Duodenogastric reflux and symptomatology before and after cholecystectomy in patients with symptomatic gall stone disease

The aim of this work was to address possible factors that initiate, maintain or worsen the symptoms of duodenogastric bile reflux in patients with gallstones and to evaluate the effect of surgical removal of the gall bladder on the duodenogastric reflux. The study was carried out on 30 female patients with symptomatic gallstone disease who were admitted to Medical Research Institute Hospital for elective cholecystectomy. Preoperative upper GIT endoscopy revealed presence of duodenogastric bile reflux in 70%, gastritis in 53.3% and duodenitis in 46.7%. The mean value of the body mass index [27.69 +/- 3.04] was in the overweight range. patients were parous and high multoparity was associated more with complications[obstructive jaundice and acute cholecystitis] with a strong association between multiparity and duodenogastric bile refulex. Positive family history of gallstone diseasee was associated more with symptoms purely retated to gallstones. Follow up by clinical assessment and endoscopy after 6 months revealed persistence of duodenogastric bile reflux in 76.7%, gastritis in 56.7% and duodenitis in 53.3% with a significant increase in the occrrence of both epigastric and right upper quadrant pain as the main symptom post operatively in 18 patients [60%] compared to 12 patients [40%] preoperatively. We concluded that duodenogastric bile reflux is responsible for the initiation of most of the gallbladder symptoms and most of those symptoms may persist or appear post operatively

Morbidity of Schistosomiasis mansoni in rural Alexandria, Egypt

A parasitological survey of stool and urine of 2577 from 3281 individuals living in Abis village, Alexandria, was undertaken in 1998 in order to investigate the prevalence of schistosomiasis in this area and the risk factors for hepatic morbidity. A random sample of 1082 individuals was interviewed using a questionnaire regarding the risk factors for liver morbidity. All interviewed adults [total 728] were clinically examined for an evidence of organomegaly [hepatomegaly and/or splenomegaly]. Individuals with clinically detected organomegaly were referred for detailed investigations [total 65]. The criteria for severe hepatic morbidity were AST/ALT ratio higher than 1, prothrombin activity <70% and an evidence of portal hypertension

Insulin and glutamic acid decarboxylase antibodies in chronic hepatitis [C] patients with diabetes mellitus

Diabetes mellitus is associated more with HCV chronic liver disease than in the general population and in the other types of chronic liver disease. The increased incidence of diabetes in HCV patients might be related to an autoimmune process produced by the virus or the virus itself has a cytopathic effect on the pancreatic beta clells. The aim of this work was to study the plasma basal insulin level and the seropositivity against glutamic acid decarboxylase [GADA] - an islet cell cytoplasmic antigen. Patients: the study was carried out on 45 patients categorized into 3 equal groups. Group I included 15 diabetic patient with HCV chronic liver disease, Group II included 15 diabetic patients with chronic liver disease which is not related to HCV, Group III included 15 non diabetic patients with HCV chronic liver disease. All patients were selected to be matched regarding age, sex and sevirity of liver disease. The results showed that basal insulin level [22.4 +/- 23.1 micro IU/ml in group I, 21.6 +/- 23.8 micro IU/ml in group II, and 8.8 +/- 6.4 micro IU/ml in group III] were significantly higher in the diabetic patients [GI and GII] compared to the non diabetic [GIII] [P<0.01]. The insulin resistance index as calculated by HOMA equation [9.6 +/- 7.9 in group I, 9.2 +/- 10.3 in group II and 2.4 +/- 1.2 in group III], were also significantly higher in the diabetic groups [p < 0.01]. Seropositivity for [GADA] was 9/15 [60%] of patients of groups I and III and 3/15 [20%] of patients of group II. We concluded that diabetes mellitus associated with HCV chronic liver disease in characterized hyperinsulinaemia and increased insulin resistance. There may be a role of autoimmunity in the pathogenesis of diabetes in HCV chronic liver disease. Follow up of the non diabetic HCV patients with positive GADA for development of diabetes is recommended

role of ultrasonography to discriminate between schistosomiasis and virus-related chronic liver disease

The aim of our study was to assess the role of ultrasonography in patients with chronic liver diseases in discriminating between schistosomiasis and viral hepatitis infections in Egypt, an area where these infections are endemic. We assessed 114 patients with chronic liver disease, clinically, ultrasonographically, biochemically, virologically, parasitologically and by liver biopsy. According to histological diagnosis; 7.9% of patients had portal fibrosis, 43% chronic hepatitis, 47.4% cirrhosis and 1.8% hepatic malignancies. Patients with cirrhosis 44 [49.4%] of them had pure HCV infection. The longitudinal diameter of the spleen was significantly higher in patients with cirrhosis- virus related liver disease than those with pure schistosomiasis, while no significant differences were found in the degree of periportal thickening between the two groups. This study shows that ultrasonography alone can not be used as a screening procedure to discriminate between schistosomiasis and viral hepatitis infections in areas where these infections are highly associated, such as in Egypt