Gastroenterology and Hepatology

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.

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…

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.

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.

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.

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.

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:…

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.

Introduction: The ostomy is a surgical procedure that creates an abdominal canal for the elimination of fecal or urinary remains in an external pouch. The clinical conditions that lead to an intestinal ostomy are related to the benign or malignant pathologies of the gastroenterological organ. Ostomy may be temporary or permanent, and its characteristics can not be voluntary, as is the case of the colostomy. This type of procedure may bring biopsychosocial impacts for the patient. Objective: Analyze the emotional effects on patients using a colostomy bag. Method: Integrative review and reporting of experience. Results: While providing psychological support for patients with colostomy, it is possible to see what are the different types of changes in their routine, which are not physiological, but also psychological, emotional and social. The adaptation is a long and continuous process, and it is related to the underlying disease, the degree of physical weakness, the individual values and the type of personality of the patient. The ostomy procedure implies not only the use of the colostomy bag, but also a new body image that needs to be reconstructed, which has direct connection with self-esteem, self-image, self concept, body concept and body scheme, important components of the patient’s identity. Having undergone the procedure, some patients may experience feelings of alienation of their own body for their body have changed after the surgery. Using a bag collector represents a mutilation on the patient’s body and leads to a lack of control over physiological excretion, the body, physical beauty and health, eventually causing self-rejection. This situation is experienced by patients with a feeling of incapacity and inutility, as a sensation of loss of productive capacity may arise, and it can still arouse feelings like hatred, disgust, repulsion and fear, making one move away from the social environment. In…

Plants of medicinal values contain bioactive compounds capable of preventing and combating several oxidative related diseases. Many diseases have been wrongly attended to using several medicinal plants of choice by mere instinct or sunrise. The phytochemical screening, (antimicrobial activity of Costus afer extract and its alleviation of carbon tetrachloride induced toxicity were evaluated. The phytochemical screening of both qualitative and quantitative analyses showed the presence of Tannins, Steroids, Phenols, Phytate, Hydrogen cyanide (HCN). Saponin, Alkaloids and Flavonoids in the aqueous, methanol and n-hexane stem extract. The antimicrobial activity of Costus afer extract using two different solvents showed its bactericical effect and no antibiotic effect on fungi microorganisms at different concentration. The study based on the toxicity of the substance, carbon tetrachloride showed the serum elevation of alanine aminotransferase (ALT, EC 2.6.1.2.), aspirate aminotransferase (AST, EC 2.6.1.1) and alkaline phosphase (ALT, EC 3.1.3.1) in the liver of the rabbits in response to the oral administration of the chemical. The rabbits fed with the Costus afer extract of methanol and N-hexane showed a moderate effect while the rabbits fed with the chemical carbon tetrachloride had a very high elevation on the enzymes. The rabbits, however fed with both the Costus afer and the chemical compound, carbon tetrachloride showed a considerable alleviation on the level of toxicity of the chemical. The rabbits fed with the Costus afer extract and the chemical carbon tetrachloride mixture statistically showed significant (p