Common Endoscopic Findings Research Articles

Histopathological study of endoscopic biopsies of large intestine

The large intestine is a site of a variety of diseases. The lesions tend to occur affecting different age groups ranging from early childhood to late adulthood. Patients may present with very vague clinical symptoms ranging from abdominal pain, loose stools, vomiting, diarrhoea, bleeding per rectum, and change in bowel habit. Patients presenting with repeated symptoms related to lower intestinal pathology are advised to undergo colonoscopic examination.To study clinico-pathological correlation of endoscopic biopsies of large intestine and to study spectrum of large intestinal lesions.The study was conducted at a tertiary care hospital from August 2018 to July 2020. All endoscopic biopsy samples were included in this study. All endoscopic biopsies were performed by high definition colonoscope. Clinical and endoscopic correlation with histopathological diagnosis was performed and results were generated.Total 133 cases were included in this study, out of 133 patients 86 were males and 47 were females. Patients showed wide age range from 11 years to 80 years. There were 25 patients each in age group of 31-40 years and 61-70 years. The most common presenting complaint was loose stools in 66 cases. The most common endoscopic finding was erythema in 82 cases. Out of 133 cases, 105 cases were non neoplastic, 08 cases were benign neoplastic and 20 cases were malignant neoplastic on histopathology.Colonoscopy is very high yielding and safe procedure to perform.Colonoscopic biopsies are proven to be of great importance. Clinical, endoscopic and histopathological correlation is always advisable in large intestinal pathology for early diagnosis and treatment.

Study of Clinical Profile of Patients with Upper Gastrointestinal Symptoms and their Association with Endoscopy at a Tertiary Care Centre

Introduction: Upper endoscopy, also referred to as Esophagogastroduodenoscopy (EGD), is performed by passing a ­flexible endoscope through the mouth into the esophagus, stomach, and duodenum. The gut is accessible with endoscopy, which can diagnose causes of pain, nausea and vomiting, bleeding, weight loss, altered bowel function, and fever1 . Aims and Objectives: To study indications and findings of patients undergoing upper gastrointestinal (GI) endoscopy, to make association of endoscopic findings in these patients presenting with different upper GI symptoms and to document the demographics of subjects undergoing upper GI endoscopy at a tertiary care centre. Materials and Methods: It was a prospective observational study carried out at the Department of Medicine at Dr Vasantrao Pawar Medical College and Hospital, with due permission from the ethics committee for the period of August 2017 to November 2019. All the patients who were found with upper GI symptoms and underwent endoscopy after giving informed consent were included in the study. Total of 136 patients presenting with upper GI symptoms fulfilling the criteria were included in the study and their endoscopic findings were associated. Results: Out of total 136 patients, maximum number of the patients belonged to 51-60 years age group (21.3%). There was male preponderance (61.8% were male 38.2% were female). The most common GI symptom was hemetemesis/malena (40.4%) followed by nausea/vomiting (27.9%). Esophagitis (37%) was the most common endoscopic finding followed by esophageal varices (33%). Out of 45 patients who had esophageal varices 32 (71%) were treated with Endoscopic Variceal Ligation (EVL) and they responded well. Conclusion: Through this study it was concluded that most of the patients presenting with upper GI symptoms were among the elderly age group (51-60 years). Upper GI bleed was the most common symptom and indication for endoscopy followed by nausea/vomiting. The common endoscopic finding among hematemesis/malena patient was esophageal varices and most of them responded well to Endoscopic Variceal Ligation.

Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

Background/AimsMore than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB). MethodsA systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB. ResultsOur search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%). ConclusionsThe majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

Prevalence of Helicobacter Pylori Infection in Patients with Dyspepsia in North of Iran.

BACKGROUND Dyspepsia is a common complaint among patients who refer to gastroenterology clinics. Studies have shown that there is a strong relationship between dyspepsia and Helicobacter pylori (HP) infection. We have investigated the prevalence of HP infection in patients with dyspepsia and its correlation with age and socioeconomic status (SES) of patients in Mazandaran province, northern Iran. METHODS In this cross-sectional study, patients with dyspepsia who had undergone upper gastrointestinal endoscopy were enrolled. Diagnosis of HP infection was according to the results of rapid urease test (RUT), and Giemsa staining of pathology samples. A questionnaire including endoscopic findings, demographic data, and SES information was completed for each patient. RESULTS The mean age of the 614 patients was 45.8±5 years, and 60% of them were female. Most patients had normal endoscopy (56.1%), and gastric ulcer and erosion was the most common abnormal endoscopic finding (24.7%). The prevalence of HP infection in patients with dyspepsia was about 66.6%. HP infection was associated with a lower prevalence in people aged below 30 years and good SES. CONCLUSION The prevalence of HP infection in patients with dyspepsia was 66.6%. In addition, HP infection rate was lower in people under the age of 30 years and patients with good SES.

Upper Gi Endoscopy-indications and Findings at Tertiary Care Hospital Hyderabad/Jamshoro

Objective: To document different indications and findings of upper GI Endoscopy in our endoscopy suite.
 Methods: A descriptive study of 500 patients who underwent upper gastrointestinal (UGI) endoscopy was conducted in the Endoscopy Unit of PNS DRIGH LUMHS Jamshoro and Civil Hospital Hyderabad from April to September 2020. Included patients underwent UGI endoscopy. Demographic data including indications and endoscopic findings of the patients was collected via study proforma.
 Results: Total five hundred patients were studied; their mean age was 42.4±16.8 years. Out of all 52.8% were males. Upper GI bleed was the commonest indication (33.2%) followed by dysphagia (21.6%), epigastrium pain (10%), surveillance and screening of varices (9% and 8.2% respectively). The most common endoscopic findings were esophageal varices (32.2 %), gastritis (18.8%), and normal (11.4%). In patients with esophageal varices, 77.4% had chronic liver disease with positive serology for HCV and HBV in 63.4% and 23% respectively.
 Conclusion: The most common indication was upper GI bleed with esophageal varices for upper GI endoscopy. The underlying etiology of varices reflects the high burden of chronic liver disease due to viral hepatitis.

Helicobacter pylori infection a risk for upper gastrointestinal diseases among patients in North Central Nigeria

Background: Since the discovery of the Upper Gastrointestinal (UGI) fiber optic endoscope machine in 1868 and following the discovery of Helicobacter pylori (H- Pylori) infection and its association with most gastroduodenal diseases in 1983 by Robin Warren and Barry Marshal, Our knowledge of diagnosis and treatment of most UGI diseases has significantly improved. Aim: The study aimed to establish the presence of H. pylori as a risk factor for common UGI disease as confirmed by UGI endoscopy and the pattern of findings in UGI endoscopy. Methodology: This study is a descriptive cross-sectional study that was carried out at the Endoscopy Unit of Jos University Teaching Hospital. A total of 260 patients referred for UGI endoscopy from August 2013 to April 2014 were recruited and investigated for H. pylori from the biopsy specimens taken during UGI endoscopy. The diagnosis of H. pylori was made by histology. Result: A total of 260 patients were studied, 159 (61.2%) males and 101 (38.8%) females. H. pylori were present in 169 (65%) and absent in 91 (35%). More females had H. pylori compared to males (67.3% and 63.5%). The common endoscopic findings were present in the stomach. Gastritis 57 (21.9%) was the most common abnormality seen in the stomach, while gastroesophageal reflux disease was the most commonly seen in the esophagus and duodenal ulcer in the duodenum. Conclusion: There is a positive correlation between H. pylori infection with endoscopic abnormalities seen among patients.

Various findings in upper gastrointestinal endoscopy in patients presenting with dyspepsia: A clinical study

Background: Incidence of Dysphagia become more prevalent because of the faulty food habits among the people in recent days.Aim: To study incidence of various oesophageal and gastric diseases with respect to age, sex, occupation, socioeconomic status and other factors in our hospital. To find the upper gastrointestinal morphological features among patients presenting with dyspepsia using endoscopy. To find the prevalence of of H-pylori infection in patients presenting with dyspepsia and screening for oesophago-gastric carcinoma among patients presenting with dyspepsia. Materials and Methods: It is a prospective study conducted on patients who presented with dyspepsia in department of general surgery, sree mookabika institute of medical sciences during the period of September 2020 – January 2021.All the patients were evaluated on basis of chief complaints, clinical examination and investigation and They underwent endoscopy and findings were documented, invasive tests like biopsy, rapid urease test and geimsa staining were done findings were tabulated and analysed . Appropriate statistical methods were applied to provide the below mentioned results.Results: Highest prevalence of dyspepsia belong to the age group of 20-40years. Most common presenting complaint was heart burn followed by nausea/vomiting /epigastric discomfort. Dyspepsia were noted more common in male gender comparing to female gender. Most common endoscopic finding among the study population were gastritis followed by esophagitis along with gastritis. H-pylori infection was present in 42.5% of study population. Malignancy was diagnosed in 2.5% patients with dyspepsia. Clinically significant endoscopic findings were observed in 80.8% of patients with non-investigated dyspepsia. Conclusion: Clinically significant endoscopic findings were observed in 80.8% of patients with non-investigated dyspepsia. Prevalence of large number of inflammatory lesions as a result of increased acid production, a remarkable prevalence of H-Pylori infection and low incidence of malignancy in the study group suggests that the non-investigated patients with dyspepsia may be initially managed medically with acid suppressive therapy or H-pylori eradication in cases suspected to be infected. Endoscopy may be undertaken in patients with recurrent symptoms or in whom drug therapy fails.

HISTOPATHOLOGICAL EVALUATION OF LOWER GASTROINTESTINAL TRACT ENDOSCOPIC BIOPSIES

Introduction: Lesions of the lower gastrointestinal (GI) tract account for a substantial source of morbidity and mortality worldwide. GIT endoscopy along with biopsy is an established procedure for investigating a wide range of gastrointestinal conditions. It is not only used to diagnose malignant and inflammatory lesions but is also used for monitoring the course, extent of the disease, response of the therapy and early detection of complications. Hence, endoscopy along with biopsy examination facilitates the diagnosis and early management.
 Methodology: Patients with lower GI tract lesions were included in the study. Endoscopic biopsies were processed for tissue processing. Haematoxlyne and Eosin stained sections were studied.
 Observations: Of the 202 colonoscopic biopsies studied, sex ratio was 1.3:1. Study population comprises of cases ranging from 6 months up to 84 years. Diarrhoea of chronic duration was the predominant clinical presentation among 27% of cases. Ulcerated lesion was the commonest endoscopic finding seen among 33% cases. On endoscopic examination, 17% cases had proliferative growth, 14% cases had polypoidal growth and 06% cases showed stricture. Rectum was the commonest site of involvement seen among 38% cases. Non-neoplastic lesions were 119 (59%), benign were 16 (08%) and malignant were 67 (33%). Chronic nonspecific colitis was the predominant non-neoplastic lesion seen among 34% cases. Adenocarcinoma was the commonest malignant lesion contributing for 85% of malignant lesions of lower GIT.
 Conclusion: Colonoscopy with biopsy examination is the gold standard tool for the diagnosis of lower GI lesions. It is simple, safe, and relatively less invasive with high accuracy.
 Keywords: Endoscopy, Colonoscopy, Lower GIT, Colorectal cancer, Biopsy.

Endoscopic and MRI response evaluation following neoadjuvant treatment for rectal cancer: a pictorial review with matched MRI, endoscopic, and pathologic examples.

A nonoperative management strategy, or Watch-and-Wait, following neoadjuvant therapies of locally advanced rectal adenocarcinomais increasingly considered for select patients. Yet, standardized tumor response assessment to best select and surveil suitable patients remains an unmet clinical challenge. Endoscopic and MRI currently provide the most reliable tumor response estimations. However, resources illustrating variable tumor responses to neoadjuvant therapies remain limited. This pictorial review aims to provide detailed and annotated examples of common endoscopic and MRI findings of rectal cancer treatment response, while also emphasizing their respective diagnostic shortcomings and consequently, the necessity for a multidisciplinary approach to optimally manage these patients.

Endoscopic Findings in Patients With Uninvestigated Dyspepsia: A Retrospective Study From Qatar.

Background and objectiveDyspepsia is a common complaint encountered in general clinical practice. The prevalence of clinically significant endoscopy findings in dyspeptic subjects of various age groups and ethnicities in Qatar is not well studied. This study aimed to evaluate the prevalence of endoscopic findings in previously uninvestigated patients with dyspepsia.Patients and methodsWe retrospectively studied subjects older than 18 years of age who underwent endoscopy for dyspeptic complaints from January 2011 to December 2017. Subjects who already had peptic ulcer disease (PUD), those who underwent endoscopy for reasons other than dyspepsia, and those with incomplete data were excluded.ResultsA total of 824 subjects were reviewed for eligibility and 733 were included for analysis. The mean ±SD age of the study subjects was 42.7 ±13.5 years, and 59.5% of the subjects were male. Epigastric pain was the predominant symptom (79.2%) followed by heartburn (26.1%). Abnormal endoscopic findings were noted in 91.8% of subjects. Gastritis (65.5%) and oesophagitis (33.1%) were the most common findings observed. The overall prevalence of gastric ulcers was 4.6%, and it was higher in subjects who were more than 60 years of age (14.1%, p=0.001). Gastric carcinoma was seen in only four (0.54%) subjects.ConclusionGastritis was the most common endoscopic finding observed followed by oesophagitis. The most common presenting symptoms were epigastric pain and heartburn. The prevalence of gastric ulcers was significantly high in patients above 60 years of age, and the incidence of gastric carcinoma was low in the study population.

S2953 Rare Metastatic Gastric Melanoma Causing Iron Deficiency Anemia

INTRODUCTION: Melanoma is the fifth most common cancer in males and sixth most common cancer in females in the United States and accounts for about 1% of all skin cancers. Melanoma is highly metastatic. The most common sites of metastasis are liver, bone and brain and rarely, the gastrointestinal (GI) tract. Within the GI tract, melanomas usually metastasize to the small intestine, followed by colon, rectum and stomach in that order. Here, we present a case of cutaneous melanoma metastatic to the stomach presenting as iron deficiency anemia. CASE DESCRIPTION/METHODS: A 74-year-old Caucasian male presented with progressive fatigue and generalized weakness due to iron deficiency anemia. He had a history of various skin cancers including cutaneous melanoma involving the scalp for which he had undergone Mohs micrographic surgery with adjuvant chemoradiation two years prior. Complete blood count showed a hemoglobin of 6.7 g/dl, MCV 83.8 fL, iron of 58 ug/dL, iron saturations of 4%, and ferritin of 18 ng/mL. An esophagogastroduodenoscopy (EGD) showed at least five, 10 to 15mm, umbilicated lesions, with central dark pigmentation within the antrum, body and fundus of the stomach. Biopsies revealed metastatic melanoma. A computed tomography of the chest, abdomen and pelvis revealed evidence of additional metastases involving bilateral lungs, liver and multiple lymph nodes within the abdomen and pelvis. He was treated with ipilimumab and novilumab as immunotherapy. DISCUSSION: Metastasis of cutaneous melanoma to stomach accounts for less than 5% of all gastrointestinal metastatic melanoma. In a case series of such patients, the median time from initial diagnosis of cutaneous melanoma to gastric metastasis was 2 years. Gastric metastatic melanoma can present with upper GI symptoms, iron deficiency anemia, and frank GI bleeding. Nodules with central umbilication, pigmentation and ulceration, described as “doughnut” or “bull’s eye” appearance is the most common endoscopic finding. Immunohistochemistry of biopsies show homogenous staining for S-100, MART1 and HMB45 proteins. Genetic analysis for BRAF V600 and NRAS mutations guides appropriate treatment with immunotherapy approved for the former. For those with NRAS mutations, gastric resection with adjuvant chemotherapy is required for treatment and palliation.Figure 1.: Multiple, 10 to 15mm, umbilicated lesions, with central dark pigmentation within the antrum, body and fundus of the stomach.Figure 2.: Rare endoscopic finding of metastatic melanoma to the stomach with a lesion with central umbilication, dark pigmentation and ulceration often described as “doughnut” or “bull's eye” appearance.

Mantle cell lymphoma with gastrointestinal involvement and the role of endoscopic examinations.

Studies on gastrointestinal (GI) tract involvement in mantle cell lymphoma (MCL) are lacking. We investigated the clinical characteristics and prognosis of MCL with GI tract involvement. We retrospectively analyzed 64 patients diagnosed with MCL from January 2009 to April 2017. At the time of MCL diagnosis, patients who were identified to have GI involvement by endoscopic or radiologic examination were assigned to the GI-MCL group. The other patients were assigned to the non GI-MCL group. The GI-MCL group included 28 patients (43.8%). The most common endoscopic finding of MCL was lymphomatous polyposis (20/28, 71.4%). The GI-MCL group had higher stage and International Prognostic Index status (P = 0.012 and P = 0.003, respectively). Among the total 51 GI lesions in the GI-MCL group, 31.4% (16/51) were detected only by endoscopic examinations and were not detected on CT or PET-CT. The cumulative incidence of recurrence was higher in the GI-MCL group compared with the non GI-MCL group but the difference was not statistically significant (P = 0.082). Stage (HR 1.994, 95% CI 1.007-3.948) and auto PBSCT (HR 0.133, 95% CI 0.041-0.437) were identified as independent predictive factors for recurrence. Recurrences at GI tract were identified in 59.1% (13/22) and 11.1% (2/18) of the GI-MCL and non GI-MCL group, respectively. Among 15 GI tract recurrences, five recurrences were detected only with endoscopic examinations. Endoscopy can reveal the GI involvement of MCL that is not visualized by radiological imaging. Endoscopic examinations are recommended during staging workup and the follow-up period of MCL patients.

Clinical significance of endoscopy before bariatric surgery: An experience of a tertiary hospital

IntroductionThe obesity has been found to be associated with many gastrointestinal disease conditions like GERD, Hiatus hernia and Helicobacter pylori. The choice between performing routine and selective upper endoscopy in the preoperative preparation of all obese patients presenting for bariatric surgery remains controversial. MethodsWe conducted a retrospective record based study on 184 patients with obesity, who were undergone endoscopy before bariatric surgery over a period of 2015–2020 at Gastroenterology clinic, Aseer Central Hospital, Abha, Saudi Arabia. ResultsThe highest proportion was aged between 35 and 44 years (36.4%) where most of them had morbid obesity (84.8%). The most common abnormal endoscopic findings were Hiatus hernia (23.4%), Gastritis (59.2%); 14.1% had duodenitis and 4.3% had ulcers. ConclusionIn conclusion, according to the higher percentage of a large range of disorders in upper-GI tract in obese patients, we suggest that routine preoperative endoscopy prior in bariatric surgery patients may help in the discovery of GI pathologies that may affect not only the surgery procedure but also the bariatric follow-up.

Indications and findings of lower gastrointestinal endoscopy: a retrospective study in Eastern Regional Hospital, Koforidua, Ghana

INTRODUCTION: Colonoscopy is a safe and effective means of visual inspection of the large bowel from the distal rectum to the caecum. There is a paucity of data on this procedure in Ghana. The only data in literature are from Kumasi and Accra. This paper reviews the indications and findings of lower gastrointestinal endoscopy (LGIE) in Eastern Regional Hospital, Koforidua, Ghana. METHODS: a retrospective study was undertaken on patients who underwent colorectal endoscopy between January 2019 and December 2019. RESULTS: one hundred and six (106) LGIE procedures were performed. Sixteen patients had flexible sigmoidoscopy and the rest had full colonoscopy. Of those who had colonoscopy, caecal intubation rate was 86.2%. Males were 69 and mean age 56.67 ± 16.48. The most common primary indication was bleeding per rectum. The most common primary endoscopic finding was haemorrhoids (54.17%) followed by colorectal tumors (15.0%). 11.6% of the patients had normal endoscopic findings. A diagnosis of haemorrhoids was made in 61.6% of those presented with bleeding per rectum as an indication and was the commonest cause of lower gastrointestinal bleeding (LGIB). CONCLUSIONS: the commonest indication for colonoscopy was rectal bleeding, while the most frequent pathology was haemorrhoids. The proportion of our patient population found to have a colorectal tumor or polyps was not insignificant. Screening program for colorectal cancer in Ghana should be considered.

Clinical Profile and Upper Gastrointestinal Endoscopic Findings of Patients Presenting with Liver Cirrhosis with Portal Hypertension

Introduction: Liver cirrhosis is a common problem faced by physicians worldwide and is also responsible for 11th most common cause of death globally. Data regarding prevalence of esophageal varices and other upper gastrointestinal changes in patients with liver cirrhosis is scare in Nepal. So this study was carried out to find clinical profile and upper gastrointestinal endoscopic findings of patients presenting with liver cirrhosis with portal hypertension.
 Methods: This was a cross-sectional observational hospital based study conducted in the department of internal medicine and endoscopy unit of the Universal College of Medical Sciences, Bhairahawa, Nepal. The study was done from 21 February 2019 to 20 November 2019 in the patients presented with liver cirrhosis with portal hypertension. Sample size of 80±10 was calculated based on the statistics of previous data. The upper gastrointestinal endoscopy was done in all the patients. The data was collected using the predesigned pro-forma.
 Results: Total 89 patients with liver cirrhosis were enrolled with mean age of 51.84±12.26 years and male: female ratio of 3.68:1. As per Child Pugh classification (CTP) 45 patients (51%) were in Class C, 33 patients (37%) were in Class B and 11 patients (12%) were in Class A. Esophageal varices were present in 51 (57.3%) patients. According to Westaby classification grade I esophageal varices were seen in 17 (19.1%), grade II esophageal varices were seen in 26 (29.2%), grade III esophageal varices were seen in 8 (8.9%) patients. Portal hypertensive gastropathy (PHG) was seen in 64 (71%) patients. The association between esophageal varices and PHG grade was found statistically significant (P= <0.001).
 Conclusions: Liver cirrhosis was more commonly seen in middle age males. Esophageal varices and portal hypertensive gastropathy were common endoscopic findings present in patients with liver cirrhosis. There was statistically significant association between esophageal varices and PHG.

Nationwide Multicenter Study of Eosinophilic Esophagitis in Korean Children.

PurposeIn East Asian countries, there are only a few epidemiologic studies of eosinophilic esophagitis (EoE) and no studies in children. We investigated the incidence and compared the clinical characteristics of EoE and eosinophilic gastroenteritis involving the esophagus (EGEIE) in Korean children.MethodsA total of 910 children, who had symptoms of esophageal dysfunction, from 10 hospitals in Korea were included. EoE was diagnosed according to diagnostic guidelines and EGEIE was diagnosed when there were >15 eosinophils in the esophagus per high power field (HPF) and >20 eosinophils per HPF deposited in the stomach and duodenum with abnormal endoscopic findings.ResultsOf the 910 subjects, 14 (1.5%) were diagnosed with EoE and 12 (1.3%) were diagnosed with EGEIE. Vomiting was the most common symptom in 57.1% and 66.7% of patients with EoE and EGEIE, respectively. Only diarrhea was significantly different between EoE and EGEIE (p=0.033). In total, 61.5% of patients had allergic diseases. Exudates were the most common endoscopic findings in EoE and there were no esophageal strictures in both groups. The median age of patients with normal endoscopic findings was significantly younger at 3.2 years, compared to the median age of 11.1 years in those with abnormal endoscopic findings (p=0.004).ConclusionThe incidence of EoE in Korean children was lower than that of Western countries, while the incidence of EGEIE was similar to EoE. There were no clinical differences except for diarrhea and no differences in endoscopic findings between EoE and EGEIE.

UPPER GASTROINTESTINAL ENDOSCOPY IN IDO-EKITI, NIGERIA: A FOUR-YEAR REVIEW

Background: Upper gastrointestinal complaints are common, and the underlying diseases varies widely. Upper gastrointestinal endoscopy is the gold standard investigation for upper gastrointestinal symptoms. It helps in the proper diagnosis and the appropriate management of the underlying lesions. Aim: To determine the characteristics of the patients undergoing upper gastrointestinal endoscopy in a rural community in south-western Nigeria. Methods: This was a retrospective cohort study of all patients who had upper gastrointestinal endoscopy between February 2016 and February 2020 (a period of 4 years). The Age, Gender, Indication and the Endoscopy findings were obtained from the Endoscopy Register. A total of 181 upper gastrointestinal endoscopies had been performed over the period. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive statistics used included frequency tables, means and standard deviations. Results: A total number of 181 Oesophagogastroduodenoscopies (OGDs) were performed during the period under review, out of which 95 (52.5%) were males and 86 (47.5%) were females with a male to female ratio of 1.1 to 1. The age range of the patients was 9 to 89 years with a mean(±SD) of 52.4(±1.69) and median of 52.0 years. The highest number of OGDs were performed on individuals within the age bracket of 50-59 years whom were mostly females. Dyspepsia constituted the commonest indication for OGD (51.9%) followed by symptoms of upper gastrointestinal bleeding (haematemesis/melaena) 16.0%, unexplained persistent vomiting 6.6% and clinical suspicion of a gastric tumour 5.5%. The commonest endoscopic abnormality detected from this study was Gastritis 28.2% followed by Gastric erosions 12.2%, Duodenal ulcers 8.8%, Gastric tumours 8.3% and Oesophagitis 7.2%. Normal endoscopy findings were found in 24.9% of the patients. Gastritis was also the commonest endoscopic finding (constituting 40.4%) in patients who had OGD done on account of dyspepsia followed by Duodenal ulcers (8.5%) and Gastric erosions (6.4%). Gastric erosions constituted the commonest cause of upper gastrointestinal bleeding in this study (44.8%) followed by Duodenal ulcers (13.8%). Conclusion: The commonest indication for upper gastrointestinal endoscopy in this study was dyspepsia while the commonest endoscopic diagnosis was gastritis. Gastric erosion was most commonly seen in patients with upper gastrointestinal bleeding. From this study, Acid-Peptic disorders were the commonest underlying gastrointestinal pathologies of patients’ symptomatology necessitating endoscopic evaluation. The findings from this study conducted in a rural community in Nigeria were similar to those conducted in urban communities in the country. Therefore, a national guideline on the endoscopic evaluation of upper gastrointestinal disorders can be universally applied irrespective of the location of practice in Nigeria.

Prevalence and Endoscopic Findings of <i>Helicobacter pylori</i> Infection among Dyspeptic Patients in Kenya

Background: Helicobacter pylori is the most common cause of chronic human infections worldwide with the highest reported prevalence in Africa. It is associated with numerous upper gastrointestinal diseases such as gastritis, peptic ulcers, and gastric cancer. Endoscopic findings in the stomach usually associated with Helicobacter pylori infections include gastritis and gastro-esophageal reflux disease (GERD), however, these findings are suggestive but not diagnostic of Helicobacter pylori infection. Methods: This was a prospective study conducted between January 2018 and February 2019 at the Aga Khan University Hospital where dyspeptic patients scheduled for gastroduodenoscopy were enrolled. These patients were evaluated for Helicobacter pylori infection by rapid urease test, culture and histopathology. Diagnostic findings and patient history collected from medical files were documented and data analyzed. Results: A total of 487 dyspeptic patients undergoing esophagogastroduodenoscopy (EGD) were enrolled in the study and 199 dyspeptic patients were positive for Helicobacter pylori infection. The prevalence was 54.6% in males and 45.4% in females (p = 0.1546. The most common clinical indication and endoscopic findings were heart burn (25.2%) and gastritis (53.7%). Histopathology revealed that 86.1% of the dyspeptic patients had chronic active gastritis (p < 0.005) and 52.8% of them had H. pylori infection. Conclusions: Classical endoscopic findings such as GERD are not always indicative of H. pylori infection as its association with H. pylori infection was not statistically significant in this study.

Endoscopic findings in patients presenting with dysphagia: An observational study

Background: Dysphagia is a symptom of an underlying disease with a variety of conditions linked to it. Therefore, its early evaluation is of prime importance. The objective of this study was to present the endoscopic findings in patients presenting with dysphagia. Material and Methods: After ethical approval, a retrospective observational study using non-probability convenient sampling technique was carried out at the Department of Medicine, Hamdard University Hospital, Karachi for a period of 1 year from 01-07-2018 to 30-06-2019. From a sample of 400 patients, 232 were selected who were above 25 years of age and presented with dysphagia. Pregnant mothers, patients previously diagnosed with GI malignancy, patients with a neurological cause of dysphagia or with normal upper GI endoscopy within last 3 months were excluded. SPSS version 20.0 was used for data analysis. Frequency and percentages of the categorical variables such as gender and the common GI Endoscopic findings were reported. Results: Apart from dysphagia, 8.2% of patients complained of abdominal pain, 6.5% of dyspepsia and 4.3% of weight loss. Of all the endoscopies performed, 6.5% were normal, 65.4% revealed oesophageal pathologies, 25% gastric and 2.6% duodenal pathologies. Of those with abnormal endoscopies, the most common diseases were oesophageal mass lesion (28.4%), gastritis (22.8%), oesophagitis (12.9%), oesophageal motility disorders (8.2%) and oesophageal structural disorders (8.2%). Conclusion: Apart from normal endoscopies, oesophageal disorders were most frequently found on endoscopy of patients who presented with dysphagia. Oesophageal mass lesions were the most common finding followed by gastritis.

Association Between Endoscopic and Histologic Findings in a Multicenter Retrospective Cohort of Patients with Non-esophageal Eosinophilic Gastrointestinal Disorders.

Little is known about the endoscopic and histologic findings of non-esophageal eosinophilic gastrointestinal diseases (EGID). To characterize the presenting endoscopic and histologic findings in patients with eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC) at diagnosis and 6months after initiating the treatment. We conducted a retrospective cohort study at 6 US centers associated with the Consortium of Eosinophilic Gastrointestinal Researchers. Data abstracted included demographics, endoscopic findings, tissue eosinophil counts, and associated histologic findings at diagnosis and, when available, after initial treatment. Of 373 subjects (317 children and 56 adults), 142 had EG, 123 EGE, and 108 EC. Normal endoscopic appearance was the most common finding across all EGIDs (62% of subjects). Baseline tissue eosinophil counts were quantified in 105 (74%) EG, 36 (29%) EGE, and 80 (74%) EC subjects. The mean peak gastric eosinophil count across all sites was 87 eos/hpf for EG and 78 eos/hpf for EGE. The mean peak colonic eosinophil count for EC subjects was 76 eos/hpf (range 10-500). Of the 29% of subjects with post-treatment follow-up, most had an improvement in clinical, endoscopic, and histologic findings regardless of treatment utilized. Reductions in tissue eosinophilia correlated with improvements in clinical symptoms as well as endoscopic and histologic findings. In this large cohort, normal appearance was the most common endoscopic finding, emphasizing the importance of biopsy, regardless of endoscopic appearance. Decreased tissue eosinophilia was associated with improvement in symptoms, endoscopic, and histologic findings, showing that disease activity is reversible.