Middle East Journal of Digestive Diseases最新文献

Background: Abnormal levels of liver enzymes have been reported in patients with COVID-19 and severe clinical presentation. However, limited studies exist in our region regarding the impact of COVID-19 on the liver's function. Thus, we aimed to investigate liver enzyme changes and their association with prognosis and outcome in hospitalized patients with COVID-19 in Jordan.

Methods: This retrospective cohort study included 359 patients with COVID-19 who were admitted to Ministry of Health hospitals all around Jordan during the second pandemic wave of COVID-19. Data such as liver enzymes, patients demographics, and outcomes were collected and statistically analysed.

Results: Approximately 39.6% of infected patients had elevated liver enzymes, and 5.9% had elevated enzymes more than twice the upper limit of normal (ULN). Among these patients, 40.8% had both aspartate aminotransferases (AST) and alanine aminotransferases (ALT) elevation, 52.1% had AST elevation alone, and 7.0% had ALT elevation alone. Factors associated with worse prognosis and outcome were older age, male sex, and comorbid autoimmune conditions. The peak and at-discharge values of AST and ALT showed significant differences.

Conclusion: Liver enzyme abnormality is common among patients with COVID-19 and AST is the most common abnormality. AST and ALT elevation can be associated with longer hospital stays, older age, and male sex.

Background: Irritable bowel syndrome (IBS) is a chronic condition characterized by recurring abdominal discomfort and irregular bowel movements. Currently, IBS diagnosis lacks specific radiological, biochemical, or endoscopic markers. Chromogranin A (CgA), a gastrointestinal protein, shows variation between patients with IBS and healthy controls. This study aimed to evaluate differences in CgA concentrations between these groups.

Methods: This review was conducted in 2023 using the PRISMA 2020 guidelines. All observational research was retrieved from MEDLINE, EBSCO-Host, ScienceDirect, and ProQuest electronic databases using a predefined search strategy. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and meta-analysis was conducted using Review Manager (RevMan) 5.4.

Results: Nine out of 14 studies eligible for meta-analysis revealed significantly higher CgA cell density (P=0.0001) in all patients with IBS compared with controls. This difference persisted across colon regions (left: P=0.04, right: P=0.0009) and duodenum (P<0.00001). Subgroup analysis found no significant disparity in CgA cell density between diarrhea and constipation-predominant IBS within the duodenum or colon.

Conclusion: CgA cell density showed trends toward IBS compared with control groups, with significant concentration differences found in the duodenum, left, and right colon. Therefore, current findings might offer a histopathological approach to confirm the IBS diagnosis.

Background: Recurrent perirectal abscesses in children under 2 years pose management challenges due to high relapse risks, with limited evidence comparing long-term outcomes of antibiotic therapy versus surgical drainage. This study aimed to compare antibiotic treatment approaches and surgical interventions in managing this condition.

Methods: This retrospective cohort study analyzed 336 medical records of children under two years old with perianal abscesses treated at Hazrat Masoumeh Children's Hospital from 2012-2019. Patients were divided into three groups: antibiotic treatment only, spontaneous drainage, and incision and drainage. Data, including demographics, abscess characteristics, and treatment outcomes (recurrence, fistula formation), were analyzed using SPSS software version 26.

Results: A retrospective cohort study of 336 children with perianal abscesses found no significant differences in age, weight, sex, or nutritional status among the three treatment groups (P>0.05). However, statistically significant differences were observed in abscess location (distance from the anus) and size, with the incision and drainage group having larger and more distally located abscesses (P<0.05). Colic was less prevalent in the antibiotic-only group. The spontaneous drainage group had a significantly higher recurrence rate (37%). Antibiotic type distribution was similar across groups. The antibiotic-only group showed symptom resolution within 3-10 days, averaging 6 days.

Conclusion: In general, according to the lowest rate of recurrence in the group receiving antibiotics and the average duration of short treatment of 6 days, the antibiotic approach is the preferred and primary method for the treatment and prevention of abscess recurrence.

Colorectal cancer (CRC) is a common malignancy with high mortality. Despite advancements in understanding its molecular causes and improved drug therapies, patient survival rates remain low. The main reasons for the high mortality rate are cancer metastasis and the emergence of drug-resistant cancer cell populations. While genetic changes are recognized as the main driver of CRC occurrence and progression, recent studies suggest that epigenetic regulation is a crucial marker in cancer, influencing the interplay between genetics and the environment. Research has shown the significant regulatory roles of non-coding RNAs (ncRNAs) in CRC development. This review explores epigenetically regulated ncRNAs and their functions, aiming to understand key regulatory mechanisms that impact CRC development. Additionally, it discusses the potential use of these ncRNAs in CRC diagnosis, prognosis, and targeted treatments.

Background: COVID-19-associated gastrointestinal (GI) symptoms are often self-limiting; however, gastrointestinal bleeding (GIB) is a critical complication in patients with COVID-19. The present study investigates the etiology, risk factors, esophagogastroduodenoscopy (EGD) findings, and outcomes associated with upper gastrointestinal bleeding (UGIB) in hospital inpatients with COVID-19.

Methods: In this retrospective case-control study, 127 patients with COVID-19 in Kerman, Iran, were diagnosed using reverse transcription polymerase chain reaction (RT-PCR) and subsequently divided into case and control groups from January 2022 to July 2022.

Results: This study evaluated 64 patients with COVID-19 with UGIB and 63 patients without. The case group reported previous history of GIB and cirrhosis at 17.2% and 12.5%, respectively (P=0.001 and P=0.01). Melena (37.5%) and peptic ulcer (21.87%) were the most common UGIB symptom and EGD findings, respectively. In the comparison of the case group with the control group, the duration of the patient's stay in the intensive care unit (ICU) (11.58±1.13 vs. 8.29±1.06 days), the need for invasive mechanical ventilation (IMV) (17.2% vs. 8.1%), and the mortality rate (26.6% vs. 18.9%) were recorded (P=0.03, 0.124, and 0.07, respectively).

Conclusion: Patients with COVID-19 and UGIB have a more prevalent ICU stay compared with those without. Melena and peptic ulcer were the most common presentations and EGD findings in these patients. Additionally, liver cirrhosis and a history of previous GIB increased the risk of GIB in patients with COVID-19.

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third leading cause of cancer-related death, with a 5-year survival rate of 10%-12%. It usually develops in the setting of chronic liver disease (CLD), with chronic viral hepatitis, alcohol, and non-alcoholic fatty liver disease (NAFLD) being the most common risk factors. Some patients are at higher risk of developing hepatocellular cancer, so it is important to screen them regularly to diagnose the disease at an early stage and improve their chances for curative treatment. Six-monthly ultrasound with or without alpha-fetoprotein (AFP) is the currently recommended surveillance method. AFP has been used as a biomarker for liver cancer; however, it has low sensitivity and specificity, which necessitates the search for other, more accurate biomarkers. Promising biomarkers include lens culinaris agglutinin-reactive AFP, des-gamma-carboxy prothrombin, methylated DNA markers, plasma microRNA expression, circulating tumor DNA, and circulating tumor cells. In addition, combinations of biomarkers, like the GALAD score and the Doylestown algorithm, may help in the early detection of HCC. In this review, we summarize the screening tests for early detection of HCC that have been studied over the last decade.

Background: This systematic review, grounded in coping theory, examines the relationship between coping strategies and quality of life (QoL) in patients with inflammatory bowel disease. It synthesizes current findings and guides future research to address existing knowledge gaps.

Methods: A comprehensive search of Scopus, PubMed, Google Scholar, and Web of Science (from April 2000 to April 2024) identified 17 peer-reviewed studies.

Results: Coping strategies directly and indirectly influence the QoL of patients with inflammatory bowel disease (IBD). Adaptive strategies, such as problem-solving and seeking social support, consistently improve QoL even in patients with active disease by promoting better disease management and emotional well-being. Maladaptive strategies, such as avoidance and emotional detachment, lead to decreased QoL and increased psychological distress. In addition, self-efficacy and psychological resilience play a key role in mediating the relationship between coping and QoL. However, coping strategies differ by disease stage and between demographic groups.

Conclusion: This study identifies significant gaps in research, such as limited multi-center and longitudinal studies, cross-cultural inconsistencies, and insufficient focus on specific populations. These gaps restrict understanding of the long-term effects of coping strategies. Future research should combine quantitative and qualitative methods to better capture patients' experiences, aiding the development of personalized interventions.

Background: White light imaging (WLI) is the current standard colonoscopy technique for diagnosing colorectal polyps in Indonesia. Various endoscopic imaging techniques have been developed to improve the accuracy of diagnosing colorectal polyps, one of which is narrow band imaging (NBI). We conducted a diagnostic study comparing the performance of NBI against WLI in distinguishing neoplastic from non-neoplastic colorectal polyps.

Methods: This was a diagnostic study that analyzes endoscopic pictures of colorectal polyps in patients who underwent colonoscopy using the WLI and NBI techniques. Previously collected biopsy tissue specimens were re-examined by a single pathologist.

Results: There were 117 subjects analyzed, and the proportion of subjects with neoplastic polyps was 65.8%. Common indications for colonoscopy were hematochezia (24.8%) and abdominal pain (23.9%). WLI showed moderate inter-observer reliability (kappa value=0.591), while NBI showed significant reliability (kappa value=0.674). NBI demonstrated better sensitivity (84.4%; 95% CI 74.4%-91.7%) and accuracy (78.6%; 95% CI 70.1%-85.7%) compared with WLI (sensitivity 74%; 95% CI 62.8%-83.4% and accuracy 71.8%; 95% CI 62.7%-79.7%). However, the specificity was the same (67.5%; 95% CI 50.9%-81.4%).

Conclusion: NBI has better performance than WLI in distinguishing neoplastic and non-neoplastic colorectal polyps.

Multiple magnet ingestion is an urgent situation in pediatric gastroenterology that requires endoscopy or surgical intervention to remove the magnet. We report a case in which multiple magnets attract each other in a special geometric shape in the gastrointestinal tract of a 2-year-old boy.