Gastroenterology Clinic Research Articles

Frequency and Related Risk Factors of Refeeding Hypophosphatemia in Patients with Liver Cirrhosis: A Pilot Study.

Refeeding hypophosphatemia (RH) is associated with poor clinical outcomes and mortality. The presence of RH in patients with liver cirrhosis remains unclear. This study aims to determine the frequency of RH related to nutritional status and disease severity in liver cirrhosis. This study was prospectively conducted in a-single center gastroenterology clinic. Malnutrition was identified by Subjective Global Assessment (SGA). The disease severity was defined using Child score and MELD score. Serum phosphate levels <2.0 mg/dl are defined as hypophosphatemia. Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in 4 patients on day 4 during study follow up. The sharpest decline of serum phosphate levels was on day 4 (median: 2.3mg/dL). The Child score and MELD score were not significantly different between RH and Non-RH groups (p>0.05). The rate of malnutrition according to SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher presence of RH than patients receiving only oral or enteral tube feding (p<0.05). RH developed in ¼ of the study participants. This study also showed that artificial feeding carries a significant risk in terms of RH. Malnourished patients with liver cirrhosis receiving parenteral nutrition, closely monitored regarding high risk of RH.

Characteristics and Risk Factors of Functional Dyspepsia Fulfilling the Rome IV Criteria Overlapping With Gastroesophageal Reflux Disease, Irritable Bowel Syndrome, and Functional Constipation in South China.

Functional dyspepsia (FD) overlapping with other gastrointestinal disorders are quite common. The characteristics of FD overlap in Chinese population with latest Rome IV criteria were unclear. This large-scale outpatient-based study assessed the characteristics of FD overlap in South China. Consecutive FD patients visited the Gastroenterology Clinic at 2 tertiary medical centers in Hangzhou, China who fulfilled the Rome IV criteria were enrolled. Complete questionnaires related to the gastrointestinal symptoms (Rome IV criteria), Reflux Disease Questionnaire, anxiety and depression, quality of sleep and life, and demographic information were collected. Among the total of 3281 FD patients, 50.69% overlapped with gastroesophageal reflux disease, 21.46% overlapped with irritable bowel syndrome, 6.03% overlapped with functional constipation. FD overlap had higher proportion of single/divorced/widowed rate, high education level, being employed, drinking, night shift, unhealthy dietary habit than FD only (P < 0.05). They had higher frequency of consultation and economic burden, as well as lower scores in quality of life (P < 0.001). Multivariate logistic regression showed that increasing age, female, low body mass index, history of gastroenteritis, anxiety, depression, and poor sleep quality were independent risk factors for FD overlap. FD overlap was quite common in China with high economic burden and poor quality of life, FD patients with history of gastroenteritis, anxiety, depression, and poor sleep quality were more likely to have overlap disorders. Awareness of the physical and psychosocial stressors in overlapping condition would help optimize the management of FD overlap in clinical practice.

Increasing Mental Health Screening inPediatric Subspecialty Clinics: An Improvement Project at Brooke Army Medical Center.

Mental health screening allows for the early identification of patients at risk of mental health disorders such as anxiety and depression. The Defense Health Administration Procedures Manual 6025.01 established that patients older than 12 years of age should receive annual mental health screening assessing suicidality risk with a standardized screening tool. To improve rates of mental health screening in this at-risk population, an A3 Lean approach to quality improvement was undertaken in the Pediatric Subspecialty Clinics at Brooke Army Medical Center. Baseline data of Patient Health Questionnaire-9 or General Anxiety Disorder-7 screening from pediatric pulmonology and cardiology clinics were 6.3%. Plan-Do-Study-Act quality improvement methods evaluated possible interventions to improve screening. A standard operating procedure (SOP) outlining scoring and interpretation recommendations was distributed in pediatric pulmonology and cardiology clinics. Using the Armed Forces Health Longitudinal Technology Application, a post-implementation chart review was conducted for 8 weeks. With the initiation of Military Health System Genesis, the SOP was adjusted and a root cause analysis was performed. The pediatric gastroenterology clinic cares for patients presenting with functional abdominal pain; therefore, the clinic was added to the second iteration to determine if anxiety or depression may play a role. Providers were educated on documentation and coding. A second post-implementation chart review was conducted for 8 weeks. Over two iterations, mental health screening of new adolescent patients in pediatric subspecialty clinics increased by 794% from baseline. Our providers screened 50% of the adolescent patients. With increased surveillance of an at-risk population, more adolescents will receive the standard of care. With refinement of the SOP and expansion to other subspecialties, this project has the potential to expand within Brooke Army Medical Center and other clinics in the Defense Health Administration.

The Association Between Peripheral Blood Neutrophil-to-Lymphocyte Ratio and Cirrhosis Complications in Adults with Compensated Liver Cirrhosis in Ahvaz, Iran

Background: The neutrophil-to-lymphocyte ratio (NLR) is an inflammation biomarker in patients with liver cirrhosis. While increased NLR is linked to poor clinical outcomes and mortality in diseases like cancers, its association with cirrhosis complications has been sparsely examined. Objectives: This study aimed to evaluate the association between NLR and cirrhosis complications in patients with compensated liver cirrhosis. Methods: This retrospective cohort study was conducted on 256 patients with compensated liver cirrhosis visiting the Gastroenterology Clinic of Imam Khomeini Hospital, Ahvaz, Iran, in 2020. The peripheral blood lymphocyte and neutrophil counts were evaluated, and the NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Cirrhosis complications were assessed based on clinical and laboratory evaluation during 1 year of follow-up. Results: During the retrospective follow-up period, 59 patients (23.05%) experienced cirrhosis complications such as spontaneous bacterial peritonitis (n = 23), gastrointestinal bleeding (n = 22), and hepatic encephalopathy (n = 14). The baseline NLR, Model for End-Stage Liver Disease (MELD) score and Child-Pugh score were significantly higher in patients who later developed complications than in those who did not (P &lt; 0.0001). The NLR with an optimal cut-off of &gt; 1.95 had a sensitivity of 84.75% and specificity of 93.91% in predicting complications during the 1-year follow-up (AUC = 0.905, P &lt; 0.0001). Conclusions: Our results indicated that the NLR is a simple, non-invasive, and cost-effective marker for predicting short-term complications in patients with compensated liver cirrhosis.

33 Gluten-free Diet Knowledge and Adherence in Adolescents with Celiac Disease: A Cross-sectional Study

Abstract Background Adolescents with celiac disease (CD) are at risk for non-adherence to the gluten-free diet (GFD). Knowledge of the GFD may impact adherence. Objectives To examine the relationship between knowledge and adherence to the GFD in a local population of adolescents with CD. Secondary objectives were to identify information sources used to learn about the GFD and to compare adolescent and parent knowledge of the GFD. Design/Methods Adolescents (12-17 years) with CD and their parents from local paediatric gastroenterology clinics completed an online survey containing a knowledge assessment (Gluten-Free Diet Quiz [GFD-Q]), validated adherence scale, GFD information sources, and demographic/clinical information. GFD-Q scores were categorized as “sufficient knowledge” based on correctly identifying: 3/3 gluten-containing foods, at least 4/7 gluten-free foods, and at least 4/7 foods that may contain gluten. Otherwise, scores were termed as indicating “insufficient knowledge”. Results Of 40 adolescents, 15/40 (37%) had sufficient knowledge and 25/40 (63%) had insufficient knowledge. Within the insufficient knowledge group, 14/25 (56%) did not correctly identify enough allowed, gluten-free foods. Parents scored higher on the GFD-Q (67% with sufficient knowledge). Adolescents reported overall adherence to the GFD (88%), with adherence similar between sufficient and insufficient knowledge groups (80% vs. 92%). Most helpful information sources include physicians, another person with CD, parent(s), and Google (online search engine). Apps were infrequently used (20% of adolescents). Conclusion Adolescents report good adherence, but struggle with knowledge of the GFD, particularly in identifying gluten-free foods. Further research is required to explore GFD educational tools, including mobile apps and dietician-led teaching sessions.

Benefit of an action camera in endoscopy education for medical students under COVID-19

BackgroundEndoscopy is an important form of clinical gastroenterology education because it gives students the opportunity to learn about diagnosis procedures and even treatment. During the COVID-19 pandemic, medical students were observed from outside the endoscopy room due to the risk of airborne infection. In this study, we investigated the efficacy of combining endoscopy education with doctor’s-eye-view videos of the procedure obtained using live-action cameras (GoPro®).MethodsFrom February to May 2021, endoscopists wore GoPro Hero8 cameras on their heads to display a doctor’s-eye view video outside the room. The efficacy of the GoPro videos in combination with endoscopic monitoring was evaluated by 15 participating medical students. The participants rated the efficacy on a 5-point scale and commented on the positive and negative points.ResultsA total of 78.6% of participants evaluated the GoPro as good; 57.2% answered that it increased their understanding, with 71.4% stating that it increased their understanding of procedures in particular. A total of 85.7% of the students answered that their interest in endoscopy had increased, and 85.7% evaluated the benefit of the GoPro videos as good. In addition, 64.3% answered that the method was effective in preventing COVID-19 infection. Education using GoPro videos enabled students to feel as if they were conducting the endoscopy themselves and enabled them to concentrate on learning.ConclusionsPractical endoscopic education using a GoPro is an effective educational tool that not only increases understanding of endoscopic practice but also stimulates students’ interest and awareness of their future as doctors.

Sofosbuvir and Velpatasvir Regimen Outcome for Chronic Hepatitis C Patients With End-Stage Renal Disease Undergoing Hemodialysis.

Background Patients on hemodialysis (HD) are most likely to contract hepatitis C (HCV) infection, which is associated with significant morbidity and disease progression. Direct-acting antivirals (DAAs) are safe and tolerable in chronic kidney disease (CKD) with a 90-100% cure rate, and limited data exist regarding their efficacy in end-stage renal disease (ESRD), particularly for HDpatients in South Asia. The study aimed to assess the outcome of a 12-week sofosbuvir (SOF) and velpatasvir (VEL) treatment regimen on ESRD patients with chronic HCV infection undergoing HDin the Pakistani Asian population. Methodology This prospective cohort study was conducted between January 2022 and January2023 at the outpatient nephrology and gastroenterology clinic of Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, Pakistan. This study included a total of 220 ESRD patients fulfilling the inclusion criteria, aged 20-55 years, who had been undergoing weekly HD sessions for at least two years, with acquired HCV infection. Data on demographic and clinical characteristics were collected through patient interviews. Laboratory and dialysis profiling was executed to assess ESRD and discover the underlying cause by ultrasound abdomen, blood pressure measurement by sphygmomanometer, random blood sugarfor diabetes, and taking note of the duration and frequency of dialysis. HCV RNA PCR was done at selected intervals to evaluate the virological response to treatment. Sustained virological response (SVR), liver cirrhosis status, and number of weekly HD sessions were compared at one year of SOF/VEL regimen. Results The mean age of patients with ESRD was 41.8 with a standard deviation (SD) of 9.3 years, and HCV diagnosis was 1.3 years with SD of 0.4 years; 52.7% (n=116) were males, 47.3% (n=104) were females, 75% (n=165) were urban dwellers, and 93.6% (n=206) were married.CKD that requires dialysis was caused mainly by hypertension (78, 35%), diabetes mellitus type 2 (52, 24%), bilateral small kidney disease (40, 18%), and others (34, 16%). One hundred and six (48.2%) received dialysis thrice weekly, 83 (37.7%) twice, and 31 (14.1%) once weekly. The study monitored the rapid virological response (RVR) at four weeks of SOF/VEL regimen in 89.5% of ESRD patients, observed end-of-treatment response (ETR) at 12 weeks in 93.2%, and noted 91.4% SVR response at one year. Only four (1.8%) relapses were observed in the study, which was statistically insignificant. The status of liver cirrhosis showed a 50% improvement, decreasing from 40% to 20%. The frequency of weekly HD sessions decreased from thrice to twice-thrice a week. Conclusion The prevalence of contracting HCV is high among CKD and dialysis ESRD patients. All-oral DAA therapy has revolutionized HCV treatment with co-morbidities. Renal functions improved after the SOF/VEL regimen for chronic HCV infection in ESRD patients undergoing HD, with the number of weekly dialysis sessions reduced and SVR reaching 91.4%. Thus, a single-tablet, pan-genotypic DAA regimen of SOF/VEL for 12 weeks is safe, effective, and tolerable regardless of the underlying etiology of ESRD, complications of cirrhosis, HCV genotype, or previous treatment exposure. The successful treatment of HCV and achieving SVR lowers the risk of ESRD complications, improves extra-hepatic manifestations, and greatly enhances survival. Further studies are warranted after the availability of other DAAs to confirm findings with no limitations.

Gastroenterology Clinic Follow-Up Reduces Gastroenterology-Specific Readmissions Among Patients With Severe Ulcerative Colitis.

Readmission within 30 days occurs in up to 18% of admitted patients with ulcerative colitis (UC). The importance of postdischarge follow-up with a gastroenterologist as well as the optimal follow-up interval is unknown. We conducted a retrospective cohort study of patients with UC who were admitted to Stanford University Hospital between 2010 and 2020. We included adult patients with UC who were admitted for a UC flare. Patients with a colectomy during hospitalization or with Clostridium difficile infection at the index hospitalization were excluded. The primary outcome was time to readmission for a gastroenterology (GI) indication, and the primary predictor (time dependent) was follow-up with a GI provider. Patients were followed for 180 days after discharge. Data were analyzed using a Cox proportional hazards model. Of the 223 patients hospitalized with UC during the study period, 25% (n = 57) were readmitted within 180 days, with 13.9% occurring within 30 days. Early follow-up (within 7 days) was observed in 29% (n = 65) of patients, while 30-day follow-up was seen in 68.7% (n = 153), and follow-up within 180 days was seen in 198 (89%) patients. In the adjusted Cox proportional hazards model, GI follow-up was associated with fewer readmissions (hazard ratio, 0.42; 95% confidence interval, 0.22-0.81; P = .009). Early follow-up was strongly associated with a reduced risk of readmission (hazard ratio, 0.24; 95% 95% confidence interval, 0.09-0.69; P = .008). Follow-up in 7 days was associated with fewer readmissions (P < .0001). Outpatient GI follow-up after UC hospitalization reduces readmissions, with the greatest reduction occurring among patients followed up within 1 week of discharge.

The Impact of Type 2 Diabetes Mellitus on Treatment Success in IBS Patients

Aim: This study aimed to investigate the impact of type 2 diabetes mellitus (T2DM) on treatment outcomes in patients diagnosed with irritable bowel syndrome (IBS) according to the Rome IV criteria. Materials and Methods: A prospective, observational cohort study was conducted at a gastroenterology clinic between March 2023 and July 2023. Participants included adults diagnosed with IBS based on Rome IV criteria. Patients with significant gastrointestinal disorders, psychiatric conditions, or contraindications to IBS treatment were excluded. Clinical assessments, including Visual Analog Scale (VAS), Bristol Stool Chart, IBS Symptom Severity Score (IBS-SSS), and IBS Quality of Life (IBS-QoL) scores, were conducted before and after treatment. Results: Of the 363 included patients, 174 had T2DM, and 189 did not. T2DM-positive patients were older, had higher BMI and HbA1c levels. The DM-negative group showed significantly better treatment responses in all clinical scores (VAS, Bristol Stool, IBS-SSS, and IBS-QoL) after treatment. While there was no initial difference in clinical scores, posttreatment scores showed a significant disparity between the two groups. Conclusion: This study highlights the complex interplay between T2DM and IBS, emphasizing the need for a comprehensive approach to patient care. It suggests that exocrine pancreatic insufficiency (EPI) may mimic IBS symptoms in T2DM patients, calling for a reconsideration of diagnosis and treatment strategies. These findings underscore the importance of looking beyond surface-level diagnoses and considering comorbidities, leading to improved healthcare for all. Further research with larger and more diverse samples is warranted to validate these results and explore treatment options in more detail.

Evaluation of the Epidemiological, Clinical, and Laboratory Characteristics of Patients with Celiac Disease in South Khorasan (Iran)

Background: Since the early diagnosis of celiac disease (CD) is crucial, understanding its epidemiological characteristics can facilitate timely diagnosis and treatment. This study investigated CD's epidemiological, clinical, and laboratory characteristics in South Khorasan Province, Iran. Objectives: This study aimed to clarify the epidemiological characteristics, clinical manifestations, and laboratory findings of patients with CD in South Khorasan Province. Methods: This descriptive epidemiological research was conducted on 110 individuals with CD referred to the Gastroenterology Clinic from March to August 2019. The data were acquired via a comprehensive questionnaire, encompassing the participants' demographic specifications, medical records, the symptoms of the disease, laboratory diagnostic evaluations, and biopsy results. The data were employed for epidemiological inquiry, and the corresponding analyses were performed in SPSS v. 22. Results: The participants' mean age was 28.38 ± 15.25 years,78 (70.9%) were men, and 32 (29.1%) were women. The most common clinical gastrointestinal symptoms included abdominal pain in 70 (63.6%), diarrhea in 44 (40%), constipation in 43 (39.1%), and nausea in 35 (31.8%). Of the 83 biopsy cases, 3 (3.6%), 4 (4.8%), 9 (10.8%), 21 (25.3%), and 43 (55.4%) belonged to Marsh-I, Marsh-II, Marsh-IIIa, Marsh-IIIb, Marsh-IIIc categories, respectively. Conclusions: Most participants were male and aged 10 to 20 years. Abdominal pain was the most common clinical symptom. All the pathologically examined patients showed evidence of CD, while approximately two-thirds were serologically positive.

Anxiety and Depression in Patients With Inflammatory Bowel Disease at King Fahad Specialist Hospital, Qassim Region.

Background Inflammatory bowel disease (IBD) includes Crohn's disease (CD) and ulcerative colitis (UC). It carries a risk of annual relapses and multiple intense flares, which require lifelong treatment and, sometimes, surgical interventions. This affects patients negatively in various aspects of their functioning, and they are left with an increased risk of disturbed quality of life and mental illnesses. Aim This study is carried out to describe the prevalence and risk factors of anxiety and depression symptoms among adult patients with IBD at King Fahad Specialist Hospital, Qassim, Saudi Arabia, and to examine the relationship between mental illness and disease activity. Patient and methods This cross-sectional descriptive study targets adult patients with IBD attending a gastroenterology clinic and medical day care unit. A self-administered questionnaire was given to patients with the help of an IBD nurse. The questionnaire includes the patient's demographic data (i.e., age, gender, etc.), symptoms and treatment patterns, the General Anxiety Disorder (GAD) questionnaire to measure anxiety, and the Patient Health Questionnaire (PHQ-9) to measure depression. Results Among the 179 IBD patients, 60.9% were males, and 40.8% were in the age group of 25-35 years. CD was the most prevalent IBD (73.2%). Perineal CD was detected in 45%. The prevalence of patients who were positive for anxiety symptoms was 17.3%, while the prevalence of depressive symptoms was 19.6%. The independent risk factor for anxiety was female gender, while the independent risk factor for depression was extraintestinal manifestation. The preventive factor for depression was treatment with IV medication. Conclusion Almost one-fifth of IBD patients were considered to have either anxiety or depression. Female gender was a risk factor for anxiety while extraintestinal manifestation of IBD was a risk factor for depression. Interestingly, treatment with IV medication was found to be the protective factor for depression. More investigations are warranted to give more insights regarding the prevalence and risk factors of psychological disorders among patients with IBD in our region.

Understanding Gut Sensations: Irritable Bowel Syndrome and Diagnostic Fluidity in Danish Clinical Practice

ABSTRACT Irritable bowel syndrome (IBS) is a prevalent health challenge in a Danish welfare context. Drawing on ethnographic fieldwork at two Danish gastroenterology clinics, and inspired by Charles E. Rosenberg’s idea of styles of explaining widespread diseases, we outline three styles of understanding and treating gut trouble in daily clinical work: “The microbial gut,” “the mindful gut,” and “the lifestyled gut.” Moreover, we suggest the concept of fluidity to characterize IBS as a diagnostic category that allows clinicians and patients to operate through complex understandings of permeable boundaries between body, mind, and environment to negotiate personalized solutions for embodied gut sensations.

Use of continuous glucose monitoring in pediatric gastroenterology allows for personalized nutrition support care – Potential for collaboration between pediatric endocrinologists and gastroenterologists

Continuous glucose monitoring (CGM) devices have been approved for the management of patients with diabetes mellitus. Some of the brands available almost completely eliminate the need for finger pricks. We aim to describe our experience with the use of CGM in two patients followed in the gastroenterology clinic due to diseases associated with hypoglycemia and how the information obtained from the devices improved care and outcomes. Data were continuously reviewed through the CGM device remote monitoring system and influenced clinical decisions related to nutrition support. CGMs are now part of standard care for patients with diabetes mellitus. The benefits of these devices and how they can improve the care of patients with disorders typically managed by the gastroenterologist need to be explored. In particular, patients with glycogen storage disorders, fatty acid oxidation defects, and ketotic hypoglycemia can benefit from GCM utilization, allowing for optimal and personalized nutritional care.

Gastroenterology Clinics of North America

Gastroenterology Clinics of North America

Screening of iron deficiency anemia in children with chronic functional constipation

Background Iron deficiency anemia (IDA) is one of the most common nutritional deficiencies worldwide. Constipation is one of the most common gastrointestinal disorders in childhood. Aim To screen for IDA or iron deficiency (ID) among children with chronic functional constipation (CFC). Patients and methods It was a prospective study. Two groups of children in the age range of 1–15 years were collected for 6 months from June 2022 to December 2022 at Alexandria University gastroenterology clinic. Children who fulfilled Rome IV criteria of CFC were assigned to CFC group. Children who did not have constipation were considered as the control group. Complete blood count, serum iron, total iron binding capacity, and serum ferritin were done for both groups. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. Quantitative data were described using range (minimum and maximum), mean, standard deviation, and median. Results Hemoglobin levels, serum ferritin and serum iron were significantly lower in the CFC group when matched with the control group. ID and IDA were significantly higher in the CFC group. The longer days of constipation were correlated with significantly lower hemoglobin, serum iron, and serum ferritin. Conclusion CFC causes mild IDA or ID. The longer the days of CF, the lower values of hemoglobin, iron and ferritin are present. ID and IDA are more common in the CFC group.

Okul Öncesi Çocuklarda Çölyak Hastalığı: Retrospektif Bir Analiz

Background: The aim of this study is to evaluate the medical parameters of celiac disease cases in the preschool age group in terms of public health and to make recommendations to health professionals, policy makers and the society. Materials and Methods: This study was conducted between February 2017 and December 2018 in Şanlıurfa Education and Research Hospital, Pediatric Gastroenterology Clinic. Clinical and laboratory findings of preschool children diagnosed with celiac disease were retrospectively analyzed. Anamnesis, physical examination findings, laboratory findings, endoscopic biopsies and pathology results of pati-ents were evaluated. Results: The most common presenting complaint was growth retardation (96.3%), followed by chronic diarrhea (32.5%) and constipation (27.5%). Height-for-age and weight-for-age values were found to be lower in patients with chronic diarrhea and duodenitis compared to those without (p&amp;lt;0.05). Patients with strong positive tissue transglutaminase-IgA (tTG IgA) levels had significantly higher Marsh scores (p&amp;lt;0.05). Conclusions: For preschool-age children, initiating the diet via early diagnosis and ensuring adherence to diet are the main objectives. Children adhering to the diet have a higher success in elementary school and a shorter adaptation period.

Accuracy of Stool Antigen Test in the Diagnosis of Helicobacter pylori Infection in the Dominican Republic.

This study proposes to define the diagnostic accuracy of the stool antigen test for H. pyloriinfection in the Dominican Republic. An observational, retrospective, and cross-sectional study was conducted. The results of the stool antigen test for H. pylori infection were compared with the results of the gastric biopsy, as a gold standard test. Patients over 18 years of age with an indication for endoscopy due to suspicion of H. pylori infection, who attended the gastroenterology clinic in 2021, were included in the study. It was shown that the stool antigen test for H. pylori infection has a 61.54% sensitivity and 59.65% specificity. According to the study population, the positive predictive value (PPV) was 67.60% and the negative predictive value (NPV) was 53.13%. Low numbers of both sensitivity and specificity were determined, which is why it is pertinent to study alternative non-invasive methods. However, it is important to assess the antibiotic exposure of the study population, since the diagnostic accuracy of the stool test can be influenced by this factor.

Serum Calprotectin as a Potentially Sensitive Biomarker for Inflammatory Bowel Disease in Egyptian Patients

Abstract Background Inflammatory bowel disease (IBD) incidence is increasing nowadays. Its diagnosis depends on invasive techniques such as colonoscopy and biopsy which is the gold standard for diagnosis. Its activity is monitored by fecal calprotectin levels which has a low compliance rate. Although it is unlikely for serum biomarkers to replace colonoscopy, a need exists for a serum biomarker that at least decreases the need for such an invasive technique. Aim of the Work The aim of this work was to evaluate serum calprotectin as a biomarker for IBD in Egyptian patients. Patients and Methods The study was conducted on 50 Egyptian IBD patients, 34% were males and 66% were females with their ages ranging from 15 to 62 years. Based on IBD type 60% were diagnosed as ulcerative colitis (UC) half of them were in clinical activity and the other half in remission and 40% were diagnosed as Chron’s disease (CD) half of them were in clinical activity and the other half in remission. IBD patients were recruited from Gastroenterology Clinic, Ain Shams University Hospitals in the period from October 2019 till October 2020. In addition, 20 race-, sex- and age- matched apparently healthy subjects were included in the study as a control group. Serum calprotectin levels were measured by ELISA. Results The results revealed that the serum levels of calprotectin were significantly higher in IBD patients than in the control group and in clinically active patients than those in remission. There was a positive correlation between serum calprotectin levels, CRP and ESR, however the diagnostic value of serum calprotectin was higher than that of CRP and ESR as serum calprotectin had higher sensitivity and specificity. The specificity of serum calprotectin in diagnosing IBD was 95% and the sensitivity was 98%; the specificity of CRP was 85% and the sensitivity was 64%; the specificity of ESR was 85% and the sensitivity was 62%. Our work revealed that there was a direct relationship between serum calprotectin and platelet count and an inverse relationship between serum calprotectin and albumin and hemoglobin levels. Conclusion Serum levels of calprotectin are increased and are associated with clinical activity in IBD patients so it may become one of the clinically valuable indicators of activity of the disease.

Efficacy and Safety of Probiotic versus Conventional Treatment of Irritable Bowel Syndrome

Abstract Background Irritable bowel syndrome is a gastrointestinal syndrome characterized by chronic abdominal pain and a change in intestinal habits without any organic cause. It affects 11% of the world-wide population. irritable bowel syndrome reduces health-related quality of life and leads to a significant economic healthcare burden. Aim of the Work The aim of this study is to investigate the efficacy of probiotics in irritable bowel syndrome (IBS) patients. Patients and Methods A randomized controlled clinical trial in Gastroenterology and Hepatology outpatient clinic at: Ain Shams University Hospitals for 6 months from November 2020 till April, 2021. 120 Person were included in this study divided into 2 group: Group 1:60 patient with irritable bowel syndrome received conventional treatment and and Lactobacillus Acidophilus probiotics. Group 2: 60 patient with irritable bowel syndrome received conventional treatment. Results There was a significant increase of passage of gas in group 1 than in group 2 but no significant difference in between group 1 and group 2 regarding stool consistency, mucus with stool, abdominal pain, Bloating and passage of stools. There was 46.7% in group 1 and 55% in group 2 had a very good treatment success with no significant difference in between. Regarding to the treatment success in group 1, there were 46.7% in group 1 had a very good treatment success, 33.3% had a good treatment success and 20% had poor response. There was 80% in group 1 had a very good overall tolerability to probiotic treatment. Conclusion This study shows moderate evidence for the use and safety of probiotics in irritable bowel syndrome. Probiotics provide a new strategy as a safer treatment for irritable bowel syndrome. In general, the use of Probiotics has been successful in practice, especially for symptom control and maintenance of remission in these entities. However, it is necessary to take into account the specific condition of the patient and their comorbidities to make informed decisions about management.

Comparison between Serum Vaspin in Chronic Kidney Disease and with Hepatitis C Virus and Normal Control Group

Abstract Background Chronic kidney disease ―CKD|| patients have insulin secretion disorders and resistance to insulin effects, that is responsible for the development of cardiovascular proceedings. Vaspin is an adipcytokine that regulates glucose and lipid metabolism. Aim and objectives To compare serum level of Vaspin in Chronic kidney disease&amp; chronic hepatitis C patients group and normal control group. Subjects and Methods This study is comparative case - control study, was conducted at in Ain shams university hospitals &amp; El Zaitoun Specialized hospital on patients attending gastroenterology and hepatology clinic and nephrology clinic0. Result There was high statistically significant difference between the studied groups as regard vaspin. Conclusion Diabetic nephropathy‖ patients presented a significant increased levels of serum Vaspin when compared to levels to control, serum Vaspin are protective roles. Also, vaspin could be used as specific predictors for liver fibrosis in CHC patients with and without diabetes.