Hemogram-derived inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio

Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, most frequently the ileocecal region. Esophageal involvement is rare in adults and may present with atypical endoscopic findings. A 50-year-old male patient diagnosed with Crohn’s disease presented with severe diarrhea, nausea, and retrosternal pain. Ileocolonoscopy findings were normal. Upper endoscopy revealed a black-gray membranous appearance in the middle and distal esophagus, suggestive of acute esophageal necrosis. Magnetic resonance enterography showed diffuse small bowel wall thickening consistent with disease activation. Infliximab therapy was initiated, resulting in clinical improvement and complete endoscopic resolution within 3 months. Esophageal involvement in Crohn’s disease is rare and may mimic acute esophageal necrosis. Anti-TNF therapy can provide clinical and endoscopic remission in such atypical cases.

Evidence regarding endoscopic retrograde cholangiopancreatography (ERCP) in adults in their 90s and 100s remains limited, and chronological age may not adequately reflect procedural vulnerability. We compared ERCP strategy and short-term outcomes across advanced age strata and included a contemporary younger reference cohort. This retrospective cohort included 48 patients aged ≥80 years undergoing ERCP for choledocholithiasis or stone-related acute cholangitis between 2023 and 2025: 80–89 years (n = 20), 90–99 years (n = 21), and ≥100 years (n = 7). A reference group of 15 consecutive patients aged <80 years treated during the same period under the same eligibility criteria was added. Only the first eligible ERCP per patient during the study period was analyzed as the index procedure; subsequent ERCPs were outcomes rather than additional observations. Clinical Frailty Scale (CFS), stone burden, treatment strategy, drainage, adverse events, intensive care use, and 30-day mortality were analyzed using nonparametric and Fisher–Freeman–Halton methods. Frailty–outcome analyses were restricted to the ≥80-year primary cohort and were exploratory and unadjusted. Median CFS was 4.0, 4.5, 6.0, and 8.0 in the <80, 80–89, 90–99, and ≥100-year groups, respectively (p < 0.001). Complete index stone clearance was 93.3%, 90.0%, 76.2%, and 71.4% (p = 0.358), while stenting was used in 6.7%, 10.0%, 33.3%, and 42.9% (p = 0.055). Successful biliary drainage remained 100%, 95.0%, 95.2%, and 100% (p = 1.000). Repeat ERCP occurred in 0%, 0%, 14.3%, and 28.6% (p = 0.027), and median length of stay increased from 3 to 4, 5, and 6 days (p < 0.001). Within the ≥80-year cohort, higher CFS remained associated with failed index clearance, stenting, post-procedure ICU requirement, and 30-day mortality in exploratory analyses. ERCP achieved high biliary drainage rates across age strata, including centenarians. The small younger reference cohort provided clinical context, while the ≥80-year analyses continued to show increasing frailty and more frequent staged management in the oldest groups. The retrospective design, small reference cohort, sparse events, and strong age–frailty correlation preclude causal or independent prognostic claims.

Background/Objectives: Amyloid deposition is an uncommon but clinically important complication of chronic inflammatory disorders, including inflammatory bowel disease (IBD). Because published estimates are heterogeneous and depend strongly on how tissue is ascertained, systematically stained biopsy cohorts may provide useful contemporary data. We aimed to determine the frequency of gastrointestinal biopsy-documented amyloid deposition in IBD patients whose rectal biopsy specimens were available for amyloid assessment. Methods: In this single-center retrospective study, 750 adults with confirmed ulcerative colitis (UC) or Crohn’s disease (CD) were screened. The analytic cohort comprised 350 patients with available rectal biopsy material for amyloid evaluation. All 350 specimens were retrospectively re-evaluated by pathologists and stained with Congo red; amyloid deposition was defined by Congo red positivity with characteristic apple-green birefringence under polarized light. Demographic data, IBD subtype, disease duration, UC extent, urinalysis findings, and known nephrological history were reviewed. Results: Of 350 included patients, 300 (85.7%) had UC and 50 (14.3%) had CD; 198 (56.6%) were women and 152 (43.4%) were men. Mean age was 48.5 years in women and 51.7 years in men (weighted cohort mean, 49.9 years), and mean IBD duration was 5.3 years. Among patients with UC, 72 (24.0%) had proctitis, 107 (35.7%) had left-sided colitis, and 121 (40.3%) had pancolitis. No specimen demonstrated Congo red-positive amyloid deposition (0/350; observed frequency 0%; exact 95% CI, 0–1.05%). No patient had proteinuria on available spot urinalysis or a known history of nephrological disease. Conclusions: No gastrointestinal biopsy-documented amyloid deposition was identified in this systematically Congo red-stained rectal biopsy cohort. The zero-event result should not be interpreted as proof that the true prevalence is zero, nor does it establish the absence of amyloid deposition at other organ sites. The UC-predominant composition, relatively short mean disease duration, and selection of only patients with available rectal biopsy material limit generalizability, particularly to longstanding or complicated CD.