Saudi Journal of Gastroenterology
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   2012| November-December  | Volume 18 | Issue 6  
    Online since November 10, 2012

 
 
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REVIEW ARTICLE
Epidemiology of viral hepatitis in Saudi Arabia: Are we off the hook?
Ayman A Abdo, Faisal M Sanai, Faleh Z Al-Faleh
November-December 2012, 18(6):349-357
DOI:10.4103/1319-3767.103425  PMID:23150019
Some 400 million people worldwide are currently infected with the hepatitis B virus (HBV), and the infection is common in the Middle East. Another 170 million people around the globe presently live with chronic hepatitis C virus (HCV) infection. Both HBV and HCV represent a worldwide epidemic. Despite significant decline in the prevalence of HBV and HCV infection in Saudi Arabia, these viral diseases cause significant morbidity and mortality, and impose a great burden on the country's healthcare system. On the other hand, Saudi epidemiology studies have shown that the hepatitis A virus seroprevalence in the country has reduced considerably over the past two decades. The progress in mapping the epidemiological pattern of viral hepatitis in Saudi Arabia has not only aided our understanding of the disease, but has also exposed the small but relevant gaps in our identification of the intricate details concerning the disease's clinical expression. In this review, we aim to document the timeline of viral hepatitis epidemiology in Saudi Arabia, while summarizing the relevant published literature on the subject.
  8,503 975 10
IMAGE QUIZ
A mysterious cause of stool ova
Stelios F Assimakopoulos, Konstantinos Thomopoulos, Markos Marangos
November-December 2012, 18(6):392-393
DOI:10.4103/1319-3767.103433  PMID:23150027
  8,098 335 1
CASE REPORTS
Intra-arterial CT angiography visualization of arterial supply to inferior vena cava tumor thrombus prior to radioembolization of hepatocellular carcinoma
Glen Roche, Terence K. B. Teo, Andrew E. H. Tan, Farah G Irani
November-December 2012, 18(6):384-387
DOI:10.4103/1319-3767.103431  PMID:23150025
Unresectable hepatocellular carcinoma has a high frequency of vascular invasion and arterial parasitization. Trans-arterial radioembolization using yttrium-90 (Y90) microspheres is a possible treatment option. Paramount to its success is the meticulous angiographic interrogation of tumor feeding arteries and extra-hepatic supply. We describe a patient with tumor invasion of the inferior vena cava with arterial supply from the right inferior phrenic artery, which was exquisitely visualized using intra-arterial computed tomographic angiography (IACTA) during the planning technetium-99m macro aggregated albumin phase. This technique was useful in planning which artery to administer Y90 microspheres into for maximal brachytherapy. Although patient outcome was poor due to significant arterio-portal shunting, we believe that IACTA is a useful adjunct to conventional digital subtraction angiography in planning radioembolization therapy.
  3,933 355 -
An incidentally discovered asymptomatic para-aortic paraganglioma with Peutz-Jeghers syndrome
Nazish Butt, Mohammad Salih, Mohammad Rizwan Khan, Rashida Ahmed, Zishan Haider, Syed Hasnain Ali Shah
November-December 2012, 18(6):388-391
DOI:10.4103/1319-3767.103432  PMID:23150026
Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal (GI) tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extraGI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers.We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was noted. An abdominal computed tomography scan (CT) revealed multiple polyps in small bowel loops. Gastroscopy revealed multiple dimunitive polyps in stomach and pedunculated polyp in duodenum. Colonoscopy revealed multiple colonic polyps. Pathological examination of the polyps confirmed hamartomas with smooth muscle arborization, compatible with Peutz-Jeghers polyps. CT scan guided left para-aortic lymph node biopsy revealed the characteristic features of extra-adrenal para-aortic paraganglioma. Although cases of various GI and extra GI malignancies in PJS patients has been reported, the present case appears to be the first in literature in which the PJS syndrome was associated with asymptomatic extraadrenal para-aortic paraganglioma. Patients with PJS should be treated by endoscopic or surgical resection and need whole-body screening.
  3,749 310 -
ORIGINAL ARTICLES
Correlation of serology with morphological changes in gastric biopsy in Helicobacter pylori infection and evaluation of immunohistochemistry for H. pylori identification
Shailaja Shukla, Mukta Pujani, Aditya Agarwal, Meenu Pujani, Anurag Rohtagi
November-December 2012, 18(6):369-374
DOI:10.4103/1319-3767.103428  PMID:23150022
Background/Aim: Helicobacter pylori is implicated in various gastroduodenal diseases and many tests are available for its detection. The present study attempted to document the morphological changes in the gastric mucosa induced by H. pylori colonization and correlate them with the severity of the infection. The study also compared various diagnostic tests and evaluated the different staining methods used for H. pylori detection, especially immunohistochemical identification. Patients and Methods: One hundred and two patients with dyspepsia were included. Enzyme-linked immunosorbent assay (ELISA) for H. pylori-specific immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) was used. Rapid urease test was performed on endoscopic biopsy and it was stained with hematoxylin and eosin (H and E), modified Giemsa, and immunohistochemical stains. Results: A significant correlation was found between the density of H. pylori and severity of gastritis. A significant correlation was observed between serology (especially when used in combination, IgG and IgA) and status of H. pylori. Immunohistochemical staining enhanced the diagnostic yield of H. pylori detection. Conclusions: Immunohistochemistry (IHC) should be used judiciously, whereas simple and economical tests like modified Giemsa should be used routinely for the detection of H. pylori. Combined ELISA (IgG and IgA) should be preferred over single ELISA. Simultaneous morphological and serological detection of H. pylori is preferable as H. pylori may not be detected on morphology alone due to its patchy distribution in the stomach.
  3,436 481 1
EDITORIAL
Endoscopic ultrasound guided fine needle aspiration: Results are reproducible
Majid A Almadi, Alan N Barkun
November-December 2012, 18(6):347-348
DOI:10.4103/1319-3767.103424  PMID:23150018
  1,575 1,586 2
ORIGINAL ARTICLES
Efficacy of endoscopic ultrasound guided fine needle aspiration in patients with solid pancreatic neoplasms
Mahmud Baghbanian, Bijan Shabazkhani, Hadi Ghofrani, Hosein Forutan, Naser Dariani, Mohamadjafar Farahvash, Najmeh Aletaha
November-December 2012, 18(6):358-363
DOI:10.4103/1319-3767.103426  PMID:23150020
Background/Aim: Endosonography is a distinct method for evaluating the structural lesions of the gastrointestinal (GI) tract, particularly the pancreatobilliary region. This procedure has made a fundamental change in the diagnosis of pancreatic mass lesion through providing fine needle aspiration. This study aims at evaluating the results and efficacy of endoscopic ultrasound fine needle aspiration (EUS-FNA) in patients with pancreatic solid mass. Patients and Methods: The present study is an observational, prospective case series nature, evaluated patients with pancreatic solid mass referred to Imam Khomeini educational hospital in Tehran for a duration of one year since November 2010. In order to determine the false negative cases, the patients were followed-up from 6 to 12 months. Results: EUS-FNA was conducted on all 53 patients without any complication. The majority of patients included in the study were males (68%) and 81% of patients had a mass in the head of pancreas. The result of cytopathology revealed 36 adenocarcinomas (68%), 7 other malignancies (13%), benign lesions (6%) and 7 non-diagnostic cases (13%). The frequency of non-diagnostic results was significantly high in masses smaller than 3 cm (6 vs. 1, P < 0.002). Patients with non-diagnostic result were younger than those with malignant cytopathology (52 ± 7.5 vs. 66 ± 7.5 years, P < 0.001).. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of this procedure concerning Adenocarcinoma were 88%, 100%, 100%, 70% and 90%, respectively. Conclusion: EUS - FNA is an effective and safe procedure in histopathologic diagnosis of pancreatic tumors. This procedure is useful in all pancreatic mass cases including resectable and non-resectable ones.
  2,343 487 4
Persistent oxidative stress in patients with chronic active hepatitis-C infection after antiviral therapy failure
Ghada El-Kannishy, Mona Arafa, Ibrahim Abdelaal, Mohamed Elarman, Rasha El-Mahdy
November-December 2012, 18(6):375-379
DOI:10.4103/1319-3767.103429  PMID:23150023
Background/Aims: Oxidative stress and hepatocellular pathological changes are common associations with chronic hepatitis C virus (CHC) disease. The aim of this study was to assess serum antioxidant-oxidant (Redox) balance in patients with CHC infection before and after intake of the traditional antiviral therapy (pegylated interferon α-2b and oral ribavirin). Patients and Methods : Blood samples from 50 biopsy-proven CHC patients, with no prior anti-viral treatment and persistently elevated serum transaminase levels for 6 months, as well as 15 age- and sex-matched healthy subjects were used for determination of the antioxidants: reduced glutathione (GSH), superoxide dismutase (SOD), α tocopherol and ascorbic acid as well as lipid peroxidation (LPO) index (malondialdehyde [MDA]). The measurements were repeated in the diseased group 25 weeks after pegylated interferon α-2b and ribavirin combination therapy. Results : Serum levels of bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly higher in CHC patients than in the control group (P < 0.05). Pretreatment serum MDA values were significantly higher in patients with CHC infection than the control group (P < 0.001), while serum antioxidant levels were significantly lower (P < 0.001). Responders (10 patients) had lower pretreatment serum levels of MDA than non-responders (35 patients) (P < 0.001). Both groups were comparable for the antioxidant serum levels. There was significant negative correlation between serum MDA and serum SOD, GSH, α tocopherol, and ascorbic acid concentrations in CHC patients. On the other hand, there was no correlation between the studied parameters and serum bilirubin, albumin, ALT, and AST. Conclusions : Redox imbalance was detected in patients with CHC. Responders had significantly lower levels of MDA than non-responders. Serum MDA may be used as a pretreatment predictor of response to antiviral treatment in patients with CHC.
  2,095 299 2
Role of proteases and antiprotease in the etiology of chronic pancreatitis
Srimanjari Kavutharapu, Balakrishna Nagalla, Vidyasagar Abbagani, Shravan K Porika, Jyothy Akka, Pratibha Nallari, Venkateshwari Ananthapur
November-December 2012, 18(6):364-368
DOI:10.4103/1319-3767.103427  PMID:23150021
Background/Aim: Chronic pancreatitis (CP) is the progressive and irreversible destruction of the pancreas characterized by the permanent loss of endocrine and exocrine function. Trypsin, the most important digestive enzyme plays a central role in the regulation of all other digestive enzymes. Chymotrypsin, an endopeptidase hydrolyzes peptides at amino acids with aromatic side chains. Alpha-1-antitrypsin is a principal antiprotease which protects the mucosal tissue from the proteolytic effects of trypsin and chymotrypsin by the formation of molar complexes. The present study is aimed at examining the role of proteases (trypsin and chymotrypsin) and anti-protease (α1-anti-trypsin) in the etiopathogenesis of chronic pancreatitis. Patients and Methods: A total of 90 CP patients and 110 age and sex matched controls were considered for the study. Serum trypsin, chymotrypsin and α1-anti-trypsin levels were determined prospectively in CP patients and compared to healthy controls as described previously. Results: The mean activity of trypsin were found to be increased in CP patients (X ± SD = 0.82 ± 0.838) in comparison to normal control group (X ± SD = 0.55 ± 0.328), (P = 0.001). Chymotrypsin activity were also found to be elevated in CP patients (X ± SD = 0.63 ± 0.278) in comparison to control group (X ± SD = 0.39 ± 0.295), (P = 0.0001). The mean α-1-anti-trypsin activity were found to be lowered in CP patients (X ± SD = 0.42 ± 0.494) in comparison to control group (X ± SD = 0.67 ± 0.465), with the variation being significant (P = 0.0003). Conclusion: The findings suggest an imbalance in the synthesis and degradation of proteolytic enzymes and antiprotease indicating an altered aggressive and defensive role in the pathogenesis of chronic pancreatitis.
  2,043 331 1
Portal hypertension: Effect of early splenic artery ligation on platelets count during splenectomy
Mahendra S Bhavsar, Hasmukh B Vora, Lakshman S Khiria, Venugopal H Giriyappa
November-December 2012, 18(6):380-383
DOI:10.4103/1319-3767.103430  PMID:23150024
Background/Aim: Hypersplenism due to splenic congestion is observed in portal hypertensive patients. This study was done to know the change in platelets count following early ligation of splenic artery during splenectomy in patients with thrombocytopenia due to portal hypertension with a hypothesis that splenic decongestion results in increased platelets count; thereby platelet transfusion can be avoided. Materials and Methods: Patients with platelets count <100,000 per mm 3 due to portal hypertension were involved and we followed a protocol of ligating splenic artery first, followed by 30 minutes waiting period for splenic decongestion. Blood sample was collected at 5 and 30 minutes for the estimation of platelets count. Results: Significant rise in platelets was observed after 5 and 30 minutes of early ligation of splenic artery with mean rise being 23735 ± 15417 and 35085 ± 20458 per mm 3 , respectively. The rise in platelets at 30 minutes was significant when compared with 5 minutes rise with mean platelets count being 91661 and 103070 per mm 3 at 5 and 30 minutes, respectively. The platelets rise was equal to 4 and 6 units of platelets concentrates, respectively. Conclusion: Early ligation of splenic artery during splenectomy for portal hypertension results in significant rise in platelets after 5 and 30 minutes. This method conserves platelets and avoids platelets transfusion and its complications.
  1,834 280 1
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