Asian Journal of Research and Reports in Gastroenterology

Leaky Gut Syndrome and Oral Lesions - A Hypothesis

2023-03-22T10:20:49+00:00

There are many oral lesions which run a chronic course and always recur despite being treated multiple times by experts. They cause tremendous damage to multiple tissues. Many oral diseases have orofacial manifestations only, while others are associated with multiple serious systemic manifestations. Various researchers across the globe have been struggling to find out permanent solutions through various therapeutic approaches like, ayurveda and holistic etc but internal root causes should be found out which might give us breakthrough quick therapies in near future.

We need to explore evidence based various hidden internal /systemic causes to achieve permanent cure of such chronic long-standing diseases.

All systems of the body are interconnected and always works in harmony. Oral diseases can never be restricted to orofacial tissues. They are strongly connected to gastro intestinal, ectodermal tissues and all the systems. This article is an attempt to find out same through few hypotheses and connecting oral lesions with other disorders.

A Literature Review: Adjunctive Use of Proton Pump Inhibitors to Variceal Band Ligation in Cirrhotic Patients

2023-09-06T14:02:53+00:00

Introduction: This review focuses on the effect of Proton pump inhibitors (PPIs), acid-suppressive agents, combined with ligation to manage rebleeding ulcers in cirrhotic patients.

Methods: Data reviewed during approximately the last 20 years combining different studies concerning the use of antiacids in Variceal Cirrhotic Patients.

Result: Data showed different results, with most supporting the role of PPIs in this field.

Conclusion: PPIs used as adjunctive to EVL in cirrhotic patients for either prophylaxis or treatment of bleeding ulcers following ligation showed successful results and a good impact on general health and should be tried on those patients to improve their care.

Sonographic Assessment of Pancreatic Echogenicity in Normal Adults in South-South Nigeria

2023-04-20T09:27:26+00:00

Background: The pancreas has a normal echogenicity that is comparable to or slightly higher than that of the liver. Fat accumulated around the pancreas determines pancreatic echogenicity, and ultrasound scan is a crucial diagnostic and screening tool for its assessment.

Objective: To determine the pancreatic echogenicity in normal adults, and their relationship with age, sex, height, weight and body mass index (BMI).

Subjects and Methods: This descriptive, cross‐sectional study was conducted in four health institutions in Bayelsa State, Nigeria from July, 2022 to February, 2023. Statistical Product and Service Solutions for Windows® version 25, SPSS Inc.; Chicago, USA was used for data analysis. Descriptive statistics (mean, standard deviation, frequency, and percentages) and analysis of variance were done. Chi-square statistics was used to examine the association between sex and echogenicity of the pancreas. The statistical significance was set at P<0.05.

Results: Most (303, 75.3%) of the participants had Grade I pancreatic echogenicity. There was positive correlation between pancreatic echogenicity and age, height, weight and body mass index. There was no significant relationship between pancreatic echogenicity and sex (X² = 0.085; p = 0.771).

Conclusion: This study has established that pancreatic hyperechogenicity does not always suggest a pathology. Healthy males and females can have pancreatic hyperechogenicity without the presence of a medical condition.

Endoscopic Evaluation of Patients with Dyspepsia in a Tertiary Care Hospital in Bangladesh

2023-07-12T07:12:30+00:00

Dyspepsia is another word for indigestion. It is a very prevalent medical condition. It is exposed as bloating, abdominal pain and nausea. Aim of the study was to evaluate gastrointestinal endoscopic findings in patients having dyspepsia. This cross-sectional study took place in Kushtia Medical College during the period of April 2022 to April 2023. The total population of this study was 66 patients attending OPD or admitted in the hospital with dyspepsia. Structured questionnaire was used to collect the necessary information. Convenient method of sampling was used as the sampling technique, which denotes non-probability method of sampling. Mean age of respondents was 41.51 (± 15.46) years. In case of distribution of the respondents, according to their age, 30.3% and 21.2% patients were in 36-45 years and 26-35 years age group respectively. Regarding gender, equal number of patients belonged to both genders, that is 50% males as well as 50% females. According to their personal history, 30.3% patients had a history of PPI and H₂antagonist drugs intake. On the other hand, smoking history was present in 15 respondents. In addition, among all the respondents, 68.2% patients complained about epigastric pain. In endoscopic evaluation, 12.1% respondents had peptic ulcer disease who were in 36-45 years of age group, in contrast, it was less common (1.5%) in aged group respondents (66-75 yrs).

The Study of Epidemiology, Clinicopathology and Current Management in Patients of Colorectal Malignancies in Northern India

2023-07-28T11:45:12+00:00

Background: Colorectal malignancy is the third most common malignancy worldwide and the incidence in India is showing an increasing trend. Rapidly increasing incidence rates could result from epidemiological factors including age , race, diet, environmental exposures, and acquisition of modern lifestyle. This study was conducted to describe the epidemiological trends, clinicopathologic characteristics and management of CRC in our settings.

Methods: This prospective study was carried out from November 2020 to November 2022 in the Department of Surgery, at Jawaharlal Nehru Medical College, Aligarh. All histologically confirmed cases of colorectal cancer were included. The data was collected and analysed using IBM SPSS Statistics for windows, version 25.

Results: A total of 54 patients with colorectal malignancy were in the study. Males outnumbered females with a Ratio of 1.24.Most of the patients were below 40years of age (42.8%) and the mean age was 45.27±14.208 years. 32 patients (57.1%) were non-vegetarian and 24 patients (42.8%) were vegetarian (P value >0.05). 19.6% of patients had a smoking addiction, 5.3% used tobacco and 3.5% of patients were alcohol drinkers (P value <0.0001). 3 patients(5.3%) had a positive family history of carcinoma or polyposis in their first-degree or second-degree relatives(P value <0.0001). Bleeding per rectum was the commonest presentation (33.9% followed by pain abdomen (26.7%). The highest number of lesion was seen in the rectum alone (46.4%), followed by ascending colon alone (19.6%).On endoscopy, 29(51.7%) patients had circumferential annular growth, 21(37.5%) patients had exophytic mass, 3(5.3%) patients had polyposis masses and 3(5.3%) ulcero-infiltrating mass. Non-mucin-secreting adenocarcinoma was the commonest pathological finding (62.5%), followed by mucin-secreting Adenocarcinoma (30.3% ) and signet ring cell carcinoma (7.1%). 32 (57.1%) patients had well-differentiated lesions, 17(30.3%) had moderately differentiated lesions and 7(12.5%) patients had poorly differentiated lesions. The majority (60.7%) of the participants have lymph node involvement. 51 patients (91.1%) underwent surgeries and 5 patients (8.9%) were given neoadjuvant chemo-radiation therapy. There was no mortality during the study period.

Conclusion: Colorectal malignancies are common in our settings and shows a trend towards younger age groups. We recommend screening high-risk groups for early diagnosis and better management.

Clinicopathological Profile Analysis of Patients with Abdominal Tuberculosis in Bangladesh: A Single Center Study

2023-11-06T12:28:49+00:00

Background: To analyze the clinicopathological profile of abdominal tuberculosis patients among 73 patients in a tertiary care hospital in Bangladesh.

Objective: To analyze the clinicopathological profileof abdominal tuberculosis patients.

Methods: It was crosssectional obsevetional study, executed in the Department of Gastroenterology Dhaka Medical College Hospital (DMCH) in collaboration with National Tuberculosis Reference Laboratory, NIDCH, Mohakhali, Dhaka from May 2015 to April 2016. Seventy-three cases of abdominal tuberculosis were studied, which were operatedonand diagnosed. Data collection included detailed history, particularly age distribution, site of abdominal tuberculosis involvement, and distribution of histopathology.

Results: Mean age of the study subject was 33.90 ± 15.14 years (range 18-70 years). The majority of the patients (53.2%) were between 18-30 years age group, followed by 18.8% between 31-40 years age group.Based upon predominant clinical features and investigations, the site of abdominal TB involvement was intestinal in 50(68.8%), peritoneal in 18(25%), and nodal in 5(6.2%) patients. Histopathology was performed in 60(81.25%) patients and showed granulomatous inflammation consistent with TB in 27/60(46.2%) specimens. Among them non-caseating, granuloma was found in 20(75%) specimens, caseating granuloma in 7(25%) specimens and TB bacilli (AFB) was not found in any (0.0%) specimen.

Conclusion: Young age at presentation, delayed presentation, poverty, and high morbidity and mortality are among the hallmarks of the disease in this region. These challenges need to be addressed to deliver optimal care for these patients. Early diagnosis, early anti-tuberculous therapy, and surgical treatment of the associated complications are essential for survival.

Step-up Approach for the Management of Acute Necrotizing Pancreatitis (ANP): Single Institution Experience

2023-11-10T12:58:50+00:00

Introduction: Acute necrotizing pancreatitis causing infected pancreatic necrosis is a severe disease with high morbidity and mortality that needs critical care and judicious management decisions. With a step-up approach in the management of acute necrotizing pancreatitis, there is a significant reduction in complications. The aim of this study is to analyze the outcome of the step-up approach in a single tertiary care centre.

Methodology: Prospective observational study conducted between January 2021 and December 2022. Patients with pancreatic necrosis or peripancreatic necrosis detected on contrast-enhanced computed tomography scans were included in the study.

Results: A total of 53 patients were included in the study. Ethanol (75.5%) and biliary (11.3%) were the two most common etiology. 32 patients (60.4%) were managed conservatively initially and 19 (35.8%) with a step-up approach. Interventions were done in 24 patients (45.3%) –image-guided percutaneous drainage-14(26.4%) patients, Percutaneous drainage followed by necrosectomy- 5(9.4%) patients, Conservative management followed by direct necrosectomy -5 (9.4%) Patients. 14(73.7%) Patients were managed with Percutaneous drainage alone successfully. Overall mortality- 4 patients. Primary end points were- mortality 02(10.5%), Enteric fistula 03(15.9%), secondary end points- biliary stricture and Pseudocyst formation 01(5.3%), need of pancreatic enzymes 02(10.5%).

Conclusion: Step-up approach management reduces morbidity and mortality in patients with necrotizing pancreatitis and infected pancreatic necrosis, in two-thirds of patients percutaneous drainage obviated the need for necrosectomy.

Upper Gastrointestinal Endoscopy in a Sub-Urban Population of South-East Nigeria: A 2.5 Year Analysis

2023-11-14T12:50:40+00:00

Background: Gastrointestinal endoscopy is a diagnostic and therapeutic procedure vital for the management of gastrointestinal pathologies. This is indispensable in modern medicine. We report our early experience with video gastrointestinal endoscopy at the Federal Medical Centre Umuahia, a tertiary hospital in southeast Nigeria.

Methods: A cross-sectional observational study of all patients who underwent esophagogastroduodenoscopy(OGD) at the Federal Medical Centre Umuahia in the two and half year period between July 2020 and December 2022 was done.

Results: The patients comprised 60 females (51.7%) and 56 males(48.3%). The mean age of the patients was 55.3 ± 17.0 with a range of 14-90 years. Dyspepsia and gastrointestinal haemorrhage accounted for over three-quarters of the indication for endoscopy. The most frequent findings at endoscopy were features of gastritis, followed by gastroduodenal erosions. Twenty-three (19.8%) of the patients had normal findings at endoscopy. Mass lesions were seen in 9.5% of the cases.

Conclusion: The diagnostic yield of endoscopy is high in appropriate indications. The appreciable proportion of oesophago-gastric tumours seen should stimulate further research. Despite the infancy of our practice, our outcomes were similar to other established centres in our nation.

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio can Predict Post-operative Complications and Mortality in Patients with Operable Esophageal and Gastric Malignancies

2023-11-20T08:32:30+00:00

Aims: Postoperative complications are a major concern following surgery for upper GI malignancies. Studies have shown that high levels of preoperative inflammatory markers have a poor prognosis. However, the relationship between preoperative platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and postoperative complications after curative resection is unclear. This study aimed to evaluate the efficacy of PLR and NLR in predicting clinical outcomes and postoperative complications in these patients.

Study Design: Single-center prospective observational study

Place and Duration of Study: Sample: Department of Surgical Gastroenterology, Tirunelveli Medical College, between January 2021 and December 2022.

Methodology: This single-center prospective study included 70 patients out of which 55 with gastric cancer underwent D2 gastrectomy and 15 with esophageal cancer underwent transhiatal esophagectomy. We evaluated the relationship between PLR and NLR and postoperative complications (≥grade 1 Clavien-Dindo classification). Using a receiver operating characteristic curve, the area under the curve (AUC) for each parameter was calculated and the power to predict postoperative complications was compared.

Results: 35.71% patients experienced postoperative complications. The AUC values of NLR (0.825) and PLR (0.161) were higher when compared to other preoperative tests in predicting postoperative complications. The optimal cut-off for NLR was 1.71 (sensitivity 96% and specificity 84.4%) and for PLR was 0.56 (sensitivity 20% and specificity 84.4%). Patients in the high NLR group had an increased incidence of complications when compared to the low NLR group. 74% in the low PLR group experienced complications, whereas only 11.6% in the high PLR group experienced grade 1 or higher complications.

Conclusion: Both NLR and PLR may serve as valuable indicators of potential postoperative complications for patients receiving surgery for operable gastric and esophageal cancers.

IgG4 Disease Revealed by a Type 1 Autoimmune Pancreatitis: A Case Report

2023-03-14T12:32:15+00:00

Aim: To describe clinical, paraclinical and evolutive features of an IgG4 disease.

Presentation of Case: The patient was a male, 51 years old, seen in consultation in the gastro-enterology and hepatology department of University teaching hospital “Campus” of Lome for epigastric pain of sudden onset six days before admission, with transfixing irradiation, evolving intermittently in a febrile context. On admission, the patient has a subicterus. The evolution during hospitalization was marked by the sudden onset three days later of bilateral inflammatory polyarthritis of the knees and ankles. Biological examination revealed diabetes mellitus; lipasemia was elevated to 122U/l. There was a disturbance of the renal balance; and a significant increase of plasma IgG4 at 2.380 g/l. The abdominal ultrasound showed a globally hypertrophic pancreatic gland, of heterogeneous structure, without focal lesions or necrosis; without biliary lithiasis. An abdominal CT scan showed, after injection of contrast medium, a global hypertrophy of the pancreas with a corporal-caudal predominance, giving a classic "sausage" appearance; associated with a lack of enhancement of the pancreatic parenchyma.

Conclusion: Type 1 autoimmune pancreatitis is the pancreatic manifestation of IgG4 disease. It is a rare pathology of recent discovery, with a predominance in elderly and male subjects. The diagnosis must be evoked in front of a pancreatic pain associated with articular manifestations, or in case of absence of obvious etiology of a pancreatitis. This diagnosis is defined by recommandations of International Association of Pancreatology. The treatment is based on the use of corticosteroids unlike autoimmune pancreatitis type 2 which is self-limiting with a low risk of relapse and complications.

Atypical Manifestation of IgG-4 Related Disease as Space Occupying Lesion Mimicking Hepatocellular Carcinoma in a Renal Transplant Recipient

2023-04-11T10:55:17+00:00

IgG₄-related disease (IgG_4-RD) is a multisystem fibro-inflammatory condition mostly prevalent in older males. The cornerstone for the treatment of IgG₄related disease is Corticosteroids.It rarely affects immunosuppressive population such as solid organ transplantation. Here we present to you a case of a young lady with a history of renal transplantation evaluated for symptoms of abdominal pain and weight loss and was diagnosed as a case of IgG₄related liver disease on the basis of liver lesion biopsy.

Eosinophilic Ascites as a Rare Manifestation of Eosinophilic Gastroenteritis

2023-07-13T11:13:43+00:00

Eosinophilic gastroenteritis (EGE) is a rare gastrointestinal (GI) disorder characterized by nonspecific gastrointestinal symptoms, peripheral eosinophilia, and eosinophilic infiltration of the intestinal wall. The disorder is classified into mucosal, muscular and sub-serosal types. Sub-serosal disease, which is complicated by ascites, is the most severe clinical form of eosinophilic gastroenteritis and requires early corticosteroid therapy. We report a similar case of a 47 year old male presenting with progressive abdominal distention, who on investigations was found to be having eosinophilic and low Serum Ascites Albumin Gradient (SAAG) ascites, patient was worked up further with upper and lower GI endoscopies and mucosal biopsies, Cross-sectional imaging, Bone marrow examination and finally diagnosed to be having eosinophilic ascites secondary to Eosinophilic Gastrointestinal Disorders (EGIDs). He was started on steroids in a tapering dose with Six Food Elimination Diet (SFED) and improved remarkably. Patient is off steroids now and is planned to continue now on SFED.

A Case Report of Hepatic Venous Outflow Tract Obstruction in Patient with Ulcerative Colitis

2023-07-25T10:49:57+00:00

We report a case of 23 year old female diagnosed as Hepatic Venous Outflow tract obstruction (HVOTO) with ulcerative colitis (UC) with Cytomegalovirus (CMV) Colitis. HVOTO with UC is a very rare entity, to the best of our knowledge there have been only few published case reports of HVOTO with UC. Our patient presented with fever, bloody stools with tenesmus, colicky abdominal pain from last 6 months, and pedal edema with abdominal distention from last 2 months. Sigmoidoscopy and biopsy was done on presentation which was suggestive of active ulcerative colitis with CMV colitis. Color Doppler of spleno-portal axis was done suggestive of HVOTO. Patient was started on Ganciclovir, Mesalamine, anticoagulants and was subjected to balloon angioplasty after which anticoagulants were continued. Patient is being followed up for 6 months now and is doing well.

Acute Appendicitis with Concomitant Typhoid Fever: A Case Report

2023-07-28T12:26:39+00:00

Typhoid fever is one of the leading causes of mortality and morbidity in crowded and unhygienic areas. Acute appendicitis is a relatively common cause of acute abdomen, especially in young adults. Infection with Salmonella typhi can be a rare cause of acute appendicitis. A 40-year-old man was admitted to Emergency Department with complaints of fever, abdominal pain, nausea, and vomiting for more than a week. His vital signs were stable. Physical examinations showed hyperactive bowel sounds (borborygmus), tenderness in the right lower quadrant region, and a positive Rovsing sign. The complete blood count and other laboratory results were within normal limits, as the patient had received oral antibiotics while on treatment at another hospital before. IgM anti-S. typhi was positive. Abdominal ultrasound revealed a blind end tube, a non-peristaltic, non-compressible appendix showing a target sign, and fluid collection periappendiceal. The patient underwent appendectomy on the fourth day of treatment, and the pathological examinations revealed that the mucosa was necrotic and that a large number of lymphoid follicles were evident. Typhoid fever may manifest as mesenteric lymphadenopathy, ileocolitis, or even bowel perforation, which mimics appendicitis. Appendicitis is usually caused by appendiceal lumen occlusion. Less frequently, enteric infections could directly infect the appendix or cause localized appendiceal lymphoid hyperplasia with obstruction. It is unclear whether primary appendicular lumen obstruction brought on by lymphoid hyperplasia or direct bacterial invasion of the appendix causes acute appendicitis and typhoid fever. There is no proof that the pathogen directly invades the appendix or that it obstructs it through proliferating lymph nodes. This case might remind clinicians that appendicitis might be a potential but uncommon differential diagnosis for typhoid fever in patients who have persistent abdominal pain, nausea, vomiting, and fever. We suggest performing a culture on appendix tissue in future studies to determine whether the bacteria that cause typhoid fever and acute appendicitis are related.

Co-occurrence of the Rare Case of Dysphagia Lusoria with Achalasia

2023-07-29T13:25:23+00:00

Dysphagia is a subjective feeling of difficulty of swallowing that has many causes. Of them, achalasia in which there is failure of relaxation of lower esophageal sphincter (LES) together with aperistalsis of the esophagus. Dysphagia lusoria a rare case of dysphagia is secondary to an aberrant right subclavian artery (ARSA) originating from left aortic arch compressing the esophagus. We found both conditions in a case presented with dysphagia and weight loss.

Aims: It is important to emphasize the importance of appropriate use of diagnostic modalities and the possibility of co-occurrence of different etiologies of dysphagia.

A Distinctly Rare Cause of Haemafecia: Recto-Sigmoid Endometriosis

2023-08-01T09:20:51+00:00

Endometriosis is defined as the growth of functional endometriotic gland and stroma outside the uterine cavity. Although it is common in women of reproductive age (10-12% of menstruating females), extra genital endometriosis is considerably rare. Bowel involvement is estimated to occur in 5%–12% with the recto-sigmoid region involved in up to 90% of these cases. Recto-sigmoid endometriosis may manifest with abdominal pain, constipation, and rectal bleeding. For diagnosis radiological investigations like Transvaginal ultrasound and MRI pelvis are widely used, endoscopic biopsy is less rewarding, however surgically resected specimen provides appropriate tissue for diagnosis. The management consists of hormonal therapy including Oral Contraceptive pills, Gonadotrophin releasing hormone analogue and surgical resection of affected segments. Hence recto sigmoid endometriosis can present as a rare etiology of haematochezia. We present the case of a 25-year-old Caucasian female patient with recto-sigmoid endometriosis.

Idiopathic Granulomatous Hepatosplenic Lesion in a Case of Chronic Liver Disease

2023-08-21T13:27:05+00:00

Granulomatous liver disease is common and can indicate underlying systemic issues. Liver biopsy findings may confuse clinicians. Some patients have abnormal liver panels without symptoms, while others show systemic manifestations. Identifying the underlying cause allows proper treatment, but in some cases, even extensive workup fails to provide a diagnosis, leading to frustration. Here, we present a similar case of chronic liver disease with hepatosplenic granulomas where the diagnosis remains elusive despite an extensive workup.

Intrahepatic Gall Bladder with Choledochal Cyst with Malrotation of Gut – A Rare Association

2023-09-12T07:17:01+00:00

Choledochal Cysts are rare cystic dilatory conditions of the biliary tree with malignant tendency. These are more frequently reported in children. Surgical removal of these cysts can significantly reduce the risk of malignancy and also reduce the associated complications. However, Choledochal Cysts have been paid lesser attention in adults. Choledochal Cysts associated with Intrahepatic gall bladder and Malrotation of the gut have rarely been reported. We herein report a case of a 15-year-old female patient with Type 4a Choledochal cyst associated with intrahepatic gall bladder and mal-rotation of the intestine which was incidentally found at surgery. The patient underwent Excision of Choledochal cyst with Cholecystectomy with Appendicectomy with Hepatico-jejunostomy with Jejuno-jejunostomy, and Ladd's procedure was simultaneously performed for asymptomatic Intestinal Malrotation.

A Rare Case of Adenocarcinoma of Ampulla of Vater – A Case Report

2023-10-03T11:24:40+00:00

Introduction: Periampullary tumors account approximately 5% of all gastrointestinal cancers, and Vater’s papilla. Vater’s papilla tumors are the second most common entity of periampullary cancer.

Case Presentation: We present a 69-year-old female patient who presented to the emergency room with symptoms including: jaundice, hyperchromic urine and involuntary weight loss, which she havd developed over the preceding three weeks ago. The results of her laboratory tests showed hyperbilirubinemia with predominance of conjugated bilirubin and she had ultrasound scan of her abdomen and pelvis which demonstrated features adjudged to be suggestive of periampullary mass associated with dilated pancreatico-biliary tree. No abdominopelvic lymphadenopathy, no free peritoneal fluid on computed tomography (CT) scan was demonstrated. She underwent Endoscopic Retrograde Cholangio-Pancreatography (ERCP) which revealed a papillary apparatus with a budding, vegetative tumor with infiltration into her duodenum. She underwent exploratory laparotomy and Whipple’s pancreaticoduodenectomy. Histopathology examination of the excised surgical specimen revealed Vater’s papilla adenocarcinoma. She would be undergoing regular follow-up assessments after she has been discharged from hospital to ascertain her progress following her pancreato-duodenectomy which we had regarded as her treatment of curative intent pursuant to our multi-disciplinary team approach to her treatment.

Conclusions: Surgical resection is the only curative treatment for ampullary carcinoma and the standard surgical approach is pancreaticoduodenectomy. In absence of lymph node metastasis and any organ metastasis, it would be envisaged that the patient would have a good five year survival pursuant to her surgery and she would have regular careful follow-up assessments with inclusion of clinical assessments, laboratory test assessments and radiology imaging assessments.

Distal Esophageal Squamous Cell Carcinoma: A Rare, but Possible Localization

2023-10-10T07:45:44+00:00

Aim: To report a rare but possible localization of a distal esophageal squamous cell carcinoma.

Case Presentation: A 71-year-old man with severe progressive dysphagia and epigastric pain for 2 months. Endoscopy revealed normal esophagus up to 37 cm from the dental arch where a tight stenosis that prevents the endoscope from advancing is visualized. The histopathological result revealed squamous cell carcinoma. Tumor Board decided to initiate neoadjuvant chemo-radiotherapy followed by surgery.

Conclusion: Management of patients with esophagus tumors is challenging. Localization of squamous cell carcinoma in the distal esophagus, although rarer, is possible.

A Rare Complication: Post-Chemotherapy Esophageal Stricture

2023-11-08T11:35:29+00:00

Dysphagia in patients undergoing cancer treatment is often associated with conditions such as reflux esophagitis, infectious esophagitis, malignant infiltration, or as a consequence of radiation therapy, the occurrence of an acute esophageal stricture resulting from chemotherapy is exceedingly rare. In this report, we present a distinctive case of an isolated chemotherapy-induced esophageal stricture in a patient who was undergoing treatment for metastatic osteosarcoma. Notably, this patient had no previous history of gastroesophageal reflux disease, caustic ingestion, or other risk factors commonly linked to the development of esophageal strictures.

A Rare Bisalbuminemia Etiology: Cholestatic Hepatitis Case Report

2023-02-13T09:34:48+00:00

Bisalbuminemias consist in a qualitative modification of the albumin pattern aspects, characterized by a duplication of the albumin fraction on the electrophoretic trace of the serum proteins. The prevalence of bisalbuminemia is about 0,03 to 1/1000. They can be inherited or acquired. We report a case of bialbuminemia admitted at the hepato-gastroenterology Department of HMIMV RABAT.

This is 52 years old patient, operated for cerebral glioblastoma treated by radio-chemotherapy who consist in Temozolomide, presented cholestatic jaundice two weeks after oral chemotherapy. Electrophoresis serum protein use a capillary electrophoresis system (Capillaries, Sebia) reveals a hypoproteinemia and duplication of the albumin fraction.

Bisalbuminemias is a qualitative abnormality of the albumin pattern, diagnosed by electrophoretic trace of the serum proteins. It can be inherited or acquired but globally without pathological effects. The acquired etiology are several whose cholestatic hepatitis induced by drug can be evoked pending a more thorough study.

Duodenal Dieulafoy’s Lesion-arising Awareness of this Rare Cause of Gastrointestinal Bleed

2023-03-14T12:24:37+00:00

Aim: The aim of this report is to raise awareness about the risk of bleeding associated with duodenal Dieulafoy lesions (DLs) and to emphasize the importance of utilizing imaging modalities when DLs are suspected as the cause of bleeding.

Presentation: This case study reports a 68-year-old male who presented with non-bloody vomiting and multiple episodes of hematochezia. An angiogram revealed active bleeding in the duodenum, which was subsequently identified and treated on the first attempt during endoscopy as a bleeding duodenal DL.

Discussion: DLs are a rare cause of gastrointestinal bleeding, characterized by dilated submucosal vessels that have a tortuous path, making them susceptible to erosion. They are most commonly found in the stomach, and are extremely rare in the duodenum, often requiring multiple endoscopic attempts to identify and treat. However, we were able to successfully treat our patient upon the first attempt with the help of angiogram prior to endoscopy. Use of multiple methods to achieve hemostasis (epinephrine injection, heat probe, and hemoclips) is effective in treating DLs.

Conclusion: It is important to recognize DLs as a potential cause of gastrointestinal bleeding, given their high mortality rate. The use of imaging prior to endoscopy can potentially prevent the need for multiple attempts at identifying and treating the lesion.

Parotid Abscess in an Ulcerative Colitis Patient on Infliximab: A Case Report

2023-04-11T11:51:50+00:00

Anti–Tumor Necrosis Factor- alpha (anti–TNFα)) is a widely used immunosuppressive drug in inflammatory bowel disease (IBD). Parotid abscess results as a complication of the primary parotitis. It is an uncommon condition, that occurs in immunocompromised host. To our knowledge, it seems to be the first case described in the literature of an ulcerative colitis who developed a parotid abscess as an adverse effect to infliximab.

Association of Gastrointestinal Symptoms and Clinical Outcomes in Hospitalized Corona Disease 2019 Patients

2023-06-07T12:20:02+00:00

The coronavirus pandemic 2019 (COVID-19) poses a serious threat to global health. Initially, the respiratory symptoms are at the forefront and dominate the prognosis of the disease. The gastrointestinal symptoms initially described as rare are reported more and more frequently in the latest studies. Our work aimed to determine the prevalence of gastrointestinal manifestations related to COVID 19 and their impact on the prognosis of the disease.

Materials and Methods: Prospective analytical descriptive study collecting all data of 93 files of patients hospitalized for a COVID-19 infection confirmed by RT-PCR over a period ranging from October 28, 2021 to April 8, 2022. The patients were divided into 2 groups to compare: Group I COVID19 patients with digestive manifestations and Group II COVID 19 patients without digestive manifestations.

Results: 91 patients were included in the study with a male predominance in the two groups. 37.4% of our patients with corona disease had gastrointestinal manifestations associated with respiratory signs and only 2.19% had isolated digestive manifestations. The main digestive symptoms were diarrhoea (25.3%), nausea (14.3%), vomiting (11%), acute abdominal pain (15.4%).

By comparing the 2 groups, we found that young subjects (less than 50 years old) presented more digestive manifestations than elderly subjects (p=0.012).

In terms of comorbidities, smoking and laboratory data, there was no statistically significant difference between the two groups.

A chest CT scan was performed in all patients and found a pulmonary embolism in 10 of them, four of whom had initially presented with acute abdominal pain. We interestingly find out that these patients with abdominal pain were more likely to present pulmonary embolism (risk x 4.27) compared with those with other symptoms (OR: 4.267, 95% CI (1.02-17.8), p 0.047).

In terms of mortality, clinical severity of the disease, length of hospitalisation, use of mechanical or non-invasive ventilation and other complications, we found no statistically significant difference between the two groups.

Conclusion: The results of this study suggest that the digestive manifestations linked to COVID 19 occur mainly in young subjects and that their presence is nonspecific and not related to the severity of the disease and does not increase the mortality rate.

In the end, it is suggested to eliminate pulmonary embolism in the face of acute abdominal pain complicated by respiratory distress.

Flexible Endoscopic Treatment of Zenker's Diverticulum: A Center Experience and Literature Review

2023-06-19T07:25:11+00:00

Zenker's pharyngo-oesophageal diverticulum is a rare acquired hernia of the posterior mucosa at the pharyngo-oesophageal junction. The pathophysiology of this condition is still poorly understood.

Our article aims to shed light on the epidemiological, clinical, paraclinical and therapeutic aspects of this pathology.

By adopting a retrospective study, we followed 3 patients with Zenker's diverticulum, between January 2019 and December 2022, in our department of Hepato-gastro-enterology.

They were 3 men aged 58, 54 and 90 years with a median age of 67.3 years.

The clinical symptoms observed were dominated by upper dysphagia and regurgitation in all cases (100%). One patient had also weight loss as a complication (33%).

The endoscopic examination combined with the cervico-thoracic CT scan allowed the diagnosis in all our patients (100%), with an average size of 3.5 cm (1.5-4 cm) for the diverticulum.

The treatment adopted for our 3 patients was endoscopic diverticulotomy performed with a diverticuloscope. . The procedure duration was 35+/- 5 minutes with simple aftercare.

The patients resumed oral feeding the next day, despite minimal postoperative pain. The median hospitalisation duration was 2 days and the average follow-up time was 12 months. Clinical success was 100% and no complications were noted.

In conclusion, endoscopic diverticulotomy is an effective treatment to quickly improve symptoms while reducing hospitalization length and complications risk, especially in elderly patients with comorbidities.

Isolated Fracture of Pancreatic Neck: A Case Report

2023-07-13T11:05:08+00:00

Aim of the Study: Through our case of pancreatic neck rupture, the study aim was to emphasize the advantages of an early laparotomy when there is a doubt about a canal disruption and the risks of a later surgical management.

Patients and Results: Our patients was operated on for a neck disruption of the pancreas due to blunt trauma,after a radiological exploration. He underwent a left pancreatectomy with spleen preservation. There were no associated injuries, no lesions of acute pancreatitis.

Then, when pancreatic trauma occurs, an exploration with echography, scanner, endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography can suggest a neck disruption and a canal rupture. When the canal is safe, a drainage close to the pancreas is sufficient. When the rupture of the canal is suspected or proved, an early laparotomy is necessary in order to investigate the pancreas and to perform the appropriate procedure. This surgery is easier before the occurence of pseudocyst and acute pancreatitis.

Nutcracker Syndrome in a Case of Ulcerative Colitis: A Rare Entity

2023-10-19T07:39:00+00:00

Nutcracker syndrome is a clinico-radiological entity that can be the cause of atypical pain. Long described by urologists and nephrologists, it encompasses all manifestations associated with venous stasis induced by stricture of the left renal vein: either between the aorta and the superior mesenteric artery, or between the aorta and the spine. The discovery of this syndrome during inflammatory bowel disease is an uncommon cause of abdominal pain. We report a case of a 21-year-old female patient whose aetiological investigation of diarrhoea and abdominal pain revealed haemorrhagic rectocolitis and the discovery of nutcracker syndrome on radiological examination. This case highlights the importance of investigating other causes of abdominal pain in inflammatory bowel disease.

Esophageal Papilloma: Case Series of 4 Patients

2023-11-27T12:32:05+00:00

Background: Papillomas are rare benign lesions that can be found in the oesophagus. Being rarely seen like a single small whitish, wart-like lesion grown from the mucosa. Histopathological examination is the gold standard for a definitive diagnosis. Excision of papillomas is recommended for definitive treatment in the fact of the potential for malignant transformation.

Ojectives: Through these differences cases, we would like to show the clinical and endoscopic difference that papillomas in the oesophagus can present.

Methods: We report clinicopathologic features of four esophageal papilloma cases detected in the endoscopy unit of our department. These patients had undergone oesophageal duodenal fibroscopy during 2022. The inclusion criteria were endoscopic appearance and histology.

Results: We present four cases of this rare endoscopic finding. While three of our patients were asymptomatic, one had an acute epigastric pain, all the lesions were excised.

Conclusion: Endoscopists should be able to make the differential diagnosis of papilloma detected in the esophagus and have knowledge about these lesions as they may carry malignant potential.