UGIB into higher and lower risk categories for treatment decisions and prognostication. 1-3 The widely used scoring systems include the Glasgow-Blatchford score (GBS), Rockall score (RS), and AIMS65 score (AIMS65) (Table 1); however, their role in clinical practice remains uncertain. 4-6 Compared with other existing scores, AIMS65 is simple, easy to remember, can be calculated with nonweighted elements, and can be routinely evaluated in the emergency department. 7 These scores have been validated and compared, in terms of their accuracy in predicting various outcomes among patients presenting with UGIB, in numerous studies. 7-11 Most of the previous studies included both patients with nonvariceal

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Background Immunoglobulin G4 (IgG4) associated autoimmune hepatitis (AIH) has been recognized as a type of autoimmune disease that responds to corticosteroid. The diagnosis is based on elevation of the serum IgG4 level, abundance of IgG4 enhanced plasma cell infiltration in the portal region of the liver, and satisfaction of the criteria for “definite AIH” under the revised International Autoimmune Hepatitis Group (IAIHG) scoring system. However, the clinical course of the disease is unclear. Case presentation A 65-year-old man with jaundice and peripheral blood eosinophilia. His IAIHG and simplified score was compatible with definite AIH and his IgG4 level was elevated. Magnetic resonance imaging did not reveal abnormalities in the hepatobiliary system or pancreas. A liver biopsy revealed interface hepatitis with IgG4 positive plasma cell infiltration in the portal region, without evidence of bile duct injury. He responded to 4-week period of induction prednisolone therapy and had no recurring symptoms under maintenance therapy of 5 mg prednisolone during the 3-year follow up. Conclusions This was a rare case that demonstrated an association between IgG4 associated AIH and the presence of peripheral blood eosinophilia.

Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed as a less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC) appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complex case of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.

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