Type 2 autoimmune pancreatitis associated with severe ulcerative colitis: Three case reports.

BACKGROUND: Type two autoimmune pancreatitis is a rare and difficult to diagnose, steroid responsive non-IgG4 inflammatory pancreatopathy that can be associated with inflammatory bowel disease. CASE SUMMARY: This case series describes three cases with varied clinical presentations and re-presentations of autoimmune pancreatitis, and all associated with an aggressive course of ulcerative colitis. The pancreatopathy was independent of bowel disease activity and developed in one case following colectomy. CONCLUSION: Clinician awareness about this condition is important to allow early diagnosis, treatment and avoid unnecessary pancreatic surgery.

Gastroenterology hospital outpatients report high rates of satisfaction with a Telehealth model of care.

AIMS: This study aimed to capture patient satisfaction with a Telehealth model of care in a tertiary hospital gastroenterology outpatient setting. An in-depth patient questionnaire addressed patients' experience with telephone based consultations, as well as capturing demographic data to predict patients who may benefit from a Telehealth model of care. METHODS: Patients aged ≥ 18 years who had a telephone appointment from 1st March 2020 to 1st September 2020 at the St George Hospital and Sutherland Hospital Gastroenterology Clinics in Sydney, Australia, were invited to complete an anonymous online survey detailing their experience. Clinics included general gastroenterology, inflammatory bowel disease, hepatology and swallow disorders. Chi squared analysis was used to investigate if demographic data (age, gender, educational status, English-spoken at home, and presence of IBD or cirrhosis) impacted on a patients rating of care they received. RESULTS: 1894 patients were invited to complete with survey, with 302 responses. 294 respondents (88.4%) rated the care they received as "very good" or "good". 254 (84.1%) stated the main reason for attending the clinic was dealt with to their satisfaction. There was no statistical relationship between age, gender, educational status and the rating of care received. 49.7% preferred their telephone appointment, and 63.6% would like the option of a telephone appointment in the future. CONCLUSION: Gastroenterology outpatients reported a very high satisfaction with Telehealth, demonstrating a potential for Telehealth to be incorporated into usual care.

Lung Ultrasound After Transbronchial Biopsy for Pneumothorax Screening in Post-Lung Transplant Patients.

BACKGROUND: Lung ultrasound has been suggested as an alternative to routine chest radiography (CXR) to screen for pneumothorax after transbronchial lung biopsy. In post-lung transplant patients, who may have altered anatomy and pleural adhesions, the validity of lung ultrasound to screen for postbiopsy pneumothoraces has not been investigated. METHODS: Lung ultrasound using an ultraportable handheld device was performed in a standardized manner 2-hour after biopsy in post-lung transplant patients. Ultrasound assessment was then compared with CXR performed immediately after lung ultrasound. RESULTS: In total, 165 patients were enrolled in the study. Eight pneumothoraces were diagnosed by image intensifier or CXR before lung ultrasound. There were 8 pneumothoraces diagnosed on CXR 2-hour postbiopsy. Lung ultrasound had a sensitivity of 75% and specificity of 93%. Positive predictive value was 35% and negative predictive value was 99%. The mean number of biopsies taken in patients with and without a pneuomothorax on CXR was 10.6 (±3.1) and 10.9 (±2.1), respectively (P=0.79). The overall pneumothorax rate was 9.7%. CONCLUSIONS: Lung ultrasound is a valid tool in excluding penumothoraces after lung biopsy. Ultrasound scans with features of a pneumothorax or patients with symptoms should still undergo CXR. The high false positive rate may be due to small pneumothoraces being seen or the presence of pleural adhesions and altered lung anatomy in post-lung transplant patients.