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Results in Journal Annals of Clinical Gastroenterology and Hepatology: 31

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Danish Muhammad, Khan Shoaib Ahmed, Samoon Dilnawaz, Majid Zain, Hanif Farina, Tassneem Abbas Ali, Luck Nasir Hasan
Annals of Clinical Gastroenterology and Hepatology, Volume 5, pp 039-040; https://doi.org/10.29328/journal.acgh.1001031

Abstract:
The involvement of bile duct in lymphoma is considered to be very rare and is usually a sequela of a disseminated disease [1]. In contrast to secondary involvement, primary non-Hodgkin’s lymphoma arising from the bile duct is extremely rare and presents with obstructive jaundice [2,3]. Non-Hodgkin’s lymphoma (NHL) accounts for 1% - 2% of all cases of malignant biliary obstruction [4]. Hepatobiliary involvement by malignant lymphoma is usually a secondary manifestation of systemic lymphoma. The first case of Non-Hodgkin lymphoma arising from bile duct was described by Nguyen in 1982 [5]. Most common extra nodal involvement of NHL is abdomen. Although, involvement of the stomach, pancreas or common bile duct is not common [6]. We present to you a case of 31year old male who presented to us with obstructive jaundice and was later diagnosed as Diffuse Large B-Cell lymphoma.
D’Souza Steve M, Yoo Byung S, Houston Kevin V, Patel Ankit J, , Johnson David A
Annals of Clinical Gastroenterology and Hepatology, Volume 5, pp 032-038; https://doi.org/10.29328/journal.acgh.1001030

Abstract:
Non-alcoholic fatty liver disease (NAFLD) is a condition that is associated with cirrhosis and hepatocellular carcinoma, and is increasing in prevalence worldwide. Sleep disruptions are commonly seen in NAFLD, and the disease process is associated with sleep disorders, including obstructive sleep apnea, circadian rhythm disorders, and insufficient sleep. The intermittent hypoxia seen in obstructive sleep apnea may contribute to fibrotic changes in the liver. A major component of this linkage may be related to gut microbiome changes. One notable change is increase in Bacteroidetes/Firmicutes ratio, and decrease in flora that ferment fiber into anti-inflammatory short-chain fatty acids. Several therapeutic options exist for NAFLD that target both sleep and NAFLD, including non-pharmacological factors, such as lifestyle modification (mainly diet and exercise). Pharmacological options include melatonin, Vitamin E, thiazolidinediones, and fecal microbiota transplantation. Core tip The pathogenesis of non-alcoholic fatty liver disease is closely tied to sleep and circadian rhythm abnormalities, through shared inflammatory pathways and altered metabolism. This review explores the pathogenesis of NAFLD in the context of sleep and circadian abnormalities. The associated inflammatory response is linked to changes in gut-microbiome interactions that contribute to the disease process. Understanding of this linkage has implications for various therapies for disease mitigation.
, Edmealem Afework, Tegegne Belachew, Mengesha Zemen
Annals of Clinical Gastroenterology and Hepatology, Volume 5, pp 025-031; https://doi.org/10.29328/journal.acgh.1001029

Abstract:
Background: Intestinal obstruction (IO) is defined as a partial or complete blockage of the bowel that results in the failure of intestinal contents to pass through. It is a common cause of emergency surgical problems. IO has been the leading cause of acute abdomen in several African countries. Objective: To assess surgical management outcome of intestinal obstruction by IESO professionals and its associated factors of intestinal obstruction in surgically treated patients at South Wollo zone. Method: A cross-sectional study was done on 216 patients ‘the data was collected from medical cards of the patient by using a pretested data abstraction format. Three nurses were involved in the process of data collection. The collected data was cleaned, coded and analyzed by SPSS version 23 statistical package. First descriptive statics was done for categorical and analyzed using frequencies and percentage. Multivariable logistic regression models was used to determine the association factors on the management outcome of intestinal obstruction when p - value < 0.05 and the strength of statistical association was measured by adjusting odds ratio and 95% confidence interval. Statistical significance was taken at p - value < 0.05. Results: From all study participants about 177 (82%) of them had good surgical outcome. Study participants who were managed by 1-3 years of work experience of IESO {(p = 0.004, AOR (95% CI) = 7.2[1.89, 27.68]}, preoperatively diagnosed as small bowel obstruction {(p = 0.001, AOR (95% CI) = 4.5[1.91, 10.40], Surgery conducted at day time {(p = 0.03, AOR (95% CI) = 2.8[1.06, 7.16]} had shown positive association with management outcome of intestinal obstruction conducted by IESO professionals. Conclusion and recommendation: Majority patients with intestinal obstruction had good surgical outcome done by IESO professionals. Year of experience of IESO Workers, preoperative diagnosis and time of surgery of the respondents had shown positive association for the occurrence of chronic liver disease whereas. In this study we can conclude that surgeries of intestinal obstruction conducted by IESO professionals are as good as intestinal obstruction surgeries conducted by physicians so there is a need to train more IESO professionals to deliver decentralized surgical service for rural areas.
, Venkataramana Sudeep Heggar, Thomas Justin V, Kodimule Shyam Prasad
Annals of Clinical Gastroenterology and Hepatology, Volume 5, pp 018-024; https://doi.org/10.29328/journal.acgh.1001028

Abstract:
Functional dyspepsia (FD) is a prevalent global health concern increasing with years. Inspired by the Traditional Chinese Medicine (TCM) liver-stomach disharmony syndrome in order to find a quick natural alternative treatment, a Ferula asafoetida-Silybum marianum (Asdamarin™) combined extract has been developed and proved its rapid efficiency and its safety with a 7-day randomized, double-blind, placebo-controlled pilot study (CTRI/2018/05/013993 dated 21/05/2018) conducted on 70 healthy human volunteers (aged 18–60 years) supplemented with 250 mg / twice a day of either a placebo or Asdamarin™. Subjects were evaluated from baseline to the end of the study (EOS) through changes in Gastrointestinal Symptom Rating Scale (GSRS), changes in Glasgow Dyspepsia Severity Score (GDSS) and changes in the short form of Nepean Dyspepsia Index (NDI-SF) for Quality of Life. Compared to the baseline a significant reduction (p < 0.001) of GDSS questionnaire score was noted in the Asdamarin™ group (from 5.66 ± 3.1 at baseline to 5.09 ± 2.8 at the End Of Study (EOS)) compared to placebo group (from 2.77 ± 1.3 baseline to 2.69 ± 1.3 EOS), a significant decrease (p < 0.001) of GSRS score noted in the Asdamarin™ group (from 32.11 ± 8.6 baseline to 19.11 ± 5.4 EOS) compared to the placebo group (from 25.23 ± 3.6 baseline to 23.2 ± 4.9 EOS), and a significant reduction (p < 0.001) of NDI-SF scoring was noted in the Asdamarin™ group (from 15.74 ± 4.1 baseline to 11.54 ± 2.1 EOS) compared to placebo group (from 12.54 ± 3.2 baseline to 11.63 ± 2.6 EOS). Asdamarin™ has been found safe and very well tolerated during the study.
Ghannouchi Mosaab, Chaka Amina, Hammouda Seifeddine Ben, Khalifa Mohamed Ben, Chaouech Asma, Nacef Karim, Hleli Kamel, Boudokhane Moez
Annals of Clinical Gastroenterology and Hepatology, Volume 5, pp 016-017; https://doi.org/10.29328/journal.acgh.1001027

Abstract:
Biliary cystadenoma is a rare cystic tumor of the liver. It has a high recurrence rate and malignant transformation risk in middle-aged women. Pre-operative diagnosis is difficult because of the lack of clinical, biological and radiological specificity. The confirmation of the diagnosis is made by the histopathological examination. Complete surgical resection is preferred because of the high risk of malignant transformation and recurrence.
, Prió Alba, Ascanio Fernando L, Serres-Créixams Xavier, Mínguez Beatríz, Genescà Joan, Castells Lluís, Villagrasa Ares A
Annals of Clinical Gastroenterology and Hepatology, Volume 5, pp 013-015; https://doi.org/10.29328/journal.acgh.1001026

Abstract:
Radiofrequency ablation is one of the most commonly used therapies for potentially curative small hepatocellular carcinoma. Although radiofrequency is usually a safe procedure, severe and potentially fatal complications can happen. This is a case of a 72 years old woman with cirrhosis secondary to Metabolic Associated Fatty Liver Disease (MAFLD), who presented recurrent hydrothorax after treating hepatocellular carcinoma (HCC) with radiofrequency ablation (RFA), and in which diaphragmatic perforation was subsequently diagnosed. We reviewed the differential diagnosis and management in a pleural effusion after a radiofrequency procedure. Although diaphragmatic perforation is an uncommon complication after RFA procedure, this case aims to help clinicians being aware of non-habitual complications.
, Hassan Zeinab
Annals of Clinical Gastroenterology and Hepatology, Volume 5, pp 005-012; https://doi.org/10.29328/journal.acgh.1001025

Abstract:
Introduction: Drug-induced Hepatotoxicity and biologic drugs have historically been challenging in IBD. We aim to study the prevalence of hepatotoxicity in adult patients using biologic medications. Methodology: With the guidelines described by PRISMA-P, a detailed search strategy for each electronic database was developed based on PubMed, Medline, and Embase. We include RCTs that assessed the efficacy and hepatotoxicity of biologics in IBD patients. Hepatotoxicity was defined as AST and/or ALT >2x upper limit of normal or cholestasis. The Odds ratio (OR) was calculated with a 95% confidence interval (CI). Heterogeneity was assessed using the Chi2 test and the I2 statistic. Results: 862 records identified in total. After removing the duplicates 564 records were left for review. Four studies did not report on how participants were randomized to treatment groups or how allocation concealment was achieved, we rated these studies at unclear risk of bias for these domains. There was no presence of any heterogeneity among studies by (Chi2= 2.21, df = 6, p = 0.90, and I2 = 0%). Our meta-analysis was conducted on the fixed effects model, with the (0.770, 95% CI [-0.630, 0.957], and p = 0.02). Hepatotoxicity was not related to any TNF-α antagonist. Thiopurine induced liver injury occurred more frequently within the first months of treatment, 50% of cases within the first 3 months (11.4% vs. 2.3%, p < 0.05). Conclusion: When hepatotoxicity occurred, the treatment was withdrawn in thirty one percent of patients. This group of patients had a dose-dependent hepatotoxicity rather than an immunologic hepatitis.
, Sira Ahmad Mohamed
Annals of Clinical Gastroenterology and Hepatology, Volume 5, pp 001-004; https://doi.org/10.29328/journal.acgh.1001024

Abstract:
Acute liver failure (ALF) in children is a severe disease with a high mortality rate. The current treatment strategies are still defective, with many cases die when liver transplantation is unavailable. The current protocol of steroids therapy improved the survival rate of hepatitis A virus (HAV)-related ALF. However, there is still a high mortality for non-HAV cases. Stem cell therapy (SCT) has been tried in experimental animals with ALF and in few adult studies with acute-on-chronic liver failure. No previous trials of SCT have been tested in children with ALF. The absence of SCT application in ALF in children could be due to some issues. These could be related to safety, sources, administration route, optimum dosage, efficacy, and survival. It is proposed that could be the future therapy if these obstacles have been well studied and solved.
, Begum Rehana, Gunabushanam Vikraman, Bonkovsky Herbert L
Annals of Clinical Gastroenterology and Hepatology, Volume 4, pp 052-057; https://doi.org/10.29328/journal.acgh.1001023

Abstract:
Coronavirus infections have caused outbreaks in humans: SARS-COV ((Severe Acute Respiratory Syndrome) and MERS-CoV (Middle East Respiratory Syndrome) resulting in significant mortality and morbidity.
, Laureti Silvio, Capozzi Nunzia, Mosconi Cristina, Modestino Francesco, Peta Giuliano, Fernando Rizzello, Bruno Antonio, Vara Giulio, De Benedittis Caterina, et al.
Annals of Clinical Gastroenterology and Hepatology, Volume 4, pp 045-051; https://doi.org/10.29328/journal.acgh.1001022

Abstract:
Purpose: Percutaneous abscess drainage (PAD) is the first-line approach for abscess in Crohn’s disease (CD) since it procrastinates or avoids surgery especially in postoperative abscesses [within 30 days post-operative (p.o.)]. We retrospectively evaluated the effectiveness, complications and outcome after PAD in postoperative and spontaneous abscesses and factors influencing the outcomes. Methods: We performed PAD in 91 abscesses, 45 (49,5%) postoperative and 46 (50,5%) spontaneous. We defined the overall success (OS) as clinical (CS) and technical success (TS) when imaging documented the resolution of the abscess with no surgery within 30 days. Conversely, patients without abscess at the time of surgery, were considered as TS but clinical failure (CF). We also analyzed the overall failure (OF) defined as CF with or without technical failure (TF). Overall technical success (OTS) was OS plus TS. Complications were classified as major and minor according to the Interventional Radiology Criteria. Results: In postoperative abscesses we found 91% OS, 9% OF, no TF and 100% OTS. In spontaneous abscesses we found 33% OS, 67% OF, 6.4% TF, 95,6% OTS. A total abscess resolution was achieved in 97,8% of patients. No major complication occurred; only 1 case of minor complication. Factors statistically influencing the outcome were postoperative vs spontaneous collections (OF: 9% vs. 67%, p < 0.0001), multiloculated vs uniloculated collections (OF: 38% vs. 1%, p < 0.0001) and upper abdominal vs lower location (OF: 13% vs. 25%, p <0.05). Conclusion: Our data confirms the safety and effectiveness of PAD even in cases needing surgery within 30 days; most remarkable, PAD allows avoidance of early reoperation in almost all the patients with postoperative abscess.
Gutiérrez-Gonzalez Luis Arturo, Macias Eillen, Herrera-Vivas Freddy, Otaiza Franz, Luis Arturo Gutiérrez-Gonzalez, Veitia Guillermo
Annals of Clinical Gastroenterology and Hepatology, Volume 4, pp 039-044; https://doi.org/10.29328/journal.acgh.1001021

D’Souza Steve M, Cundra Lindsey B, Yoo Byung Soo, Parekh Parth J, Johnson David A
Annals of Clinical Gastroenterology and Hepatology, Volume 4, pp 020-033; https://doi.org/10.29328/journal.acgh.1001018

Fayadh Makki H, Awadh Salim, El Kiwisney Loai, Quadri Abdul Hadi, Shetty Prasad K, Naguib Mervat
Annals of Clinical Gastroenterology and Hepatology, Volume 4, pp 011-014; https://doi.org/10.29328/journal.acgh.1001016

Abstract:
Celiac disease affects 1% of the world population; however it is under diagnosed in UAE. The disease has many clinical manifestations, ranging from severe malabsorption to minimally symptomatic or non-symptomatic presentation. Hypocalcaemia is a common finding in celiac disease and could be the only presentation of the disease; however hypercalcemia has been previously reported in patients with celiac disease either due to primary hyperparathyroidism or tertiary hyperparathyroidism due to prolonged hypocalcaemia. A normal calcium level on the other hand in patients with untreated celiac disease who also have primary hyperparathyroidism can be due to interplay of these two conditions and may delay the diagnosis of primary Hyperparathyroidism. We report the very first case from our practice in UAE with untreated celiac disease and normal calcium level at presentation, where a diagnosis of primary hyperparathyroidism was not entertained initially. Patient went on gluten free diet which then caused normalization of intestinal abnormalities and likely calcium absorption manifesting as hypercalcemia on subsequent labs. This led to further work up and finally the diagnosis of Primary hyperparathyroidism due to parathyroid adenoma.
, Güzel Kerim
Annals of Clinical Gastroenterology and Hepatology, Volume 4, pp 006-010; https://doi.org/10.29328/journal.acgh.1001015

Abstract:
Introduction: Pancreatic pseudocysts (PPs) are mostly delayed complications of acute or chronic pancreatitis and trauma. Pancreatic pseudocysts are usually managed by supportive medical treatment without surgical procedure. All the surgical interventions (percutaneous, endoscopic or surgical approaches) are based on the location, size, symptoms, complications of the pancreatic pseudocyst and medical condition of the patients. Recently, laparoscopic cystogastrostomy has become most appropriate approach especially for retrogastric pancreatic pseudocysts. In this study, we would like to report results of laparoscopic anterior transgastric cystogastrostomy by using linear articulated endo GIA stapler (Covidien medium thick purple) and versa-lifter (versa lifter®, laparoscopic retractor, manufactured by protomedlabs, France) in 14 pancreatic pseudocysts patients. Methods: We retrospectively analyzed data of patients with pancreatic pseudocysts treated by laparoscopic anterior transgastric cystogastrostomy from September 2010 to October 2014. All of the patients were controlled for the recurrence of pancreatic pseudocysts in February 2017. Results: 14 patients with pancreatic pseudocysts were managed by laparoscopic anterior transgastric cysto-gastrostomy. Conversion was performed in only one patient (7%). There were no symptoms and signs of recurrence of pancreatic pseudocyst during on average 43.6 months follow up time. Conclusion: Laparoscopic cystogastrostomy by using articulated linear endo-GIA stapler and versa-lifter is a safe and effective method for management of appropriate retro-gastric pancreatic pseudocysts.
Mohan Priya, Priya Mohan, Sumathi Bavanandam, Sunil Kumar Ks
Annals of Clinical Gastroenterology and Hepatology, Volume 1, pp 001-003; https://doi.org/10.29328/journal.hcg.1001001

Nanthakumar S, S Nanthakumar, , Nirmala Dheivamani, Natarajan B, Krishna Mohan
Annals of Clinical Gastroenterology and Hepatology, Volume 1, pp 004-006; https://doi.org/10.29328/journal.hcg.1001002

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