Troy Gastroenterology

ABSTRACTHeterotopic ossification (HO) following distal biceps tendon repair is an uncommon but potential complication. This may present pain, limited range of motion, or sensory changes due to nerve compression. This case study reports the case of a patient who developed significant functional limitation after primary distal biceps tendon repair complicated by heterotopic ossification. Radiographs confirmed extensive ossification surrounding the radial tuberosity. Plain radiographs were obtained to confirm the presence and maturity of the HO; a CT scan was performed to delineate the extent and proximity to the neurovascular bundle for operative planning. Surgical revision was performed using an Achillies tendon allograft to reconstruct the distal biceps tendon while excising the ossified tissue. Postoperatively, the patient experienced marked improvement in motion and resolution of pain. No recurrence was observed at follow‐up. This case emphasizes the importance of early recognition of heterotopic ossification after tendon repair and demonstrates that timely revision with an Achillies allograft can effectively restore elbow function and minimize recurrence.

ABSTRACTCeliac disease (CeD) has been linked to both autoimmunity and chronic liver disease, but most data on the link to primary biliary cholangitis (PBC) originate from small studies and have yielded conflicting results. A systematic search was performed in the databases of Medline, Embase, Cochrane and Web of Science Core Collection for studies published between 1990 and 2024, using search terms related to CeD, gluten and PBC. The search identified 2016 publications, of which 94 were read in full text. Of these, a total of 25 studies were included in this review, with 22 deemed relevant for meta‐analysis. We applied a random effects model to estimate the weighted pooled prevalence along with corresponding 95% confidence intervals (CIs). Results were reported in accordance with the PRISMA guidelines. Our main analysis contained 15 006 individuals with PBC from 22 studies. Among these, 286 (1.9%; 286/15174) had a CeD diagnosis yielding a pooled prevalence of 1.71% (95% CI: 1.08–2.44). When restricting the analysis to 15 studies with biopsy‐confirmed CeD, the pooled prevalence was 1.53% (95% CI: 0.51–2.91). This prevalence is comparable to the serology‐based prevalence of CeD, of around 1%, in the general population. Our findings suggest that the prevalence of CeD in PBC is similar to that observed in the general population. These findings do not support routine screening for CeD in individuals with PBC.

The current consensus guideline offers a comprehensive and practical guidance on the diagnostic and monitoring of patients with inflammatory bowel disease (IBD). It provides recommendations on requirements for initial diagnosis, detection of complications, the use of monitoring tools in patients with IBD and diagnostics in specific situations, such as pregnancy, postoperatively and for cancer surveillance. The guideline is a joint project of the European Crohn's and Colitis Organization (ECCO), the European Society of Gastrointestinal and Abdominal Radiology, the European Society of Pathology, and the International Bowel Ultrasonography Group under the leadership of ECCO.

A 66-year-old female patient presented with hematemesis. Esophagogastroduodenoscopy (EGD) revealed a 30 mm solitary polyp in the middle part of the stomach. The bleeding source was not identified. Contrast-enhanced CT showed a 30 mm mass in the stomach. The area surrounding the mass was well enhanced in the arterial phase, suggesting possible bleeding from this area.

This chapter provides a comprehensive overview of edge computing architecture, categorizing its components into on-premises edge, network edge, and data center edge, each representing a unique deployment approach. Through collaboration with cloud and peripheral devices, edge computing enables powerful data processing, caching, storage, and efficient content delivery. The chapter also examines four collaborative models within edge computing: edge-to-edge, edge-to-device, edge-to-cloud, and cloud-edge-device, each enhancing interoperability across various layers. Finally, the chapter emphasizes the importance of network integration in supporting smooth data flow and communication in distributed systems, highlighting how strategic model selection can optimize system performance.

We commend Dr Ananthakrishnan [1] for highlighting the clinical implications of our findings of an increased risk of major adverse cardiovascular events after coronary intervention in patients with inflammatory bowel disease (IBD) [2]. In patients with IBD, chronic inflammation is widely recognised as the key driver in the pathogenesis of cardiovascular disease (CVD) and recurrent cardiovascular events. Therefore, effective management of inflammation would be the optimal therapeutic approach to reduce the risk. To complicate matters, some novel targeted therapies have shown adverse cardiovascular side effects, and it is currently unknown whether the side effects of modern IBD therapies might even outweigh their anti-inflammatory benefits. In addition, these observations were made in the context of IBD-ologists already recommending lifestyle changes, including smoking cessation, a healthy diet and physical activity, as a means of reducing disease activity in IBD. But do we really spend enough time counselling patients about relevant CVD risk factors, or do we focus primarily on IBD-related symptoms? While there is no urgent need for IBD-ologists to attain a second specialty in cardiology, it is essential to apply a systematic CVD risk assessment in clinical practice and refer high-risk patients to cardiologists at an early stage. We need to raise awareness among both patients and healthcare professionals that patients are much more likely to die from cardiovascular causes than from IBD itself. It is time to incorporate a systematic approach to CVD risk assessment and management into daily clinical care. Optimal treatment goals should include not only achieving clinical remission, but also reducing CVD risk through effective primary prevention measures. CVD-preventive therapies could even serve as adjunctive treatments in IBD. Statins may reduce the risk of colorectal cancer [3] and improve disease outcomes in patients with IBD [4]. In addition, European guidelines for the management of chronic coronary syndromes advocate the use of anti-inflammatory treatments, such as colchicine, and individualisation of the optimal duration of dual antiplatelet therapy after percutaneous coronary intervention [5]. Despite the robust evidence of increased CVD risk in IBD, further mechanistic studies are needed to disentangle the risk attributed to inflammation and IBD therapies. In addition, studies are needed to estimate the individual contributions of smoking, BMI, lipid profiles, diet, physical activity and duration of dual antiplatelet therapy after coronary interventions to the elevated risk of CVD events in IBD. While there are specific guidelines [6] on how to manage CVD risk in other chronic inflammatory diseases such as rheumatoid arthritis, there is a lack of guidance on CVD risk management in IBD. The evidence base is now sufficient to support updating guidelines with recommendations on how to assess and manage CVD risk in patients with IBD. We urge a concerted effort to increase awareness of the CVD risk among IBD-ologists, primary care physicians and cardiologists not only to achieve disease remission in the gut but also to maintain a healthy heart. F.E., R.E. and A.F. jointly drafted and edited this editorial. F.E. has served as an advisory board member for Boehringer Ingelheim. A.F. has served as a speaker and advisory board member for Janssen Cilag Ab and Tillotts Pharma. This article is linked to Ebrahimi et al. papers. To view this article, visit https://doi.org/10.1111/apt.70162 and https://doi.org/10.1111/apt.70177. No new data was generated in this article.