Findings Of Upper Gastrointestinal Endoscopy Research Articles

253. CLINICAL USEFULNESS OF ENDOSCOPY, BARIUM FLUOROSCOPY, AND CHEST COMPUTED TOMOGRAPHY FOR THE CORRECT DIAGNOSIS OF ACHALASIA

Abstract Background The definite diagnosis of esophageal achalasia is established using manometry, which is per- formed in patients with suspected achalasia based on the findings of screening examinations, such as upper gastrointestinal endoscopy, chest computed tomography (CT), or a barium swallow test. However, the exact values of test characteristics in these supportive diagnostic examinations remain unclear. Methods We estimated the sensitivity and specificity of characteristic findings in the supportive diagnostic examinations for achalasia by comparing the data of a large number of achalasia patients and others with digestive symptoms. Patients Achalasia patients (n=119) and non-achalasia patients with suspected achalasia and repeated feelings of chest discomfort (n=37) who were treated in a single university hospital. Results Characteristic findings on chest CT (i.e. dilated esophagus, air-fluid level formation) and barium swallow tests were observed in more than 80% of achalasia patients but in less than 10% of non-achalasia patients. In contrast, conventional characteristic findings of upper gastrointestinal endoscopy (i.e. intra- esophageal food debris, feeling of resistance at the esophagogastric junction) were seen in only 40%-70% of achalasia patients. In particular, the feeling of resistance at the esophagogastric junction was observed by the examiner in only 30%-50% of patients. Conclusion Intra-esophageal food debris or resistance at the esophagogastric junction on upper gastrointestinal endoscopy will be positive in only about half of patients with achalasia. Other supportive diagnostic examinations, such as chest CT or barium fluoroscopy, should therefore be included in order to avoid overlooking the disease.

The Study of Correlation between Symptoms of Gastritis and Endoscopic Biopsy

Abstract Background: Gastritis is a very common disorder that is widely distributed worldwide, representing one of the most prevalent pathological entities in gastroenterology and digestive endoscopy. This study aims to analyse the correlation between the endoscopic findings and the symptoms of gastritis. Upper gastro-intestinal (UGI) endoscopy is a widely used investigation for a variety of UGI symptoms namely dysphagia, dyspepsia, abdominal pain, etc., and when combined with biopsy, its diagnostic accuracy get increased manifold. Materials and Methods: This is a study with 70 patients with symptoms of gastritis underwent UGI endoscopy and biopsy included in study. Biopsy was taken from gastric/duodenal mucosa and was sent for histopathology examination. Data of patient’s age, gender, food habits, oral hygiene, etc., were then taken into consideration and findings of UGI endoscopy were correlated with these data and also correlated with histopathological report. Results: Gastritis significantly affects the lifestyle of the majority of our participants as out of 70, 65 (95%) had gastritis in our study. Helicobacter pylori was present among 41.5 % of study participants. Other less common findings were esophagitis in 20 % and duodenitis in 7% of study participants. The mean age of participants were 46.76 ± 16.25 years. Conclusion: Histopathology plays a major role in diagnosing H. pylori infection. So, histological examination as an adjunct to UGI endoscopy should be considered as best diagnostic tool rather than UGI endoscopy alone or clinical examination or radiological examination alone. It helps to treat the gastritis patients by diagnosing the underlying cause and management accordingly.

Correlation between Gastrointestinal Symptoms Questionnaire and Findings of Upper Gastrointestinal Endoscopy in Gastrointestinal Disorders

Abstract Background Gastrointestinal diseases are among the most common problems in tropical countries and commonly manifest as diarrhea, abdominal pain, abdominal distention, gastrointestinal bleeding, intestinal obstruction, malabsorption, or malnutrition. Aim of the Work The aim of this work is to compare the efficacy of gastrointestinal Symptoms questionnaire and results of upper gastrointestinal endoscopy to create an optimally reliable tool for measuring the presence and severity of GI symptoms and to measure the symptomatic response to treatment more objectively. Subjects and Methods This study has been conducted on 100 patients complaining of gastrointestinal symptoms attending the gastrointestinal endoscopy unit in Faculty of Medicine, Ain Shams University hospital. All patients have been evaluated by upper GI endoscopy to measure the correlation between gastrointestinal symptoms questionnaire and upper GI endoscopy. Results There was significant correlation between gastrointestinal symptoms questionnaire and results of upper gastrointestinal disorders. Conclusion Gastrointestinal symptoms questionnaire is an easy used tool which can be used to measure the presence, severity of gastrointestinal symptoms and the symptomatic response to treatment more objectively.

Upper gastrointestinal endoscopy findings in adults with dyspepsia younger than 60 years in Lagos, Nigeria

Abstract Background and Objectives: Recent guidelines from international gastroenterology bodies recommend that upper gastrointestinal endoscopy (UGIE) should not be routinely performed in patients with dyspepsia who are younger than 60 years old as the yield for major abnormalities is low. The objectives of this study were to determine the spectrum of UGIE findings in patients with dyspepsia who are younger than 60 years and to document the association of alarm features with UGIE findings in them. Materials and Methods: This is a retrospective study of the UGIE records of adult patients younger than 60 years with dyspepsia at five centers in Lagos, Nigeria, between June 2016 and December 2020. UGIE findings were categorized as major (gastric or duodenal ulcers, esophageal varices, masses suspected to be cancer, strictures, and foreign bodies), minor (erosions or inflammation), or normal. Results: There were 1499 adult patients with dyspepsia who were younger than 60 years, 796 (53.1%) females, mean age 40.9 ± 9.8 years, and 158 (10.5%) with at least one alarm feature. Major findings were seen in 194 (12.9%), minor findings in 1023 (68.2%), and no abnormalities were seen in 282 (18.8%). Alarm features, or age 40 years and above, were associated with major findings. Half of all gastric cancers were seen in patients younger than 50 years, and of these, 70% occurred within the 40–49 age group. Conclusion: This study shows that the prevalence of UGIE findings in patients with dyspepsia who are younger than 60 years is high, and major findings are common in those with alarm features or who are aged 40 years and above. We recommend endoscopy for the evaluation of dyspepsia in those who have alarm features or are aged at least 40 years.

急性膵炎後の被包化壊死増大に伴い脾梗塞・胃壁虚血に陥り外科手術を要した1例(Acute pancreatitis and enlarged area of walled–off necrosis followed by infarction of the spleen and ischemia of the gastric wall requiring surgery: case report)

症例は40歳の男性。基礎疾患に高トリグリセリド血症があり，急性膵炎を繰り返していた。約9か月前に壊死性膵炎を発症して膵尾部と胃脾間，結腸間膜に被包化壊死を合併，以降定期的にCT画像検査による経過観察を行っていた。今回左側腹部痛を主訴に来院し，腹部CT検査において胃脾間，膵尾部に各々44mm，43mmの被包化壊死を認め，いずれも2か月前の検査時より被包化壊死の増大を認めた。またそれぞれの被包化壊死に隣接して胃穹窿部の浮腫性変化と脾動脈閉塞，脾梗塞を認めた。ヘパリン・抗菌薬・鎮痛薬による保存的治療から開始したが，発熱が継続し，炎症反応の改善も得られず，入院第4病日のCT検査では脾梗塞の状況に改善がなく，一方で被包化壊死に接する胃壁全層の虚血所見が明らかとなったため，保存的治療を断念し，緊急開腹術での膵尾部切除・脾摘出・胃部分切除術を施行した。病理所見では被包化壊死と脾動脈との間には炎症性細胞の浸潤を認め，脾動脈内腔には白色血栓を認めた。胃壁漿膜側は被包化壊死に伴う炎症所見や周囲血管内の血栓形成を認めた。被包化壊死の自然史は明確ではなく，保存的治療においては，症状や画像所見を丁寧に評価して外科的治療介入の時期を見逃さないことが重要である。 A 40–year–old male with hypertriglyceridemia and recurrent acute pancreatitis was undergoing regular imaging to monitor walled–off necrosis (WON) that had developed 9 months earlier secondary to necrotic pancreatitis. The patient presented with acute left abdominal pain. Abdominal CT showed WON by the gastrosplenic ligament (44mm) and in the pancreatic tail (43mm). Both areas grew since the last imaging 2 months earlier. Edematous changes in the fornix, splenic artery occlusion, and splenic infarction were observed adjacent to areas of WON. Despite conservative management, fever and elevated inflammatory biomarkers persisted. CT after admission showed no change in the splenic infarction. It also detected ischemia in all layers of the gastric wall adjacent to areas of WON. Emergency laparotomy was performed for pancreatic tail resection, splenectomy, and partial gastric resection. Pathologic examination showed infiltration of inflammatory cells between the areas of WON and the splenic artery and a white thrombus in the splenic artery lumen. There was inflammation and thrombus in the blood vessels surrounding areas of WON on the serosal side of the gastric wall. Although the natural history of WON is not well studied, careful evaluation of clinical findings and imaging for timely surgical intervention is required. 2012年の改訂アトランタ分類 1により膵炎の局所合併症としてみられる膵あるいは膵周囲の液体貯留は，壊死の有無と発症からの経過時間により，間質性浮腫性膵炎後に発症する急性膵周囲液体貯留（acute peripancreatic fluid collection: APFC）と壊死性膵炎後に発症する急性壊死性貯留（acute necrotic collection: ANC），それぞれが4週以上経過した膵仮性嚢胞（pancreatic pseudocyst: PPC）と被包化壊死（walled–off necrosis: WON）の4つのカテゴリーに分類された。ガイドライン 2, 3, 4ではこれら膵局所合併症に関して無症候性，非感染性のものについては保存的加療を推奨し，症候性，感染合併症例を治療適応としている。今回我々は，繰り返す急性膵炎後にWONを発症し，その経過観察中に合併した脾動脈本幹閉塞による脾梗塞と，胃後壁への炎症波及に伴う胃壁虚血に対して外科的治療を施行した1例を経験した。これまでに急性膵炎に伴う脾梗塞の発生率は約7%と報告され 5，また急性膵炎に伴い胃壁梗塞および脾梗塞を合併した報告例はある 6が，WONの自然経過における同合併症の発生に関しては明確にされていない。我々は自験例におけるWONの経時的画像所見と術中所見および切除標本の病理学的所見からその機序と治療方針について考察した。 本論文は倫理委員会の承諾を必要としない症例報告である。また，個人情報保護法に基づいて匿名化がなされており，患者本人から論文出版に関する同意を取得している。 患 者：40歳の男性 主 訴：左側腹部痛 基礎疾患：高トリグリセリド血症（LPL遺伝子異常症疑い） 生活歴：喫煙歴なし，飲酒習慣なし 現病歴：以前より急性膵炎を繰り返していた。9か月前に壊死性膵炎を罹患以降，膵尾部と胃脾間，結腸間膜にWONが形成されていた（Fig. 1a–c）。6か月前，4か月前には浮腫性膵炎を罹患し絶食，輸液，ガベキサートメシル酸塩点滴，抗菌薬，経管栄養による保存的治療を受けていた。今回来院約12時間前に突然左側腹部痛を自覚，改善を認めないため，ウォークインで救急外来を受診した。 Abdominal computed tomography (CT) with contrast (a–e: contrast–enhanced CT, delayed phase, f: contrast–enhanced CT, arterial phase). a: 9 months before admission, at the onset of WON, a solitary lesion was found in the pancreatic tail. b: 6 months before admission, cystic lesions were found in the pancreatic tail and by the gastrosplenic ligament. There was no abnormal contrast effect on the spleen. c: 4 months before admission, cystic lesions were found in the pancreatic tail and by the gastrosplenic ligament. There was no abnormal contrast effect on the spleen. d: Edematous changes in the fornix of the stomach adjacent to WON on arrival (white arrow). e: All layers of the gastric wall were poorly enhanced on day 4 of admission (black arrow). f: On CT scan at the time of admission, the splenic artery next to WON in the pancreatic tail had a contrast defect (white and black arrowheads). d–f: There was poor contrast enhancement of the spleen. 経 過：来院時のバイタルサインは意識清明，心拍数91/分，血圧169/109mmHg，呼吸数24/分，酸素飽和度97%（室内気），体温37.1℃であった。身体診察では，腹部は平坦，左側を中心に腹部全体の圧痛，筋性防御を認めた。血液検査では，白血球18,100/µL，CRP 12.15mg/dLと非特異的炎症反応上昇を認め，Fib 536mg/dL，D–dimer 1.29µg/mLと軽度の線溶系亢進を認めた。膵酵素の上昇は認めなかった（Table 1）。腹部造影CT検査（Fig. 1d）では，胃脾間に最大径44mm（前回2か月前撮影時41mm），膵尾部に最大径43mm（前回2か月前撮影時38mm）のWONを認め，膵尾部以遠の脾動脈造影欠損，脾全体の造影不良を認めた（Fig. 1f）。またWONに接した胃穹窿部壁の造影不良を認めたが（Fig. 1d白矢印），胃周囲の血管には造影欠損を認めず，胃壁の浮腫性変化と考えた。脾梗塞の診断で入院加療とし，抗菌薬，ヘパリン15,000単位/日点滴静注，疼痛管理を開始した。入院後痛みは軽減したが，発熱の持続と第3病日の血液検査では白血球17,900/µL，CRP 31.40mg/dLと炎症反応の改善を得られず，入院第4病日に腹部造影CT検査を再検したところ，胃穹隆部の壁全層に及ぶ造影欠損が明確となった（Fig. 1e黒矢印）。上部消化管内視鏡検査を施行したところ，噴門部大弯から後壁にかけて胃粘膜の虚血性変化を認めた（Fig. 2）。比較的広範囲で胃壁全層の虚血壊死が生じていると疑われたため治療方針を改め，同日，緊急開腹手術を行った。腹腔内には漿液性腹水を少量認め，大網切開し網嚢腔を開放すると胃脾間・膵尾部のWONは胃後壁・膵尾部と強固に癒着一塊となっていた。脾動脈への前面からのアプローチは炎症波及により剥離困難であったため膵脾脱転したうえで脾動脈を根部から約1cmの部位で結紮し，膵臓も同部位で切離，合わせて梗塞に陥った脾を摘出した。胃後壁はWON癒着部から1cmほど離れた部位で胃壁を貫通し，壊死した胃粘膜を視認しつつWONを含めた胃部分切除を行った。結果的に胃穹窿部から体部後壁までを切除した（手術時間3時間39分，術中出血量470mL）。病理所見では胃後壁・WON・膵尾部・脾臓は一塊となり（Fig. 3a），線維性肉芽組織からなるWONの嚢胞壁には好中球浸潤を伴う中等度の急性炎症がみられ，内部は壊死物質で満たされていた。胃壁は固有筋層に及ぶ潰瘍形成を認め，一部で胃壁全層に及ぶ凝固壊死，浮腫，高度の急性炎症を認めた。漿膜側にはWONに伴う炎症所見とともに周囲の動脈内に血栓形成を認めた（Fig. 3b）。胃壁の明らかな穿孔は認めなかった。WONと隣接する動脈との間には炎症性細胞の浸潤を認め，脾動脈内腔は白色血栓で閉塞（Fig. 3c），脾臓は凝固壊死に陥っていた。術後経過は良好で，術後4日目に経口摂取を開始，同11日目に退院した。 Upper gastrointestinal endoscopy findings. There was ischemia of the gastric mucosa from the cardia and greater curvature to the posterior wall. Macroscopic and microscopic (×20) surgical pathology findings. a: Macroscopic cystic lesions were partially solid. (b, c) Histologically, the wall of the cystic lesion consists of fibrous granulation tissue with no epithelium, acute inflammation with infiltration by neutrophils, and contained internal necrotic tissue. b: The gastric wall had ulcer formation extending to the muscularis propria, coagulative necrosis throughout all layers, edema, and severe acute inflammation. Inflammatory infiltrates and thrombus were observed in the blood vessels surrounding WON on the serosal side of the gastric wall. c: In the pancreas, there was severe fibrosis, edema, and moderate to severe acute and chronic inflammation. A white thrombus was observed in the lumen of the splenic artery. W: walled–off necrosis (WON), P: pancreas, St: stomach, Sp: spleen 急性膵炎における壊死性膵炎の発症率は10～20%とされ 7，WONは壊死性膵炎の晩期合併症として生じる。WONは膵実質および膵周囲脂肪組織の壊死部が時間とともに当初の固形から融解壊死により液状化し，周囲を肉芽性・繊維性皮膜で覆う状態になったものである。近年までWONと間質性浮腫性膵炎の晩期合併症であるPPCは明確には区別されておらず，両者を含めた検討において，経過観察症例の30～50%で重大な偶発症・合併症が発生したと報告され 8, 9，発生6週以降では自然消退は期待できず偶発症・合併症率が高いとする報告 10や，嚢胞径が6cmを超えるものでは自然消退の可能性が低下し偶発症・合併症率が高くなるとする報告 9がある。一方でManraiら 11は壊死性膵炎153名の観察研究において，143名がANCを合併し，そのうちの84名がWONに移行したが，84名のWON症例中，保存的治療を受けた23名（約27%）において局所病変の自然消失もしくは軽快が得られたと報告した。また酒井ら 12は10cmを超える巨大WONの保存的治療例を報告している。このようにWONに関する保存的治療経過の詳細は未だ不明な点もあるが，現在のガイドライン 2, 3, 4においては，膵局所合併症の種数やサイズは問わず，無症候性，非感染性の症例に対しては保存的に経過観察することが推奨され，症候性の症例では感染合併が疑われるか否か，全身状態が安定か否かにより抗菌薬投与やインターベンション治療が選択される。インターベンション治療に際しては，経皮的或いは内視鏡的経消化管的ドレナージなどの非侵襲的処置から開始し，治療効果が不十分な場合には外科的手術を行うというstep–up approach法の有用性が確認されている。 本症例はこれまでに急性膵炎を繰り返していたが，今回9か月前に発症した壊死性膵炎の際に膵尾部に造影不良域を認めたほか，結腸間膜および胃脾間に不整形脂肪織濃度上昇を認めていた。膵尾部不染領域は8か月前には最大径40mmの境界明瞭な多房性病変となり，7か月前には膵尾部病変は同サイズ，胃脾間に径50mmの嚢胞性病変，結腸間膜に径67mmの不整形脂肪織濃度上昇域を認めていた。いずれも壊死性膵炎を契機に発生しており，WONと診断し1か月ごとのCT検査を行い経過観察していた。経過中の6か月前と4か月前にはそれぞれ間質性浮腫性膵炎を発症し保存的治療を行っているが，その際はいずれの局所合併症も大きさに著変はなく，その後は2か月前のCT検査において膵尾部病変は径38mm，胃脾間病変は径41mm，結腸間膜病変は径23mmとそれぞれ縮小傾向であり，脾動脈，脾臓，胃壁の造影効果にも異常は認めなかった。したがって本症例において，脾梗塞と胃壁虚血を同時に発症したのは，膵局所合併症出現から約9か月が経過したところであった。局所合併症のサイズは続発症が増加するとされる60mmより小さい40mm前後であり，この間腹部自覚症状も認めなかったため，外来経過観察中であった。 膵局所合併症の経過中にみられる病態として，感染，消化管・胆管閉塞，腹腔内・隣接消化管や臓器への破裂・穿通，出血がある 13。本症例では胃壁虚血と脾動脈閉塞に伴う脾梗塞を発症した。膵局所合併症の消化管瘻・穿破は嚢胞性病変が消化管に癒着して線維化が進行することにより，癒着臓器の伸展が強制されて生ずると考えられる。本症例では病理所見として胃壁漿膜側にWONによる炎症波及を認め，周囲動脈内の血栓形成が散見された。炎症所見は一部固有筋層に及び，比較的広範囲の胃粘膜虚血が起き，潰瘍形成を生じたと考えられた。脾梗塞に関しては，WONによる脾動脈の物理的圧排のほか，経過中に繰り返された膵炎の炎症波及による脾動脈周囲の線維化から脾動脈狭窄を生ずる機序，血管炎に伴う血栓形成機序などの関与が考えられる。本症例は短胃動脈や胃大網動脈からの十分な側副血行路が発達する前に脾全体の梗塞を来しており，動脈周囲に好中球浸潤を伴う急性炎症所見を認めることから，徐々に進行する物理的圧迫よりも，炎症に伴って急速に進行する血栓形成の要素が大きいと考えられた。脾動脈閉塞の結果として生じた脾梗塞は，発熱，疼痛などの自覚症状が改善しない場合や，膿瘍形成，破裂，敗血症性ショック，出血などの合併症を来した場合には脾摘術の適応がある 14。梗塞範囲が増えるほど合併症のリスクが高まると考えられるが，脾機能亢進症に対して行われる部分的脾塞栓術のように，無菌性脾梗塞と適切な梗塞率が保たれていれば外科的治療を必要としないという報告 15や，胃癌術後に発症した全脾梗塞の保存的治療例の報告 16がある。本症例は当初，胃壁造影不良域を浮腫性変化と捉えていた。脾梗塞に対しては出血・感染合併による病態悪化時の手術適応を念頭に置きつつ，ヘパリン・抗菌薬・鎮痛薬による内科的治療から開始したが，発熱が続き炎症反応の改善も得られなかった。入院第4病日の再評価において脾動脈閉塞および脾梗塞の状況に変化はなく，一方で胃壁の虚血所見が明確となったため，保存的治療を断念して手術治療を行った。本症例は来院時点で左側を中心とした腹部全体の圧痛・筋性防御や非特異的炎症反応上昇という腹膜炎を疑う所見を認めており，当初からstep–up approach法に則った治療介入を検討すべきであった。本症例の術中所見においてWONは胃壁と強固に癒着していたためWONを含め一塊切除とする膵尾部切除・脾摘出・胃部分切除術を施行した。 WONの合併症治療においては，常に外科的治療に移行する選択肢を念頭に置き，症状や画像所見から臨床経過を継続的に評価することが致死的合併症を防ぐために重要である。 本症例は，繰り返す急性膵炎に生じたWONの経過観察中に脾動脈本幹閉塞からの脾梗塞および胃壁虚血を合併した。自然消退しない膵局所合併症の治療方針を検討するうえで教訓的な1例と思われ報告した。 本論文の要旨は，第49回日本救急医学会総会・学術集会において発表した。 著者全員において本症例報告に関する利益相反はない。

Indications and Findings of Upper Gastrointestinal Endoscopy in Elderly Patients in Parakou, Republic of Benin

Indications and Findings of Upper Gastrointestinal Endoscopy in Elderly Patients in Parakou, Republic of Benin

Clinical symptoms, endoscopic findings, and lower esophageal sphincter characteristics in patients with absent contractility.

Absent contractility is a rare esophageal motility disorder defined by high-resolution manometry which remains poorly understood in pathogenesis and management. We investigated the clinical symptoms, upper gastrointestinal endoscopy findings, and lower esophageal sphincter (LES) characteristics in adult patients diagnosed with absent contractility on high resolution manometry and factors associated with erosive esophagitis that were found on endoscopy in these patients. A cross-sectional study was conducted in patients with absent contractility who were examined at the Institute of Gastroenterology and Hepatology, Vietnam between March 2018 and December 2020. Clinical symptoms, endoscopic findings, and LES metrics were collected and compared between individuals with and without erosive esophagitis. Logistic regression analysis was used to examine a variety of factors associated with erosive esophagitis. Among 7519 patients who underwent high resolution manometry, 204 (2.7%) were diagnosed with absent contractility. The mean age of the study sample was 45.9 years, 65.7% were women, and none had systemic sclerosis. The most common symptoms were regurgitation, belching, epigastric pain, and bloating. On endoscopy, 50% had erosive esophagitis, mostly Los Angeles grade A (42.9%). On manometry, 44.6% of the patients had LES hypotension and 68.1% had low integrated relaxation pressure in 4 seconds (IRP4s). Male sex (adjusted odds ratio = 2.01, 95% confidence interval: 1.04-3.89) and an IRP4s < 5 mm Hg (adjusted odds ratio = 2.21, 95% confidence interval: 1.12-4.37) were significantly associated with erosive esophagitis. Absent contractility was present in many patients without known systemic diseases. Erosive esophagitis was common and associated with male sex and low IRP4s.

Esophageal manometry findings in patients with refractory symptoms of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder. High-resolution esophageal manometry (HREM) and 24-h pH study help to properly evaluate GERD patients. The aim of the present study was to classify patients with refractory GERD symptoms into various groups based on endoscopic and physiological testing.The present study is a retrospective analysis of patients referred for HREM and 24-h pH recording between 2019 and 2021. We included all adult patients (age > 18 years) who were referred for evaluation of refractory GERD symptoms. Upper gastrointestinal endoscopy findings, HREM, and 24-h pH findings were noted. Patients were divided into erosive reflux disease (ERD), non-erosive reflux disease (NERD), reflux hypersensitivity (RH), and functional heartburn (FH) based on test results. Demographic details and HREM parameters were compared in the four groups. Statistics used are one-way analysis of variance (ANOVA) and Chi-squared tests. A p-value of <0.05 was considered statistically significant.A total of 144 patients were included-NERD (56, 38.9%), ERD (42, 29.2%), RH (28, 19.5%), and FH (18, 12.5%). Age (p 0.74), andsex distribution (p 0.47), and symptom profile (p 0.12) were similar. The presence of type 2/3 esophagogastric junction (EGJ) morphology was commoner in ERD and NERD (p <0.001). Moreover, the esophagogastric junction contractile integral (EGJ-CI) and basal inspiratory pressures were significantly lower in these two groups (p<0.05). EGJ-CI was low in 32 cases of ERD (76.2%), 41 cases with NERD (73.2%), 7 cases with RH (25%), and 3 cases with FH (16.7%), respectively (p-value < 0.00001).FH and RH account for 32% of cases with refractory GERD symptoms. Impaired EGJ function was more common in ERD and NERD patients compared to FH and RH patients.

Correlation between Gastrointestinal Symptoms Questionnaire and Findings of Upper Gastrointestinal Endoscopy in Gastrointestinal Disorders

Correlation between Gastrointestinal Symptoms Questionnaire and Findings of Upper Gastrointestinal Endoscopy in Gastrointestinal Disorders

Erosive Gastroesophageal reflux disease – are we missing pulmonary symptoms?

Background: Gastroesophageal reflux disease (GERD) is a common condition that affects about 20- 30% of the adult population, presenting with a broad spectrum of symptoms and varying degrees of severity and frequency. Extra esophageal manifestations like respiratory symptoms are being increasingly recognized. There are only very few studies on the prevalence of pulmonary symptoms in patients with erosive gastroesophageal reflux disease. Aim: The objective of the study was to determine the frequency of pulmonary symptoms in patients with erosive gastroesophageal reflux disease, Materials and Methods: This was a cross-sectional study done on 100 patients diagnosed based on upper gastrointestinal endoscopy findings. Patients were first interviewed about GERD symptoms using the GERD Health-Related Quality of Life questionnaire. Then the respiratory symptoms are assessed. Demographic details are recorded in a proforma. Pulmonary function tests were done on all the patients. Upper GI endoscopic findings are graded according to Los Angeles (LA) grading from A to D Results: The prevalence of pulmonary symptoms was 60%. The most prevalent symptom was a cough, then followed by dyspnoea on exertion, chest pain, wheezing, and snoring. There was a significant association found between LA grading and pulmonary symptoms like wheezing, cough, chest pain, and hoarseness of voice. No significant association was found between GERD duration and pulmonary symptoms. There was a statistically significant association found between LA grading and pulmonary function test. No association was found between quality of life scoring and pulmonary symptoms. Conclusion: There was a high prevalence of pulmonary symptoms in patients with erosive gastroesophageal reflux disease. Erosive GERD can affect pulmonary function according to severity. There was no association between prolonged GERD and pulmonary symptoms.

Evaluation of Significant Endoscopic Findings Using Alarm Features of Dyspepsia in Patients Visiting Gastroenterology Department at RIHS Islamabad

Objective: The aim of this study is to analyze significant findings of upper gastrointestinal endoscopy in patients having alarming features of dyspepsia. Study Design: Retrospective study Methodology: This retrospective study was conducted in the Gastroenterology Department at RIHS Islamabad from March 2021 to March 2022 and included adult patients presenting with alarm features and were referred for gastroscopy for dyspepsia. Those ageing below 18 years were excluded. The information including demographic data, referral for the procedure, endoscopic findings and present alarm features and dyspeptic symptoms was recorded. The diagnosis was made on the basis of visual examination. Results: A total of 140 patients who underwent gastroscopic procedures were included in the study. Most of the subjects (74.1%) reported epigastric burning, 10.8% complained of heartburn, 10.8% of regurgitation and 8% reported globus. Few of the participants reported symptoms such as bloating (5.3%), burping (5.3%), abdominal fullness (3.8%), chest pain (3.8%) and early satiety (0.8%). No significant relation was observed between warning signs and findings from the endoscopy. Conclusion: Dyspeptic patients showing alarming signs such as vomiting, dysphagia and upper gastrointestinal bleeding must be prescribed immediate endoscopy. Keywords: Dyspepsia, gastroenterology, endoscopic findings, epigastric burning

Pediatric upper gastrointestinal endoscopic findings in Kaduna, Nigeria

Background Endoscopy is an important diagnostic and interventional procedure for children presenting with gastrointestinal (GI) symptoms. In resource-limited countries like Africa, the practice of pediatric endoscopy remains rudimentary, lacking in trained pediatric endoscopists and appropriate-sized endoscopes. Patients and methods This was a retrospective study of the findings in all children and adolescents referred for upper gastrointestinal endoscopy (UGIE) within a period of 2 years from February 2014 to February 2016. Results In all, 86 children and adolescents were referred for UGIE. There were 32 (37.2%) males and 54 (62.8%) females. The mean age was 13 years. Upper abdominal pain (47.7%), dyspepsia (19.8%), and upper GI bleeding (11.6%) were the major indications for referral. Fourteen (15.1%) patients were found to have normal UGIE findings. Commonest abnormalities seen at endoscopy were gastritis in 18 (22.1%), 14 (16.2%) had hiatus hernia, eight (9.3%) esophageal varices, seven (8.1%) gastric erosions, six (7.0%) had duodenitis, while five (5.8%) patients had esophagitis. Foreign body and duodenal ulcer were seen in three (3.5%) patients each, gastric ulcer and bile reflux in two patients each, while duodenal worms, esophageal atresia, caustic ingestion, and antral diverticular were seen in one (1.2%) patient each. Conclusion This study shows that endoscopy as an investigative tool in pediatric patients has high diagnostic yield with vital therapeutic potential, and is safe in the assessment of GI diseases.

Three year experience of Upper Gastrointestinal Endoscopic procedures at a tertiary care hospital of South Punjab

Introduction: Endoscopy has become a necessity in diagnosing gastrointestinal (GI) disorders. The objective of our study was to evaluate the different indications and findings of upper GI endoscopy. Methods: This retrospective analysis was undertaken at department of Gastroenterology, Nishtar Hospital Multan. Records of all upper GI endoscopic procedures from 1st January 2018 till 31st December 2020 were evaluated. Results: A total 3299 upper GI endoscopic procedures were perfumed during the three-year time period. Mean age was 47 years. Majority of patients were males. Almost 48% of patients belonged to the middle-aged group. The most common indication was upper GI bleeding (57%), followed by dyspepsia (15%). The most common finding was esophageal varices (43%), followed by portal gastropathy (26%) and gastritis (16%). Conclusion: This study concludes that the majority of endoscopies are being undertaken as a result of complications of cirrhosis and portal hypertension. Keywords: Endoscopy, audit, indications, findings

A Study on the Correlation Between Endoscopic Findings and Symptoms of Gastro-Esophageal Reflux Disease

Background and Aim: Gastroesophageal reflux disease (GERD) is a physiological passage of stomach contents into the esophagus. It is basically the pathological complications and symptoms. Endoscopy is a gold standard investigation tool that eliminates the gastroesophageal reflux disease co-morbidities such as malignancy and Barret’s esophagus. The present study was carried out to evaluate the correlation between endoscopic findings and symptoms of gastroesophageal reflux disease. Materials and Methods: This intervention cross-sectional study was carried out on 109 gastro esophageal reflux disease patients in Gastroenterology department of Isra University Hospital, Hyderabad for six months duration from January 2021 to June 2021. Suspected gastroesophageal reflux disease patients were assessed thoroughly by physical examination, history, and endoscopy for gastrointestinal symptoms. Severity, symptom type, duration, and frequency were assessed as clinical symptoms. The upper gastrointestinal endoscopy findings were evaluated in terms of esophageal erosions, and their grades such as Grade A, Grade B, Grade C, and Grade D. The endoscopy abnormal findings such as hernia, esophagus, malignancy, and Barret’s esophagus were correlated with gastroesophageal reflux disease. Result: Out of 109 patients, 78 (71.5%) were females while 31 (28.5%) were male. The mean age of the patients was 43.54 ± 7.3 years with an age range between 25 and 67 years and the mean BMI was 43.34 ± 5.76 kg/m2. Gastro esophageal reflux disease symptoms such as malignancy and Barrett’s esophagus shown no evidence on pre-operative endoscopy. About 29 (26.6%) patients had normal endoscopy. The symptomatic patients were 80 (73.4%) which were categorized based on LA classifications into Grade A 62 (77.5%), Grade B 13 (16.3%), Grade C 3 (3.8%) and Grade D 2 (2.5%). Based on the reflux score system, patients were distributed as mild 43 (53.8%), moderate 11 (13.8%), severe 5 (6.3%), and very severe 21 (26.3%). Conclusion: Our study found a significant correlation between gastro esophageal reflux disease and endoscopy esophagitis findings. Pre-operative endoscopy should be carried for abnormal endoscopy in both symptomatic and asymptomatic patients. Keywords: Gastro-oesophageal reflux disease, Endoscopy, Esophagitis

Upper gastrointestinal endoscopy findings in Mbale Regional Referral Hospital, Eastern Uganda: a 10-year retrospective analysis.

Endoscopy is required for formal diagnosis of many upper gastrointestinal (UGI) conditions including oesophageal cancer (OC). There is a paucity of data on endoscopy findings in East Africa as access to testing is challenging for patients. We describe the findings of 10 years of UGI endoscopy in Mbale Regional Referral Hospital (MRRH). Records of patients that underwent UGI endoscopy in MRRH, November 2009 - March 2019 were retrospectively analysed. Indication, macroscopic findings, histology and patient demographics were retrieved. Sub-group analyses were performed on those with a histological diagnosis of oesophageal cancer. 833 eligible patients received single UGI procedures during the study period. Mean age was 54.8 years, range 16-93 years and 56.9% of patients were male. The main indication was dysphagia (42%) and the most common findings OC (34%) and gastritis (28%). 151 patients had histologically proven OC with a median age of 60 years and a 2:1 male to female ratio. 145/151 (96%) of samples tested revealed squamous cell carcinoma (SCC). Those undergoing endoscopy in MRRH are most commonly male patients presenting in their 5th decade with dysphagia. There is a high proportion of significant findings including gastritis, peptic ulcer disease, and oesophageal cancer.

Upper Gastrointestinal Lesions during Endoscopy Surveillance in Patients with Lynch Syndrome: A Multicentre Cohort Study.

Simple SummaryPatients with Lynch syndrome are at increased risk of upper gastrointestinal cancer. Recommendations for upper gastrointestinal endoscopy screening vary widely with limited data supporting effectiveness. The aim of our study was to investigate yields of upper gastrointestinal endoscopy screening in a large multicentre cohort of 172 Lynch syndrome mutation carriers. In our study, upper gastrointestinal endoscopy surveillance detects frequent neoplastic lesions particularly after the age of 40 years. Ours results suggest that Lynch patients should be considered for upper gastrointestinal endoscopic and Helicobacter pylori screening.Background: Patients with Lynch syndrome are at increased risk of gastric and duodenal cancer. Upper gastrointestinal endoscopy surveillance is generally proposed, even though little data are available on upper gastrointestinal endoscopy in these patients. The aim of this retrospective study was to evaluate the prevalence and incidence of gastrointestinal lesions following upper gastrointestinal endoscopy examination in Lynch patients. Methods: A large, multicentre cohort of 172 patients with a proven germline mutation in one of the mismatch repair genes and at least one documented upper gastrointestinal endoscopy screening was assessed. Detailed information was collected on upper gastrointestinal endoscopy findings and the outcome of endoscopic follow-up. Results: Seventy neoplastic gastrointestinal lesions were diagnosed in 45 patients (26%) out of the 172 patients included. The median age at diagnosis of upper gastrointestinal lesions was 54 years. The prevalence of cancer at initial upper gastrointestinal endoscopy was 5% and the prevalence of precancerous lesions was 12%. Upper gastrointestinal lesions were more frequent after 40 years of age (p < 0.001). Helicobacter pylori infection was associated with an increased prevalence of gastric, but not duodenal, lesions (p < 0.001). Conclusions: Neoplastic upper gastrointestinal lesions are frequent in patients with Lynch syndrome, especially in those over 40 years of age. The results of our study suggest that Lynch patients should be considered for upper gastrointestinal endoscopic and Helicobacter pylori screening.

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.

Demographic Correlation with Upper Gastrointestinal Endoscopy Findings – A Prospective Study

Demographic Correlation with Upper Gastrointestinal Endoscopy Findings – A Prospective Study

Multidisciplinary approach to paediatric aerodigestive disorders: A single-centre longitudinal observational study.

Aerodigestive clinics (ADCs) are multidisciplinary programmes for the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth. Our objective was to describe the demographic, clinical, etiological and investigational profile of children attending the inaugural ADC at a tertiary paediatric centre in Queensland. Children referred to the ADC at Queensland Children's Hospital from August 2018 to December 2019 were included. Data on clinical, growth and lung function parameters, bronchoscopy and upper gastrointestinal endoscopy findings, thoracic imaging and comorbidities were retrospectively analysed. Fifty-six children (median (range) age 4 years (3 months-15 years); 18 female) attended the ADC during this 17-month period. Forty-six (82%) children had previous oesophageal atresia with tracheo-oesophageal fistula; 43 of these were type C. Previous isolated oesophageal atresia, congenital diaphragmatic hernia and congenital pulmonary malformation were the underlying disorder in three (5%) children each, with one child having a repaired laryngeal cleft. Vertebral Anal Tracheo Esophageal Renal Limb anomalies (VACTERL)/Vertebral Anal Tracheo Esophageal renal anomalies (VATER) association was seen in 21 (38%) children. Growth was adequate (median weight and body mass index z-score -0.63 and -0.48, respectively). Thirty-four (61%) children reported ongoing wet cough, with 12 (21%) requiring previous hospital admission for lower respiratory tract infection. Fourteen (25%) had bronchiectasis on computed tomography chest and 33 (59%) had clinical tracheomalacia, apparent on bronchoscopic examination in 21 patients. Dysphagia was reported in 15 (27%) children, 11 (20%) were gastrostomy feed-dependent and 5 (9%) had biopsy-proven eosinophilic oesophagitis. High proportion of children attending the ADC have ongoing respiratory symptoms resulting in chronic pulmonary suppuration and bronchiectasis. Potential benefits of this model of care need to be studied prospectively to better understand the outcomes.

The Association between Frailty and Abdominal Symptoms: A Hospital-based Cross-sectional Study.

Objective The association between frailty and abdominal symptoms has not been evaluated. Methods We conducted a hospital-based, retrospective cross-sectional study of consecutive outpatients ≥65 years old at the Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center from 2017 to 2019. Patients were included in the study if all of the following information was available from their medical records: patient's profile, the evaluation of osteoporosis, sarcopenia, frailty, nutritional status, findings of upper gastrointestinal endoscopy, and questionnaire results for abdominal symptoms [Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and Constipation Scoring System (CSS)]. We divided the subjects into frailty and non-frailty groups and investigated the risk factors for frailty. Results Of the 313 eligible study subjects [134 men (42.8%) and 179 women (57.2%); mean age, 75.7±6.0 years; mean body mass index, 22.8±3.6 kg/m2], frailty was noted in 71 cases (22.7%). In a univariate analysis, an older age (p<0.001), female gender (p=0.010), successful eradication of Helicobacter pylori (p=0.049), proton pump inhibitor (PPI) use (p<0.001), laxative/prokinetics use (p=0.008), sarcopenia (p<0.001), osteoporosis (p<0.001), hypozincemia (p=0.002), hypoalbuminemia (p<0.001), low lymphocytes (p=0.004), a high CONUT score (p<0.001), a high FSSG score (p=0.001), and a high CSS score (p<0.001) were significantly associated with frailty. A multivariate logistic regression analysis showed that an older age [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.08-1.24, p<0.001], PPI use (OR 2.42; 95% CI 1.18-4.98, p=0.016), sarcopenia (OR 7.35; 95% CI 3.30-16.40, p<0.001), hypozincemia (OR 0.96; 95% CI 0.92-0.99, p=0.027), a high FSSG score (OR 1.08; 95% CI 1.01-1.16, p=0.021), and a high CSS score (OR 1.13; 95% CI 1.03-1.23, p=0.007) were significantly associated with frailty. Conclusion Advanced age, PPI user, sarcopenia, hypozincemia, a high FSSG score, and high CSS score are associated with frailty.