Gastroenterology and Hepatology

  • Dietary intakes, nutrition status and micronutrient deficiency in picky eating children under 5 years old in the Vietnam National Hospital of Pediatrics

    Background: Recently, picky eating behaviors have become more and more common in Vietnam. Early identification of nutritional deficiencies through assessment of nutritional status and dietary intake is important to be able to intervene in time to help children optimum in growing physically and cognitively. Objective: The aim of this study was to evaluate dietary intake of under five years old children with picky eating behavior and the consequences of these diets on their nutrition status. Methods: Dietary intake was assessed using 24-hour dietary recall for 124 under five years old who presented with picky eating behavior at Vietnam National Hospital of Pediatrics. Nutrients intakes were calculated using validated dietary analysis software and compared with age-appropriate Vietnam Recommended(Recommended Nutrient Intakes- RNI). Nutrition status was assessment follow WHO guideline 2009, micronutrients deficiency was evaluated based on laboratory tests. Results:84.7% of the children had an unbalanced diets, lacking in overall energy intake(70-90% of RNI:48 and ≤ 50%: 19%). Prevalence of stunting (32.3%), under weight (28.2%), wasting (13.7%) and micronutrients deficiency was high. Conclusions: Children with picky eating behavior had high prevalence of inadequate diet, malnutrition and micronutrient deficiencies. Early identification and treatment of picky eating behavior in children is needed to prevent malnutrition.

  • New progress in endoscopic treatment of esophageal tracheal fistula

    Esophageal tracheal fistula is a pathological communication between the esophagus and the trachea and/or bronchus. It is caused by the progression of malignant tumors such as esophageal cancer and lung cancer, as well as radiotherapy and chemotherapy. Once the esophageal tracheal fistula is diagnosed, it needs immediate treatment to block the fistula as soon as possible, relieve symptoms and improve the quality of life of the person. Digestive endoscopic minimally invasive interventional techniques, represented by esophageal stents, are an important means of treating esophageal fistula. In this study, the esophageal stent type selection, placement method and efficacy in the treatment of esophageal tracheal fistula, and the application of other digestive endoscopy techniques is summarized.

  • Conventional and Alternative Measures for IBS Management

    Irritable bowel syndrome (IBS) or irritable bowel disease (IBD), is also known as spastic colitis, mucus colitis, and nervous colon. It is a chronic, or long-term, condition, but symptoms tend to change over the years. It’s not uncommon for people with IBS to have episodes of both constipation and diarrhea. Symptoms such as bloating and gas typically go away after a bowel movement. There is no cure for IBS. Treatment is aimed at symptom relief. Certain foods as well as stress and anxiety can be triggers for IBS symptoms for many people. Medications are available to ease the symptoms of IBS, but some patients feel better trying natural remedies instead of (or in addition to) conventional drugs. Objective of the Study: To detail conventional and alternative treatment approaches of IBS. Limitation of The Study: Surgical considerations of IBS patients are not included in this article. Findings: Lifestyle modification, specially food habit alteration mostly effective along with psychological counseling and medication adherence. Practical Implications: GPs, gastroenterologists, medicine specialists, pharmacy and medical students will get best benefit out of this article.

  • EFFICIENCY OF DAA ON HCV-INFECTED KIDNEY TRANSPLANT PATIENTS AT CHO RAY HOSPITAL – VIETNAM

    Purposes:To evaluate the efficiency of DAA (Direct Antiviral Agent), in particular sofosbuvir, ledipasvir in Hepatitis C treatment for patients with kidney transplants. Take note in the side effects and drug interactions during the treatment processes. Method:Intervention, prospective, cohort, case studies, non-randomized, open on to all kidney transplant cases with chronic Hepatitis C tested positive HCV RNA (+); the patients from the cases above had agreed to be the research’s subjects from 11/2015 to 8/2018 at Cho Ray hospital. Two regimens Sofosbuvir/Ribavirin and Sofosbuvir/Ledipasvir have been used for treatments, which depend on HCV genotype and liver cirrhosis levels. Results:In 440 patients who had been observed after kidney transplants, 44 cases anti HCV (+), 29 cases HCV RNA(+) and 4 cases HBV/HCV Confection. There were 15 cases with chronic Hepatitis C participated in study. Males made up 66.6% of the group with the average age 49± 7.06 yrs. There were 6.7% of them not taking full-course treatments. 80% of the patients were infected with only C virus, while 20% of the patients were co-infected with B and C virus. 40% of them had histories of previous blood transfusions. The ratio of patients with elevated liver enzymes was 33.3%. Genotype 1 (a and b) was 33.3%, genotype 2 was 6.7%, genotype 6 was 53.3% and 6.7% unidentifiable genotype. There were 2 cases which were treated with Sofosbuvir/Ribavirin regimen and 13 cases which were treated with Sofosbuvir/Ledipasvir regimen. Rapid virologic response (RVR) is 100%. Sustained virologic response (SVR) within 12 weeks and 24 weeks is 100%. Relapse ratio 0%. In regimen using Sofosbuvir / Ledipasvir, the side effects are mild and transient, including skin irritation, digestive disorders which account for 7.7%. In regimen using Sofosbuvir / Ribavirin, side effects including severe anemia, fatigue, loss of appetite related to Ribavirin occur in 50% of cases…

  • Inflammatory bowel disease and amebiasis

    Amebiasis affects around 500 million people in the world. Clinical manifestations of intestinal amebiasis can overlap with symptoms of the inflammatory bowel disease (IBD). Many studies evaluated the relationship of IBD patients during exacerbation periods and amoebic colitis as it is important to rule out the infection before starting steroids and/or immunosuppressive treatment. This mini-review focused on the best strategy to diagnose the infection in this specific population, using classical stool analysis for ova and parasites, serology, investigations by PCR and colonoscopy according to the degree of clinical suspicion. It also suggested an algorithm for management approach where patients were divided into asymptomatic carriers vs. symptomatic patients under 5 ASA or immunosuppressive therapy having either a vegetative or cystic form of the infection. All these patients were treated accordingly by intraluminal agents, and nitroimidazole was added in the vegetative form. 5-ASA was not a contraindication for treatment, while immunosuppression is forbidden until after eradiation of EH. Amoebic infection should always be ruled out before starting treatment with steroid or immunosuppressive medications, in order to minimize its deleterious outcomes on IBD patients.

  • Study of the effect of sofosbuvir and daklatasivir on respiratory system in patients with chronic hepatitis C

    Back ground: The aim is to study effect of sofosbuvir and daklatasivir on respiratory system. Patient and methods : A randomized study was done after all patients gave an informed consent before the start. The study population consists of 21 patients receiving treatment of HCV coming to the outpatient clinic of beni suef university hospital. Results : There is no major adverse effect of sofosbuvir and daklatasivir on respiratory system as proved by assessment of pulmonary function and Computed tomography before and after treatment.

  • Liver cirrhosis with high IgG4 in a patient with, diabetes mellitus, ulcerative colitis with papillary thyroid cancer, is it all related ? which one to blame& is it time to raise awareness about IGG4 and hepatobiliary diseases

    Back ground: There is possible etiological relation between high IgG4 in a patient with liver cirrhosis, ulcerative colitis, diabetes mellitus , prostatitis ,venous thrombosis and thyroid cancers and the use of immunosuppressive & biologic agents. Method: a study of patient with multiple organ involvement with persistently elevated IgG4. A 56 years old male with persistently elevated IgG4 over 2.5 times normal level, diabetic on insulin, ulcerative colitis on azathioprin & adalimumab developed deep skin pigmentation and liver enzymes elevation with portal hypertension and liver cirrhosis, azathioprine & adalimumab were stopped and golimumab started, after 3 infusions of golimumab papillary thyroid cancer developed .Total thyroidectomy followed by radio iodine after which severe sialo adenitis developed which responded to steroids. His ulcerative colitis was treated with vedolizumab with good response. liver cirrhosis progressed with bleeding varices and portal vein thrombosis with factor Leiden V mutation. Results and conclusions: High IgG4 can be related to many organs including pancreas,liver,thyroid ,small and large bowel,parotid glands ,in this patients all these were affected resulting in colitis,diabetes,liver cirrhosis and thyroid cancer and sialo adenitis. Awareness is needed on the associations with high IgG4. Conclusion: A patient with elevated IgG4 , liver cirrhosis , diabetes mellitus, ulcerative colitis developed skin pigmentation, and papillary thyroid cancer associated with persistently elevated IgG4.

  • Domination of Gastric Complications Among Diabetic Patients

    This article covers the epidemiology, pathophysiology/complications and management of diabetic gastroparesis (DGP), and more broadly diabetic gastroenteropathy, which encompasses all the gastrointestinal manifestations of diabetes mellitus (DM). Hyperglycemia, autonomic neuropathy, and enteric neuromuscular inflammation and injury are implicated in the pathogenesis of delayed gastric emptying (GE). Initial options include dietary modifications, supplemental oral nutrition, and antiemetic and prokinetic medications. Patients with more severe symptoms may require a venting gastrostomy or jejunostomy and/or gastric electrical stimulation (GES). To date, few population-based studies have estimated the true prevalence and incidence of gastroparesis. Nonetheless, its prevalence appears to be rising, as does its incidence among minority populations, documented via hospitalizations, which can impose significant economic burdens on patients.

  • INCIDENCE OF GASTRITIS AND DUODENITIS IN THE POPULATION OF PERNAMBUCO: AN ANALYSIS FROM NATIONAL HEALTH INDICATORS

    Introduction: Gastritis is the inflammation of the mucosa that lines the inner walls of the stomach. Duodenitis consists of an inflammation of the duodenum. The main complaints are abdominal pain and epigastric burning. One of the main risk factors for these diseases is infection with the bacterium Helicobacter pylori. In Brazil, it is estimated that 80% of the population is a carrier of the bacteria, which is alarming if compared to the world average. Objective: Analyze prevalence data of new gastritis and duodenitis cases from 2013 to 2017 per sample of municipalities in the State of Pernambuco with more than 100 new cases in the period. Methodology: It is a study in secondary databases, conducted from the Basic Data indicators of Brazil, an integral tool of the health information system, using quantitative analysis of variables. Results: The new cases in 2013 halved in 2017. The municipality of Petrolândia obtained the largest relative reduction of the new cases in the period, from 38 in 2013 to 1 new case in 2017. Recife presented 96 new cases less when comparing 2017 and 2013, which is the largest absolute reduction among municipalities. Afogados da Ingazeira, Jaboatão dos Guararapes and Pesqueira also reduced the number of new cases in the period. On the other hand, the municipality of Buíque maintained the same rate of new cases in the period. Discussion: With the exception of the municipality of Buíque, it is generally observed that there were significant reductions in the number of new cases when evaluating the totality of the municipalities of Pernambuco, which may possibly be associated with the expansion of preventive public health education policies aimed at awareness of the population about adequate food hygiene, with a view to reducing the number of infections and reducing public spending on procedures and treatments. Conclusion:…

  • Electronic Procedural Reporting for Colonoscopy; Challenges (Discrepancies) in Data Entry and Report Generation

    Aims: Computerized reporting systems that generate standardized endoscopy reports are available and facilitate easy retrieval of data for quality assurance review. We aim to compare the accuracy of extracted database fields in our reporting system (endoPRO) for key measures of quality to the final edited endoscopy report for colonoscopy procedures. Methods: In a retrospective analysis, we compared data retrieved from endoPRO to the final colonoscopy reports at Hamilton Health Sciences (HHS). The data included demographics, indications for procedures, bowel prep quality, findings, extent of exam, and recommendations. Discrepancies, changes or missing information pertaining to key quality indicators for colonoscopies were recorded. Results: In total, 1843 colonoscopy procedures were done at HHS from January to March 2010, and reports for 592 colonoscopies, randomly selected, were analyzed for this study. Discrepancies were seen in: Indication – 34 cases (5.7%), Assistants present during colonoscopy – 94 cases (15.9%), Quality of bowel preparation – 35 cases (5.9%), Findings & impressions – 38 cases (6.4%) including polyps, inflammation, diverticulosis and haemorrhoids. Conclusions: Our study demonstrates the variability between data found in patients’ final colonoscopy reports and data retrieved from the endoscopy databases. Structured endoscopy reporting and the use of databases facilitate quality assurance but editing of procedure reports after structured data entry compromises accuracy of the data in key quality measures. Inaccurate or incomplete data recording will compromise the enhancements in quality assurance that would accrue otherwise from regular audit processes.