A. M. Atiaallah, Mutaz Ogeal Osman, Yasir Gaffer Abdalhreem, Eman Abdlarhheem, Abdalagadir Ahmed Abdalagadir, Mawada Farah Ismail
Background: Pneumatosis intestinalis also called Pneumatosis cystoides intestinalis (PCI) is a rare disease and difficult to diagnosis that confuses many doctors. A vast number of factors are suspected to contribute to its pathogenesis, such as Crohn’s disease, intestinal stenosis, ulcerative colitis, drug use, extra-gastrointestinal diseases, and chronic obstructive pulmonary disease. Case Report: A 41-year-old man presented to port Sudan teaching hospital on 20 July 2021 with symptoms of abdominal pain, abdominal distension. A physical examination revealed tenderness all over the abdomen. Then patient was admitted to the hospital, and resuscitation was done. Laboratory investigations revealed no abnormalities. Radiological investigation: abdominal ultrasonography and plain abdomen x-ray showed signs of intestinal obstruction. Finally, patient was undergone exploratory laparotomy on next day. Final diagnosis reached after result of histopatlogy was presented as: Pneumatosis cystoides intestinalis. Conclusions: Pneumatosis intestinalis difficult to diagnosis, so an efficient recognition of the clinical scenario, encompassing the current clinical context, comorbid conditions, physical examination findings, laboratory data, and radiographic details, assists the clinician in reaching the correct diagnosis and offering appropriate treatment.
{"title":"Pneumatosis Cystoides Intestinalis – An Incidental Post-Operative Rare Case Report in Port Sudan Teaching Hospital, Sudan","authors":"A. M. Atiaallah, Mutaz Ogeal Osman, Yasir Gaffer Abdalhreem, Eman Abdlarhheem, Abdalagadir Ahmed Abdalagadir, Mawada Farah Ismail","doi":"10.33425/2639-9334.1059","DOIUrl":"https://doi.org/10.33425/2639-9334.1059","url":null,"abstract":"Background: Pneumatosis intestinalis also called Pneumatosis cystoides intestinalis (PCI) is a rare disease and difficult to diagnosis that confuses many doctors. A vast number of factors are suspected to contribute to its pathogenesis, such as Crohn’s disease, intestinal stenosis, ulcerative colitis, drug use, extra-gastrointestinal diseases, and chronic obstructive pulmonary disease. Case Report: A 41-year-old man presented to port Sudan teaching hospital on 20 July 2021 with symptoms of abdominal pain, abdominal distension. A physical examination revealed tenderness all over the abdomen. Then patient was admitted to the hospital, and resuscitation was done. Laboratory investigations revealed no abnormalities. Radiological investigation: abdominal ultrasonography and plain abdomen x-ray showed signs of intestinal obstruction. Finally, patient was undergone exploratory laparotomy on next day. Final diagnosis reached after result of histopatlogy was presented as: Pneumatosis cystoides intestinalis. Conclusions: Pneumatosis intestinalis difficult to diagnosis, so an efficient recognition of the clinical scenario, encompassing the current clinical context, comorbid conditions, physical examination findings, laboratory data, and radiographic details, assists the clinician in reaching the correct diagnosis and offering appropriate treatment.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126161205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
João Kleber de Almeida Gentile, Emanuela Alves Delmondes, J. Pereira, Isabela Bercovici Soares Pereira, Renata de Oliveira Belo Custódio dos Santos
Acute necrotizing esophagitis (black esophagus) is a rare clinical entity that is characterized by partial or total loss of the epithelium, ulceration up to the circumferential slough of all layers of the mucosa and submucosal, frequent involvement of deep muscle layers, and frequent perforations. Its blackish appearance in endoscopic examinations has given it the name of black esophagus. We describe a rare case of black esophagus caused by hepatic cirrhosis associated with gastric ulcer.
{"title":"Black Esophagus (Acute Esophageal Necrosis) Caused by Liver Cirrhosis","authors":"João Kleber de Almeida Gentile, Emanuela Alves Delmondes, J. Pereira, Isabela Bercovici Soares Pereira, Renata de Oliveira Belo Custódio dos Santos","doi":"10.33425/2639-9334.1057","DOIUrl":"https://doi.org/10.33425/2639-9334.1057","url":null,"abstract":"Acute necrotizing esophagitis (black esophagus) is a rare clinical entity that is characterized by partial or total loss of the epithelium, ulceration up to the circumferential slough of all layers of the mucosa and submucosal, frequent involvement of deep muscle layers, and frequent perforations. Its blackish appearance in endoscopic examinations has given it the name of black esophagus. We describe a rare case of black esophagus caused by hepatic cirrhosis associated with gastric ulcer.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114048737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fabiana Tornincasa Franca, João Kleber de Almeida Gentile, Renato Migliore, Pedro Marcos Santinho Bueno de Souza, José Cesar Assef
Obesity is an epidemic disease in the modern world. The clinical therapies, when isolated, are not effective to weight loss and control in morbidly obese patients (BMI > 40 Kg/m²) in long term. Surgery is the only method proven effective to achieve these goals. The Gastric Bypass Roux-Y (RYGB) is the most commonly performed bariatric surgery in the world including Brazil and is considered the gold standard of bariatric procedures because of its effectiveness in losing and maintaining long term weight loss associated with lower complication rates. There is a discussion about the need of using the sylastic ring at the end of gastric pouch, when the RYGB surgery is done, surgery known as the Fobi-Capella, because the high incidence of complications related to the ring and the difficulty in the intake of solids. Today, many surgical teams perform Capella’s surgery without placement the ring, with the argument that weight loss is similar without the limitations and complications related to the ring. The proposal of this study is analyzing the need to use the ring in morbidly obese patients comparing the weight loss after one year and nutrition quality. Thus, we compared two groups of patients, first group submitted in 2009 to gastric bypass (RYGB with ring or Capella’s surgery) and the second group operated in 2010 (RYGB without ring), analyzing the results for weight loss and quality of life after 1 year elapsed from surgery through established questionnaires as BAROS and specific questionnaires on nutrition quality. Of the total 21 patients, 12 patients were submitted to RYGB with ring and the other 9 patients were submitted RYGB without placement of the ring. The surgery is aimed at weight loss and resolution of comorbidities associated with obesity. It is considered an effective surgical technique when weight loss is greater than 50% of the overweight in 75% of patients. The study showed that both types of surgery, with or without the ring, reach the objective. The study noted that patients submitted to RYGB with ring have an important restriction on the intake of meat, while the group submitted to RYGB surgery without the ring eat better foods rich in protein and has no postprandial vomiting, with a better-quality food. Regarding quality of life, we observe significant improvement in all variables in both groups without statistical difference.
{"title":"Evaluation of Weight Loss and Quality of Life in Morbidly Obese Patients Undergoing Y De Roux Gastric Bypass Surgery with Reduction Ring and Without Ring, After The First Year of Follow-Up","authors":"Fabiana Tornincasa Franca, João Kleber de Almeida Gentile, Renato Migliore, Pedro Marcos Santinho Bueno de Souza, José Cesar Assef","doi":"10.33425/2639-9334.1058","DOIUrl":"https://doi.org/10.33425/2639-9334.1058","url":null,"abstract":"Obesity is an epidemic disease in the modern world. The clinical therapies, when isolated, are not effective to weight loss and control in morbidly obese patients (BMI > 40 Kg/m²) in long term. Surgery is the only method proven effective to achieve these goals. The Gastric Bypass Roux-Y (RYGB) is the most commonly performed bariatric surgery in the world including Brazil and is considered the gold standard of bariatric procedures because of its effectiveness in losing and maintaining long term weight loss associated with lower complication rates. There is a discussion about the need of using the sylastic ring at the end of gastric pouch, when the RYGB surgery is done, surgery known as the Fobi-Capella, because the high incidence of complications related to the ring and the difficulty in the intake of solids. Today, many surgical teams perform Capella’s surgery without placement the ring, with the argument that weight loss is similar without the limitations and complications related to the ring. The proposal of this study is analyzing the need to use the ring in morbidly obese patients comparing the weight loss after one year and nutrition quality. Thus, we compared two groups of patients, first group submitted in 2009 to gastric bypass (RYGB with ring or Capella’s surgery) and the second group operated in 2010 (RYGB without ring), analyzing the results for weight loss and quality of life after 1 year elapsed from surgery through established questionnaires as BAROS and specific questionnaires on nutrition quality. Of the total 21 patients, 12 patients were submitted to RYGB with ring and the other 9 patients were submitted RYGB without placement of the ring. The surgery is aimed at weight loss and resolution of comorbidities associated with obesity. It is considered an effective surgical technique when weight loss is greater than 50% of the overweight in 75% of patients. The study showed that both types of surgery, with or without the ring, reach the objective. The study noted that patients submitted to RYGB with ring have an important restriction on the intake of meat, while the group submitted to RYGB surgery without the ring eat better foods rich in protein and has no postprandial vomiting, with a better-quality food. Regarding quality of life, we observe significant improvement in all variables in both groups without statistical difference.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123617392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandoval-Jurado Luis, Campos Dania, R. Jose, Ramírez Mirza, Barbosa Lizzette, Sánchez Abel, De León Juan Pablo
The small intestine is by far the most difficult area to study from an endoscopic point of view, since traditional endoscopy only covers up to the 2nd portion of the duodenum and colonoscopy up to the terminal ileum. On rare occasions we find it necessary to use non-traditional endoscopic equipment to be able to study this middle area of the small intestine. Gastrointestinal stromal tumor is one of the neoplastic differential diagnoses found at this level. Given the advancement of genetics associated with immunohistochemistry, we have been able to better evaluate and characterize these lesions of mesenchymal origin. A case of a jejunal gastrointestinal stromal tumor with an initial presentation of melena is presented. Where together gastroenterology, surgery and pathology, the mentioned final diagnosis was reached.
{"title":"Gastrointestinal Bleeding Secondary to Jejunum GIST, Report Case","authors":"Sandoval-Jurado Luis, Campos Dania, R. Jose, Ramírez Mirza, Barbosa Lizzette, Sánchez Abel, De León Juan Pablo","doi":"10.33425/2639-9334.1054","DOIUrl":"https://doi.org/10.33425/2639-9334.1054","url":null,"abstract":"The small intestine is by far the most difficult area to study from an endoscopic point of view, since traditional endoscopy only covers up to the 2nd portion of the duodenum and colonoscopy up to the terminal ileum. On rare occasions we find it necessary to use non-traditional endoscopic equipment to be able to study this middle area of the small intestine. Gastrointestinal stromal tumor is one of the neoplastic differential diagnoses found at this level. Given the advancement of genetics associated with immunohistochemistry, we have been able to better evaluate and characterize these lesions of mesenchymal origin. A case of a jejunal gastrointestinal stromal tumor with an initial presentation of melena is presented. Where together gastroenterology, surgery and pathology, the mentioned final diagnosis was reached.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117092738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Hepatitis C is a more common infection in the psychiatric population and psychiatric comorbidities are more common in patients with chronic viral hepatitis C. No prospective studies on hepatitis C management in a psychiatric setting in France had not been yet published. Objectives: 1/ to make a short review of the literature 2/ To determine the prevalence of HCV in the psychiatric inpatient population, to assess the feasibility of the simplified care pathway recommended by HAS and to improve the screening and management of hepatitis C in closed psychiatric settings. Methods: Collecting prospective and retrospective data on the management of hepatitis C from 2017 to 2020 among the psychiatric hospital’s incoming population. Results: Current data on the prevalence and management of hepatitis C in psychiatric settings are insufficient. In our study, the number of serologies performed among entrants increased from 2016 to 2020 with coverage of screening from 24% to 100%. In 2020, a C viral load was achieved in all patients with positive C serology. All patients with a positive viral load were assessed for fibrosis with FIBROSCAN on-site and treated with direct antivirals except 2. Conclusion: our original approach to HCV has been efficient. This cooperation between organized caregivers (hepatology mobile team and medical biology laboratory) has increased rate of screening and management of HCV in psychiatric hospitals. Hospitalization and/or psychiatric follow-up is a risk factor for hepatitis C and should lead to hepatitis screening. Larger prospective studies are needed.
{"title":"Management of Hepatitis C in Psychiatric Settings: Review of The Literature and Review of Experiences Over 4 Years in A Psychiatric Hospital.","authors":"A. Remy, R. Bouquié, J. Hervet","doi":"10.33425/2639-9334.1055","DOIUrl":"https://doi.org/10.33425/2639-9334.1055","url":null,"abstract":"Introduction: Hepatitis C is a more common infection in the psychiatric population and psychiatric comorbidities are more common in patients with chronic viral hepatitis C. No prospective studies on hepatitis C management in a psychiatric setting in France had not been yet published. Objectives: 1/ to make a short review of the literature 2/ To determine the prevalence of HCV in the psychiatric inpatient population, to assess the feasibility of the simplified care pathway recommended by HAS and to improve the screening and management of hepatitis C in closed psychiatric settings. Methods: Collecting prospective and retrospective data on the management of hepatitis C from 2017 to 2020 among the psychiatric hospital’s incoming population. Results: Current data on the prevalence and management of hepatitis C in psychiatric settings are insufficient. In our study, the number of serologies performed among entrants increased from 2016 to 2020 with coverage of screening from 24% to 100%. In 2020, a C viral load was achieved in all patients with positive C serology. All patients with a positive viral load were assessed for fibrosis with FIBROSCAN on-site and treated with direct antivirals except 2. Conclusion: our original approach to HCV has been efficient. This cooperation between organized caregivers (hepatology mobile team and medical biology laboratory) has increased rate of screening and management of HCV in psychiatric hospitals. Hospitalization and/or psychiatric follow-up is a risk factor for hepatitis C and should lead to hepatitis screening. Larger prospective studies are needed.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116086835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Fistula in-ano is an abnormal chronic infected tunnel (tract) between the rectum or the anal canal and perianal skin usually, with granulation tissue which connecting a primary orifice (internal) to a secondary one (external). This morbid antity represents a dilemma for both, patients and surgeon-proctologists because of postoperative issues occurrence such as fecal incontinence. The surgical management of this infectious condition has emerged nowadays, by emphasing new surgical techniques that preserve anal sphincter's integrity and functional. Over the last decade, numerous techniques sparing anal sphinters have gained popularity such as endoscopic approach (VAAFT), Laser, fibrin glue, transanal advancement flap repair [1,6]. In the same perspective,we are presenting in this paper, our preliminary outcomes of a combination of endoscopic approach (VAAFT) with Radifrequency Ablation of the fistula's tract that we nicknamed with the acronym of E-RaFisTura). Methods: We enrolled 10 males patients with anal fistula, age groupe 50-70 years, without any comorbidity in the term of diabetes mellitus, bowel inflammatory disease. Preoperatively each of them underwent a digital rectal examination, pelvic MRI, colonoscopy to rule out any concomitant abscess, Crohn's disease. Fleet enema, subcutaneus lower molecular weight heparin as well as intravenous broad spectrum antibiotic were administered an hour prior the surgical procedure. All patients were shifted to endoscopic surgical treatment of anal fistula (VAAFT) by using the fistuloscope of Piercarlo Meinero combined to the device of Fistura (Radiofrequency Ablation) with its probe 6-7 F (Figure 1 a,b,c). Then we visualized the fistula's tract and we seal it with radiofrequency thermocoagulation without damaging the anal sphincters by closing the internal opening with a suture node (Vicryl Rapid 3-0). Taxinomically, 2 patients had intersphincteric fistula, 3 transphincteric and the 5 others had submucosal anal fistula. Outcomes: We are inthe third month of follow up, none of the aboved mentioned patients has presented any postoperative issue excepting some local discomfort in immediate postoperative day, relieved with voltaren. Furthermore, the orificial wound healing is successful. Conclusion: Focused on our preliminary results, despite the small volume of patients, this combination of endoscopic and radiofrequency ablation can be regarded with optimism in selected patients. We will perform a powerful prospective study with a huge sample to have more accurate opinion. Bioethics Considerations: All enrolled patients had given their written consent prior. Furthermore,this surgical trial was approved by the Ethical commitee of Our Clinic.
{"title":"Endoscopic Radiofrequency Ablation of Fistula in Ano (E-RaFisTura) in the Era of Surgical Innovation. A Serial Prospective Evaluation of 10 Patients","authors":"A. Xiarchos, F. Tshijanu, A. Tsakpini","doi":"10.33425/2639-9334.1060","DOIUrl":"https://doi.org/10.33425/2639-9334.1060","url":null,"abstract":"Background: Fistula in-ano is an abnormal chronic infected tunnel (tract) between the rectum or the anal canal and perianal skin usually, with granulation tissue which connecting a primary orifice (internal) to a secondary one (external). This morbid antity represents a dilemma for both, patients and surgeon-proctologists because of postoperative issues occurrence such as fecal incontinence. The surgical management of this infectious condition has emerged nowadays, by emphasing new surgical techniques that preserve anal sphincter's integrity and functional. Over the last decade, numerous techniques sparing anal sphinters have gained popularity such as endoscopic approach (VAAFT), Laser, fibrin glue, transanal advancement flap repair [1,6]. In the same perspective,we are presenting in this paper, our preliminary outcomes of a combination of endoscopic approach (VAAFT) with Radifrequency Ablation of the fistula's tract that we nicknamed with the acronym of E-RaFisTura). Methods: We enrolled 10 males patients with anal fistula, age groupe 50-70 years, without any comorbidity in the term of diabetes mellitus, bowel inflammatory disease. Preoperatively each of them underwent a digital rectal examination, pelvic MRI, colonoscopy to rule out any concomitant abscess, Crohn's disease. Fleet enema, subcutaneus lower molecular weight heparin as well as intravenous broad spectrum antibiotic were administered an hour prior the surgical procedure. All patients were shifted to endoscopic surgical treatment of anal fistula (VAAFT) by using the fistuloscope of Piercarlo Meinero combined to the device of Fistura (Radiofrequency Ablation) with its probe 6-7 F (Figure 1 a,b,c). Then we visualized the fistula's tract and we seal it with radiofrequency thermocoagulation without damaging the anal sphincters by closing the internal opening with a suture node (Vicryl Rapid 3-0). Taxinomically, 2 patients had intersphincteric fistula, 3 transphincteric and the 5 others had submucosal anal fistula. Outcomes: We are inthe third month of follow up, none of the aboved mentioned patients has presented any postoperative issue excepting some local discomfort in immediate postoperative day, relieved with voltaren. Furthermore, the orificial wound healing is successful. Conclusion: Focused on our preliminary results, despite the small volume of patients, this combination of endoscopic and radiofrequency ablation can be regarded with optimism in selected patients. We will perform a powerful prospective study with a huge sample to have more accurate opinion. Bioethics Considerations: All enrolled patients had given their written consent prior. Furthermore,this surgical trial was approved by the Ethical commitee of Our Clinic.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122674005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carolina da Silva Pinto Martins, F. H. Barbosa de Almeida, L. F. Coelho, G. Pitanga, João Kleber de Almeida Gentile
Background: Coronavirus disease 2019 (COVID-19), caused by the coronavirus of severe acute respiratory syndrome, has become a threat to global health due to the high rates of morbidity and mortality. Predominantly, the infection is related to respiratory symptoms, but gastrointestinal manifestations, including hepatic, have also been reported. Objectives: This literature review addresses the new coronavirus pathogenic mechanism in the liver and its consequences. The repercussions of liver damage are mild to moderate elevations in serum levels of transaminases, gamma-glutamyl transferase, alkaline phosphatase and hypoalbuminemia. Design and Setting: In this literature review we searched PubMed for studies published between March, 2020 and June, 2020. Methods: The search terms included “COVID 19”, “Gastrointestinal”, “Liver”. The eligible studies were those that focused on liver manifestations caused by the new coronavirus and infected patients who already had liver comorbidities. Results: The liver damages result both from the direct virus aggression in the cells, as well as secondary to the patient's evolution and possible pre-existing morbidities, explaining the alterations in liver enzymes. Conclusions: This literature review helps to understand the hepatic involvement, although further studies are needed to elucidate the course and prognosis of the disease. The most severe enzymatic changes are strongly related to a worse prognosis. Therefore, doctors must pay attention to the evolution of the infection.
{"title":"COVID-19 Liver Manifestations. What should we know? A Literature Review.","authors":"Carolina da Silva Pinto Martins, F. H. Barbosa de Almeida, L. F. Coelho, G. Pitanga, João Kleber de Almeida Gentile","doi":"10.33425/2639-9334.1056","DOIUrl":"https://doi.org/10.33425/2639-9334.1056","url":null,"abstract":"Background: Coronavirus disease 2019 (COVID-19), caused by the coronavirus of severe acute respiratory syndrome, has become a threat to global health due to the high rates of morbidity and mortality. Predominantly, the infection is related to respiratory symptoms, but gastrointestinal manifestations, including hepatic, have also been reported. Objectives: This literature review addresses the new coronavirus pathogenic mechanism in the liver and its consequences. The repercussions of liver damage are mild to moderate elevations in serum levels of transaminases, gamma-glutamyl transferase, alkaline phosphatase and hypoalbuminemia. Design and Setting: In this literature review we searched PubMed for studies published between March, 2020 and June, 2020. Methods: The search terms included “COVID 19”, “Gastrointestinal”, “Liver”. The eligible studies were those that focused on liver manifestations caused by the new coronavirus and infected patients who already had liver comorbidities. Results: The liver damages result both from the direct virus aggression in the cells, as well as secondary to the patient's evolution and possible pre-existing morbidities, explaining the alterations in liver enzymes. Conclusions: This literature review helps to understand the hepatic involvement, although further studies are needed to elucidate the course and prognosis of the disease. The most severe enzymatic changes are strongly related to a worse prognosis. Therefore, doctors must pay attention to the evolution of the infection.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132629832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose/Background: Pneumatosis cystoides intestinalis, a rare entity, is not an isolated diagnosis but a finding that suggests an underlying process whose pathogenesis is not well understood. In this case series, we explore a novel histopathological finding of hyperganglionosis in pneumatosis cystoides intestinalis [PCI] as a cause-vs-effect phenomenon. Methods: In a previously published index case of PCI we discovered hyperganglionosis as an associated finding. This discovery led to a twenty-year retrospective search of the Laboratory Information Service [LIS] in our surgical pathology laboratory that identified a total of twenty three cases with reported finding of PCI of which seven cases were excluded due to lack of availability of histological slides and /or blocks. In the remaining sixteen cases all the relevant histopathological slides were reviewed to confirm the diagnosis of PCI. One representative block in each case was subjected to immunohistochemical staining with antibodies to S100, Calretinin and CD68 for further evaluation of hyperganglionosis with review to their clinical context. Results: This study reports on sixteen cases of PCI that have been studied in detail with their additional stains and their clinicopathological review. All cases upon review confirmed the presence of the diagnostic pathological finding of multiple, varied size and shapes of non-communicating cysts of PCI either mucosal/ submucosal intramuscular and/or subserosal. Additionally, prominent, enlarged hypertrophic ganglions associated with hypertrophic nerve fibers were seen in association with these cysts as highlighted by S100 and Calretinin. CD68 stained slides outlined the histiocytes and giant cells surrounding the cysts of PCI as expected. Conclusion: The exact pathogenesis of non-communicating air-filled cysts within the bowel wall remains poorly understood especially in cases with no evidence of perforation /obstruction and /or ischemic changes/. Many theories have been proposed to explain the presence of intramural gas that include the mechanical theory of mucosal injury, bacterial theory of gas production, counterperfusion-saturation theory and the pulmonary gas theory. We propose a neuronal theory with a detailed discussion of dysgenetic ganglion cells with abnormal peristalsis resulting reversal airflow’ with intramural accumulation of intraluminal air or that these hypertrophied ganglions and nerves could be the resultant effect of the forced intramural expansion by the cysts; thus, reminiscent of the debate of which came first -the chicken or the egg.
{"title":"Hyperganglionosis in Pneumatosis Cystoides Intestinalis- A Clinicopathological Review in Adults","authors":"S. Tharmaradinam, S. Kanthan, R. Kanthan","doi":"10.33425/2639-9334.1053","DOIUrl":"https://doi.org/10.33425/2639-9334.1053","url":null,"abstract":"Purpose/Background: Pneumatosis cystoides intestinalis, a rare entity, is not an isolated diagnosis but a finding that suggests an underlying process whose pathogenesis is not well understood. In this case series, we explore a novel histopathological finding of hyperganglionosis in pneumatosis cystoides intestinalis [PCI] as a cause-vs-effect phenomenon. Methods: In a previously published index case of PCI we discovered hyperganglionosis as an associated finding. This discovery led to a twenty-year retrospective search of the Laboratory Information Service [LIS] in our surgical pathology laboratory that identified a total of twenty three cases with reported finding of PCI of which seven cases were excluded due to lack of availability of histological slides and /or blocks. In the remaining sixteen cases all the relevant histopathological slides were reviewed to confirm the diagnosis of PCI. One representative block in each case was subjected to immunohistochemical staining with antibodies to S100, Calretinin and CD68 for further evaluation of hyperganglionosis with review to their clinical context. Results: This study reports on sixteen cases of PCI that have been studied in detail with their additional stains and their clinicopathological review. All cases upon review confirmed the presence of the diagnostic pathological finding of multiple, varied size and shapes of non-communicating cysts of PCI either mucosal/ submucosal intramuscular and/or subserosal. Additionally, prominent, enlarged hypertrophic ganglions associated with hypertrophic nerve fibers were seen in association with these cysts as highlighted by S100 and Calretinin. CD68 stained slides outlined the histiocytes and giant cells surrounding the cysts of PCI as expected. Conclusion: The exact pathogenesis of non-communicating air-filled cysts within the bowel wall remains poorly understood especially in cases with no evidence of perforation /obstruction and /or ischemic changes/. Many theories have been proposed to explain the presence of intramural gas that include the mechanical theory of mucosal injury, bacterial theory of gas production, counterperfusion-saturation theory and the pulmonary gas theory. We propose a neuronal theory with a detailed discussion of dysgenetic ganglion cells with abnormal peristalsis resulting reversal airflow’ with intramural accumulation of intraluminal air or that these hypertrophied ganglions and nerves could be the resultant effect of the forced intramural expansion by the cysts; thus, reminiscent of the debate of which came first -the chicken or the egg.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122554446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Alshekhani, B. Salim, Zana Nasraddin Mohialdeen, B. J. H. Amin
{"title":"Clinical Characteristic of Inflammatory Bowel Disease Diagnosed in Kurdistan Center for Gastroenterology and Hepatology (Kcgh) – Asulaimaiyah-Iraqi Kurdistan-Iraq","authors":"Mohamed Alshekhani, B. Salim, Zana Nasraddin Mohialdeen, B. J. H. Amin","doi":"10.33425/2639-9334.1050","DOIUrl":"https://doi.org/10.33425/2639-9334.1050","url":null,"abstract":"","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128787995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aim: Gastro esophageal reflux disease is common in the population, with a long pharmacological and non-pharmacological treatment. One of the non-pharmacological treatments is the elevation of the head of the bed to avoid gastro esophageal reflux when the patients are in the supine position. The objective of this investigation was to evaluate the effects of two bed wedges placed over a flat mattress on symptoms and acid reflux. Patients and Methods: Two bed wedges were placed over a flat mattress, one with 18 cm depth (5.5° inclination, wedge-1) and the other with 28 cm depth (8.6° inclination, wedge-2) and evaluated the effect on symptoms and gastro esophageal reflux. The bed wedge-1 was tested in 12 patients and the bed wedge-2 in 25 patients. All patients were assessed for symptoms, and underwent upper digestive endoscopy and 48-hour pH monitoring. The pH was measured continuously 5 cm proximal to the lower esophageal sphincter for 48 hours – 24 hours on a bed wedge (18 cm or 28 cm depth) and 24 hours without a bed wedge (i.e., on a flat mattress), in a random order. Results: Both bed wedges reduced the frequency of gastro esophageal reflux symptoms in the supine position compared with the flat mattress. Bed wedge-2 caused more discomfort during the night than the wedge-1. The pH monitoring measurements were not different between the two wedges. Conclusions: The bed wedges tested reduced the frequency of symptoms, but had no effect on gastro esophageal acid reflux. The 28 cm-depth wedge caused discomfort in supine position in most its users.
{"title":"Effect of an Anti-Reflux Bed Wedge on Gastro esophageal Reflux Symptoms and Acid Reflux","authors":"Andrea Oliveira Batista, F. Pinto, R. Dantas","doi":"10.33425/2639-9334.1052","DOIUrl":"https://doi.org/10.33425/2639-9334.1052","url":null,"abstract":"Background and Aim: Gastro esophageal reflux disease is common in the population, with a long pharmacological and non-pharmacological treatment. One of the non-pharmacological treatments is the elevation of the head of the bed to avoid gastro esophageal reflux when the patients are in the supine position. The objective of this investigation was to evaluate the effects of two bed wedges placed over a flat mattress on symptoms and acid reflux. Patients and Methods: Two bed wedges were placed over a flat mattress, one with 18 cm depth (5.5° inclination, wedge-1) and the other with 28 cm depth (8.6° inclination, wedge-2) and evaluated the effect on symptoms and gastro esophageal reflux. The bed wedge-1 was tested in 12 patients and the bed wedge-2 in 25 patients. All patients were assessed for symptoms, and underwent upper digestive endoscopy and 48-hour pH monitoring. The pH was measured continuously 5 cm proximal to the lower esophageal sphincter for 48 hours – 24 hours on a bed wedge (18 cm or 28 cm depth) and 24 hours without a bed wedge (i.e., on a flat mattress), in a random order. Results: Both bed wedges reduced the frequency of gastro esophageal reflux symptoms in the supine position compared with the flat mattress. Bed wedge-2 caused more discomfort during the night than the wedge-1. The pH monitoring measurements were not different between the two wedges. Conclusions: The bed wedges tested reduced the frequency of symptoms, but had no effect on gastro esophageal acid reflux. The 28 cm-depth wedge caused discomfort in supine position in most its users.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130110574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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