Value of screening colonoscopy in the diagnosis of Egyptian patients with lower gastrointestinal symptoms

Colorectal cancer is a major cause of mortality allover the world. Fecal occult blood testing, flexible sigmoidoscopy and total colonoscopy are the most commonly recommended screening tests for colorectal cancer, yet screening rates are still below target levels. To fully realize the benefits of early detection of colorectal cancer, screening rates must be improved. The current study has been conducted to study the current pattern of colorectal lesions from endoscopic and histopathologic perspectives in relation to clinical and laboratory aspects in Egyptian patients with different lower gastrointestinal symptoms. 165 cases with different lower gastrointestinal symptoms presented to Gastroenterology and Endoscopy Unit, Specialized Medical Hospital, Mansoura University. Clinical, laboratory, colonoscopic and histopathological examination of colonoscopic samples were done during the period from October 2005 to July 2006. The main lower gastrointestinal symptoms were abdominal pain, distension, altered bowel habits, dysentery and rectal bleeding. Ulcerative colitis represented 9.1% while colorectal carcinoma represented 4.1% of cases. The commonest symptoms and laboratory findings associated with colorectal carcinoma group were constitutional symptoms, constipation, rectal bleeding, fecal occult blood and iron-deficiency anemia. The colonoscopic examination is safe, accurate and cost-effective means of the screening for colorectal carcinoma

Study of gall bladder contractility and prevalence of gallstones in Egyptian patients with liver cirrhosis

Gall bladder stones are considered a public health problem allover the world. Many factors have been proposed to explain the increased incidence of gallstones in liver cirrhosis as alcoholism, changes in total bile acid pool, decreased cholesterol secretion, hemolysis secondary to hypersplenism, increased oestrogen levels and changes in gall bladder and sphincter of Oddi motility, but the exact mechanism has not been yet elicited. Our objective was to study gall bladder contractility and prevalence of gallstones in patients with liver cirrhosis in addition to analysis of the effect of portal hypertension on these two parameters. Eighty patients with chronic liver disease were enrolled [60 patients with liver cirrhosis and 20 patients with pure hepatosplenic schistosomiasis]. Ultrasonographic diagnosis of gallstones with evaluation of gall bladder contractility and portal hypertension were done. An increase in the number of subjects with gallstones with an increase of gall bladder fasting volume and residual volume with a decrease in gall bladder ejection fraction in the patients than the controls. Also there was an increase in the percentage of patients with gallstones among those with higher grades of portal hypertension. Patients with liver cirrhosis have higher frequency of gallstones with diminished gall bladder contractility and higher measures of portal hypertension

Serum thrombopoietin levels in patients with liver cirrhosis; relation to severity of the disease, spleen size and platelet count

Background: thrombopoietin [TPO] is an important regulator of megakaryocyte maturation and platelet production. The role of TPO [which is mainly produced by the liver] in thrombocytopenic cirrhotic patients is still under investigation. The aim of this study was to measure the serum TPO levels in cirrhotic patients and examine its relationship with circulating platelet count, splenic size and clinical stage of liver cirrhosis

Study design and methods: this study was conducted on 88 subjects, divided into 2 groups, group I [patient group] included 72 patients with liver cirhosis [diagnosed by combination of clinical, laboratory, ultrasound and histopathological data], they were further divided into 2 subgroups, group IA: included cirrhotic patients with thrombocytopenia [36 patients, 28 males and 8 females with age 50.3:8.5 years], and group IB: included cirrhotic patients with normal platelet count [36 patients, 26 males and 10 females, with age 50.64+/-6.8 years]. Group ll comprised 16 healthy persons with matched age and sex, used as a control group. All included persons were subjected to: thorough history taking, full clinical examination, beside the following investigations: complete blood picture, kidney and liver function tests, Hepatitis B and C markers, serum TPO level [by sensitive sandwich ELISA] and abdominal Doppler ultrasound. The following invasive investigations were done for group I [patients] only: bone marrow aspiration, upper gastrointestinal endoscopy, sigmoidoscopy and liver biopsy [the latter was done for 21 patients only]. Patients with pure schistosomal fibrosis were excluded from the study. Patients were classified according to the Child-Pugh score into 3 classes of clinical severity A, B and C

Results: cirrhotic patients were thrombocytopenic in comparison to control [P<0.0001]. Serum TPO levels were lower in cirrhotic patients [130.6-79 Pg/mi] than control group [225.5-36 pg/m] [P<0.0001] and also in patients with thrombocytopenia [101-77.5 pg/m] than in patients with normal platelet count [160.2-70.3 pg/m] [P<0.001]. TPO had a significant positive correlation with platelet count [P-0.0001 for sub-group IA and P=0.04 for subgroup 1B]. However serum TPO did not correlate with spleen size. Splenic size had a significant negative correlation with platelet count in cirrhotic patients [P-0.03 for subgroup IA and P=0.004 for subgroup 1B]. In cirrhotic patients, serum TPO levels were found to be decreased as the disease progressed in subgroup IA, 188.25+73.05 pg/ml in patients of Child-Pugh class A, 63.8:23.28 pg/ml in class B and 51:26 pg/ml in class C, while in group 1B, 247.3:40.49 pg/ml in class A 121.3+/-29.6 pg/ml in class B and 112+/-27 pg/ml in class C]. Child-Pugh score has a significant negative correlation with TPO level in both sub-groups IA and 1B [P=0.0001] and with platelet count [P=0.0001 for subgroup IA and 0.01 for subgroup IB], but no significant correlation with spleen size. In comparing class A, B and C in both subgroups [IA and IB], spleen size was significantly larger in Child class A of subgroup IA when compared to same class of subgroup 1B [P-0.0001] with slight significant decrease in TPO in class A of subgroup I than class A of subgroup B [p-0.02]

Conclusion: we concluded that low TPO production may play a role, along with hypersplenism, in the development of thrombocytopenia in patients with liver cirrhosis. In early stage of cirrhosis [Child-Pugh class A], splenomegaly and hypersplenism may be the main path mechanism of thrombocytopenia. While advanced liver cirrhosis [Child-Pugh class B and C], causing more reduction in TPO production, plays a central role in the pathogenesis of thrombocytopenia