A Curious Case of Vanishing Hepatocellular Carcinoma (HCC).

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. Spontaneous regression of HCC is rare with few documented cases in literature. The mechanism of this phenomenon is unknown, but tumor hypoxia and systemic inflammatory response have been suggested as possible etiologies. This article aims to shed more light on this rare phenomenon and provides an opportunity to review the proposed pathophysiology of spontaneous HCC regression. In this case report, we describe an interesting case of a 39-year-old male with HCC who underwent spontaneous regression.

Hospitalization Trends and Outcomes of Eosinophilic Esophagitis in the United States: A Decade-Long Nationwide Analysis.

Background Eosinophilic esophagitis (EoE) is a chronic antigen-mediated esophageal disease characterized by infiltration of the esophageal mucosa by eosinophils. The prevalence of EoE continues to rise worldwide. However, certain aspects of the epidemiology and pathogenesis remain unclear. Methods This study examined the hospitalization trends of EoE using an extensive inpatient database in the United States, the National (Nationwide) Inpatient Sample (NIS), to identify hospitalizations between 2010 and 2019. We assessed patient demographics as well as hospital-specific variables using the NIS. We obtained the prevalence rate of EoE for each year and used joinpoint regression analysis to obtain trends after adjusting the rate for age and gender. We also sought to characterize the outcomes of these hospitalizations by obtaining the mortality rate, length of stay (LOS), and total hospital charges (THC). Results Of 305 million hospitalizations included in the study, 33,878 were for EoE. The prevalence rate per 100,000 hospitalizations of EoE increased from 6.6 in 2010 to 15.5 in 2019. The annual percentage change obtained from the joinpoint regression analysis was 13.3% from 2010 to 2014 and 7.2% from 2014 to 2019. Most of the hospitalizations were among the male gender and young adults. Almost 95% of hospitalizations across the study period were seen in urban hospitals. We did not notice any significant trend in the mortality rates or length of stay over the study period. The THC increased significantly across the study period. Conclusion There has been an upward trend in the average prevalence rate of EoE over the decade from 2010 to 2019 which almost parallels that of inflammatory bowel disease. This represents a significant burden of disease for a condition that was initially recognized in the late 20th century.

Independent Predictors and Causes of Thirty-Day Gastrointestinal Readmissions Following COVID-19-Related Hospitalizations: Analysis of the National Readmission Database.

Background: The coronavirus disease 2019 (COVID-19) pandemic led to significant mortality and morbidity in the United States. The burden of COVID-19 was not limited to the respiratory tract alone but had significant extrapulmonary manifestations. We decided to examine the causes, predictors, and outcomes of gastrointestinal (GI)-related causes of 30-day readmission following index COVID-19 hospitalization. Methods: We used the National Readmission Database (NRD) from 2020 to identify hospitalizations among adults with principal diagnosis of COVID-19. We identified GI-related hospitalizations within 30 days of index admission after excluding elective and traumatic admissions. We identified the top causes of GI-related readmission, and the outcomes of these hospitalizations. We used a multivariate Cox regression analysis to identify the independent predictors of readmission. Results: Among 1,024,492 index hospitalizations with a primary diagnosis of COVID-19 in the 2020 NRD database, 644,903 were included in the 30-day readmission study. Of these 3,276 (0.5%) were readmitted in 30 days due to primary GI causes. The top five causes of readmissions we identified in this study were GI bleeding, intestinal obstruction, acute diverticulitis, acute pancreatitis, and acute cholecystitis. Multivariate Cox regression analysis done adjusting for confounders showed that renal failure, alcohol abuse, and peptic ulcer disease were associated with increased odds of 30-day readmission from GI-related causes. Conclusions: GI manifestations of COVID-19 are not uncommon and remain an important cause of readmission. Targeted interventions addressing the modifiable predictors of readmission identified will be beneficial in reducing the burden on already limited healthcare resources.

Trends and Disparities in Colonic Diverticular Disease Hospitalizations in Patients With Morbid Obesity: A Decade-Long Joinpoint Analysis.

Objective We aimed to describe epidemiologic trends in outcomes of colonic diverticular disease (CDD) hospitalizations in morbidly obese patients. Methods We searched the United States National Inpatient Sample databases from 2010 through 2019, obtained the incidence rate of morbid obesity (MO) among CDD hospitalizations, and used Joinpoint analysis to obtain trends in these rates adjusted for age and sex. Hospitalizations involving patients less than 18 years of age were excluded. Trends in mortality rate, mean length of hospital stay (LOS), and mean total hospital charge were analyzed. Multivariate regression analysis was used to obtain trends in adjusted mortality, mean LOS, and mean total hospital charge. Results We found an average annual percent change of 7.5% (CI = 5.5-9.4%, p < 0.01) in the adjusted incidence of MO among hospitalizations for CDD over the study period. We noted a 7.2% decline in mortality (p = 0.011) and a 0.1 days reduction in adjusted LOS (p < 0.001) over the study period. Hospitalizations among the middle-aged and elderly had adjusted odds ratios of 7.18 (95% CI = 2.2-23.3, p = 0.001) and 24.8 (95% CI = 7.9-77.9, p < 0.001), respectively, for mortality compared to those in young adults. The mean LOS was 0.29 days higher in females compared to males (p < 0.001). Conclusion The incidence of MO increased among CDD hospitalizations while mortality and mean LOS reduced over the study period. Outcomes were worse in older patients, with an increased mean LOS in females compared to males.

Effect of the COVID-19 pandemic on the epidemiological trends and outcomes of gastrointestinal bleeding: a nationwide study.

The COVID-19 pandemic altered healthcare delivery in the United States. This study examined the effect of the COVID-19 pandemic on the epidemiological trends and outcomes of gastrointestinal bleeding. We compared the admission rate, in-hospital mortality rate, and mean length of hospital stay between 2019 and 2020 to estimate the pandemic effect. The study highlighted disparities in outcomes of gastrointestinal bleeding hospitalizations stratified by sex and race. We noted a 9.5% reduction in the total number of hospitalizations in 2020. We also observed a 13% increase in overall mortality during the pandemic (P < 0.001). There was a 15.8% increase in mortality among men (P = 0.007), compared to a 4.7% increase among women (P = 0.059). There was a significant increase in mortality among Whites in 2020 compared to Black and Hispanic populations. On multivariable logistic regression, admission during the COVID-19 pandemic was associated with increased length of stay when adjusted for age, sex, and race. Despite the direct COVID-19-related morbidity and mortality, the so-called indirect effect of the pandemic cannot be overlooked. For the remainder of the pandemic and future health emergencies, it is critical to balance mitigation of the spread of the contagion with clear public health messages to not neglect other life-threatening emergencies.

Epstein-Barr Virus-Positive Lymphoepithelioma-Like Carcinoma in Celiac Disease.

Lymphoepithelioma-like carcinoma (LELC) is a rare lymphoproliferative malignancy that has been described in many organs over the years. LELC in the duodenum has rarely been described in literature. This article aims to present a rare cause of melena in a young man and the diagnostic challenge that ensued to throw more light on this rare disease. In this article, we describe a 43-year-old man who presented with melena and weight loss and was subsequently diagnosed with LELC after multiple endoscopic biopsies. The patient was also found to have celiac disease in association with his LELC.

Different Approaches to the Management of Cholecystoenteric Fistula.

A cholecystoenteric fistula is an anomalous communicating tract between the gallbladder and any segment of the gastrointestinal tract. It is a rare complication of gallstone disease and typically affects elderly patients with multiple medical comorbidities. These fistulae can present in a variety of ways, and the diagnosis is often made only after extensive workup. Despite notable advances in imaging techniques in the last half-century, a considerable number of cases are still discovered incidentally during open or laparoscopic surgery. We present a series of 3 cases, each with different etiologies and presentations, but all of whom were found to have a cholecystoenteric fistula. Each case was managed differently, highlighting the diversity of this intriguing condition.

Trends and Disparities in Outcomes of Clostridioides difficile Infection Hospitalizations in the United States: A Ten-Year Joinpoint Trend Analysis.

Background: Clostridioides difficile infection (CDI) is the most frequently reported nosocomial infection. This study aimed to describe epidemiological trends, sex, race, and economic disparities in clinical and mortality outcomes among CDI hospitalizations over a decade. Methods: We queried Nationwide Inpatient Sample databases from 2010 to 2019, identified hospitalizations with CDI, and obtained the incidence and admission rate of CDI per 100,000 adult hospitalizations each year. We analyzed trends in mortality rate, mean length of hospital stay (LOS), and mean total hospital charge (THC). We highlighted disparities in outcomes stratified by sex, race, and mean household income quartile. Results: Of the 305 million hospitalizations included in our study, over 3.3 million were complicated by CDI, with 1.01 million principal admissions for CDI. Among primary admissions for CDI, the mortality rate decreased from 3.2% in 2010 to 1.4% in 2019. Mean LOS reduced from 6.6 to 5.3 days while mean THC increased from US$40,593 to US$42,934 between 2010 and 2019. Females had a 21% decrease in adjusted odds of mortality compared to males (all P-trends < 0.001). Middle-aged and elderly patients had aOR of 4.96 and 14.74 respectively for mortality when compared to young adults (P < 0.001). Mortality rates showed a steady decline among Whites over the study period. Mean LOS trends were similar across racial subgroups. Conclusions: Outcomes of CDI hospitalizations improved over the studied decade. Older age, male sex, and being from a minority racial group were associated with worse clinical and mortality outcomes. Further studies are needed to elucidate the reasons for these findings.

Rates, Reasons, and Independent Predictors of Readmissions in Portal Venous Thrombosis Hospitalizations in the USA.

Background: Portal vein thrombosis (PVT), generally considered rare, is becoming increasingly recognized with advanced imaging. Limited data exist regarding readmissions in PVT and its burden on the overall healthcare cost. This study aimed to outline the burden of PVT readmissions and identify the modifiable predictors of readmissions. Methods: The National Readmission Database (NRD) was used to identify PVT admissions from 2016 to 2019. Using the patient demographic and hospital-specific variables within the NRD, we grouped patient encounters into two cohorts, 30- and 90-day readmission cohorts. We assessed comorbidities using the validated Elixhauser comorbidity index. We obtained inpatient mortality rates, mean length of hospital stay (LOS), total hospital cost (THC), and causes of readmissions in both 30- and 90-day readmission cohorts. Using a multivariate Cox regression analysis, we identified the independent predictors of 30-day readmissions. Results: We identified 17,971 unique index hospitalizations, of which 2,971 (16.5%) were readmitted within 30 days. The top five causes of readmissions in both 30-day and 90-day readmission cohorts were PVT, sepsis, hepatocellular cancer, liver failure, and alcoholic liver cirrhosis. The following independent predictors of 30-day readmission were identified: discharge against medical advice (AMA) (adjusted hazard ratio (aHR) 1.86; P = 0.002); renal failure (aHR 1.44, P = 0.014), metastatic cancer (aHR 1.31, P = 0.016), fluid and electrolyte disorders (aHR 1.20, P = 0.004), diabetes mellitus (aHR 1.31, P = 0.001) and alcohol abuse (aHR 1.31, P ≤ 0.001). Conclusion: The readmission rate identified in this study was higher than the national average and targeted interventions addressing these factors may help reduce the overall health care costs.

Plasmapheresis in hypertriglyceridemia-induced acute pancreatitis.

The study involved hospitalizations with a diagnosis of hypertriglyceridemia-induced acute pancreatitis (HTGAP). This cohort was grouped into plasmapheresis and nonplasmapheresis groups using ICD-10 codes (6A550Z3 and 6A551Z3). Information was obtained on inpatient mortality, length of stay, total hospital charges, as well as the occurrence of comorbid systemic immune response syndrome, sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, kidney failure, hypocalcemia, and need for transfusion of blood products. The study identified independent predictors of plasmapheresis. The plasmapheresis group had a higher proportion of patients with diabetes mellitus and obesity. Inpatient mortality was higher in the plasmapheresis group (0.86% vs 0.57%), and plasmapheresis was also associated with longer length of stay and higher total hospital charges. Overall, plasmapheresis was associated with higher proportions of inpatient complications. Patients with HTGAP had higher odds of undergoing plasmapheresis if they were in an urban location (adjusted odds ratio [aOR] 6.14, 95% confidence Interval [CI] 1.86-20.28, P = 0.003), larger hospital (aOR 3.37, 95% CI 2.14-5.29, P < 0.001), and teaching hospital (aOR 2.01, 95% CI 1.39-2.92, P < 0.001). Black patients were less likely to undergo plasmapheresis than white patients (aOR 0.42, 95% CI 0.23-0.78, P = 0.006). Patients with HTGAP who receive plasmapheresis may be at higher risk of numerous in-hospital complications, including death, compared to those who do not receive plasmapheresis. Black and older patients were less likely to undergo plasmapheresis.