Gastrointestinal Department Research Articles

Correlations between Clinic Preferences and Alcohol Use Disorder: an Alcohol Cohort Study in Northern Taiwan in 2022

IntroductionChronic alcoholism can result in severe liver conditions such as fatty liver disease and cirrhosis, potentially leading to life-threatening complications and premature death.ObjectivesThis study investigated the age-sex distribution of patients with alcohol addiction and aimed to identify differences in clinic department preferences based on their principal and additional diagnoses in Taiwan, in 2022.MethodsWe conducted a comprehensive analysis of the diagnostic patterns of 334 patients with alcohol addiction from the Taoyuan General Hospital, Ministry of Health and Welfare.ResultsFigure 1 depicts patient demographics, highlighting 297 male and 37 female patients with alcohol-related disorders. Males aged 41-60 years were particularly dominant, as shown in Figure 2. Principal diagnoses, including alcoholic liver disease and acute pancreatitis, are detailed in Table 1. Additional diagnoses, such as chronic pancreatitis and esophageal varices, are presented in Table 2. For departmental preferences, Table 3 reveals the Gastrointestinal (GI) department as the top choice, followed by Kidney, Neurological, and Cardiovascular/Chest.Table 1.Top 5 Principal Diagnoses of Alcohol Addiction Patients.ICD-10-CMPrinciple diagnosisTimesRankK70Alcoholic liver disease431K85Acute pancreatitis272F10Alcohol related disorders183A41Other sepsis144K86Other chronic pancreatits115Table 2.Top 5 Additional Diagnoses of Alcohol Addiction Patients. ICD-10-CMAdditional diagnosisTimesRankF10Alcohol related disorders401K86Other chronic pancreatits182I85Esophageal varices163K70Other sepsis16E87Other disorders of fluid, electrolyte and acid-base balance154R65Symptoms and signs specifically associated with systemic inflammation and infection105Table 3.Top 5 Departments for Alcoholism Patient Presentation.DepartmentTimesRankGastrointestinal1621Kidney392Neurological253Cardiovascular Chest154Image:Image 2:Conclusions The study revealed that patients with alcohol addiction often delay seeking psychiatric help instead of presenting for medical care only after liver or gastrointestinal complications occur. This underscores the crucial need for better health education regarding the relationship between alcohol addiction and liver disease. Prompt recognition and early intervention for substance addiction can significantly reduce these risks and improve patient outcomes.Disclosure of InterestNone Declared

Effect of screening colonoscopy frequency on colorectal cancer mortality in patients with a family history of colorectal cancer.

Colorectal cancer is a common malignant tumor in China, and its incidence in the elderly is increasing annually. Inflammatory bowel disease is a group of chronic non-specific intestinal inflammatory diseases, including ulcerative colitis and Crohn's disease. To assess the effect of screening colonoscopy frequency on colorectal cancer mortality. We included the clinicopathological and follow-up data of patients with colorectal cancer who underwent laparoscopic colectomy or open colectomy at our Gastrointestinal Department between January 2019 and December 2022. Surgical indicators, oncological indicators, and survival rates were compared between the groups. The results of 104 patients who met the above criteria were extracted from the database (laparoscopic colectomy group = 63, open colectomy group = 41), and there were no statistically significant differences in the baseline data or follow-up time between the two groups. Intraoperative blood loss, time to first ambulation, and time to first fluid intake were significantly lower in the laparoscopic colectomy group than in the open colectomy group. The differences in overall mortality, tumor-related mortality, and recurrence rates between the two groups were not statistically significant, and survival analysis showed that the differences in the cumulative overall survival, tumor-related survival, and cumulative recurrence-free rates between the two groups were not statistically significant. In elderly patients with colorectal cancer, laparoscopic colectomy has better short-term outcomes than open colectomy, and laparoscopic colectomy has superior long-term survival outcomes compared with open colectomy.

Protocolo diagnóstico de la pirosis retroesternal

Pyrosis is one of the typical symptoms of gastroesophageal reflux disease. It is one of the most common causes for consultation in primary care and gastrointestinal department clinical practice. In Spain, it has been reported that approximately one out of every three people has pyrosis on a regular basis. Therefore, its diagnosis is of utmost importance. Pyrosis’ favorable response to empirical treatment with proton pump inhibitors allows for diagnosing it in the absence of alarm symptoms. If alarm signs are present, an upper gastrointestinal endoscopy (UGIE) should be performed as soon as possible. Patients who do not respond to medical treatment and whose UGIE does not show abnormalities compatible with gastroesophageal reflux disease should undergo a pH meter test±esophageal impedance testing without treatment.

Results of laparoscopic Heller-Toupet operation for achalasia

Objectives: This study was carried out to evaluate surgical outcomes of laparoscopic Heller-Toupet surgery for achalasia. Methodology: This is a retrospective case series implemented at the Gastrointestinal Department, Hanoi Medical University Hospital between January 2015 and August 2022, including 71 patients with achalasia who underwent laparoscopic Heller-Toupet. Results: 52.1% of patients in the study are male (more than female 47.9%). The average age of the cohort was 44.9±13.9 years. The incidence of dysphagia was 100%. Most patients report esophageal dilatation grade II (76.1%) and disease severity stage I (57.7%). The mean muscle opening length was 7.4±1.3 cm, the operative time was 135±25 minutes. There was no conversion, no intra-and postoperative adverse events. Long-term outcomes: good (no or very mild dysphagia) was 90.1%, moderate (moderate dysphagia) was 9.9% and clinical incidence of reflux syndrome was 17%. There was no case requiring intervention or re-operation. Conclusions: Laparoscopic Heller-Toupet is a safe, low rate of intra- and postoperative complication, and brings good long-term outcomes in the treatment of achalasia.

Superior mesenteric artery syndrome in an 8-year-old boy: a case report

BackgroundSuperior mesenteric artery syndrome (SMAS), also known as Wilkie's syndrome, is a rare disease that mainly presents as intestinal obstruction with a variable incidence ranging from 0.013 to 0.3% (Salehzadeh et al. in Case Rep Gastrointest Med, 2019, 10.1155/2019/3458601). In this syndrome, the third part of the duodenum, located between the abdominal aorta and the superior mesenteric artery, is wholly or partially obstructed (Mosalli et al. in J Pediatr Surg 46:e29–31, 2011).Case presentationAn 8-years-old Arabian male patient was admitted to the gastrointestinal department at the pediatric hospital in Damascus, Syria, with complaints of chronic abdominal pain and periodic vomiting since he was two years old. At the age of Seven, he was diagnosed with appendicitis, and after two months of persistent symptoms, he was diagnosed with an umbilical hernia. Finally, after a long time of suffering, he was diagnosed with SMAS and underwent a successful surgical operation. After 3 months of follow-up, he was in good health with no symptoms.ConclusionWhenever a patient complains of vomiting and chronic abdominal pain, intestinal obstruction is suspected, Common differential diagnoses were excluded and the cause is anonymous, we should consider superior mesenteric artery syndrome.

A real-word study: is normothermic intraoperative intraperitoneal chemotherapy impactful as we expect?

Patients with gastric cancer have a poor prognosis. Currently, intraperitoneal chemotherapy has been considered a therapeutic option to improve prognosis due to its appealing theoretical rationales. But there is no consensus on the choice of chemotherapeutic agents used in intraperitoneal chemotherapy for gastric cancer. The real-world efficacy of applying intraoperative chemotherapy in gastric cancer still remains undefined. Patients with gastric cancer who underwent radical gastrectomy at the Gastrointestinal Department of The First Affiliated Hospital of Anhui Medical University between 2012 and 2019 were enrolled in this study. Patients were divided into two groups based on whether they received intraperitoneal chemotherapy. The t-test (mean of two samples) was conducted to compare the difference in measurement data between the two groups, and the chi-square test was used to compare the difference in count data. Kaplan-Meier method with log-rank test was performed to analyze the overall survival of patients. Kaplan-Meier method with log-rank test was also performed in various subgroups to respectively compare the survival of patients. Multivariate Cox analysis was performed to analyze the prognosis factors of these patients. A total of 1253 patients were included in the final analysis, in which 861 patients received intraperitoneal chemotherapy and 352 not received intraperitoneal chemotherapy. The clinicopathological features of the participants in the two groups were comparable. There was no significant difference between the two groups in overall survival (P > 0.05). Consistently, no significant difference was found between the two groups in each subgroup (P > 0.05). The multivariate Cox analysis demonstrated that only age, BMI, pathological type, TNM stage, and differentiation grade were independent risk factors of survival. Intraoperative intraperitoneal chemotherapy usage did not improve survival in patients with gastric cancer undergoing radical gastrectomy.

Endoscopic study on portal hypertensive colopathy in cirrhotic patients

Background and Aim: Liver Cirrhosis patients are more prone to lower gastrointestinal (GI) bleeding hypothetically caused by portal hypertensive colopathy (PHC) and anorectal varices (ARVs). The present study aimed to determine the incidence of colopathic lesions and investigate their association with cirrhosis severity and portal hypertensive colopathy manifestation. Patients and Methods: This cross-sectional study was carried out on 80 liver cirrhosis patients in the Department of Gastrointestinal, CMH Hospital Lahore from January 2021 to December 2022. Individuals aged >18 years with liver cirrhosis were enrolled. Each individual underwent laboratory, clinical, and ultrasonographic examinations. Upper gastrointestinal endoscopy was used to detect the PHC. Based on the colopathic lesions severity, patients were categorized into three grades: grade I (colonic mucosa), grade II (mucosa with mosaic-like pattern), and grade III (angiodysplasia-like colon lesions). SPSS version 27 was used for data analysis. Results: The overall mean age was 48.62±5.6 years with an age range 19 to 70 years. Of the total patients, there were 60 (75%) male and 20 (25%) females. Child-Pugh classification of patients were as follows: Class A 16 (20%), Class B 29 (36.3%), and Class C 35 (43.7%).

Gastrointestinal Disease in the Population Aged 80 Years and above in Korea during Recent Decades: Multi-center Cross-sectional Study

Globally, the population aged 80 years or older is growing faster due to the rising life expectancy. Korea has already entered into an advanced aged society, and a post-aged society is expected in 2025. This study evaluated the patterns of gastrointestinal disease in the population aged 80 years or older during the recent decade in Korea. This study retrospectively reviewed the medical records of patients admitted to the gastrointestinal department of Suwon St. Vincent's hospital, Incheon St. Mary's hospital, and Uijeongbu St. Mary's Hospital - general hospitals of Seoul-Gyeonggi province in Korea. It was a repeated cross-sectional study in 2009 and 2019. The number of admitted patients aged 80 years or older increased from 549 (9.0%) in 2009 to 1,073 (14.4%) in 2019 (p<0.01). As for the in-hospital mortality, there was no significant difference (p=0.25). On the other hand, the combined morbidities increased, and the duration of admission also increased (7.2±7.8 days vs. 8.1±8.2 days, p=0.03). The number of upper gastrointestinal hemorrhage and patients who are bleeding associated with drugs users increased (p<0.01). The proportion of lower gastrointestinal disease decreased (p<0.01) because of the decrease in procedure-related admissions (p<0.01). The number of those with pancreaticobiliary tract disease increased markedly (p<0.01), and the rate of cases that could not perform the procedure decreased (p=0.04). The patterns of gastrointestinal disease in the population aged 80 years or older have changed in the recent decade in Korea. Hence, more preparation for this medical environment is needed.

Multiple polypoid lesions with erosion of the gastric mucosa in adult T-cell lymphoma/leukemia superimposed on cytomegalovirus infection.

We report here unique endoscopic findings of cytomegalovirus (CMV) gastritis associated with adult T-cell leukemia/lymphoma (ATLL). A 67-year-old Japanese man presented to a hematologist with a month history of appetite loss. Physical examination showed blurred consciousness (GCS E4V2M5) with labored breathing and hypotension. Blood examination revealed hypercalcemia (adjusted Ca: 3.24 mmol/L), anemia (Hb: 70 g/L), and leukocytosis (white blood cell count: 21.3 × 109/L) with abnormal lymphocytes (7%). Human T-cell lymphotropic virus type 1 antibody and provirus DNA monoclonality were positive. A blood transfusion was given, and noradrenaline and denosumab were administered. Upper gastrointestinal tract endoscopy showed multiple polypoid lesions with redness and erosive surface (upper left; see Figure 1). A gastric-biopsy specimen showed the presence of CD3+CD4+CD8− T cells, compatible with the gastric involvement by ATLL, and CMV gastritis presenting with inclusion bodies positive for anti-CMV antibody by immunohistochemistry (upper right and lower left; see Figure 1). CMV antigenemia was present, and soluble interleukin-2 receptor was markedly elevated at 119,194 U/ml. CMV enteritis was also observed. He was treated with ganciclovir for CMV gastroenteritis. One-month after repeated endoscopy revealed a significant regression of redness and erosion of polypoid lesions (lower right; see Figure 1). Two months later, he has been undergoing chemotherapy for ATLL. Since gastric involvement by ATLL presenting as multiple lymphomatous polyposis could only been observed in advanced stage [1, 2], we seldom encounter with this lesion nowadays. Although CMV antigenemia is frequently observed in ATLL patients [3], we rarely treat ATLL patients with CMV infections, particularly gastritis. The present case illustrates the rare complication of ATLL in these days (see Figure 1). This study was conducted by the support of the staffs at gastrointestinal department in the Uji Tokushukai Medical Center. All the authors have no conflict of interest. The authors received no specific funding for this work. All procedures performed in this study involving the patient were in accordance with the ethical standards of our institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Conceptualization, Methodology, Investigation, Data curation, Visualization, Writing-Reviewing and Editing: Yutaka Shimazu. Investigation, Data curation and Visualization: Fumihiko Kouno. Investigation, Writing-Reviewing and Editing: Shinsaku Imashuku. Investigation, Writing-Reviewing and Editing: Keisuke Shindo. Investigation, Supervision and Writing-Reviewing and Editing: Takashi Miyoshi.

Endometriosis in para-aortic lymph node resembling a malignancy: a case report and literature review

BackgroundEndometriosis is a common benign gynecological disease characterized by growing-functioning endometrial tissue outside the uterus. Extra-pelvic endometriosis, which accounts for approximately 12% of endometriosis, is more challenging to diagnose because of its distance from the pelvic organs. Halban's theory of benign metastasis indicates that endometrial cells can appear in extra-pelvic organs via lymphatic and blood vessels, but endometrial lymph node metastasis cases are still rare. We report a case of endometriosis in a para-aortic lymph node whose clinical behavior mimicked a malignancy.Case presentationA 52-year-old perimenopausal woman underwent laparoscopic hysterectomy plus bilateral salpingectomy (the patient insisted on the preservation of her ovaries) at a local hospital 2 years earlier because of adenomyosis. The patient presented with a complaint of low back pain to the gastrointestinal outpatient department of our hospital. The carbohydrate antigen 125 (CA125) was abnormally elevated at 5280.20 U/ml, human epididymis 4 (HE4) was 86.0 pmol/L, while other tumor markers were normal. Serum female hormone results were in the postmenopausal range, and her gastroenteroscopy showed no abnormalities. Moreover, both enhanced magnetic resonance imaging and positron emission tomography-computed tomography showed a high possibility of a retroperitoneal malignant lymph node (metastasis possible, primary site unknown). One week after admission, she underwent laparoscopic exploratory surgery, during which we observed normal shape and size of both ovaries while the left ovary was cystic-solid. After opening the retroperitoneal space, an enlarged lymph node-like tissue measuring 8 × 4 × 3 cm3 was found near the abdominal aorta. When the surrounding adhesions were separated, lymph node-like tissue was poorly demarcated from the abdominal aorta and renal artery. Some lymph node samples and left ovary were sent for intraoperative frozen section, which revealed benign lesions, similar to endometrial tissue. The lymph node tissue was then excised as much as possible, and the second set of intraoperative frozen sections showed high probability of endometrial tissue. The final histopathology and immunohistochemistry staining reached a diagnosis of para-aortic lymph node endometriosis. Gonadotropin-releasing hormone antigen treatment was recommended every 28 days because of the high preoperative CA125 and imaging-based suspicion of malignancy. The serum CA125 subsequently decreased to normal levels, and no para-aortic lesions were detected on abdominal enhancement CT. She is being followed up regularly.ConclusionIt is known that the incidence of lymph node metastasis in pelvic endometriosis is relatively rare. Our report shows that endometriotic tissue can metastasize via the lymphatic route and suggests that endometriotic tissue has the characteristics of invasion and metastasis.

367 Comparing Mortality Rates in Patients with Gastric Cancer in a Single Tertiary Centre: What Can We Learn from the Numbers?

Abstract Aim Over 6500 of primary gastric cancer diagnoses are made each year in the United Kingdom. Depending on the suitability of a surgical intervention and the patient’s choice, the treatment plans for such patients can be generally divided into curative, palliative, and no treatment. Recently, a tertiary Upper Gastrointestinal (UGI) Department has noticed an increase in mortality rates after a curative intervention and therefore, the aim of this study is to compare mortality rates in the three aforementioned subgroups with respect to the TNM staging in this tertiary centre. Method Patients who were discussed at an UGI disciplinary team meeting between 1st January 2013 and 31st December 2020 were identified. Among them, patients with a primary gastric cancer were selected and patients with metastatic gastric cancer at the time of diagnosis were excluded. In addition, patients without histological staging were excluded as well. Results 279 patients with primary gastric cancer were included in this study. Patients who received palliative treatment have higher mortality rates in all T stages apart from T1 where the 90 days mortality rate was 16.67% and 0% for curative and palliative treatment respectively. Conclusions As it has been shown that the majority of patients who received palliative treatment has higher mortality rates, clinicians should continue to consider curative surgical resection in patients who are suitable. In addition, other precautions including consideration of dual consultant operation in patients with borderline respectability or patients with borderline fitness for surgery need to be taken to reduce the mortality rates further.

Rectal Bleeding and Cow’s Milk Protein-induced Allergic Proctocolitis: A Prospective Study

To assess time to resolution of food protein–induced allergic proctocolitis (FPIAP).In this study, researchers evaluated 76 infants aged <4 months with rectal bleeding (RB) referred to the pediatric gastrointestinal department at Trousseau Hospital in Paris, France, between May 2014 and December 2017. Only infants whose RB responded to a cow’s milk elimination diet were included in the study.This was a prospective cohort of infants with concern for cow’s milk protein (CMP) allergy who had resolution of RB with CMP elimination. Exclusion criteria included RB because of another etiology and exclusively breastfed infants. A total of 2 to 8 weeks after resolution of RB, CMP oral food challenge (OFC) was completed. If FPIAP was confirmed, OFC was repeated every 2 months after the age of 4 months to assess the time to tolerance of CMP. Ongoing FPIAP CMP was defined as RB, behavioral change, diarrhea, and vomiting. Tolerance was defined as CMP daily without symptoms.Only 31% of the cohort failed OFC at initial diagnostic challenge, meaning that over two-thirds of infants who initially responded to CMP exclusion did not have return of symptoms on rechallenge just weeks later. Of the patients confirmed to have FPIAP CMP, the median age of tolerance was determined to be 6.8 months, with >75% of the cohort tolerant by 10 months. Infants with a first-degree family history of atopic disease developed tolerance later (8.9 months versus 5.1 months).In this work, it was confirmed that the majority of RB in infants is likely not related to FPIAP CMP. This study also revealed that the time to resolution might be earlier than previously thought.Although there are no solid guidelines on introduction of CMP in presumed FPIAP CMP, the majority of patients exclude CMP until approximately 1 year. In this study, it was found that only one-third of RB before 4 months was due to FPIAP. Of those with FPIAP, CMP could be challenged earlier and at more frequent intervals depending on family wishes. A major limitation of this study is that exclusively breastfed infants were excluded and the lack of information on maternal diet in those who were nursing.

Results of laparoscopic Heller - Toupet surgery for achalasia

Abstract Background: Currently Heller - Toupet procedure is the main method for achalasia. This study aimed to evaluate surgical outcomes of laparoscopic Heller - Toupet surgery for achalasia. Materials and methodology: This is a retrospective case series conducted at Gastrointestinal Department - Viet Duc Hospital University and Department of General Surgery - Hanoi Medical University Hospital between January 2015 and August 2020, including 71 patients with achalasia who underwent laparoscopic Heller - Toupet surgery. The research contents included clinical and paraclinical features, surgical techniques, perioperative and postoperative complications, and long-term outcomes. Results: In total, 71 patients with achalasia were undergone laparoscopic Heller - Toupet surgery, male and female rates accounted for 52.1% and 47,9%, respectively. The average age of the cohort was 44,9±13,9. The incidence of symptomatic dysphagia was 100%. Esophageal dilatation grades I, II, III, IV are 7.0%, 76.1%, 15.5% and 1.4%, respectively. The severity of the disease: Stage 0, I, II, III are 2.8%, 57.7%, 33.8%, and 5.6%, respectively. The mean myotomy length was 5.7 ± 1.6 cm. The operative duration was 124.3 ± 27.4 minutes. There was no conversion, as well as intra- and postoperative morbidity. Long-term outcomes: Good (no or very mild dysphagia) was 89.9%, moderate (moderate dysphagia) was 10.1% and clinical incidence of reflux syndrome was 16.7%. There was no case requiring intervention or re-operation. Conclusions: Laparoscopic Heller - Toupet procedure is safe, has low rates of morbidity, and provides good long-term outcomes for achalasia. Keywords: Achalasia; laparoscopy, Heller - Toupet procedure

PGI20 Diagnosis and Treatment Patterns of Gastroesophageal Reflux Disease in China: A Retrospective Real-World Study

This study sought to assess real-world diagnostic practices, treatment patterns, treatment effectiveness, and cost of gastroesophageal reflux disease (GERD) in China, which are currently limited. Retrospective data of patients with a GERD diagnosis were pooled from Electronic Medical Records across 11 hospitals (10 provinces) in China (January 2015 to December 2017). Primary outcomes included GERD patient characteristics, trends in hospital department visits, symptom types, and treatment patterns. Secondary outcomes included the proportion and grade of erosive esophagitis (EE), mucosal healing rate, healthcare resource utilization and associated costs. Descriptive analyses and Wilcoxon rank-sum test are performed. 71,904 patients (48.1% male; mean (SD) age, 49.28 years) with a GERD diagnosis were identified, of which 65.6% were diagnosed and treated in a gastrointestinal department. GERD subtypes identified were non-erosive reflux disease (NERD;82.8%), EE (15.5%), and Barrett’s esophagitis (1.7%). Los Angeles A-B comprised the majority of EE (93.8%, n=1396/1488). Typical, atypical, and extraesophageal symptoms occurred in 62.7%, 48.3% and 12.1% of GERD patients, respectively. Approximately, 16.4% of GERD patients underwent endoscopic examination. Proton pump inhibitors (PPIs) were the most prescribed medication for GERD (95.6%), followed by gastroprokinetic agents (57.3%). Furthermore, 75.8% of PPIs were prescribed in combination regimens (74.1% with gastroprokinetic agents, 6.5% with mucosal protectants and 2.9% with H2 antagonists). The EE mucosal healing rate after standard treatment regimens was 50% in EE patients who has two endoscopic results within 12 weeks. Overall, median cost per outpatient visit was significantly higher for gastrointestinal vs. non-gastrointestinal departments (¥424.6 vs. ¥387.82; p<0.01). NERD was the most common subtype in GERD patients in China. Low endoscopy (to diagnose GERD) and mucosal healing rates in EE were observed. PPI combination treatment was the most prescribed regimen, suggesting inadequate symptom control with PPI monotherapy.

CURRENT SITUATION OF MEDICINES USED IN THE TREATMENT OF GATROENTERITIS

Objectives: To investigate the current situation of using drugs to treat gastroenteritis of outpatients at the gastrointestinal department of Vinh Long General Hospital. Subjects and methods: Study of retrospective cross- sectional description on 310 medical records of patients over 18 years old diagnosed with gastroenteritis, outpatient treatment at the internal department, Vinh Long General Hospital from November 2019 to July 2020. Results: Patients using PPI drugs in gastroenteritis accounted for 95.16%, of which Esomeprazole was used the most 38.39%, rabeprazole accounted for 31.94%, lansoprazole accounted for 11.94%, pantoprazole 3.87%. Most of the patients were used in combination with supportive drug treatment. The group of antiemetic drugs, reduce flatulence used with a high rate of 59.68%, the group of mucosal protection drugs accounted for 54.84%. The most common side effects were mild, with 9.35%. Conclusion: Patients using PPI drugs in gastroenteritis accounted for 95.16%, rarely encounter drug interactions and side effects.

Gastrointestinal Disease-Specific Survivorship Care: A New Personalized Model Integrating Onco-Wellness.

Although the number of gastrointestinal (GI) cancer survivors is projected to increase in the coming years, there are currently no survivorship care models that address the specific and growing needs of this population. Current survivorship care models were evaluated to assess their suitability for GI cancer survivors. A survivorship care model based on foundational wellness principles is under development to address the specific needs of GI cancer survivors. This model delivers a cohesive and collaborative care continuum for survivors of different GI malignancies. Oncology providers in GI departments and internal medicine providers in survivorship programs are positioned to provide a comprehensive approach for the care of patients treated with curative intent. Survivorship care is introduced at the conclusion of active treatment in the form of an Onco-wellness consultation, an in-person or telemedicine comprehensive care plan creation and review by our Survivorship Program. Personalized care plan including long term and late effects of treatment, nutrition, physical activity and rehabilitation recommendations, prevention of secondary malignancies and psychosocial needs are reviewed. As patients transition from active treatment to survivorship within the GI Program, the GI Advance Practice Professionals (APPs) are well-positioned to deliver comprehensive survivorship care specific to the GI patient’s needs while integrating recommendations and principles from the Onco-wellness consultation. With projected shortages of both oncology and primary care physicians, such an APP-based model has the potential to bridge gaps in the survivorship care continuum and mutually benefit patients and physicians.

An uncommon cause of intermittent dysphagia.

A 42 year old woman admitted to the gastrointestinal department of Taleghani hospital; a teaching referral hospital in Tehran; Iran with epigastric pain; fever and dysphagia. She complained of intermittent dysphagia; regurgitation and epigastric pain( without any benefit from PPI treatment) one month in each year from five years before admission.

THE COMBINATION OF PLR - NLR AND BISAP IN THE PROGNOSIS OF ACUTE PANCREATITIS AT CHO RAY HOSPITAL

Background: Acute pancreatitis (AP) is an inflammatory process in which the local pancreatic injury leads to systemic inflammation. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been shown to predict the severity of various diseases related to inflammation. Data about prognostic value of the combination of PLR - NLR and Bedside index of severity in acute pancreatitis (BISAP) score in patients with AP was still limited. This study aimed to investigate the prognostic value of the combination of PLR - NLR and BISAP scorein patients diagnosed with AP and its relationship with the severity of the disease. Methods: A prospective cross-sectional study. Results: The study records a total of 132 patients being enrolled from February 2019 to September 2019 at the Gastrointestinal Department and Intensive Care Unit of Cho Ray Hospital with AP due to alcohol use (n = 42), gallstone (n = 12) and hypertriglyceridemia (n=36). Patients with PLR ≥ 375.55 and/or NLR ≥ 12.46 had a higher rate of severe AP compared to those with PLR &lt; 375.55 and NLR &lt; 12.46 (OR 2.619, 95% CI: 1.206- 5.686, P 0.013). The combination of PLR - NLR and BISAP demonstrated a predictive value of severe AP (AUC 0.667, 95% CI: 0.579-0.748) with sensitivity being 65.7%, specificity being 67.7%, PPV being 43.4% and NPV being 84.0%. Conclusion: Our study demonstrated that the combination of NLR - PLR and BISAP can predict the severity of acute pancreatitis Key words: Acute pancreatitis (AP), Neutrophil to lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR), Severity, BISAP score

A new endoscopic submucosal resection -ligation technique for gastric tumors.

Although most subepithelial lesions are benign, the malignant forms could present as serious life-threating cancers. Their accurate diagnosis depends on complete surgical resection. Different endoscopic methods have been recommended for the resection. Recently, the EMR has been considered as a safe and effective technique, while various revised EMR techniques have been introduced. In this study, a new version of EMR has been evaluated in two patients. Two middle-aged cases with gastric subepithelial tumors were admitted to Taleghani gastrointestinal department. The polyps were resected via our new Endoscopic Mucosal Resection (EMR) technique. In this technique, the needle knife was used for un-roofing the mucosal surface. Then, the polyps were resected with hot snares. The hemoclips were applied for ligation too. We found no early or delayed complications. Furthermore, the microscopic margins of the lesions were free. Our study represented a safe and cost-beneficial technique for subepithelial lesions and no complications was found and the margins were free. However, further investigations are required for confirming the validity of this new EMR technique.

What impact do Rome IV criteria have on patients with IBS in China?

Background: The Rome criteria for functional gastrointestinal diseases (FGIDs) have been updated from Rome III to Rome IV. This study aimed to investigate the impact of the update on patients with irritable bowel syndrome (IBS) in China.Methods: A previous database including consecutive patients with FGIDs (according to Rome III criteria) from gastrointestinal department of a tertiary hospital in China was re-analyzed. Demographic information, clinical symptoms, psychological status (Zung self-rating scale), and sleep quality (Pittsburgh sleep quality index) were compared between patients with Rome III and Rome IV IBS.Results: Of the 946 patients with FGIDs, only 58 (6.1%) were diagnosed with Rome IV IBS [less than 292 (30.9%) under Rome III criteria] with a surge of the number of unspecified functional bowel disorders (U-FBD). All patients with IBS were divided into three groups: group A [meeting both Rome III and IV criteria, accounting for 43 (4.6%) of patients with FGIDs], group B [meeting only Rome III criteria, 249 (26.3%)], and group C [meeting only Rome IV criteria,15 (1.6%)]. Significant differences in frequency and severity of symptoms, subtypes, and sleep quality among groups (all p < .05) were found. Patients with Rome III IBS having sleep disorder tended to be more serious than those without. On the contrary, it was not the case under Rome IV criteria.Conclusions: Number of IBS patients was greatly reduced accompanied by a surge in U-FBD. Besides, the updated criteria also had great impacts on clinical parameters, sleep quality and psychological state of IBS patients.HighlightsRome IV criteria removed the description of abdominal discomfort for IBS.The updated Rome criteria had great impacts on IBS patients in our database.Our study analyzed the characteristics of IBS patients who fulfilled both criteria.Alterations in the Rome criteria also led to changes in the disease spectrum of FBD.