Introduction Ehlers-Danlos syndrome (EDS), specifically the hypermobility type (hEDS), is associated with a variety of gastrointestinal (GI) conditions. This study aims to evaluate the prevalence of and factors associated with gut dysmotility in patients with hEDS. Methods This is a retrospective study of hEDS patients conducted at the Cleveland Clinic's Center for Personalized Genetic Healthcare between January 2007 and December 2017. Demographics, GI motility testing, endoscopic, and imaging data were extracted from the patients' charts. Results A total of 218 patients with hEDS were identified. Among them, 136 (62.3%) patients had at least one GI symptom at the time of EDS diagnosis. Motility testing was performed and reported in 42 (19.2%) patients. Out of them, five (11.9%) had esophageal dysmotility, 18 (42.8%) had gastroparesis, five (11.9%) had small bowel/colon altered transit time, and four (9.5%) had global dysmotility. In univariable analysis, patients with postural orthostatic tachycardia syndrome (POTS) [

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Acute cholecystitis is the inflammation of the gallbladder, classically caused by gall stones obstructing the cystic duct. In contrast, acalculous cholecystitis is a gallbladder inflammation occurring in the absence of cholelithiasis with a reported prevalence of 10% of all cases of acute cholecystitis. Reactive acalculous cholecystitis is an extremely rare subset of this disease that results from an adjacent inflammatory or infectious intra-abdominal process that may lead to gallbladder stasis, ischemia, and subsequent wall inflammation. Many factors have been associated with acalculous cholecystitis, including (but not limited to) hemodynamic instability, altered immunity, and biliary tree anomalies. Lack of specific signs and symptoms of this particular entity often delays the diagnosis. Herein, we present a rare case of acute, reactive, acalculous cholecystitis secondary to a perforated duodenal ulcer found incidentally during laparoscopic cholecystectomy.

As a result of the obesity epidemic, Nonalcoholic fatty liver disease (NAFLD) and its complications have increased among millions of people. Consequently, a group of experts recommended changing the term NAFLD to an inclusive terminology more reflective of the underlying pathogenesis; metabolic-associated fatty liver disease (MAFLD). This new term of MAFLD has its own disease epidemiology and clinical outcomes prompting efforts in studying its differences from NAFLD. This article discusses the rationale behind the nomenclature change, the main differences, and its clinical implications.

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver resulting in approximately 800,000 deaths annually. A growing body of research investigating statin use and HCC risk has shown conflicting results. We aim to evaluate the current evidence of statin impact on HCC risk.We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through May 2019 to identify all studies that evaluated the association between statin use and HCC. We included studies that presented an odds ratio (OR) with a 95% confidence interval (CI) or presented data sufficient to calculate the OR with a 95% CI. Statistical analysis was performed using the Comprehensive Meta-Analysis (CMA), Version 3 software, and a Forrest plot was generated. We assessed for publication bias using conventional techniques.Twenty studies (three randomized controlled trials, six cohorts, and 11 case-controls) with 2,668,497 patients including 24,341 cases of HCC were included in the meta-analysis. Our findings indicate a significant risk reduction of HCC among all statin users with a pooled odds ratio of 0.573 (95% CI: 0.491-0.668, I2= 86.57%) compared to non-users. No publication bias was found using Egger's regression test or on visual inspection of the generated Funnel plot.The results indicate that statin use was associated with a 43% lower risk of HCC compared to statin nonusers. Further prospective randomized research is needed to confirm the association. Categories: Preventive Medicine, GastroenterologyKeywords: viral hepatitis b and c, cirrhosis, cancer prevention, hepatocellular carcinoma (hcc), statin use their role in cardiovascular disease treatment and prophylaxis is essential [15]. Besides the effect of cholesterol formation, statins are known to have proapoptotic, antiangiogenic, antiproliferative, and immunomodulatory effects. For these reasons, many researchers have aimed to assess whether statins can decrease the risk for multiple malignancies, including HCC [11][12][13][14].The results of observational and randomized controlled trials (RCTs) have not been consistent. While most observational studies showed statistically reduced risk for HCC in patients who were using statins, the data from the RCTs did not. Hence, we conducted this study to examine the association between statin use and HCC utilizing all available published high-quality literature.