Gastroenterology Insights 2019-08-17T10:32:53+02:00 Francesca Baccino Open Journal Systems <p><strong>Gastroenterology Insights</strong> is an online-only, international, Open Access, peer-reviewed journal, which publishes scientific papers about gastrointestinal diseases. Manuscripts dealing with original basic science research, biology, epidemiology, and clinical research involving all gastrointestinal and liver diseases are welcomed. <strong>Gastroenterology Insights</strong> publishes original articles, editorials, perspectives, reviews, brief reports and case reports.</p> Screening colonoscopy in Port Harcourt, Nigeria 2019-08-17T10:32:51+02:00 Emeka Ray-Offor Fatimah B. Abdulkareem <p>Colonoscopy is a screening tool for colorectal cancer. The cost of this service, ready availability and expertise are factors limiting its routine use in low-/middle-income countries. The aim was to study premalignant colonic polyps in asymptomatic middle-aged Nigerians and highlight the usefulness of screening colonoscopy in a sub-Saharan African population. We carried out an observational study on asymptomatic patients undergoing screening colonoscopy in a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria from January to December 2018. The variables collated were demographics, endoscopic and histologic findings. Statistical analysis was done using IBM SPSS Statistics for Windows, version 20 Armonk, NY. A total of 144 colonoscopy procedures were performed during the study period with 70 asymptomatic cases for screening indication. Sixty-five were males and 5 females. The age range was from 48 years to 60 years; mean 54.8 ± 3.6 years. A polyp-detection rate of 53.7% was recorded with multiple polyps seen in 13 cases. Adenoma(s) detected in 19 persons were: 22 tubular adenomas with low grade dysplasia; 3 tubulo-villous adenomas with low grade dysplasia; 1 sessile serrated adenoma. The adenoma detection rate was 28.8%. No abnormality was detected in 19 cases. There is a worrisome prevalence of adenomatous polyps; villous adenoma is rare. A targeted policy of screening and surveillance by colonoscopy will curb the rising incidence of colorectal cancer.</p> 2019-05-17T08:15:40+02:00 ##submission.copyrightStatement## Role of human leukocyte antigens DRB1-DQB1 haplotype in the susceptibility to gastroesophageal reflux disease 2019-08-17T10:32:53+02:00 Batool Mutar Mahdi Riyadh Mohamad Hasan Wafaa Hazim Gastro oesophageal reflux disease is due to involuntary gastric contents reflux into the esophagus from stomach, causing heartburn and acid regurgitation symptoms. Genetic and environmental factors are important factors in the causation of disease. Human Leukocyte antigens considered as an excellent marker for population genetics analysis and disease association. This study aimed to investigate the association between HLA-DRB1-DQB1 haplotype that inherited in linkage and its association with gastro oesophageal reflux disease (GERD). Patients and healthy controls were prospectively recruited from gastrocolonoscope unit at Al-Kindy Teaching Hospital (Baghdad-Iraq) between January and July 2016. Forty Iraqi Arab Muslims patients with a history of heartburn and dyspepsia compared with 100 Iraqi Arab Muslims control. All study patients and control group underwent upper gastroesophageal endoscope examination and HLA-DRB1 and HLA-DQB1 genotype were done using sequence spesific oligonucleotide primer to both groups. The frequencies of two haplotype HLA-DRB1⁄03-DQB1⁄03 and HLADRB1⁄ 13-DQB1⁄06 were significantly higher in patients with GERD while haplotype HLA-DRB1⁄03-DQB1⁄02 was significantly higher in control group. Sex had an effect in disease developing that haplotype HLADRB1⁄ 03-DQB1⁄03 was significantly more common in female patients that increased susceptibility to disease. This study identified that two haplotypes HLA-DRB1⁄03- DQB1⁄03 and HLA-DRB1⁄13- DQB1⁄06 leads to increased susceptibility to GERD and haplotype HLA-DRB1⁄03-DQB1⁄02 was protective against GERD development. 2018-10-01T14:15:11+02:00 ##submission.copyrightStatement## Desmoid abdominal tumour: A clinical case report and brief literature review 2018-10-30T09:18:08+01:00 Irina Ivanova Shahswar Arif Dinko Dinev Kalin Kalchev Maria Atanassova Iskren Kotzev Desmoid tumors are unique mesenchymal neoplasm. They are able to spread to proximal tissues but tend not to metastasize. Our case presents a 66-year-old female referred for evaluation of the prominent, palpable mass located into the left abdomen. Imaging studies revealed a tumor up to 22 cm, extending below the diaphragm to the retroperitoneal and intra-abdominal cavity. Contrast enhanced ultrasound showed strong inhomogeneous arterial hyper-enhancement followed by persistent enhancement in a venous phase. Histology obtained with trucut needle biopsy established desmoid tumor, with overall proliferating activity (Ki-67 expression) of 20%. The lesion had been identified as sporadic and <em>unresectable</em>. During the patient’s follow-up a slow but continuous elevation of serum creatinine was registered eventually led to anuria, requiring emergent hemodialysis. The non-obstructing nephropathy is an unusual complication of the disease course, therefore we briefly reviewed the published data on abdominal desmoid tumors and critically analyzed the relation with kidney injury. 2018-07-11T16:21:27+02:00 ##submission.copyrightStatement## Knowledge of lactose intolerance among clinicians 2018-10-30T09:18:09+01:00 Nebras Ebrahim Hasan Manal Hasan Zainaldeen Fatima Abdulameer Almadhoob Manaf Ali Yusuf Salim Fredericks Lactose intolerance is associated with the inability to digest significant amounts of lactose. Several conditions have symptoms that overlap with those of lactose intolerance. Thus, it is commonly misdiagnosed. There are established investigation procedures that aid diagnosis which include the lactose challenge and the hydrogen breath tests. However, differential diagnosis remains challenging. We aimed at identifying gaps in knowledge regarding lactose intolerance among medical practitioners using a survey consisting of 15 questions. It was completed by 98 doctors. Most questions were answered correctly by more than half of the participants. There was no significant difference in the frequency of correct answers between the different medical specialists or age of participating doctors. Crucially, one question relating to the hydrogen breath test was answered incorrectly by 85% of the participants. This highlights acceptable knowledge of general issues, but not the diagnostic aspects, of lactose intolerance among doctors. 2018-06-08T12:45:09+02:00 ##submission.copyrightStatement## Risk scoring systems to predict in-hospital mortality in patients with acute variceal bleeding due to hepatitis C virusinduced liver cirrhosis 2018-12-12T14:54:06+01:00 Moataz Hassanien Maged El-Ghannam Mohamed Darwish El-Talkawy Yosry Abdelrahman Gamal El Attar Hoda Abu Taleb <p>This study was designed to validate and to compare accuracy of the prognostic scores; mainly Child Turcotte Pugh (CTP), creatinine-modified Child Turcotte Pugh (CTP-Cr), model for end-stage liver disease (MELD), albumin bilirubin score (ALBI), and AIMS65, for the predicting clinical outcomes in cirrhotic Egyptian patients presenting with acute variceal bleeding (AVB). Retrospective single center study involving 725 patients presenting with AVB due to liver cirrhosis and HCV infection either alone or mixed with HBV infection. In hospital mortality prognostic scores were calculated; mainly CTP, modified CTP-Cr, MELD, ALBI, AIMS65. The endpoint is either patient improvement or death. 725 patients were included over 1-year period. 547 (75%) survived and 178 (25%) died. Patients presented with hematemesis (515/71%), melena (120/16.5%) or hematemesis and melena (90/12.5%). Those with hematemesis for the first time were 241 (33%) and recurrent attacks were 484 (66.8%). The non-survivors had significantly more incidence of shock on presentation, more blood transfused units, history of NSAIDS intake, more ICU admission days and were more likely to be Childs C. Child, modified CTP-Cr, MELD, ALBI and ALMS65 scoring systems showed significant difference between survivors and nonsurvivors. Liver specific scores (Child, MELD) and gastrointestinal bleeding scoring systems (ALBI, AIMS65) are useful in predicting clinical outcomes of AVB in cirrhotic patients. CTP-Cr score had the highest prognostic capability of in hospital mortality. Presence of active bleeding at time of endoscopy, more complications, old age, shock and higher CPT-Cr score are additional independent predictors of in hospital mortality.</p> 2018-05-07T13:12:02+02:00 ##submission.copyrightStatement## Comparison of the effect of misoprostol and chewing gum on intestinal movements after cesarean delivery 2018-12-04T09:24:51+01:00 Nazila Najdi Alireza Kamali Pegah Eslami <p>Cesarean is one of the major surgeries after which mother will need to be hospitalized for a long period of time. One of the leading causes of the increase in the duration of hospitalization of such patients is the surgeons’ projections about the development of ileus and defecation. Given the previous studies, misoprostol can increase bowel movements. Moreover, gum-chewing has been recommended as a cheap and available technique for accelerating the resumption of normal Intestinal Movements. The present study is a singleblind randomized clinical trial which has been done on 324 women over 18 years of age with singleton pregnancy who had visited Taleghani Hospital in Arak and was elective cesarean section candidates. The surgery and anesthesia techniques were similar for all patients. These patients were randomized into three groups of 108, namely control, misoprostol, and gum-chewing groups. The patients in these three groups were compared with one another in terms of normal bowel sound, gas passage, defecation and discharge. The results have shown the mean age of a total of 324 patients has been 26.66 years. The results suggest that the time of hearing the first normal bowel sound, the first gas passage, and defecation have been shorter in the misoprostol group, gum-chewing group and control group, respectively. The difference observed between the three groups has been significant at a 0.05 significance level. Furthermore, no significant difference was observed between the patients in the misoprostol and gum-chewing groups and the patients in the control group while reviewing the time of discharge of these patients. The findings have been indicative of the positive effects of the misoprostol and gumchewing techniques on the intestinal function of patients and mothers’ breastfeeding. Also, it has been observed that using misoprostol can be more effective than chewing gum.</p> 2018-05-07T00:00:00+02:00 ##submission.copyrightStatement## Multiple hepatic hemangiomas in a Nigerian man 2018-07-12T15:21:17+02:00 Abiodun Christopher Jemilohun Taofeek Abiodun Ajadi Modupeola Maria Bello Hepatic hemangiomas are benign tumors of the liver which are often found incidentally. We present a 34-years-old man with a two-month history of upper abdominal pain and incidental finding of multiple hepatic masses. The patient sought medical attention at several healthcare facilities where he posed a diagnostic dilemma before he was referred to us. Computed tomographic scan revealed four hypodense hepatic nodules of varying sizes. The nodules demonstrated peripheral enhancement with progressive centripetal filling till they were totally filled during the delayed phase. Abdominal ultrasonography confirmed the four hepatic lesions. The largest lesion was in the left lobe measuring 73×72 mm while the smallest was in the right lobe (24×20 mm). All the masses demonstrated increased vascularity on color Doppler imaging. The paucity of reported cases of hepatic hemangioma in Nigeria, the multiplicity of the tumor and the giant size of one of them make this case remarkable and reportable. 2017-12-13T11:51:31+01:00 ##submission.copyrightStatement## Spontaneous thrombosis of large splenorenal shunt during balloon-occluded retrograde transvenous obliteration in a patient with chronic persistent hepatic encephalopathy. Is this catheter assisted trans-venous occlusion? 2018-07-12T15:21:16+02:00 Lijesh Kumar Cyriac Abby Philips Prakash Zacharias Sudarshan Patil Philip Augustine Large spontaneous portosystemic shunts in cirrhosis are implicated in recurrent and/or chronic persistent hepatic encephalopathy. In long standing cases, these shunts lead to portal vein thrombosis and hepatic dysfunction. Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique that is usually employed for shunt closure in the patients manifesting the features of chronic hepatic encephalopathy. There are several reports documenting systemic and portal vein thrombosis as a part of the procedure. We report first time a patient in whom the difficult and partial BRTO procedure led to the extensive thrombosis of the large splenorenal shunt itself without sclerosant instillation. 2017-12-13T11:40:48+01:00 ##submission.copyrightStatement##