Proton Pump Inhibitors (PPI) are one of the most prescribed medications in the United States. However, PPIs have been shown to increase the risk of enteric infections. Our study aims to evaluate the correlation between PPI and COVID-19 severity. We performed a retrospective cohort study on patients who tested positive for SARS-CoV-2 from March to August 2020. Patients were categorized based on PPI user status. Primary outcomes included need for hospital or ICU admission and 30-day mortality. Secondary outcomes looked to determine the severity of COVID-19 infection and effect of comorbid conditions. 2,594 patients were reviewed. The primary outcomes of our study found that neither active nor past PPI use was associated with increased hospital admission or 30-day mortality following completion of multivariate analysis. Additionally, there was no association between COVID-19 infection and the strength of PPI dosing (low, standard, high). However, the following covariates were independently and significantly associated with increased admission: age, male gender, diabetes, COPD, composite cardiovascular disease, kidney disease, and obesity. The following covariates were associated with increased mortality: age, male gender, COPD, and kidney disease. In conclusion, the high risk features and comorbidities of PPI users were found to have a stronger correlation to severe COVID-19 infection and poor outcomes as opposed to the use of PPI therapy.

Bouveret syndrome (BS) is an extremely rare form of gallstone ileus where a stone travels through a biliaryenteric fistula and causes gastric outlet obstruction. A 92-year-old male presented with gastric outlet obstruction secondary to an impacted gallstone in the duodenal bulb seen on imaging. Endoscopic therapy failed twice due to the immense gallstone size, and an open gastrotomy was required to remove the stone. The procedure was successful; however, the patient, unfortunately, passed away days after the operation due to other hospital illnesses. BS should be considered in patients with advanced age and significant comorbidities presenting with gastric outlet obstruction.

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Neurofibromas are benign nerve sheath tumors commonly associated with Neurofibromatosis type 1 (NF1). In patients without the diagnosis of the NF1, these lesions are referred to as solitary neurofibromas. Gastrointestinal involvement is exceedingly rare in NF1 and can manifest in a variety of different ways. This case report involves a 50-year-old hispanic female with an isolated neurofibroma of the perianal region in the absences of any medical or family history of NF1. Since there are very few cases of solitary neurofibromas reported in literature, it is important to document such cases and follow patients with this disease closely given that it can be an initial presentation of NF1 and because of its possible malignant potential.

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