Middle East Journal of Digestive Diseases
Volume:13 Issue: 3, Jul 2021

Upper gastrointestinal (GI) bleeding is a common cause for Emergency Department and hospital admissions and has significant mortality and morbidity if it remains untreated. Upper endoscopy is the key procedure for both diagnosis and treatment of acute upper GI bleeding. The aim of this article is to review the optimal timing of endoscopy in patients with acute upper GI bleeding. The cost-effectiveness and the influence of urgent or emergent endoscopy on patients’ outcomes are discussed. Also, we compare and contrast the available evidence and guidelines regarding the recommended time points for performing endoscopy in different clinical settings.

Three manometric patterns are seen in high-resolution manometry (HRM). Response to treatment has been reported to be different in these subtypes. We aimed to investigate the frequency and response to treatment in subtypes of achalasia.

306 patients between 15 to 60 years old, naïve to treatment with idiopathic achalasia (IA) were evaluated prospectively in a cohort study for 8 years. The patients were treated with pneumatic balloon dilation (PBD), and evaluated before and one month after PBD with Achalasia Symptom Score (ASS) and timed barium esophagogram (TBE) and then every 6 months with ASS. The primary study outcome was defined as a reduction in ASS (equal to or less than 4) and a reduction greater than 80% in the volume of barium in TBE at 1 month after PBD compared with baseline values.

According to HRM, 57 were classified as type I (18.62%), 223 as type II (72.9%), and 26 as type III (8.5%). The mean lower esophageal sphincter (LES) residual pressures before treatment were 34.05 ± 31.55, 32.99 ± 17.90, and 37.47 ± 14.07 mmHg in types I, II, and III, respectively (p = 0.18). The mean ASS values before treatment were 12.23, 11.50, and 11.50, for types I, II, and III, respectively (p = 0.29). The ASS dropped to 2.50 in type I, 2.40 in type II, and 2.12 in type III at 1 month after treatment (p = 0.83). Eventually, at the end of follow-up, 24 patients with type I (83%), 82 patients with type II (67%), and five patients with type III (83%) showed sustained good responses (p = 0.528).

Manometric subtypes of achalasia did not have an important role in clinical success in the long term. Achalasia has no definite cure, but with current treatment modalities, palliation of symptoms is possible in over 90% of patients.

In December 2019, COVID-19 emerged from China and spread to become a pandemic, killing over 1,350,000 up to November 18, 2020. Some patients with COVID-19 have abnormal liver function tests. We aimed to determine the clinical significance of liver chemistries in patients with COVID-19.

We performed a cross-sectional study of 1044 consecutive patients with confirmed COVID-19 in two referral hospitals in Tehran, Iran, from February to April 2020. All cases were diagnosed by clinical criteria and confirmed by characteristic changes in the spiral chest computed tomography (CT) and nucleic acid testing of the nasopharyngeal samples. We evaluated the association between abnormal liver enzymes or function tests and survival, intensive care unit (ICU) admission and fatty liver changes in CT scans.

The mean age was 61.01 ± 16.77 years, and 57.68% were male. Of 495 patients with elevated alanine transaminase (ALT) levels, 194 had chest CT scans, in which fatty liver disease was seen in 38.1%. 41 patients (21.13%) had moderate to severe, and 33 (17.01%) had borderline fatty liver disease. Bilirubin, albumin, and partial thromboplastin time (PTT), along with other markers such as HCO3 , C-reactive protein (CRP), triglyceride,and length of admission, were significantly associated with ICU admission and mortality. Prothrombin time (PT), platelet count, and low-density lipoprotein (LDL) levels were also correlated with mortality. Fasting blood sugar (FBS) and pH were important indices in ICU admitted patients.

Liver function tests accurately predict a worse prognosis in patients with COVID-19. However, liver enzymes were only slightly increased in those who died or needed ICU admission and were not related to the fatty liver changes.

Non-alcoholic steatohepatitis (NASH) is a serious comorbidity in patients with obesity and because of the high risk of cirrhosis and the extreme mortality rate of NASH, approaching effective treatment methods, and improvements are crucial. Following few studies comparing the impact of laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (LSG) surgery on NASH, our study was conducted to assess the effect of these two surgical methods separately in patients with NASH through ultrasonography, and concurrently, on other factors such as lipid profiles and blood pressure to reduce the complications of complex obesity surgeries on patients and also provide a solution to prevent NASH-related cirrhosis.

This study was performed at Imam Khomeini Hospital Complex; Vali-e-Asr Hospital affiliated to Tehran University of Medical Sciences.All patients with obesity who had undergone bariatric surgery at Vali-e-Asr Hospital during 2017 and 2018 were included in this prospective cohort study. Weight, body mass index (BMI), blood pressure, Alanine transaminase(ALT), Aspartate transaminase(AST),lipid profile and Fasting blood sugar(FBS)were evaluated before and one year after surgery. The patients underwent an ultrasound examination before surgery to determine the fatty liver grade. The type of operation (sleeve or bypass) was governed by the patient him/herself after receiving thorough clarifications about the available methods, their complications, and expected outcomes. In addition, by the separation of fatty liver grading with ultrasound modality, the correlation between ultrasound grading, laboratory results, and the rate of weight loss in patients who undergone both sleeve and bypass surgeries were evaluated and compared during a one-year follow-up.

In this study, 44 patients were included. 22 patients underwent laparoscopic sleeve gastrectomy (LSG), and 22 patients underwent laparoscopic gastric bypass (LGB) surgery. The mean age of the patients was 40.45 ± 12.01 years. 35 patients (79.5%) were women, and 9 patients (20.5%) were men. Most patients (81.8%) had grade I and II in terms of preoperative liver ultrasonography results. Bariatric surgery (LSG and LGB) greatly enhanced NASH’s hepatic status in liver ultrasonography. Since the liver status of patients with preoperative ultrasonography was not significantly different between the two groups, there was no substantial distinction among the two groups in this regard, postoperatively. Weight and BMI, lipid profile, liver enzymes, FBS, and mean arterial blood pressure (MAP) were significantly reduced individually in both groups and all patients one year after surgery. None of the postoperative variables and their modifications had a prominent difference between the two groups except for Highdensity lipoprotein(HDL)level after surgery. The postoperative HDL was considerably higher in the LGB group (p = 0.014). However, the changes in HDL were not statistically different between both groups. The levels of AST, ALT, total cholesterol, LDL, and FBS were associated with the NASH grade.

Both types of LSG and LGB bariatric surgeries have been shown to significantly reduce BMI and improve lipid profiles, liver enzymes, and blood glucose levels in patients one year after surgery. The NASH status was also ameliorated considerably. The two types of surgery were not remarkably different in these modifications. Besides, there was a significant correlation between AST, ALT, total cholesterol, LDL, and FBS levels with the NASH grade.

Gastric cancer (GC) is the fifth most common cancer and the third most common causes of cancer death worldwide. The aim of this study was to investigate the factors affecting the survival of patients with GC with metastatic as an intermediate event using illness-death model.

In this retrospective cohort study, 339 patients with GC who referred to Shahid Bahonar and Afzalipour hospitals in Kerman during 2001 to 2016, were included. Demographic, therapeutic, and clinical data were collected from medical records of patients. To evaluate the factors affecting the survival of patients and the relationship between these factors, with metastatic as an intermediate event the illness -death model was used.

One, three, and five-year survival of patients with GC was estimated to be 63, 40, and 30%, respectively. The results of analysis of illness-death model showed that age (HR=0.98, P=0.007) and histological grade (HR=1.77, P=0.007) affected metastasis whereas history cigarette smoking (HR=1.89, P=0.02) and chemotherapy (HR=0.63, P=0.02) affected death hazard without metastasis. history of opium use (HR=2.11, P=0.002), family history of GC (HR=2.48, P=0.01) and histological grade (HR=1.85, P=0.02) were identified as factors affecting death hazard in patients with metastasis.

In this study, age of patients at the time of diagnosis and effect of histological have a significant effect on the occurrence of metastasis. Therefore, it is recommended to pay more attention and provide care to patients at lower ages of metastasis for timely diagnosis in order to prevent metastasis and death.

Left ventricular diastolic dysfunction (LVDD) is the earliest cardiac dysfunction noted in patients with liver cirrhosis, which increases the morbidity and mortality in such patients. There are sparse studies from India evaluating the predictive factors of LVDD in patients with cirrhosis. Hence we undertook this prospective study with an aim to evaluate the factors predicting the development of LVDD in liver cirrhosis.

104 patients with cirrhosis were enrolled in this prospective study. A detailed cardiac evaluation was done by 2 D echocardiography with tissue Doppler imaging by an experienced senior cardiologist. The severity of liver disease was defined by Model For End-Stage Liver Disease (MELD) and Child-Pugh score.

The prevalence of LVDD was 46% in our study. Multivariate logistic regression analysis revealed that serum albumin, MELD score, and presence of ascites (OR = 0.1, 95%CI 0.03-0.3, p < 0.001; Or = 1.12, 95%CI 1.03-1.22, p < 0.001; OR = 4.19, 95%CI 1.38-12.65, p < 0.01, respectively) were independent predictors of LVDD in patients with cirrhosis. Diastolic dysfunction was unrelated to age, sex, and etiology of cirrhosis. The patients with cirrhosis and LVDD had significantly higher child Pugh score, MELD score, and lower serum albumin than patients without LVDD. The echocardiographic parameters like E/e’ ratio, Deceleration time (DT), and Left atrial volume index (LAVI) were significantly different in cirrhotic patients with higher MELD and child Pugh score than lower.

The present study showed a significant correlation of diastolic dysfunction with the severity of the liver disease. Low serum albumin, high MELD score, and presence of ascites significantly predict the development of LVDD in patients with cirrhosis.

The prevalence of Helicobacter pylori (H. pylori) in developing countries is 50.8%, with the highest occurrence presented in Africa (79.1%). It increases the risk of chronic gastritis, peptic ulcer, cancer of the stomach, and lymphoma. The effect of standard
treatment for H. pylori eradication is below 80%, and evaluation of alternative lines of treatment is needed. We aimed to compare the hybrid, reverse hybrid, and levofloxacin quadruple therapies as first-line therapy in Egypt.

This was a randomized interventional trial done in the clinics affiliated with the Internal Medicine Department. 330 individuals were selected according to the inclusion criteria. They were divided into three groups: group 1 (110 subjects who received a reverse hybrid regimen), group 2 (110 subjects who received a hybrid regimen), and group 3 (110 subjects who received a non-bismuth levofloxacin quadruple regimen).

Group 3 had a significantly lower eradication rate of 82.7% versus 92.7% and 91.8% in groups 1 and 2, respectively. There were non-significant differences in the incidence rates of adverse events among the three groups.

Both the reverse hybrid and hybrid groups had good eradication rates in the Egyptian population, but non-bismuth levofloxacin quadruple therapy did not obtain a sufficient eradication rate.

BACKGROUND:

 Dyspepsia is a common complaint among patients who refer to gastroenterology clinics. Studies have shown that there is a strong relationship between dyspepsia and Helicobacter pylori (HP) infection. We have investigated the prevalence of HP infection in patients with dyspepsia and its correlation with age and socioeconomic status (SES) of patients in Mazandaran province, northern Iran.

In this cross-sectional study, patients with dyspepsia who had undergone upper gastrointestinal endoscopy were enrolled. Diagnosis of HP infection was according to the results of rapid urease test (RUT), and Giemsa staining of pathology samples. A questionnaire including endoscopic findings, demographic data, and SES information was completed for each patient.

The mean age of the 614 patients was 45.8±5 years, and 60% of them were female. Most patients had normal endoscopy (56.1%), and gastric ulcer and erosion was the most common abnormal endoscopic finding (24.7%). The prevalence of HP infection in patients with dyspepsia was about 66.6%. HP infection was associated with a lower prevalence in people aged below 30 years and good SES.

The prevalence of HP infection in patients with dyspepsia was 66.6%. In addition, HP infection rate was lower in people under the age of 30 years and patients with good SES.

Awareness of the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) infections, as blood transmitted infections, among blood donors can help policymakers improve the guidelines, share experiences, and estimate the blood safety over the country and in
the region. We aimed to determine the prevalence of HBV and HCV infection in Iranian blood donors based on the present published literature.

A meta-analysis was carried out based on the results of an electronic literature search in the international and national databases for all articles published until October 2020. We selected studies that had appropriate sampling and valid statistical analysis as well as proper measurement methods. The heterogenic indices of the studies were determined using Cochran’s (Q) and I-square (I2) tests. According to the heterogeneity results, a fixed or random-effects model was implemented to estimate the pooled prevalence of HBV and HCV. Meta-regression was conducted to explore the suspected sources of heterogeneity.

We included 61 and 58 eligible studies related to HBV and HCV, respectively. The pooled prevalence of HBV was 0.57% (95% confidence interval (CI): 0.47 – 0.67, I2:99.9%) among the blood donors. The range of prevalence rates of HBV was between
0.10% and 2.34% in different areas of Iran. The pooled prevalence of HCV was 0.22% (95% CI: 0.20 – 0.24, I2: 98.64%) in blood donors, which varied between 0.02% and 1.09% in separate locations. Subgroup and meta-regression analyses revealed that the
year of publication, geographical location, and quality of the studies probably generated the heterogeneity.

The prevalence of HBV and HCV decreased steadily in Iranian blood donors during the past two decades. It should be asserted that most of the health policies and safety measures taken in recent years in Iran have been effective and promising

Systemic sclerosis (SSc) is a relatively common connective tissue disease, which is characterized by inflammation, progressive skin fibrosis, and injuries of small vessels, particularly in the lung and kidney. It seems that Helicobacter pylori (H. pylori) might contribute to the development of SSc as an extra-gastrointestinal autoimmune disease. We investigated the association between H. pylori infections and disease severity in patients with SSc.
Study design: This is a cross-sectional study.

Sampling method in this study was census method in such a way that all patients with SSc referred to Imam Reza Education and Research University Medical Center from May 2015 to August 2016 were included in the study. Finally, 74 patients were selected based on the inclusion criteria.Inclusion criteria were: 1. Definitive SSc based on  American College of Rheumatology/European League Against Rheumatism 2010 (ACR/EULAR) classification for scleroderma, which was diagnosed within the last two years. 2. Not taking any proton pump inhibitors. 3. Not taking any H. pylori treatment with a standard regimen within the recent 2 months. Disease severity was assessed and determined by two rheumatologists based on the Medsger's Disease Severity Scale (MDSS). H. pylori stool antigen was evaluated based on the test which sensitivity and specificity was proven. All obtained data were statistically analyzed by SPSS 16 using Fisher’s exact test Spearman correlation test (RSpearman).

 Forty one  (55.4%) of the 74 patients had positive stool antigens. We found a significant positive association between the severity of disease based on MDSS and titer of H. pylori stool antigen (p ≤0.001).

 This study reveals that H. pylori infection may play a significant role in the severity of organ involvement in SSc.

Melanoma is a very aggressive skin cancer that could metastasize to any organ in the body. The treatment of melanomas includes surgical resection, chemotherapy, and immunotherapy. After resections, melanomas could recur at the previous site or present as a distant metastatic lesion. The symptoms of melanoma are vague and primarily occur because of the local disruption of the tissue architecture. Presented here is a case of gastric melanoma that presented with abdominal discomfort and melena in a patient with a history of penile melanoma that was completely resected 3 years earlier. This case illustrates the importance of having metastatic lesions to the intestinal tract as a differential for a patient with gastrointestinal hemorrhage.

Peritoneal granulomatous reaction to foreign body-like materials of a dermoid cyst is a rare condition and has always been challenging in diagnosis for physicians. Macroscopic view of granulomatous peritoneum, which mimics peritoneal carcinomatosis or peritoneal seeding originating from ovarian carcinoma, necessitates a detailed microscopic evaluation of peritoneum, which shows multinucleated giant cells and granuloma formation indicating a foreign body reaction in the peritoneum. To avoid unnecessary radical surgeries and salvage chemotherapies in these patients, a detailed microscopic evaluation of their peritoneum is necessary. The present study introduces a 23-year-old woman with new-onset ascites and an elevation of CA125 level suspicious of ovarian carcinoma but with a peritoneal microscopic finding pathognomonic of foreign body reaction.

Liver hemangiomas are common. Giant liver hemangiomas are rare and symptomatic patients require treatment. Surgery is the curative procedure. Other options such as intra-arterial embolization may be used to decrease the volume and bleeding of these lesions. Three cases of giant liver hemangioma were treated with liver resection, one with left lateral hepatectomy and two with right lateral hepatectomy. All patients had made an uneventful recovery with no recurrence at 3-year follow-up. Most hemangiomas are small, asymptomatic, and do not require any treatment. Liver resection is a safe and effective treatment for giant hemangiomas.