Gastroenterology and Hepatology

  • 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…

  • Gastrointestinal manifestations in patient with Common Variable Immunodeficiency Syndrome (CVID): A Case Report

    A 57 yo male with a background history of common variable Immunodeficiency syndrome (CVID) on Immunoglobulin Infusion (Kiovig) 40mg three weekly was referred for investigation of diarrhoea and follow up from previous history of colonic polyps. Colonoscopy showed an irregular looking ileocaecal valve (ICV) with an adjacent flat polyp (Paris IIa). Biopsies showed low grade dysplasia. There was also a duodenal polyp noted on gastroscopy and biopsy again showed low grade dysplasia. In light of the findings of upper and lower gastrointestinal tract polyps, a small bowel capsule endoscopy (SBCE) was arranged. This showed an irregular area of mucosa in the proximal small bowel with significant ulceration and inflammation (Figure 1). There were also multiple scattered lymphagiectasias and lymphoid hyperplasia in the distal small bowel (Figure 2). Anterograde double ballon enteroscopy (ADBE) was subsequently performed to the distal jejunum about 8 weeks after the SBCE. The duodenal polyp seen at gastroscopy was visualised during ADBE (Figure 3). In addition, two diminutive (

  • Efficacy Of Potassium-Competitive Acid Blocker vs Proton Pump Inhibitor as First-Line and Second-Line Treatment for Helicobacter Pylori Eradication

    Introduction: Eradication of H. pylori reduced the risk of gastric cancer by 75%, thus, its therapy with high eradication rates is needed. Nowadays, the success rate of H.pylori eradication regimen (PPI-based) has dropped to less than 75% due to clarithromycin resistance and inadequate gastric acid suppression. Vonoprazan, a Potassium-competitive acid blocker (PCAB) was released for use in first-line and second-line treatment for H.pylori eradication. It shows better acid suppression effect in acid-related disease. Aim: The aim of this study was to compare the efficacy of PCAB and PPI as first-line and second-line treatment for H. pylori eradication. Method: We search the Medline, Google Scholar and Directory of Open Access Journals (DOAJ) databases in October 2019. The study selection process was plotted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Results: In studies assessing first-line therapy, 776 patient were using PPI and 965 patient were using PCAB. In first-line therapy, PCAB has higher ITT and PP compared to PPI. According to Sue et al, in PPI group, more patient complain of diarrhea (49 vs 25; p < 0.001). In studies assessing second-line therapy, 1,069 patient were using PPI and 605 patient were using PCAB. Two studies showed no significant differences between PCAB and PPI in second-line therapy, but one study showed PCAB superiority (ITT PPI vs PCAB 85% vs 90% p=0.045; PP PPI vs PCAB 91% vs 96% p=0.008). There is no difference in adverse event between PCAB and PPI. Conclusion: In conclusion, PCAB has higher eradication rate (ITT and PP) compared to PPI as first-line therapy for H.pylori eradication. Further study is still needed in comparing efficacy of PCAB and PPI as second-line therapy. Both therapies were safe and well tolerated.

  • Esophageal cancer in Bobo-Dioulasso (Burkina Faso): epidemiological, clinical, endoscopic and anatomopathological aspects

    Introduction. Our study aims to strengthen the literature on esophageal cancer in Burkina Faso by assessing its endoscopic frequency and describing its epidemiological, anatomical-clinical and endoscopic characteristics. Patients and Methods: This was a descriptive cross-sectional study conducted from January 1, 2015 to June 30, 2018. Included in this study were all patients who had upper gastrointestinal fibroscopy (UGIF) with biopsy, and in whom esophageal cancer was confirmed histologically. The variables studied were: age, sex, main circumstance of diagnosis, endoscopic appearance, and histological type, as well as risk factors. Results: During the study period, 29 cases of esophageal cancer were diagnosed, with an average endoscopic incidence of 8.3 cases/year. The average age was 58.34 years. There were 17 (58.6%) males, or a sex ratio of 1.5. The definite risk factors of alcohol consumption and active smoking were present in 31.0% of patients. The average duration of consultation was 65.8 days, and the main symptom at diagnosis was dysphagia (72.4%). The preferred location was the lower third for nearly three-quarters of tumors; and the budding form was dominant (56.3%). At histology, squamous cell carcinoma was the dominant type (65.5%). Conclusion: This study shows us an increase in the average annual incidence of esophageal cancer in Bobo-Dioulasso. It mainly affects males from the age of 50, with clinical, endoscopic and histological characteristics similar to those found in the literature. The great delay in diagnosis limits the therapeutic options for this cancer with a formidable prognosis.