Faculty Bibliography

Advances in basic science and diagnostic techniques have led to a dramatic decrease in the incidence of hepatitis C virus infection in the US. Further advances in treatment are necessary for comparable reductions in prevalence during the next millennium.

Pill-induced esophageal injury is a well described clinical entity. In contrast, pill-induced gastric injury has not been well characterized. In this report, we describe two patients with acute gastric ulcers due to pill ingestion and review the available literature on pill-induced gastric injury. The first patient presented with upper gastrointestinal hemorrhage and was found to have a large gastric ulcer with multiple potassium chloride pills in the ulcer crater. The second patient presented with odynophagia and endoscopy revealed doxycycline-induced esophageal and gastric injury. To our knowledge, this is the first case report of doxycycline-induced gastric ulcer

Spontaneous intramural hematoma of the esophagus (SIHE) is a rare condition usually affecting middle-aged or elderly women. It presents as acute substernal or epigastric pain, typically accompanied by dysphagia or hematemesis. SIHE is not usually associated with vomiting, and is therefore clearly distinguished from emetogenic esophageal disorders, such as the Mallory-Weiss lesion and the Boerhaave syndrome. The diagnosis has traditionally been made by barium esophagram. Therapy is conservative; a favorable prognosis is the rule. The pathogenesis is in dispute. We present a case of SIHE without a discernible mucosal breach, suggesting a primary intramural bleed as the initiating event. We document the utility of computed tomographic scan and magnetic resonance imaging in the diagnosis of SIHE

The Hermansky-Pudlak syndrome (HPS) is a triad of tyrosine-positive albinism, platelet dysfunction, and the deposition of an abnormal ceroid-like pigment in the tissues. Complications of the syndrome, such as pulmonary fibrosis, renal failure, and cardiomyopathy, have been described. Granulomatous colitis has been documented in several families with the HPS. The bowel disease of the HPS is a unique type of inflammatory bowel disease with clinical features suggestive of idiopathic ulcerative colitis and pathologic features suggestive of Crohn's disease. Analogous to the presentation of Crohn's disease with perianal and perirectal involvement, we describe the occurrence of perianal disease and a perirectal abscess in a 29-yr-old woman with HPS and mild granulomatous colitis

Gastrointestinal involvement by Kaposi's sarcoma in patients with cutaneous or lymph node involvement is common. Since the advent of the acquired immune deficiency syndrome in 1981, primary gastrointestinal involvement, i.e., without skin or lymph node involvement, has not been adequately documented. We describe a patient with acquired immune deficiency syndrome and primary gastrointestinal involvement by Kaposi's sarcoma