Helicobacter pylori: revising our concepts of the Pathophysiology and management of peptic ulcer disease

With the introduction of Helicobacter pylori by Marshall and Warren as the pathogen causing type B gastritis and peptic ulcer disease, our previous understanding of the pathogenesis of peptic ulcer disease has been dramatically revised. This bacterium is also thought to be responsible for the development of non cardia adenocarcinoma of the stomach and mucus associated lymphatic tissue proliferation [MALT] lymphoma. Therefore it is now essential to eradicate the infection not only to treat peptic ulcer disease but to prevent possible malignancy. Treatment is indicated for all patients with evidence of Helicobacter pylori infection. The diagnosis is based on urease activity of the bacterium as in urease quick tests or C[13] or C[14] breath test.Other modalities are the serology [ELISA] tests or direct proof of bacterium by histology. Different regimes have been tried with different eradication rates. Triple therapy with Bismuth or Omeprazole in combination with 2 antibiotics is recommended. Successful eradication of Helicobacter pylori has markedly reduced not only the risk of recurrence of peptic ulcer disease but also it is hoped to reduce gastric malignancy

Endoscopic management of benign biliary stricture

To present the experience of the Gastroenterology Department of the Riyadh Armed Forces Hospital, with endoscopic management of benign biliary strictures.Design: A retrospective study of patients diagnosed by endoscopic retrograde cholangiopancreatography [ERCP], as having benign biliary strictures. Thirty-seven patients with benign biliary strictures who were endoscopically diagnosed or treated over a 9-year period. Twenty-four of these patients had postoperative strictures and in the remaining 13 patients, the causes included sclerosing cholangitis, inflammation or benign neoplasm. The management in these patients was surgical in 18, combined surgical and endoscopic in ten and endoscopic only in nine. Nasobiliary drainage was performed in all ten cases of combined endoscopic and surgical approach before patients were referred to surgery. The last nine patients were managed by endoscopy alone, four had balloon dilatation and five had endoprostheses inserted [four of these were plastic stents and one was an expandable metal stent]. In benign biliary strictures, endoscopic management with stricture dilatation followed by stenting should be tried first before any surgical intervention is considered

Intragastric balloon in the treatment of obesity

We report our experience on the use of the intragastric balloon in the treatment of obesity in our unit. Five patients had balloon insertion and in two other patients balloons were removed which had been inserted in another hospital. We used the balloons [D.O.T. APS, Rodovre, Denmark] for an average period of 73 days and found that this procedure was ineffective and probably harmful to the patients

Evaluation of gastro-esophageal reflux disease results in 40 patients

Forty patients were investigated for evidence of gastro-oesophageal reflux disease using upper gastrointestinal endoscopy, 24-h ambulatory pH recording and standard oesophageal manometry. The first group comprised 30 patients referred with the diagnosis of non-ulcer dyspepsia where the 24-h pH recording was positive in 12 [40%] and endoscopic findings of oesophagitis were noted in eight [26.6%] of them. The second group consisted of 10 patients referred with the diagnosis of non-cardiac chest pain, four of whom [40%] had positive pH results and none had endoscopic features of reflux. Thus a significant number of patients [40%] labelled as having non-ulcer dyspepsia and non-cardiac chest pain were shown to have abnormal gastro-oesophageal reflux

Endoscopic management of a biliary leak following surgery

This is a report of a patient who presented to our unit with massive biliary leak after cholecystectomy. This was related to retained common bile duct stone. The patient was treated by endoscopic sphincterotomy, stone removal and stenting. The leak was sealed after 2 months and the stent was removed