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Acta Scientific Gastrointestinal Disorders

Journal Papers (33) Details Call for Paper Manuscript submission Publication Ethics Contact Authors' Guide Line
1 Hepatic and Gastro-Intestinal Manifestations of Volumetric Overload Shocks (VOS) Causing ARDS , Ahmed Ghanem
Substantial physics and physiological evidence with clinical relevance and significance currently exists that affirms Starling's law is wrong (Figure 1) [1-3]. Evidence that volumetric overload shocks (VOS) [4-7] cause the acute respiratory distress syndrome (ARDS) is also available [8]. These VOS are complications of fluid therapy in surgical patients due to many errors and misconcep-tions on fluid therapy [8] that mislead physicians into giving too much fluids during the resuscitation of shock and prolonged ma-jor surgery [9]. The clinical manifestations of VOS causing ARDS is shown in table 1, among the multiple system and vital organ dysfunctions are the hepatic and gastro-intestinal (GIT) manifes-tations [10-14]. These include hepatic dysfunction with elevated bilirubin, alkaline phosphates and liver enzymes of SGOT [10,11] and delayed recovery of intestinal function or paralytic ileus with nausea and vomiting [12,13]
2 Esophageal Dilatation in Children with Esophageal Strictures, Outcome and Safety at Single Center Experience , Abdulhamid Alhadab, Shaden N AlMahamed, Zahid Arein and Abdelhai Hammo
Objective: The aim of this study is to assess the clinical response, nutritional outcome, and safety of endoscopic esophageal dilatation in pediatric esophageal stricture at KFSH-Dammam, Saudi Arabia.Method: Charts of children between the age of 1 month and 16 years old with esophageal stricture who underwent endoscopic esophageal dilatation at King Fahad specialist Hospital-Dammam over a 5 years period from January 2014 until January 2019, was retrospectively reviewed. Patient’s characteristics, procedure modality for stricture dilatation, clinical response, post dilatation catch up growth, and complications were reviewed and evaluated.Result: A total of 17 patients (median age, 2.7 years were identified. The median follow-up period was 2 years. Post esophageal atresia repair stricture (47.1%) and corrosive esophageal injury (17.6%) were the leading cause of strictures. The main presenting symptoms were dysphagia (88.2%) followed by vomiting (64.7%) and then chronic cough (35.3%). Majority of strictures were short segment < 2 cm in length (70.6%). A total of 74 dilatation sessions were performed with an average of 4.3 sessions per patient. 70.8% underwent balloon dilatation. Complete response was achieved in (70.6%) while partial response in (29.4%). Complications of dilatation including esophageal perforation were reported in 1.3%, and post-dilatation chest pain in 2.7%. The mean weight-for-age z-score improved significantly after ED therapy from -1.8 ± 0.79 SD at presentation to -1.01 ± 0.85 SD (P value = 0.003).Conclusion: Our single centre experience demonstrates that endoscopic dilatation is an effective and safe procedure for symptomatic esophageal stricture in children with different etiology. The choice of dilator device is based on multiple factors with minimal reported complications. Maintaining an age appropriate esophageal lumen by dilatation is very crucial to allow for satisfactory oral intake and promote catch-up growth which is the ultimate goal of dilatation
3 Extracorporeal Detoxification and Immunocorrection in Treatment of Corona Virus Pneumonia Complications , Voinov VA, Ilkovich MM, Kovalev MG and Voinova YV
The new corona virus pneumonia caused by COVID-19 having begun in China, has now reached almost all countries of the world, affecting more than 500,000 people, of which more than 25,000 people have died. Unfortunately, specific measures for both preventing and treating this infection, which has pandemic status, are still lacking, which makes this problem very urgent. In severe pneumonia, acute respiratory distress syndrome (ARDS) develops - toxic pulmonary edema with severe and difficult to correct respiratory failure, which requires an extracorporeal membrane oxygenation (ECMO). Since endotoxemia is the basis for ARDS development, extracorporeal detoxification methods should play a leading role in the treatment of this complication. Moreover, with help of hemosorption, not only detoxification is achieved, but also decontamination (delay and removal of pathogens), and with plasma exchange, the body's immune defense system is restored.
4 Meckel’s Diverticulum: Bibliography Review and Presentation of a Case , Carlos Sanjuan-Sánchez and María G García-Rangel
Meckel ́s diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, is a true diverticulum because contain of the layers of the intestinal wall. Is usually found within 100 cc of the ileocecal valve, is more frequent in men and children with congenital malformations. The diagnostic of symptomatic diverticulum is rare because there is not a specific clinical sing. Treatment of the symptomatic diverticulum is diverticulectomy or intestinal resection, asymptomatic case is still controversy. We reported the case of a male of 24 years old who had acute abdomen, the management was a laparotomy finding diverticulitis of a Meckel ́s diverticulum. Intestinal resection was the decision in the case with entero-anastomosis in two planes with clinical good respond.
5 Covid-19 Crisis: How Tortuous is the Coronavirus Road Ahead? , Avinash Jayaswal
Covid-19 disease is the third betacoronavirus zoonotic infec-tion affecting humans in two decades, and has been by far the most catastrophic in terms of human lives and economic wreck. The global pandemic that started in the meat market in Wuhan, China, has already claimed 116,000 lives and infected 1,8 million people and counting [1]. The first Indian to test positive for covid-19 was a medical student who had arrived in Kerala from Wuhan at the end of January [2], which is around the same time the first American and the first Korean were tested. The response was mapped out immediately by a group of government officials in Kerala as their experience with the outbreak of Nipah in 2018, a brain-damaging virus originating from bats and transferred to humans, was still fresh [2]. That outbreak was successfully managed despite techni-cal shortfalls. This time they put forward a plan of contact tracing, isolation and surveillance state-wide, until the whole country went into confinement with more than 12,000 cases two months later, in an attempt to curb viral spread.
6 Adult Sigmoido-Rectal Intussusception Presenting as Gangrenous Bowel and Rectal Prolapse: A Rare Presentation , Renu Saini, Urmila Basu, Niraj Kumar, Raj Mithun Degala and Sanjay Kumar Dubey
Intussusception in adults especially sigmoido-rectal intussusceptions is extremely uncommon. In this report we have described a case of sigmoido-rectal intussusception in an elderly gentleman presenting as prolapsed gangrenous bowel who underwent laparotomy and resection anastomosis and made an uneventful recovery. Adult intussusceptions are generally associated with a pathological entity predominantly malignant. Insidious presentation with vague abdominal pain is the usual presentation and emergency presentation as seen in our case with gangrenous prolapsing bowel in the absence of a predisposing etiology is extremely uncommon. While adult intussusception usually requires operative intervention controversy exists with respect to attempted reduction prior to resection.
7 Not Only Helicobacter pylori Lives in Stomach - Case Report , Leandro Bressianini Jurkonis, Carolina Rebello Hilgert, Maria Cristina Figueroa Magalhães and Jean Rodrigo Tafarel
This case report brings attention to an unusual pathogen which can live in the human stomach and cause dyspeptic symptoms, weight loss and typically does not spring as the first hypothesis of medical doctors. The 67-year-old Brazilian man described in this report had a delay in his diagnosis of almost 2 years, until his complaints were resolved, which makes this an interesting case report.
8 Spectrum of Pulsion Esophageal Diverticulum and Approach to the  Management Based on Presence or Absence of Symptoms , Ajeet  Kumar  Lohana;Rajesh  Bansari;Fakhar  Ali  Qazi  Arisar;Wasim Jafri
Introduction: Pulsion esophageal diverticulum (PED) is a rare esophageal disorder. A minority of individuals develops characteristic symptoms, such as dysphagia,; however;, the majority does not produce any symptoms. Progression and requirement of a follow up in asymptomatic diverticulum is not well determined. In this study, the spectrum of presentation and approach to management of PED based on presence or absence of symptoms is determined. Method: In this retrospective study, 28 consecutive patients identified having PED from January 2010 to December 2017. Information regarding clinical spectrum of the disease and treatments were recorded. Patients follow up charts were reviewed to determine onset of new symptoms in asymptomatic individuals and resolution/recurrence of symptoms in symptomatic individuals after respective treatments. Results: Mid esophageal diverticulum (MD) was the most common diverticulum (17/28) (60.7%). 13/28 (46.42%) of individuals were asymptomatic and all of these patients harbor MD of ≤1 cm in size. Over a mean follow up of 14 months none of asymptomatic patient developed new symptoms and/or complications. A total of 15/28 (53.54%) patients were symptomatic, predominantly with dysphagia (10/15) (66.66%) and having Zenker’s Diverticulum (ZD) among 4, MD among 4, Epiphrenic Diverticulum (ED) among 6, and MD+ED among 1 patient. Out of 15 symptomatic patients, one third (5/15) of patients underwent surgical interventions due to persistent troublesome symptoms; another one third (5/15) could not undergo surgical resection despite persistent symptoms because of comorbid condition and patient refusal; and in remaining one third (5/15) of patients the symptoms were fairly controlled with  supportive  treatment  only.  1/5  (20%)  of  symptomatic  individuals  who  underwent  surgery  had  recurrence  of  symptoms  postoperatively. Conclusion: MD type with ≤1 cm may not require treatment or long term follow up. Zenker’s and Epiphrenic Diverticula produce persistent  symptoms  even  if  small.  Two  thirds  of  such  symptomatic  patients  require  surgical  or  endoscopic  resection  because  of  troublesome symptoms; however rest of symptomatic patients can be controlled with supportive treatment without necessitating surgical intervention
9 Perplexity in Diagnosis of Pancreatic Lesions , Tanveer Ahmed
Cystic lesions of Pancreas are always challenging for Gastroen-terologist.  In  the  recent  past  cystic  lesions  of  pancreas  remained  undiagnosed  and  number  of  patients  were  diagnosed  after  sur-gery. But in new era Endoscopic Ultrasound have made it so much easy  and  now  cystic  lesions  of  pancreas  are  diagnosed  easily  and  treated well and surgery is needed only in 10 - 25% patients. Only 20%  cystic  lesions  are  malignant  while  others  are  benign  lesions  so early diagnosis and treatment of cystic lesions is very important in reducing mortality and morbidity in number of patients.
10 Metastatic Renal Epithelioid Angiomyolipoma: An Interesting and Rare Case Report , Jill David,Reginald Chounoune,Alene Wright,Abdul Waheed and Frederick D Cason
Angiomyolipomas are the most common clonal mesenchymal tumors of the kidney. Metastatic renal epithelioid angiomyolipomas (MREA) are a less common variant that are found to have malignant potential. We present a case of a 59-year old female diagnosed and treated for MREA which was initially thought to be a benign renal mass. The patient was being followed with serial abdominal imaging which showed subsequent development of two large abdominal masses. Appropriate surgical intervention was performed, the  patient  tolerated  the  procedure  with  minimal  complications,  and  the  post-operative  microscopic  evaluation  of  biopsied  specimens confirmed the diagnosis of MREA. Unlike commonly benign renal angiomyolipomas, MREA is a highly aggressive lesion. It is imperative for clinicians to identify and differentiate this life-threatening lesion from renal cell carcinoma (RCC). A multimodality treatment approach including resection of tumor and adjuvant therapy may provide optimum treatment for MREA.
11 Acute Pancreatitis Revealing Cystic Dilatation of the Common Bile Duct: A Case Report , Naouel Lemdaoui,Raouf Menoura,Abderraouf Bataiche,Ha-kim Rahmoune,Nada Boutrid and Soumia Satta
Cystic dilatation of the common bile duct (CDCBD) is a rare congenital defect. More than half of the reported cases are pediatric and 80% are involving girls. Its symptomatology is often atypical and it is commonly of incidental discovery and rarely revealed by a severe complication like acute pancreatitis.
12 Identification and Characterisation of Periodicum pradatorius: An Emerging Pathogen of Physicus novicius and Litterae scientific , Rasher Dan,Thomas Thug and Peter Throb
Litterae scientific has, over the last decade in particular, been the subject of escalating insult from anumber of rogue elements; none more insidious than Periodicum  pradatorius[1]. Coinciding with the growth of the internet [2], this opportunistic infectious agent gains access to its intermediary host (Physicus novicius) primarily via Email, though social media platforms have also been implicated [3]. Once established in the hosts’ inbox, the virus either remains dormant until activated by the unwitting host, or neutralised by the hosts’ immune defences (i.e. antispam software).
13 The Challenge to Move the GI Tract , Alfredo Fernandez
One of the most difficult approaches are when we have a patient with any symptoms of abnormal motility in this case the inhibit of bowel movements and reflux of GI tract and the same time the patient suffer of any cardiac arrhythmia and neurological disorder including  any  mood  disturbance.  The  reason  is  because  the  meds  that we can use to improve the motility affect some how the dopa-mine receptors in the brain and heart too. Therefore thousands of patients  can’t  be  able  to  improve  her  multiple  symptoms  of  acid  reflux, gas, constipation and upper - lower dyspepsia then the Man-agement of all those conditions stuck in some matter that neither Surgeons  and  Clinicians  can’t  be  able  to  help  them  and  burden  of  this patients medically and economic too increasing their frustra-tion therefore we need to learn how treat this patients and allow their compliant with this condition management.
14 Pedunculated Giant Gastric Adenoma Embedded in the Entire Duodenum , RB Bayramov, RT Abdullayeva and SE Huseynova
Introduction: Adenomatous polyps of the stomach are uncommon tumors, comprising only 7 - 10% of all gastric polyps. Most gastric adenomas are solitary, pedunculated masses, measuring up to 3 - 4 cm in size, and commonly located in the antrum. Method: We present a patient with a giant pedinculated tubulovillous adenoma with features of moderate dysplasia developed in the middle third of the stomach and embedded in the entire duodenum and obturated it, who was referred to the hospital with clinical manifestations of duodenal obstruction. The correct diagnosis was made preoperatively at the specialized hospital on the basis of CT and upper gastrointestinal endoscopy. Case Presentation: 44-year old female was admitted because if epigastric pain and vomiting. First upper gastrointestinal endoscopy carried out at an unspecialized hospital gave duodenal carcinoma obturating the lumen. Abdominal CT and upper gastrointestinal endoscopy  in  specialized  center  revealed  giant  gastric  adenoma  with  long  and  thick  pedicle  embedded  in  the  entire  duodenum  and  obturated  it.  Middle  segment  gastric  resection  wit  gastro-gastroanastomosis  via  laparotomy  was  carried  out.  The  size  of  the  adenoma’s mass was 118 × 10 × 8 cm, of the pedicle – 8 × 4 cm. Conclusion: The  case  emphasizes  that  such  giant  gastric  adenomas  with  a  long  pedicle  can  be  embedded  in  the  duodenum  and  obturate  it  completely  causing  the  manifestations  of  duodenal  obstruction.  In  unspecialized  hospitals  misdiagnosis  can  be  made.  Middle segment gastrectomy can be a preferential option in the case of middle third location of the giant gastric adenoma.
15 Which is the Role of Locoregional Interventional Procedures for Secondary Hepatic Malignancies? , Roberto Iezzi
In the last decade remarkable advances in cancer care has cre-ated new challenges leading the clinical practice towards a person-alized medicine. Metastatic tumors to the liver continue to be an important health problem, representing the most common malig-nant tumor of the liver. Furthermore, liver is also frequently the sole organ harbouring metastases. Therapy directed at the liver to control or eliminate the predominant or exclusive site of disease should theoretically translate into improved survival. Due to the high incidence most of the available data relate to metastases aris-ing from colorectal primaries and the results obtained with resec-tion of colorectal hepatic metastases provide the most compelling evidence in support of this paradigm.
16 Remdesivir-Gate for COVID-19 , Mina T Kelleni
A full-scale clinical trial of remdesivir used for adult patients admitted to hospital for severe COVID-19 has clearly exposed that remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients on placebo. Further, remdesivir was not associated with statistically significant clinical benefits including the time to clinical improvement (hazard ratio 1.23 [95% CI 0.87 - 1.75]). Further, neither a significant mortality difference nor a decrease in viral load over time has been reported as compared to placebo
17 Laparoscopic Groin Hernia Repair: A Systematic Institutional Study , Tuhin Shah;Ashish Prasad Rajbhandari;Bhuban Rijal;Rabin Koirala;Arjana Shakya
Abstract Keywords:Inguinal Hernia; TEP; TAPP; Groin Hernia; Laparoscopic Inguinal Hernia RepairIntroductionIntroduction:Laparoscopic inguinal hernia repair is an option for inguinal hernia repair and is emerging rapidly as more surgeons are using this method and reporting the results.It has gained a key role in inguinal hernia repair with advantages reported in many trials and guidelines. Case Report:This is a retrospective descriptive study conducted in Surgery Department of Nepal Medical College and Teaching Hos-pital, Nepal from November 2017 to April 2019. All patients more than 16 years of age with inguinal hernias were given the choice of laparoscopic or open repair. Those who opted for laparoscopic repair were included in the study. Results:A total of 47 patients were included ranging from 16 to 78 years. There was a male predominance with 40 patients; and TEP (total extraperitoneal) repair was done in 30 while TAPP (transabdominal preperitoneal) repair was done in 17 patients. In 11 patients, we did a combined procedure in the form of Pantaloon hernia in 4, umbilical hernia in 2 and cholecystectomy in 5 patients. In this study, 10 patients had surgical complications, 4 each had peritoneal tear and seroma collection and 2 had SSI. The average total hospital stay was 3.2 (range 2-6) days and we do not report any hernia recurrence in our study. Conclusion:Laparoscopic inguinal hernia repair can be safely considered in a developing country with limited resources after at-taining proper training and expertise.
18 A Study to Evaluate the Efficacy and Safety Measures of Opioid Analgesics in Acute Pancreatitis , S Aravind;G Balaji
Abstract Background: Acute pancreatitis is a sudden inflammation of the pancreas. Occurs in order of frequency including a gallstone impacted in the common bile duct beyond the point where the pancreatic duct joins it; heavy alcohol use; systemic disease; trauma; and, in minor mumps. Acute pancreatitis may be a single event; it may be recurrent; or it may progress to chronic pancreatitis. Method: A prospective study about the efficacy and safety measurement of opioid analgesics in the treatment of acute pancreatitis was held in a tertiary care hospital. Objectives: To study the treatment outcomes of opioid analgesics by using case summaries and discharge medication chart. To assess the safety measures to be followed during the therapy of opioid analgesics. To minimise the ADR`S. Results: During the study it was observed that many patients have been suffered with severe abdominal pain prior to the treatment with opioid analgesics. This severity of pain is far most better after the treatment.
19 Role of Fibroscan and Non Invasive Markers to Assess Hepatic Fibrosis and Steatosis at Initial Presentation of Patients with Hepatitis B , Ankur Shah;Rathi Chetan;Shah Jayshri A
Abstract Objectives: To analyse the Role of Fibroscan (FS) and non-invasive markers to assess hepatic fibrosis and steatosis at initial presen-tation of patients with Hepatitis B. Methods: An observational prospective study of patients with chronic hepatitis B (CHB) evaluated at single Liver Clinic, Mumbai from April 2014-March 2017. Serological markers, transient elastography (fibroscan) for HF, APRI, FIB-4, AST/ALT ratio and E-score were analyzed. Controlled attenuation parameter (CAP) score on fibroscan was used for grading of hepatic steatosis. Patients were categorized into 2 groups: No significant fibrosis (< F2), significant fibrosis (> F2) group. AST/ALT ratio was divided into 2 groups: No significant fibrosis for ≤ 1, significant fibrosis > 1. Results: 178 study patients with male preponderance (68%), had asymptomatic infection, 24 patients were symptomatic; ascites (7), variceal bleeding (11) and hepatocellular carcinoma (8). 139 patients underwent fibroscan, 80 had HS on CAP score. 40/100 patients with normal AST and ALT had significant fibrosis (> F2) on fibroscan. Amongst noninvasive biochemical tools, only FIB-4 had significant correlation with fibroscan, (p < 0.05). The ROC curve areas (AUROC) of FIB-4, APRI and AST/ALT ratio that differentiated patients with significant HF from without fibrosis was 0.704, 0.674, 0.567, respectively. The sensitivity and specificity of FIB-4, APRI and AST/ALT ratio to differentiate patients with significant HF from those without was 42.6% and 92.3%, 72.1% and 60.2%, 29.5% and 83.3%, respectively. Conclusion:Fibroscan and FIB-4 had significant correlation of HS in CHB patients. These can be used as non-invasive modalities to monitor HS in CHB patients.
20 Small Bowel Bleeding Associated with Meckel’s Diverticulum. Complex Diagnosis with Monoballoon Enteroscopy , Jonatán Mendoza Ramírez;Diego Angulo Molina;Javier García Guerrero;Jorge Santín Rivero;Laura Montserrat Bernal López
Abstract Meckel's diverticulum is a congenital diverticulum, which contains intestinal mucosa and ectopic tissue (gastric or pancreatic). The diagnostic accuracy of monoballoon enterosocopy has been reported between 58 - 74% compared to 67% of the endoscopic cap-sule in the evaluation of evident small bowel bleeding. Meckel's diverticulum is rarely diagnosed in adults and is usually associated with complications such as gastrointestinal bleeding, obstruction and diverticulitis (30%). The treatment for symptomatic Meckel's diverticulum is surgical resection, with or without an adjacent bowel segment.
21 EUS Guided Liver Workup Versus Percutaneous Guided in a Community Hospital , Matthew M Eves;Allison Harvey;Michael Lysek;Roshanak Derakhshandeh
Abstract Background and Aims: Previous studies confirm endoscopic ultrasound (EUS) can complete liver biopsy, paracentesis and EGD during one procedure. This study evaluates translating these studies to a community hospital. Results: Mean number of portal triads was 12.7 EUS vs. 12.4 percutaneous (p value 0.89). Mean length of the longest core 0.94 EUS vs. 1.06 cm percutaneous (p value 0.14). Etiology of hepatitis 4/7 EUS vs. 0/4 percutaneous (p value 0.03). Confirmation of cirrhosis 4/6 EUS vs. 1/3 percutaneous. Total cost $1705 EUS vs. $3984 percutaneous. No significant complications occurred. Methods: 17 patients requiring EUS liver biopsy were compared to 17 transcutaneous patients for quality, cost and safety. This included evaluation for varices and diagnostic paracentesis. Conclusion: No significant biopsy sample differences existed. EUS provided better diagnostic information and clearly has economic advantages. The benefits of EUS guided liver workup translate to a community hospital
22 Successful Pelvic Exenteration for T4b Rectal Cancer: A Case Report , GZ Bounab;S Bicha;H Rahmoune; N Boutrid;R Sayoud;H Boutrid;N Lemdaoui
Abstract Pelvic exenteration (PE) or pelvectomy is defined as radical “En Bloc” resection of two or more contiguous pelvic organs, followed by reconstruction or diversion of visceral functions. PE was first reported by Brunschwig in 1948 as a particular and radical surgery for advanced and recurrent cancer and considered as "the most radical surgical attack so far described for pelvic cancer". Its broad indications are curative strategies discussed by a multidisciplinary team; PE must be done “En Bloc” with negative margin status.We report a case of a rectal mucinous carcinoma in a 38 year-old man. The patient benefited radical treatment through total PE with terminal colostomy and urinary diversion (ureterostomy by Bricker's method) with good post-operative outcomes.
23 Evaluation of the Frequency and Factors of Hospital Mortality in Surgery at the Kankan Regional Hospital , Camara Soriba Naby;Camara Alpha Kabinet;Diallo Amadou Djoulde;Balde Oumar Taibata;Balde Abdoulaye Korse;Sanoh Doukara;Toure Aboubacar;Diallo Aissatou Taran;Diallo Biro
Abstract Purpose of the Study: The purpose of this study is to make an analysis on the factors of mortality at the prefecture hospital of Kankan.Materials and Methods: Its was a prospective cross-sectional observational study over a period of 6 months. The target population consisted of all patients admitted to the surgical department during the study period. Introduction: By its very definition, mortality can be defined as the number of deaths that have occurred in a population during a given period. The mortality rate is expressed as a percentage; it is the proportion between the total number of deaths in a given space and the size of the population. Results: The sex ratio of nearly 1.42 (M/F) reflected a strong male prevalence of mortality with a frequency of 20 cases, 59% against 14 women, or 41%. In our study, the hospitalization time was less than 10 days with extremes of 1 to 27 days.The average age of the deceased patients was 41 ± 10 years with extreme ages of 2 years and 81 years. The maximum number of deaths concerns the age group between 50 and over with a percentage of 38.22%.Introduction Conclusion: This study allowed us to understand that most of our deceased patients were due to septic wounds, see generalized sepsis and the chronic poverty of the patients which impacts the adequate management.
24 The Evolving Role and Challenges Faced by Gastroenterologist in the Era of COVID-19 Pandemic and Beyond , Muhammad Kamran;Wasim Jafri
Abstract COVID-19 has had a profound impact on both global economy as well as the healthcare system. The long-term consequences of this contagion are yet to be witnessed. In this perspective, the field of gastroenterology also has an important part to play, as the virus very commonly affects the gastrointestinal tract, including the liver. In this brief review, we will first describe the common gastrointestinal and hepatic manifestations pertinent to COVID-19 and also discuss why the GI tract is frequently involved in this viral disease. Subsequently, we will analyze the constantly changing role of gastroenterologists in terms of their interactions with patients in the out-patients department, ward and endoscopy suite. We will also touch upon the different hurdles being faced by them during these testing times, dealing with the COVID-19 patients and at the same time engaged in an incessant struggle to maintain continuity of care for patients with pre-existing disorders of the digestive system. Finally, we will be discussing the problems and currently being encountered by fellowship training programs throughout the world and will try to provide certain practical solutions to some of them. Our overall aim of writing this review is to highlight the issues faced by present day gastroenterologist, so that concerned authorities and academic societies can offer guidance to alleviate these concerns without compromising standard of care of the patients.
25 Abdominal Attacks May Reveal Hereditary Angioedema! , Naouel Lemdaoui;Nada Boutrid;Hakim Rahmoune;Mounira Amrane;Abderraouf Bataiche;Hala Boutrid
We received a 14-years old girl suffering from recurrent acute attacks of abdominal pain and nausea with facial swelling and la-bial angioedema, reoccurring irregularly since 3 years without a clear trigger. A large panel of radiological and laboratory investigations could not unveil the cause of these episodes, until she was readmitted in the ward during a similar crisis with afebrile abdominal pain, face swelling and a transient crural macular rash.The patient is on her first day of menses and is free from urti-caria or pruritus.This clinical stereotyped sequence is highly suggestive of Here-ditary Angioedema (HAE), the most common type of complement related, non-allergic angioedema; with peritoneal involvement and intestinal swelling revealed by pain and vomiting.
26 SPATZ3 Intragastric Balloon: Efficacy, Fungal Contamination and Complications during the 12 Months of Use , Bruno Queiroz Sander;Oliveira ASB;Maiolini R;Pereira CRT;Sindorf ML;Ferreira CO;Silva MIF;Rosa ED;Barral MCM;Clasen SPAS;Freitas JBA;Benvenuti ECSC;Pessoa DF;Bonates HA;Scoralick MO;Ribeiro MMS;Matos CRQS;Carvalho CAM;Braga KM;Rosado JJS
Introduction: The intragastric balloon is the medical treatment indicated for patients with overweight and obesity, it’s safe and effective with great results all over the world. The presence of fungi on the external surface of the intragastric balloon has been the main cause of silicone fragility and perforation of the balloon, with the need for prosthesis replacement. One of the objectives of this study will be to evaluate the effectiveness of the use of oral anti fungal medication (Nystatin) to try to reduce the appearance of fungi on the surface of the balloon and, thus, try to also reduce the rate of leakage or rupture of the prosthesis, in addition, this study aims to evaluate the effectiveness of Spatz in weight loss, as well as the complications presented during the period of its use. We divided the 268 participants in this study into two distinct groups: In the first group, we mixed Nystatin with the usual balloon filling solution and in the second group, we used only the usual filling solution, without the use of anti fungal. Results: In the group where anti-fungal was placed in the balloon filling solution, a little less than 10% of fungal patency was obser-ved on the surface of the balloon, while in the other group, without the anti-fungal, this prevalence was close to 20%, or that is, almost twice as much. We did not observe significant variations in fungal colonization in relation to the age or gender of the participants in this study. The appearance of ulcers, despite the considerable incidence, was not a problem and, in most cases, it was treated con-servatively. Conclusion: The use of anti fungal mixed with the usual filling solution of the balloon decreases the presence of fungi on its surface and, consequently, decreases the rate of perforation or early rupture of the prosthesis. Spatz proved to be a safe and very effective IGB as an auxiliary method for weight loss. Keywords: SPATZ3; Intragastric Balloon; Fungal
27 Weight Regain after Bariactric Surgery. Endoscopic Suture with Overstitch Use for Gastrointestinal Anastomosis Decrease. Inicial Results: Brasilian Multicenter Study , Bruno Queiroz Sander;Marcelo Pereira Sander;Jimi Scarparo;Felipe Matz;Felipe Ramos;Carlos Henrique Rodrigues Castro;Stephany Roman Farfan;Waldemilson Cleber de Castro Vieira;Hellen Guimarães Sampaio;Edson Portela;Linsmar Dantas Conceição;Diego Paim Carvalho Garcia;Luiz Ronaldo Alberti
A new potential treatment option for weight regain after bariatric surgery is endoscopic suturing with the OverStitch system. The aim of this study was to analyze the weight regain after this procedure in patients who underwent bariatric surgery. There was a significant mean reduction in weight and BMI. There was progressively an increase of Total Body Weight Loss percentage. No complications were observed during or after the procedure. Keywords: Obesity; Gastroplasty; Weight Regain
28 Recurrence of Helicobacter pylori Infection after Successful Eradication Therapy in Egyptian Patients , Mohamed AA Bassiony;Amr T El Hawary;Marwan N Elgohary
Background: Helicobacter pylori (H. pylori), a highly prevalent gastrointestinal organism, infects more than 50% of the global population. It is the most common risk factor for peptic ulcer disease, cancer stomach and gastric lymphoma. Eradication therapy regimens for H. pylori are highly effective. However, bacterial resistance to antibiotics and patients non-adherence to the treatment regimens significantly increased the recurrence rates of H. pylori infection in the last few decades. Patients and Methods: We evaluated and followed up 157 patients for one year after confirmed successful eradication of H. pylori infection. We investigated the patients at 3, 6, 9 and 12 months for recurrence of H. pylori infection using urea breath and stool antigen tests. Study Aim: To assess the prevalence and possible risk factors of H. pylori recurrence in Egyptian patients after eradication therapy. Results and Conclusion: We found a one-year recurrence rate of 19% after successful eradication therapy of H. pylori. The education level of the patients and alcohol consumption were the most significant predictors of H. pylori recurrence. The one-year recurrence rate in our study is high but comparable to those reported in the developing countries most probably due to high rates of re-infection and non-adherence to the preventive measures.
29 Non-Alcoholic Steatohepatitis (NASH): A Critical Stage of Chronic Liver Disease , Ali Mahzari
Endoplasmic Reticulum; TNF-α: Tumour Necrosis Factor Al-pha; IL-6: Interleukin 6; IL-1β: Interleukin 1 Beta; NAFLD: Non-Al-coholic Fatty Liver Disease; NASH: Non-Alcoholic Steatohepatitis; NLRP3: NOD-, LRR- and Pyrin Domain-Containing Protein 3; MCD: Methionine Choline Deficient; TG: TriglycerideNon-alcoholic steatohepatitis (NASH) is a severe and progres-sive stage of NAFLD, in which hepatocyte damage, inflammation and fibrosis are present. Unlike simple hepatic steatosis, NASH may become a more prominent public health issue in the near fu-ture with the potential of becoming the leading indication for liver transplantation.
30 Comparing the Effects of Biofeedback and Posterior Tibial Nerve Stimulation (PTNS) on Dyssynergic Defecation Sings and Symptoms , AR Pakghalb;R Bazaz Behbahani
Background: According to past studies it was proved that the treatment of dyssynergic defecation was by doing treatment exercises to defecate properly with biofeedback, but recent studies have proved that using tibial nerve stimulation plays an important role in treatment and recovery of pelvic floor dysfunctions therefore this study took a look at the comparison of exercise therapy with bio-feedback and posterior tibial nerve simulation in patient’s treatment. Materials and Methods: This study was a randomized clinical trial of 42 patients who complained of hard stool, 30 patient were chosen based on RomeIII criteria and they were put into separate groups of biofeedback and PTNS. And then some factors including, volume and time of balloon expulsion, patients complaints and RomeIII criteria before and after intervention were Investigated and compared. Finding: In both groups symptoms of dyssynergic defecation have decreased compared to before treatment but in quantitative criteria a difference was observedin fever of biofeedback. In quantitative criteria time and volume of balloon expulsion were in favor of biofeedback group (p < 0/05). In qualitative criteria including, hard stool, painful defecation, excessive strain and feeling of incomplete defecation significant changes were observed in both groups (p < 0/05 in following criteria such as, bleeding, number of defecation per week and manual maneuver there were so significant differences in groups (p > 0/05). In relation to quantitative criteria, obstructive defecation changes were significant in favor of PTNS group Conclusion: Using PTNS in dyssynergic defecation is effective. Keywords: Biofeedback; Posterior Tibial Nerve Stimulation; Constipation; Dyssynergic Defecation; Anorectal Dyssynergia; Anorectal
31 Is the Proximal Subtotal Gastrectomy a Better Choice in Selected Patients than Radical Gastrectomy: A Comparison of Morbidity, Mortality and Survival after Surgical Treatment of Proximal Third Gastric Adenocarcinoma , Jagric Tomaz;Jagric Timotej
Background/Aim:The theoretical functional advantages of proximal resection with jejunal interposition could outweigh the higher risk of recurrence in the unfit elderly population. The aim of our study was to evaluate proximal resection as an alternative in selected patients. Methods: Between 1993 and 2009, 161 patients were operated on in our centre for adenocarcinoma of the proximal third of the stomach. They were divided into three groups: PG: proximal resection with jejunal interposition; TH: transhiatal extended total gastrectomy; GT: total gastrectomy. We analysed the postoperative morbidity, 30-day mortality, survival, and quality of life with a questionnaire. Results: The patients in the PG group were significantly older and in worse general condition. The number of harvested lymph nodes was significantly smaller than in the GT and TH groups. There were no significant differences in the distribution of TNM stages be-tween groups. There were no differences in the morbidity and 5-year survival rates between groups. No differences were found in the total scores of the GIQLI questionnaire. Conclusion: Proximal resection should be reserved only for high-risk elderly population with proximal gastric cancer. These resec-tions carry acceptable morbidity and mortality; however, the reconstruction with jejunal interposition does not bring the desired functional benefits.
32 Functional Gastrointestinal Disorders in Children , Rajeev Gupta
Functional gastrointestinal (GI) disorders (FGIDs) are common disorders characterized by recurring GI symptoms that cannot be attributed to structural or biochemical abnormalities [1,2].The common functional disorders seen in pediatric patients are functional dyspepsia, irritable bowel syndrome, functional abdom-inal pain and cyclic vomiting. There other less common conditions as well and these functional gastrointestinal disorders continue to challenge the medical professionals and have a significant emo-tional and economic impact. Functional gastrointestinal disorders (FGIDs) are common, the prevalence of FGIDs has been reported to range between 12% and 29%
33 Gut Dysbiosis, Probiotics and COVID-19 , Andrew P Smith
The impact of COVID-19 is well documented, with over sixteen million people infected and 665,000 deaths [1]. With any infection it is necessary to consider countermeasures which can improve im-mune functioning and the immunological response to vaccination. Our bodies are host to large numbers of bacteria which colonise the skin and the digestive system. These organisms are referred to as microbiota and interest here lies in the gut microbiota. These show large individual variation [2], which may plausibly explain differences in susceptibility to and severity of disease. An abnor-mal gut microbiota is referred to as gut dysbiosis, and this has been shown to be a risk factor for disease. For example, hypertension is linked to gut dysbiosis [3], as is coronary heart disease [4]. Similar-ly, patients with both Type 1 [5] and Type 2 [6] diabetes show signs of gut dysbiosis. Susceptibility to, and the severity of COVID-19 has been shown to be associated with the same diseases that lead to gut dysbiosis.