Gastroenterology and Hepatology

  • EPIPHRENIC OESOPHAGEAL DIVERTICULUM – A CASE REPORT

    Epiphrenic oesophageal diverticulum is rare world-wide and account for less than 10% of all oesophageal diverticula. We present Mrs O.E. a 64-year old Nigerian of the Yoruba tribe who presented with early satiety and upper abdominal discomfort of five months duration. The early satiety was of insidious onset and had been progressive. This initially made her to reduce the size of her meal intake but eventually progressively led her to taking just a meal per day. This is in contrast with her premorbid intake of three meals per day. She has associated history of regurgitation worse in the recumbent position which she described as containing undigested food. She has no abdominal swelling, odynophagia or dysphagia. No history of haematemesis or melaena. She has weight loss and easy fatigability. The upper abdominal (epigastric) discomfort is characterized as a feeling of peppery, burning sensation which radiates to the back and had no association with meals or with time of the day. It has no relation to posture and said to be worse with consumption of peppery or spicy food substance. Minimally relieved with the use of antacids. No other significant contributory history. Review of systems was also not contributory. Clinical examination was not remarkable. A provisional diagnosis of a suspected Gastric Tumour was made likely a Gastric Lymphoma or Adenocarcinoma to rule out Gastrointestinal Stromal Tumour(GIST). Barium swallow revealed a Distal (Epiphrenic) oesophageal diverticulum. Findings at upper GI Endoscopy include: (1) Distal (Epiphrenic) oesophageal diverticulum (2) Reflux oesophagitis (3) Gastric Atrophy; probably age-related to rule out chronic Helicobacter pylori-infection. Histology revealed Reflux oesophagitis, Mildly active chronic corporeal gastritis with mild atrophy and Chronic non-specific antral gastritis. She was managed conservatively with long term proton pump inhibitor therapy, modification of dietary habits and liberal oral fluid intake with significant clinical improvement and resolution…

  • POST-VAGOTOMY GASTROPARESIS – A CASE REPORT

    We present Mr M.A. a 27 year old Nigerian of the Yoruba tribe who has been having recurrent dyspeptic symptoms for 5 years but not previously endoscopically evaluated for peptic ulcer disease who now presented with six days history of abdominal pain which was initially epigastric but later became generalized associated with four episodes of vomiting and a day history of abdominal distension and fever. He was acutely ill-looking and dehydrated. The Abdomen was moderately distended, does not move with respiration, generalized tenderness with guarding and rebound tenderness, intra-abdominal organs were difficult to palpate due to the guarding. Bowel sound was absent. Examination of the other systems was not remarkable. A provisional diagnosis of Generalized peritonitis likely secondary to perforated peptic ulcer was made. He had an emergency exploratory laparotomy under general anaesthesia. He was commenced on intravenous fluids and parenteral proton pump inhibitor(PPI) and antibiotics. Intra-op findings include 2 liters of bilious peritoneal fluid, Multiple fibrous adhesions, a 2.5cm x 2cm gastric perforation at the anterior wall of the antrum and a grossly normal bowel. The surgical operation performed was a Graham Omental patch closure of the gastric defect with Bilateral Truncal Vagotomy and Peritoneal lavage. Post-operative state was satisfactory and he was later discharged. He presented at the gastroenterology out-patient clinic eight months later with complaints of early satiety, feeling of indigestion and episodes of vomiting. Vomitus is usually offensive / foul smelling and contains undigested or partially digested stale food substances. Abdominal examination revealed a positive succussion splash. Other clinical examination findings were not remarkable. A Provisional Diagnosis of suspected Gastric outlet obstruction probably secondary to a chronic duodenal ulcer was made. Endoscopy findings revealed copious fluid and food debris in the stomach cavity which had an offensive smell with remnants of partially digested stale food substances…

  • Virological response of hepatitis Delta infection to treatment with Pegylated Interferon alpha 2a in a high prevalence country

    The prevalence of Hepatitis Delta Virus (HDV) infection in Cameroon is 11.01%. Pegylated interferon alpha 2a (PEG-IFN α 2a) is the standard treatment worldwide. This study aimed to describe the virological response to this drug in cameroonians. Methods: We carried out a cross-sectional study from 1 January 2012 to 31 December 2018. It took place in eleven (11) health facilities of Yaoundé and Douala. Patients with HDV infection and treated with PEG INF α 2a for at least 48 weeks were included. The primary endpoint was Virologic Response (VR) and secondary endpoints were Rapid Virologic Response (RVR) and Late Virologic Response (LVR). Results: We included 133 patients. The mean age was 36.33 ± 10.9 years. The male sex accounted for 65.41% of cases. The VR was 67.67%. Leukopenia, fever, headache, asthenia and abdominal pain were the most common adverse events in 88.72%, 68.42%, 53.38%, 45.11% and 35.34% of cases respectively. Factors associated with VR were the presence of diabetes (aOR= 4.32; CI95% [1.22 – 15.30], p= 0.023), fever (aOR= 5.16, CI95% [1.48 – 18.04], p=0.01) and ALT levels greater than 40 IU/l (aOR= 3.69, IC95% [1.15 – 11.18], p= 0.028). Conclusion: VR is high in cameroonians. The presence of diabetes and elevated transaminases are factors associated with this virologic response. We recommend the use of interferon treatment for patients with HDV infection in Cameroon with very strict monitoring of side effects.

  • 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.