Middle East Journal of Digestive Diseases最新文献

Gastric necrosis is a very rare surgical emergency in a previously healthy child. A 13-year-old boy with abdominal pain and coffee-ground vomiting was admitted to the emergency department. Physical examination revealed signs of peritonitis and septic shock. The patient underwent a laparotomy. Gastric necrosis and discoloration of the lower esophagus and duodenum due to ischemia were present. Distention of gastric and duodenum was also seen. Total gastrectomy and Roux-en-Y esophagojejunostomy were done. The patient underwent a chest computed tomography (CT), and patchy ground-glass opacity was observed in both lungs. Consolidation was seen in the lower lobe of the lung. The polymerase chain reaction (PCR) for coronavirus was tested two times. The first time was negative, and the second time was positive. The patient was discharged in good condition. During the follow-up period, severe anastomotic strictures occurred. In our case, gastric necrosis and positive coronavirus were reported.

Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow tract obstruction and is commonly associated with an underlying hypercoagulable state. Systemic amyloidosis is a disorder characterized by systemic deposition of misfolded proteins leading to end organ damage. Amyloidosis is commonly associated with coagulation abnormalities, mainly leading to increased bleeding diathesis. Here, we report a case of amyloid light chain (AL) amyloidosis presenting as BCS. A 40-year-old man presented with abdominal distension along with anorexia and weight loss. On evaluation, he had severe hypoalbuminemia, raised alkaline phosphatase, and non-visualization of hepatic veins on abdominal imaging. Further evaluation confirmed the diagnosis of AL amyloidosis with renal, cardiac, and hepatic involvement. AL amyloidosis rarely can present with BCS. A high index of suspicion is needed as symptoms can be variable and non-specific.

Background: Diarrhea-dominant irritable bowel syndrome (IBS-D) is a deliberating and chronic condition that can impair social activities. Determining proper medication with satisfactory outcomes has been a challenge. The 5-hydroxytryptamine 3 receptor antagonist (5-HT3 RA) drugs have demonstrated favorable outcomes on IBS-D in the last 3 decades. Ondansetron, also a 5-HT₃ RA is known as an antiemetic. Our aim was to evaluate the efficacy of ondansetron in IBS-D.

Methods: In this single-center, double-blind, randomized controlled trial, patients with IBS-D were recruited. Patients were randomized on a 1:1 ratio and assigned into two groups: imipramine 25 mg/daily plus ondansetron 4 mg/3 times per day and imipramine 25 mg/daily plus placebo. The primary endpoint was the frequency of diarrhea per day after 8 weeks of treatment. The secondary endpoints consisted of changes in the frequency of defecation urgency per day, the number of days with gastrointestinal pain and bloating, and the patients' overall satisfaction regarding bowel habits after 8 weeks of the treatment.

Results: Data from 98 patients were analyzed. Ondansetron, compared to placebo, improved the primary outcome, and the stool consistency was increased significantly (3.29±1.19 vs 4.55±1.17, P<0.001). Moreover, the response rate for the diarrhea frequency was significantly higher in the ondansetron group compared to the placebo (77.5% vs 34.7%, P<0.001). In the ondansetron group, fewer urgencies were experienced, and pain severity and feeling of bloating declined as well (P<0.01).

Conclusion: Ondansetron can mitigate almost all IBS-D-related symptoms, which may indicate it as a drug of choice; however, further evidence is required to ascertain its safety.

Gastric bezoar is a very rare clinical condition and hard to treat. Phytobezoars are one of the most common types of bezoars, which happens with the consumption of indigestible fibers. In this report, we presented an elderly man with gastric phytobezoar who presented with peptic ulcer and was treated successfully with proton pump inhibitor (PPI) and Coca-Cola. Surveillance endoscopy showed a completely healed ulcer. It was shown that cautious use of Coca-Cola can be helpful and safe in treating concomitant phytobezoar and gastric ulcers. To the best of our knowledge, this is the first report of phytobezoar from Iran, which was treated with cola.

Background: The present study attempted to evaluate the effect of oral gabapentin and acetaminophen for postoperative analgesia in anorectal surgery.

Methods: This double-blind clinical trial was carried out on 144 patients who were candidates for anorectal surgery. The patients were randomly assigned into three groups of control, acetaminophen 500 mg, and gabapentin 300 mg for two hours before the surgery. Data on pain severity based on the visual analog scale (VAS) were evaluated and analyzed.

Results: The results of the current study indicated that in patients taking acetaminophen and gabapentin tablets before surgery, the amount of postoperative pain decreased, and the amount of decrease in postoperative pain in the patients who received acetaminophen and gabapentin tablets compared with the placebo group was significant (P<0.001). Also, an evaluation was done using a proposed fuzzy logic model.

Conclusion: Taking acetaminophen and gabapentin tablets one hour before the operation causes a significant reduction in postoperative pain in patients who are candidates for anorectal surgery. The results are promising and encourage one to pay attention to more studies with the goal of possibly using them as a decision-support model in the future.

Anal fistula has been a challenging clinical issue for years due to its complex pathogenesis. The risk of frequent recurrence and incontinence complicates long-term treatment. Recent scientific literature has reviewed new techniques used for anal fistula treatment in recent years, assessing the advantages and disadvantages of each based on clinical outcomes. Although surgery is the main method used to treat anal fistula, there is no simple technique that can completely heal complex anal fistula. The surgical treatment should consider the healing outcome and the protection of anal function comprehensively. Several innovative techniques have emerged in recent years, such as combined techniques based on drainage seton and LIFT-plug, which appear to be relatively effective therapies. However, more multi-center prospective trials with long-term follow-up are needed to validate their effectiveness. In some situations, medical treatment may also be considered.

Volvulus affecting the gastrointestinal (GI) tract is one of the common causes of recurrent pain in the abdomen, and often, patients present with non-specific abdominal pain associated with nausea and/or vomiting. A high degree of suspicion is required at the clinician's end to suspect this diagnosis, which is usually confirmed by imaging using radiographs, fluoroscopic evaluation, and computed tomography. Familiarity of the clinician and radiologist with the imaging appearances of these emergent conditions on various imaging modalities is quintessential to avoiding life-threatening complications like bowel ischemia or perforation, which are associated with delayed or missed diagnosis. Our article describes the clinical features and classical imaging of the various types of volvulus affecting different bowel segments in the entire GI tract.

Pancreatic tuberculosis (TB) is extremely rare and has similar clinical and radiological findings compared to pancreatic malignancy. Challenges in detecting individuals with pancreatic TB, especially in rural areas with limited supporting resources, are the reasons for a more complete care strategy. We report a case of pancreatic TB in a 25-year-old woman admitted to the emergency department (ED), who was initially suspected of having a pancreatic tumor. Her chief complaints were fever, fatigue, and abdominal pain, while she also experienced weight loss. Exploratory laparotomy and further pathological evaluation suggested pancreatic TB. Subsequently, the patient was given anti-TB drugs and showed clinical improvement. In conclusion, this case report highlighted that pancreatic TB could mimic pancreatic cancer; however, it is a treatable condition. Thus, it is important for physicians to consider this as a differential diagnosis, especially in high-risk populations and in rural areas with limited diagnostic tools.

Background: Sofosbuvir (SOF) is a revolutionary treatment for patients with hepatitis C virus (HCV). However, its efficacy and safety among patients with end-stage renal disease (ESRD) remains controversial. In this study, we examined the levels of SOF metabolite (GS-331007) (SOF-007) in human plasma of patients infected with HCV having ESRD using an optimized liquid chromatography-mass spectrometry (LC-MS) analytical method.

Methods: In this case-control study, 10 clinically confirmed cases and five controls were enrolled. SOF-007 was extracted from plasma using methanol precipitation. The limit of detection (LOD) for the drug and its metabolite were 0.85 and 2.3, respectively. Such a wide range of quantification in a period of separation time shorter than 3.0 minutes (run time) allowed monitoring of the plasma concentration of analytes up to 4 hours (pre-dialysis and post-dialysis) for 12 weeks in non-cirrhotic patients with HCV infection undergoing dialysis.

Results: SOF-007 in the plasma of HCV patients with healthy kidneys showed no cumulative effect. An analysis comparing patients with ESRD and healthy participants showed that their behaviour was similar, followed by dialysis with a relatively small cumulative effect.

Conclusion: The plasma concentrations of SOF-007 decreased significantly after the 4-hour period of dialysis compared with the plasma concentrations hemodialysis of pre-dialysis in HCV patients with ESRD.