Saudi Journal of Gastroenterology
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   2010| April-June  | Volume 16 | Issue 2  
    Online since March 23, 2010

 
 
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ORIGINAL ARTICLES
Accuracy of rapid urease test in diagnosing Helicobacter pylori infection in patients using NSAIDs
Mojgan Foroutan, Behnam Loloei, Shahrokh Irvani, Ezanollah Azargashb
April-June 2010, 16(2):110-112
DOI:10.4103/1319-3767.61238  PMID:20339181
Background/Aim: This study aimed to determine the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the results of rapid urease test (RUT). Patients and Methods: The study evaluated 210 consecutive patients for the diagnosis of Helicobacter pylori (H. pylori) infection. They were divided into case and control groups based on history of NSAID use (n=70 each). Two biopsy specimens were collected from antrum and corpus of stomach during endoscopy and sent for rapid urease testing and histopathology. Sensitivity, specificity, and accuracy rate of RUT test were compared against histology. Results: The average age was 55.2±12.9 and 43.3±12.1 years in the case and control groups, respectively. Among NSAID users, RUT sensitivity, specificity and accuracy rate were all 100%. The sensitivity, specificity and accuracy rate of RUT in patients without history of NSAID use were 97.37, 98.57 and 98.14%, respectively. The overall sensitivity, specificity and accuracy rate of RUT were 98.57, 99.29, and 99.04%, respectively. Conclusion: Our study shows that sensitivity, specificity and accuracy rate of RUT are not affected by NSAID use. Rapid urease test remains a reliable test for diagnosis of H. pylori in patients on NSAIDs.
  11,130 738 3
REVIEW ARTICLES
Gastrointestinal and hepatic manifestations of primary immune deficiency diseases
Saleh Z Al-Muhsen
April-June 2010, 16(2):66-74
DOI:10.4103/1319-3767.61230  PMID:20339173
Primary immune deficiency diseases (PIDs) are a heterogeneous group of inherited diseases characterized by variable genetic immune defects, conferring susceptibility to recurrent infections. They have a vast array of manifestations some of which involve the gastrointestinal and hepatobiliary systems. These complications can be the consequence of five different factors, namely, infection, autoimmune process, unregulated inflammation, malignancies and complications of therapeutic intervention. They may precede the PID diagnosis and, once developed, they pose high risk of morbidity. Untrained clinicians may treat these manifestations only at the level of their presentation, leaving the PIDs dangerously undiagnosed. In fact, early diagnosis of PIDs and accompanied gastrointestinal and hepatic complications clearly require appropriate treatment, and in-turn lead to an improved quality of life for the patient. To improve the awareness of gastroenterologists and related health care providers about these diseases, we have reviewed herein the complications of different PIDs focusing on gastrointestinal and hepatic manifestation.
  9,369 1,526 1
CASE REPORTS
Spontaneous rupture of a giant hepatic hemangioma - sequential management with transcatheter arterial embolization and resection
Vaibhav Jain, Vijay Ramachandran, Rachana Garg, Sujoy Pal, Shivanand R Gamanagatti, Deep N Srivastava
April-June 2010, 16(2):116-119
DOI:10.4103/1319-3767.61240  PMID:20339183
Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneum. Patient was successfully managed by TAE, followed by tumor resection. TAE is an effective procedure in symptomatic hemangiomas, and should be considered in such high risk patients prior to surgery.
  9,587 952 14
ORIGINAL ARTICLES
Bile duct injuries following laparoscopic cholecystectomy: A clinical study
Waheeb R Al-Kubati
April-June 2010, 16(2):100-104
DOI:10.4103/1319-3767.61236  PMID:20339179
Background/Aim: This study aimed at assessing the outcome of laparoscopic cholecystectomy (LC) by determining the frequency of complications, especially of bile duct injuries. Materials and Methods: The case files of all patients undergoing laparoscopic cholecystectomy between 2002 and 2006 (inclusive) at King Hussein Medical Center (KHMC) were retrospectively analyzed. We evaluated the data according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open. Results: During the four years (January 2002 and December 2006), 336 patients underwent LC for chronic cholecystitis (CC), of whom 22 (6.5%) developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%); 43 other patients (12.8%) had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC. Conclusion: Bile duct injury is a major complication of LC. Anatomical anomalies, local pathology, and poor surgical techniques are the main factors responsible. The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.
  8,095 1,152 10
DEBATE
Liver biopsy for histological assessment - the case against
Faisal M Sanai, Emmet B Keeffe
April-June 2010, 16(2):124-132
DOI:10.4103/1319-3767.61244  PMID:20339187
Percutaneous liver biopsy (LB) remains an important tool in the diagnosis and management of parenchymal liver diseases. In current practice, it is most frequently performed to assess the inflammatory grade and fibrotic stage of commonly encountered liver diseases, with the diagnostic role relegated to secondary importance. The role of LB remains a vastly controversial and debated subject, with an ever-increasing burden of evidence that questions its routine application in all patients with liver dysfunction. It remains, essentially, an invasive procedure with certain unavoidable risks and complications. It also suffers shortcomings in diagnostic accuracy since a large liver sample is required for an ideal assessment, which in clinical practice is not feasible. LB is also open to observer interpretation and prone to sampling errors. In recent years, a number of noninvasive biomarkers have evolved, each with an impressive range of diagnostic certainty approaching that achieved with LB. These noninvasive tests represent a lower-cost option, are easily reproducible, and serve as suitable alternatives to assess hepatic inflammation and fibrosis. This article aims to debate the shortcomings of LB while simultaneously demonstrating the diagnostic accuracy, reliability and usefulness of noninvasive markers of liver disease thereby making the case for their utilization as suitable alternatives to LB in many, although not all, circumstances.
  5,983 1,082 12
REVIEW ARTICLES
Pylorus preserving pancreaticoduodenectomy for peri-ampullary carcinoma, is it a good option?
Faisal Alsaif
April-June 2010, 16(2):75-78
DOI:10.4103/1319-3767.61231  PMID:20339174
Pancreaticoduodenectomy (PD) is the standard surgical treatment for resectable peri-ampullary tumors. It can be performed with or without pylorus preservation. Many surgeons have a negative opinion of pylorus preserving PD (PPPD) and consider it an inferior operation, especially from an oncological point of view. This article reviews the various aspects of PD in the context of operative factors like blood loss and operation time, complications such as delayed gastric emptying and anastomotic leaks, and the impact on quality of life and survival. We aim to show that PPPD is at least as good as classic PD, if not better in some aspects.
  5,910 958 2
ORIGINAL ARTICLES
Serum paraoxonase 1 activity status in patients with liver disorders
Vivekananda Kedage, Manjunatha S Muttigi, Mahesh S Shetty, Renuka Suvarna, Soumya S Rao, Chitralekha Joshi, Mungli Prakash
April-June 2010, 16(2):79-83
DOI:10.4103/1319-3767.61232  PMID:20339175
Background/Aim: Paraoxonase 1 (PON1) is an esterase, exclusively synthesized by liver. The present study has two objectives: to determine the PON1 activity status in various disorders associated with hepatocellular damage and to correlate the changes of PON1 activity with the standard liver function and fasting lipid profile tests in these disorders. Patients and Methods: The study groups consisted of 95 patients with liver diseases including acute viral hepatitis (14), cirrhosis with portal hypertension (33), leptospirosis (14), sepsis and multi organ failure (15), left ventricular failure (9), and falciparum malaria (10); and 53 healthy controls. Serum PON1 activity was measured manually using spectrophotometer. Liver function test parameters and fasting lipid profile were performed in clinical chemistry auto analyzer (Hitachi 912). Results: The serum PON1 activity in patients with acute viral hepatitis and sepsis decreased significantly ( P <0.001) and moderately in falciparum malaria ( P <0.05). However, in patients with cirrhosis, leptospirosis and left ventricular patients, its activity did not change significantly. On applying Pearson correlation, serum PON1 activity correlated positively with high-density lipoprotein-cholesterol (HDL-C) in patients with sepsis (r=0.633, P <0.05), left ventricular failure patients (r=0.814, P <0.05) and negatively with acute viral hepatitis patients (r=- 0.528, P <0.05). Conclusion: PON1 activity has decreased significantly in acute viral hepatitis, sepsis with multi organ failure and falciparum malaria patients. Determination of PON1 activity may serve as a useful additional test in assessing these conditions.
  4,934 838 10
Antioxidant enzyme activities in hepatic tissue from children with chronic cholestatic liver disease
Nagwa A Ismail, Sawsan H Okasha, A Dhawan, Azza O Abdel-Rahman, Olfat G Shaker, Nehal A Sadik
April-June 2010, 16(2):90-94
DOI:10.4103/1319-3767.61234  PMID:20339177
Background/Aim: To study the oxidative stress status in children with cholestatic chronic liver disease by determining activities of glutathione peroxidase (GPx), superoxide dismutase (SOD) and catalase (CAT) in liver tissue. Materials and Methods: A total of 34 children suffering from cholestatic chronic liver disease were studied. They were selected from the Hepatology Clinic, Cairo University, and compared with seven children who happened to have incidental normal liver biopsy. The patients were divided into three groups: extrahepatic biliary atresia (n=13), neonatal hepatitis (n=15) and paucity of intrahepatic bile ducts (n=6); GPx, SOD and CAT levels were measured in fresh liver tissue using ELISA . Results: In the cholestatic patients, a significant increase was found in mean levels of SOD, GPx and CAT in hepatic tissue compared to control children. The three enzymes significantly increased in the extrahepatic biliary atresia group, whereas in the groups of neonatal hepatitis and paucity of intrahepatic bile ducts, only GPx and CAT enzymes were significantly increased. Conclusion: Oxidative stress could play a role in the pathogenesis of cholestatic chronic liver diseases. These preliminary results are encouraging to conduct more extensive clinical studies using adjuvant antioxidant therapy.
  4,898 836 5
Study of respiratory disorders in endoscopically negative and positive gastroesophageal reflux disease
Maha M Maher, Amr A Darwish
April-June 2010, 16(2):84-89
DOI:10.4103/1319-3767.61233  PMID:20339176
Background/Aim : The relation between respiratory disorders and reflux symptoms has been debated since the beginning of the last century and the interest in this question has increased during the last few decades. This study aims to investigate the relation between specified respiratory disorders and reflux symptoms and examine the correlations between respiratory disorders and endoscopic findings in patients with gastroesophageal reflux disease. Patients and Methods: This study included 515 patients evaluated for gastroesophageal reflux disease (GERD) by patient self-report symptom questionnaire; modified four grade Likert scale and endoscopic assessment using endoscopic Los Angeles Classification. All participants were asked about various respiratory symptoms experienced during the past six months and exposed to measuring body mass index (BMI), medical history, pulmonary physical examination, chest X-ray, respiratory function tests and available sleep studies. Results : A total number of 515 patients were categorized according to endoscopic findings into two groups; (group1) subjects with normal endoscopic studies (NERD) 118 (22.9%) patients and (group2) subjects with abnormal endoscopic studies (ERD) 397 (77.1%). The proportion of females was significantly higher in ERD group (80.1%) as compared with NERD group (62.7%) ( P <0.02). Duration of reflux symptoms found to be significantly prolonged in ERD group ( P <0.03). The cases of ERD group were more likely to be overweight (BMI>25) P <0.02. History of pulmonary symptoms preceding GERD symptoms was found in 15% of patients. There were 294 patients (57.1%) with different pulmonary manifestations. These manifestations were significantly higher among female group ( P <0.01) and among obese, above 40 years old ( P <0.001, 0.05 respectively). Among all patients with respiratory manifestations the commonest disorders diagnosed were chronic pharyngitis (50.3%), chronic bronchitis (15.8%), bronchial asthma (12.6%) and recurrent pneumonia (3.3%). Obstructive sleep apnea and recurrent hemoptysis were present in 2.7% and 1.5% of the studied patients respectively. There were three cases of chronic lung abscess. There was a significant difference between ERD and NERD groups in their relations to respiratory disorders ( P<0.001). There were statistically significant differences in FEV1, FVC and FEV1/FVC ( P <0.02, P <0.05 and P <0.05) respectively in ERD group as compared with NERD group. Conclusion : The study confirms the strong link between gastroesophageal reflux symptoms and various respiratory disorders. Endoscopy of the upper digestive tract remains an important exam in the evaluation of GERD. Respiratory symptoms are more prevalent among erosive esophagitis patients with a positive correlation with degree of severity. There is direct relationship between the severity of airways obstruction as detected by FEV1 and FEV1/FVC and GER symptoms.
  3,933 952 12
Autoimmune hepatitis: Single-center experience of clinical presentation, response to treatment and prognosis in Saudi Arabia
Hind I Fallatah, Hisham O Akbar, Yousif A Qari
April-June 2010, 16(2):95-99
DOI:10.4103/1319-3767.61235  PMID:20339178
Background /Aim : Autoimmune hepatitis (AIH) is a common cause of end-stage liver disease worldwide. It is a disease prevalent in children and adults, with female predominance and variable clinical presentations. AIH has favorable responses to steroids and immunomodulators. Diagnosis of AIH is based on clinical and laboratory criteria, as suggested by the International Autoimmune Hepatitis Group. Data on the disease pattern of AIH from the Middle East countries is scarce. Materials and Methods : In this retrospective analysis, we studied clinical and laboratory features, immunological data, radiological findings, liver biopsy findings and response to therapy in patients with AIH from the hepatology clinics of King Abdul Aziz, University Hospital, Jeddah, from 1994 to 2008. Results : We diagnosed 41 patients with AIH, and 33 were included in the analysis. The mean age was 32.3 years, with female predominance of 75.7%. De- compensated cirrhosis at presentation was found in 45.5% of the patients. Acute hepatitis was associated with significantly higher levels of the serum ALT and bilirubin (P=0.001 and P=0.03, respectively). All our patients had type 1 AIH. Treatment with prednisolone and azathioprine resulted in complete or partial remission in majority of the patients (54.8%). However, patients with advanced disease showed a poorer response to treatment (P=0.016). Six patients with poor compliance had relapse of AIH. Two patients had a flare of the disease during pregnancy, and they responded well with prednisolone. The longest follow-up was 14 years and the shortest was 2 months. Four patients died from liver disease. Conclusion : AIH patients in Saudi Arabia are likely to present with advanced disease at a young age and would have a poorer response to therapy as compared with patients in other countries worldwide.
  4,044 756 9
CASE REPORTS
Percutaneous endoscopic colostomy: A new technique for the treatment of recurrent sigmoid volvulus
Ibrahim K Al-Alawi
April-June 2010, 16(2):120-121
DOI:10.4103/1319-3767.61241  PMID:20339184
Sigmoid volvulus is a common cause of large bowel obstruction in western countries and Africa. It accounts for 25% of the patients admitted to the hospital for large bowel obstruction. The acute management of sigmoid volvulus is sigmoidoscopic decompression. However, the recurrence rate can be as high as 60% in some series. Recurrent sigmoid volvulus in elderly patients who are not fit for definitive surgery is difficult to manage. The percutaneous endoscopic placement of two percutaneous endoscopic colostomy tube placement is a simple and relatively safe procedure. The two tubes should be left open to act as vents for the colon from over-distending. In our opinion, this aspect is key to its success as it keeps the sigmoid colon deflated until adhesions form between the colon and the abdominal wall.
  4,157 608 1
ORIGINAL ARTICLES
Gastrointestinal duplications: Experience in seven children and a review of the literature
Abdur-Rahman L Olajide, Abdulkadir A Yisau, Nasir A Abdulraseed, Ibrahim O.O Kashim, Adeniran J Olaniyi, Adesiyun O.A Morohunfade
April-June 2010, 16(2):105-109
DOI:10.4103/1319-3767.61237  PMID:20339180
Background/Aim: Enteric duplication (ED) is a rare congenital anomaly that can occur anywhere along the alimentary tract from the mouth , down to the anus and the nearby organs. This uncommon anomaly may be asymptomatic or presents with vague symptoms mimicking other common pathologies. We aim to present our experience, management challenges and patterns of ED with a review of the literature. Settings and Design: The study was carried out at a Nigerian Tertiary Hospital (2005-2008 inclusive). Materials and Methods: We retrospectively analyzed seven patients with ED managed in our hospital for sex, age, clinical presentations, duplication size and site, presence of ectopic tissue, complications, associated anomalies, radiological workups, and prognosis. Data was analyzed using SPSS 11.0 for window. Results: Seven children between the age range of 44 hours-10 years had ED, one sublingual and six intraabdominal duplications. Midgut volvulus with long segment bowel gangrene complicated two cases. The diagnosis was incidental in all. Three cases were diagnosed following conventional radiological contrast examination and the rest at surgery. Ultrasound was not helpful in making diagnosis in all the six intraabdominal duplications. Though surgery was recommended for all, one of the patients declined. Only one patient had unsuccessful surgery. Conclusions: ED requires high index of clinical suspicion and careful management. Many cases of nonspecific abdominal pains should be properly evaluated before patients suffer avoidable complications.
  3,552 839 6
CASE REPORTS
Peritonitis due to Mycobacterium fortuitum following gastric banding
Fahad M Al Majid
April-June 2010, 16(2):113-115
DOI:10.4103/1319-3767.61239  PMID:20339182
Mycobacterium fortuitum is a rapid growing nontuberculous organism that has rarely been associated with peritonitis in an otherwise healthy host. We describe a patient who developed peritonitis due to the organism after gastric banding operation, which resolved after removal of the gastric band and institution of appropriate antibiotic therapy.
  3,276 430 1
EDITORIAL
Pylorus preserving pancreaticoduodenectomy
Mehrdad Nikfarjam
April-June 2010, 16(2):65-65
DOI:10.4103/1319-3767.61229  PMID:20339172
  2,890 780 2
DEBATE
Liver biopsy for histological assessment: The case in favor
Khalid A Alswat, Khalid Mumtaz, Wasim Jafri
April-June 2010, 16(2):133-139
DOI:10.4103/1319-3767.61245  PMID:20339188
Liver biopsy (LB) is the gold standard method for assessment of liver histology. It provides valuable, otherwise unobtainable information, regarding the degree of fibrosis, parenchymal integrity, degree and pattern of inflammation, bile duct status and deposition of materials and minerals in the liver. This information provides immense help in the diagnosis and prognostication of a variety of liver diseases. With careful selection of patients, and performance of the procedure appropriately, the complications become exceptionally rare in current clinical practice. Furthermore, the limitations of sampling error and inter-/intra-observer variability may be avoided by obtaining adequate tissue specimen and having it reviewed by an experienced liver pathologist. Current noninvasive tools are unqualified to replace LB in clinical practice in the face of specific limitations for each tool, compounded by a poorer performance towards the assessment of the degree of liver fibrosis, particularly for intermediate stages.
  2,603 568 2
IMAGE QUIZ
Clinical significance of numerous irregular polypoidal lesions in the duodenum
Ahmed Helmy, Lina Asaad, Ingvar Kagevi, Hamad I Al-Ashgar
April-June 2010, 16(2):140-141
DOI:10.4103/1319-3767.61246  PMID:20339189
  2,101 834 -
LETTERS TO THE EDITOR
Acute appendicitis: Is removal of a normal appendix still existing and can we reduce its rate?
Jyotindu Debnath
April-June 2010, 16(2):122-122
DOI:10.4103/1319-3767.61242  PMID:20339186
  2,271 532 -
Problem of a rare anomalous hepatic artery during whipple procedure
Aswini K Pujahari
April-June 2010, 16(2):122-123
DOI:10.4103/1319-3767.61243  PMID:20339185
  1,816 359 2
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