Appropriateness of fecal immunochemical testing utilization for colorectal cancer screening at an academic center.

Fecal immunochemical testing (FIT) has become the most utilized test for colorectal cancer (CRC) screening. This retrospective quality assurance report analyzed data for 411 patients from one academic center in Central New York who underwent FIT between September 2015 and September 2016. All 67 positive tests and 344 of 952 negative tests were analyzed. Subjects from the FIT-negative "control group" were chosen at random. The mean age was 67 years and the male/female distribution was 391/20, with differences between the FIT-positive and -negative groups. FIT was inappropriately used in 210 (51%) of the 411 patients. The most common reasons for inappropriate FIT use were a documented refusal of colonoscopy (39.60% of inappropriate use), FIT occurring within the recommended surveillance interval from previous colonoscopy (27.98%), and a Charlson Co-Morbidity Index score ≥5 (22.87%). Other reasons were a history of adenoma (9.25%), family history of CRC/high-risk adenoma <60 years of age (5.84%), active/overt gastrointestinal bleed (4.87%), history of CRC (1.46%), and history of inflammatory bowel disease (1.46%). The results of this study show that FIT is being utilized inappropriately about 50% of the time.

Primary Diffuse Large B-Cell Lymphoma of the Descending Colon.

Primary non-Hodgkin lymphoma of the gastrointestinal tract is rare with an incidence of 10-15% of all non-Hodgkin lymphoma cases and 1-4% of all gastrointestinal tumors. The most common sites of involvement include the stomach, small intestines, colon and rectum. Primary colorectal lymphoma is extremely rare representing only 0.2-0.6% of all colorectal malignancies. The presentation is usually non-specific leading to delay in diagnosis. Imaging is used to locate the tumor and its extension. Colonoscopy usually shows a fungating mass, infiltrative or ulcerative lesion. Diffuse large B-cell lymphoma is the most common histological subtype. Management of diffuse large B-cell lymphoma usually involves chemotherapy, radiation, surgery or a combination approach.

Effects of obesity on the course of inflammatory bowel disease.

Obesity is increasingly common among patients with inflammatory bowel disease (IBD). The interplay between proinflammatory states of obesity and the course of IBD is yet to be elucidated. We conducted a retrospective study of 55 patients with IBD over the course of 5 years (2012 to 2017). We documented various clinical outcomes (mean number of clinic visits, hospitalizations/flares, procedures, and escalations in therapy) based on three initial weight groups: normal weight, overweight, and obese. There was an increasing trend in all clinical outcomes with increasing weight and a statistically significant difference in mean clinic visits (P = 0.048) and mean hospitalizations/flares (P = 0.004) when comparing normal-weight to obese individuals. Our study suggests that obesity influences burden of disease and treatment in IBD. This should encourage clinicians to treat obesity in IBD patients as an active problem because it may help improve clinical outcomes.