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Gastrointestinal stromal tumors (GIST) are uncommon tumors accounting for 1% of gastrointestinal neoplasms. The most common location of GISTs is in the stomach. Commonly, these tumors present incidentally with an increased presence within older patients. Spontaneous rupture of a GIST is a rare presentation of this uncommon tumor. Our case highlights the diagnostic dilemma and imaging that helped diagnose an abnormal presentation of a ruptured GIST in a young patient.

Vascular ectasia is a common cause of lower gastrointestinal (GI) bleeding in older patients. They typically present as flat or slightly raised fern-like bright red lesions. We report a rare case of a vascular ectasia presenting as a pedunculated polypoid lesion in a young patient with rectal prolapse. The pedunculated polyp was removed using hot snare polypectomy. This case highlights a unique presentation of a rare lesion and endoscopic management of these lesions.

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Results: A total of 145 ER, 7875 SR, and 70 HR procedures for G-GIST management was identified. According to different approaches, there was no difference in primary payer types or median household income. There was slight male to female predominance in ER and HR but not in the SR group. Racial disparities were noted in the ER .SR but not in HR (Figure). Most procedures were performed in teaching institutions: ER (93%), SR (86%), and HR (86%). Mortality for SR was 0.8%, and no inpatient deaths were recorded for ER or HR. Mean charges were highest for HR ($163,794) and lowest for ER ($86,811), with LOS highest for HR (10.7d), followed by ER (;7d) and SR (5.5d). More complications were noted in HR (43%, vs 28% in ER and 18% in SR) (Table ). Most SR and HR patients were discharged home (94% and 93%, respectively); A lesser percentage of ER (72%) were discharged home with a relatively higher percentage of 28% sent to long-term care facilities compared to SR (5%) and HR (7%). Conclusion: Minimally invasive management of G-GIST is evolving, with surgery still being most common. Both endoscopic and hybrid techniques are promising alternatives to surgery and show a lower mortality rate, however, with a higher percentage of non-fatal complications (both), increased cost (HR only), and increased LOS (both) compared to SR. Larger studies can help guide providers in choosing the optimal individual approach in G-GIST management.

Background: Sprue-like enteropathy (SE) related to olmesartan use was first reported in 2012. In 2017, the manufacturer of Benicar paid $300 million for 2300 claims for olmesartan-related SE. Objective: A study in 2019 suggested that SE was related to olmesartan and with the possibility of angiotensin receptor blocker (ARB) class effect. To further characterize this condition, our group examined reports of ARB-related SE to Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: All reports of ARB-related SE from January 2017 to December 2021 were downloaded from the FAERS database. Gastrointestinal adverse events including SE were reviewed. Reporter categories included physicians, pharmacists, other health care professionals, consumers, and attorneys. Results: A total of 106 590 reports of ARB-related adverse effects were analyzed. Sprue-like enteropathy was identified in 4337 cases (4.1% of total reports). Of these, 4240 cases (98.0%) of ARB-related SE were reported in patients using products with olmesartan, and 97 cases of SE were reported for all other ARBs (eprosartan, losartan, telmisartan, irbesartan, valsartan, and candesartan). Reports of olmesartan-related SE increased rapidly in 2017, continued at a high rate in 2018 and 2019, and essentially stopped in 2020 and 2021. Conclusions and Relevance: Reports to FAERS for ARB-related SE are mostly related to olmesartan. There was a steep decline in reports of olmesartan-related SE following the lawsuit with potential of lawyer interference. There are reports of SE related to ARBs other than olmesartan, with increased physician awareness and the potential to discover a class effect with future studies.

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