INTRODUCTION: Social media platforms such as TikTok are major sources of health information but raise concerns about misinformation. METHODS: We conducted a content analysis of the top 200 TikTok videos on colorectal cancer, irritable bowel syndrome, and inflammatory bowel disease. Videos were categorized by content focus and narrator type. RESULTS: Colorectal cancer videos were largely health care provider generated (66.5%), whereas irritable bowel syndrome and inflammatory bowel disease content was mostly patient-driven (79.14% and 80.32%), with frequent misinformation. Dietary changes were commonly discussed; evidence-based treatments were underrepresented. DISCUSSION: Greater health care engagement and content regulation are needed to improve the quality of online gastrointestinal health information.

Introduction: Clostridioides difficile infection (CDI) is a major complication in patients with inflammatory bowel disease (IBD), contributing to increased morbidity, mortality, and health care burden. This study aimed to evaluate national trends and clinical outcomes associated with CDI in hospitalized IBD patients in the United States. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2012 to 2021. Adult patients hospitalized with a primary or secondary diagnosis of IBD (Crohn’s disease or ulcerative colitis) were stratified into 2 groups by the status of CDI diagnosis (either primary or secondary diagnosis). Demographic characteristics, hospital outcomes, and complications were compared between CDI and non-CDI cohorts. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality, septic shock, and venous thromboembolism (VTE). Results: Among 4,193,564 hospitalized IBD patients, 534,190 (12.7%) had CDI. CDI patients were older (mean: 68.8 vs 53.3 y, P < 0.001), with higher in-hospital mortality (3.6% vs 2.0%, P < 0.001), VTE (23.7% vs 6.2%, P < 0.001), septic shock (5.4% vs 4.0%, P < 0.001), and mechanical ventilation use (4.2% vs 2.8%, P < 0.001). Ulcerative colitis was more frequently associated with CDI than Crohn’s disease (30.3% vs 25.0%, P < 0.001) and independently predicted septic shock (OR: 1.09) and VTE (OR: 1.06) but was associated with lower mortality (OR: 0.81). Conclusion: The presence of CDI in hospitalized patients with IBD led to significantly worse outcomes. Ulcerative colitis is more commonly associated with CDI and increased risk of complications. These findings highlight the need for early detection, preventive strategies, and tailored management of CDI in the IBD population.

BACKGROUND Non variceal upper gastrointestinal bleeding (NVUGIB) is a life-threatening condition requiring prompt and effective hemostasis. Various endoscopic interventions, including novel hemostatic powders (HP), over-the-scope clips (OTSC), and traditional approaches, have been employed to manage upper gastrointestinal bleeding (UGIB). Despite advancements, comparative efficacy and safety of these modalities remain uncertain. AIM To evaluate the efficacy and safety of novel hemostatic interventions compared to conventional endoscopic techniques for managing UGIB. METHODS Cochrane, MEDLINE, PubMed and Scopus libraries were searched for randomized controlled trials (RCTs) published up to October 2024. Only RCTs comparing novel interventions, such as HP or OTSC, with conventional endoscopic treatments computed tomography (CT) were included. The primary outcome was the 30-day rebleeding rate. Secondary outcomes included initial hemostasis, short-term rebleeding rates, need for salvage therapy (surgical/angiographic), 30-day all-cause mortality, and bleeding-related mortality. We performed pairwise and network meta- analyses for all treatments. RESULTS Seventeen studies were included in this analysis. Regarding the 30-day rebleeding rate, OTSC and HP showed superior efficacy compared with CT [OTSC vs CT: Relative risk (RR): 0.47, 95% confidence interval (CI): 0.33-0.65; HP vs CT: RR: 0.73, 95%CI: 0.45-1.13], while OTSC and HP had comparable efficacy (RR: 0.56, 95%CI: 0.30-1.05). OTSC ranked the highest in the network ranking estimate for this outcome. For the secondary outcomes, OTSC demonstrated superior efficacy for the short-term rebleeding rate (OTSC vs CT: RR: 0.35, 95%CI: 0.14-0.74; HP vs CT: RR: 0.62, 95%CI: 0.28-1.35; OTSC vs HP: RR: 0.59, 95%CI: 0.17-1.67). Regarding the initial hemostasis rate, OTSC was slightly more effective than CT (OTSC vs CT: RR: 1.20, 95%CI: 1.06-1.57) and comparable to HP (OTSC vs HP: RR: 1.08, 95%CI: 0.89-1.40). There were no significant differences among treatments for all-cause mortality, bleeding-related mortality, or the necessity of surgical or angiographic salvage therapy. OTSC consistently ranked highest across most outcomes in the network ranking estimate. CONCLUSION This meta-analysis highlights OTSC as the most effective intervention for reducing 30-day and short-term rebleeding rates in NVUGIB, surpassing both CT and HP, supporting OTSC as a preferred first-line treatment for NVUGIB, while HP and CT remain viable alternatives. Further studies are needed to explore long-term outcomes and cost-effectiveness.

Triple A syndrome (TAS) is a rare disorder inherited in an autosomal recessive manner. It is characterized by the triad of alacrimia, achalasia, and adrenal insufficiency. It is caused by mutations in the AAAS gene (achalasia-addisonianism-alacrima syndrome), which disrupts the protein ALADIN (Alacrima-Achalasia-Adrenal insufficiency Neurologic disorder protein), which plays an important role in nucleocytoplasmic transport and cellular stress response. Unlike the presented cases, most patients with TAS present in early childhood with various symptoms including dry eyes, difficulty swallowing, and recurrent infections in addition to signs of adrenal crisis such as hypotension, hypoglycemia, and hyperpigmentation. Diagnosis can be achieved by genetic testing, revealing the mutations in the AAAS gene. Management of TAS mainly focuses on addressing each condition separately such as prescribing artificial tears for alacrimia, glucocorticoid replacement therapy for adrenal insufficiency, and performing pneumatic dilation or surgical intervention for achalasia. Early diagnosis is crucial for improving quality of life and minimizing the morbidity and mortality linked to the syndrome.

BACKGROUND Refractory ascites (RA) and spontaneous bacterial peritonitis (SBP) are severe complications of decompensated cirrhosis, contributing to high morbidity and mortality. RA develops when ascites persists despite maximum diuretic therapy, while SBP arises from bacterial translocation and immune dysfunction in cirrhotic patients with ascites. Identifying key risk factors associated with these conditions is crucial for early intervention and improved patient outcomes. AIM To assess clinical and biochemical predictors of RA and SBP in a cohort of hospitalized patients with cirrhotic ascites. METHODS A retrospective chart review was conducted on patients with cirrhotic ascites diagnosed with RA or SBP at University Medical Center, El Paso, from July 1, 2013 to December 31, 2023. Patient demographics, clinical history, laboratory parameters, ascitic fluid analysis, and cirrhosis severity scores [Model for End-Stage Liver Disease-Sodium (MELD-Na) and Child-Pugh] were recorded. Statistical analyses, including multivariate logistic regression, were performed to identify independent predictors of RA and SBP, with a significance threshold of P < 0.05. RESULTS A total of 179 patients were included, with a mean age of 59.08 ± 13.04 years, predominantly male (55.9%) and Hispanic (98.3%). The most common etiology of cirrhosis was alcohol-related liver disease (45.3%), and most patients had Grade III ascites (95.5%). Among them, 115 (64.2%) had RA, and 57 (31.8%) had SBP. RA was significantly associated with abnormal serum potassium levels [odds ratio (OR) = 2.27, 95%CI: 1.06–4.84, P = 0.034], while SBP was independently predicted by gastrointestinal bleeding (OR = 2.59, 95%CI: 1.18–5.64, P = 0.017) and thrombocytopenia (platelet count < 50000; OR = 3.27, 95%CI: 1.08–9.88, P = 0.035). CONCLUSION RA and SBP are major complications of cirrhosis, with electrolyte imbalances and coagulopathy playing key roles in their development. Our study confirms that abnormal potassium levels significantly predict RA, while gastrointestinal bleeding and thrombocytopenia are strong predictors of SBP. These findings emphasize the need for early risk stratification and targeted management strategies to improve outcomes in high-risk cirrhotic patients, particularly in minority populations with limited healthcare access. Further prospective studies are warranted to validate these results and explore potential interventions to reduce RA and SBP incidence.