Rapid Onset of Inflammatory Bowel Disease after Receiving Secukinumab Infusion.

Secukinumab, an interleukin (IL)-17A antagonist, was associated with disease exacerbations in Crohn's disease, and de novo cases of inflammatory bowel disease (IBD) have been reported in studies of rheumatoid diseases. However, there has been no detailed report demonstrating the linkage between secukinumab therapy and new-onset IBD. We present a unique case of rapid-onset fulminant colitis after receiving 1 dose of secukinumab infusion followed by improvement with combination antibiotics, corticosteroids, and calcineurin inhibition. Health care providers should be aware of the possible association between IL-17 antagonist therapy and the risk of developing new-onset fulminant IBD.

Are Gastroenterologists Willing to Implement the "Predict, Resect, and Discard" Management Strategy for Diminutive Colorectal Polyps?: Results From a National Survey.

GOALS: To determine whether gastroenterologists would be willing to accept the "predict, resect, and discard" strategy for diminutive colorectal polyps and identify potential barriers to implementation in clinical practice. BACKGROUND: The ASGE recently published a Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document on managing diminutive colorectal polyps using the "predict, resect, and discard" strategy. However, there is no data on whether gastroenterologists would accept this paradigm shift. STUDY: We performed a random survey of gastroenterologists at a national meeting. Awareness of and willingness to adopt the "predict, resect, and discard" practice, reasons for not utilizing it, and whether a financial incentive would be persuasive in implementing the practice were assessed. RESULTS: A total of 105 gastroenterologists were surveyed. Seventy-six (72%) were aware of the PIVI statement and 64 (61%) stated they would be willing to implement this in practice. Medical-legal concerns (85%) and lack of financial incentives (32%) were the 2 most commonly cited barriers to implementation. Greater than 50% of those resistant to performing the service would be willing do so if given a financial incentive, with ∼50% of gastroenterologists who cited an appropriate incentive preferring >$75 to do so. Of these, private practice gastroenterologists and those who had financial interest in sending polyps to pathology were the most likely to request this amount. CONCLUSIONS: Approximately two-thirds of gastroenterologists are willing to adopt the "predict, resect, and discard" strategy for managing diminutive colon polyps. Medical-legal concerns and lack of financial incentives are the primary barriers to implementation.

Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy: Case report.

BACKGROUND: Intravesical instillation of Bacillus Calmette-Guérin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications. CASE PRESENTATION: We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement. CONCLUSIONS: This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.