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Methods: We prospectively analyzed the biopsies from 341 patients with IM and, at a minimum, biopsies of both antrum and oxyntic mucosa. Three gastrointestinal pathologists (RG, CR, KT) reviewed all cases and recorded the type and location of IM. In keeping with the recent AGA guidelines for the management of gastric IM, cases with IM in the oxyntic mucosa were classified as extensive; cases with mixed complete and incomplete IM were classified as incomplete IM. The percentage of incomplete IM in the 2 groups was compared by calculating odds ratios (OR with 95% CI). Results: There were 199 (58.4%) patients with limited IM and 142 (41.6%) with extensive IM. Among those with limited IM, 146 (73.3%) had complete IM and 53 (26.6%) had incomplete IM (Table ). Among those with extensive IM, 84 (59.2%) had complete IM and 58 (40.8%) had incomplete IM (OR 1.90; 1.20 -3.01; P, .01). Conclusion: Compared to patients with limited IM, patients with extensive IM had approximately twice the risk for incomplete IM. However, our study also shows that in patients with limited IM, who would not be considered at increased risk for dysplasia and GC by the AGA guidelines, over a quarter have incomplete IM, which would put them in the increased risk category. Therefore, relying solely on extent might result in the misclassification of patients who are at increased risk for dysplasia and GC. Until there are more robust methods to stratify risk in the evolving field of GC prevention, we suggest that optimal screening strategies can be substantially aided by reporting both extent and subtype of gastric IM.Introduction: In the US, 9.6% of the population (31 million people) do not have health insurance. Uninsured patients with cancer are more likely to present with advanced disease, not receive equal treatment, and display worse survival than those with insurance. Gastric cancer is one of the leading causes of death worldwide, and curative treatment depends on the disease stage at the time of diagnosis. The purpose of this study is to determine the association of insurance status with disease stage at presentation and survival among patients diagnosed with gastric cancer using the National Cancer Database (NCDB). Methods: The analysis cohort included gastric cancer patients in the NCDB diagnosed from 2010 to 2015. Patients were excluded if no information was available regarding insurance status or cancer staging at the time of diagnosis. Multivariable logistic regression models were used to determine the association between insurance status and gastric cancer stage at diagnosis/presentation. Cox regression models were used to determine the association between insurance status and all-cause mortality. Results: Following exclusions, 178,641 patients had gastric cancer during the study period. 171,199 patients (95.8%) had insurance in comparison to 7,442 patients (4.2%) who were uninsured. Univariate analysis between the groups demonstrated a statistically significant higher proportion of poor differentiation (53.2%), advanced disease (46.2%)...

Introduction: Pyogenic liver abscesses (PLA) are suppurative infections in the hepatic parenchyma with high mortality. Risk factors include diabetes mellitus, underlying hepatic/biliary disease, and gastrointestinal malignancy. It is hypothesized that diverticular disease leads to disruption of the colonic mucosa, facilitating bacterial translocation into the portal venous system. We present a patient with acute sigmoidal diverticulitis complicated by pyogenic liver abscesses and septic portal vein thrombosis. Case Description/Methods: A 71-year-old male with type 2 diabetes presented with acute onset fevers/chills, abdominal pain, and jaundice. Labs showed a leukocytosis of 19,000 IU/L and a cholestatic liver injury pattern with hyperbilirubinemia. CT abdomen and pelvis revealed right portal vein thrombosis, a right hepatic hypodense lesion, and concurrent sigmoidal diverticulitis. He was started empirically on piperacillin-tazobactam and metronidazole. E. histolytica serology and AFP were negative. MRCP demonstrated right hepatic duct diminution and numerous hyperintense foci in the right liver lobe. He underwent ECRP with multiple stent placements and liver biopsy, revealing acute cholangitis. Blood cultures grew Streptococcus intermedius. At discharge, he was prescribed amoxicillin/clavulanic acid for four weeks. At follow up two weeks later, imaging showed intrahepatic abscess resolution and interval improvement in portal vein thrombosis. Discussion: Many case reports illustrate a relationship between pyogenic liver abscesses and sigmoidal diverticulitis. Although Escherichia coli and Klebsiella spp. are the predominate pathogens in PLA, the Streptococcus milleri group (including S. intermedius) are well documented as culprits. As seen in our patient, pylephlebitis is a known consequence of diverticulitis and treatment is aimed at the primary infection; anticoagulation remains controversial. In patients with acute diverticulitis with features of acute cholangitis, we suggest a heightened consideration of both pyogenic liver abscess and pylephlebitis

laboratory workup, had decreasing hemoglobin levels with elevated WBC count and lactate. Contrast-enhanced abdominal CT scan revealed portal and superior mesenteric vein thrombosis, bowel wall ischemia along the segment of the jejenum in the left hemiabdomen, and infrarenal abdominal aorta and ascending aorta thrombi. Emergency exploratory laparotomy was done with segmental jejunoileal resection and primary end-to-end anastomosis with intraoperative findings of gangrenous small bowels measuring 100 cm in length, with the rest of the proximal small bowels noted to be dilated and edematous. The patient was transferred to the intensive care unit post-operatively for closer monitoring; Heparin drip was started 24 hours post-surgery. Histopathology results showed extensive transmural infarction, hemorrhage, and necrosis on small bowel segments; organizing thrombi were seen on mesenteric vessels. The patient was worked-up for other causes of hypercoagulable states which showed elevated Homocysteine levels at 20.6 (NV: 5-12). Discussion: It is likely that HHcy may increase the risk of patients with liver cirrhosis to develop arterial and venous thrombosis considering the pivotal role the liver plays in the metabolism of sulphur amino acids and Hcy-related vitamin storage. Therefore, identification of this high-risk group may be important to plan prevention management, such as vitamin supplementation, other Hcy-lowering strategies, or long-term anticoagulation.