Fecal microbiota transplantation in recurrent Clostridium difficile infection: A retrospective single-center chart review.

BACKGROUND AND AIM: Fecal microbiota transplantation (FMT) has been proposed as a treatment option for patients with recurrent Clostridium difficile (C. difficile) infection but remains a novel option. We examined if FMT is an effective means of treating recurrent C. difficile infection. METHODS: A retrospective review of 35 patients who underwent FMT was completed. Demographics and other variables, including the use of proton pump inhibitor therapy and history of inflammatory bowel disease, were collected. RESULTS: Twenty-five patients (71.4%) belonged to a high-risk population (working in a hospital setting, rehabilitation center, or nursing facility) and a total of 74.3% of patients (n = 26 patients) had no history of proton pump inhibitor use. Twenty-five patients (71.4%) had used metronidazole prior to transplantation, 35 patients (100%) had used vancomycin, and 7 patients (20%) had used fidaxomicin for prior infection. Four patients (11.4%) had used all three antibiotics during prior treatment. Of the eight patients who had a history of inflammatory bowel disease, six (75%) experienced resolution of symptoms after transplantation. A total of 30 patients (85.7%) had resolution of their symptoms 6-8 weeks' posttransplant, while 5 patients (14.3%) continued to have symptoms. CONCLUSIONS: Our retrospective chart review supports that patients benefit from FMT in the setting of recurrent C. difficile infection.

An Unusual Presentation of Spigelian Hernia Incarceration after Colonoscopy.

Spigelian hernias are uncommon and predominantly affect the abdominal wall.The incidence of Spigelian hernias after colonoscopy is even rarer with only one case outlined in the surgical literature. This is the case of a 66-year-old man who underwent routine colonoscopy and presented to the hospital with systemic inflammatory response syndrome (SIRS). A computed tomography (CT) scan demonstrated a Spigelian hernia in the location of a prior left ventricular assist device (LVAD) placement. This required surgical resection and resulted in a complicated post-operative course. This case offers a unique perspective on a rare colonoscopic complication not well represented in the literature. It offers the learning point of remaining vigilant for a rare, but potentially deadly, colonoscopic outcome. This case also illustrates the decision-making heuristic of availability bias.

Long-Term Follow-Up of Fecal Microbiota Transplantation for Treatment of Recurrent Clostridium difficile Infection in a Dual Solid Organ Transplant Recipient.

Clostridium difficile infection is one of the most frequent causes of healthcare-associated infections, and its rates are also increasing in the community. Mounting evidence suggests that fecal microbiota transplantation (FMT) may be effective; however, as there is paucity of data regarding the use of FMT in patients with solid organ transplants, we present a case of successful FMT in a patient with dual solid organ transplant.

Mantle cell lymphoma: a rare cause of a solitary duodenal mass.

Mantle cell lymphoma is a very aggressive lymphoma with a very poor prognosis. It commonly involves the gastrointestinal tract but rarely presents as primary gastrointestinal lymphoma. The most notable cases of primary gastrointestinal mantle cell lymphomas have been described as multiple lymphomatous polyposis and have a very poor prognosis. We report a case of primary gastrointestinal mantle cell lymphoma that was discovered by endoscopic biopsy of a single duodenal polyp in a 70-year-old woman who was previously treated for Helicobacter pylori gastritis. She presented with a 6-month history of indigestion, heartburn and abdominal bloating. A subsequent workup revealed one extranodal site of involvement, lymphatic involvement below the diaphragm and a normal bone marrow biopsy. We followed a wait-and-watch approach including serial CT scans and blood tests. Two years later, her symptoms have not progressed and her disease has remained stable.

Schatzki ring and Barrett's esophagus: do they occur together?

Our purpose was to determine the prevalence of Barrett's esophagus in the presence of Schatzki ring. We performed a retrospective case-control study with an endoscopic database. Barrett's esophagus was present in 3 of 409 (0.73%) patients with Schatzki ring and in 16 of 888 (1.80%) patients without Schatzki ring. Short segment Barrett's esophagus was present in 3 cases and 10 controls. Long segment Barrett's esophagus was present in no cases and six controls. Logistic regression models adjusting for the presence of a hiatal hernia revealed a significant decrease in the odds of Barrett's esophagus in cases compared to controls (OR, 0.24; 95% CI, 0.07-0.87; P = 0.029). Barrett's esophagus is less prevalent in patients with Schatzki ring compared to patients without Schatzki ring. Long segment Barrett's esophagus was not observed in patients with Schatzki ring. A responsible protective effect or mutually exclusive pathophysiology should be considered.