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Inflammatory fibroid polyps are rare mesenchymal lesions. The frequency of Helicobacter pylori infection in the gastric mucosa overlying inflammatory fibroid polyps and its relation with the histologic features of the polyps are undetermined. The clinico-pathological features of inflammatory fibroid polyps, the frequency of Helicobacter pylori infection in the overlying gastric mucosa, and its putative impact on the phenotype of the polyps were evaluated. Gastric inflammatory fibroid polyps diagnosed in our Hospital from 1998 to 2012 were reviewed and the histological. The histological sections were stained with hematoxylin and eosin and modified Giemsa for the evaluation of Helicobacter pylori infection. Inconclusive cases were further analyzed by immunohistochemistry with anti-Helicobacter pylori antibody. Diagnosis was confirmed in 54 polyps, 85 % developed in females, mean age 63 ± 11 years. Most polyps were sessile (74 %), with a mean size of 15 ± 12 mm, 96 % were located in the antrum and 85 % were removed by snare polypectomy. Helicobacter pylori infection was identified in 48 % of the polyps. Most inflammatory fibroid polyps developed in the submucosa, and mucosal extension was observed in 96 % of the cases. Chronic gastritis was observed in all cases (63 % with activity, 31 % with intestinal metaplasia, and 61 % with foveolar hyperplasia). Erosion and ulceration of the overlying gastric mucosa was observed in 48 % and 11 % of the polyps, respectively. Onion skin features were present in 52 % of the polyps and were more frequently observed in cases without evidence of Helicobacter pylori infection. Background changes in gastric mucosa were not distinctive according to Helicobacter pylori infection. Chronic atrophic gastritis with intestinal metaplasia was associated with the presence of perivascular onion skin lesions. To our knowledge, this is the second largest series of gastric inflammatory fibroid polyps. Helicobacter pylori infection was identified in about half of the cases and was associated with a lower frequency of onion skin features in the polyps.

Clinicians are increasingly facing the decision of performing anal cancer screening in high-risk groups. Anal cytology is commonly the first approach. We systematically reviewed recommendations favoring anal cytology for anal cancer screening. Three databases were searched: PubMed, Scopus, and Embase, from January 2007 to 12 September 2019. The references cited by the retrieved articles and the websites of relevant organizations were also searched without language restrictions. Studies reporting guidelines from regional or national societies, institutes, or groups were included. Eight papers met the inclusion criteria and were selected, five were from the United States of America (USA) and three from Europe. There were no national recommendations published. There was one guideline specifically for solid-organ transplant recipients. The other seven targeted HIV-positive patients, with HIV-positive men who have sex with men (MSM) included as a screening group in all of these. Two recommendations favored screening in all HIV-positive patients. Five recommendations targeting HIV-positive patients made considerations about the cytology follow-up, recommending at least annual cytology in case of a normal result, and in case of squamous cytological abnormalities, a referral for anoscopy/high-resolution anoscopy. There were no recommendations for upper and lower age limits for screening. In conclusion, several societies recommend anal cancer screening using anal cytology in HIV-positive MSM patients. There is a lack of screening recommendations for other high-risk groups, with only one society recommending screening in transplant recipients.

Background: Canine leishmaniasis, a zoonotic disease caused by Leishmania infantum vectored by phlebotomine sand flies, is considered a relevant veterinary and public health problem in various countries, namely in the Mediterranean basin and Brazil, where dogs are considered the main reservoir hosts. Not only diseased dogs but also those subclinically infected play a relevant role in the transmission of L. infantum to vectors; therefore, early diagnosis is essential, under both a clinical and an epidemiological perspective. Molecular tools can be a more accurate and sensitive approach for diagnosis, with a wide range of protocols currently in use. The aim of the present report was to compare four PCR based protocols for the diagnosis of canine Leishmania infection in a cohort of dogs from the Douro region, Portugal. Results: A total of 229 bone marrow samples were collected from dogs living in the Douro region, an endemic region for leishmaniasis. Four PCR protocols were evaluated for Leishmania DNA detection in canine samples, three single (ITS1-PCR, MC-PCR and Uni21/Lmj4-PCR) and one nested (nested SSU rRNA-PCR). Two of the protocols were based on nuclear targets and the other two on kinetoplastid targets. The higher overall percentage of infected dogs was detected with the nested SSU rRNA-PCR (37.6%), which also was able to detect Leishmania DNA in a higher number of samples from apparently healthy dogs (25.3%). The ITS1-PCR presented the lowest level of Leishmania detection. Conclusions: Nested SSU rRNA-PCR is an appropriate method to detect Leishmania infection in dogs. Accurate and early diagnosis in clinically suspect as well as apparently healthy dogs is essential, in order to treat and protect animals and public health and contribute to the control and awareness of the disease. publishersversion published

To evaluate anal sphincter abnormalities detected by endoanal ultrasound in obstructed defecation due to rectocele and rectal intussusception.The retrospective analysis includes 45 patients with obstructed defecation syndrome due to rectocele and/or rectal intussusception with or without fecal incontinence, and submitted to endoanal ultrasound.Ninety-three percent (n = 42) were women (mean age of 63 ± 12 years), and 47% (n = 21) of the patients had fecal incontinence. In total, 29% (n = 13) had a previous anorectal surgery, and 93% (n = 39) of the women had a previous vaginal delivery. An isolated rectal intussusception was diagnosed in 20% (n = 9) of the patients, an isolated rectocele in 24% (n = 11), and rectal intussusception and rectocele in 56% (n = 25). Thirty-six percent of patients had anal sphincter lacerations (n = 16): 12% (n = 2) had only internal laceration, 69% (n = 11) had only external laceration, and 19% (n = 3) had both. Two patients had a thinner internal anal sphincter with 0.9 and 1.2 mm, respectively. In total, 25% of the patients without fecal incontinence had an occult anal sphincter laceration, and all were women with an external sphincter laceration in the anterior quadrant and a previous vaginal delivery. In patients with obstructed defecation and fecal incontinence, 48% had sphincter lacerations. Previous anorectal surgery was a predictor of anal sphincter laceration (odds ratio [OR] 4.8; 95% confidence interval [CI] = 1.214-18.971; P = .025), but fecal incontinence (OR 2.7; 95% CI = 0.774-9.613; P = .119) and previous vaginal delivery (OR 1.250; 95% CI = 0.104-15.011; P = .860) were not.Endoanal ultrasound should be considered in obstructed defecation with or without fecal incontinence, especially if surgical correction is planned.

A 59-year-old female was admitted due to the suspicion of food impactation after having eaten bread. An upper endoscopy revealed an indeterminate, bluish foreign body in the mid esophagus that was extracted with a forceps. After removal, it was clear that it was a puzzle piece. The patient then recalled that she had been playing with a puzzle with her granddaughter, while eating bread.

Inflammatory fibroid polyp of the gastrointestinal tract is a rare, benign neoplasm, most frequently located in the gastric antrum. Symptoms depend on the location and the size of the lesion. Biopsies are limited for the diagnosis of inflammatory fibroid polyps and diagnosis may not be possible until resection. The authors present a case of a 55-year-old woman, presenting with an upper gastrointestinal bleeding due to a large gastric inflammatory fibroid polyp imitating a gastrointestinal stromal tumor.

Primary internal anal sphincter degeneration was first described in 1997 by Vaizey et al. as a cause of passive faecal incontinence (FI), and was diagnosed in 3.5% of the patients with FI [1]. It was defined as the presence of thin and hyperechogenic internal anal sphincter (IAS), intact anal sphincters, passive FI, and low anal pressure at rest. In addition, external anal sphincter (EAS) was structural and functionally normal, neurological dysfunction and all other possible causes of FI were excluded. This article is protected by copyright. All rights reserved.

Liver abscesses are very rare complications of ulcerative colitis, with only nine cases described in the literature, to our knowledge. We report a case where a recurrence of liver abscess occurred in an ulcerative colitis patient, in two different hepatic lobes, which has not been previously described. The recurrence was in the caudate lobe having the cultures yielded Staphylococcus aureus . This is also the first case report of liver abscess in this location and caused by this microorganism in an ulcerative colitis patient. A review of the literature concerning liver abscesses involving ulcerative colitis patients is also provided.

Background: Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn’s disease. Aims: To evaluate the predictive factors of small bowel patency in Crohn’s disease patients. Patients and methods: Retrospective analysis including 151 Crohn’s disease patients submitted to patency capsule (Agile® Patency Capsule) from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention), other patients were considered to have negative patency of the small bowel (patency capsule retention). Results: Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention). In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn’s disease patients were stricturing (OR 10.16, p < 0.001) and penetrating phenotypes (OR 11.73, p = 0.001), left-sided colonic lesions (OR 3.77, p = 0.038), ileal stricture (OR 9.76, p = 0.003); previous intestinal surgery was found to be protective (OR 0.16, p = 0.006). Conclusions: Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn’s disease patients.

A 65-year-oldman presented to the emergency department with a foreign body in his rectum. He had inserted a Cuban cigar case into his anus approximately 9 hours before admission. The case had no sharp edges, and its cap was on. The patient’s abdomen was soft and not distended. Abdominal radiography showed a long, radiopaque, cylindrical foreign body in the rectum and sigmoid (●" Fig.1), with no signs of perforation. Proctosigmoidoscopy, performed without sedation, confirmed the presence of the object (●" Fig.2). Several attempts were made to remove it with a polypectomy snare, but the foreign body was very long and inflexible, so that it could not pass through the acute angle of the rectosigmoid junction. An esophageal overtube was then introduced up to the proximal edge of the cylindrical case, reducing the angle of the rectosigmoid junction so that the distal tip of the case could be disimpacted (●" Video 1). With its distal tip fixed by a polypectomy snare, the foreign body was moved to the distal rectum and finally removed with manual assistance (●" Fig.3). Afterward, the endoscope was removed, and no complication followed the procedure. The patient was asymptomatic at discharge. Retained rectal foreign bodies are not uncommon and often present a management dilemma [1,2]. Frequently, hospital admission is delayed until after several efforts have been made to remove the object at home [1]. Extraction can be difficult, and severe complications may occur [1]. Low-lying foreign bodies are usually palpable on digital rectal examination and can often be removed manually [3]. High-lying foreign bodies are located proximally to the rectosigmoid junction, and proctosigmoidoscopy is required for removal [3,4]. Surgery should be reserved for unstable patients, those with perforation, and those in whom transanal attempts at removal have failed [1]. To the best of our knowledge, no previous cases in which this technique was used have been described. The use of an overtube can straighten the colorectum, facilitating the removal of a rectal foreign body.

Background and study aims: One of the indications for capsule endoscopy (CE) is the detection of proximal small bowel (SB) involvement in Crohn's disease (CD) patients. Our aim was to assess clinical, laboratory and endoscopic predictors associated with proximal SB involvement in CD patients submitted to CE. Patients and methods: Retrospective multicenter study in which Lewis score (LS) was systematically determined in 190 CE of patients diagnosed with CD between 2003 and 2014. Results: Significant inflammatory activity (LS > 135) was present in 23 % of the patients in the first tertile and in 31 % of the patients in the second tertile. Albumin, haemoglobin, and total proteins were significantly lower in patients with a LS > 790 compared to patients with a LS 0.249 predicts proximal SB involvement with 90 % sensitivity and 40 % specificity (AUROC 0.732). Conclusions: One-third of patients had proximal SB involvement. Predictive factors were significant weight loss, stricturing behaviour, and ileal involvement at ileocolonoscopy. These data help to select CD patients that benefit the most from performing a CE.

Leishmaniasis is among the world's most neglected diseases. Currently available drugs for treatment present drawbacks, urging the need for more effective, safer, and cheaper drugs. A small library of artemisinin-derived trioxanes and synthetic trioxolanes was tested against promastigote and intramacrophage amastigote forms of Leishmania infantum . The trioxolanes LC50 and LC95 presented the best activity and safety profiles, showing potential for further studies in the context of leishmanial therapy. Our results indicate that the compounds tested exhibit peroxide-dependent activity.

High-resolution anoscopy (HRA) is a procedure where patients with an increased risk of anal cancer, like men who have sex with men, human immunodeficiency virus infected individuals, transplant patients and women with a history of lower genital tract neoplasia, with abnormal anal cytology results, are submitted to anal and perianal visualization under magnification. This will allow for a better detection of anal high-grade lesions that can be treated, in an effort to prevent anal cancer. Anal cancer screening follows the same principles that cervical cancer screening. During this procedure, an anoscope is inserted and a colposcope is used to examine systematically the squamocolumnar junction, the transformation zone and the perianal skin. Initially the observation is done with no staining and then with the application of acetic acid and Lugol’s iodine solution, allowing for better lesion identification and characterization. Any suspicious lesion seen should be carefully evaluated and biopsied. Without HRA only a small percentage of suspicious lesions are identified. High-grade lesions that are detected can be ablated under HRA. This is a challenging exam to perform, with a long learning curve and the number of clinicians performing it is limited, although the growing number of patients that need to been screened. Specific equipment is required, with these patients ideally been followed by a multidisciplinary team, in a reference centre. HRA remains unfamiliar for many gastroenterologists.

A 41-year-old man, on tuberculostatic treatment for three months for disseminated tuberculosis, developed a tuberculous esophagomediastinal fistula, which was successfully closed with endoscopic clips. Use of endoscopic clips in esophageal perforations and closure of fistulas following surgical complications has been described, but to our knowledge there are no previous reported cases of tuberculous esophagomediastinal fistulas managed with clipping. In this case, endoscopic clips associated with tuberculostatic treatment were crucial allowing fistula closure in a symptomatic patient. © 2013 Sociedade Portuguesa de Gastrenterologia Published by Elsevier Espana, S.L. All rights reserved.

We report a case of a cirrhotic patient who developed a spontaneous bacterial empyema due to Clostridium perfringens. To our knowledge, only two cases of spontaneous bacterial empyema due to C. perfringens in cirrhotic patients were previously reported in literature. It should be suspected in a Child C cirrhotic patient, with a previous history of pleural effusion, fever and dyspnea. It has a fatal outcome as far as it has been described.

The efficacy of tumor necrosis factor alpha (TNF-α) inhibitors in the treatment of Inflammatory Bowel Disease (IBD) is well established. Many cutaneous and mucosal lesions have been described under anti-TNF-α therapy, some of them being considered as paradoxical. In this series we aimed to review the cases of oral lichen planus (OLP) in IBD patients under treatment with anti-TNF-α agents. Histologic findings from oral lesions of IBD patients treated with anti-TNF were revised. Three female patients with IBD developed oral lichen planus (OLP) after starting anti-TNF-α therapy. Other etiologies were excluded. In light of the increasing use of TNF-α inhibitors the occurrence of OLP is a potentially emerging side effect, thus we recommend a careful monitoring for oral manifestations in IBD patients treated with anti-TNF-α agents.

Fecal incontinence has a profound impact in a patient’s life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100% sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter. The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely, there is currently no evidence to support the use of elastography in fecal incontinence evaluation.

Summary of the features of metastatic cutaneous Crohn’s disease of the face based on eight case reports available in the published literature SexAge(years)MontrealclassificationActivity orremissionTreatment of CDbefore MCDTemporal relationshipbetween MCD and CDYears of CDevolutionLocation ofMCD on the faceTreatmentof MCD Type of lesionCasereferencesMale 31 A2L2NDp Activity Azathioprine andmethylprednisoloneAfter diagnosisof CD9 Temporal+submandibularOral mesalazine, oralmethylprednisolone, andsulfasalazine 3% oimenton the skinPlaques [1]Female 45 ND ND Infliximab ND ND Malar+supraorbitary ND Erythematous plaques [2]Male 16 A1L3ND Remission? Prednisone, 6-MPand olsalazineAfter diagnosis of CD 3 Chin+malar+perioral Prednisone and dapsone Papulonodular [3]Female 63 A2L2B3 Remission Infliximab After diagnosis of CD 30 Chin+malar+perioral Infliximab, ciprofloxacin, andtopical steroidsErythema+ulceration [4]Female 35 A2L3B3 Remission Totalproctocolectomywith ileostomyNo medicationAfter diagnosis of CD 5 Forehead None Erythematous [7]Female 44 A2L3ND Remission? ND After diagnosis of CD 17 Malar Topical flucinolone acetonide0.01% creamErysipela-like plaque [8]Female 44 A2L3B2 Activity ND After diagnosis of CD 22 Perioral region Oral sulfasalazine Erythematous plaques [9]Male 36 A2L2 NDp Activity Sulfasalazine After diagnosis of CD 14 Chin Intralesional triamcinolone Erythematous nodulesand plaques[10]CD, Crohn’s disease; MCD, metastatic Crohn’s disease; ND, not described.

The triticale cultivar BRS Minotauro was developed by the Brazilian Agricultural Research Corporation Embrapa. It is a result of a cross of Brazilian wheat and rye with hexaploid triticale. BRS Minotauro is hexaploid, has a medium cycle, medium to tall plant stature, adapts extremely well to cultivation conditions in the south of Brazil, with an average grain yield of 3,790 kg ha -1 , i.e., 9% higher than the mean yield of the controls, and has a high yield stability in different environments.

Dear Editor: The authors report a case of a 54-year-old woman who was admitted in the emergency department due to severe anal pain. She referred that this pain started after she had eaten chicken bones 4 days before. She also complained of obstructed defecation and the presence of small hard bones in the stools. The perianal area was ulcerated and very painful. On digital examination, small bones were palpable in the stools. No signs of perforation were found on the plain abdominal radiograph. A proctosigmoidoscopy showed stools with multiple small bone fragments in the rectum (Fig. 1) and signs of ischemia of the distal rectum and anal canal mucosa due to the previous impaction of these fragments (Fig. 2a, b). Some large bones were removed during proctosigmoidoscopy, but it was impossible to remove all. The patient was admitted in the surgical ward, and symptoms progressively improved, with subsequent mucosa healing and passage of the bones in the stools. She was discharged 5 days later. Rectal foreign bodies often represent a difficult diagnostic and management dilemma. Although the majority is inserted through the anal canal, in rare cases, it results from an orally ingested object that becomes impacted in the rectum [1]. Patients may be asymptomatic or present with abdominal pain, rectal bleeding or pain, and constipation. Though most objects pass without incident, complications can arise following ingestion of foreign body. Ischemia of the rectum is very rare due to its extensive collateral blood supply, but hard objects pressing constantly against a particular area of the bowel wall may decrease the capillary perfusion pressure and, if prolonged, it may induce ischemic lesions [2].

Introduction: The role of Capsule Endoscopy (CE) in patients with established Crohn's Disease (CD) is not fully determined. Identification of predictive factors of small bowel disease may help the selection of patients that could benefit from CE. Aims and Methods: Evaluate whether clinical parameters, biomarkers, laboratory and endoscopic findings correlate with the presence of small bowel lesions in patients with CD. A transversal and multicentric study was carried out including patients with CD submitted to CE between 2003 and 2013. Data was analyzed using Pearson Chi-Square, Fischer's exact test, Mann-Whitney, Kruskal-Wallis and logistic regression as appropriate. Lewis score was calculated in all procedures. Results: One hundred and ninety patients with established CD were included, being 57% female. According to Montreal classification, 75% had diagnosis between 17 and 40 years-old (A2), 43% had ileal disease (L1) and the majority (75%) had non-stricturing non-penetrating disease (B1). Hemoglobin levels were significantly lower (p=0.006) in patients with higher Lewis score (>790) comparing with those with lower scores, although those differences were clinically insignificant (median 13.1 vs 13.9 g/dL). Similarly, albumin was lower (41 vs 45 mg/dL, p

Rye cultivar BRS Serrano was developed by Embrapa. It resulted from a cross between the rye populations Garcia and Bage. BRS Serrano attains high dry matter yield as forage plant and high grain yields

Background: Inflammatory bowel disease (IBD) is associated with a higher prevalence of opportunistic infections. Epstein–Barr virus (EBV) is a ubiquitous virus related to several malignancies, namely lymphoma; its prevalence in patients with IBD and its relation with different therapeutic regimens are not well studied. Methods: Patients followed in our IBD outpatient clinic were consecutively enrolled for participation in a prospective study, and healthy volunteers were recruited as controls. EBV DNA was measured at least 1 time in each patient. Results: Three hundred and seventy-nine individuals were enrolled in the study (93 treated with 5-aminosalicylates, 91 with azathioprine, 70 with infliximab, 43 with combined treatment with infliximab and azathioprine, and 82 controls). More than 90% of the patients had previous EBV exposure. EBV DNA was found in 132 samples (35%); its prevalence was significantly higher in every group of patients with IBD, comparing to controls. Among patients with IBD, infliximab with or without azathioprine was related to higher prevalence of EBV comparing to azathioprine alone or 5-aminosalicylates (P , 0.05). Age above 60 years was related to EBV DNA positivity with a specificity of 92%. Concerning treated groups, ulcerative colitis was the only risk factor identified for high levels of EBV DNA (.1000 and 2500 copies per milliliter). No relationship was found between EBV and C-reactive protein. Conclusions: IBD is a risk factor for the presence of EBV DNA in blood, particularly in older patients and in those taking infliximab. C-reactive protein was not related to EBV DNA prevalence. (Inflamm Bowel Dis 2013;19:1710–1716)

Rectal Calcified Fibrous Tumor Diagnosed After Endoscopic Submucosal Dissection of a Suspected Neuroendocrine Tumor

Transperineal ultrasound is an inexpensive, safe and painless technique that dynamically and non-invasively evaluates the anorectal area. It has multiple indications, mainly in urology, gynaecology, surgery and gastroenterology, with increased use in the last decade. It is performed with conventional probes, positioned directly above the anus, and may capture images of the anal canal, rectum, puborectalis muscle (posterior compartment), vagina, uterus, (central compartment), urethra and urinary bladder (anterior compartment). Evacuatory disorders and pelvic floor dysfunction, like rectoceles, enteroceles, rectoanal intussusception, pelvic floor dyssynergy can be diagnosed using this technique. It makes a dynamic evaluation of the interaction between pelvic viscera and pelvic floor musculature, with images obtained at rest, straining and sustained squeezing. This technique is an accurate examination for detecting, classifying and following of perianal inflammatory disease. It can also be used to sonographically guide drainage of deep pelvic abscesses, mainly in patients who cannot undergo conventional drainage. Transperineal ultrasound correctly evaluates sphincters in patients with fecal incontinence, postpartum and also following surgical repair of obstetric tears. There are also some studies referring to its role in anal stenosis, for the measurement of the anal cushions in haemorrhoids and in chronic anal pain.

Rubber band ligation is one of the most important, cost-effective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vaso-vagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier's gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis.

Celiac hepatitis is characterized by the presence of liver injury in patients with celiac disease that resolves after gluten-free diet.To evaluate predictive factors of celiac hepatitis at celiac disease diagnosis.Retrospective study including 46 adult patients with the diagnosis of celiac disease.Eighty-seven percent were women, with a mean age of 33 ± 11 years, 87% had a Marsh 3 and 46% (n = 21) had celiac hepatitis. These patients had a median Immunoglobulin A anti-tissue transglutaminase antibody (TTG-IgA) level of 208.0 U/ml (p25-p75: 89-1316 U/ml), a mean aspartate aminotransferase of 42 ± 24 U/L, alanine aminotransferase 50 ± 28 U/L, alkaline phosphatase 111 ± 64 U/L, at the time of diagnosis. Median TTG-IgA one year after diagnosis was 9U/ml (p25-p75: 4.5-30.5 U/ml) and 33% of the patients had normal values. At diagnosis, patients without celiac hepatitis had a median TTG-IgA of 77U/ml (p25-p75: 24-288 U/ml), mean aspartate aminotransferase of 23 ± 4 U/L, alanine aminotransferase 20 ± 6 U/L, alkaline phosphatase 69 ± 17 U/L. Median of TTG-IgA one year after diagnosis was 6 U/ml (p25-p75: 3-19 U/ml) and 48% had normal values. The celiac hepatitis group patients had higher values of TTG-IgA (p = 0.007) at diagnosis. There was a statistically significant positive correlation between TTG-IgA and alanine aminotransferase (r = 0.324, p = 0.028) at diagnosis. The odds of having celiac hepatitis was almost 5-fold higher in patients with a TTG-IgA level higher than 310 U/ml (OR = 4.8, 95%CI = 1.213-18.781, p = 0.025).Higher TTG-IgA levels are a predictive factor for celiac hepatitis in adult patients with celiac disease at diagnosis.