Department Of Gastroenterology Research Articles

Exploring the Role of Hepatic Venous Pressure Gradient Values in Patients with Acute on Chronic Liver Failure: A Pilot Study

Abstract Introduction: Acute on chronic liver failure (ACLF) has been a difficult entity to define. The use of the hepatic venous pressure gradient (HVPG) for the measurement of portal pressure is well established in chronic liver disease. This is based on data showing that improvements in the HVPG are associated with improvements in clinical outcomes. Methods: The study was a prospective observational study conducted in the department of gastroenterology of a tertiary care center in Northern India for 2 years. Thirty cases each of ACLF (Group I), compensated cirrhosis (Group II), and decompensated cirrhosis (Group III) were enrolled. We evaluated the role of HVPG values and complications in patients with liver disease. Results: The mean age of the cohort was 44.2 ± 7.3 years. The most common etiology of ACLF noted in the study was alcohol (54.4%), followed by infections by hepatotropic viruses (22.2%). ACLF has high short-term mortality compared to compensated and decompensated cirrhotics. Compensated cirrhosis is associated with the lower risk of bleed. The model for end-stage liver disease score was higher among the patients of ACLF (25.2 ± 3.1) and decompensated cirrhosis (23.93 ± 2.8) than compensated cirrhotics (9.7 ± 1.8). The mean HVPG was 12.3 ± 7.5 mmHg, which was significantly higher than the normal gradient. It was also noted that the HVPG was significantly higher in the ACLF and decompensated cirrhotics. Conclusions: HVPG monitoring is recommended in ACLF and decompensated liver disease at admission to stratify the risk of early mortality.

Preventing NASH with Empagliflozin and Linagliptin: A Diabetic Drug Combination

Objective: To determine the effect of anti-diabetic drug combination of 25mg empagliflozin and 5mg linagliptin for the prevention of NASH. Study Design & Setting: Quasi-Experimental Study design, Department of Gastroenterology, Medicare Cardiac and General Hospital Karachi from October 2022 to March 2023. Methodology: This study was carried out after approval from the ethical board of the hospital. The selection criteria of patients included positive family history of obesity, hyperlipidemia/ hypertriglyceridemia, hypothyroidism, smoking and F3 Fibrosis on transient elastography. The initial screening of clinical history, physical examination, laboratory findings were recorded after taking the written consent from each patient. The baseline findings were recorded and the effect of drugs was examined after follow-up of six months. Results: The study included 150 patients who received the treatment of empagliflozin and linagliptin. The mean age of these patients was 37±4.9 years. Majority of them were males 76% and 60% were diagnosed type 2 diabetes more than 5 years ago. Hyperglycemia and hypoglycemia were found in 16.7% in patients with headache of 26.7%. The baseline findings were significantly changed with effective and favorable results as p-value<0.001. Conclusion: The treatment with combine effect of the antidiabetic drugs empagliflozin (25 mg) and linagliptin (5 mg) showed a safety profile of preventing NASH with the fixed dose. It reduced the ALT and AST levels, reduced BMI, triglyceride level, HBA1C and the risk of progression of advance liver disease NASH. After taking antidiabetic drugs, Fibrosis was improved and it showed F1–F2 on transient elastography.

Experience of providing care to a family member with Crohn's disease and a temporary stoma: A qualitative study

ObjectivesThe aim of this study is to understand the feelings and experiences of the main caregivers of temporary ostomy patien ts with Crohn's disease (CD). And explore the caregivers' inner feelings, to provide reference and basis for constructing the health education content of the main caregivers of CD patients with a temporary stoma. MethodsA qualitative descriptive approach was used to conduct an unstructured interview among 11 primary caregivers of CD patients with temporary enterostomy from the gastroenterology department of The Second Hospital of Nanjing. Participants were selected using a purposive sampling technique. Data were collected between July 2021 and September 2021. The interviews were audio recorded and then transcribed for a qualitative thematic analysis. ResultsFive themes and accompanying subthemes were identified: (1) negative psychological experience (2) perceived caregiver burden (3) future uncertainty (4) disease benefit (5) insufficien support system. ConclusionsStudy findings suggest that caregivers of CD temporary enterostomy patients have problems such as negative psychology, heavy caregiver burden, uncertain future, lack of support system, etc., but they also have positive experience of feeling of benefit from the disease, and are eager to obtain more disease information from more channels.Therefore, medical staff should improve their professionalism and health education capabilities, carry out diversified and targeted health education activities to reduce the burden of care, stimulate positive caregiver responses and help caregivers respond to and deal with caregiving problems in a timely and accurate manner.

Effect Analysis of Quality Control Circle on Improving the Qualification Rate of Bowel Preparation for Electronic Colonoscopy in Hospitalized Patients

Objective: This study aims to investigate the impact of quality control circle activities on enhancing the qualified rate of bowel cleansing before electronic colonoscopy in hospitalized patients. Methods: A total of 200 patients from the Department of Gastroenterology at our hospital were selected as study subjects during the second quarter of 2022. The quality control circle management group conducted focused discussions to comprehensively evaluate the current situation, analyze underlying factors, calculate the qualified rate of bowel preparation, and implement appropriate control measures. Conclusion: The qualified rate of bowel preparation significantly improved after the implementation of the quality control circle activities, with statistical significance (P < 0.05).

Development of a model for predicting acute cerebral infarction induced by non-variceal upper gastrointestinal bleeding

ObjectiveTo evaluate the risk factors for acute cerebral infarction(ACI) in patients with non-variceal upper gastrointestinal bleeding(NVUGIB), and construct a model for predicting ACI in NVUGIB patients. MethodsA model for predicting ACI induced by NVUGIB was established on the basis of a retrospective study that involved 1282 patients who were diagnosed with NVUGIB in the emergency department and Gastroenterology Department of Nanchang University Affiliated Ganzhou Hospital from January 2019 to December 2021. Receiver operating characteristic (ROC) curves were drawn to evaluate the sensitivity and specificity of the model and CHA2DS2-VASc score to predict ACI. Delong’s test was used to compare AUCs of the present score and the CHA2DS2-VASc score. ResultsThere were 1282 patients enrolled in the study, including 69 in the ACI group and 1213 in the non-ACI group. Multivariate analysis revealed that hypertension, diabetes, red blood cell (RBC) transfusion, mechanical ventilation, D-dimer, rate pressure product (RPP), somatostatin and mean platelet volume (MPV) were factors associated with ACI induced by NVUGIB. A model based on the eight factors was established, Logit(P)= 0.265 + 1.382 × 1 + 1.120 × 2 + 1.769 × 3 + 0.839 × 4–1.549 × 5–0.361 × 6 + 0.045 × 7 + 1.158 × 8(or 1.069 ×9) (X1, hypertension=1; X2, diabetes=1; X3, RBC transfusion=1; X4, mechanical ventilation=1; X5, somatostatin=1; X6, MPV(fL); X7, D-dimer(ng/l); X8, low RPP= 1; X9, high RPP = 2). The area under ROC curve of the model was 0.873, the sensitivity and specificity were 0.768 and 0.887, respectively. The area under ROC curve of CHA2DS2-VASc score was 0.792, the sensitivity and specificity were 0.728 and 0.716, respectively. Delong’s test showed the area under ROC curve of the present study was significantly larger than that of CHA2DS2-VASc score. ConclusionsHypertension, diabetes, RBC transfusion, mechanical ventilation, D-dimer, RPP, somatostatin and MPV were factors associated with ACI induced by NVUGIB. A model constructed based on these factors showed excellent prediction of ACI, and was superior to CHA2DS2-VASc score. However, this needs to be further validated by multi-center study with a larger sample size.

Correlation between Portal Vein Diameter and Esophageal Varices Grades in Chronic Liver Disease Patients using Ultrasonography and Endoscopy as a Diagnostic Tool

Background: Chronic liver disease accounts for 2.2% of deaths and 1.5% of disability-adjusted life years. Variceal bleeding is one of the preventable caused of death in chronic liver disease. About 30-40% of patients with compensated cirrhosis and 85% of those with decompensated cirrhosis are found to possess EV on screening endoscopy.Objective: To determine the correlation between Portal Vein Diameter (PVD) on ultrasound examination and grades of Esophageal Varices (EV) on endoscopy in patients with Chronic liver disease (CLD). Material and Methods: This was a cross-sectional, correlational study, carried out in the Department of Diagnostic Radiology in collaboration with the Department of Gastroenterology, at Lady Reading Hospital Peshawar, Pakistan. A total of sixty patients were sampled via consecutive random sampling from Jan 2022 to Sept 2022. The criteria used for dilated portal vein was = 13mm and = 13 cm for splenomegaly. Results: Out of total 60 patients with CLD, PVD ranged from 10 to 18mm, mean PVD being 14.1mm ±1.4. The splenic sizes ranged from 10 to 23 cm, with the mean splenic cranio-caudal dimension being 14.9 cm ± 2.1. The highest association is between the large EV and PVD > 15 mm i.e., 52% of total large EVs. The differences between PVD to EV groups were statistically significant as determined by one-way ANOVA (F (2,57) =8.281, p= 0.001) and correlation was also statistically significant on Pearson's Correlation test (rs)[60] = 0.490, p < 0.001.Conclusion: As there is a significant positive correlation between PVD and grades of EV in CLD patients. The PVD on ultrasound should be utilized where an endoscopic facility is not available, or is overburdened, to prevent life threatening esophageal variceal bleed. Keywords: Chronic liver disease, Esophageal varices, Portal vein diameter.

Celiac Disease in Uzbek Children: Insights into Disease Prevalence and Clinical Characteristics in Symptomatic Pediatric Patients.

A few studies on pediatric Celiac Disease (CD) are available from Central Asia. Recent immunogenetic research has highlighted that the HLA-DQ2/8 genetic predisposition to CD as well as the dietary intake of gluten in this geographical area, are comparable to other regions of the world where CD prevalence is known to be 1% or higher. This is a prospective and cross-sectional study investigating the prevalence and clinical characteristics of CD in symptomatic children referred to the pediatric gastroenterology department of a tertiary hospital in Uzbekistan from 1 September 2021, until 31 July 2022. In addition to collecting the relevant information related to clinical manifestations and laboratory analyses from the clinical files, a specific survey was also administered to patients' guardians. Serological, histopathological, and immunogenetic parameters specific to CD, fecal zonulin, and pancreatic elastases were assessed in CD patients. The study population consisted of 206 children. Overall, almost all of them (n = 192; 93.2%) were referred because of gastrointestinal manifestations, which were associated with extra-gastrointestinal manifestations in most cases (n = 153; 74.3%); a minority (n = 14; 6.8%) was mainly referred due short stature and/or growth failure only. Among all of these study participants, CD was diagnosed in 11 children (5.3%). Notably, although diarrhea was similarly reported in CD and non-CD patients, watery diarrhea (type 7 according to the Bristol stool scale) was much more frequently and significantly observed in the former group. All of these CD patients showed anti-tTG IgA 10 times higher than the upper normal limit, except one child with lower serum levels of total IgA; however, all of them received a diagnostic confirmation by histopathological analysis due to the lack of EMA testing in the country. Notably, most CD children (82%) showed a Marsh III histological grading. Around half patients (54.5%) showed zonulin values above the reference range, whereas none showed insufficient levels of pancreatic elastase. However, no correlation or association between zonulin and clinical, laboratory, histopathological, and immunogenetic parameters was found. This study may further suggest a relevant prevalence of CD in Uzbek children, based on this partial picture emerging from symptomatic patients only. Additionally, we highlighted the prevalence of typical CD forms with watery diarrhea, which should strongly support a full diagnostic work-up for CD in the local clinical setting. The high levels of anti-tTG IgA and high Marsh grade might also lead us to speculate a significant diagnostic delay despite the classical clinical expression of CD.

Computed tomography in the diagnosis of fever of unknown origin: A case report

Fever of unknown origin can be a symptom of at least 200 diseases. Positron emission tomography-computed tomography, although highly informative, may not be readily available as an imaging tool. We present a clinical case of giant cell arteritis where computed tomography played a key role in arriving at a diagnosis.
 A 61-year-old woman presented to the hospital with a nocturnal fever up to 39.5С, accompanied by chest and scapular pain, and substantial weight loss (10 kg over 3 months). Lymphoproliferative and infectious diseases were excluded. Baseline colonoscopy had revealed erosions in the colonic mucosa, leading to a preliminary diagnosis of ulcerative colitis, and subsequently, the patient was admitted to the gastroenterology department. Follow-up colonoscopy had excluded this diagnosis. Additional imaging via chest and abdominal computed tomography scan revealed wall thickening of aorta and its branches with subtle contrast enhancement.
 Conditions, such as tuberculous aortoarteritis and syphilitic aortitis, were excluded. The patient was diagnosed with giant cell arteritis involving brachiocephalic trunk, subclavian arteries, and celiac trunk. Prednisolone was administered with subsequent reduction in symptoms.
 Although computed tomography may not be regarded as the gold standard for the differential diagnosis of fever of unknown origin, this case underscores its valuable contribution in establishing a definitive diagnosis.

Correlation between prescribing doctor attributes and intestinal cleanliness in colonoscopy: a study of 22522 patients

Objective This study aimed to analyze the correlation between different attributes of doctors who prescribe colonoscopies and the cleanliness of the intestine to guide the development of colonoscopy application protocols. Methods Data on colonoscopy cases conducted in the gastroenterology department of Hangzhou First People’s Hospital between April 2018 and March 2021 were collected. The gender, age, professional attributes of the prescribing doctors, and Boston Bowel Preparation Scale (BBPS) score were recorded. In addition, the correlation between the prescribing doctors’ characteristics and the intestine’s cleanliness was analyzed. Results The study included 22,522 patients with a mean BBPS score of 6.83 ± 1.94. There were 16,459 male and 6,063 female doctors with similar BBPS scores (p = 0.212). The study found no significant difference in BBPS scores between 19,338 internist and 3,184 non-internist (p = 0.154). However, BBPS scores differed significantly between 18,168 gastroenterologists and 4,354 non-gastroenterologists (p = 0.016) and between 19,990 intestinal-related specialties(gastroenterology and gastrointestinal surgery) and 2,532 non-intestinal-related specialties (p = 0.000). In addition, BBPS scores were significantly different between 18,126 prescribing endoscopiests and 4,396 non-endoscopiests (p = 0.014). However, there was no significant difference in BBPS scores among doctors of different ages (p = 0.190). The study found significant differences in BBPS scores between male and female patients and those under or over 40 years (p = 0.000). Conclusion To improve colonoscopy preparation quality, priority should be given to doctors in gastroenterology, intestinal-related specialties, and endoscopiests. Their expertise may result in better education and improved bowel cleanliness.

Prevalence of Helicobacter pylori infection in dyspeptic patients presenting to a tertiary care center of a developing country: a cross-sectional study

Background: Among the various causes for dyspepsia in patients presenting to the gastroenterology department, Helicobacter pylori is the most common etiological agents. Here, we explore the prevalence of Helicobacter pylori infection, particularly, in dyspeptic patients and different endoscopic findings in such patients. Methods: We conducted a simple observational study in the gastroenterology department of a tertiary care center of Nepal. The Helicobacter pylori was detected using rapid urease test and endoscopic findings were collected from gastroduodenoscopy unit. The obtained data was analyzed using Statistical Package for Social Sciences (IBM-SPSS), version 22. Results: The overall prevalence of Helicobacter pylori infection in dyspeptic patients in our center was found to be 0.329 (0.259 – 0.406) at 95% Confidence Interval (CI). There was significant association of Helicobacter pylori infection with alcohol history (12 [52.17] vs 44 [29.93], p = 0.035) and endoscopic findings of duodenal ulcer (3, 100%) followed by gastritis (29, 50.88%). Conclusions: Amidst various etiology for dyspepsia, Helicobacter pylori was still prevalent at our center. However, considering the variability of its prevalence due to factors like alcohol history, more comprehensive studies are needed to estimate actual proportion in patients presenting with dyspeptic symptoms.

Evaluation of Gastrointestinal System Complaints and Comorbidities in Pediatric Familial Mediterranean Fever Patients.

Familial Mediterranean fever (FMF) is the most prevalent hereditary autoinflammatory disease among children. Abdominal pain and various gastrointestinal system (GIS) manifestations may arise directly from FMF or concomitantly with FMF. This study aimed to evaluate GIS complaints and findings other than classic peritonitis attacks in patients with FMF and to interpret concomitant GIS and hepatic disorders in these patients. The medical and genetic findings of patients with FMF who attended our clinic between December 2011 and December 2021 were reviewed. Gastrointestinal system symptoms, liver function tests, abdominal images, and endoscopic and histopathological data were extracted from medical records. A total of 576 pediatric patients (female, 52.3%) diagnosed with FMF were included. Among them, almost one-fifth displayed GIS complaints, such as abdominal pain, defecation problems, and dyspepsia, distinct from typical FMF attacks. High serum aminotransferase levels were detected in 18.4% of the patients, with viral infections being the most common cause of moderate/severe hypertransaminasemia. In addition, during follow-up, 26.9% of them were referred to the pediatric gastroenterology department. At least 1 gastroenterological and hepatobiliary disorder was detected in 17.5% of the patients because of organic and functional GIS disorders or hepatobiliary disorders, such as gastroesophageal reflux disease, esophagitis, functional dyspepsia, and inflammatory bowel diseases. Various GIS and hepatic disorders can be encountered in children with FMF. The spectrum of these complaints and pathologies can range from frequently observed health problems to more severe diseases.

Endoscopic Evaluation among Patients Presenting with Upper Gastrointestinal Tract Bleeding

Background: Bleeding from the upper gastrointestinal tract is a critical medical condition that requires prompt diagnosis and management. Endoscopic evaluation plays a pivotal role in identifying the source of bleeding, determining its severity, and guiding appropriate interventions. Objective: The objective of this study was to conduct a comprehensive endoscopic evaluation in patients who have presented with bleeding originating from the upper gastrointestinal tract. Study Design: Descriptive cross-sectional study. Settings: Department of Gastroenterology, Islamic International Medical College, Rawalpindi Pakistan. Duration: Study duration was 7 months from November 2021 to April 2022. Methods: Patients who were 18 years of age or older and presented with active or recent upper gastrointestinal bleeding, regardless of gender, and were scheduled for endoscopic examination, were incorporated into the study. Upper gastrointestinal endoscopies were performed. The procedure was involving the direct visualization of the esophagus, stomach, and duodenum using an endoscope. Any visible lesions or bleeding sources were documented. Data regarding the location and nature of bleeding sources and the endoscopic diagnosis were recorded in a standardized data collection form and analyzed by SPSS version 26. Results: The study included 59 patients with a mean age of 52.27 years. Esophageal endoscopic findings revealed "Grade I to III Esophageal varices (EV) being less common (3.4%, 11.9%, and 13.6% respectively). LAX LEs, esophagitis and Hiatus hernia were observed in 10.2%, 3.4%, and 6.8% of cases. Rarer findings, including Venules, Ecstatic vein, Candidiasis, and various combinations, each accounted for 1.7% of cases. Portal hypertension gastropathy was the most prevalent condition (20.3%), followed by Antral gastritis (45.8%), Erosive gastropathy (10.2%), and other less frequent conditions, such as fundal varices, GOVI varices, diffuse gastritis and Ulcer. Grade II and III EV, and PHTN gastropathy, were significantly more prevalent among males, while Antral gastritis was notably higher among females (p < 0.05). Although the endoscopic findings did not show any statistically significant differences based on gender (p > 0.05). Conclusion: PHTN gastropathy, antral gastritis, grade III EV and erosive gastropathy were the most common conditions among patients with Hematemesis, along with less frequent findings like grade I to III Esophageal varices, Venules, Ecstatic vein, Candidiasis, and combinations of these conditions.

Outcome of the Endoscopic Biliary Stenting for Irretrievable Common Bile Duct Stones in an Academic Hospital – A Prospective Study

Background: Choledocholithiasis is characterized by the existence of a stone in the common bile duct. Based on findings published in the Medical Clinics of North America, around 10-15% of individuals with gallstones experience the development of choledocholithiasis. Presently, the established approach for addressing common bile duct stones involves the implementation of endoscopic papillotomy and stone extraction. The combined utilization of Dormia basket, balloon catheter, and lithotripsy achieves a success rate of approximately 90%. In cases where traditional endoscopic removal methods prove ineffective, biliary stenting plays a crucial role in the conservative management of CBD stones. Objectives: The main goal of the study was to evaluate the outcome of biliary stenting in irretrievable common bile duct stones. Materials and Methods: This observational study took place at the Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, from January 2018 to December 2018. The study included consecutive patients who were 18 years or older and diagnosed with common bile duct stones. These patients underwent endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The study specifically focused on patients who received biliary stenting for irretrievable common bile duct stones, and they were enrolled as participants in the study. Results: Out of the 83 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction, 29 patients (35%) were deemed as having irretrievable stones, necessitating the implementation of stenting. Among these irretrievable stone cases, the average age was 46.69, and there was a predominance of females with 17 patients (58.6%). Of the 29 cases, 22 patients completed the follow-up. During the follow-up ERCP, a significant reduction was observed in both the average number of stones (3.14 vs. 1.9; P=0.002) and their size (16.32 vs. 12.4; P=0.005). Successful stone extraction was achieved in 14 patients (63.64%) during the second ERCP. In one patient (4.55%), spontaneous clearance of the stone occurred, while in 7 patients (31.81%), stone extraction was not possible during the second ERCP. The reduction in mean stone size was the only significant factor affecting the success of the second ERCP. However, there was no correlation found between the duration of stenting and the reduction in stone size (r=-0.193, p=0.401). Conclusion: Our study shows that repeat ERCP can successfully extract stones regardless of stenting duration. Unlike Western data, we emphasize the effectiveness of endoscopic biliary stenting in a context with limited access to advanced techniques, where initial stone extraction rates are lower. This approach is particularly beneficial for patients with stone sizes over 15 mm, avoiding the need for complex surgical procedures.

Heterogeneity in strategies to maintain the teaching activities during SARS-CoV-2 pandemic

IntroductionDuring the SARS-CoV-2 pandemic, the training of medical students was severely disrupted. Government authorities imposed a second national lockdown, which lasted from December 2020 to May 2021, forcing medical schools to adapt their teaching strategies. Several surveys have assessed students’ perspectives, but there is limited data available to objectively assess and compare different strategies between medical faculties. The aim of this study was to evaluate the lecturer-based perspective to assess the impact on the theoretical and practical education of medical students before and during the second lockdown.MethodsWe developed a questionnaire focusing on theoretical and practical training during pandemic before and during the second lockdown. The questionnaire was sent by personal invitation in January 2021 to all responsible lecturers of gastroenterology and hepatology departments at university hospitals in Germany.ResultsThe complete response rate was obtained from 52.5% (21/40) teaching centres representative of all regions in Germany. While the majority of respondents (62%) reported a limited impact of the lockdown on theoretical training, 90.5% reported a significant impact on practical training during the SARS-CoV-2 pandemic response. Several centres adapted virtual or hybrid education early during the pandemic, bedside teaching was down to 38.1% (8/21), particularly for students in the early phase of education, suggesting a substantial long-term impact on students' skills.ConclusionOur questionnaire-based data provide one of the first systematic evaluation of faculty-based assessments of the potential impact of the pandemic during lockdown on medical education. We observed considerable heterogeneity in strategies for maintaining teaching activities during the SARS-CoV-2 pandemic in Germany.

Association between pancreatic cancer and diabetes: insights from a retrospective cohort study

BackgroundStudies investigating the prevalence of pancreatic cancer have revealed a heightened risk of 1.5 to 2.0 times among individuals with long-standing type 2 diabetes mellitus.AimsWe aimed to estimate the prevalence of diabetes among patients with pancreatic cancer, and identify the factors associated with type 2 diabetes mellitus in this population.MethodsThis retrospective observational and analytical study was carried out in the Department of Gastroenterology of the Mohammed VI University Hospital over a period of 5 years, between 2018 and 2022, including all patients with confirmed cases of pancreatic adenocarcinoma.ResultsOut of the 197 patients, 38.1% had a history of diabetes, among them, 42.7% had new-onset diabetes, while the remaining 57.3% had long-standing diabetes. Diabetic patients were significantly older than nondiabetic patients (mean age of 67.2 vs. 63, P = 0.009). Diabetes was more prevalent among obese patients (66.7%, P = 0.01), and less frequent among individuals with chronic alcohol consumption (20% vs. 80%, P = 0.04), and tobacco smokers (24.4% vs75.6%, P = 0.03). Among patients with an ECOG score ≥ 3, DM, 54.5% were DM-patients (P = 0.033). The same significant association was found for the Nutritional Risk Index, Patients who had moderate or severe malnutrition were more likely to be diabetic 74.7% (P = 0.004). Diabetic patients were less likely to undergo surgery due to comorbidities and general health deterioration. However, no significant differences were observed in sex, tumor stage or location.ConclusionOur study has shown an increased prevalence of diabetes in pancreatic cancer and highlights the importance of considering this cancer in cases of recent onset or uncontrolled diabetes, especially in elderly individuals.

Elevated CK-MB levels are associated with adverse clinical outcomes in acute pancreatitis: a propensity score-matched study.

Cardiac injury, reflected by the measured concentrations of chemicals released from injured cardiac muscle, is common in acute pancreatitis (AP). However, there is no adequate evidence assessing the impact of cardiac injury on AP-related outcomes. Creatine kinase-myocardial band (CK-MB) mainly exists in the myocardium. Therefore, we sought to evaluate the relationship between the increase in CK-MB and the adverse clinical outcomes of AP. This propensity score-matched study analyzed AP patients admitted to the Department of Gastroenterology in the First Affiliated Hospital of Nanchang University from June 2017 to July 2022. Propensity score matching and multivariate logistic regression analysis were used to explore the relationship between CK-MB elevation and AP outcome variables. A total of 5,944 patients were screened for eligibility, of whom 4,802 were ultimately enrolled. Overall, 896 (18.66%) of AP patients had elevated (>24 U/ml) CK-MB levels, and 895 (99.89%) were paired with controls using propensity score matching. The propensity score-matched cohort analysis demonstrated that mortality (OR, 5.87; 95% CI, 3.89-8.84; P < 0.001), severe acute pancreatitis (SAP) (OR, 2.74; 95% CI, 2.23-3.35; P < 0.001), and infected necrotizing pancreatitis (INP) (OR, 3.40; 95% CI, 2.34-4.94; P < 0.001) were more frequent in the elevated CK-MB (>24 U/ml) group than in the normal CK-MB (≤ 24 U/ml) group. Using the multivariate logistic regression analysis, elevated CK-MB levels were independently associated with increased mortality (OR, 2.753, 95% CI, 2.095-3.617, P < 0.001), SAP incidence (OR, 2.223, CI, 1.870-2.643, P < 0.001), and INP incidence (OR, 1.913, 95% CI, 1.467-2.494, P < 0.001). CK-MB elevation was an independent risk factor for adverse clinical outcomes in AP patients. CK-MB elevation was significantly related to adverse outcomes in AP patients, which makes it a potentially useful laboratory parameter for predicting adverse clinical outcomes of AP.

Histopathological Changes in the Gall Bladder Mucosa Associated with Helicobacter Pylori Gastritis

Objective: To identify Helicobacter Pylori (HP) gastritis-associated histopathological changes in Gall Bladder (GB) mucosa in patients undergoing cholecystectomy. Methodology This prospective comparative cross-sectional study was conducted in the Gastroenterology department of Liaquat National Hospital, Karachi, Pakistan, from December 2021 to December 2022. The study included all patients admitted with a diagnosis of any Gall Bladder pathology and those who were electively scheduled for cholecystectomy. Participants were categorized into two groups based on the presence of HP: group A (HP positive) and group B (HP negative) in gastric mucosa before cholecystectomy. HP detection was performed using various methods, including HP stool antigen (HPSA), Urea breath test (UBT), HP antibodies, and biopsy confirmation through gastroscopy. Results: The mean age of patients in group A was 42.88 ± 8.28 years, and in group B, it was 43.35 ± 8.74 years (p=0.458). According to the GB histological findings, Chronic cholecystitis with focal Cholesterolosis was significantly more common in group A (75.4%), while Chronic cholecystitis alone was significantly higher in group B (66.2%) (p=0.001). Dysplasia was observed more frequently in group B compared to group A. Erosion was more prevalent in group A, patients than in group B (p=0.001). Although symptom improvement in the HP positive group with persistent symptoms post-eradication was not statistically significant, it did show some improvement (p=0.527). Conclusion: The histological findings of chronic cholecystitis with focal Cholesterolosis were significantly higher in the HP positive group compared to the HP negative group, while chronic cholecystitis alone was significantly more common in the HP gastritis negative group. Some HP gastritis group patients experienced symptom improvement after HP eradication.

Endoscopic removal of ingested foreign body in children: experience of a tertiary care hospital of Bangladesh

Purpose: Foreign body ingestion is a common incident in children &amp; majority of ingested foreign body removed spontaneously, few percentages (10%) remain in GI tract. The timing of endoscopy depends on some clinical &amp; radiological parameters. The aim of this study to is to observe clinical profile of foreign body ingestion in children in Bangladesh. Methods: This cross-sectional descriptive study was conducted from February 2016 to December 2019 in the department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total of 29 cases of upper GI tract foreign bodies were studied. Patients with history of ingested foreign body, were clinically examined. Asymptomatic foreign body ingestion was frequently observed. Routine neck and chest X-ray in both AP and lateral views were obtained for these cases. Flexible endoscopy for foreign body extraction with suitable foreign body retriever was used to remove the foreign bodies. Data were expressed as percentage &amp; number. Results: Foreign body was commonly seen 22 (75.9%) in 1-5 years of age. Sex distribution of foreign body ingestion cases, where 15 (51.7%) were male child. Among the ingested foreign bodies only 3 (10.3%) were removed within 24 hours of ingestion, 10 (34.5%) cases were removed between 24-48 hours and the remaining 16 (55.2%) were removed after 48 hours. Coin was the most common foreign body 19(65.5%). Other foreign bodies were metallic chain 3 (10.3%), button battery 2 (6.9%), others 5 (17.2%). Conclusion: The study showed that foreign body ingestion is more common in 1-5 years age group, coin was the most commonly ingested foreign body.

Qualitative evaluation of a palliative care case management intervention for patients with incurable gastrointestinal cancer (PalMaGiC) in a hospital department

PurposeGeneralist palliative care in hospital departments largely lacks an overall structure to fully manage the symptom burden and support needs of patients with incurable gastrointestinal cancer. Palliative care case management interventions show promising results in reducing healthcare use and enhancing quality of life. Less is known about these interventions and their potential to improve the quality of generalist palliative care in hospital departments. The aim of this study was to explore patients’ experience of a palliative care case management intervention (PalMaGiC) to acquire knowledge about its advantages and disadvantages and, if needed, adjust the intervention. MethodsQualitative semi-structured interviews with patients (n = 14) with incurable gastrointestinal cancers of the oesophagus, pancreas, colon, or rectum were conducted and analysed using content analysis. Participants in the study were affiliated with PalMaGiC, an intervention in a gastroenterology department based on symptom assessment, care planning, care coordination, and needs-based follow-up. ResultsParticipants perceived the intervention as filling a gap and as a secure lifeline in the healthcare system since it provided 24-h access, a designated specialist nurse, and a patient-healthcare alliance. Using a needs-based approach, PalMaGiC changed the participants’ focus from disease to quality of life. Participants requested more open dialog within complementary and alternative medicine, greater focus on promoting hope and using need assessment questionnaires differently in assessing symptoms and problems. ConclusionThe PalMaGiC intervention can potentially meet the needs of patients requiring palliative care in hospital departments, but further development of the content and personalised approach is needed.

The efficacy and tolerability of polyethylglycol solution with and without bisacodyl in preparation of colon before colonoscopy.

Objective: To compare the efficacy of four liter Polyethylin glycol alone with two liter polyethylin glycol plus bisacodyl in preparation of large bowel before colonoscopy. Study Design: Randomized Control Trial. Setting: Department of Gastroenterology, Hepatology and GI Endoscopy, SZABMU, Pakistan Institute of Medical Sciences, Islamabad. Period: 1st January 2021 to 31st December 2021. Material &amp; Methods: One hundred seventy patients, both males and females, who had indications for colonoscopy were included. After informed consent two equal groups of 85 were made. In group A, bisacodyl was added with two liters polyethylin glycol while in group B four liter Polyethylin glycol alone was used to prepare the gut before colonoscopy. Results: Out of 170 patients, the calculated Ottawa score was almost same in both groups. Extraordinary cleaning was found more regularly within the combination group (p &lt; 0.05). No intense adverse effects were found among the 2 regimens besides nausea, abdominal pain, and anal irritation which were seen a bit more in group B. The tolerability was better with bisacodyl and 2-L PEG preparation (P&lt;0.05). Conclusion: 2 L PEG+ bisacodyl preparation is a good alternative to 4-L PEG preparation for bowel cleansing, with distinct advantages in terms of tolerability, acceptability and compliance.