ABSTRACT
Injection sclerotherapy has a prominent role in the treatment of bleeding hemorrhoids. The commonly used sclerosants are not available or very expensive in Nigeria. We prospectively evaluated 50% dextrose water, used as a nonallergenic sclerosant, in the treatment of bleeding internal hemorrhoids. Forty consenting adult patients (median age 50 years [range 35–67]; 22 women) with bleeding hemorrhoids, seen over a 2-year period, were offered injection sclerotherapy with 50% dextrose water. They were assessed for response, tolerance and complications. The duration of symptoms before presentation was 3 months to 15 years. The bleeding stopped after the injection in all patients. No patient needed a repeat procedure. No complication was recorded during follow up which ranged from 2 months to 12 months. We conclude that endoscopic hemorrhoidal sclerotherapy using 50% dextrose water offers a simple, safe and effective modality of treatment if properly utilized.
ABSTRACT
Background: Helicobacter pylori has become recognized as a major cause of gastroduodenal diseases in man. Evidence indicates that once acquired; H. pylori persists; usually for life unless eradicated by antimicrobial therapy. Over the past few years; we have accumulated some knowledge of the epidemiology of H. pylori in Ile-Ife; South-West Nigeria. In one collaborative study; we detected H. pylori in 195 (73) patients referred for endoscopy at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Furthermore we have observed a variegated gastric inflammatory response and atrophy including atrophic pangastritis but are yet to demonstrate MALToma in any of our patients. In addition we have demonstrated that dental plaque is a possible source of gastric H. pylori infection and such an endogenous source could account for difficulty in eradication leading to re-infection. Presently; infected patients are treated with standard combination therapy made up of amoxycilin and ciprofloxacin with a proton pump inhibitor /bismuth. Reports however have shown that the incidence of antimicrobial resistance in Helicobacter pylori is a growing problem and which has been linked with failures in treatment and eradication. Given this situation it has become necessary to have information about the susceptibility of isolates to particular antimicrobial agents before the selection of an appropriate treatment regimen. Objectives: More recently; we sought to study antimicrobial susceptibility of locally isolated H. pylori strains. Methods: We subjected 32 isolates to antimicrobial susceptibility testing against seven agents. Results: All the isolates showed multiple acquired antimicrobial resistance as they were all resistant to amoxicillin; clarithromycin; metronidazole; while 29/31; 27/31 showed resistance to rifampicin and tetracycline respectively. Five (15.6) of these isolates showed resistance to ciprofloxacin. Conclusions: Our findings suggest that H. pylori strains isolated within our study environment have acquired resistance to all the commonly pres-cribed antibiotics. On the basis of the findings it would be necessary to re-evaluate the eradication treatment regime in our setting