Madeline Cleary

Background/Objectives : Autoimmune metaplastic atrophic gastritis (AMAG) is a chronic, autoimmune-mediated condition associated with increased risk of malignancy and nutritional deficiencies, yet diagnostic and follow-up processes remain inconsistent and unclear. This study investigates follow-up testing performance in patients with AMAG and neuroendocrine tumors (NET), as well as the correlation between endoscopic impressions and histologic findings. Methods: We retrospectively analyzed 65 gastric biopsies with final diagnoses or comments mentioning the possibility of AMAG, 12 of which included well-differentiated WHO grade 1 NET arising in AMAG. H&E slides were reviewed to assess atrophy severity, the presence or absence of enterochromaffin-like (ECL) cell hyperplasia, and Helicobacter organisms. The final diagnostic line or comments made were scored from 1 to 5, based on the strength of the language used to alert the treating clinician to the likelihood of AMAG. Corresponding endoscopy reports were scored from 1 to 5 based on the likelihood of the reports documenting AMAG features. Data regarding follow-up laboratory testing relevant to AMAG and biopsy performance were collected from the electronic medical records. Results: Endoscopy scores showed no significant associations with the histology comment score or atrophy grade. The histology comment score was positively associated with performing at least a total of three laboratory tests (p = 0.03). No association was found between the presence or absence of follow-up biopsy and histology comment score (p = 0.60). Follow-up biopsy was more common in patients with NET than those with AMAG without NET (p < 0.001). Conclusions: Poor endoscopic–histologic correlation with variable follow-up practices highlights the need for standardized protocols in AMAG management. Enhanced adherence to biopsy guidelines, standardized pathology reporting, and consistent surveillance, particularly for patients with AMAG without NET, are imperative to improve diagnosis and outcomes. Future research should focus on optimizing endoscopic techniques, standardizing serological tests, and establishing evidence-based surveillance protocols for AMAG patients.

Background and aims: Colorectal cancer is the second leading cause of cancer death in the United States, yet ∼25% of patients undergoing colonoscopy have suboptimal bowel preparation. Bowel preparation is cited as the leading deterrent to an elective colonoscopy. Methods: This randomized, controlled, single-blinded noninferiority trial assessed the efficacy, safety, and patient tolerability of oral sulfate tablets (OST) compared with polyethylene glycol (PEG) based bowel preparation formulations, with explicit consideration of patient satisfaction and adverse events. Between March and August 2024, adult outpatients at Albany Medical Center requiring routine colonoscopies were consented and enrolled. Endoscopists were blinded to preparation assignments and graded the cleansing of the colon based on the US FDA Bowel Prep Scoring Scale. Patients completed a preparation satisfaction questionnaire. Results: This study assessed 177 patients (n=94 OST/n=83 PEG). Overall cleansing scores favored OST with 67.0% “excellent” preparations versus 57.8% for PEG. Although differences were not statistically significant in segmental analyses, trends favored OST. Generally, bowel preparation cleansing scores for the proximal, mid, and distal colon were numerically better for OST. Polyp identification was higher for OST (60.6%) versus PEG (54.2%). Tolerability favored OST, with 18.1% of patients in the OST group reporting adverse events (AE) versus 65.1% of patients in the PEG group. The most common AE for both groups was nausea. OST was “tolerable” to “very easy” to consume in 88.3% of patients compared with 78.6% for patients in the PEG group. OST was again requested by 92.6% of patients, compared with 60.7% of patients in the PEG group. Conclusions: This real-world study demonstrates the noninferior efficacy and safety of OST compared with conventional PEG-based formulations while highlighting improved patient tolerability, palatability, and potential preference bias due to free-of-charge provision.