Introduction: IgG4-related disease (RD) is now known to affect multiple organs, including the gastrointestinal system, kidneys, lungs, and retroperitoneum. Diagnosis of IgG4-RD involves a combination of clinical, radiological, serological, and histopathological findings. Case Series: This case series underscores the importance of recognizing IgG4-RD as a potential etiology of diseases of unclear pathology with patient presentations, including pancreatitis, cholangitis, renal and mesenteric ischemia, back mass, and interstitial lung disease. Conclusion: Further, we discuss the histological findings, imaging, serology, other organ involvement and response therapy (HISORt) criterion of diagnosis, and treatment options including steroid-sparing agents.

Background: Sarcoidosis is a [chronic granulomatous disease of unknown etiology that predominantly affects the lungs but can involve virtually any organ, including the liver. Pulmonary involvement occurs in over 90% of patients, while hepatic involvement is reported in 5–25% of cases. Despite the expanding therapeutic armamentarium, evidence regarding both pulmonary efficacy and hepatic safety/efficacy of sarcoidosis therapies remains fragmented across heterogeneous studies. This systematic review synthesizes the available evidence on pharmacological therapies for sarcoidosis, with a dual focus on pulmonary outcomes (forced vital capacity, steroid-sparing, radiographic response) and hepatic outcomes (hepatotoxicity, efficacy in hepatic sarcoidosis).Methods: A comprehensive literature search was conducted across PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov through May 2025. Studies evaluating pharmacological therapies for sarcoidosis reporting pulmonary and/or hepatic outcomes were included. Therapies were categorized as first-line (glucocorticoids, methotrexate), second-line (antimetabolites, hydroxychloroquine), third-line (anti-TNF biologics, rituximab, repository corticotropin injection), and investigational agents (JAK inhibitors, efzofitimod, antifibrotics). Data were extracted on study design, sample size, pulmonary function outcomes, hepatic efficacy, hepatotoxicity, and adverse events. Quality assessment was performed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies.Results: A total of 22 therapies across 4 treatment lines were identified with reportable pulmonary and/or hepatic outcome data. The evidence base comprised 8 randomized controlled trials, 8 single-arm trials, multiple retrospective cohort studies, and real-world database analyses. Key findings are summarized by treatment line below.Conclusions: Methotrexate has emerged as a noninferior first-line alternative to prednisone for pulmonary sarcoidosis. Anti-TNF agents, particularly infliximab, provide modest but consistent pulmonary benefit and demonstrate efficacy in hepatic sarcoidosis phenotypes. JAK inhibitors and efzofitimod represent promising investigational therapies. Hepatotoxicity remains a critical consideration across multiple drug classes, necessitating structured monitoring. Prospective studies specifically evaluating hepatic sarcoidosis outcomes are urgently needed.

IntroductionGastrointestinal functional disorders are based on gut-brain axis dysfunction and have overlapping symptoms. This review demonstrates a diagnostic dilemma in the patients presenting with chronic cannabis use and hot bathing behavior, prompting a diagnosis of Cannabis hyperemesis syndrome (CHS). It highlights the lack of guidelines generally used for diagnosis and even the drawback of the Rome criterion with a requirement of improvement with cessation, which does not allow a diagnosis at the initial visit. Some patients get ultimately diagnosed with Cyclic vomiting syndrome (CVS) which is overlapping disorder often ignored in cannabis smokers.MethodsThe authors reviewed databases including PubMed and Cochrane to look at reviews published in the last 5 years proposing guidelines for diagnosis, postulating shared pathophysiology based on animal/human studies and consolidated the treatment protocols.DiscussionThe signs and symptoms of the diseases highly overlap. This occurs due to the internal endocannabinoid system with CB1 receptor stimulation leading to improvement in nausea but persistent use leading to possible contrary effects or receptor downregulation. Rome criterion, used for diagnosis and CVS includes acute stereotypical vomiting episodes with 3 episodes in a year and 2 in 6 months preceding diagnosis and relative symptom-free interval, supported by personal or family history of migraines whereas CHS has CVS-like episodes, cannabis use and improvement on cessation in criterion with hot showers as support. Thangam et al proposed a better criterion with at least one year of >4 times/week cannabis use and 6 months of cessation to allow washout. Lastly, treatment includes cannabis cessation, anti-emetics including ondansetron, and even aprepitant. Sumatriptan has been used as a good abortive agent as well. For maintenance of remission, coenzyme Q, tricyclic antidepressants and topiramate has shown promise. Lifestyle modifications and therapy are adjuvantsConclusionGut brain axis is complex and leads to overlap in presentation and delayed diagnosis. Using defined criterion is the key for diagnosis and treatments though less studied have been postulated and can be used as per limited data available.The underlying case and review show the similarities and differences between cyclic vomiting and cannabis hyperemesis while touching upon pathogenesis and treatments. It also focuses on the prevalence of cannabis use in patients with cyclic vomiting and the role of the endocannabinoid system in the pathogenesis of both diseases.

Interstitial lung diseases (ILDs) comprise a heterogeneous group of pulmonary disorders associated with substantial morbidity and mortality. We examined mortality attributed to selected J84-coded ILDs in the United States from 1999 to 2024 using CDC WONDER underlying-cause-of-death data. Age-adjusted mortality rates (AAMRs) per 100,000 population were standardized to the 2000 U.S. population and stratified by sex and race. Joinpoint regression was used to identify changes in temporal slope and estimate annual percent change (APC), average annual percent change (AAPC), 95% confidence intervals (CIs), and p-values. After the removal of overlapping years between the CDC WONDER database series, 444,573 unique deaths occurred. Annual deaths increased from 11,358 in 1999 to 22,849 in 2024, while AAMR increased from 4.2 to 5.1 per 100,000. Overall, AAMR increased during 1999–2004 (APC 2.32%, 95% CI 1.39–3.26; p < 0.001) and more slowly during 2004–2024 (APC 0.36%, 95% CI 0.16–0.56; p = 0.001), with an overall AAPC of 0.75% (95% CI 0.60–0.90; p < 0.001). Male AAMRs remained higher than female AAMRs, while race-specific trends were heterogeneous. No temporal reduction in population mortality coincided with the introduction of antifibrotic therapies; however, this ecological analysis cannot evaluate treatment effectiveness or individual treatment exposure.

Patients with inflammatory bowel disease (IBD) often require long-term immunosuppressive or advanced therapy, raising concerns about treatment-associated malignancy risk. This systematic review evaluated malignancy outcomes associated with biologic, advanced small-molecule, and thiopurine therapies in adults with IBD. PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through June 2025, with supplementary screening of Google Scholar and reference lists. Eligible primary studies included randomized controlled trials and prospective or retrospective cohort studies evaluating malignancy outcomes. Thiopurines were included because they remain clinically important comparators and are central to combination-therapy risk. The Newcastle–Ottawa Scale and the Cochrane risk-of-bias tool were used for observational studies and randomized trials, respectively. Because of substantial clinical and methodological heterogeneity, we did not perform a de novo meta-analysis; pooled estimates from previously published meta-analyses are reported only as contextual evidence. Twenty-eight studies met the inclusion criteria. Thiopurines showed the most consistent malignancy associations, including lymphoma, non-melanoma skin cancer (NMSC), acute myeloid leukemia/myelodysplastic syndrome, and urinary tract cancer. Anti-tumor necrosis factor (anti-TNF) monotherapy was not associated with a clear increase in overall cancer incidence, although a modest lymphoma signal was reported in some datasets. Combination anti-TNF plus thiopurine therapy showed the strongest lymphoma signal. Current evidence has not demonstrated an increased malignancy risk with vedolizumab or ustekinumab, including in available cohorts of patients with prior malignancy; however, confidence is limited by observational designs, small event numbers, heterogeneous cancer histories, and limited follow-up. IBD-specific data for Janus kinase inhibitors and sphingosine-1-phosphate receptor modulators remain comparatively immature, and long-term surveillance is required. Overall, treatment decisions should integrate absolute baseline risk, age, smoking, prior malignancy, prior NMSC, Epstein–Barr virus-related risk, disease-related cancer risk, and cumulative immunosuppressive exposure.

Interstitial lung diseases (ILDs) comprise a heterogeneous group of pulmonary disorders associated with substantial morbidity and mortality. We examined mortality attributed to selected J84-coded ILDs in the United States from 1999 to 2024 using CDC WONDER underlying-cause-of-death data. Age-adjusted mortality rates (AAMRs) per 100,000 population were standardized to the 2000 U.S. population and stratified by sex and race. Joinpoint regression was used to identify changes in temporal slope and estimate annual percent change (APC), average annual percent change (AAPC), 95% confidence intervals (CIs), and p-values. After the removal of overlapping years between the CDC WONDER database series, 444,573 unique deaths occurred. Annual deaths increased from 11,358 in 1999 to 22,849 in 2024, while AAMR increased from 4.2 to 5.1 per 100,000. Overall, AAMR increased during 1999–2004 (APC 2.32%, 95% CI 1.39–3.26; p<0.001) and more slowly during 2004–2024 (APC 0.36%, 95% CI 0.16–0.56; p=0.001), with an overall AAPC of 0.75% (95% CI 0.60–0.90; p<0.001). Male AAMRs remained higher than female AAMRs, while race-specific trends were heterogeneous. No temporal reduction in population mortality coincided with the introduction of antifibrotic therapies; however, this ecological analysis cannot evaluate treatment effectiveness or individual treatment exposure.