Monjur Ahmed

Gastrointestinal stricture can occur in the esophagus, stomach, small intestine, colon, and anorectum. Most of the strictures are benign. The prevalence of esophageal strictures (ES) secondary to eosinophilic esophagitis has increased. Pyloric stenosis (PS) is rarely seen in clinical practice. Sleeve stenosis (SS) and stomal stenosis or gastrojejunal anastomotic stricture (GJAS) are increasingly seen due to bariatric surgery. Crohn's disease (CD) remains a significant challenge even in the biologic era. The symptomatology of strictures depends on the location, severity, and underlying cause. Imaging studies and endoscopic procedures are the primary investigations to diagnose and evaluate strictures. Various treatment modalities are available to treat gastrointestinal strictures. Successful stricture treatment can significantly improve a patient's quality of life. Benign strictures carry a much better prognosis than malignant strictures. Multiple other factors influence response to treatment.

Certain esophageal diseases have a predilection for affecting different parts of the esophagus. This predilection is noted in our clinical practice as we investigate various esophageal diseases using multiple imaging and motility studies, as well as endoscopic procedures with biopsies. Clinical presentations vary with the stage and location of the disease. Clinicians can suspect certain diseases when a particular part of the esophagus is involved and then can perform appropriate investigations. Esophageal diseases with section involvement, with their symptomatology, diagnostic tests, and management, have been discussed in this narrative review. This review aims to revisit those diseases with a current update.

Gastrointestinal fistulas are increasingly being encountered in our clinical practice because of the increased burden of Crohn’s disease, bariatric surgeries, interventional endoscopic procedures, nonsurgical trauma, and war and disaster zones worldwide. Presentation depends on the location and specific type of the fistula. Symptomatic ones can have a tremendous impact on social life and can cause dehydration, electrolyte imbalance, malnutrition, increased morbidity, and mortality. Different imaging studies and endoscopic procedures are done to establish the diagnosis. Treatment modalities to close the fistula depend on the underlying disease and the type of fistula. They include conservative treatment, medical therapy, endoscopic interventions, and surgery. Currently, there is no accepted treatment algorithm due to a lack of controlled clinical trials. The prognosis varies from fistula to fistula, and the mortality can be as high as 50%.

Mesentery was discovered as a new organ in 2017. It is a continuous membranous tissue from the duodenojejunal flexure to the anorectal junction. It has distinct anatomy, physiology, and disease states. Primary mesenteropathies include vascular and non-vascular diseases. Some of them are common, and some of them are rarely seen in clinical practice. Secondary mesenteropathies occur when infection or malignancy in another organ spreads to the mesentery. Each entity has specific diagnostic and treatment protocols. Increased awareness of different mesenteropathies and an understanding of their various presentations at different stages of life can help in early diagnosis and improved clinical outcomes.

Mesentery was discovered as a new organ in 2017. It is a continuous membranous tissue from the duodenojejunal flexure to the anorectal junction. It has distinct anatomy, physiology, and disease states. Primary mesenteropathies include vascular and non-vascular diseases. Some of them are common, and some of them are rarely seen in clinical practice. Secondary mesenteropathies occur when infection or malignancy in another organ spreads to the mesentery. Each entity has specific diagnostic and treatment protocols.

Intestinal Parasitic Infections in 2023

The benefit of radiation is immense in the field of gastroenterology. Radiation is used daily in different gastrointestinal imaging and diagnostic and therapeutic interventional procedures. Radiotherapy is one of the primary modalities of treatment of gastrointestinal malignancies. There are various modalities of radiotherapy. Radiotherapy can injure malignant cells by directly damaging DNA, RNA, proteins, and lipids and indirectly by forming free radicals. External beam radiation, internal beam radiation and radio-isotope therapy are the major ways of delivering radiation to the malignant tissue. Radiation can also cause inflammation, fibrosis, organ dysfunction, and malignancy. Patients with repeated exposure to radiation for diagnostic imaging and therapeutic procedures are at slightly increased risk of malignancy. Gastrointestinal endoscopists performing fluoroscopy-guided procedures are also at increased risk of malignancy and cataract formation. The radiological protection society recommends certain preventive and protective measures to avoid side effects of radiation. Gastrointestinal complications related to radiation therapy for oncologic processes, and exposure risks for patients and health care providers involved in diagnostic or therapeutic imaging will be discussed in this review. Gastroenterol Res. 2022;15(6):285-296 doi: https://doi.org/10.14740/gr1567

Background: The COVID-19 pandemic caused medical education to shift unprecedentedly, leading medical schools to switch to virtual platforms and modify student-patient interactions. On top of educational changes, medical students adapted to their support network, finances, and mental and physical health changes. Objective: To understand the holistic impact of COVID-19 on medical students and medical education and identify how to distribute resources during future educational disruptions in a large medical university in the United States. Methods: An anonymous online survey was distributed to medical students at Sidney Kimmel Medical College, Philadelphia, in February 2021. Participants self-reported the impact of the COVID-19 pandemic on their medical education, family life, financial burden, mental health, and physical health. Results: 168 out of 1088 students at Sidney Kimmel Medical College completed the survey, with 58% (98/168) of the respondents identifying as female. The class breakdown was as follows: 38% (63/168) first years, 18% (31/168) second years, 21% (36/168) third years, 20% (34/168) fourth years, and 2% (4/168) were considered “other” (including research year, Master’s program). A total of 28% of respondents reported developing new mental illness, with second years having the highest incidence at 39%. In total, 42% said the pandemic affected a previous mental health condition. Further, 96% of third and fourth years reported COVID-19 affected their clinical rotations. In total, 68% of first years reported their entrance to medical school was severely affected. Moreover, 13% reported losing a family member due to COVID-19, and 7% reported personal sickness due to COVID-19. Additionally, 16% reported incurring a financial burden due to the pandemic. Conclusion: COVID-19 impacted the well-being of students by affecting their mental health and financial burdens. Clinical rotations and medical school entrance were the most problematic aspects. In the future setting of major educational disruptions, this study provides a starting point for where to focus resources, mental health support, financial support, and academic flexibility.

Bile is a unique body fluid synthesized in our liver. Enterohepatic circulation preserves bile in our body through its efficient synthesis, transport, absorption, and reuptake. Bile is the main excretory route for bile salts, bilirubin, and potentially harmful exogenous lipophilic substances. The primary way of eliminating cholesterol is bile. Although bile has many organic and inorganic contents, bile acid is the most physiologically active component. Bile acids have a multitude of critical physiologic functions in our body. These include emulsification of dietary fat, absorption of fat and fat-soluble vitamins, maintaining glucose, lipid, and energy homeostasis, sustenance of intestinal epithelial integrity and epithelial cell proliferation, reducing inflammation in the intestine, and prevention of enteric infection due to its antimicrobial properties. But bile acids can be harmful in certain altered conditions like cholecystectomy, terminal ileal disease or resection, cholestasis, duodenogastric bile reflux, duodenogastroesophageal bile reflux, and bile acid diarrhea. Bile acids can have malignant potentials as well. There are also important diagnostic and therapeutic roles of bile acid and bile acid modulation.

Video Capsule Endoscopy in Gastroenterology