Gastroenterology Insights <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> en-US <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> (Francesca Baccino) (Tiziano Taccini) Mon, 07 May 2018 11:45:17 +0200 OJS 60 Role of human leukocyte antigens DRB1-DQB1 haplotype in the susceptibility to gastroesophageal reflux disease 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. Batool Mutar Mahdi, Riyadh Mohamad Hasan, Wafaa Hazim ##submission.copyrightStatement## Mon, 01 Oct 2018 14:15:11 +0200 Desmoid abdominal tumour: A clinical case report and brief literature review 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. Irina Ivanova, Shahswar Arif, Dinko Dinev, Kalin Kalchev, Maria Atanassova, Iskren Kotzev ##submission.copyrightStatement## Wed, 11 Jul 2018 16:21:27 +0200 Knowledge of lactose intolerance among clinicians 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. Nebras Ebrahim Hasan, Manal Hasan Zainaldeen, Fatima Abdulameer Almadhoob, Manaf Ali Yusuf, salim Fredericks ##submission.copyrightStatement## Fri, 08 Jun 2018 12:45:09 +0200 Risk scoring systems to predict in-hospital mortality in patients with acute variceal bleeding due to HCV-induced liver cirrhosis <em>Background</em>: 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), MELD, albumin bilirubin score (ALBI), and AIMS65, for the predicting clinical outcomes in cirrhotic Egyptian patients presenting with acute variceal bleeding (AVB). <em>Methods</em>: 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. <em>Results</em>: 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 non-survivors. <em>Conclusion</em>: 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. Moataz Hassanien, Maged El-Ghannam, Mohamed Darwish El-Talkawy, Yosry Abdelrahman, Gamal El Attar, Hoda Abu Taleb ##submission.copyrightStatement## Mon, 07 May 2018 13:12:02 +0200 Comparison of the effect of misoprostol and chewing gum on intestinal movements after Cesarean delivery <p><em>Introduction</em>: 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. <em>Methods and materials:</em> the present study is a single-blind 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.<em> Results</em>: 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.<em> Conclusion</em>: the findings have been indicative of the positive effects of the misoprostol and gum-chewing 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> Nazila Najdi, Alireza Kamali, Pegah Eslami ##submission.copyrightStatement## Mon, 07 May 2018 11:45:16 +0200 Multiple hepatic hemangiomas in a Nigerian man 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. Abiodun Christopher Jemilohun, Taofeek Abiodun Ajadi, Modupeola Maria Bello ##submission.copyrightStatement## Wed, 13 Dec 2017 11:51:31 +0100 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? 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. Lijesh Kumar, Cyriac Abby Philips, Prakash Zacharias, Sudarshan Patil, Philip Augustine ##submission.copyrightStatement## Wed, 13 Dec 2017 11:40:48 +0100 Cholecystocutaneous abscess: A rare presentation of a common problem Fistulating cholecystocutaneous abscess is a known rare complication of chronic gallstones disease. In these modern days, this complication is exceedingly rare due to early diagnosis with radiological imaging, use of broad spectrum antibiotics and early surgical management of biliary tract disease. Here we present a case of an 89-yearold with cholecystocutaneous abscess that was mistaken for simple subcutaneous abscess. The management include initial control of subcutaneous abscess and use of antibiotics followed by definitive surgical excision of gall bladder and the fistula tract. Yuni Ongso, Han Nien Beh ##submission.copyrightStatement## Wed, 13 Dec 2017 11:30:15 +0100