Showing papers in "Open Journal of Gastroenterology in 2013"

Predictors of early rebleeding and mortality after acute variceal haemorrhage in patients with cirrhosis

Abstract: The upper gastrointestinal bleeding from esophageal or gastric varices is the most dangerous complication of portal hypertension. The purpose of this study was to identify the predictors of early rebleeding and mortality after a bleeding episode. Patients and Methods: It was a retrospective study including 215 patients admitted in our department of hepatology and gastroenterology at the Hassan II University Hospital of Fez, from January 2001 to January 2010. Results: The mean age of our patients was 51 years. Thirty percent of patients had cirrhosis due to virus (B or C). The majority of patients (79%) had only esophageal varices. Fifty patients (23%) had a bleeding recurrence. Twenty-five patients (11.5%) died during the first ten days, of which 52% had presented rebleeding (p = 0.01). In 30% of cases, the rebleeding was secondary to a fall of pressure ulcers. Univariate analysis showed that early mortality of patients was significantly associated with advanced age (p = 0.018), low prothrombin time (PT) (p = 0.022), low serum sodium (p = 0.03), low platelet count (p = 0.05), and elevated transaminases (p = 0.02). Conclusion: The survival of cirrhotic patients after a bleeding episode was influenced by advanced age, a low rate of PT, of serum sodium, and of the platelet count, and elevated transaminases.

Prevalence of the hepatitis B surface antigen in a population of workers in Cameroon

Abstract: Hepatitis B surface antigen prevalence in populations of blood donors in Cameroon is estimated at 6%-16%. As such, the Objective of this study was to determine the prevalence of Hepatitis B surface antigen in a population of bank employees, who represent a sample closer to the general population. In tests carried out both Yaounde and Douala in December 2011, we detected the hepatitis B surface antigen among 267 workers, including 151 men and 116 women of a median age of 37 years. The Results obtained revealed that the overall prevalence stood at 7.1%, with a 9.9% prevalence ratio in men, three times higher than that in women (3.4%). Subjects aged 20-29 years and senior staffs were more affected (each of them recording 8.1%). Potential nosocomial risks were detected mostly at the level of dental care (52.8%). Among the other risks of exposure, scarification (53.6%) was more frequent. A univariate analysis revealed an insignificant relationship with tattoos (OR 2.6, 95% CI 0.5-10.8, p = 0.2). These results led to the Conclusion that Hepatitis B surface antigen carrier prevalence in a population of workers in Cameroon is not different from that of blood donors. It is mainly due to early vertical and horizontal contamination.

Anti free radical & anti inflammatory effect of rebamipide in chronic gastritis

Abstract: Background/Aim: Free radicals have a role in the development of chronic gastritis. The aim of this study to know the effect and efficacy of rebamipide on free radicals in chronic gastritis. Method: Forty five patients in the division gastroenterology Cipto Mangunkusumo Hospital Jakarta 2009-2010 with moderate and severe gastritis endoscopically were included in this study. Before and after rebamipide treatment the patient were performed endoscopical examination and were taken 5 biopsies for histopathological examination and free radicals (MDA & Carbonyl Compound) examination. All patients were given rebamipide 100 mg three times a day for 28 days. Data were analyzed with t test or wilcoxon signed rank test. Exclusion: GERD, Peptic ulcer, PPI treatment, NSAID consumption etc. The symptoms were recorded on day-0 and day-28. The severity symptoms were measured by VAS. Result: The mucosal damage on day-0 was 2.268 ± 0.45 vs day-28 was 1.707 ± 0.78 (P P = 0.710) and corpus neutrophil: day-0: 0.12 ± 0.40 vs day-28: 0.07 ± 0.26 (P = 0.421). The mean endoscopical mucosal severity score was decreased significantly on day- 28 compared to day-0 (1.707 ± 0.78 vs 2.268 ± 0.45; P P = 0.047). The mean of carbonyl compound on day-0 was 4.14 ± 3.01 and on day-28 was 5.12 ± 2.71 (P = 0.642). Conclusion: Rebamipide significantly reduced the extend of symptoms associated with chronic gastritis. The improvement in symptoms was associated with the decreased of endoscopic severity score and the mean gastric mucosal malondialdehyde (MDA) significantly but not the histopathologic appearance and carbonyl compound.

Irritable bowel syndrome in Chinese nursing and medical school students—Related lifestyle and psychological factors

Abstract: Background: Previous studies have shown that the prevalence of irritable bowel syndrome (IBS) is 10% - 15% in the general population. IBS is a functional gastrointestinal disorder characterized by abdominal pain, abdominal discomfort and disordered defecation associated with a stressful lifestyle. However, the cause of IBS has not been clarified yet. Based on a similar, previous study in Japan, this study investigated the prevalence of IBS and the relationship between IBS and stress, lifestyle and dietary habits among nursing and medical school students in China. Methods: Designed to investigate IBS symptoms, life- style, dietary intake, life events, anxiety and depresssion, a blank self-administrated questionnaire was used to survey 2500 nursing or medical students in China. Questionnaires were collected from 2141 stu- dents (85.6%) and responses obtained from 1934 students (90.3%) were analyzed. Results: On the whole, the prevalence of IBS was 32.1% in this study, 26.6% in males and 33.6% in females. In females, the IBS group showed a bedtime later than that in the non-IBS group, and the length of time asleep in the IBS group was shorter than that in the non-IBS group (p p = 0.005). In females, the IBS group showed a frequency for the intake of vegetables and potatoes that was lower than that of the non-IBS group (p = 0.007, p = 0.023). The prevalence of IBS among nursing and medical school students in China (32.1%) was significantly lower than that in Japan (35.5%). Especially, the number of females in the constipation dominant IBS subgroup in China (11.8%) was less than that found in Japan (20.4%). Conclusions: The prevalence of IBS was high among nursing and medical students in China, but lower than that shown in Japan.

Insulin resistance with impaired fasting glucose increases the risk of NAFLD

Abstract: Background: Our aim was to investigate the frequency of elevated liver enzymes and NAFLD in patients with known insulin resistance during 15 years of follow-up. Methods: Subjects with insulin resistance were identified from a population-based prospective cohort study in Sweden, Malm? Diet and Cancer Study, conducted in 1991-1996. Inall, 285 non-diabetic subjects with insulin resistance established by HOMA-IR (homeostasis model assessment) were invited to do the liver function testing and if elevated, they should be further assessed by radiological examination of the liver, anthropometric measures and blood testing. Results: 165 subjects (57.9%) agreed to do the liver function testing. Of these, 25 subjects (15%) had elevated liver enzymes. After exclusion of other diseases, 5 of the remaining 21 subjects (23.8%) had radiological signs of steatosis. Liver steatosis significantly correlated with ALT (alanine aminotransferase) (p = 0.04), HOMA-IR (p = 0.00) and the metabolic syndrome (p = 0.03). 80% of the subjects with NAFLD had either developed type 2 diabetes mellitus or had impaired fasting glucose and 80% fulfilled the WHO-criteria for the metabolic syndrome, which were of significant differences to the group without NAFLD. Conclusion: The risk of developing elevated liver enzymes and NAFLD at long-term follow-up in insulin resistant subjects is not insignificant, but mainly associated with the simultaneous development of impaired fasting glucose, established diabetes mellitus and/ or the metabolic syndrome.

Helicobacter infection decreases basal colon inflammation, but increases disease activity in experimental IBD

Abstract: Background: Helicobacter species are best known for their roles in the pathology of gastritis; however, several Helicobacter species also colonize the intestine, and less is known about effects of Helicobacter on the development of intestinal inflammation. To evaluate contributions of Helicobacter in inflammatory bowel disease, we investigated whether and how pre-existing intestinal colonization would affect disease severity and biomarkers of inflammation in experimental IBD. Materials and Methods: Mice were infected with H. muridarum 2 weeks prior to induction of colitis mediated by 3% dextran sulfate (DSS). Disease activity index, stool blood and consistency, colon length, myeloperoxidase, histopathology, blood and lymphatic vessels, and numbers of dilated mucosal crypts were measured in control, DSS-only, H. muridarum-infected, and H. muridarum-infected + DSS mice. Results: Prior to DSS challenge, H. muridarum-infected mice showed little distal gut injury by several indices of colon inflammation with decreased blood vessel density in the submucosa, and lower lymphatic density in the mucosa and submucosa. However, after DSS colitis, H. muridarum-infected mice exhibited significantly greater disease. Weight change, stool bleeding, diarrhea, and angiogenesis were all increased in H. muridarum-infected mice in DSS colitis compared to DSS controls. Conclusions: Our data show that Helicobacter colonization of the intestine, unlike that of the stomach, lowers basal gut inflammatory scores, but increases disease activity and inflammation in an acute colitis model. Intestinal Helicobacter infection may therefore represent a significant sub-clinical factor which predisposes the gut to inflammatory injury.

Role of laparoscopy in diagnosis of peritoneal tuberculosis (About 414 cases)

Abstract: Peritoneal tuberculosis is still common in Morocco. Its diagnosis is based on several methods. Laparoscopy with directed biopsies is still considered as the referenced method. The aim of our work is to show the place and the importance of laparoscopy in the diagnosis of peritoneal tuberculosis through the study of various endoscopic aspects. Materials and Methods: This is a retrospective descriptive study extended from January 2001 to December 2011. We collected 414 cases of isolated ascites confirmed by ultrasonography. Different parameters were analyzed: epidemiological data, indications of laparoscopy and its results and complications. Results: The average age of our patients was 38 years (range: 8 years - 90 years) with a female predominance (sex ratio F/M: 2.3). Abdominal ultrasound performed in all patients has confirmed the presence of ascites in 100% of cases. Based on clinical data (soft or tense abdomen) and ultrasound (free or partitioned ascites), we performed a standard laparoscopy in 313 cases and open laparoscopy in 101 cases. The presence of granules was noted in 318 cases (76.8%). Peritoneal tuberculosis was found in 81.5% of cases with small whitish granulations distributed homogeneously, while peritoneal carcinomatosis was confirmed in 86.8% of patients with large granules distributed inhomogeneously. The presence of adhesions was observed in 33% of cases with peritoneal tuberculosis, while it was mentioned in only 2.8 cases of carcinomatosis. Conclusion: Despite the development of imaging means, ascitic fluid culture and PCR (polymerase chain reaction), laparoscopy remains indispensable for an early diagnosis of peritoneal tuberculosis and adequate management.

Prevalence of HBs Ag among blood donors in Transfusion Center, Abidjan (Ivory Coast)

Abstract: Aim: To study the prevalence of HBsAg among persons without risk factors for hepatitis B. Patients and Methods: Cross-sectional study (28 January to 31 December 2010) about 4310 new volunteers blood donors consecutively recruited. Among all, a risk factor for hepatitis B was investigated (standardized questionnaire and clinical examination). Blood of all blood donors without risk factors of hepatitis B (n = 3823) were systematically collected for HBsAg, hepatitis C antibody, syphilis serology and human immunodeficiency virus serology. The blood was analyzed with a third generation ELISA (Abbott Murex). Results: HBsAg was positive in 179 persons (4.68% [95% CI 4% - 5%]). It was associated with hepatitis C antibodies (0.28% (n = 11)), syphilis antibodies (0.68% (n = 26)) or anti-human immunodeficiency virus antibodies (0.2% (n = 8)). In multivariate analysis, age 30 to 39 years (1.545 [95% CI 1.074 to 2.222]), male sex (2.426 [95% CI 1.550 to 3.799]) and positive syphilis serology (14.344 [95% CI 5.161 to 39.865]) were associated with presence of HBsAg. Conclusion: The prevalence of HBsAg among adult without risk factors for hepatitis B was not negligible. Also, it is essential to maintain routine screening before any vaccination against hepatitis B in adult. Our study is not for an immunization against hepatitis B only targeting risk populations in adult.

Enhanced aquaporin 8 expression after subtotal colectomy in rat

Abstract: Background: Aquaporins (AQPs), the family of water-selective channels, are localized in various organs and tissues, including the gastrointestinal (GI) tract. However, the roles of AQPs in the GI tract remain unclear. Materials and Methods: Male SD rats were subjected to subtotal colectomy (Group C, n = 22) or a sham operation (Group S, n = 16) and were sacri-ficed on postoperative days 7, 14, and 28. Total RNAs from the distal ileum and rectum were extracted. Quantitative RT-PCR was performed to measure AQP8 mRNA expression. For light-microscopy or immunohistochemistry, paraffin-embedded sections of 4 μm were prepared with H-E staining or anti-AQP8 antibody reaction. Mann-Whitney U-test was performed to compare the AQP8 distributions between the two groups, and the statistical significance was defined as p

A methachromatic-based experimental model for identification of bowel as the focus of an acute inflammation

Abstract: Diarrhea is the most common symptom of acute inflammation in gastrointestinal tract and the patients are isolated in order to inhibit transmission and to conduct investigations. Yet there is no standard test to distinguish gastrointestinal infection from more generalized diseases at admittance which might cause delay in therapy. Hepatocyte growth factor (HGF) is produced upon injury by mesenchymal cells. On the contrary to chronic inflammation, HGF produced in the course of acute inflammation is biologically active and shows binding affinity to heparan sulphate proteoglycan (HSPG) and dextran sulphate (DS). Based on this phenomenon, an agarose gel containing DS was prepared and immobilized on loops to investigate the feces samples for the presence or absence of growth factors such as HGF with affinity to DS. The study is conducted as a clinical evaluation of an experimental model to distinguish acute infectious gastroenteritis from other causes of diarrhea. 656 fecal samples gathered consequently from patients seeking for bowel disturbances and healthy were tested by the test and the medical reports were investigated. Upon interaction with DS, methylene blue changes color to pink. This phenomenon was inhibited by HGF and converted by addition of anti-HGF antibodies to the samples. The test distinguished acute infectious gastroenteritis with high sensitivity and specificity (96% and 92% respectively) from other causes of diarrhea. We introduce a metachromatic experimental model that might distinguish acute inflammation in alimentary tract from other causes of diarrhea. This model might be used in developing rapid diagnostic tests.

Gut sterilization in experimental colitis leukocyte mediated colon injury, and effects on angiogenesis/lymphangiogenesis

Abstract: Inappropriate responses to normal commensal bacteria trigger immune activation in both inflammatory bowel disease and experimental colitis. How gut flora contribute to the pathogenesis of inflammatory bowel disease is unclear, but may involve entrapment of leukocytes and remodeling of the vascular system. Here we evaluated how the progression and tissue remodeling in experimental colitis differ in a germ- free model of mouse colitis. Four treatment groups were used: control, antibiotic-treated (ABX), dextran sulfate colitis (DSS) and DSS pre- and co-treated with antibiotics (DSS + ABX). In days 0 - 3 of the study, germ-free mice received antibiotics (vancomycin, neomycin, and metronidazole). During the next 11 days, antibiotics were continued and DSS (3%) added to “colitis” groups. Disease activity, weight, stool form and blood were monitored daily. Mice were sacrificed and tissue samples harvested. Histopathological scores in controls (0.00) and in ABX (1.0+/–0.81) were significantly (p –0). Extents of injury, inflammation and crypt damage were all improved in DSS + ABX. The Disease Activity Index score (day 11) was significantly worse in the DSS group compared to the DSS + ABX group. Stool blood and form scores were also significantly improved among these groups. Importantly, myeloper- oxidase was significantly reduced in DSS + ABX, indicating that neutrophil infiltration was blocked. Colitis was associated with an increase in blood and lymphatic vessels; both of these events were also significantly reduced by gut sterilization. Our experiment shows that clinical and histopathological severity of colitis was significantly worse in the DSS colitis group compared to the DSS + ABX group, supporting the hypothesis that development of IBD is likely to be less severe with appropriate antibiotic treatment. In particular, gut sterilization effectively reduces leuko- cyte-dependent (PMN) injury to improve outcomes and may be an important target for therapy.

Patient preferences and factors related to the pre-procedure process at a large, urban county hospital

Abstract: Background: Evaluation of the pre-procedural process prior to endoscopic procedures has never been conducted. Methods: Prospective cross-sectional, multi-language survey was administered to outpatients undergoing endoscopy at a large, diverse county hospital that examined patients’ pre-procedural preferences. Multivariate logistic regression was used to assess the relationship between patient preferences and several patient-related variables. Results: 128/156 outpatients completed the survey. The majority of respondents were female (53.1%), did not speak English (61.7%), were of Asian (39.1%) or Hispanic (29.7%) racial background, and had a mean age of 56.1 ± 15.7 years. Most patients underwent colonoscopy (48.4%) with 90.6% of patients knowing the indication for their procedure. While waiting for their endoscopic procedure, 42.2% of patients preferred waiting in a gurney while 28.1% preferred to wait in a chair. In terms of being comfortable wearing a hos- pital gown and sitting in a chair or gurney in the pre-procedure area, mean patient anxiety scores were 5.2 ± 3.3 and 6.1 ± 3.2, respectively (scale of 1 - 10). Race was associated with several pre-procedural patient preferences; Hispanics were less comfortable than Asians wearing a hospital gown while sitting in a chair with other patients prior to their procedure (OR = 0.3, CI 0.1 - 1.0) while Whites and African-Americans were less likely than Asians to prefer sitting in a chair as compared to a gurney before their procedure (OR = 0.09, CI 0.008 - 0.9 and OR = 0.07, CI 0.007 - 0.8, respectively). Patients who had undergone a prior endoscopic procedure were less comfortable wearing a hospital gown and sitting in a chair (OR = 0.3, CI 0.1 - 0.7) or gurney (OR = 0.4, CI 0.2 - 1.0) in the pre-procedure area. Conclusion: A patient’s race and having had a prior endoscopic procedure were the most powerful predictors on pre-procedure patient preferences while sex, type of endoscopic procedure and patient knowledge of the indication for their procedure were not. Our study highlights the importance of patient preferences and factors involved in the pre procedure process at a large, diverse county hospital.

Annular pancreas producing duodenal obstruction: A case report

Abstract: Annular pancreas is a rare congenital anomaly characterized by the presence of ectopic pancreatic tissue surrounding the duodenum. This malformation is usually asymptomatic in adults, but can manifests as pancreatitis, duodenal stenosis, or duodenal or gastric ulceration. We report the case of a young patient of 18 years old hospitalized for epigastric pain and vomiting, in whom radiological investigations showed an annular pancreas. At operation, a complete obstruction of the duodenum between its first and second parts was found, caused by an annular pancreas. No other congenital anomaly of the intra abdominal organs was noted. A gastroenterostomy was performed. Both the rarity of this congenital abnormality and its successful correction by surgical means have prompted us to make the following presentation.

Management of acute esophageal variceal bleeding by endoscopic sclerotherapy in technically difficult endoscopic band ligation cases—A population based cohort study

Abstract: Endoscopic band ligation is regarded as the main therapeutic option for acute esophageal variceal bleeding, while sclerotherapy may be used in the acute setting if ligation is technically difficult. The incidence of difficult-to-perform band ligation in acute esophageal variceal bleeding, as well as the outcome of patients subjected to injection sclerotherapy as an alternative treatment, has not been clearly investigated. Our aim is to study the outcome of patients subjected to injection sclerotherapy in the acute setting of esophageal variceal bleeding when endoscopic band ligation is technically difficult to perform. We included 151 patients with acute esophageal variceal bleeding originnating from medium or large sized varices. All patients were planned for EBL as the 1st treatment option (EBL group 61.6%), meanwhile, EIS using 5% ethanolamine oleate was reserved as the 2nd treatment option when EBL was technically difficult (EIS group 38.4%). The mean time to restore hemodynamic stability was significantly prolonged in the EIS group (11.5 ± 6.5 hrs versus 9.5 ± 5.0 hrs, p 0.05). Initial control of bleeding was significantly higher in the EBL group versus the EIS group (96.7% vs 84.5%, p 0.021). Re-bleeding was more among the EIS group (42.9% vs 24.2%, p 0.04). There were no significant differences as regarding mortality and duration of hospital stay. So, a considerable proportion of cases presenting with acute variceal bleeding will have difficulty in performing EBL. In these patients, sclerotherapy is not a waning procedure with an accepted success rate, without much additional complications and without deranging mortality.

Influence of meteorological factors on the seasonal onset of esophagogastric variceal bleeding

Abstract: Purpose: To investigate the influence of meteorological factors on the esophagogastric variceal bleeding. The rhythmicity and variation mechanism of the onset of esophagogastric variceal bleeding were determined by large sample study. Methods: 572 patients with esophagogastric variceal bleeding confirmed by endoscopy were enrolled in the study, and the gender, age, onset date and Child-Pugh grading of liver function were recorded, the meteorological data were provided by the Shiyan Meteorological Bureau, which included temperature, air pressure, air speed, precipitation, sunshine duration and so on. Results: The onset numbers in the four seasons were 130, 122, 144 and 176, respectively, and differences of the onset number in different seasons were significant (X2 = 11.888, p = 0.008), and the onset number in winter reached to maximum, while it decreased to minimum in summer. The results of Child-Pugh grading were as follows: Grade A 113 (19.8%), Grade B 234 (40.9%), and Grade C 225 (39.3%). There was no significance among the different grades by crosstabs analysis (X2 = 4.463, p = 0.107). The Spearman correlation analysis concluded the result of (r > 0 and p ?C accumulated temperature. The p value was more than0.01 inthe other factors. Conclusion: The onset of esophagogastric variceal bleeding was rhythmical, which rose to the maximum in winter and decreased to minimum in summer. The onset of the disease correlated positively with daily air pressure (mean, maximal, minimal), daily mean temperature, ten days’ air pressure (mean, daily difference, maximal, minimal and range) and ten days’ temperature range, and correlated negatively with daily maximal temperature, daily minimal temperature, ten days’ temperature (mean, maximal and minimal) and ten days’ ≥0°C accumulated temperature, and had no relationship with other factors. The mechanism of the onset may associate with the increase of portal venous flow through vasoconstriction induced by chill factors. It also may be the variation of air pressure which influenced the intraesophageal pressure and led to intraesophageal hemangiectasia that may increase the risk of bleeding.

Transhepatic percutaneous endoscopic gastrostomy

Abstract: We describe the case of a hepatic injury after the insertion of a PEG. In a cirrhotic woman affected by a locally advanced cancer of the pharynx, the PEG tube was inserted through the edge of the left lobe of the liver. The patient was treated with a conservative approach by managing abdominal pain and the PEG was removed after 4 months without complication. Hepatic injury is a rare complication of PEG placement; in order to avoid it, PEG tube should be inserted to the left of the abdominal midline and the lower edge of the liver should be defined by palpation; in cirrhotic patients, where left hepatic lobe hyper-trophy is common, ultrasound guidance could have been appropriate.

Risk factors for internal anal sphincter dysfunction in Japanese adults

Abstract: Purpose: The internal anal sphincter provides most of the resting anal tone and is the main muscle responseble for continence. This study was designed to estimate the prevalence of, and identify risk factors associated with, internal anal sphincter dysfunction in Japanese adults. Methods: Anorectal manometry was performed in 1193 women and 1124 men aged 20 years or older. The maximal resting pressure, measured by a rapid pull-through technique, was defined as the highest resting pressure recorded. Internal anal sphincter dysfunction was defined as a maximal resting pressure less than 30 mmHg. Potential risk factors were assessed through self-reports, interviews, physical examinations, and medical record reviews. Multivariate logistic regression analysis was used to identify independent risk factors for internal anal sphincter dysfunction. Results: Significant differences in maximal resting pressure were seen between women (58.1 ± 24.9 mmHg) and men (68.8 ± 23.5 mmHg, P < 0.001). Maximal resting pressure decreased significantly with increasing age in both sexes. The prevalence of internal anal sphincter dysfunction was 10.4% (15.5% in women, 5.1% in men). In a multivariate logistic regression model, age, mental disease, pelvic organ prolapse repair, and fecal incontinence were independently associated with a greater risk of internal anal sphincter dysfunction in women and men. Conclusions: Internal anal sphincter dysfunction is a common problem for women and men. Several of the identified risk factors are preventable or modifiable, and may direct future research in fecal incontinence therapy.

Alpha-fetoprotein testing for hepatocellular carcinoma may not be helpful in nonalcoholic steatohepatitis

Abstract: Background & Objectives: Diagnosing hepatocellular carcinoma (HCC) often utilizes serum tumor markers. Although the most commonly used tumor marker in clinical practice, alpha-fetoprotein (AFP) is not included in recent guidelines for diagnosing HCC. The overall performance characteristics of AFP as a tumor marker is viewed as insufficiently sensitive or specific. The diagnostic value of AFP specifically in nonalcoholic steatohepatitis (NASH) related HCC is unknown. We aimed to determine the utility of AFP testing in NASH-related HCC. Methods: Retrospective review of 737 HCC patients referred from 1993- 2011 to a single facility treating the majority of chronic liver disease in Hawaii. HCC was diagnosed histologically by percutaneous biopsy, liver biopsy at the time of surgery, or examination of the resected liver. Patients were classified according to HCC risk factors including NASH, hepatitis B and C infection, and alcohol-related. Other data collected included: demographics, ethnicity, presence of cirrhosis, tumor characteristics (size, number, vascular invasion), diabetes, hyperlipidemia, body mass index (BMI) and blood testing to calculate Model for End-Stage Liver Disease (MELD) score. Elevated AFP was defined as >20 ng/mL. Sensitivity of AFP was determined and compared between various subgroups. Results: Elevated AFP levels were detected in 64.3% of patients. AFP sensitivity was 47% for NASH-related HCC (n = 100), and 67.2% for HCC with viral or alcoholic risk factors (n = 637) (OR 0.43, 95% CI 0.28 - 0.66, p = 0.0001). Elevated AFP had higher sensitivity in females (71.9% vs. 61.8%, OR 1.58, 95% CI 1.1 - 2.27, p = 0.013), non-diabetics (67.4% vs. 57.2%, OR 0.65, 95% CI 0.47 - 0.89, p = 0.0093), and cirrhotics (67.1% vs. 56.8%, OR 1.55, 95% CI 1.10 - 2.19, p = 0.0012).AFP did not vary significantly with regard to hyperlipidemia or BMI. AFP was more sensitive in advanced disease including tumors > 5 cm, multiple tumors, or vascular invasion (all with p < 0.05). AFP did not vary with MELD score. Conclusions: Normal AFP is common in NASH-related HCC. Better tumor markers may be needed to optimally screen and diagnose NASH-related HCC. Without more effective tumor markers, HCC detection relies heavily upon imaging and liver biopsy.

Use of ultrasonic transient elastography (Fibroscan) in the assessment of hepatic focal lesion stiffness

Abstract: Background and Aim: Hepatic focal lesions differ in their tissue composition and in the degree of stiffness, so our aim was to evaluate the role of Ultrasonic Transient Elastography (Fibroscan) in the measurement of hepatic focal lesions stiffness in order to differentiate hepatocellular carcinoma (HCC) focal lesions from other non HCC focal lesions. Methods: The study was conducted on 34 patients with hepatic focal lesion(s) in the right lobe located near the liver surface and more than or equal4 cmin diameter, detected by imaging studies and diagnosed by CT and histopathology. Stiffness over the focal lesions was measured by the fibroscan. Results: The median value of stiffness was 72.5 kPa over HCC focal lesions, 17.2 kPa over lymphoma focal lesions, 6.5 kPa over metastatic focal lesions and 10.5 kPa over the sarcoidosis focal lesion. Conclusions: Hepatocellular carcinoma focal lesions are much stiffer than lymphoma, metastasis or sarcoidosis focal lesions. Fibroscan may be a useful non-invasive method in the prediction of hepatocellular carcinoma in the future.

Virological profile of hepatitis B infection in Black African HBsAg chronic carriers

Abstract: Aims: 1) Describe virological profile of patients followed-up for chronic Hepatitis B virus (HBV); 2) Search for a correlation between cirrhosis and virological profile of patients. Patients and Methods: Retrospective study about 75 HBsAg positive patients followed-up for at least one year in two medical structures of Abidjan. Studied parameters: clinical signs, biological check-up (serum transaminases every 3 months for at least one year, platelets count and prothrombin rate), abdominal echography, virological check-up (HBsAg, HBeAg, anti-HBe, total anti-HBc, anti-VHC and anti- HIV Ab, HBV DNA biannual quantification during at least one year). Histological or biochemical evaluation of hepatic activity and fibrosis were realized in case of transaminases elevation or HBV DNA > 2000 IU/ml. Results: The mean age of our 75 patients (54 men) was 42.1 ± 11.54 years. HBV was fortuitously discovered in most of our patients (74.7% of the cases). The HBV inactive chronic carriage was 50.7%; HBeAg-positive and HBeAg-negative chronic hepatitis represented respectively 9.3% and 40% of the cases. Mean B viral load was 327.5 IU/ml in HBV inactive chronic carriers, 44,047,663 IU/ml in HBeAg-positive chronic HBV and 20,231,822 IU/ml in HBeAg-negative chronic HBV. Cirrhosis prevalence was significantly high- er in positive or negative HBeAg chronic HBV than in HBV inactive chronic carriers (32.4% vs. 5.3%, p = 0.008; OR = 8.6). Conclusion: Our patients’ virological profile was dominated by HBeAg-negative chronic HBV and HBV inactive chronic carriage. The risk of having cirrhosis was multiplied by 8.6 in case of active chronic hepatitis compared with HBV inactive chronic carriage.

Primary Extra-Gastrointestinal Stromal Tumor (GIST) arising from mesentery of small bowel and presenting as abdominal mass: A rare entity

Abstract: Introduction: Majority of mesenchymal tumors of gastrointestinal tract are Gastrointestinal Stromal Tumor (GIST). It is, however, a rare tumor, accounting for less than 1% of primary gastrointestinal (GI) neoplasms. Though, these tumors are refractory to conventional chemotherapy or radiotherapy but show a good response to targeted adjuvant chemotherapy with tyrosine kinase inhibitors following surgical resection. Case Report: we report here a case of primary Extra-GIST tumor arising from mesentry of small bowel near duodeno-jejunal junction in a 69 years old male patient. The patient presented with a palpable mass in upper abdomen for past 15 days. On examination, a non-tender mobile lump of size around 17 × 10 cm, with bosselated surface and firm in consistency was palpable involving epigastric, left hypochondrium and umbilical region. Contrast enhanced computed tomography of abdomen revealed a heterogenous mesentric mass. On surgical intervention a mass was found involving mesentery near dudenojejunal junction without involvement of gastrointestinal tract. Complete surgical resection of the tumor was done and adjuvant chemotherapy with Imatinib mesylate was started as HPE revealing GIST with mitotic index of >10/50 HPF and 17 × 10 cm size placed the patient in high risk category. Patient was discharged on 12th of post-operative day with advice of regular follow-up. Conclusion: GIST occurrence is not restricted to bowel but can involve unusual sites also. The mainstay of treatment remains surgical resection with adequate margin. In cases where tumour has malignant potential (high mitotic figures on histopathology) adjuvent treatment with tyrosine kinase may prevent or delay relapse.

Cirrhotic cardiomyopathy among patients with liver cirrhosis

Abstract: Introduction: Cirrhotic cardiomyopathy (CCM) is a clinical syndrome in patients with liver cirrhosis characterized by an abnormal and blunted response in cardiac output and contractility to physiologic, pathologic, or pharmacologic stress but a normal to increased cardiac response at rest [1-4] Information on the epidemiology and natural history of CCM is limited Methods: All patients with a diagnosis of cirrhosis (N = 451) seen at gastroenterology clinic over the four years were evaluated CCM was defined using echocardiogram (ECHO) and electrocardiogram (ECG) criteria [1] Patients with structural or ischemic heart disease or incomplete information were excluded (N = 220) Results: Among the 231 patients with cirrhosis, 118 (511%) met criteria for CCM, and no patient had this problem documented in their medical record Those with CCM were older (627 vs 578 years; p age (OR 16 per quartile; 95% CI 12-20) Patients with alcoholic and unknown causes of cirrhosis are more likely to have CCM, (p CCM, a diagnosis of exclusion, defined by ECHO and ECG criteria is a common problem among cirrhotic patients attending a gastroenterology practice Advancing age and female gender were associated with a higher prevalence of CCM, but the cause of cirrhosis was not possibly limited by smaller sample size within cause-specific categories CCM was not recognized by our clinicians, and routine screening tests were not performed Provider awareness of CCM is needed since implementation of angiotensin receptor blocker and beta-blocker therapy early in the course of cirrhosis may modify the changes in cardiac function [5,6]

Lack of estrogen receptors expression in malignant and pre-malignant colorectal lesions in Egyptian patients

Abstract: Background: incidence of Colorectal cancer (CRC) is increasing globally. In Egypt, CRC ranks the sixth most common cancer in males and the fifth in females. Aim: To assess the expression of estrogen receptors (alpha and beta) in pre-malignant (adenomatous polyps and IBD), malignant colorectal lesions and normal colonic mucosa in group of Egyptian patients. Methods: This prospective study was done on 45 patients presenting with colonic symptoms, patients were divided into four groups; 15 CRC patients, 10 patients with adenomatous polyps, 10 IBD patients and 10 patients in the control group. Patients subjected to: Stool analysis, FOBT, CBC, CEA, Abdominal ultrasound & colonoscopy and biopsy (number = 80), Pathological, immunohistochemistry and RT- PCR quantification of ERα and ERβ were done. Results: Mean age: 39.2 (12 - 73), gender: M/F: 28/17. Bleeding per rectum was the commonest presentation; 29/45 (64.4%). CEA was significantly elevated in the CRC group compared with other studied groups (1692 mg/L vs. 4.0, 4.0 and 4.4 mg/L). Ultrasonography of the studied patients showed that metastatic CRC: 3/15 (20%); Colonic wall thickening: 5/15 (33.3%), 1/10 showed colonic polypoidal lesions in adenomatous polyps groups, in IBD group: 4/10 (40%) showed colonic and ileocecal thicknening. All the studied patients showed negative results for estrogen receptors (alpha and beta) by the use of immunohistochemistry staining and RT-PCR technique. Conclusion: Role of estrogen receptors in the colonic mucosa, precancerous and colorectal cancer is doubtful, contradictory results with some literature data could be due to racial and genetic difference in the studied population.

Towards an easier pleurodesis: Ultrasound-guided iodopovidone sclerotherapy in cirrhotic patients with hepatic hydrothorax *

Abstract: Background and Aim: Hepatic hydrothorax is one of the complications encountered in end stage liver disease. Pleural drainage carries the risk of massive protein and electrolyte depletion as well as the risk of bleeding and hepatic encephalopathy. Pleurodesis following pleural aspiration decreases the chance of pleural effusion recurrence, and has been a widely used long-standing method of controlling recurrent pleural effusions. The aim of this study is to evaluate the effect of pleurodesis using ultrasound-guided iodopovidone sclerotherapy in hepatic hydrothorax. Patients and Methods: This prospective study included 56 patients with clinical, laboratory and radiological evidence of liver cirrhosis and symptomatic right sided hepatic hydrothorax. All patients were subjected to repeated thoracentesis. Ten ml of lidocaine 2% were injected in the pleural space followed by 20 ml of iodopovidone. The follow-up was done after 3 months. Results: The sclerotherapy procedure was successful in 40 out of 56 cases (71.4%), and the success rate was 66.7% in massive effusion and reached 80% in moderate effusion. Twenty eight patients (50%) had to repeat the procedure for a second time, sixteen of which (28.6%) failed despite the second trial and twelve cases (21.4%) showed no fluid reaccumulation. Conclusion: Ultrasound-guided iodopovidone sclerotherapy is an effective approach for a successful pleurodesis in hepatic hydrothorax.

Acute hepatitis associated with the use of natural product camu-camu

Abstract: A 45-year-old previously healthy caucasian man was admitted for pruritus, scleral icterus and dark urine. The patient was reported to have taken a spoon of a preparation containing camu-camu (myrciaria dubia) a day. He took no other drugs and did not drink alcohol or use illicit substance. Laboratory studies reveiled an elevated aspartate transaminase of 403 U/L, and alanine transaminase of 1185 U/L, alkalinephosphatase of 335 U/L, gamma glutamyl transpeptidase of 300 U/L, and elevated total bilirubin of 142 μmol/L. His complete blood count was normal. Tests for viral, metabolic or autoimmune causes of liver injury were negative. Liver biopsy demonstrated centrilobular hepatocellular damage was compatible with drug toxicity which was not of very recent origin. Clinical and laboratory signs of liver injury gradually improved and the patient was discharged. Myrciaria dubia is used as a dietary supplement with antioxidant properties. To our knowledge, this is the first report of liver injury probably related to use of camu-camu. Exclusion of other causes and the histological diagnosis were compatible with drug toxicity render camu-camu which was most likely as the cause of acute heaptitis most likely. It is important to increase the awareness of both clinicians and patients about the potential dangers of herbal remedies in absence of reliable studies of clinical efficacy and benefit-risk assessment.

Rapidly enlarged inflammatory hepatocellular adenoma: A case report *

Abstract: We present a rare case of rapidly enlarging inflamematory hepatocellular adenoma (IHCA) in a 60-year-old Japanese man. Screening abdominal computed tomography (CT) for the fatty liver patient revealed a 1.7-cm liver mass in the anterior segment of the liver. After 19 months, the lesion had rapidly enlarged to 6 cm in diameter and the patient was referred to our hospital. On perflubutane microbubble contrast-enhanced ultrasonography, the tumor showed a characteristic centripetal filling pattern in the vascular phase. We performed hepatic anterior segment resection because we could not rule out malignant tumor. Histopathological examination showed hyperplasia of mildly atypical hepatocytes and sinusoidal dilatation with marked inflammatory cell infiltration. Immunohistological staining revealed positive staining for serum amyloid A and C-reactive protein; therefore, we diagnosed this tumor as IHCA. The patient remains alive 42 months after operation without evidence of recurrence.

Open fistulectomy with sphincter fixation for anal fistula

Abstract: Purpose: This study aimed to report clinical data and recurrence rates in patients with anterolateral low fistulas who underwent open fistulectomy with sphincter fixation. Methods: The study group consisted of 133 consecutive patients with anterolateral, low intersphincteric, or low trans-sphincteric fistulas who had undergone open fistulectomy with sphincter fixation between January 2006 and December 2010. This procedure involves complete removal of the fistula tract by incision of anal sphincters, followed by fixation of the sphincter muscles. Results: Success was achieved in 127 (95.5%) patients with a median follow-up time of 12 months. Anal fistula recurred in 4 cases (3%). Non-healing fistula with persistent anal discharge developed in 2 patients. Maximal resting pressure, but not maximal squeeze pressure, was significantly decreased after surgery. Five patients (4%) developed temporary anal incontinence after surgery. Conclusions: Open fistulectomy with sphincter fixation was effective for the management of patients with anterolateral low fistula in this study. The high success rate suggests that this procedure is a reasonable option in this group of patients.

Disparity in clinical care for patients with inflammatory bowel disease between specialists and non-specialists

Abstract: Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa p term corticosteroids (UC: 23% vs. 5%, p p peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.

Prevalence of hepatitis B infection and factors associated in children of Ivorian HBsAg carrier subjects

Abstract: Aims of the Study: 1) Determine the Prevalence of Hepatitis B virus (HBV) infection in children (contact subjects) of chronic Hepatitis B surface antigen (HBsAg) carrier subjects (index subjects); 2) Search for factors associated with HBV infection in these children. Patients and Methods: Retrospective-crosssectional study (January 5th, 2006 through December 31st, 2012). Studied parameters: biological and clinical characteristics of index subjects; Prevalence of HBsAg and Hepatitis B core antibody (HBcAb) in their children. Search for the HBV infection associated factors in the children (univariate analyses through Chi-square or Fisher’s exact test; multivariate analysis through a backward logistic regression). Results: Our 44 subjects’ median age was 43.1 ± 7.49 years and 88.6% of them lived with a spouse. Average number of children per index subjects was 2.3 ± 1.1. Our 92 children’s median age was 9.3 ± 4.55 (ranging from 1 to 15 years), and 43 (44.8%) were vaccinated against HBV. HBV infection prevalence was 24% (23/96 of which, 4 were HBsAg positive and 19 HBcAb positive subjects without HBsAg). Independent factors associated with HBV infection in children of index subjects were HBV DNA for index subjects >2000 IU/ml (OR = 11.5; p = 0.001), existence of HBV in two parents (OR = 7.9; p = 0.03) and absence of HBV vaccination in the children (OR = 30.9; p = 0.003). Conclusion: Immunization coverage for children of index subjects was insufficient, especially before the introduction of HBV vaccine into the enlarged vaccination program. Outside vertical transmission, those children were more exposed to HBV intrafamilial transmission risk when they were not immunized against HBV, when both parents were infected and when HBV viremia in index subjects was higher than 2000 IU/ml.

Patient stress and satisfaction when allowed the presence of an accompanying person during endoscopy

Abstract: Introduction: Patients undergoing esophagogastroduodenoscopy (EGD) have variable stress and anxiety and therefore commonly receive medications as sedative-anxiolytics. These medications have small but significant risks. To possibly make procedures safer and to increase patient satisfaction, this study aimed to measure the effects of allowing an accompanying person (AP) to be present in the endoscopy suite during EGD. Patients and Methods: Forty-two patients were randomly divided into two groups who would either be or not be offered to have an AP during endoscopy. Spielberger’s well-validated state and trait anxiety evaluations were administered to patients before and after EGD. APs also completed questionnaires as to their reactions after EGD. Results: 84.2% of the patients after EGD recommended accompaniment. Patients who underwent EGD with an AP tended (p < 0.06) to have decreased measurable anxiety compared to patients who were not offered an AP. The benefit was significant for persons with higher levels of anxiety prior to EGD (p < 0.04). Patients undergoing EGD for the first time had significantly more anxiety than those with previous EGD experience (p < 0.034). There was no significant reduction in sedative dosage when APs were present. Conclusions: Offering to permit the presence of an accompanying person during EGD was often shown to improve patient satisfaction and reduce anxiety.