BackgroundThis study's objective was to evaluate the association between proton-pump inhibitor (PPI) use and bone fracture incidence and bone mineral density (BMD) by meta-analyzing the estimates reported by epidemiological and cohort studies.MethodsData were acquired from studies identified after a literature search in electronic databases. Odds ratios (ORs), hazard ratios (HRs), and risk ratios (RRs) between PPI use and bone fracture incidence were pooled under the random effects model, and meta-analysis of standardized mean differences between PPI users and controls in cross-sectional values and BMD changes was conducted.ResultsThirty-three studies fulfilled the eligibility criteria. These studies provided data from 2,714,502 individuals with a mean age of 66.91 years (95% confidence interval [CI], 63.37–70.46); 33.21% (95% CI, 30.44–35.99) were males and 64.61% (95% CI, 60.73–68.49) were females. Overall, fracture incidence was 22.04% (95% CI, 16.10–27.97) in PPI users and 15.57% (95% CI, 12.28–18.86) in controls. The overall effect size of the point estimate was 1.28 (95% CI, 1.22–1.35) between PPI use and bone fracture incidence. There was a trend towards increased fracture incidence from short duration use: OR 1.29 (95% CI, 1.19–1.40), medium duration use: OR 1.33 (95% CI, 1.12–1.55) and long duration use: OR 1.62 (95% CI, 1.33–1.90). There was no significant difference in the standardized mean differences between PPI users and controls, either in cross-sectional BMD values or in the BMD change observed in longitudinal studies.ConclusionsPooling of ORs, HRs, and RRs suggested that PPI use might increase fracture risk. However, there was no effect of PPI use on BMD.

BackgroundGastroparesis is a syndrome characterized by delayed gastric emptying in the absence of any mechanical cause. While often associated with diabetes mellitus, most cases of gastroparesis are idiopathic. The purpose of the present paper is to review the co-morbid conditions that most likely associate with non-diabetic gastroparesis.MethodsThe Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (HCUP-NIS) data were used from the year 2013 - 2014 and the Apriori algorithm was run on this subset of patients to identify what co-morbid conditions are most likely associated with gastroparesis.ResultsNotable conditions that were found to be most closely linked with gastroparesis were: chronic pancreatitis, end stage renal disease, irritable bowel syndrome, systemic lupus erythematosus, fibromyalgia, and venous thromboembolism. Some of the implications of these findings are briefly discussed.ConclusionsGastroparesis is strongly associated with multiple medical conditions which may be potential targets for treatment.

The endoscopy nurse detected 94 % of the significant lesions seen by the physician and no clinically relevant findings were overlooked. A pre-evaluation of the capsule video by trained staff is an accurate method and might be time effective.

Objective The aim of this study was to evaluate the differences in clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP), ERCP followed by cholecystectomy (EC) and percutaneous aspiration (PA) in the elderly population with choledocholithiasis. Methods We included a total of 43 338 elderly patients aged 60 years or older and 45 295 patients younger than 60 years for comparison in our study. Data were obtained from the Nationwide Inpatient Sample (Healthcare Utilization Project) for years 2001–14 by identifying patients who were admitted for gallstone complications based on the ICD 9 diagnostic code. Multiple logistic regression was used to calculate the odds of in-hospital mortality and to detect statistical differences among the treatment groups, age groups and between male and female patients. Univariate ordinary linear regression was used to compare the length of hospital stay and readmission frequency among the different age groups. Results The age of the patient affected mortality and the length of hospital stay after any type of procedure of gallstones removal. In a manner independent of the patient’s age, PA was associated with the highest risk of death and length of stay, while the EC was characterized by lowest mortality and ERCP by the shortest length of stay. Neither age of the patient nor the type of procedure affected the likelihood of readmission. The odds of death and the probability of readmission were not affected by patient sex. However, in patients aged between 60 and 79 years, the female gender predicted a shorter duration of stay in the hospital. Conclusions A patient’s age negatively affects the treatment outcomes of cholelithiasis with associated complications. The EC procedure appears to be the method of choice for the management of complicated gallstones in patients of all ages.

Babesiosis is a zoonotic, tick-borne infection caused by the protozoan Babesia. It is transmitted by the Ixodes ticks which transmit the infection to humans. Babesia microti, Babesia duncani, Babesia divergens, and Babesia venatorum are species that have been identified as being infectious to humans worldwide. The most common species causing infection to humans is B. microti which is endemic to the Northeast and Midwestern United States with most infections occurring between the months of May and October. We report a case of an elderly man with acute liver failure due to an infection with B. microti.

Esophageal leukoplakia or epidermoid metaplasia is a rare lesion resembling the commonly found oral leukoplakia. When found, it is typically seen incidentally on endoscopy as a white plaque but rarely it may present as a globus sensation. Histologically, it is seen as epidermal metaplasia with orthokeratosis, closely resembling the skin. Although rare, esophageal leukoplakia is precancerous and may pose a serious threat. We present a unique case of a 61-year-old male with a history of COPD, tobacco, and alcohol dependence presenting with a six-month history of nausea and emesis resulting in poor oral intake despite having an appetite. The patient also reported weight loss. Considering his risk factors for esophageal carcinoma and alarm symptoms, an upper endoscopy was performed that revealed localized white, plaque-like mucosal changes characterized by altered texture in the lower third of the esophagus at 40cm. Biopsy results showed squamous epithelium with orthokeratosis and a prominent granular cell layer. These findings were consistent with esophageal epidermoid metaplasia. The lesion was ablated using argon plasma coagulation and radiofrequency ablation on subsequent endoscopy. The patient reported continued resolution of symptoms with each treatment session. Esophageal leukoplakia may increase the risk for squamous cell carcinoma of the esophagus and should be followed closely. Guidelines on surveillance are yet to be established given the rarity of the disease.

Background Gastroparesis is a debilitating condition that may impact morbidity and mortality, but there is a lack of long-term studies examining this relation. The aim of this study was to determine the predictors of mortality in gastroparesis and to determine the nutritional deficiencies. Methods Between September 30, 2009 and January 31, 2020, we identified 320 patients (mean age 47.5±5.3 years, 70% female, 71.3% Whites, 39.7% diabetic and 60.3% nondiabetic) with gastroparesis. 99m Tc sulfur-labeled food was used to diagnose gastroparesis. Cox proportional-hazard regression was used to compute the association of mortality predictors. Results Of the 320 patients, 46 (14.4%) died during the study period. Among diabetics, advanced age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03-1.10; P<0.001), chronic kidney disease (CKD) (HR 4.69, 95%CI 1.62-13.59; P=0.004), and malnutrition (HR 10.95, 95%CI 3.23-37.17; P<0.001) were associated with higher mortality, whereas in nondiabetics older age (HR 1.05, 95%CI 1.01-1.09; P=0.04), CKD (HR 10.2, 95%CI 2.48-41.99; P=0.001), chronic obstructive pulmonary disease (COPD) (HR 7.5, 95%CI 2.11-26.82; P=0.002), coronary artery disease (CAD) (HR 9.7, 95%CI 1.8-52.21; P=0.008), and malnutrition (HR 3.83, 95%CI 1.14-29.07; P=0.03) were associated with increased mortality. Overall, 48.8% had vitamin D, 18.2% had vitamin B12, and 50.8% had iron deficiencies. Only 19.4% of the whole cohort was evaluated by a nutritionist. Conclusions Advanced age, CAD, CKD, COPD and malnutrition were associated with higher mortality in gastroparesis. Despite the high prevalence of nutritional deficiencies, consultation of a specialist nutritionist was uncommon.

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