A Descriptive Study on the Population of Patients with Inflammatory Bowel Disease at the Veterans Affairs Caribbean Healthcare System in San Juan.

OBJECTIVE: Inflammatory bowel disease (IBD) comprises a group of related conditions characterized by idiopathic inflammation of the gastrointestinal (GI) tract. Several studies have described the epidemiology of IBD in Puerto Rico (PR) but none have included the US military and Veteran population. The goal of this study was to describe the prevalence of IBD in this population as well as to describe patients' characteristics. METHODS: We conducted a retrospective analysis of 163 patients using data gathered from electronic medical records of Veterans who received care at the VA Caribbean Healthcare System (VACHS) and the diagnosis of IBD between October 1, 2010 and September 30, 2015. The prevalence out of 100,000 in our study was calculated for each Fiscal Year. RESULTS: Overall, the prevalence of IBD markedly increased among VA patients. Among 163 patients who met inclusion criteria, 7 (4.3%) patients had a diagnosis of undetermined IBD, 45 (27.6%) had Crohn's disease (CD) and 111 (68.0%) had ulcerative colitis (UC). This information was used to compare the epidemiologic data of IBD in the population receiving care at the VACHS with the epidemiologic data of IBD in the general population in PR. CONCLUSION: This is the first study to describe the prevalence of IBD and to describe additional characteristics of patients with IBD receiving care at the VACHS.

Small Bowel Bleeding: A Challenging Diagnosis.

The small intestine is an uncommon site for acute gastrointestinal (GI) bleeding. However, it is responsible for most cases in which the etiology of bleeding is not identified through endoscopy or colonoscopy. Despite great advances in technology, small bowel bleeding (SBB) is often a challenging diagnosis, requiring multiple blood transfusions, diagnostic procedures, and re-admissions. Consequently, it increases comorbidities, complications, and costs to the health care system. The presentation of SBB is diverse, and the etiology is dependent on the patient's age. It may require aggressive resuscitation and immediate bleeding-site localization for proper and successful care. The management is based on the etiology, the available technology, and physician expertise. We present a case of SBB in which multiple imaging and endoscopic procedures were required to identify the culprit lesion. Additionally, we review the most common etiologies, radiologic modalities, and endoscopic procedures available.

The Perils of Diagnosing and Treating Overlap Syndrome.

Autoimmune hepatitis (AIH) may present with clinical, laboratory abnormalities and histological features suggestive of primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). These variants of AIH are known as overlap syndromes. We present a case of a 62 year-old-male who presented with altered liver function tests, anemia and unintentional weight loss. Initial laboratories revealed anemia and a cholestatic pattern. Diagnostic work-up was remarkable for a positive antinuclear antibodies (ANA) test and a liver biopsy suggestive of an AIH-PBC overlap syndrome. This case illustrates the complexity of establishing the diagnosis and effective therapy in this condition.