Arab Journal of Gastroenterology

Editorial Board

2009-12-01

A note from the Editor’s desk

2009-12-01

The World Gastroenterology Organization 2009; progress and challenges

Eamonn M.M. Quigley — 2009-11-30

In London this November, during Gastro 2009, the joint meeting of the United European Gastroenterology Federation (UEGF), the World Gastroenterology Organization (WGO), the Organization Mondiale d’Endoscopie Digestive (OMED) and the British Society of Gastroenterology (BSG), the term of the current leadership of WGO, including my term as president, will come to an end. I take this opportunity both to reflect on what WGO has achieved in these past years and to identify the challenges that lie ahead.

HCV offensive mechanisms versus host’s defensive strategies

Abdel-Rahman El-Zayadi — 2009-12-04

Abstract: At each stage of the life cycle of the virus, hepatitis C virus (HCV) interferes with the cellular antiviral mechanisms of the host. Therefore, HCV infection represents a fencing match between the virus and the host cell. The host’s defense depends primarily on activation of the immune response, including activation of interferon (IFN) signalling, expression of cytokines (TNF-α, IL-12, IL-10, IFN-α) and stimulation of cellular immune response (CIR) and humoral immune response (HIR). HCV offense relies on envelope mutation, evasion of the host immune response and interference with the endogenous cellular antiviral factors.

Alterations in colonic mucosal lesions in patients with portal hypertension

2009-11-26

Abstract: Background and study aims: Portal hypertensive colopathy (PHC) is a clinical entity in liver cirrhosis. The frequency and profile of colonic mucosal lesions of this entity are not well studied. The aim of this study is to evaluate the prevalence of colonic mucosal changes in patients with liver cirrhosis and their clinical significance.Patients and methods: Forty patients with post-viral liver cirrhosis and portal hypertension (PHT) underwent upper gastrointestinal endoscopy as well as a full length colonoscopy to detect changes in colonic mucosa. PHC was diagnosed endoscopically by the presence of vascular ectasia, diffuse hyperaemic mucosa and rectal varices. Biopsies were obtained from the recto-sigmoid area as well as from any abnormal mucosal lesions apart from angiodysplastic areas.Results: Diffuse hyperaemia, angiodysplasia and rectal varices were found in 40%, 32.5% and 17.5% of patients while haemorrhoids in 42.5%, respectively. The prevalence of PHC increased with worsening Child-Pugh class, the mere presence of oesophageal varices while platelet count was significantly associated with angiodysplastic lesions only. None of other upper endoscopic features of PHT was significantly related to PHC. Moreover, history of lower gastrointestinal (GI) bleeding was significantly associated with the presence of rectal varices and haemorrhoids. Colonoscopic features of PHC were significantly associated with the histopathological diagnosis revealing 79% sensitivity and 66.6% specificity.Conclusion: PHC is a frequent finding in patients with PHT. Colonoscopic features suggestive of PHC were in concordance with the histopathological evidence. Although the presence of haemorrhoids is not a feature of colopathy, yet it should be considered together with anorectal varices as a cause of lower GI bleeding.

Prediction of oesophageal varices in patients with compensated cirrhosis: A novel scoring system

2009-11-16

Abstract: Background and study aims: Patients with liver cirrhosis are recommended to undergo an evaluation of oesophageal varices to assess their risk of bleeding. Predicting the presence of oesophageal varices through non-invasive means may reduce the number of unnecessary endoscopies. This study was designed to develop a predictive model for varices in patients with Child-Pugh A liver cirrhosis.Patients and methods: Retrospective analysis was performed on 70 patients with compensated cirrhosis. Clinical and laboratory parameters Child-Pugh class and platelet count were assessed. Ultrasonographic characteristics of splenic axis and portal vein diameter were noted. The data were assessed by univariate analysis and a multivariate logistic regression analysis.Results: We found the prevalence of oesophageal varices in patients with child A liver cirrhosis to be 64.3%. Platelet count, splenic axis, portal vein diameter, platelet count/splenic axis ratio, portal vein congestive index, and renal resistive index were found to be significantly associated with the presence of oesophageal varices on univariate analysis. A platelet count of 100,000, platelet count/splenic axis ratio <900, renal resistive index ⩾0.68, and a portal vein congestive index of ⩾0.07 had the highest discriminating value, at which the number of true positive patients was highest and the number of false positive patients was lowest (50% and 3%, 63% and 13%, 41% and 0%, 57% and 1%, respectively). Multivariate analysis identified platelet count, platelet count/splenic axis ratio, renal resistive index, portal vein congestive index as independent factors for the presence of oesophageal varices.Conclusion: Our data suggest that a new score system composed of some laboratory and ultrasonographic parameters may predict the presence of varices in patients with Child-Pugh A cirrhosis, and that the score system may help physicians to identify patients who would most likely benefit from screenings for oesophageal varices.

A study of duodenal intraepithelial lymphocytic population and its relation to coeliac disease in a cohort of patients in the Nile delta of Egypt

Hanan AlSaeid Alshenawy, Eiman Adel Hasby, Asem Ahmed Elfert — 2009-11-13

Abstract: Background and study aims: Coeliac disease is the permanent intolerance to dietary gluten, the major protein component of wheat. Recent epidemiological studies have provided evidence showing that this disorder is common in various parts of the world. The counting and the immunoprofile of intraepithelial lymphocytes of the small bowel have been proposed as methods to measure mucosal infiltration in gluten-sensitive patients. The aim of the present study was to quantify and define the immunohistochemical profile of intraepithelial lymphocytes in the duodenal mucosa of patients suffering non-ulcer dyspepsia, and compare them with known cases of coeliac disease.Patients and methods: Archival paraffin wax embedded duodenal sections from 50 endoscopic biopsies were stained using CD3, CD4, and CD8 antibodies. Sections were obtained from 24 patients with confirmed coeliac disease, 20 patients with non-ulcer dyspepsia, and 6 patients with functional dyspepsia as control. Patients with non-ulcer dyspepsia were on gluten containing diets. The number of intraepithelial lymphocytes was quantified in five different villi by counting the number of lymphocytes/100 epithelial cells in each villus, and calculating the mean. Endomysial antibodies and testing for Helicobacter pylori were done in all cases.Results: A positive correlation was observed between the degree of villous atrophy and CD3, CD4, and CD8+ intraepithelial lymphocytes. A positive correlation was also observed with the lamina propria lymphoid aggregates. H. pylori infection had a positive correlation with the degree of lymphoid aggregation in the lamina propria.Conclusion: Although the difference between potential coeliac disease and non-coeliac controls was significant, these lesions overlapped considerably. Clinicians as well as pathologists should increase the index of suspicion of coeliac disease. The frequent occurrence of duodenal intraepithelial lymphocyte expansions in other diseases may justify the use of immunohistochemical examination of duodenal biopsy specimens from patients suffering from dyspepsia.

Digestive tract emergencies in ultrasound – To see or not to see

Lucas Greiner — 2009-11-02

The normal features of the intestine in ultrasonography are well defined: as rule, all parts of the gastrointestinal (GI) tract have a three-layer appearance, corresponding to the muscularis propria, the submucosa, and the mucosa. All parts of the GI tract have a more or less pronounced luminal filling content of various properties: water or water-like liquids are contents that enable the best visualisation, while gas or faeces filling the intestinal tube can prove less favourable or even a hindrance to ultrasound examination.

Eradication of Helicobacter pylori decreases the expression of p53 and c-Myc oncogenes

Hanan AlSaeid Alshenawy, Amr Mahrous Alshafey — 2009-11-12

Abstract: Background and study aims: Although it is fairly well accepted that Helicobacter pylori infection (H. pylori) plays a significant role in causing gastric cancer, the exact mechanisms involved in its pathogenesis are unclear and there is controversial data about the state of chronic gastritis and the precancerous lesion after treatment of H. pylori. This study was designed to investigate the relationship between H. pylori infection, the activity of chronic gastritis and oncogenes before and after treatment of H. pylori.Patients and methods: Fifty-five of chronic gastritis cases were studied for H. pylori, activity of chronic gastritis, p53 and c-Myc expression. Positive H. pylori cases were re-evaluated again for the activity of gastritis, expression of p53 and c-Myc after treatment (6 months later).Results: Forty-five cases were positive for H. pylori. The activity of chronic gastritis correlated with H. pylori infection. p53 and c-Myc expression correlated positively with the grade of chronic gastritis. After treatment of H. pylori, the activity of gastritis decreased and the expression of both p53 and c-Myc decreased.Conclusion: H. pylori infection in the gastric mucosa may be implicated in the pathway of gastric carcinogenesis. It seems that H. pylori infection is responsible for early genomic instability even before any neoplastic changes and its eradication can reverse the sequence of inflammation and related atrophy, metaplasia, and genomic instability and, thus, may prevent gastric cancer development.

Metastatic gastrointestinal stromal tumours of the stomach: A report on two cases and literature review

2009-12-10

Abstract: Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours of the gastrointestinal tract, accounting for approximately 1% of gastric malignancies. We report on two cases of large malignant irresectable stromal tumours of the stomach with presence of concomitant distant metastases, treated palliatively, and followed by adjuvant imatinib therapy. The rarity lies in the presence of distant as well as lymph node metastases. The literature on this topic is reviewed.

Synchronous occurrence of colonic intraepithelial neoplasia and small bowel stromal tumour

2009-12-14

Abstract: We report the diagnosis of synchronous gastrointestinal stromal tumours affecting the small bowel and intraepithelial neoplasia of the colon in a 52-year-old patient. After surgical resection of the two tumours outcome was favourable. We discuss the causality of this association, based on a literature review of the few previously published cases.

World Gastroenterology Organisation practice guidelines: Obesity

2009-12-07

Review team:

Author Index

2009-12-01