Background. Fecal microbiota transplantation (FMT) is a well-established therapeutic option for patients with antibiotic resistant Clostridioides difficile infection (CDI). However, the efficacy of FMT in patients with chronic liver disease remains elusive. Aims. We studied the effect of FMT on chronic liver disease (CLD) patients with CDI at our tertiary medical center. Methods. A cohort of all patients who received FMT from December 2012 to May 2014 for refractory or recurrent CDI was identified. Patients were monitored for a year after FMT. Descriptive analysis was conducted to compare the effect of FMT in patients with and without CLD. Results. A total of 201 patients with CDI received FMT, 14 of which had a history of CLD. Nine of these patients exhibited cirrhosis of the liver with a mean Child-Turcotte-Pugh score of 8. CDI development in these patients was associated with recent exposure to antibiotics and was observed to be significantly different between both groups (17% of CLD patients vs. 58% in the general cohort, p=0.01). Four patients with CLD received >1 FMT, of which 2 did not respond to treatment. There was no significant difference between patients with liver disease and the rest of the cohort with regard to FMT response (12/14 (87%) vs. 164/187 (88%), p=0.68). Conclusion. FMT is a safe and effective therapy against CDI for patients with CLD and cirrhosis.

Background: Esophageal variceal bleeding remains a common reason for hospitalization in the United States. The main objective of this study was to analyze demographic variations and outcomes in hospitalizations related to esophageal varices (EV) in the US.Methods: We performed a retrospective observational cohort study using National Inpatient Sample (NIS) database for all hospitalizations with discharge diagnoses of EV, with and without hemorrhage from 2001 to 2011.Results: In 2001, there were 19,167 hospitalizations with discharge diagnoses of EV with and without bleeding compared to 45,578 in 2011 (P<0.001). There was a 138% increase in the number of total EV hospitalizations, a 221% increase in hospitalizations with EV without hemorrhage, and a 7% increase in hospitalizations for patients with EV and hemorrhage. Age group 50-64 was the most affected, accounting for 31.4% of EV hospitalizations in 2001 and 46.7% of EV hospitalizations in 2011 (P<0.001). The overall in-hospital mortality rate was 3.4% for patients with EV without hemorrhage and 8.7% for patients with EV with hemorrhage (P=0.0003). Conclusions:The number of hospitalizations for patients with asymptomatic EV increased significantly between 2001 to 2011, with only a small concurrent increase in the number of hospitalizations for patients with esophageal variceal bleeding.

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We appreciated the recent study by Farha et al 1 reporting the high rate of actionable findings on EGD in their large series of patients with Lynch syndrome. This is an important addition to the literature that highlights the real-world benefit of screening upper endoscopy in Lynch syndrome.We believe that the use of push enteroscopy as the screening modality would further increase the benefit of these procedures, especially because the majority of small-bowel cancers occur in the duodenum and jejunum in Lynch syndrome. 2,3 This was previously endorsed in guidelines, including those by the Mallorca Group recommending "inspection of the distal duodenum during upper gastrointestinal endoscopy" 4 and the National Comprehensive Cancer Network advocating "EGD with extended duodenoscopy to distal duodenum or into the jejunum," 5 but it has fallen out of the recommendations.To assess the incidence of neoplasia identified during screening with push enteroscopy in Lynch syndrome, we performed a retrospective analysis after approval by our institutional review board. According to our clinical protocol, push enteroscopy with use of a pediatric colonoscope was the standard for upper GI tract screening during the study period. The inclusion criteria included a pathogenic or likely pathogenic variant in a mismatch repair gene and at least 1 enteroscopy performed for screening. The exclusion criteria included multiple hereditary cancer syndromes or previous small-bowel neoplasia.We assessed 172 enteroscopies performed in 129 patients with Lynch syndrome (mean 1.3 per patient, range 1-3). Distal duodenal or jejunal adenomatous polyps were identified in 2 procedures (1.2%). Notably, these polyps were found on initial screening enteroscopy in patients who had received previous EGD within 3 years. Other neoplasia identified that would have been within reach of an EGD included 1 duodenal bulb adenocarcinoma (0.6%) and 1 gastric cancer (0.6%). No procedural adverse events were noted.In our experience, push enteroscopy has identified distal duodenal and proximal jejunal neoplastic lesions that would not have been identified with standard EGD screening and at a rate similar to gastric and proximal duodenal neoplasia. Given this, we favor the use of push enteroscopy in Lynch syndrome.

BackgroundLynch syndrome has not traditionally been considered to have a high colorectal adenoma burden. However, with increasing adenoma detection rates in the general population, the incidence of adenoma detection in Lynch syndrome may also be increasing and leading to higher cumulative adenoma counts.AimTo clarify the prevalence and clinical impact of multiple colorectal adenomas (MCRA) in Lynch syndrome.MethodsA retrospective review of patients with Lynch syndrome at our institution was performed to assess for MCRA (defined as ≥10 cumulative adenomas).ResultsThere were 222 patients with Lynch syndrome among whom 14 (6.3%) met MCRA criteria. These patients had increased incidence of advanced neoplasia (OR 10, 95% CI: 2.7-66.7).ConclusionsMCRA is not unusual in Lynch syndrome and is associated with a significantly increased likelihood of advanced colon neoplasia. Consideration should be given to differentiating colonoscopy intervals based on the presence of polyposis in Lynch syndrome.