Liver disease is one of the leading public health problems faced by healthcare practitioners regularly. As such, there has been a search for an inexpensive, readily available, non-invasive marker to aid in monitoring and prognosticating hepatic disorders. Recently, red blood cell distribution width (RDW) has been found to be associated with various inflammatory conditions with implications for its use as a potential marker for assessing disease progression and prognosis in multiple conditions. Multiple factors effect red blood cell production whereby a dysfunction in any process can lead to anisocytosis. Furthermore, a chronic inflammatory state leads to increased oxidative stress and produces inflammatory cytokines causing dysregulation and increased intracellular uptake and use of both iron and vitamin B12, which leads to a reduction in erythropoiesis causing an increase in RDW. This literature review reviews in-depth pathophysiology that may lead to an increase in RDW and its potential correlation with chronic liver diseases, including hepatitis B, hepatitis C, hepatitis E, non-alcoholic fatty liver disease, autoimmune hepatitis, primary biliary cirrhosis, and hepatocellular carcinoma. In our review, we examine the use of RDW as a prognostic and predictive marker for hepatic injury and chronic liver disease.

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Introduction: Non-Hodgkin lymphoma is classified as nodal and extranodal. Extranodal lymphoma frequently involves the stomach and is associated with H. Pylori infection. Colonic involvement, however, is rare. We present a case of MALT lymphoma that was found incidentally on colonoscopy. Case Description/Methods: A 73-year-old male with a history of diabetes presented for surveillance colonoscopy. Previous colonoscopy reports were unavailable, but the patient endorsed a history of benign polyps. Colonoscopy revealed a patchy area of inflammation and ulceration localized to the rectum and rectosigmoid colon. Biopsies demonstrated prominent lymphoid aggregates with inconclusive flow cytometry. He was referred to oncology who recommended further sampling. He underwent repeat colonoscopy 5 months later which demonstrated a 3 cm polyp in the cecum in addition to multiple segmental aphthae (uniform punctate lesions with surrounding erythema and central pallor) stretching from the distal sigmoid colon to the rectum. Pathology of the polyp demonstrated several lymphoid aggregates and rectosigmoid biopsies demonstrated prominent lymphoid aggregates that were positive for CD20, CD79a, BCL-2. Findings overall were consistent with extranodal marginal zone lymphoma. PET scan demonstrated diffuse lymphadenopathy, splenomegaly, and intense hypermetabolic activity throughout the colon. Stool studies were not obtained. The patient was recommended for chemotherapy with weekly rituximab which has been well tolerated to date. Discussion: Colorectal lymphoma is a rare occurrence, and represents less than 1% of all colorectal malignancies. Furthermore MALTomas present as primary colonic lymphomas in only 2.5% of cases. MALTomas predominate in men aged 50-70 years old and are associated with chronic immunosuppression and H. pylori infection when found in the stomach, although this does not necessarily hold true when found in the colon. Patients can present with symptoms of abdominal pain, obstruction, or GI bleeding. Endoscopic appearance of MALTomas is not well defined and can range from a single polypoid lesion to ulcerated mucosa or erosions. A combination of surgery, chemotherapy, and radiation is available for treatment of advanced disease.Primary colonic lymphoma is rare and there are only a few cases reported in the literature. Although rare, it is important to keep NHL in the differential when polypoid or ulcerated lesions are found on colonoscopy.

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Conclusion:In summary, this small study of 12 patients with BE and EV suggests that endoscopic surveillance may not be prioritized in the setting of varices. As a subset of these patients may still develop dysplasia and even adenocarcinoma, decision-making in this setting should weigh the relative risks of surveillance endoscopy and biopsies versus a more conservative approach. Two of these patients without adequate surveillance developed advanced pathology. This study highlights the importance and difficulty in providing adequate endoscopic surveillance in patients with BE and EV.