Showing papers in "Open Journal of Gastroenterology in 2017"

Prevalence and Correlates of Overweight and Obesity among School Children in Sohag, Egypt

Abstract: Background: Continually rising prevalence of obesity and overweight in children and adolescents is a major public health concern. This is due to its various and serious health hazards on one side and its preventable nature on the other side. This study aims at identification of prevalence of overweight and obesity and its risk factors among children between 6 - 14 years of age in Sohag, Egypt. Method: A cross sectional study was conducted on 711 school children between 6 - 14 years in four months’ period from February to May 2016. Weight and height of the studied children were measured to calculate BMI, which was compared with standard Egyptian growth charts for determining overweight and obesity. Then a questionnaire containing data about socio demographic, parental obesity, early life and dietary risk factors was completed by the children’s parents. Result: Out of 711 studied children, 117 (16.5%) were overweight and 104 (14.6%) were obese. Residing in urban area, having an obese parent or both of them, low level of maternal education, being on formula feeding during early life and lack of fresh vegetables and fruits in diets were significant risk factors for overweight and obesity in the studied children (P value < 0.05). Conclusion: Improperly educated mothers together with sedentary life style manifested in obesity among the parents and lack of sport practice among children constituted the majors risk factors for childhood obesity. This emphasizes the need for increased health awareness of the community about the importance of proper nutrition and physical activity.

Fecal Microbiota Transplantation for Fibromyalgia: A Case Report and Review of the Literature

Abstract: A 58-year-old patient diagnosed with fibromyalgia, irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS), non-responsive to variety of treatments over the years, suffered from significant social and occupational disabilities. The patient was interested in fecal microbiota transplantation (FMT), but given that FMT is not approved for these indications, he used an online protocol for FMT screening and preparation and self-instilled the filtrate using an enema 6 times. FMT resulted in a gradual improvement of symptoms and 9 months after the last treatment, the patient reported full recovery of symptoms, going back to work at full time employment. Improvement of symptoms was associated with major alterations of the enteric microbiota, according to next generation sequencing analysis performed before the first FMT and after the last FMT. Most prominent alterations at the genus level included a decrease in fecal Streptococcus proportion from 26.39% to 0.15% and an increase in Bifidobacterium from 0% to 5.23%. This case is added to several additional case reports that demonstrated the effectivity of FMT in these functional disorders that are lacking an otherwise good medical therapeutic intervention. We conclude that randomized controlled trials are required to ground FMT as a possible therapy for these difficult-to-treat conditions.

Gastric Intestinal Metaplasia Is the Most Common Histopathological Phenotype among Endoscopically Diagnosed Atrophic Gastritis Patients in North-East China

Abstract: Background: Gastric cancer and gastric precancerous lesions are highly prevalent in China. However, prevalence of the different precancerous lesions has not been reported from the north-east region of China. Detection of precancerous gastric lesions at an early stage complemented with a follow-up strategy for high risk groups would probably aid in declining the mortality rate in patients with gastric cancer. Helicobacter pylori infection, salt intake, smoking, alcohol, family history of gastric cancer, atrophic gastritis and intestinal metaplasia are established risk factors of gastric cancer. The aim of this study was to evaluate the frequency of various histopathological phenotypes among atrophic gastritis patients in this region and to report if gender and increasing age carry risk in the development of these lesions. Methods: This retrospective study was conducted on 518 patients with endoscopic diagnosis of atrophic gastritis. Using the patient number in database, histopathological diagnosis of the biopsy specimen of all patients was recorded. All biopsy specimens were assessed for the presence of inflammation, atrophic gastritis, metaplasia and/or dysplasia. Results: Intestinal metaplasia was observed in 67.38% of patients. Dysplasia and atrophy were present in 9.46% and 3.67% patients, respectively. Gender and increasing age were not found to be risk factors for intestinal metaplasia, dysplasia and atrophic gastritis (p-values 0.08, 0.43, 0.297 and 0.98, 0.20, 0.54; respectively). 19.49% subjects showed inflammatory activity which was significantly associated with female gender (P = 0.0008). Conclusion: Intestinal metaplasia was the most histopathological phenotype among endoscopically diagnosed atrophic gastritis patients. Large-population based on prospective studies should be designed to determine prevalence of precancerous lesions and the risk factors involved in the progression of these lesions in our region.

The Diagnostic Challenges, Possible Etiologies and Lack of Researches of Hepatocellular Carcinoma in Somalia

Abstract: Globally, hepatocellular carcinoma is the second amongst all causes of cancer deaths and it is one of the common malignancies in both developing and developed countries. The causes are variety all of the world ranging from geography, life style and advanced medical care that is available in those countries either developing such as Somalia or developed countries. Somali contributes to global burden of hepatitis B which is a known risk factor for HCC and has categorized to the world a part of high prevalence of hepatitis B which is greater than 10%, while there is no more available data of hepatitis C in Somalia that contributes the world. Diagnoses of hepatocellular carcinoma are now forward in many countries of developed world, but reality are different from developing countries such as Somalia which is now out for civil war and has a lack of medical experts in all fields of medicine such as physician, surgeons, pathologists, radiologists and the experts of the laboratory field, even if we have these medical personal who are few or they are elder than above 60 years old plus medical equipment (such as imaging and laboratory equipment). All these challenges, the author of this manuscript has faith in the diagnosis of hepatocellular carcinoma that can be rationally made to consider the clinical presentation of this disorder and to maximize use of offered diagnostic tools and to refer the few medical experts in the country.

Bisacodyl and Sodium Picosulfate Improve Bowel Function and Quality of Life in Patients with Chronic Constipation—Analysis of Pooled Data from Two Randomized Controlled Trials

Abstract: Background: Quality of life (QoL) is impaired in chronic constipation. Among nonprescription laxatives QoL data out of randomized controlled trials are available only for bisacodyl and sodium picosulfate (SPS). Methods: In two randomized, double-blind, placebo-controlled, parallel-group trials, the efficacy and safety of treatment with either bisacodyl or SPS, respectively, were assessed. After a 2-week baseline period patients with functional constipation were randomized to a 4-week treatment with either bisacodyl (2 tablets = 10 mg), SPS (18 drops = 10 mg), or matching placebo in a ratio of active drug to placebo of 2:1. Dose reduction as well as resuming the original dose was permitted. Patients who did not experience a bowel movement for more than 72 h were allowed to use a bisacodyl suppository. The primary endpoint was the mean number of Complete Spontaneous Bowel Movements (CSBMs) per week during the trial. QoL was assessed using the Patient Assessment of Constipation (PAC)-QoL questionnaire. Results: Active treatment led to a greater improvement of PAC-QoL scores for every domain. Active treatment was also superior to placebo for all individual questions of the questionnaire. Of note, SPS or bisacodyl not only improved satisfaction with stool patterns (“quite a bit/extremely satisfied” in 12.8% of patients on placebo and 50.3% on active treatment) but bloating was also considerably ameliorated (“not at all feeling bloated” in 24.5% on placebo and 41.4% on active treatment). Conclusion: Bisacodyl and SPS not only improve stool variables but also quality of life in patients with chronic functional constipation. (EudraCT Nos. 2007-001991-34 and 2007-002087-10).

Pancreatic Cancer: Epidemiological, Clinical and Therapeutic Aspects in Abidjan (Ivory Coast)

Abstract: Aim: The aim was to study the epidemiological, clinical and therapeutic aspects of pancreatic cancers in Ivory Coast. Materials and methods: A retrospective multi-center and multidisciplinary study aimed at describing sixteen years and four months from January 1, 2000 to April 30, 2016 in several hospitals in the city of Abidjan taking charge of pancreatic cancers (hepato-gas troenterology services of the universities hospitals of Cocody and Yopougon), internal medicine departments of University Hospital of Treichville and Abidjan Military Hospital, the department of oncology of the university hospital center of Treichville, private clinics (DANGA, PISAM and GMP), the COBA center in Treichville. The diagnosis of cancer was based on either histological criteria or a set of clinical and paraclinical arguments. Patients whose files did not include imaging were excluded from this study. The following parameters were collected: age, sex, reason for consultation, physical signs, personal and family antecedents, tumor characteristics, delay in diagnosis and the nature of the treatment administered. Results: We have observed 150 cases of pancreatic cancer. The mean age of patients was 59.09 years with extremes ranging from 24 years to 88 years. Our study population consisted of 98 men and 52 women (sex ratio 1.88). Risk factors were dominated by diabetes 20.7%. Epigastralgia is the main reason for consultation (48%). The tumor was localized at the cephalic level in 84.67%. In 13 cases the diagnosis was histological and was dominated by adenocarcinoma (100%). The majority of our patients was seen at an advanced stage of the disease: stage IV (74.56%). The average time to diagnosis was 2.76 months. Fourteen of our patients (9.33%) had benefited surgery. This was curative surgery in 35.71% (n = 5) and palliative in 64.29% (n = 9). Among those who benefited from this curative surgery, three died two months after surgery and two lost to follow-up. The majority (90.67%) of our patients had received symptomatic treatment. Conclusion: Pancreatic cancer is an appalling cancer with a very bad and late diagnosis because of its insidious symptomatology. Most of the time, tumors had already metastasized before diagnosis, so the treatment is often symptomatic.

Urinary Vascular Endothelial Growth Factor (VEGF) as a Novel Marker for Early Prediction of Esophageal Varices in Patients with Chronic Liver Disease

Abstract: Background/Aims: Vascular Endothelial Growth Factor (VEGF) has a crucial role in portal hypertension and collateral vessels formation. This study aims to assess urinary VEGF in cirrhotic patients as a predictor of presence of esophageal varices, and variceal bleeding. Settings and Design: 42 cirrhotic patients were randomly selected and classified into 2 groups according to the presence of variceal bleeding. Methods and Material: Urinary VEGF was measured and corrected against urinary creatinine. Platelet count, liver functions, abdominal ultrasonography and upper endoscopy were done. Statistical Analysis Used: Comparison was done by Mann Whitney and Kruskal Wallis tests. Correlation was done using Spearman rank correlation. Multivariable logistic regression was done to identify predictors of variceal bleeding and presence of large varices. Receiver operator characteristic curve (ROC) analysis was used to determine the optimum cut off value of predictors. Results and Conclusions: Urinary VEGF was lower in cirrhotic patients with esophageal varices than those without. Low VEGF, low platelet count and splenomegaly were found to be independent predictors of both the presence of large esophageal varices, and variceal bleeding. Cut-off values for platelet count ≤ 166.3 × 103/μL, and corrected VEGF ≤ 59.12 pg/mg were predictive of large esophageal varices with 93.1%, 86.2% sensitivity and 74.5%, 58.2% specificity respectively. While variceal bleeding could be predicted at a platelet count ≤ 153 × 103/μL, and corrected VEGF ≤ 45.08 pg/mg with 90.9%, 81.8% sensitivity and 72.6%, 59.7% specificity respectively. The study concludes that urinary VEGF can be used as an alternative to upper endoscopic screening.

Noninvasive Fibrosis Scores as Prognostic Markers for Varices Needing Treatment in Advanced Compensated Liver Cirrhosis

Abstract: Background/purpose: Noninvasive assessment of esophageal varices (EVs), their size and bleeding stigmata may reduce endoscopic burden, cost and drawbacks. We aimed to evaluate the diagnostic performance of noninvasive fibrosis scores (AAR, APRI, FIB-4, King and VITRO scores) in predicting the presence of EVs and high risk varices needing treatment (VNT) in HCV-related cirrhosis of Egyptian patients. Methods: This prospective study included 154 HCV-related advanced compensated cirrhotic patients with no history of bleeding who underwent screening endoscopy for EVs. AAR, APRI, FIB-4, King and VITRO scores were assessed. Results: Esophageal varices were found in 120 patients (77.9%) and VNT in 92 patients (59.7%). Apart from AAR, all scores demonstrated statistically significant correlations with the presence and the size of EVs. Using area under receiver operating characteristic curve (AUC), these scores were good predictors for the presence of EVs and VNT, where VITRO score had the highest AUC (0.920 and 0.900) and accuracy (97.1% and 87%), sensitivity (75, 82.6%), specificity (100, 93.5%), PPV (100, 95%) and NPV (53.2, 78.4%) with cutoffs >1.3 and >1.8 respectively. Conclusion: Noninvasive fibrosis scores can predict the presence of EVs and VNT. VITRO score was the best predictor with higher accuracy for clinical applicability than studied scores.

Plummer-Vinson Syndrome and Esophageal Cancer in an Endoscopy Center of Dakar

Abstract: Introduction: Plummer Vinson Syndrome (PVS) is a rare pathology combining dysphagia, an iron deficiency anemia and a cervical esophageal web. It is one of the risk factors of the esophageal cancer. Objectives: To report the epidemiological, clinical, paraclinical and histological characteristics of patients with Plummer-Vinson syndrome associated with esophageal cancer. Patients and Methods: This was a retrospective study carried out at the digestive endoscopy center of Aristide le Dantec hospital in Dakar from January 2008 to December 2015. We included all patients with Plummer-Vinson syndrome associated with esophageal cancer. Results: We included 7 patients. The mean age was 36 years (24 - 65 years). There were 5 women and 2 men. The mean diagnostic period was 9 months (6 months - 15 years). The main clinical manifestations were dysphagia (100%), weight loss (100%) and clinical anemia (71.4%). The biology showed a mean hemoglobin level of 8.8 g/dl (6 - 11 g/dl), serum iron at 30.8 μg/dl (11 - 52 μg/dl) and ferritinemia at 6.2 ng/dl (1.5 - 25 ng/dl). The upper digestive endoscopy revealed a stenosis web of the cervical esophagus in all patients. An endoscopic dilatation was performed in all cases. After dilation, the endoscopy showed a tumor of the middle third of the esophagus in 4 cases and of the lower third in 3 cases. It was about of a squamous cell carcinoma in the tumors of middle third and of an adenocarcinoma in those of the lower third. Conclusion: At Aristide le Dantec hospital of Dakar, PVS is sometimes associated with an epidermoid carcinoma or an adenocarcinoma of the esophagus. The improvement of the prognosis depends on the early realization of an upper gastrointestinal endoscopy (UGI) in case of any dysphagia and the monitoring of the patients.

Risks of Viral Hepatitis B Transmission in Mother-to-Infant of Pregnant Women Carriers of Chronic Viral Hepatitis B in Cote d’Ivoire

Abstract: The aim of this study was to identify the risk factors of mother-to-child transmission of HBV in positive Ag Hbs pregnant women in Cote d’Ivoire. Methods: This was a transversal prospective study that took place over a period of 7 months (from February 2016 to August 2016) in 2 university hospital and 2 private clinics. We consecutively recruited 91 pregnant women who were positive for HBs Ag in prenatal consultations. For each pregnant woman record included in the study, we provided Socio-demographic (Age, marital status, education level, social rank, gravidity, parity) and biological data (HBs Ag, Anti-HBc Total Ac, Hbe Ag, Ac anti-Hbe Ac, DNA-VHB, Ac anti-HCV Ac, retroviral serology, transaminases). All of these data were collected using a survey sheet developed for the study. Results: The age of our pregnant women HBs positive ranged from 18 years to 44 years with a mean age of 30.10 years. The age group from 20 to 39 years was the most represented with a frequency of 92.31%. Almost of all positive HBs Ag pregnant women was HBe Ag negative, only 3.3% was HBe Ag positive. The viral load above 2000 IU/ml was found in 21 (23.03%) patients. There were 4 co-infected patients, which 3 HBV-HIV and 1 HBV-HCV. Only 19 (20.88%) pregnant HBs Ag positive women were able to bring back the supplementary virological assessment within a period less than one month. Conclusion: According to our work the virologic profile of positive HBs Ag in pregnant women in Cote d’Ivoire is characterized by an important viral replication objectified by a high viral load in about 23% pregnant women, a negativity of HBe antigen in 96.6% of them.

The Role of Ultrasonically Guided Fine Needle Cytology in the Diagnosis of Focal Liver Lesions in Sulaimani-Kurdistan Region, Iraq

Abstract: Background: Fine Needle Aspiration Cytology (FNAC) under image guidance has gained increasing acceptance as the diagnostic procedure of choice for patients with focal hepatic lesions. It can be performed percutaneously or endoscopically. FNA may also be performed at laparoscopy or laparotomy under direct vision when image guided FNA fails to provide diagnostic tissue. In experienced hands, FNA is safe, minimally invasive, accurate, and cost-effective. However, the main aim of this study is to assess the role of FNAC in the evaluation of focal liver lesions. Patients and method: This prospective study was conducted over one year, on 100 patients in Kurdistan Center for Gastroenterology and Hepatology (KCGH) and in Sulaimani General Teaching Hospital. All patients were properly assessed by history analyses and thorough clinical examination. Laboratory investigations including hematological, biochemical, viral markers, and tumor markers were requested. Thus, ultrasonically guided FNA was performed after obtaining a written informed consent from the patients. Results: FNAC showed that eighty patients (80%) had secondary liver metastasis. Ten patients (10%) had HCC; three patients had hemangioma; one patient had abscess; and 6 patients had inconclusive result; two patients had simple cyst. Apart from mild post procedure pain, no complication or mortality had been recorded. Conclusion: FNAC is simple, easy, rapid and a minimally invasive procedure that has an acceptable diagnostic yield for focal liver lesions.

Gastric Polyps in a Digestive Endoscopy Center in Dakar

Abstract: Introduction: The gastric polyp is a tumor protruding into the gastric lumen. It is asymptomatic most often with a risk of malignant degeneration closely related to its histological nature. These data are very rare in Africa. Objectives: Reporting the frequency and endoscopic and histological characteristics of gastric polyps in the digestive endoscopy center of Aristide Le Dantec hospital in Dakar. Patients and methods: This was a retrospective study carried out in the digestive endoscopy center of Aristide Le Dantec Hospital in Dakar from January 2012 to December 2016. We have included all patients with one or more gastric polyps coupled with histological findings available. Results: There were 60 patients with gastric polyps, hence a prevalence of 0.8%. We included 37 patients. Their mean age was 46 years [21 years - 75 years]. The sex-ratio was 0.48. Epigastralgia was the most frequent endoscopic indication (51.3%). The polyp was unique in 26 patients (70.3%) with an average size of 6.87 mm [2 - 15 mm]. Polyps were sessile in 31 cases (83.8%) and pediculate in 6 cases (16.2%). They were most often in the antrum (51.4%). Antral erosions (13.5%) and fundic atrophy (13.5%) were the main associated endoscopic lesions. These were hyperplastic polyps in 27% of cases and adenoma in 16.2% of cases. Chronic atrophic gastritis (10.8%) and intestinal metaplasia (10.8%) were the main histological lesions associated with polyps. Helicobacter pylori (Hp) were present in 17 patients (45.9%). Conclusion: The prevalence of gastric polyps is 0.8% in the endoscopy center of Aristide Le Dantec hospital. They are usually hyperplastic or adenomatous.

Esophageal Cancer in Sudan: Demographic and Histopathlogical Variations

Abstract: Background: Sudan is experiencing a growing cancer problem. Esophageal cancer (EC) is a devastating disease with high mortality. Our objective was to study the demographic factors and histopathological pattern of EC cancer in Khartoum, Sudan. Methods: In a retrospective cross-sectional study, the records and histopathology reports of all patients diagnosed endoscopically as EC and who were referred to Zain center, a reference histopathology center in Khartoum Sudan, were studied over a 6-month period. Descriptive and simple statistics were used for analysis. Results: Out of 74 histopathologically studied patients, 66 (89.2%) had squamous cell (SCC) cancer (average age 59 y, mainly females) and 8 (10.8%) had adenocarcinoma (AC-average age 69 y). The female to male ratio is 1.5:1. In females with SCC, the tumors mainly located in the upper and middle thirds of the oesophagus. On the other hand, 6 out of the 8 patients with AC were men, with the tumors located mainly in the lower third. Conclusions: In Khartoum, Sudan, esophageal cancer affects females (predominantlySCC) more than males (predominantly AC). It occurs at a relatively young age, and is predominantly squamous cell in type. No specific risk factors were identified and this needs further studies.

Screening for Hepatitis B and C in Occupational Settings: Cross-Sectional Study about 4268 Corporates Agents in Côte d’Ivoire

Abstract: Aim: To screen hepatitis B and C in occupational setting. Methods: Cross-sectional study multicenter in 16 enterprises (one occupational exposure; 5602 agents). Screening was preceded by information, sensibilisation and informed consenting physician labor, labor union and agents. Hepatitis B surface antigen (HBsAg) and antibodies anti-hepatitis C (Elisa, third generation) were tested in all. For those with HBsAg positive, this test was completed by IgM and IgG, anti HBc, HBeAg, antibodies anti HBe, transaminases and HBB DNA; for those with positive anti-VHC antibodies, test was completed by transaminases and VHC’s RNA. Results: Rate of participation was 76.2% (4268/5602 labors). HBsAg or hepatitis C antibodies were positives in 425 (9.9%) of cases (HBsAg positive: 8.48%; Hepatitis C Antibodies positives: 1.50%; both: 0.05%). In HBsAg positive, viral replication and cytolysis were seen respectively in 2.5 % and 18.2%. According with transaminases, serologic markers and viral load, immunotolerance, inactive and immuno active phase were suspected in 0.56%, 80.9% and 1.6% of cases. In hepatitis C antibodies positives persons, any had viral replication but cytolysis was observed in 33.3% (n = 21). HBsAg was significantively (p < 0.00001) higher in exposed occupational enterprise versus non-occupational setting (14.4% vs 7.8%). They were no differences (p = 0.71) about hepatitis C antibodies in the two setting (1.8% vs 1.7%). Conclusion: Prevalence of HBsAg and hepatitis C antibodies was high in occupational setting in hepatitis endemic country. It’s important to screen all of person in these setting with no consideration with blood exposed or not exposed enterprise.

Gastric Mucosal Atrophy Might Be Associated with the Efficacy of First-Line Therapy Using Vonoprazan for Helicobacter pylori

Abstract: Aim: To investigate the factors related to the effect of eradication therapy with vonoprazan for Helicobacter pylori (H. pylori). Methods: We retrospectively reviewed medical records of H. pylori-positive patients who received first-line (40 mg vonoprazan/60 mg lansoprazole or 20 mg rabeprazole, 1500 mg amoxicillin, 400 mg clarithromycin, all 2/day for 7 days) (n = 4118). H. pylori eradication was assessed by the 13C-urea breath test with success defined as a result of < 2.5‰. Using propensity score matching, successful eradication rates were compared between two groups: those receiving vonoprazan and those receiving a proton pump inhibitor. Related factors and adverse events were investigated. Results: Successful first-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.8% and 91.4% for VPZ therapy. Eradication rates using propensity matched patients (n = 1053) who received first-line vonoprazan therapy were higher than in those using proton pump inhibitor (PPI) therapy (92.1% vs. 79.7% in per-protocol analysis, p < 0.0001). Multivariate analysis confirmed that gastric mucosal atrophy was associated with treatment success. Conclusions: Low-dose clarithromycin triple therapy for first-line H. pylori eradication therapy using vonoprazan was more effective than standard triple therapy with proton pump inhibitor. Gastric mucosal atrophy was associated with treatment success.

Study of the Efficacy of Triple Therapy of Sofosbuvir, Pegylated INFalpha 2a and Ribavirin in Treatment of Chronic Hepatitis C Patients Genotype 4 with High Fibrosis

Abstract: Purpose: The aim is evaluation of the efficacy of triple therapy of sofosbuvir, pegylated INFalpha 2a and ribavirin in treatment of chronic hepatitis C (CHC) patients genotype 4 who have high fibrosis. Materials and Methods: Fifty HCV patients with high fibrosis (F3 & F4) were included in the study. Results: SVR rate was 54%; non-responders rate was 12% and relapsers rate was 34%. When comparing SVR between F3 group patients and F4 group, it was 88% and 66% respectively, which means that SVR was higher in the F3 group. Conclusion: Triple therapy including pegylated INFalpha 2a is not an ideal therapy in treatment of CHC patients genotype 4 with cirrhosis because of low sustained virological response rates and high incidence of side effects.

Jejunostomy Feeding Tube Placement in Gastrectomy Procedures: A Systematic Review

Abstract: Many nutritional interventions have been developed to improve nutritional outcomes following upper gastrointestinal surgery. The aim of this systematic review was to investigate whether or not the routine use of intraoperative jejunostomy feeding tubes in partial and total gastrectomy procedures is warranted when assessing complications and nutritional benefits such as improved chemotherapy tolerance. An electronic search of MEDLINE, Web of Science, Embase and CINAHL databases was performed to identify studies which reported complications and/or post-operative outcomes of patients who received an intraoperative jejunostomy feeding tube in gastrectomy procedures. Five articles met the inclusion criteria (n = 636) with four retrospective cohort studies and one RCT. Studies varied in regards to the complications and nutritional outcomes reported. Jejunostomy feeding tube insertion may carry a risk of increased infectious complications but appears to reduce patient post-operative weight-loss and may improve chemotherapy tolerance. Due to the lack of high-quality studies, it is unclear if the routine use of an intraoperative jejunostomy feeding tube is indicated for all patients undergoing gastrectomy procedures or only those at a high-risk of post-operative malnutrition. More comprehensive research is recommended, particularly on the usefulness of home enteral nutrition post-gastrectomy.

Predictors of Spontaneous Bacterial Peritonitis (SBP) in Liver Cirrhosis: Current Knowledge and Future Frontiers

Abstract: Spontaneous bacterial peritonitis (SBP) in patients with cirrhotic liver disease is a serious complication that contributes to the high morbidity and mortality rate seen in this population. Currently, there is a lack of consensus amongst the research community on the clinical predictors of SBP as well as the risks and benefits of prophylactic antibiotic therapy in these patients. Pharmacological gastric acid suppression (namely with PPIs and H2RAs) are frequently prescribed for these patients, many times without a clear indication, and may contribute to gut bacterial overflow and SBP development. However, this remains controversial as there are conflicting findings in SBP prevalence between PPI/H2RA-users and non-users. In addition, studies show recent antibiotic use, whether for SBP prophylaxis or for another infectious process, appear to be associated with higher rates of SBP and drug-resistant organisms. Other researchers have also explored the link between zinc, platelet indices (MPV), and macrophage inflammatory protein-1 β (MIP-1β) levels in liver cirrhosis, all of which appear to be promising markers for classifying SBP risk and diagnosis. This literature review was limited by the number and quality of studies available as most are retrospective in nature. Thus, more ongoing, prospective studies and trials are needed to judge the true value of the findings in the studies reviewed in hopes that they can guide appropriate prevention, diagnosis, and management of SBP.

Attempted Colonic Preservation Strategies Do Not Increase the Risk of In-Hospital Mortality in Patients Presenting with Acute Left-Sided Colonic Emergencies

Abstract: Background. Colonic malignant obstruction and perforated diverticulitis are acute left sided colonic emergencies (ALSCE) that are typically managed with colorectal resection. Colonic preservation techniques such as laparoscopic lavage and endoscopic stenting have emerged as management options, the safety of which has been debated. We aimed to determine if these alternate colonic preservation techniques result in increased in-hospital mortality. Materials and Methods. Retrospective analysis of prospectively collected data of 210 patients with ALSCE managed from June 2001 to April 2014. Data collected included demographic, pathology type, ASA grading, operative and post-operative progress. Univariable and multivariable logistic regression was performed to determine factors contributing to treatment arm allocation and in-hospital mortality. These were performed on the whole treatment cohort, as well as per pathology subgroup. Results. 210 patients were included. Non-resectional management was attempted in 147 patients (70%), of which 38 (26%) required un-planned colonic resection or died in hospital. Those treated with colonic preservation were younger, had lower ASA scores and had lower Hinchey scores (in the diverticular perforation group) than those in the resection group. Female gender was the only independent predictor of increased in-hospital mortality risk. Importantly, the type of procedure performed (colonic preservation vs. resection) did not predict in-hospital mortality risk. Conclusion. Attempted colonic preservation strategies do not increase the risk of in-hospital mortality in patients presenting with ALSCE. Given the inherent benefits of colonic preservation, these treatment strategies should be considered when managing ALSCE.

Sociodemographic Factors of Alcohol Consumption in a Population of Hospitalized Patients in Ouagadougou (Burkina Faso)

Abstract: The prevalence of excessive alcohol consumption is high in our context. The fight against this scourge requires accurate identification of sociodemographic factors for a better communication strategy. Objective: To determine the sociodemographic factors associated with alcohol consumption in a population of hospitalized patients. Methods: A cross-sectional study was conducted during two months in 14 hospital departments of the University Hospital CHU-Yalgado Ouedraogo (CHUYO) in Ouagadougou, by interview and document review. All patients hospitalized for less than a year, aged 18 at least and consenting were included. Excessive alcohol consumption was defined as consumption ≥210 g/week in men and 140 g/week in women according to WHO, a score ≥8 in men and in women ≥7 by AUDIT Questionnaire, a score ≥2 according to the DETA questionnaire. Socio-demographic factors as age, sex, religion, educational level, marital status, occupation and salary status were filled for all patients. Results: A total of 391 patients were included. The average age was 44 ± 16.26 years and the sex ratio of 1.34. Among them, 135 (34.53%) were consumers of alcohol. The prevalence of excessive consumption ranged from 7.92% to 10.49%. A statistically significant relationship was found between alcohol consumption and sex (p < 0.03), religion (p < 0.01) and education level (p < 0.01). On the contrary, no significant relationship was found between alcohol consumption, age, marital status and occupation. The salary status “employee” appears to promote the consumption of alcohol by some tools. Conclusion: The excessive consumption of alcohol is common in our population especially by educated men of non-Muslim religion. This hypothesis should be corroborated in a study within the general population to better set control strategies against this scourge.

Analysis of Recent Cases of Postbulbar Duodenal Ulcer in Japan

Abstract: Although the incidence of postbulbar duodenal ulcers is low, many complications occur, such as hemorrhage, stenosis and perforation, and there are many points to be paid attention to with regard to its pathology. A high acid level has been pointed out as a cause, but this is not conclusive, and its association with Helicobacter pylori (Hp) infection is also unclear. We investigated chronic cases excluding acute cases such as acute duodenal mucosal lesion we encountered between 2001 and 2015. Five cases corresponded, accounting for 1.4% of all chronic duodenal ulcer cases, and there were more male patients (four patients were male), as previously reported. All cases were solitary punched-out ulcer on the medial side near the superior duodenal flexure, and many complications were observed such as melena in all patients, narrowing in 2, and penetration in 1. No specific pathology, such as Crohn’s disease, vasculitis, or Zollinger-Ellison syndrome, was noted, no patient was previously medicated with NSAIDs or low dose aspirin, and 3 patients were infected with Hp. All cases were healed by proton pump inhibitor administration or gastric acid secretion-suppressing treatment with selective proximal vagotomy. Recurrence after Hp eradication occurred in all of the 3 Hp-infected patients, suggesting that involvement of Hp in the cause of disease is unlikely.

Assessment of the Efficacy of Rifaximin in the Management of Irritable Bowel Syndrome (IBS)

Abstract: The aim of our study was to assess in our context, the efficacy of Rifaxim in improving the symptoms of irritable bowel syndrome particularly in its diarrheal (IBS-D) or mixed (IBS-DC) component and therefore assess its impact on patients’ quality of life. Patients and methods: This was an uncontrolled, non-comparative prospective cohort study of a single group of patients. Patients recruitment was done in two University Hospitals for 6 months (September 2015-February 2016). Were included ambulatory patients, male or female, aged 18 - 75 years, with diarrheic IBS (IBS-D) or mixed IBS (IBS-DC) diagnosed according to Rome III criteria and who agreed to participate in the study. Each patient received 400mg Rifaximin × 2/d for 15 days. The overall assessment of the efficacy of treatment at D15 (end of treatment) and D30 (2 weeks post-treatment) was the primary criterion of judgment. The statistical tests used were the Chi-square test and Fisher’s exact test for the qualitative variables and Student’s test for the quantitative variables. Results: A total number of 30 patients (16 women) with an average age of 44.5 ± 13.9 years were included. The overall assessment of symptoms by the patient with the Likert scale found 28 (93.3%) patients, 12 (40%) patients and 10 patients (33.3%) for a scale ≥2 at D0, D15 and D30 respectively. The assessment of the intensity of pain or abdominal discomfort found at D0, D15 and D30 respectively: 27(90%), 13(43.4%) and 6(20.1%) patients who had an EVA score > 2. The mean score for Francis to assess the improved quality of life was 247.1 ± 97.4 at D0, 99.8 ± 63.1 at D15 and 128.8 ± 70.6 at D30. Conclusion: There is a good overall improvement of symptoms in our patients suffering from IBS-D or mixed (IBS-DC) on Rifaximin with improvement of the quality of life.

Prevalence and Factors Associated with Alcohol Consumption in Urban Schools in Burkina Faso

Abstract: Background: In 2005, the World Health Assembly asked member states to develop effective strategies and programs to reduce the negative consequences of harmful use of alcohol. To develop effective policies, we must already understand the phenomenon of alcohol consumption. But in Francophone west Africa, there are very few studies on the prevalence of alcohol, consumption patterns and factors associated with this consumption. The objectives of this study were to estimate the prevalence of alcohol use in schools in Burkina Faso and to identify socio-demographic factors associated with episodes of “heavy drinking”. Method: A cross-sectional study was conducted in October 2013 in six secondary schools of Bobo-Dioulasso. Three hundred and sixty-two students randomly drawn by stratified cluster sampling were interviewed by using a self-administered questionnaire adapted from the model ESPAD and WHO AUDIT questionnaire. HED (Heavy Episodic Drinking) was defined as consuming at least six local measures of alcoholic beverages around the 30 days prior investigation. The search for factors was performed using logistic regression and estimating standard errors were adjusted for clustering data. Results: The prevalence of experimentation of alcohol was estimated to 45.6% [CI 95% = 40.4 - 50.7]. This prevalence was reduced to 34.8% [CI 95% = 29.9 - 39.7], 24.3% [CI 95% = 19.9 - 28.7] and 18% [CI 95% = 14 - 21.9] if one considered the use of alcohol at least once respectively in the 12 months, 30 days and 7 days before the survey. The prevalence of HED was 16% [CI95% = 12.2 - 19.8]. Independent factors associated with the HED were alcohol use by parents or friends and father’s occupation. Episodes of “heavy drinking” were 8.3 (CI 95% = 4.9 - 14) and 2.8 (CI 95% = 1.3 - 5.8) respectively more frequent among students whose parents and friends were drinking. Neither religion nor sex nor age was not statistically associated with HED. Conclusion: This study confirms the high prevalence of alcohol consumption in schools in Burkina Faso and challenges policy makers to adopt effective policies to fight against the harmful use of alcohol especially in schools.

Relationship between the Level of Helicobacter pylori and Number of Platelets in Non-ITP Patients Who Underwent Gastroscopy

Abstract: Purpose: To investigate both the presence of H pylori in non-ITP patients who had not undergone H pylori eradication, and also its relationship (if any) with the number of platelets Methods: This retrospective study was performed with a total of 220 cases aged between 18 and 65 years who had undergone gastroscopy H pylori levels of the participants were investigated, and concurrently their hemograms were analyzed, and their platelet counts were performed At the same time, cases in the H pylori positive arm were compared with sub-groups categorized based on their degree of positivity Results: A statistically significant difference was not detected between platelet counts of the cases based on their H pylori levels (p = 0583) A statistically significant difference was detected between H pylori levels, and distribution of histopathological diagnosis of the cases (p = 0001; p H pylori has not any effect on platelet counts

Evaluation of CD64 Index in HBV and in Chronic HCV Infections

Abstract: Background and aims: CD64 [Fc gamma receptor 1 (FcγRI)] is a promising biomarker used in predicting severe bacterial infection. The study was designed to assess their level in all stages of HBV infection and in chronic HCV infection before and after treatment with direct acting antiviral therapy as a possible biomarker of inflammation. Patients and methods: A case-control study was conducted, 50 patients with different disease stages of HBV infection (10 acute, 15 chronic hepatitis, 15 liver cirrhosis (LC) and 10 with hepatocellular carcinoma (HCC)), twenty patients with chronic HCV and 15 as a control group. Laboratory and imaging studies were evaluated. The levels of CD64 expressions in peripheral blood and CD64 Index were measured for all patients by flowcytometry using fluorescein isothiocyanate (FITC)-conjugated anti-CD64 monoclonal antibody. Results: The levels of CD64 expressions in peripheral blood and CD64 index were significantly higher in patients with HBV and HCV than in control group (P value = 0.01, 0.01 and 0.000, 0.000 respectively). They were increased significantly with disease progression in patients with HBV infection, acute hepatitis B infection showed the highest values. Their levels were significantly decreased in patients with HCV infection post treatment than before treatment. Conclusions: The levels of CD64 expressions in peripheral blood and CD64 index are considered good biomarkers of inflammation in viral hepatitis both B and C and could detect disease progression and also suppression of inflammation after antiviral therapy.

Clinical and Etiological Profile of Ascites in the Departmental University Hospital of Porto-Novo

Abstract: Aim: To determine the frequency, the clinical and etiological aspects of ascites in the Internal Medicine Division of the University Hospital of Porto-Novo. Methods: It was a cross-sectional study with a descriptive focus covering the period from January 16 to August 31, 2015. It covered patients hospitalized for ascites in Internal Medicine Department at the Departmental University Hospital of Porto-Novo during the study period. Data were collected on a survey sheet and entered by Excel and analyzed with SPSS. The Chisquare test was used for statistical analysis and a significance threshold of 5% was retained. Results: Of the 511 hospitalized patients during the study period, 61 (11.9%) had ascites. The mean age was 49.6 ± 13.6 years with extremes of 19 years and 80 years. There was a male predominance with a sex ratio of 2.05. Ascites were often type III (34 patients, 55.7%), or type II (22 patients, 36.1%). The frequent signs were hepatomegaly (65.6%), splenomegaly (45.9%), pelvic limb edema (44.3%), and abdominal collateral venous circulation (39.3%). The macroscopic appearance of the ascites fluid was dominated by citrin yellow (82%), followed by hazy (11.5%). The hematic appearance was found in 6.5% of the cases. Hepatic cirrhosis was the most frequent etiology (34.4%) followed by overall heart failure (21.0%). Hepatocellular carcinoma was found in 16% of cases and nephrotic syndrome in 10% of cases. Conclusion: The etiological diversity of ascites, found in our study, imposes a careful clinical and paraclinical approach.

No Change in Frequency of Microsatellite Instability in Colorectal Cancers over a Period of 15 or More Years

Abstract: Microsatellite instability (MSI) is a molecular change resulting from inactivation of DNA mismatch repair systems, occurring with a reported incidence between 15% - 20% of all sporadic colorectal cancers. Our aim was to determine whether a change in the incidence of MSI in colorectal cancer had occurred at our institution over time. We assayed 106 cases from the mid-1990s and 69 cases from 15 or more years later for MSI. Those tumors with MSI were assayed for BRAF mutation and methylation. MSI was detected in 15 (14.2%) of the early cases and 11 (15.9%) of the later cases. For the two groups with MSI, a similar percentage was methylated and had a BRAF mutation. One tumor in each group was MSI, unmethylated, and BRAF wild type. Our data indicate consistency in the frequency of microsatellite unstable colorectal cancer across a time span of 15 or more years.

Surgical Bypass versus Endoscopic Stenting for Unresectable Head Pancreatic Cancer, Which Palliative Treatment Is Better in Developing Countries, Morocco as an Example

Abstract: Background: Metal stents for unresectable pancreatic cancer are associated with longer patency and superior cost-effectiveness However, they are too expensive to be recommended routinely in developing countries Moreover, a debate on outcome results in these patients who receive plastic biliary endoprothesis versus surgical bypass as palliation of obstructive jaundice We aimed to compare retrospectively the outcomes in patients treated with plastic stent or surgical bypass as a palliative option for these patients Patients and Methods: We have examined data for patients (n = 86) who received endoscopic stenting (n = 64) or surgical bypass (n = 22), from January 2013 to November 2016, as a palliative treatment for obstructive jaundice from inoperable cancer head pancreas Results: Serum bilirubin and CA199 levels were comparable in age and gender matched patient groups Moreover, post-operative major complications and 30-days mortality showed no significant differences among patient groups However, surgical bypass treated patients showed longer initial hospital stay (9 vs 6 days, p = 0014), higher cost ($1600 vs $1088) and longer survival (192 vs 101 days, p = 0003) compared to endoscopy-stenting treated patients Re-hospitalization was required for 5 stented patients (averaged $448) Conclusion: Biliary bypass surgery for unresectable pancreatic cancer may improve patient survival, although prolongs hospital stay It may be recommended for relatively fit patients with a life expectancy of 6 months and more

Degree of Hyper-Dynamic Circulation Correlates with the Severity of Liver Disease and Predicts Poor Outcome in Spontaneous Bacterial Peritonitis Patients in Intensive Care Unit

Abstract: Background: Circulatory dysfunction is known in spontaneous bacterial peritonitis (SBP) patients. We aimed to determine whether degree of hyper-dynamic circulation is significantly correlated with severity of liver disease and poor outcome in these patients or not. Methods: 61 patients diagnosed to have SBP were enrolled. In addition to routine laboratory investigation, Child Pugh and APACHE II scores were calculated for all patients. Degree of renal impairment was defined using Acute Kidney Injury Network (AKIN) criteria. Stroke volume (SV) was measured by M mode and 2-dimensional Doppler echocardiography. Cardiac output (CO) and Systemic vascular resistance (SVR) were also calculated. All data were statistically analyzed. Results: SV, CO, SVR were significantly correlated with Child Pugh score, p value < 0.001, <0.001, and 0.011 respectively. In 46 (75.4%) patients who had AKI, degree of kidney injury using AKIN criteria is significantly correlated with SVR, SV, and CO. Inpatient mortality occurred in 10 (16.4%) patients. Non-survivors had lower SVR and higher SV and CO compared to survivors (1805 ± 105 dyn·sec/cm2, 80.3 ± 11.2 ml, and 6.7 ± 1.1 L/min vs 1936 ± 504, 67.6 ± 12.7, and 5.7 ± 0.9, p value 0.029, 0.005, 0.007 respectively). Using the Receiver Operating Characteristics (ROC) curve, the cut-off value of CO that predicts mortality was 5.89 L/min with sensitivity and specificity measuring 80%, 70.6% respectively. The area under the curve (AUC) is 0.767 with 95% confidence interval (CI) is 0.566 to 0.968, p value 0.008. At this value, the odds ratio (OR) is 7.33 with p value 0.012. Conclusion: Degree of hyper-dynamic circulation is significantly correlated with the severity of liver disease and predicts poor outcome in SBP patients.

Upper Gastrointestinal Endoscopy at University Hospital Souro Sanou Bobo-Dioulasso (Burkina Faso), about 1022 Cases: Signs and Lesions Observed

Abstract: Upper gastrointestinal endoscopy is an excellent way for the diagnosis of high digestive pathology. We report the results of 1022 upper gastrointestinal endoscopy performed at Bobo-Dioulasso CHU-SS, in western Burkina Faso (West Africa). The aim of this study was to document the indications and lesions found in high endoscopy at the CHUSS. Patients and Methods: It was a cross-sectional study, prospective to describe the results of gastroscopy performed from 1st January 2015 to 30th June 2016 at the digestive endoscopy unit CHU-Souro Sanou Bobo-Dioulasso. Results: In the study period, 1022 upper gastrointestinal endoscopies were performed. The main indications were: The epigastric pain (48.6%), portal hypertension (10.7%) and gastroesophageal reflux disease (9.9%). The pathologies observed were dominated by gastropathies (48.11%), peptic ulcer (27%) and oesophageal varices (9.68%). Epigastralgias were the main circumstance for the discovery of: 52.3% of esophagitis, 49.17% of gastropathies and 46.12% of peptic ulcers. Histopathologically, the results of the 236 biopsies were dominated by gastritis (88.56%), stomach cancers (7.63%) and esophagus (3.81%). Conclusion: The main indication of the UGIE at the CHU-Souro Sanou in Bobo-Dioulasso was epigastralgia. The pathologies observed were dominated by gastropathy, esophagitis and PUD.