Gastroenterology and Hepatology

  • Treatment of hepatocellular carcinoma using the Smart Fusion needle navigation system: conversion from real-time 4D-echo data

    Advances in ultrasound systems have improved the accuracy of hepatocellular carcinoma (HCC) diagnosis and treatment. We have been treating HCC using real-time 4D and Live 3D-echo technologies. However, these treatment methods have drawbacks such as vibrations during puncture and a limited angle of needle insertion. To overcome these problems, systems that can display ultrasound images simultaneously with computed tomography (CT) and magnetic resonance images in a real-time manner for reference purposes have been reported. These systems have recently been equipped with a needle tip navigation system, making it possible to reliably visualize tumors and determine the needle tip position in a tumor. These developments have enabled the safe treatment of HCC. Treatment using needle navigation is performed as follows: A Canon APLIO800 ultrasound system is used with a conventional convex probe (PVT-375BT) and a micro-convex probe (PVT-382BT). The system function is known as Smart Fusion. Ultrasound images can be displayed with volume data from other modalities, such as CT and magnetic resonance imaging (MRI), in relation to the positional information using a magnetic sensor. This enables the use of CT/MRI data as reference for accurate puncture and treatment of lesions that are difficult to identify by ultrasound alone. Axis alignment is also completed by displaying the xiphoid process on a CT image and having the system learn the orientation of the probe placed perpendicular to the body axis. Then, landmark alignment is performed and fine-adjusted by aligning a target point near the lesion with the same point as displayed on CT (Fig. 1). Case presentation A 7x-year-old woman was found to have elevated tumor markers and a liver tumor identified by regular blood testing and CT performed in August 20xx and was admitted to our hospital for treatment. Abdominal ultrasonography showed a hypoechoic lesion measuring approximately 3 cm in diameter…

  • Prevalence of HBsAg and anti-HCV antibodies during a screening campaign in August 2019

    Introduction: Hepatitis B (HBV) and C (HCV) virus infections represent a major public health problem, with significant mortality and morbidity worldwide. The aim of this study was to determine the prevalence of HBsAg and anti-HCV antibodies, and to investigate the risk factors associated with these two infections. Patients and methods: An analytical cross-sectional study was carried out during a free screening campaign for viral hepatitis B and C organized by the University Teaching Hospital of Yaounde from 20th to 23rd August 2019. Screening for HBsAg and anti-HCV antibodies was carried out using a rapid diagnostic test (On Site HBsAg/HCV Ab Rapid Test (CTK Inc 10110 Mesa Rim Road San Diego, CA 92121 USA) in accordance with the manufacturer’s Instruction. Positive samples had a confirmatory ELISA test. A structured questionnaire was used to investigate the risk factors for viral hepatitis B and C. Results: A total of 746 participants (412 women, 334 men) were registered. The average age of the participants was 29.6 ± 15.5 years. The prevalence of HBsAg was 10.3% (men: 14.7%; women: 7%; p = 0.002). The prevalence of HCV-Ab was 4.7% (men: 6.3%; women: 3.4%; p = 0.08). Unprotected sexual intercourse (59.4%), dental care (38.7%) and scarification (37.1%) were the main factors of HBV and HCV transmission. Male sex (OR = 2.2; IC = 1.3 – 3.6; p = 0.002), lack of vaccination (OR = 3.4; IC = 1.2 – 9.6; p = 0.01), tattoos (OR = 6.6; IC = 1.4 – 30.2; p = 0.02) and close contact with an HBV-infected person (OR = 1.7; IC = 1.01 – 2.9; p = 0.04) were the factors associated with HBV transmission. Age groups ≥ 55 years (OR = 1.3; IC = 1.1 – 1.5; p < 0.0001) and [45 – 54] (OR = 1.06; IC = 1.0...

  • Oral health status of patients with decompensated liver cirrhosis in two hospitals of Yaoundé Cameroon: A comparative study

    Background: Liver cirrhosis is an ultimate complication of all chronic liver diseases. The oral cavity especially the periodontium is affected by malnutrition, coagulation disorders, immunodeficiency which are some of the main features present in patients with liver cirrhosis. The aim of this study was to determine the prevalence and determinants of oral pathologies in patients with decompensated liver cirrhosis in two hospitals of Yaoundé Cameroon. Patients and Methods: This was a cross-sectional and analytical study comparing the oral health status of decompensated liver cirrhotic patients in Yaoundé with sex and age (±3 years) matched healthy controls from the same area. We enrolled patients with liver cirrhosis (Child Pugh score greater than or equal to 7) and their corresponding healthy controls. For each participant, socio-demographic data, clinical data on liver cirrhosis and on oral examination were collected. Oral examination evaluated the level of oral hygiene, gingival index (GI), probing depth (PD) and Clinical attachment loss (CAL), determined and identified oral mucosal lesions. The mean Decayed-Missing-Filled-Teeth (DMFT) index and prevalence of dental caries were also determined. The groups were then compared with regards to periodontal oral mucosal and dental variables using chi square test and Mantel – Haenszel odds ratio was used to determine the strength of association between decompensated liver cirrhosis and oral pathologies. The student‘s T-test was used to compare mean values of quantitative variables. A p-value ˂ 0.05 was statistically significant. Results: We included a total of 80 participants among which 40 liver cirrhotic patients and 40 sex and age (±3 years) matched controls. The mean age was 50.0(±19.0) years for the cases and 52.4(±17.9) years for the healthy controls. Hepatitis B virus (HBV) and Hepatitis C virus (HCV) were the main aetiology of liver cirrhosis representing 42.5% and 30% respectively and Child Pugh class B (65% of cases)…

  • Prevalence, clinical characteristics and related mortality of cirrhosis in a tertiary hospital setting in Sub Saharan Africa

    Background: Published data on the prevalence and mortality associated to cirrhosis is rare in Cameroon. The aim of this study was to determine the prevalence, clinical and para clinical characteristics and associated mortality of cirrhosis at the Yaounde University Teaching Hospital (YUTH), Cameroon. Methods: Files of patient’s followed up or admitted for cirrhosis at the YUTH between June 1st 2016 and June 30th 2018 were reviewed. The diagnosis of cirrhosis was made based on clinical, biological, ultrasonographic and/or endoscopic signs of portal hypertension and chronic liver failure. In other to establish the cause of cirrhosis, markers of documented chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) was sought in the file of the patients and if not present, hepatitis C antibody and hepatitis B surface antigen testing were requested. In patients negative for HBV and HCV markers, alcohol intake was considered as a cause of cirrhosis in someone who have been consuming more than 30 g/day (for males) or more than 20 g/day (for females) of alcohol. Data analyses were performed using Epi info V 3.5.4. Results: During the period of study, 1748 patients were admitted in the internal medicine unit among which 117 had cirrhosis giving a prevalence of 6.7%. There were 67 males (57.3%) and 50 females (42.7%). The mean age of patients was 51 +/- 19.862 years. Patients with HCV related cirrhosis were older (mean age: 68years) than those with HBV induced cirrhosis (mean age: 38years). The most frequent signs were ascites 104 patients (88.9%), asthenia 92(78.6%), hepatomegaly 68(58.1%), jaundice 61(52.1%), abdominal distension 54(46.2%) and gastrointestinal bleeding 29(24.8%). Anaemia was present in 58 patients (49.6%), thrombocytopenia in 56 patients (47.9%), low prothrombine time in 64 patients (54.7%). Mean serum albumine was 27.59 g/l (6-70), mean total bilirubine 49.41mg/l (3-275mg/l), mean AFP 75693 mg/ml (0.8-1578022). Spontaneous…

  • Usefulness of Castor Oil and Elobixibat and Lactulose and ascorbic Aid for Bowel Preparation for Colon Capsule Endoscopy-Initial examination

    Colon capsule endoscopy was approved for reimbursement under the national health insurance system of Japan in 2014. However, the capsule excretion rate after recommended bowel preparation reportedly ranges from 70% to 90%, and administration of boosters is also necessary. The caster oil-based booster had an emission rate of 97%, but required a total water content of 3L. Considering whether it is possible to popularize colon capsule endoscopy by reducing the amount of water, including dialysis patients with water restrictions, we will consider whether the capsule discharge rate can be improved by combining new laxatives.

  • Pure alphafetoprotein producing neuroendocrine carcinoma of the stomach: A case report

    Alpha-fetoprotein-producing gastric carcinoma (AFP-GC) is a rare malignant tumor, and has been regarded as a distinct category because of its particularly aggressive biological behavior and poor patient prognosis. In the literature, AFP-GC was never reported in neuroendocrine carcinoma of the stomach. In this article, we described a 60-year old man who sought medical attention because of epigastric pain and poor appetite. His laboratory data were within normal limits except for elevated serum level of alpha-fetoprotein. He was found to have an ulcer on gastroscopic examination which led to the final diagnosis of AFP producing neuroendocrine carcinoma of the stomach. He underwent a radical gastrectomy followed by chemotherapy using leucovorin and 5-fluorouracil.His disease was brought under remission for only six months before radiological recurrence occurred. His recurrent disease was treated with irinotican plus cisplatin without a significant response. His prognosis looked grave. We reported the first case of AFP producing gastric neuroendocrine carcinoma to share our experience.

  • Non-alcoholic Fatty Liver Disease among patients with Inflammatory Bowel Disease in Qatar: Prevalence and Risk Factors

    Background: Non-alcoholic fatty liver disease (NAFLD) has been increasingly identified in patients with inflammatory bowel disease (IBD), though metabolic risk factors for NAFLD are less frequent in IBD patients. Qatar is among countries characterized by the high prevalence of fatty liver. We aimed to characterize NAFLD in IBD patients and to determine factors associated with its severity. Methods: A retrospective observational study was conducted to estimate the prevalence of NAFLD in all IBD patients followed at Hamad hospital, Doha, Qatar between January 2008 to December 2017. The associations between two or more qualitative variables were assessed using χ2-test and quantitative data between two independent groups were analyzed using the unpaired t-test. Multivariate logistic regression analysis was applied to determine the predictive values of each predictor for NAFLD among IBD patients. Results: Among 913 IBD patients with a mean age of 36.9±13.2 years and BMI 26.9±6.1; 550 were males (60.2%), 383(41.9%) with Crohn’s disease and 530 (58.1%) with Ulcerative colitis. 24 (22.2%) patients had severe steatosis. The overall prevalence of NAFLD was 11.8% (95% CI 9.9, 14.1) and does not differ significantly between CD and UC patients (11.7% vs 11.9%; P=0.949).Patients who developed NAFLD were older at baseline (42.6±12.5 vs 36.2±13.1 years; P 30 kg/m2 (adjusted OR 2.24; 95% CI 1.28, 3.91; P=0.01) and diabetes mellitus (adjusted OR 1.98; 95% CI 1.15, 3.4; P=0.02) significantly associated with an increased risk of NAFLD. Females were less likely having the risk of NAFLD (adjusted OR 0.58; 95% CI 0.36, 0.93; P = 0.02) in comparison to males. The treatment with biologic does not increase the risk of steatosis. The predicted cutoff NAFLD score ≥ -1.67 had good predictive ability for significant steatosis in IBD cases. Conclusion: The prevalence of NAFLD is not uncommon among IBD patients in Qatar. Older age, high BMI and…

  • Endoscopic Outcome of non complicated Gastric Ulcer following Standard Medical Treatment in sub-Saharan African Population

    Background.The endoscopic outcome of gastric ulcers is not well described in sub-Saharan Africa. This study was therefore conducted in order to track the endoscopic outcome of non complicated gastric ulcers following standard medical treatment in sub-Saharan African population. Methods.This was a prospective cohort study conducted from January to July 2018 in three tertiary healthcare centers in Yaounde (Cameroon).Gastric ulcers and gastric H. pylori infection were diagnosed and monitored by upper digestive endoscopy performed before and at least four weeks following treatment with proton pump inhibitors alone or combined with antibiotics depending on H. pylori status. A complete case analysis was done using the SPSS software, version 21.0. p-values ≤0.05 were considered as significant. Results. Ninety-six patients (54.2% males) with a mean age of 55.3 ± 14.9 years were initially enrolled. In most patients, the ulcer frequently was unique (76%) and the antrum was the commonest localization 76 (79.2%). Among patients with H. pylori infection, the quadruple therapy was the most prescribed treatment 41 (87.2%) patients. There were 60 (62.5%) subjects lost to follow-up. Of the 36 (37.5%) patients who underwent repeat endoscopy, 26 (72.2%) had ulcer healing and 8/13 patients had successful H. pylori eradication. A delay of repeat endoscopy >8 weeks was the only predictor of non-healing of the ulcer: relative risk 0.6[95% CI: 0.3-1.08], p = 0.05. Conclusion.Ulcer healing was found in nearly 2/3 of patients and H. pylori eradication in almost ¾ of patients. This study should be repeated in a large sample.

  • Gastric Outlet Obstruction: Transform in Etiogenesis

    Objective: To determine the frequency of various etiologies of Gastric Outlet Obstruction in Northern part of Rajasthan, India. Design & Duration: Prospective study carried out from March 2018 to March 2019. Methodology: The data of all the patients who presented with the features of Gastric Outlet Obstruction during the above mentioned period was collected. This data was analyzed with specific reference to recent trends in its etiology. This change in trend was compared with other local and international studies. Results: Fifty patients were included in the study. All patients underwent upper GI endoscopy and biopsy; 40 cases were diagnosed by this method and the remaining by CT scan. Gastric carcinoma was the most common cause of Gastric Outlet Obstruction seen in 36% of the cases. The next common etiology was peptic ulcer disease which was responsible for 32% of the patients. Conclusion: The ratio between benign and malignant etiologies of Gastric Outlet Obstruction is showing a gradual change in favour of malignant lesions. This change is similar to the trends reported in the western literature.

  • Clinical Picture of Celiac disease: Experience from a health care provider in Arabia

    Background: Most studies describing clinical features and associations of celiac disease come from the studies conducted in the western world. Our aim was to determine the clinical features and associations of Celiac disease from our centre serving a Middle East population in Saudi Arabia. Methods: This retrospective study was conducted in a health care provider serving the Eastern Province of Saudi Arabia. All patients with biopsy-confirmed celiac disease receiving health care at our centre between April 2002 and December 2018 were identified. Individual case records were reviewed. In addition, the Slicer Dicer function was also used from the Electronic medical health record [EPIC] for analysing the clinical features and associations. Results: We analyzed the clinical features of 149 patients with Celiac disease. 66% of these were females. There was progressively increased yield of confirmed Celiac disease over the study period. This was paralleled by an increase in TTG antibody tests performed year by year. 77 (51.6%) patients had gastrointestinal symptoms. 26% of patients had iron deficiency anemia. 24 patients (16%) had diabetes, of which 46% were type 2. 18 (12%) patients had osteoporosis or osteopenia, and 28 (19%) had various skin diseases. Conclusion: In Saudi Arabia, celiac disease is being increasingly recognized, largely because of increased awareness and increasing TTG antibody testing. Many patients present with non-gastrointestinal symptoms. Knowledge about the varied clinical features and the targeted use of celiac serology should lead to even earlier recognition of the disease.