The American Journal of Gastroenterology最新文献

{"title":"S3257 Aggressive Metastatic Intrahepatic Cholangiocarcinoma in a Young Patient","authors":"Lay She Ng, Sagar Patel, Aladdin Dahbour","doi":"10.14309/01.ajg.0001140488.13193.67","DOIUrl":"https://doi.org/10.14309/01.ajg.0001140488.13193.67","url":null,"abstract":"Introduction: Cholangiocarcinoma is a rare and aggressive malignancy of biliary tree, with its incidence, particularly of intrahepatic cholangiocarcinoma, rising in the United States. This case highlights diagnostic challenges in a young patient with metastatic intrahepatic cholangiocarcinoma. Case Description/Methods: A 40-year-old African American woman with a history of recurrent hidradenitis suppurativa presented with right-sided abdominal and flank pain, nausea, 100 lb unintentional weight loss, and oligomenorrhea over 2 years. No malignancy workup was done until worsening symptoms led to hospital admission. Computed tomography Abdomen/Pelvis revealed hepatomegaly with innumerable hepatic masses, multiple pulmonary nodules and bilateral inguinal lymph nodes. Liver biopsy revealed malignant glandular cells forming infiltrative nests and glands, positive for CK7 and CDX-2, and negative for CK20, GATA-3, TTF-1, p40, and HepPar-1. Despite treatments including cisplatin/gemcitabine/durvalumab, pemigatinib, and FOLFOX, the disease further progressed with spinal, sternal, pulmonary, hepatic, and soft tissue metastases. Discussion: Cholangiocarcinoma typically presents between ages 60–70, but increasing cases in younger individuals demand attention. This patient, diagnosed at age 37 with no identifiable risk factors, exemplifies the need to consider malignancy in patients with persistent weight loss and systemic symptoms. Her delayed diagnosis highlights the importance of maintaining a high index of suspicion and addressing potential barriers to timely care. The advanced stage at diagnosis in this patient raises questions about potential factors contributing to the delay. While specific causes are uncertain, studies suggest that socioeconomic status and racial disparities can play a role in delayed diagnosis and access to guideline-recommended diagnostic procedures. These factors underscore the need for improved healthcare access and early detection strategies, particularly for younger patients who may face barriers to timely and comprehensive cancer care. This case highlights the critical need for heightened awareness, improved early detection strategies, and equitable healthcare access for young patients presenting with persistent symptoms, as cholangiocarcinoma increasingly affects younger individuals with often advanced disease at diagnosis and poorer outcomes, despite the lack of identifiable risk factors.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S701-S701"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147887306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S3253 Incidental Finding of Solid Pseudopapillary Neoplasm (SPN) Following a Motor Vehicle Accident: A Case Study","authors":"Umang Makhijani, Ganesh Ramaprasad, Chetan Pai","doi":"10.14309/01.ajg.0001140472.69963.4a","DOIUrl":"https://doi.org/10.14309/01.ajg.0001140472.69963.4a","url":null,"abstract":"Introduction: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare, low-grade malignant tumor predominantly affecting non-White women in their 30s–40s. It features pseudopapillary structures and is often found incidentally. While generally indolent with excellent prognosis after resection, SPN can show local invasion or metastasis. We report an 18-year-old African American woman diagnosed with SPN after a motor vehicle accident, highlighting its underreported incidence in the United States and importance in differential diagnoses. Case Description/Methods: An 18-year-old African American woman with no significant medical history presented after a high-speed motor vehicle accident, reporting cervical tenderness. Initial trauma evaluation and FAST ultrasound were unremarkable. However, a pan-scan, including contrast-enhanced abdominal computed tomography revealed a 1.4 cm low-attenuating mass in the pancreatic head. Eight months later, esophagogastroduodenoscopy with endoscopic ultrasound (EUS) identified a 2.0 × 2.9 cm oval mass in the uncinate process without local invasion. Fine-needle aspiration confirmed a low-grade neoplasm consistent with SPN. Immunohistochemistry was positive for β-catenin. The patient is currently awaiting surgical consultation. Discussion: SPN is classified by the World Health Organization as a low-grade malignant pancreatic tumor primarily affecting young non-White women. It accounts for 0.2%–2.7% of all pancreatic neoplasms. Though 5 times more common in women, SPN may follow a more aggressive course in men. Most SPNs are discovered incidentally—such as during trauma work-ups. Symptoms may include abdominal pain, nausea, palpable mass, or jaundice. Diagnosis often involves endoscopic ultrasound-guided fine needle aspiration. Histologic features include pseudopapillary structures with fibrovascular cores, nuclear grooves, and eosinophilic cytoplasmic globules. A key molecular feature is mutation of the CTNNB1 gene, causing nuclear β-catenin accumulation—confirmable by immunohistochemistry and essential for distinguishing SPN from other pancreatic tumors. Surgical resection is the preferred treatment, achieving 5-year survival rates above 90%. Around 15% of cases may exhibit high-grade features, including vascular invasion or liver metastases. In such cases, targeted therapies show promise, though more research is needed. As imaging becomes more prevalent, SPN incidence may rise. This case highlights the need for awareness, particularly among underrepresented groups such as African American women in the United States.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S700-S701"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147902760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S278 The Incidence of Exocrine Pancreatic Insufficiency Following an Index Episode of Acute Necrotizing Pancreatitis: A Propensity-Matched Analysis of United States Collaborative Network Data","authors":"Ujwala Pamidimukkala, Vikram Ram Rajagopalan, Azizullah Beran, Mina Batarseh, Hussein Baydoun, Awais Ahmed, Nasir Saleem, Daryl Ramai, Mohannad Yousef, Aladdin Dahbour, Indira Bhavsar-Burke, Mohammad Al‐Haddad, Itegbemie Obaitan","doi":"10.14309/01.ajg.0001128572.37935.7d","DOIUrl":"https://doi.org/10.14309/01.ajg.0001128572.37935.7d","url":null,"abstract":"Introduction: Acute necrotizing pancreatitis (ANP), a severe form of acute pancreatitis, can lead to long-term metabolic complications including exocrine pancreatic insufficiency (EPI), which may cause weight loss, steatorrhea, and associated conditions such as anemia and osteoporosis which arise as a consequence of malabsorption. The incidence of EPI after acute pancreatitis has been previously described in small single- and multi-center cohort studies; however, the comparative long-term incidence of EPI in ANP and acute interstitial pancreatitis patients using real-world nationally representative data has not been previously quantified. Methods: We searched the United States Collaborative Network on the platform TriNetX from inception to May 23, 2025 using International Classification of Diseases, Tenth Revision (ICD-10) codes appropriate to ANP and acute interstitial pancreatitis. We identified all patients with a documented fecal elastase value less than 200 ug/L placed on pancreatic enzymes supplementation during a 12-month follow-up period. One-to-one propensity score matching was carried out based on demographic variables and all comorbidities associated with malabsorption. The primary outcome (EPI) was calculated and expressed as an odds ratio along with a 95% CI. Statistical significance was defined as a 2-sided P-value < 0.05. Results: Our database search found 148,135 patients with a diagnosis of acute pancreatitis and EPI in the follow-up window. After propensity-score matching was carried out, 17,176 patients were included into our study (8,588 patients in each cohort). We found an EPI incidence of 8.7% in the ANP cohort over the follow-up period, compared to an EPI incidence of 2.2% in the acute interstitial pancreatitis cohort. There were increased odds of EPI in patients with an index episode of ANP compared to patients with acute interstitial pancreatitis (odds ratio 4.2, 95% CI 3.595, 4.991, P = 0.000). Conclusion: There are significantly higher odds of developing EPI in patients with ANP over a 12-month period compared to patients with acute interstitial pancreatitis. Our findings highlight the importance of careful long-term monitoring for EPI to prevent downstream malabsorption-related complications in this patient population. Prospective studies are needed to validate our findings.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S59-S59"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147902879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S3256 Biliary Strongyloidiasis Presenting With an Ampullary Lesion on Magnetic Resonance Imaging","authors":"Ronan Allencherril, Mary R. Schwartz, Thomas R. McCarty","doi":"10.14309/01.ajg.0001140484.48540.06","DOIUrl":"https://doi.org/10.14309/01.ajg.0001140484.48540.06","url":null,"abstract":"Introduction: Strongyloides stercoralis is an intestinal parasite found globally that infrequently presents with disseminated disease in immunocompetent patients. Infections are often confined to the intestinal lumen, with rare involvement of the biliary tract. We present a case of biliary strongyloidiasis presenting with ampullary thickening on imaging. Case Description/Methods: An 84-year-old gentleman with a history of obstructive sleep apnea, cholelithiasis status-post cholecystectomy, and pancreas cysts presented due to an abnormal magnetic resonance cholangiopancreatography (MRCP). He reported chronic epigastric pain refractory to proton pump inhibitor (PPI) and a 70 lb weight loss over the past 2 years. He was hospitalized for epigastric pain and found to have worsening intrahepatic biliary dilation and a possible lesion of the ampulla. Labs showed normal liver chemistries and a peripheral eosinophilia. MRCP showed a double duct sign with ampullary thickening and stable pancreatic head cysts. The decision was made to proceed with endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Upper endoscopy showed congested periampullary mucosa. EUS revealed atrophy and hyperechoic strands of the pancreas with mildly dilated pancreatic duct and a 20 mm septated cystic lesion in the pancreatic head which was sampled by fine needle aspiration (FNA). On EUS, the common bile duct was 12 mm with mild narrowing at the lower third of the common bile duct with an abrupt tapering at the distal main duct. There was wall thickening of the ampulla on EUS. On ERCP, the lower third of the main bile duct contained a mild stenosis with upstream dilation. Sphincterotomy and balloon sweep were performed with removal of sludge. Brushings were sent for cytology and 1 plastic stent was placed in the common bile duct. Cytology returned with larvae compatible with S. stercoralis and the patient was treated with ivermectin. Stool ova and parasite testing also showed S.stercoralis. FNA cytology confirmed intraductal papillary mucinous neoplasm and the biliary stent was removed on subsequent ERCP. After treatment with ivermectin, his abdominal pain resolved and he was discharged with no further concerns. Discussion: This case shows a unique presentation of biliary Strongyloides in an immunocompetent patient without environmental risk factors. The case enforces the importance of sampling indeterminate biliary strictures as well as differential for peripheral eosinophilia.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S701-S701"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147905839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S3254 Metastatic Melanoma in the Pancreas Head: A Case Report","authors":"Umang Makhijani, Ganesh Ramaprasad, Anwar Dudekula","doi":"10.14309/01.ajg.0001140476.76684.ba","DOIUrl":"https://doi.org/10.14309/01.ajg.0001140476.76684.ba","url":null,"abstract":"Introduction: Pancreatic adenocarcinoma is the most common primary pancreatic tumor; however, 2%–5% of pancreatic malignancies represent metastases, typically from the kidney, breast, lung, colon, with rarer origins including sarcomas or melanomas. Metastatic melanoma involving the pancreas is rare and diagnostically challenging due to nonspecific symptoms. We present a case of metastatic melanoma manifesting as a pancreatic head mass, highlighting the diagnostic process, management, and clinical course. Case Description/Methods: A 53-year-old man with metastatic melanoma to the lungs and kidney had been under oncology follow-up. His melanoma was diagnosed via kidney biopsy 1 year earlier, with no identifiable cutaneous primary. He underwent resection of left upper lobe lung mass confirming metastatic melanoma and received combination chemo and immunotherapy. He presented with pain, nausea, vomiting, and acute-on-chronic anemia. Lab work showed elevated liver enzymes and common bile duct (CBD) obstruction. Imaging Studies: A PET scan performed 1 week before admission showed a new hypermetabolic mass in the posterior pancreatic head. Computed tomography abdomen confirmed the pancreatic head mass with biliary obstruction. Biopsy and Histopathology: Endoscopic ultrasound-guided fine needle aspiration (FNA) of the mass revealed spindle and dyscohesive epithelioid cells with coarse brown pigment, consistent with metastatic melanoma. Endoscopic retrograde cholangiopancreatography (ERCP) identified a segmental biliary stricture; a sphincterotomy, papilla dilation, and temporary covered metal stent placement were performed. Discussion: Pancreatic metastases often present with nonspecific symptoms such as abdominal pain, jaundice, and weight loss. Imaging is crucial, with computed tomography and magnetic resonance imaging delineating tumor extent and Endoscopic ultrasound-FNA providing definitive diagnosis. Melanoma should be considered in patients with a suggestive history and pancreatic lesions. Treatment/Prognosis: Surgical resection was not feasible due to tumor location. Patient was restarted on combination immunotherapy (Opdualag), but follow-up PET showed no response. Advanced endoscopy revealed a jejunal melanoma lesion. Radiotherapy (25 Gy in 5 fractions) was delivered to pancreatic mass, and follow-up imaging showed treatment response. Conclusion: This case highlights the need to consider pancreatic metastasis in melanoma patients with new abdominal symptoms. While treatment options include immunotherapy, radiotherapy, and surgery, prognosis remains poor, with median survival of 6–12 months. Early recognition and histologic confirmation are vital for guiding management.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S701-S701"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147912780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S282 A Global Database Study on the Correlation Between Statin Use and the Incidence of Acute and Severe Acute Pancreatitis in Overweight and Obese Patients","authors":"Patricia Rojas, Andrew Ofosu, Moamen Gabr, Rosanne Danielson, Milton T. Smith, Inuk Zandvakili, Wei-Wen Hsu, Luis F. Lara","doi":"10.14309/01.ajg.0001128588.34437.d4","DOIUrl":"https://doi.org/10.14309/01.ajg.0001128588.34437.d4","url":null,"abstract":"Introduction: More than half of overweight and obese patients will need to take statins throughout their lives; however, these medications are often linked to side effects like myalgias, headaches, among others. Nonetheless, recent studies have found anti-inflammatory effects including down-regulation of pro-inflammatory cytokines and decrease of oxidative stress. Increased risk of acute pancreatitis (AP) in patients on statins has been reported, but these have been used to treat metabolic dysfunction-associated steatotic liver disease, prevent post-endoscopic retrograde cholangiopancreatography (ERCP) AP, and prevent diabetes after AP. We studied the correlation between statin use and the risk of AP and severe AP in overweight and obese patients. Methods: The global research database TriNetX comprises 96 health care organizations and over 315 million individual medical records providing de-identified data. Data from 2014 to 2024 were compiled. Over 95% of the patients were from health care organizations in the USA. Patients >18 years with a BMI >24.9 were included and comprehensive exclusion criteria (36 total) were made to homogenize the comparison groups and to control confounders. Patients had no previous pancreatic disease and had to be on any statins for at least 1 year and were followed longitudinally. The cohorts were 1:1 propensity score matched for age sex, race, body weight, and smoking status. Results: After matching, each cohort had 298,732 patients. The average age was 61.7 13.5 (SD), there were 50.1% women in each group, and 15.3% were African Americans. The risk of AP was significantly lower at 0.277% in patients on statins and 0.367% in patients not on statins, RR 1.325, 95% CI 1.211-1.450, P < 0.0001. Additionally, these patients also had a lower risk of severe AP and need to undergo ERCP (RR of 1.067, 95% CI 1.047-1.087, P < 0.0001, and RR of 1.669, 95% CI 1.461-1.907, P < 0.0001, respectively). Other AP complications, like pancreatic steatorrhea or pancreatectomy, were not analyzed due to their low number of cases. Conclusion: In this retrospective cohort, AP, severe AP and need to undergo ERCP were less common in patients on statins. Statins may control the increased risk of gallstones and hypertriglyceridemia in obese and overweight patients which can increase the risk of AP and may also have anti-inflammatory effects. Thus, statins may play a protective role against AP and severe AP in these patients which may outweigh the risks of the medication. More evidence to include statins as a cause of drug induced AP and the potential benefits in the treatment of AP with statins is necessary.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S59-S60"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147881648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S280 Prior Biliary Sphincterotomy and Peri-Procedural Rectal Indomethacin Administration Significantly Reduce Post-ERCP Pancreatitis Incidence Compared to Index Endoscipic Retrograde Cholangiopancreatography","authors":"Grace E. Kim, Rahul Sandella, Sebastian Dobrow, Eric M. Montminy, Uzma D. Siddiqui, Dennis Chen","doi":"10.14309/01.ajg.0001128580.98339.54","DOIUrl":"https://doi.org/10.14309/01.ajg.0001128580.98339.54","url":null,"abstract":"Introduction: Rectal indomethacin (RI) has been shown to reduce the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients. Limited data exists on the protective effect of RI in non-high-risk patients, and administration in this setting varies based on provider preference. Previous research found patients with prior sphincterotomy still had a 2.7% rate of PEP. This study population did not routinely receive RI. Our aim was to examine the impact of RI on PEP rates in patients with prior sphincterotomy undergoing repeat ERCP (rERCP) compared to index ERCP (iERCP). Methods: Patients who had initial ERCP with biliary sphincterotomy and at least 1 subsequent ERCP at a single tertiary referral center from 2022 to 2024 were identified using a procedure database. All patients received RI peri-procedurally. Demographics, procedure details, and PEP data were retrospectively collected. Results: Overall, 158 patients undergoing 423 ERCPs met the inclusion criteria. The most common indications were malignant obstruction for iERCP and anastomotic stricture for rERCP. Pancreatic duct (PD) manipulation occurred in 43.7% of iERCPs with PD stent placement in 89.9% of them; PD manipulation and stent placement occurred in 0.8% of rERCPs. PEP incidence was significantly lower for rERCP (n = 1) compared to iERCP (n = 12; 0.4% vs 7.6%, P = 0.00005). The rERCP patient who developed PEP did not have PEP after his iERCP, and PD was not manipulated during the rERCP. Age, gender, inpatient status, PD manipulation, PD stenting, and peri-procedural administration of lactated ringers were not associated with PEP occurrence. Conclusion: Our study demonstrates a drastic reduction in PEP rates at rERCP compared with iERCP in patients who underwent RI administration. Compared to the published PEP rate of 2.7% for rERCP without routine RI, our PEP rate of 0.4% suggests a protective benefit of RI in these low-risk patients. Our study also utilized a novel design by examining the same population of patients for iERCP and rERCP to mitigate external confounding factors. Further prospective studies are needed to confirm the PEP-reducing benefit of RI for patients with prior sphincterotomy and evaluate the cost effectiveness of administering RI in all patients undergoing ERCP.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S59-S59"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147908635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S3255 Pancreatic Duct Stent Placement Following a Pancreatic Ductal Disruption Secondary to Chronic Pancreatitis: A Case Study","authors":"Umang Makhijani, Najy Issa, Anwar Dudekula","doi":"10.14309/01.ajg.0001140480.48282.23","DOIUrl":"https://doi.org/10.14309/01.ajg.0001140480.48282.23","url":null,"abstract":"Introduction: Disconnected pancreatic duct syndrome (DPDS) refers to rupture or injury of the pancreatic duct, often resulting from severe or necrotizing acute pancreatitis, though it can also stem from blunt abdominal trauma, surgical complications, pancreatic malignancy, or chronic pancreatitis. It leads to disconnection of the main pancreatic duct from the duodenum or small intestine, impairing drainage of pancreatic juices and causing various complications. We present a comprehensive case of DPDS, explore its clinical significance, highlight diagnostic and treatment approaches used, and emphasize the need for further research to establish universally accepted guidelines. Case Description/Methods: A 57-year-old man with chronic pancreatitis and metabolic dysfunction-associated steatotic liver disease cirrhosis presented with dyspnea, lightheadedness, and abdominal distension. Paracentesis revealed ascitic fluid with high amylase, concerning for a pancreatic duct leak. Initial endoscopic retrograde cholangiopancreatography (ERCP) with pancreatogram failed; repeat ERCP 3 days later confirmed a leak. A pancreatic sphincterotomy was performed and a plastic stent placed in the ventral duct. Despite intervention, he had recurrent ascites requiring paracentesis, which later revealed Candida peritonitis and Streptococcal septicemia. Hepatic abscesses developed, necessitating interventional radiology (IR)-guided drain placement. Persistent abscesses prompted transfer to a tertiary center for potential further IR procedures. His course was further complicated by left pleural effusion and pneumothorax. Two ventral drains were placed and later removed following computed tomography-confirmed improvement. He was discharged on Augmentin and oral fluconazole to complete 4 weeks post-drain removal, totaling 8–10 weeks of antibiotic therapy. Discussion: Pancreatic ductal disruptions may result in leakage of pancreatic enzymes into the abdominal cavity, leading to complications such as recurrent (peri-)pancreatic fluid collections, pancreatic ascites, pleural effusions, persistent fistula, peritonitis, or abscesses, as seen in this case. The condition remains underrecognized, often delaying diagnosis. Imaging modalities include contrast-enhanced computed tomography, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography (ERCP). Prompt diagnosis is essential, with management options including percutaneous drainage, surgery, or endoscopic interventions to repair the duct or drain collections. This case illustrates the complexity and severity of DPDS and reinforces the urgent need for universally recognized guidelines to aid in timely diagnosis and effective management.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S701-S701"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147918810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S281 Correlation Between Statin Use and the Incidence of Acute Pancreatitis in Patients With Diabetes: A Global Database Study","authors":"Patricia Rojas, Andrew Ofosu, Moamen Gabr, Rosanne Danielson, Milton T. Smith, Inuk Zandvakili, Wei-Wen Hsu, Luis F. Lara","doi":"10.14309/01.ajg.0001128584.77163.bb","DOIUrl":"https://doi.org/10.14309/01.ajg.0001128584.77163.bb","url":null,"abstract":"Introduction: Statins are widely used to control serum lipids and reduce the risk of cardiovascular events. Common side-effects include myalgias, hepatotoxicity, proteinuria, and diabetes which are usually offset by the benefit. These medications have anti-inflammatory effects including down-regulation of pro-inflammatory cytokines. They have also been used to prevent post-endoscopic retrograde cholangiopancreatography acute pancreatitis (AP), and to prevent development of diabetes after AP, but an increased risk of AP in patients on statins has also been reported, without a clear mechanism of action. We studied the correlation with statin use and the risk of AP and severe AP (SAP) in patients with type 2 diabetes mellitus (DM2). Methods: We used the global research database TriNetX which comprises over 315 million individual electronic medical records providing de-identified data. For this analysis data from 2014 to 2024 were compiled, and >85% of the patients were from the United States. Adult patients (>18 years) with DM2 were included in the analysis and comprehensive exclusion criteria (39 total) were made to homogenize the comparison groups and to control confounders. Patients had no previous pancreatic disease and had to be on any statins for at least 1 year and were followed longitudinally. The cohorts were 1:1 propensity score matched for age sex, race, body weight, and smoking status. Results: After matching, each cohort had 138,008 patients. The average age was 66.2 12.2 (SD), there were 47% women in each group, and 19.3% were African Americans. The risk of AP was similar, 0.275% in patients on statins and 0.337% in patients not on statins, RR 1.227, 95% CI 1.07-1.41, P = 0.003. However, patients with DM2 that were not on statins had a decreased risk of developing severe AP, RR of 0.906, 95% CI 0.88-0.93, P < 0.0001. Both groups had a similar need to undergo endoscopic retrograde cholangiopancreatography (RR of 1.33, 95% CI 1.06-1.67, P = 0.0136). Conclusion: In this retrospective cohort, the risk of AP was similar in patients with DM2 on statins. Interestingly, patients with DM2 on statins were more likely to develop SAP. It is not clear if this was associated with transient or persistent SAP or if it resulted in poorer outcomes. The effect of variables including medical history, and concomitant drug interactions may play a role in this perceived increased association. Statins metabolized by CYP3A4 may be more pancreato-toxic, so the type and dose of statin may play a role. More evidence to include statins as a cause of drug induced AP or SAP is necessary.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S59-S59"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147892372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S277 Disparities and Trends in Cholecystitis-Related Mortality Among Diabetic Adults in the United States, 1999 to 2020: A Population-Based Analysis Using CDC WONDER","authors":"Usama Sakhawat, Usman Mazhar, Hafsah Ali, Ali Hamza, Fnu Veena, Muhammad Hamza Rafique, Muhammad Khizar Asif, Sheena Shamoon, Kinza Bakht, Muhammad Arham, Allah Dad, Faseeh Haider, Ahmad Faizan, Muhammad Shahbaz, Rama Hassan, Ahmed Shehadah, Khandokar Talib, Toseef Javaid","doi":"10.14309/01.ajg.0001128568.27587.74","DOIUrl":"https://doi.org/10.14309/01.ajg.0001128568.27587.74","url":null,"abstract":"Introduction: Cholecystitis, a common gallstone disease complication, may pose a higher mortality risk in diabetic patients due to immunometabolic dysfunction and delayed diagnosis. However, national trends and demographic disparities in cholecystitis-related mortality among diabetic adults remain poorly characterized. Methods: We analyzed CDC WONDER multiple cause-of-death data (1999 to 2020), identifying deaths listing both diabetes mellitus (ICD-10 E10–E14) and cholecystitis (K81). Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated for U.S. adults aged ≥25 years and assessed using joinpoint regression, stratified by sex, race/ethnicity, age groups, Census region, state, and 2013 urbanization level. Results: From 1999 to 2020, AAMR for cholecystitis among diabetic adults showed a non-significant rise from 1999 to 2002 (annual percentage changes [APC]: +8.6%), a significant decline from 2002 to 2015 (APC: –2.1%), followed by a significant rise from after 2015 (APC: +5.9%). Overall AAPC was +1.26% (P = 0.13). A total of 8,470 deaths were recorded. Racially, AAMR was highest in American Indian or Alaska Native (3.3), followed by Hispanic or Latino (2.9), Black or African American (2.7), Asian or Pacific Islander (1.8), and White (1.5). AAMRs increased for both genders; men had consistently higher rates, rising from 2.0 to 2.8, compared to 1.4 to 1.8 in women. Regionally, the highest rate was in the West (2.1), followed by the Midwest and South (1.7 each), and the Northeast (1.6). AAMRs increased in both metropolitan (1.7 to 2.2) and non-metropolitan areas (1.7 to 2.5), with a greater rise in the latter. Among middle-aged adults (45–64), AAMR increased from 0.7 to 1.2, with a significant post-2015 rise (APC: +9.24%, CI: 1.59-17.46). In older adults (≥65), AAMRs rose from 7.0 in 1999 to 8.1 in 2020, with an initial increase from 1999 to 2002 (APC: +8.79%, CI: –3.08 to 22.12), a significant decline from 2002 to 2015 (APC: –1.99%, CI: –3.14 to –0.83), and a significant rise from 2015 to 2020 (APC: +4.56%, CI: 0.69 to 8.58, P < 0.05). Conclusion: Rising cholecystitis-related mortality among diabetic adults, particularly among Hispanics, men, residents of the West and non-metropolitan areas, along with a post-2015 increase in mortality among middle-aged and older adults, underscores the importance of implementation of stratified public health policies and clinical protocols tailored to demographic and regional risk factors to reduce mortality and improve outcomes.","PeriodicalId":188050,"journal":{"name":"The American Journal of Gastroenterology","volume":"120 10S2","pages":"S58-S59"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147881809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}