Indications For Upper Gastrointestinal Endoscopy Research Articles

Helicobacter pylori Infection among Patients Undergoing Upper Gastrointestinal Endoscopy in a Tertiary Care Center.

Helicobacter pylori is a gram-negative gut bacterium associated with dyspepsia, peptic ulcer disease, and gastric cancer, whose prevalence is still common in developing countries. Upper gastrointestinal endoscopy is the gold standard, first-line investigation for evaluating gastrointestinal disorders. The aim of the study was to find out the prevalence of Helicobacter pylori infection among patients undergoing upper gastrointestinal endoscopy in a tertiary care centre. A descriptive cross-sectional study was conducted in a tertiary health care centre among the patients undergoing upper gastrointestinal endoscopy from 5 January 2020 to 5 January 2023 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling method was used. The point estimate was calculated at a 99% Confidence Interval. Among 1,975 patients, Helicobacter pylori infection was found in 561 (28.41%) (25.79-31.03, 99% Confidence Interval). The indication for upper gastrointestinal endoscopy was mostly dyspepsia 256 (45.68%) followed by abdominal pain 205 (36.54%). The most common endoscopic finding was gastritis 445 (79.32%) followed by hiatal hernia 93 (16.58%). The commonest biopsy finding was chronic active gastritis 478 (85.20%). The prevalence of Helicobacter pylori infection among patients undergoing upper gastrointestinal endoscopy was found to be similar to other studies done in similar settings. The persistence of H. pylori emphasizes the need of continuous research to address ever evolving H. pylori infections and resistance that are developing against available treatment modalities. endoscopy; Helicobacter pylori; upper gastrointestinal tract.

An Insight into Upper Gastrointestinal Endoscopy at CDSIMER

Introduction: Upper gastrointestinal endoscopy is very commonly done diagnostic and therapeutic outpatient basis tool for patients with upper gastrointestinal symptoms. Upper gastrointestinal endoscopy was carried out as OPD procedure in department of general surgery at CDSIMER. Objectives: To study the various patterns of upper gastrointestinal diseases in our population and their course of management. Methods: A retrospective study of upper gastrointestinal endoscopy in CDSIMER over past 1 year. Demographics, medical history, indications for upper gastrointestinal endoscopy and the various disease patterns were collected. All patients undergoing upper gastrointestinal endoscopy between 18 and 90 years. Paediatric age group(<18 years),elderly patients above 90 and patients with bleeding disorders are excluded. Results: Among 359 symptomatic patients who underwent upper gastrointestinal endoscopy, 328 (91.36%) had abnormal results. The top four results were antral gastritis (44.29 %), pangastritis (20.33%), GERD (13.09%) and oesophageal candidiasis (4.73%). Inflammation of gastric mucosa in antral gastritis was more severe in the H.pylori positive group (23.17%). 220 males and 108 females were affected. Most affected were the age between 38 to 47 years. Conclusion: Upper gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool in patients with dyspepsia and other upper gastrointestinal symptoms. Training with endoscope is mandatory for surgeon and physicians treating these set of patients. Also it can be a valuable screening tool for diagnosis of carcinoma oesophagus and carcinoma stomach.

Clinical Indication of Upper Gastrointestinal Endoscopy and its outcome

Introduction: Upper gastrointestinal (GI) symptoms are the commonest complaints among the patients for which they seek medical attention. Diseases associated with these symptoms are leading causes of morbidity and mortality worldwide. Objective: To assess the clinical indication of upper gastrointestinal endoscopy and its outcome. Materials and Methods: This was a retrospective study was conducted at Department of Gastroenterology,Abdul Malek Ukil Medical College Hospital, Noakhali, Bangladesh from January 2020 to December 2020. Six hundred two (602) patients were included. All patients who had come with anemia, dyspepsia, suspected gastrointestinal bleed, dysphagia, malena were included in this study. The data was collected using Microsoft excel software and was classified into indications for performing the endoscopy and their obtained results .The results were further classified into age and sex. Results: Total 602 patients who underwent UGIE during the one year study period were analyzed. Among them 326 were males (54.2%) and 276were females (45.8%). None of the patients were on aspirin or proton pump inhibitors. The maximum number of people who underwent the procedure were within 20 – 60 year age group and there was decreasing trends before and after this age group. The patients underwent esophagogastroduodenoscopy mainly because of dyspepsia 226 37.5%) and pain abdomen 163(27.07%), followed by gastroesophageal reflux symptoms 92(15.2%), dysphagia 48(7.9%), suspected varices 30 (4.9%), gastrointestinal bleeding 23(3.8%), anemia had the least of all indication 20(3.3%). Among the indication for upper gastrointestinal endoscopy was considered appropriate according to ASGE criteria, endoscopy was normal in 268(44.5%) patients. Erosive gastritis is the most frequent diagnosis 78(12.9%), followed by non-erosive gastritis 42(6.9%), followed by esophagitis 40 (6.6%), duodenal erosions 38(6.3%) duodenal ulcer 36(5.9%), gastric ulcer 30(4.9%), esophageal varices 21(3.4%), carcinoma of esophagus 16 (2.6%), carcinoma of stomach 12 (1.9%), hiatus hernia 11(1.82%) others 10(1.8%) Conclusion: In conclusion, uppers gastro-intestinal endoscopy is a simple, safe, more reliable and valuable tool with easy learning curve, it enables direct visualization of the upper GI tract and when combined with histopathological examination helps in diagnosing as well as therapeutic interventions for patients with various pathologies. Compared to previous decade there has been gradual rise in GERD which can be attributed to changes in lifestyle and/or a high fat diet with lack of exercise, leading to obesity.

Indications for upper gastrointestinal endoscopy before bariatric surgery: a multicenter study

BackgroundThe role of preoperative upper gastrointestinal endoscopy before bariatric surgery is still debated, and a consensus among the international scientific community is lacking. The aims of this study, conducted in three different geographic areas, were to analyze data regarding the pathological endoscopic findings and report their impact on the decision-making process and surgical management, in terms of delay in surgical operation, modification of the intended bariatric procedure, or contraindication to surgery.MethodsThis is a multicenter cross-sectional study using data obtained from three prospective databases. The preoperative endoscopic reports, patient demographics, Body Mass Index, type of surgery, and Helicobacter pylori status were collected. Endoscopic findings were categorized into four groups: (1) normal endoscopy, (2) abnormal findings not requiring a change in the surgical approach, (3) clinically important lesions that required a change in surgical management or further investigations or therapy prior to surgery, and (4) findings that contraindicated surgery.ResultsBetween 2006 and 2020, data on 643 patients were analyzed. In all of the enrolled bariatric institutions, preoperative endoscopy was performed routinely. A total of 76.2% patients had normal and/or abnormal findings that did not required a change in surgical management; in 23.8% cases a change or a delay in surgical approach occurred. Helicobacter pylori infection was detected in 15.2% patients. No patient had an endoscopic finding contraindicating surgery.ConclusionsThe role of preoperative UGE is to identify a wide range of pathological findings in patients with obesity that could influence the therapeutic approach, including the choice of the proper bariatric procedure. Considering the anatomical modifications, the incidence of asymptomatic pathologies, and the risk of malignancy, we support the decision of performing preoperative endoscopy for all patients eligible for bariatric operation.Graphical abstract

HISTOPATHOLOGICAL BASES OF ORGANIC DYSPEPSIA IN BENIN CITY – A HOSPITAL BASED STUDY OF 186 CASES

Dyspepsia is a symptom complex characterized by features which include epigastric pain or discomfort, belching, bloating and heart burn amongst others, and is one of the commonest indications for upper gastrointestinal endoscopy in Nigeria. The aim of this study was to determine the histopathological bases of organic dyspepsia in this environment. Upper gastrointestinal endoscopy specimens from 186 patients diagnosed with organic dyspepsia in our centre over the 6-month study period were the materials for the study. These were subjected to tissue processing and histopathological examination. The vast majority of the cases of organic dyspepsia had their histopathological bases in the stomach, mostly from various forms of chronic and reactive gastritis, with occasional cases of gastric mucosal ulcers and frank malignancies. Helicobacter pylori-associated chronic gastritis continues to underlie most organic causes of dyspepsia in our environment.

Recent trends in the antibiotic resistance of Helicobacter pylori in patient with dyspepsia.

The aim of this study was to determine the resistance status and to identify the point mutations conferring resistance to clarithromycin and fluoroquinolones among dyspeptic patients in Manisa, Turkey.The study included a sample of 140 patients with an indication for upper gastrointestinal endoscopy randomly selected from 2100 dyspeptic patients attending to the Gastroenterology and Endoscopy Unit at Manisa Celal Bayar University Hafsa Sultan Hospital between April 2016 and May 2018. A commercially available GenoType Helico DR test was used to detect the presence of Helicobacter pylori and mutations associated with resistance to clarithromycin and fluoroquinolones in biopsy specimens.In total, 116 (82.9%) of 140 biopsies obtained from the same number of dyspeptic patients were positive for H pylori and 82 (approximately 71%) of them harbored resistance mutations in 23SrRNA and/or gyrA. Resistance to clarithromycin, levofloxacin, or both were detected in 43.1% (50/116), 27.6% (32/116), and 16/116 (13.8%) of tested biopsies, respectively. The most common mutation conferring resistance to clarithromycin was A2147G (96%, 48/50). Resistance to fluoroquinolones was frequently due to mutation in codon 91 and the most common mutation detected was D91G (34.4%). Heteroresistance patterns were observed in 48.0% (24/50) of clarithromycin-resistant samples and 28.1% (9/32) of levofloxacin-resistant samples.The resistance rates and detected mutations in this study are in line with the country data. However, to achieve better H pylori eradication and to prevent the spread of multidrug-resistant strains in Turkey, the molecular-based susceptibility tests should be considered routinely. Further studies are needed to determine the various mutations among resistant strains.

Duodenal tropism of SARS-CoV-2 and clinical findings in critically ill COVID-19 patients

PurposeDuodenal involvement in COVID-19 is poorly studied. Aim was to describe clinical and histopathological characteristics of critically ill COVID-19 patients suffering from severe duodenitis that causes a significant bleeding and/or gastrointestinal dysmotility.MethodsIn 51 critically ill patients suffering from SARS-CoV-2 pneumonia, severe upper intestinal bleeding and/or gastric feeding intolerance were indications for upper gastrointestinal endoscopy. Duodenitis was diagnosed according to macroscopic signs and mucosal biopsies. Immunohistochemistry was performed to detect viral specific protein and ACE2. In situ hybridization was applied to confirm viral replication.ResultsNine of 51 critically ill patients (18%) suffering from SARS-CoV-2 pneumonia had developed upper GI bleeding complications and/or high gastric reflux. Five of them presented with minor and four (44%) with severe duodenitis. In two patients, erosions had caused severe gastrointestinal bleeding requiring PRBC transfusions. Immunohistochemical staining for SARS-CoV-2 spike protein was positive inside duodenal enterocytes in three of four patients suffering from severe duodenitis. Viral replication could be confirmed by in situ hybridization.ConclusionOur data suggest that about 8% of critically ill COVID-19 patients may develop a severe duodenitis presumably associated with a direct infection of the duodenal enterocytes by SARS-CoV-2. Clinical consequences from severe bleeding and/or upper gastrointestinal dysmotility seem to be underestimated.

Correlation between the symptoms of upper gastrointestinal disease and endoscopy findings: Implications for clinical practice

ObjectiveDigestive symptoms are the most common complaints among patients who seek primary healthcare services. This study aims to identify digestive symptoms and determine their association with upper gastrointestinal endoscopy findings in patients treated at a public endoscopy centre in Northeast Brazil. MethodsWe conducted a cross-sectional study using data from 751 patients with digestive symptoms who had an indication for upper gastrointestinal endoscopy. We identified the association between these variables through Fisher's exact test or Chi-square test and calculated the odds ratio. ResultsEpigastric pain occurred in 83%, post-prandial plenitude in 72.6%, and heartburn in 72.3% of the patients. Women were more likely to present with epigastric pain (p = 0.001; odds ratio [OR] = 1.25; confidence interval [CI] = 1.07–1.47), post-prandial plenitude (p = 0.001; OR = 1.21; CI = 1.06–1.37), retrosternal pain or burning (p = 0.03; OR = 1.11; CI = 1.004–1.24), heartburn (p = 0.04; OR = 1.10; CI = 0.98–1.24), unintentional weight loss (p = 0.01; OR = 1.12; CI = 1.02–1.24), and dysphagia (p = 0.01; OR = 1.14; CI = 1.03–1.25). There was no statistically significant association between digestive symptoms and endoscopic findings of the upper gastrointestinal tract. Additionally, there was no significant association between digestive symptoms and abnormalities detected by endoscopy. ConclusionDyspeptic symptoms of epigastric pain, post-prandial fullness, and heartburn were the most common symptoms in patients referred for endoscopy. Dyspepsia, heartburn, and dysphagia were more common in women than in men. Digestive symptoms were not associated with positive endoscopy findings or abnormalities detected by endoscopy.

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.

Endoscopy for gastroesophageal reflux disease and survival in esophageal adenocarcinoma.

Gastroesophageal reflux disease (GERD) is a risk factor of esophageal adenocarcinoma (EAC) and the most common indication for upper gastrointestinal endoscopy. Yet, whether GERD or endoscopy practice influence survival in EAC is largely unknown and was assessed in our study.This nationwide cohort study included all Swedish residents diagnosed with EAC in 1997-2013 with follow-up to 2018. Exposures were history of GERD and endoscopies prior to EAC. The main outcome was EAC-specific 5-year mortality. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for potential confounders. Among 6,600 EAC patients (79.3% males, median age 70 years) followed for 9,138 person-years, 440 (6.7%) had GERD and 592 (9.0%) had ≥1 endoscopy before EAC diagnosis. GERD was associated with a decreased risk of mortality (adjusted HR 0.71, 95% CI 0.64-0.80), which was only slightly attenuated by adjustment for prior endoscopies (HR 0.79, 95% CI 0.70-0.90), and further adjustments also for tumor stage and surgical resection (HR 0.74, 95% CI 0.62-0.89). Compared to EAC patients without prior endoscopy, mortality was unchanged in GERD patients having undergone 1 or 2 endoscopies before EAC diagnosis (HR 1.02, 95% CI 0.80-1.31, for 1 endoscopy; HR 0.90, 95% CI 0.63-1.30, for 2 endoscopies), while the mortality was decreased in patients with ≥3 endoscopies (HR 0.55, 95% CI 0.36-0.85). Our study indicates that GERD may be associated with a better prognosis in the event of EAC; however, the use of endoscopy screening has a limited impact on survival unless performed very frequently.

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline.

Dysphagia and obstruction are among the most common indications for upper gastrointestinal endoscopy in African countries 1 . In a survey conducted by the European Society of Gastrointestinal Endoscopy (ESGE) International Affairs Working Group (IAWG), benign esophageal strictures as well as malignant upper gastrointestinal obstruction were reported as some of the most prevalent diseases leading to gastrointestinal endoscopy 1 . Management of esophageal obstruction may vary, depending on the cause of obstruction as well as the availability of resources. According to the ESGE original guideline, it could involve, for example, stent placement, radiotherapy/brachytherapy, or bypass surgery 2 . For resource-limited settings, however, a number of additional factors need to be considered before recommendations can be made. These involve economic considerations and resource availability. Furthermore, patients in low-resource settings presenting with malignant esophageal obstruction are often unfit for surgery due to presentation with advanced malignant disease as well as comorbidities such as HIV/AIDS and tuberculosis 3 . For such situations, self-expanding metal stents (SEMS) of the esophagus may provide a suitable palliative option 3 4 . After the initial ESGE cascade guidelines on non-variceal upper gastrointestinal bleeding (NVUGIH), we aimed this ESGE cascade guideline to standardize management of esophageal stenting for benign and malignant disease in low-resource settings 2 5 .

Prevention of overuse: A view on upper gastrointestinal endoscopy.

Many upper gastrointestinal (GI) endoscopies worldwide are performed for inappropriate indications. This overuse of healthcare negatively affects healthcare quality and puts pressure on endoscopy services. Dyspepsia is one of the most common inappropriate indications for upper GI endoscopy as diagnostic yield is low. Reasons for untimely referral are: unfamiliarity with dyspepsia guidelines, uncertainty about etiology of symptoms, and therapy failure. Unfiltered open-access referrals feed upper GI endoscopy overuse. This review highlights strategies applied to diminish use of upper GI endoscopies for dyspepsia. First, we describe the impact of active guideline implementation. We found improved guideline adherence, but resistance was encountered in the process. Secondly, we show several forms of clinical assessment. While algorithm use reduced upper GI endoscopy volume, effects of referral assessment of individual patients were minor. A third strategy proposed Helicobacter pylori test and treat for all dyspeptic patients. Many upper GI endoscopies can be avoided using this strategy, but outcomes may be prevalence dependent. Lastly, empirical treatment with Proton pump inhibitors achieved symptom relief for dyspepsia and avoided upper GI endoscopies in about two thirds of patients. Changing referral behavior is complex as contributing factors are manifold. A collaboration of multiple strategies is most likely to succeed.

Antibiotic Resistance in Helicobacter pylori: A Mutational Analysis from a Tertiary Care Hospital in Kashmir, India

Background:Helicobacter pylori infection is recognised as type 1 carcinogen by the International Agency of Research on Cancer. Previous studies in our hospital have revealed high prevalence of H. pylori in our population with a high recurrence rate after completion of treatment. This prompted us to undertake this study. Aim: This study aimed to determine common gene mutations leading to resistance to clarithromycin, metronidazole, tetracycline and quinolones in H. pylori in patients attending our hospital. Settings and Design: This is a cross-sectional hospital-based study. The study was approved by the Institutional Ethics Committee. Materials and Methods: This study was conducted on 196 adult dyspeptic patients with an indication for upper gastrointestinal endoscopy. Gastric biopsies collected from them were subjected to histopathological examination, rapid urease test (RUT) and culture. Of the 196 patients, 95 met the inclusion criteria. Drug susceptibility testing (DST) by various polymerase chain reaction-based methods was done for 47 RUT-positive biopsies and 13 H. pylori isolates. Results: Maximum resistance was seen to metronidazole (81.66%) followed by clarithromycin (45%) and quinolones (3.33%). No high-level resistance was seen to tetracycline. In clarithromycin-resistant cases, A2142G mutation was more prevalent than A2143G mutation. Multidrug resistance (resistance to metronidazole and clarithromycin) was seen in 41.66% of patients. Conclusions: Tetracycline and quinolones could be the antibiotics of choice in the eradication of H. pylori in this region, while recurrence of the infection with H. pylori could be expected among patients receiving either metronidazole or clarithromycin, for eradication therapy. DST should be done on a routine basis utilising both phenotypic and genotypic methods to prevent further emergence of resistance in this region.

Appropriateness of Indications of Upper Gastrointestinal Endoscopy and its Association With Positive Finding

Upper Gastrointestinal Endoscopy is a frequently advised investigation for upper abdominal symptoms. Studies have questioned the appropriateness of indications for upper gastrointestinal endoscopy and have shown that inappropriate indications range from 5% to 49%. The unnecessary upper gastrointestinal endoscopy expose patients to the risk. The number of upper gastrointestinal endoscopy is rising in our region and we assume so is the number of unnecessary upper gastrointestinal endoscopy. With an aim to find out the appropriateness of the indications of upper gastrointestinal endoscopy and compare its association with positive findings, we conducted a cross-sectional descriptive study. All patients undergoing diagnostic upper gastrointestinal endoscopy during study period were included in the study. Appropriateness of indications for upper gastrointestinal endoscopy was defined as per American Society for Gastrointestinal Endoscopy criteria as "appropriate" and "inappropriate". Upper gastrointestinal endoscopy findings were classified as "significant" and "insignificant" based on endoscopy findings. The extent of this association between appropriateness of indications and upper gastrointestinal endoscopy findings was expressed as the odds ratio of finding a relevant diagnosis in patients with an ''appropriate'' indication compared with those with an 'inappropriate'' indication. Seventy-nine patients were included in the study. Fifty- two (65.8%) of the indications were considered appropriate as per American Society for Gastrointestinal Endoscopy guidelines. Thirty-three (63.5%) of the appropriate indications has clinically significant finding as compared to seven (25.9%) of inappropriate indication with an odds ratio of 4.962 (95% CI:1.773 - 13.890, P=0.002) which is statistically significant. Appropriate indications have significantly higher rates of clinically significant findings. Use of guidelines may decrease the number of unnecessary procedures.

Upper gastrointestinal tract endoscopic lesions in a rural African hospitalo: 252endoscopies at the Kara University Hospital, Togo.

To analyze the indications for upper gastrointestinal endoscopy (UGIE) and determine the frequency of the pathological findings observed in rural areas of Africa. This retrospective study includes 9 series of 5-day visits to perform these examinations. Patients were informed of the presence of the endoscopy team by a bulletin on a rural radio station and by general practitioners at the Kara University Hospital. Patients were recruited from the hospital clinics and from the general population of the Kara region. The study includes all UGIE reports from August, 2007, through September, 2014; these contain the indications for the procedure, the patients' sex and age, and the examination report. The study included 252 reports for 133 women and 119 men with a mean age of 42.44 years (range: 20 to 102 years). The most frequent indications were dyspeptic syndrome (79.76%) and diffuse abdominal pain (11.11%). In all, we observed 139 gastroduodenal lesions among the patients with dyspepsia, principally bile reflux (23.02%), gastroduodenal inflammatory lesions (18.71%) and gastroduodenal ulcers (17.99%). The most commonly observed lesions for diffuse abdominal pain were again, bile reflux (30.77%), followed by gastritis, esophageal mycoses, and tumors. This work made it possible to identify the various pathological lesions of the UGI tract seen on endoscopies in a rural hospital in Togo.

Upper GI Endoscopy in Children: An Experience from Bangabandhu Sheikh Mujib Medical University (BSMMU)

Background: Upper gastrointestinal (UGI) endoscopy is a safe and sensitive investigation in the diagnosis of upper gastrointestinal diseases. There is limited study on paediatric upper GI endoscopy in our country. This study was done only in BSMMU, a tertiary care health facility of Bangladesh.Objectives: The aim of the study was to find out the indications, common endoscopic findings and immediate post procedure complication of UGI endoscopy in children.Methods: This is a retrospective analysis of 100 patients from August 2013 to October 2014. The indications for UGI endoscopy, common endoscopic findings and immediate post procedure complications were collected from case recording &were analyzed.Results: The commonest indication was upper GI bleeding in the form of hematemesis with or without melenae (41%). The most common finding was esophageal varices (49%). Less common findings were esophagitis, gastritis & gastro-duodenal ulcer. There was no post procedure complication.Conclusion: In the study, the commonest indication for Pediatric UGI endoscopy was upper GI bleeding and the commonest endoscopic abnormality was esophageal varices. No immediate post procedure complication was noted in the study.Bangladesh J Child Health 2016; VOL 40 (1) :17-20

Upper gastrointestinal endoscopy in children: The Lagos University Teaching Hospital experience

Background. Paediatric endoscopy is now standard care in the developed world for the management of gastrointestinal (GI) disorders. However, in developing countries endoscopy remains an underutilised tool. Objective. To determine the indications and the spectrum of endoscopic findings in children seen at the Lagos University Teaching Hospital, Nigeria. Methods. The indications for upper GI endoscopy and endoscopic findings in children ≤16 years old, referred for the procedure from June 2013 to June 2016, were documented. The endoscopic yield in these children was also determined. Results. In total 71 children were referred for upper GI endoscopy during the study period. There were 35 boys and 36 girls aged 3 months to 16 years. The indications for upper endoscopy were recurrent abdominal pain in 37 (52.1%), upper GI bleeding in 17 (23.9%), recurrent vomiting in 7 (9.9%), dyspepsia in 5 (7.0), heartburn in 2 (2.8%), dysphagia in 1 (1.4), portal hypertension in 1 (1.4) and ingestion of corrosives in 1 (1.4%) of the subjects. Endoscopic findings were as follows: gastritis 19 (26.8%), hiatus hernia in 13 (18.3%), gastric erosions in 12 (16.9%), oesophageal varices 6 (8.4%), duodenitis in 4 (5.6%), gastric ulcer in 3 (4.2%), gastric polyp in 2 (2.8%). The overall endoscopic yield was 60.2%. Conclusion. There is a need to increase the awareness of the role of paediatric endoscopy in the diagnosis and treatment of GI disorders in developing countries. Recurrent abdominal pain still remains a relevant indication for the procedure. The need to develop training programmes for paediatric endoscopy and paediatric gastroenterology in general in developing countries cannot be overemphasised.

Upper Gastrointestinal Endoscopy in Patients Aged 65 Years or Older: Indications and Main Findings From a Referral Hospital, Jazan, Saudi Arabia

Background: It is well known that incidence of gastrointestinal (GI) disease increases with age. Endoscopy for the evaluation of upper gastrointestinal (UGI) symptoms in elderly patients frequently provides useful diagnostic information. Objectives: To ascertain the indications for and describe the outcomes of upper gastrointestinal endoscopy in older patients (65+ years) referred to King Fahd Central Hospital (KFCH), Jazan, South West Saudi Arabia. Methods: This is a retrospective, descriptive, cross-sectional hospital-based study conducted at KFCH. Records of 591 elderly patients were reviewed during the period of 11 years from 1994 to 2005. Indications for and diagnoses from upper gastrointestinal endoscopy were statistically analyzed. Results: The mean age of patients studied was 73.5 years, with men representing 64.8% (n = 383). The most common indications for upper gastrointestinal endoscopy were: UGI bleeding, indicated by hematemesis or melena (139, 23.5%); epigastric pain (67, 11.3%); and acid peptic disease (60, 10.2%). Gastritis was the most common finding of the procedure, with no significant differences between males (20.9%) and females (23.6%). Esophageal varices was the second most common upper GI endoscopy finding among the study participants (102, 17.3). Conclusions: The most common indications for upper gastrointestinal endoscopy were UGI bleeding, epigastric pain and Acid Peptic Disease, Gastritis and esophageal varices were the most common findings of upper GI endoscopies performed in the studied population.

Intrafamilial transmission of Helicobacter pylori: genotyping of faecal samples

Background: After more than 20 years of research, there is a little information about the detailed routes of Helicobacter pylori transmission. The aim of this study was to explore intrafamilial transmission of H. pylori in children who had indication for upper gastrointestinal endoscopy and their parents.Methods: Children (aged up to 15 years) were studied during September 2012 to October 2013. The parents of those with positive urea breath test results were asked to provide faecal and blood samples after giving informed consent. Non-invasive tests such as immunoassay for serological antibodies against H. pylori and detection of its antigen in faeces were measured. The genetic similarity of the family strains was investigated by the random amplification of polymorphic DNA (RAPD-PCR) genotyping method.Results: According to the genotyping results of 30 families, in 10 (33.3%) children related H. pylori genotypes to their mothers were found, while only 2 children (6.7%) had similar genotypes to their fathers. Interestingly, children with similar H. pylori genotype with their mothers had higher IgA (35.7 ± 10.8) and IgM antibody titres (87.23 ± 19.15) than other children. In addition, in these children, lower titres of IgG antibodies (9.93 ± 3.31) were found rather than children who had no H. pylori in their faeces or had no similarities with their parents (30.28 ± 6.15).Conclusions: In conclusion, mother-to-child transmission is the main route of intrafamilial transmission of H. pylori in Iranian families. Molecular typing of H. pylori can be useful in identifying a high-risk population.

A Rare Cause of Upper Gastrointestinal Bleeding; Non-Hodgkin’s Lymphoma

Acute upper gastrointestinal bleeding (UGIB) is a common indication for upper gastrointestinal endoscopy, with a large audit reporting 14% mortality [1,2]. Although, the gastrointestinal tract is the most common site of the lymphoma, lymphoma is a rare cause of the gastrointestinal bleeding [3]. In this paper, we present a case with non-Hodgkin’s Lymphoma (NHL) resulting in massive gastrointestinal bleeding.