Gastroenterology and Hepatology

  • 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.

  • Polypoid Collagenous Colitis: A Microscopic Colitis with a Macroscopic Appearance

    Collagenous colitis is a type of microscopic colitis which was originally named based on specific histologic features and the lack of macroscopic abnormalities in the colon. However, there are reports in the literature that describe various macroscopic findings on colonoscopy in patients with histologically confirmed microscopic colitis. We report a case of collagenous colitis that was characterized by a diffusely polypoid colonic mucosa on gross examination of a right hemicolectomy specimen that was performed for a benign neoplasm in a 72 year old man. It is important for endoscopists to be aware of the various macroscopic abnormalities that may be present in this “microscopic” disease.

  • UPPER GASTROINTESTINAL ENDOSCOPY IN IDO-EKITI, NIGERIA: A FOUR-YEAR REVIEW

    Background: Upper gastrointestinal complaints are common, and the underlying diseases varies widely. Upper gastrointestinal endoscopy is the gold standard investigation for upper gastrointestinal symptoms. It helps in the proper diagnosis and the appropriate management of the underlying lesions. Aim: To determine the characteristics of the patients undergoing upper gastrointestinal endoscopy in a rural community in south-western Nigeria. Methods: This was a retrospective cohort study of all patients who had upper gastrointestinal endoscopy between February 2016 and February 2020 (a period of 4 years). The Age, Gender, Indication and the Endoscopy findings were obtained from the Endoscopy Register. A total of 181 upper gastrointestinal endoscopies had been performed over the period. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive statistics used included frequency tables, means and standard deviations. Results: A total number of 181 Oesophagogastroduodenoscopies (OGDs) were performed during the period under review, out of which 95 (52.5%) were males and 86 (47.5%) were females with a male to female ratio of 1.1 to 1. The age range of the patients was 9 to 89 years with a mean(±SD) of 52.4(±1.69) and median of 52.0 years. The highest number of OGDs were performed on individuals within the age bracket of 50-59 years whom were mostly females. Dyspepsia constituted the commonest indication for OGD (51.9%) followed by symptoms of upper gastrointestinal bleeding (haematemesis/melaena) 16.0%, unexplained persistent vomiting 6.6% and clinical suspicion of a gastric tumour 5.5%. The commonest endoscopic abnormality detected from this study was Gastritis 28.2% followed by Gastric erosions 12.2%, Duodenal ulcers 8.8%, Gastric tumours 8.3% and Oesophagitis 7.2%. Normal endoscopy findings were found in 24.9% of the patients. Gastritis was also the commonest endoscopic finding (constituting 40.4%) in patients who had OGD done on account of dyspepsia followed by Duodenal…

  • 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.