role of capsule endoscopy in obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding is mostly recurrent and originates in the small bowel, which can be only partially examined by conventional endoscopy. Capsule endoscopy has revolutionized the evaluation of obscure gastrointestinal bleeding [OGIB]. The diagnostic yield of capsule endoscopy in OGIB was a main concern of many studies. The aim of this study is to assess the diagnostic yield of capsule endoscopy in cases of OGIB. Capsule-related complications and degree of inter-observer variation will be recorded as well. 54 consecutive patients suffering from OGIB, whether occult or overt, were subjected to capsule examination and data analysis. The majority [74.1%] presented with obscure overt bleeding. Examination was complete in 68.4%. The commonest lesions were angiodysplasias [17.5%]. Examinations were negative for lesions in 35.1% and hampered by limitations in 19.3%. The capsule diagnostic yield was 56.1%, while capsule retention occurred in 3.5%. The inter-observer agreement for the cause of bleeding was 91.2%. Capsule endoscopy proved helpful in solving the mystery of OGIB. It succeeded in diagnosing the cause of bleeding and directing further management with good compliance, high proportion of inter-observer agreement and low incidence of complications

Quality of life of Egyptian donors after living-related liver transplantation

Quality of life after liver donation must remain a primary outcome measure when we consider the utility of living donor liver transplants. In making clinical decisions on the use of transplantation for chronic liver diseases, consideration should be given to the key factors likely to affect subsequent health related quality of life. It would be beneficial for donors, if factors predicting good quality of life are identified. The aim of this study was to assess the health related quality of life changes experienced by donors following living related liver transplantation using the Short Form 36 [SF-36] questionnaire. Between August 2001 and December 2006, 125 adults received liver grafts from living donors at Dar Al-Fouad Hospital, Cairo, Egypt. The SF-36v2 questionnaire was applied to 30 donors after at least 6 months following donation and maximally 4 years after donation [mean +/- SD:3.28 +/- 1.56 years]. Furthermore, 30 healthy volunteers were taken as a control group. None of the donors required re-surgery and no deaths were reported. Only 4 [13.3%] donors experienced minor complications, which did not affect their quality of life and had no long term effects. No significant difference was found between donors and control group when means of the Physical and Mental Component Summary were compared. The physical functioning domain was the only domain of health which showed a statistically significant difference between both groups. Health related quality of life of donors was not compromised after full recovery. All donors had good recovery and returned to regular activities within 2-4 months post donation

Impact of 10 years of hepatitis B vaccination on the frequency of acute symptomatic hepatitis B at a major urban referral center in Egypt

This study aimed to determine the impact of 10 years of universal hepatitis B immunization on the prevalence of acute symptomatic viral hepatitis B in Egypt compared with previous results reported by the same authors in 1983. Two hundred consecutive patients with acute symptomatic viral hepatitis, diagnosed clinically and biochemically, were enrolled from Embaba Fever Hospital [EFH], Giza Governorate, Egypt in the period from December 2001 to September 2002. Serological tests were done using ABBOTT AXSYM [Abbott laboratory, Abbott Park, III] for hepatitis A virus [anti-HAV IgM], hepatitis B virus [HBsAg, anti-HBc total and IgM, anti HBs], hepatitis C virus [anti-HCV IgM and total, in addition to PCR], hepatitis D virus [anti-HDV IgM] and hepatitis E [anti-HEV IgM]. In addition, the patients were screened for IgM Ab of cytomegalovirus [CMV], Ebstein barr virus [EBV] and PCR for HGV and transfusion transmitted virus [TTV]. In the present study, the overall acute HBV infection was accounted for 31.5% of the acute viral hepatitis cases, with a male predominance of 62.4% and a significant increased prevalence in adolescent and adults. Although the clinical presentation of HBV did not differ from those of the various causes of hepatitis, the mean ALT levels were significantly higher in acute HBV when compared with acute HAV infection. The frequency of acute hepatitis B was decreased from 43.4% in 1983 to 31.5% in 2002, which was particularly evident in children and there were no significant changes in the rate of acute hepatitis among HBsAg carriers [12.3% and 9%, respectively]. Despite the lower coverage rate of hepatitis vaccination in those <9 years [37.9%], there was virtual absence of acute hepatitis B. The use of multiple seromarkers decreased the prevalence of the undiagnosed cases in those suffering from acute hepatitis to 6.5%

Prehepatic portal hypertension in Egyptian children: a single center study

Background: Portal vein thrombosis [PVT] is considered the most important etiology of prehepatic portal hypertension in children and a leading cause of esophageal varices and hematemesis in these children

Aim of the study: The aim is to analyze the data of children with prehepatic portal hypertension secondary to PVT presenting to the Pediatric Hepatology Unit, Cairo University. Egypt. Study design. The study included 120 children with PVT who presented during the period 1987-2002. They were retrospectively analyzed for the presenting symptoms, the risk factors for the development of PVT, the diagnostic tools and the therapeutic measures carried out for them. Most of them 114/120 were followed up for variable periods. [ranging from 2 months to 12 years]

Results: The male: female ratio was 1.4:1, with ages ranging between 1-18 years. The most important presenting symptoms were: hematemesis in 32%, abdominal distention in 25% and accidentally detected splenomegaly in 181%.Risk factors for the development of PVT included: neonatal sepsis: 3.3%, umbilical catheterization: 5.8%, umbilical sepsis: 5% and severe gastroenteritis and dehydration 1 7%, while there was no risk factor detected in 81%. Ultrasonography was diagnostic in 99% and the remaining 1% were diagnosed by Doppler examination. In contrast, out of 36 children with portal vein occlusion detected by ultrasonography, 9 showed patent portal vein by Doppler examination. Upper gastrointestinal endoscopy revealed esophageal varices in 91% Therapeutic sclerotherapy and band ligation were done for 74.2%, and 13.3% respectively. Prophylactic sclerotherapy was performed in 7.5% and only one case underwent prophylactic band ligation

Conclusion: Prehepatic portal hypertension presents early in life commonly with bleeding esophageal varices. Ultrasonography is a helpful diagnostic tool. Sclerotherapy and band ligation are the most important therapeutic measures in the present study

community-based study of viral hepatitis infection in Giza Governorate, Egypt: Seroprevalence, risk factors and associated morbidity

Hepatitis viruses are major causes of acute and chronic liver diseases in Egypt. The aim of this study was to investigate the seroprevalence, risk factors and associated morbidity of viral hepatitis in Giza Governorate, Egypt. The study was conducted in 4 rural and 4 semiurban communities and included 2305 subjects selected by a cluster r and om method. They underwent complete clinical and abdominal ultrasonographic [US] assessment and laboratory tests including stool and urine examination, hemoglobin, ALT estimation and viral hepatitis markers by enzyme immunoassay. The latter included anti-HAV IgG, HBsAg, anti-HBc, anti-HBs, anti-HCV and anti-HEV IgG. Subsets of sera were tested for HBV DNA and HGV RNA by specific PCR. The overall prevalence of anti-HCV was 20.9% [age-adjusted prevalence = 24.5%; CI: 22.7-26.3%] and was significantly rising with age from 10% below age of 20 years to 40% among those above 50 years. The infection rate of hepatitis B virus [HBV] was 57.1% with HBsAg carrier rate of 3.6%. Seropositivity of anti-HBs and anti-HBc was very high [45.8% and 44.7%, respectively] and correlated positively with age with no sex-related difference. Combined HCV and HBV infection was evident in 13% of subjects. HBV DNA was detected in 86% of HBsAg-positive cases and in 20% of HBsAg-negative anti-HBc- and anti-HCV-positive cases. Seromarkers for hepatitis B and C were significantly commoner in semiurban than in rural communities. Dental manipulation and previous parenteral antischistosomal therapy were significant risk factors for hepatitis B and C infection. Anti-HAV was positive in 99.7% whereas anti-HEV was positive in HBV= Hepatitis B virus. CLD = Chronic liver disease. HCC = Hepatocellular carcinoma. US = Ultrasonography. ALT = Alanine transaminase. OR = Odds ratio. CI = Confidence interval. 9.2%. HGV RNA was detected in 16.5% of the studied samples. It was always associated with HBV and /or HCV infection. History of hematemesis was recorded in 1.2% of individuals. US examination revealed hepatomegaly in 19.2% of subjects, splenomegaly in 8.2%, bright liver in 31%, coarse liver texture in 10%, periportal fibrosis in 20% and ascites in 2%. These findings were significantly more common in anti-HCV- and HBsAg-positive subjects. ALT elevation was commonest and highest in individuals with positive HBsAg or with HBV-HCV coinfection. Hepatitis B and C infection and associated morbidity still constitute a great health problem in Egypt. Hepatitis A is holoendemic and hepatitis E is endemic. Hepatitis G is always associated with HBV or HCV infection. Occult hepatitis B should be considered in future studies

Comparative study between abdominal sonography and upper GI endoscopy in the assessment of severity of portal hypertension in Egyptian children

100 patients in pediatric age group, presenting with hepatomegaly were studied by ultrasonography and upper G.I. endoscopy aiming to assess the severity of portal hypertension, comparing the portal vein diameter with the presence and grading of oesophageal varices. The results showed no direct correlation