Esophageal intramural pseudodiverticulosis, a rare cause of food impaction: case report and review of the literature.

Esophageal intramural pseudodiverticulosis (EIPD) is a rare, benign condition of uncertain etiology and pathogenesis, which usually presents with either progressive or intermittent dysphagia. Acute presentation with food impaction, requiring emergency esophago-gastroduodenoscopy (EGD), is rare. We report a case of EIPD presenting as food bolus impaction in an elderly black female. The patient had no previous history of dysphagia or odynophagia. Currently accepted risk factors, such as diabetes mellitus, chronic alcoholism, and reflux esophagitis, were not present in our patient. Emergency EGD established the diagnosis and also dislodged the food bolus. Histopathological evaluation of the mucosa diagnosed co-existent acute candidal infection. Medical treatment with proton pump inhibitor and azole antifungal led to resolution of her symptoms. Review of the literature revealed that stenosis, strictures, perforation, gastro-intestinal bleed, and fistula formation are potential complications of EIPD. Multiple motility abnormalities have been described but are not consistent. Treatment of the underlying inflammatory and or infectious condition is the mainstay of management of this unusual condition.

Early improvement in albuminuria in non-diabetic patients after Roux-en-Y bariatric surgery.

BACKGROUND: Obesity is a growing epidemic in the USA that has been shown to be associated with chronic kidney disease and albuminuria. Bariatric surgery is an effective means of achieving long-term weight loss and improvements in metabolic derangements including albumin excretion over the long term. METHODS: We report changes in urinary albumin excretion levels in the early post-operative period for a euglycemic, predominantly Hispanic American cohort undergoing Roux-en-Y gastric bypass surgery. RESULTS: Our cohort of 38 patients was largely female (89.5%) and predominantly Hispanic (76.3%) with a mean BMI of 46 ± 8.0 kg/m(2). Over half (53.3%) of the patients with significant preoperative albumin excretion in our cohort lowered their albumin excretion levels to <20 mg/g of creatinine. This early reduction in albumin excretion in our cohort correlated significantly with the level of albumin excretion preoperatively but not with the degree of weight loss experienced in this early post-operative period. CONCLUSIONS: Improvements in microalbuminuria in the early post-operative period after Roux-en-Y surgery may result from an interplay between changes in gastrointestinal hormones, insulin sensitivity, blood pressure, and adipose tissue-and needs further study.