Gastroenterol. Insights, Volume 3, Issue 1 (April 2011) – 4 articles

It is currently recommended that all patients with liver cirrhosis undergo upper gastrointestinal endoscopy (UGIE) to identify those who have esophageal varices (EV) that carry a high risk of bleeding and may benefit from prophylactic measures. In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. The aim of this study was to assess the value of Doppler sonography for the prediction/screening of EV)in cirrhotic patients. In this twoyear prospective study, 50 patients with liver cirrhosis, referred to Al-Zahra hospital, were enrolled. Patients underwent detailed clinical examination, biochemistry tests (hematology, liver function tests), Gray-scale ultrasonography and Doppler sonography of hepatoportal system. Degree of esophageal varices was assessed at UGIE; Paquet's grades 0 – III were classified as group A (0-I; No or Mild EV) and group B (II-III; Moderate to severe EV). Three portal hemodynamic indices including liver vascular index, portal hypertension index, and congestive index was also measured. Degree of esophageal varices was assessed at UGIE. The relationship between the presence and degree of EVs with Doppler results were evaluated. Among 50 consecutive cirrhotic patients (41 males and 9 female, with mean age of 52.1(±16.2) year) were enrolled. 19 (38%) patients were placed in group A (No or mild EV), while 31(62%) had endoscopic evidences of moderate to severe esophageal varices (group B). Our study showed that among three portal hemodynamic indices we studied, only portal hypertension index has statistically significant correlation with degree of EVs confirmed by UGIE (P=0.029). Doppler ROC area under the curve was not significant but was near to be (AUC=0.64). Our data indicate that Doppler sonographic evaluations have no highly accurate predicting value for the presence of EV and its severity in patients with cirrhosis. However, we think Doppler study can be helpful for further investigation and finding more established and unchangeable information. Full article

The diagnosis of irritable bowel syndrome (IBS) is symptom-based and experts have developed diagnostic criteria for IBS. Distinguishing inflammatory bowel diseases (IBD) from IBS, especially with mild disease activity, can be difficult. Another concern is microscopic colitis (MC). MC and IBS have similar symptoms and a normal endoscopic appearance. Our study investigated the prevalence of patients with IBD, MC, and colorectal cancer among 968 patients that fulfill the Rome III criteria for IBS. Among these patients, four were found with IBD (0.4%) and seven with MC (0.7%). Among the IBD patients, three suffered from Crohn’s disease, affecting the terminal ileum, and one with ulcerative rectosigmoiditis. Of the seven patients with MC, two had collagenous colitis and five had lymphocytic colitis. Two IBS diarrhea-predominant patients had adenocarcin­oma in the sigmoid colon. These patients were a female aged 58 years and a male aged 56 years. We concluded from our study and earl­ier studies that symptom-based diagnosis of IBS may lead to missing a number of other gastrointestinal disorders that require quite different management than that for IBS. Full article

It has been uncertain what types of erythematous gastric mucosa are produced by Helicobacter pylori (H. pylori)-infection. We therefore design the present study to identify the type of erythematous mucosa associated with H. pylori-infection. A total of 590 consecutive Japanese patients (mean age 58.7 years, 185 men and 405 women) referred to our hospital for diagnostic upper gastrointestinal endoscopy were recruited in this study. We assessed endoscopically the type of gastric mucosal erythema, including spotty erythema, haemorrhagic erosion, reddish streaks, and raised erosion. H. pylori infection was diagnosed by a positive endoscopic 13C-urea breath test (e-UBT). Of the 402 H. pylori-positive subjects, spotty erythemas in the corpus were found in 177 (44.0%), haemorrhagic erosions in 26 (6.5%), reddish streaks in the antrum in 21 (5.2%) and in the corpus in 10 (2.5%), and raised erosions in the antrum in 58 (14.4%) and in the corpus in 4 (1.0%). For spotty erythema in the upper body, sensitivity was 44.0%, specificity was 92.6% for H. pylori infection. Seventy-two (86.7%) of 83 patients with antral reddish streaks and 65 (52.8%) of 123 patients with antral raised erosions had H. pylori-negative e-UBT. Spotty erythema in the corpus was one of most frequent endoscopic findings reflecting H. pylori infection. In contrast, antral reddish streaks and raised erosions were likely to indicate the absence of H. pylori. Full article

Perforation is a known but rare complication to Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES). Most of the perforations are located in the periampullary area due to ES. This report presents an unusual perforation in the third part of the duodenum following ES. The patient an eigthy-sixt-year-old man underwent ERCP with ES. The patient had Magnetic Resonance Cholangio-pancreatography (MRCP) and Computerized Tomography (CT) verified cholelithiasis and intra- and extrahepatic cholestasis. The perforation was not found under the ERCP procedure but was clinically revealed when the patient developed pneumoscrotum after the procedure. A CT-scan with oral contrast later confirmed the duodenal perforation. Full article