Physicians with difficult patient scenarios regularly bring their questions to the AGA Community () to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Severe colitis in asymptomatic patient on screening colonoscopy ()
Check out an update on the forum’s most popular case, involving a 51-year-old male seen for a screening colonoscopy. Biopsied samples of patchy areas throughout the colon revealed severe active chronic colitis with lymphoplasmacytic infiltrate, crypts and crypt abscesses, and no granulomas.
2. Paraplegic colonic gas ()
Symptoms started 2 years ago for this 28-year-old paraplegic male, who was hospitalized with multiple episodes of postprandial abdominal bloating and pain. He has a permanent catheter and is on a diet mostly of meat and specific vegetables. His physician solicited the community for help with management of colonic gas and symptoms.
3. Small submucosal nodule and gastric intestinal metaplasia ()
The physician needs advice on next steps for a 55-year-old female who had an EGD for dyspepsia. Biopsies of a 1-cm nodule and surrounding areas revealed moderate chronic inactive gastritis with focal intestinal metaplasia and reactive hyperplastic changes with no dysplasia.
4. Perianal Crohn’s preceding luminal disease ()
This extensive case of a 16-year-old female started with severe constipation, until she developed a painful abscess on the right perianal region. Perianal fistula with abundant granulation tissue and mucoid discharge was noted, and biopsies revealed inflammation with fibrosis, giant cell reaction, and granulomatous inflammation. This past summer, an MR enterography and pelvic MRI revealed a small right perianal intersphincteric fistula with possible drainage through the skin.
More clinical cases and discussions are at