Gastroenterology and Hepatology

  • Usefulness of Castor Oil and Elobixibat and Lactulose and Ascorbic Aid (Movicol) for Bowel Preparation for Colon Capsule Endoscopy:A Case Report

    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. Some patients have been tested for the second and third time since the test was started in 2014. There is an opinion that these patients could reduce the booster more, and this time we will use the booster with mobiprep to perform the booster on the day with 350 ml.

  • Usefulness of Castor Oil and Elobixibat and Lactulose for Bowel Preparation for Colon Capsule Endoscopy in the patients on Dialysis -Including examination of small intestinal lesions-

    Colon capsule endoscopy was approved for reimbursement under the national health insurance system of Japan in 2014. Dialysis patients are potentially susceptible to bleeding because of the fragile intestine, impaired platelet function, or oral administration of nonsteroidal antiinflammatory drugs (NSAIDs) or anticoagulants. However, the capsule excretion rate after recommended bowel preparation reportedly ranges from 70% to 90%, and administration of boosters is also necessary. For dialysis patients, liquid loading is a problem. The patient on dialysis has moisture restrictions. The caster oil-based booster had an emission rate of 97%, but required a total water content of 3L. A study was conducted on dialysis patients using a protocol in which castor oil was supplemented with Elobixibat and Lactulose to determine whether booster volume could be reduced and elimination rates improved.

  • Knowledge of Nutrition Care for Children on Peritoneal Dialysis at National Hospital of Pediatrics, Vietnam

    Background: Nutrition is critically important for chronic kidney diseases, especially for children on CAPD (continuous ambulatory peritoneal dialysis). Nutrition not only plays the role of medication but also can control most abnormal metabolism disorders and preserve the residual renal functions. However, most patients’ families just focus on peritoneal dialysis while ignoring nutrition for the patients. Objective: Survey the knowledge of nutrition care for children with CAPD prescription. Method: Cross-sectional study on the nutritional status of 31 children undergoing CAPD. Interview and assess knowledge on kidney diseases with peritoneal dialysis, knowledge on nutrition care and nutrition practice of 31 mothers with children undergoing CAPD via a designed questionnaire. Result: The ratio of malnutrition of children on CAPD was 37.8%. Knowledge on caregiving and hygiene for CAPD was good with 74.4% mothers knowing about complications of peritonitis, 64.4% was aware of peritoneal catheter exit-site infection. However knowledge on nutrition was limited, only 25.8% mothers having knowledge on nutrition for the children. 9.7% mothers could meet the requirement in nutrition practice. Recommendation: It is necessary to enhance nutrition communication and counselling to achieve the expected treatment outcomes.

  • Kayexalate or Kalimate crystals: are they the culprits or the bystanders?

    Sodium polystyrene sulfonate (Kayexalate) or its analog calcium polystyrene sulfonate (Kalimate) has long been used to treat hyperkalemia in patients with chronic kidney disease (CKD). Although the side effect was rare, there were many case reports in the literature. Its etiology remains unclear. Lillemoe et al., on five uremic patients who developed catastrophic colonic necrosis that was temporally associated with the use of Kayexalate in sorbitol, contributed to death in four of their patients. They further provided experimental evidence implicating sorbitol as the agent responsible for colonic necrosis in a rat model. In contrast to the results of aforementioned animal study, Ayoub et al., published another experimental study in rats, they demonstrated that sodium polystyrene sulfonate (SPS), not sorbitol, was the main culprit for colonic necrosis. Recently, we encountered three patients who had hyperkalemia and were on Kalimate in water. They underwent colonic and gastric biopsy because of developing gastrointestinal symptoms. Kalimate crystals were found in all biopsy specimen, admixed with inflammatory exudate, or standing along on the mucosa surface, without provoking inflammatory reaction. We reviewed the photographs in the published case reports, they were similar to ours. Therefore, we felt that those crystals were bystanders, not the culprits. We fell that SPS ion-exchange resins, if given in water, appears to be clinically effective and reasonably safe to treat hyperkalemia in patients with CKD.

  • Gallic acid produces hepatoprotection by modulating EGFR expression and phosphorylation in induced preneoplastic liver foci in rats

    The purpose of this study was to analyze the role of gallic acid as liver protector and identify its role in the regulation of EGFR expression and phosphorylation in induced preneoplastic liver lesions in rats. Male Wistar rats were randomly divided into four groups. (1) Control; (2) animals receiving gallic acid (AG) 50 mg/kg v.o. for 8 weeks; (3) animals with preneoplasia (P) induced by a single dose of diethylnitrosamine 200 mg/kg i.p. (DEN) and two weeks after a single dose of carbon tetrachloride 2 mL/kg i.p. (CCl4); and (4) animals with preneoplasia treated with GA during 8 weeks. In order to evaluate GA hepatoprotection on preneoplastic lesions, we performed histological examination of liver tissue using H&E staining as well as an immunohistochemical analysis for PCNA. To evaluate the effect of GA on EGFR expression and phosphorylation, we performed an immunohistochemical and western blot analysis. The results indicated that GA significantly decreased EGFR expression and pY1068 EGFR phosphorylation in animals with preneoplastic lesions. GA significantly decreased PCNA expression in animals with preneoplastic lesions, suggesting it may work as an antiproliferative agent. Additionally, GA improved the architecture and organization of liver tissue and significantly decreased serum AST, ALT and FA, which are indicators of hepatocellular damage. By histopathological and immunohistochemical analysis we demonstrated an improvement in liver morphology, a reduction of preneoplastic liver foci and a reduction of cell proliferation, as well as an improvement on liver functionality. In conclusion, GA produces hepatoprotection by modulating EGFR expression and phosphorylation in preneoplastic lesions.

  • Effectiveness and safety of glecaprevir and pibrentasvir for hemodialysis patients with hepatitis C virus infection at a single center

    Background/Aims: Glecaprevir/pibrentasvir (GLE/PIB) is a pan-genotypic regimen for the treatment of hepatitis B virus (HCV) infection. GLE and PIB are direct acting antiviral (DAA) agents that can be used for patients with chronic renal failure who are on hemodialysis (HD) and those with HCV genotype 2 infections. Here, we report the usefulness and safety of GLE/PIB in 13 hemodialysis (HD) patients with HCV infection. Material and Methods: The subjects comprised patients with genotype 1 and 2 (six each) and one unknown genotype patient in whom GLE/PIB therapy was introduced by December 2018. The mean age was 69.2 (59-78) years (seven men and six women). The mean HCV RNA amount prior to treatment initiation was 4.81 (2.1-6.5). The administration periods were 8 and 12 weeks (n = 9 and 4, respectively). Results: Twelve patients received all the doses orally while an increase in total bilirubin (T-BIL) caused administration to be discontinued in one patient. HCV RNA at week 4 after treatment initiation became undetectable in 11 (91.6%) of the 12 patients. All patients achieved rapid viral response (RVR). Concerning adverse effects, although itching occurred in three (25%) patients, the symptom improved following administration of oral medication and the treatment was able to be continued. Conclusion: The results suggest that GLE/PIB can also be safely administered to HD patients. However, the usefulness and safety need to be further studied by examining more cases.

  • Silent but Treacherous: A Case Report of Silent Perforated Peptic Ulcer in an Elderly Patient

    Peptic ulcer disease (PUD) is one of the most common gastroduodenal disorders. Its prevalence has been decreasing over recent years. It has multiple complications, one of which is the life-threatening perforation. The latter usually present in a dramatic clinical picture and often necessitate an emergent surgical approach. A silent gastric perforation, however, is one of the rare conditions in the clinical practice which makes the diagnosis more challenging. We describe a case of silent perforated peptic ulcer complicated with septic shock and treated by surgery. This report highlights the wide spectrum of the clinical presentations of the peptic ulcer disease.

  • Study the Role of Combined M2-Pyruvate kinase, Calprotectin and Occult Blood Test as Fecal Biomarkers for Early Detection of Colorectal Cancer

    Background and study aim: One of the main requirements of biomarkers for detecting CRC is that it must allow detection of the disease at earlier stages. The current study is designed to investigate the role of combined M2-Pyruvate kinase, Calprotectin, and Fecal occult blood test measurements as fecal diagnostic biomarkers for early detection of colorectal cancer. Patients & Methods: Total number of 72 subjects (48 patients and 24 healthy controls) were included in the study. Patients with cancer colon and patients with organic non-malignant colorectal lesions were recruited from Oncology and Gastroenterology Outpatient Clinics and Inpatient Department Menoufia University Hospital. Results: There was a highly significant difference between studied groups regarding age and gender (P> 0.001), cancer colon was higher among old age (mean ± SD is 58.96±6.3) and males (70.8%), There was a highly significant difference between studied groups regarding Hb, CRP and ESR (P >0.001); lowest Hb level was detected in cancer group (8.7±1.7). On the other hands highest CRP and ESR levels were in cancer group (7.29±4.47) and (14.71±6.19) respectively. There was a significant difference between studied groups regarding platelets (P >0.05); lowest platelet number was detected in cancer group (272.4±66.9). There was non-significant difference between studied groups regarding WBCs (P 0.001), There was a highly significant difference between studied groups regarding M2-Pyruvate kinase and Occult Blood (P >0.001), There was highly significant difference between M2-PK in cancer and control groups (p >0.001), There was significant difference between calprotectin in cancer and control groups (p >0.05), There was highly significant difference between occult blood in cancer and control groups (p >0.001), There was highly significant difference between Combined M2-PK and Calprotectin in cancer and control groups (p >0.001), There was highly significant difference between Combined M2-PK and Occult blood in cancer and control groups (p>0.001), There was…

  • Significance of nutritional treatment for patients with inflammatory bowel disease in the era of biologics

    Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease (CD), is a chronic gastrointestinal tract inflammatory disorder. Although its etiology remains unknown, it has been reported that nutrition is involved in the onset of IBD. Patients with IBD often experience malnutrition due to malabsorption and increased energy requirements. Malnutrition is a serious issue for patients with IBD, especially in young people. Growth retardation characterized by delayed skeletal maturation and onset of puberty is a representative complication. In addition, immunosuppression, osteoporosis, and sarcopenia are important issues. Functional foods and diets have been known to alleviate gastrointestinal inflammation by modulating inflammatory cytokines. Furthermore, appropriate nutritional treatment has been reported to be effective on the induction and maintenance of remission in patients with IBD, especially with CD. Conversely, there are negative reports regarding the efficacy of nutritional therapy in patients with IBD. Recently, various new therapeutic agents such as biologics have emerged as key drugs in IBD treatment. In this new era, the efficacy of nutritional treatment, including combination therapy with biologics, should be reconsidered to improve the quality of life in patients with IBD. In this review, the nutritional treatment for patients with IBD is reviewed, and the latest evidence is provided.

  • LAPAROSCOPIC SLEEVE GASTRECTOMY FOR SUPER – SUPER OBESE PATIENTS (BMI>60 KG/M2) – SINGLE INSTITUTION EXPERIENCE

    Background: According to the official WHO publications, obesity became one of the greatest public health challenges of the 21st century. In addition to causing various physical disabilities and psychological problems, excess weight drastically increases a person’s risk of developing a number of noncommunicable diseases (NCDs), including cardiovascular disease, cancer and diabetes. The risk of developing more than one of these diseases (co-morbidity) also increases with body weight gain. Obesity is already responsible for 2–8% of health costs and 10–13% of death cases and the numbers rise progressively. Objective: To perform retrospective analysis of medical records data of patients with very specific range of morbid obesity (super-super obesity- BMI >60) with laparoscopic sleeve gastrectomy and systematized preoperative criteria and morbid risk for surgical treatment. Methods: Our study includes group of 13 patients with BMI>60 kg/m2. All patients taking part in the program for treatment of morbid obesity meet the criteria of the national regulatory health system. LSG was performed following official description. We conducted a 6, 9, 12, 24, 36, 60 months follow up of patient’s status and evaluation of quality of life, and we presented the percentage of excess weight loss (EWL). Results: Evaluation of preoperative consultations and clinical examinations permitted to perform as first step Laparoscopic SG for all patients. Postoperative results were very satisfying for nine of our (69 %) patients. Three patients after interval of 10-15 months obtained complementary second step operation – duodenal switch. We found that LSG is effective procedure for SSO patients. Conclusion: The group of Super-super obese patients is very specific because conservative treatment is usually not effective, limited and only weight loss surgery may propose acceptable results. Patients with BMI super to 60 kg /m2 presented satisfying results of LSG, their co-morbidities are not absolutely contraindications, and only well conducted preoperative and…