FMT is a promising treatment modality for rCDI compared with MT alone. Different forms and routes of FMT administration seem to be equally efficacious. In future, more well-designed RCTs directed at homogenous FMT preparation and delivery methods are required to validate these findings.

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Spontaneous pneumomediastinum (SPM) is an uncommon finding in young adults presenting usually without any comorbidities or an underlying pathology. It is most commonly due to alveolar rupture in the setting of an inciting event such an underlying asthma, barotrauma, valsalva maneuver, or esophageal rupture. Individuals can have varying presentations, from chest pain, dyspnea and dysphagia, to anxiety, weakness, or facial and neck swelling. The majority of patients have subcutaneous emphysema on examination and can have abnormal laboratory findings such as an elevated C-reactive proteins and leukocytosis. Diagnostic modalities used include chest x-ray, CT scan, ultrasound and barium swallow or esophagram. Majority of individuals and treated conservatively with rest, analgesia and oxygen administration. The prognosis of SPM is usually good with resolution within several days in most cases and the recurrence rate is very low. We report the case of a 22-year-old female presented with SPM diagnosed by chest x-ray and chest CT scan who was treated conservatively with subsequent spontaneous resolution.

Swyer-James-Macleod syndrome (SJMS) is a rare etiology of a unilateral hyperlucent hemithorax but an important one, which should be considered in any individual with such findings. Presentation usually occurs in adulthood with an asymptomatic history in many cases or with a history of childhood infections. Clinically, symptomatic patients may present with productive cough, dyspnea on exertion, hemoptysis, decreased exercise tolerance and recurrent pulmonary infections. Many individuals are asymptomatic only requiring conservative management. However, some patients may require surgical intervention. SJMS can be easily misdiagnosed and must be suspected for example, in any patient diagnosed with asthma who does not respond to therapy. We report a case of a 51-year-old African American male diagnosed with SJMS on the basis of his medical history, clinical presentation and x-rays and computed tomography chest scans findings.

Concomitantly administered PPIs with P2Y12 inhibitors have a protective effect on the GI events. It also decreases the post-PCI angina without increased adverse cardiovascular outcomes.

Patient: Male, 57Final Diagnosis: Left atrial to esophageal fistulaSymptoms: Chest pain • syncopeMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Unusual clinical courseBackground:Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation.Case Report:A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier. Several hours after admission to the ED, the patient transiently became unresponsive and had a right sided hemiplegia. A brain MRI revealed multiple cerebral infarcts. On the following day, the patient had an episode of melena, and an esophagogastroduodenoscopy (EGD) was performed which did not reveal any source of bleeding. While the patient was being monitored in the intensive care unit (ICU), he had an episode of hematemesis and went into cardiac arrest from which he was successfully resuscitated and transferred to another facility. He had another EGD, which uncovered a flap of mucosa covering the lower third of his esophagus and a 1 cm fistulous opening was seen with fresh blood oozing out of it. The patient had another cardiac arrest during the endoscopy and died despite all measures.Conclusions:We present this case to stress the importance of early diagnosis of LAEF. LAEF can be fatal if diagnosis is delayed or missed. Early surgical intervention can reduce LAEF morbidity and mortality. Newer diagnostic modalities such as endoscopic ultrasound (EUS) can be helpful in cases where conventional imaging is unclear.

Xanthomas are localized nonneoplastic lesions within tissues that may manifest as papules, plaques, or nodules. These lesions can be found anywhere along the gastrointestinal tract, commonly in the stomach and colon, and rarely in the small intestine and esophagus. Esophagogastroduodenoscopy (EGD) with biopsy is the gold standard tool for diagnosis. Here, we report a rare case of a lower solitary nodular esophageal xanthoma in an elderly black female. Correspondingly, all cases of esophageal xanthomas reported in the English medical literature were reviewed and presented with the reported case.

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