Endoscopic appearance, dissecting microscopy and histopathology in malabsorption disorders

Small bowel biopsy is essential for the diagnosis of malabsorption and recently endoscopic inspection of duodenal mucosa was reported to be helpful in diagnosing cocliac disease. In a study of 214 patients suspected to have malabsorption, we compared the diagnostic yield of endoscopic appearance, dissecting microscopy and histopathology of small bowel biopsies. The endoscopic appearance was abnormal in 64%, 20.3%, 66.6% and dissecting microscopy showed abnormalities in 68.5%, 26.5% and 83.3% in celiac disease, tropical sprue and primary intestinal lymphoma respectively, reflecting the site of lesions in the small bowed in these disorders. Moreover, in organic causes of malabsorption the endoscopic appearance and dissecting microscopy showed a predictive value of 100% and 94.3% respectively. There was no statistical difference between both procedures in all the groups studied. It seems that endoscopic inspection of the duodenal mucosa and dissecting microscopy examination of the biopsy is safe, rapid, easy and reliable procedure in the diagnosis and differentiation of various syndromes of malabsorption

Pattern of disaccharidases in chronic diarrhoea and malabsorption

Disaccharide-splitting enzymes were analyzed in the jejunal mucosae of 48 patients suffering from chronic diarrhoea and/or malabsorption, and the results were compared to those of 11 controls. Four [36.4%] of the controls were found to have partial lactase deficiency with a mean ratio of sucrase to lactase activity of 54.8 [SEM +/- 60.06] Significant reduction in the disaccharidases [lactase, sucrase, maltase, and isomaltase] were observed in patients with celiac disease and primary intestinal lymphoma; other groups exhibited variable affection in all disaccharidasas. High incidence of hypolactasia in these patients is the net results of both genetic influence on lactase activity and as a consequence to mucosal injury. It is suggested that further studies should be carried out using intestinal biopsy and direct enzyme assay in a large number of healthy adults

Helicobacter pylori in various gastrointestinal diseases

Two hundred and ten patients with different upper gastrointestinal diseases as well as celiac disease and liver cirrhosis were studied to determine the frequency of gastric irthabitation by Heicobacter pyloti [HP]. The study also assessed the effect of a combination of sucralfate, Amoxiycillin And Metronidazole on eradication of HP, relief of symptoms and healing of ulcers and duodenitis. Per endoscopic antral biopsies were taken from all patients for rapid urease test [RUT]. Except for patients with liver cirrhosis, a second biopsy was also taken for histopathology and identification of the organism in the stained specimens: RUT was positive for HP in 88.3% of duodenal ulceration, 72.7% of duodenitis, 66.7% of gastric atrophy, 61.9% of cirrhosis, 60% of gastric ulcer, 59.25% of celiac disease and in 57% of non-ulcer dyspepsia [NUD] patients. HP was identified histologically in 73.3% of duodenal ulceration, 72.7% of duodenitis, 66.7% of gastric atrophy, 60% of gastric ulcer and 55.5% of non-ulcer dyspepsia. After triple therapy RUT became negative in 47%, 573% and 85.7% of patients with duodenal ulcer, non-ulcer dyspepsia and duodenitis respectively. The overall healing rates were 63.3% in duodenal ulceration and 100% in duodenitis. This study rests that despite the non-specific correlation of HP with celiac disease and liver cirrhosis, there is a strong association with both ulcer and non-ulcer patients; the triple therapy proved to be effective for both clinical improvement and endoscopic resolution of the lesions

Gastric carcinoma in Iraq: evaluation of clinical and diagnostic procedures

Gastric carcinoma is the 8th common and the commonest G.I. cancer in Iraq. 418 patients with biopsy proved cancer were studied clinically and by various diagnostic procedures. Non-specific dyspepsia was the presenting symptom in 2/3 patients and peptic ulcer like pain in 19,7% of patients. Tumor mass in the antrum was the commonest endoscopic finding and an ulcer was found in 23% of patients, but neither size nor site of the ulcer was helpful in differentiating benign from malignant ulcers. Barium series was helpful in 62,% of patients whereas brush cytology was diagnostic in 82% of patients. Histopathology was reported as adenocarcinoma in all but the disease was well advanced in all patients and curative measures were either palliative or not feasible

significance of serum alpha feto protein in malignant and non malignant liver diseases

Serum alpha feto protein [AFP] is a reliable marker for hepato cellular carcinoma [HCC]. In 113 patients with HCC and other hepato biliary diseases, and 45 normal controls, AFP was estimated by radioimmunoassay. It was elevated in 80% of HCC patients compared to 40% and less in other hepato biliary diseases [P < 0.001]. Moreover, the mean value in HCC was 17854 ng/ml, compared to a mean of 18.7 ng/ml which was the highest among the non malignant conditions studied. Again, the specificity of AFP level compared to normal controls, benign liver diseases, and metastatic liver diseases were [100%, 87.3%, and 94.7%] respectively. It seems that serum AFP is a reliable and sensitive marker and is recommended for the early diagnosis of HCC

Pattern of jaundice in a general hospital evaluation of clinical and diagnostic parameters

A series of 390 patients with clinical jaundice were studied to categorise the aetiology of jaundice and evaluate the various diagnostic parameters. The cause was hepatocellular disease in 209 [53.6%] obstructive in 106 [27.2%], haemolytic in 41 [10.5%] and miscellaneous, in 34 [8.7%] patients. Initial clinical assessment has identified the aetiology in 78.2% of patients whereas biochemical liver function tests were not significantly discriminant among the various groups. In cholestatic jaundice, ultrasound was diagnostic in 92% and PTC in 93.8% of patients, whereas liver biopsy was diagnostic in all patients examined. It is recommended that to establish the cause of jaundice, the initial assessment is by full clinical evaluation and a screening biochemical and haematological profile. In cholestatic jaundice US may be needed and when still necessary more invasive techniques as liver biopsy and PTC can be performed

Zieve's syndrome

Seven patients with Zieve's Syndrome are discussed. All were chronic, heavy alcoholics with mild anaemia, reticulocystosis, mildly abnormal liver functions, elevated serum lipids and fatty infiltration of the liver. Follow-up after abstinence showed normalisation of these values, whereas in one patient alcoholic bin ge produced a flare up of all these abnormalities. The occurrence of this syndrome in Iraq should be thought of particularly on a background of increasing alcoholism

Brush cytology in the diagnosis of gastroesophageal lesions

Ninety patients of various gastroesophageal lesions and 10 normal control individuals were examined by brush cytology technique, endoscopy and punch biopsy when indicated. Bruch cytology was diagnostic in 96% of benign lesions and 82% of malignant lesions, which was comparable to endoscopic and histopathological diagnosis. Moreover the combination of the three methods was complementary and elucidated the diagnosis in all the patients studied

Alcoholic liver disease in Iraq

Alcohol abuse is emerging as a serious cause of liver disease in Iraq. In a prospective study of 72 patients, liver injury was related to the amount and duration of alcohol consumption. Hepatomegaly was found in 79% and stigmata of liver disease in half the patients. Abnormal liver functions were not specific but a high SGOT/SGPT ratio was found in 34% of patients. Gastroscopy demonstrated varices, thus confirming chronic liver disease, in 63% of patients, and revealed various types of gastro-duadenal mucosal lesions in half the patients. Liver biopsy confirmed alcohol-associated liver pathology in all patients. Among other associated diseases, ten patients had diabetes mellitus and two had alcoholic cardiomyopathy which suggest that alcohol abuse can cause multi-system injury

Hepatocellular carcinoma in Iraq

Hepatocellular cancer [HCCA] is not an uncommon tumour. Thirty seven [37] patients with histologically proved lesions are reported. Generalized weakness, abdominal pain and swelling and weight loss were present in 3/4 of patients, as were ascites and hepatomegaly, whereas jaundice was found in 2/3 of patients with ascites but ascetic Fluid examination and liver function tests were not very helpful. HBsAg was detected in 55.6% of patients and alpha feto protein [AFP] in 62.9% of patients. Ultra sound [US] detected hepatic tumours in 90.9% of patients. HCCA was associated with underlying chronic liver disease in 62.2% of patients. HCCA should be considered on clinical suspicion even in patients without evidence of underlying chronic liver disease. Haemorrhagic ascites should raise the suspicion and confirmation is best obtained by US and liver biopsy

diagnostic approach to ascites: a prospective study of 100 patients

In a prospective study of 100 patients with ascites the major causes were cirrhosis in 53%, intraabdominal tumors in 17%, TB peritonitis in 15% and heart disease in 10% of patients. Helpful clinical observations included, lone ascites suggesting TB peritonitis, splenomegaly pointing to cirrhosis and abdominal masses suggesting malignancy. Helpful biochemical data in cirrhosis were urinary urobilinogen, low serum albumen and high Y globulin. High ascites protein and cell count point to TB or malignancy, whereas haemorrhagic fluid is strongly suspicious of malignancy. Peritoneoscopy and biposy are diagnostic, particularly in TB and malignancy. However, a thorough clinical assessment is still the best method of diagnosis since it ellucidated the aetiology in 94% of cases

Endoscopic pattern of peptic ulcer disease: a study of 1633 patients in Iraq

In a prospective study of 1633 patients of peptic ulcer disease, studied by endoscopy, various forms of chronic duodenal lesions accounted for 75% of the cases. Based on endoscopic and biopsy findings in symptomatic patients, it is suggested that duodenitis is a true entity. There was a significant difference in the incidence ratio of chronic D.U. to chronic G.U. of 11 / 1. Two types of acute gastroduodenal erosions were recognized, linear ulcers and aphthous ulcers, the latter often concommittant with oral aphthae but not associated with G.l. bleeding. G.l. bleeding occurred in 221 patients [13.5%] and was the presenting feature in 80% of them. However, there was a significant higher tendency of bleeding in acute erosions than other forms of peptic ulcer disease [p < 0-01]. Again, Bleeding due to drugs was more likely due to acute rather than chronic ulcer disease [p <0-01]. Endoscopy proved a most valuable and safe diagnostic procedure, radiology being helpful in 60% of cases only and. it is recommended as a routine procedure for diagnosis and planning of treatment

On the side effects of histamine H2 receptor antagonist: cimetidine

Side effects to cimetidine were observed in four out of 420 patients [0.9%]. One patient had transient, reversible and reproducible fever and neutropaenia. Three patients had muscle pains which disappeared with out sequellae though cimetidine was continued. The literature was reviewed. It seems that cimetidine is a safe drug for the treatment of chronic duodenal ulceration

Erythema nodosum in primary intestinal lymphoma

A patient with primary intestinal lymphoma [Mediterranean lymphoma] associated with erythema nodosum is reported. The similarity of the clinical picture and laboratory data to Crohn's disease of the small bowel is stressed