Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope

To evaluate the management of foreign bodies in the upper Gastrointestinal tract in a tertiary care hospital in Peshawar. In this descriptive study, conducted at Gastroenterology Department Hayatabad Medical Complex Peshawar from May 2002 to May 2009, a total of 40 consecutive patients presenting with history of foreign body ingestion were included. Radiological survey was made before endoscopy in all the patients. Flexible endoscope, esophageal over tube and other accessories were used for removal of the foreign bodies. Female to male ratio was 1.5:1. The mean age of the sample was 19.92 +/- 23.5. Dysphagia [n=18, 45%] was the most common symptom in the esophageal foreign bodies followed by retrosternal pain or discomfort [n=11, 27.5%]. The most common foreign body was coin ingestion [n=24, 60%]. Meat bolus and bone chip impaction was present in 9 [22.7%] patients. The success rate in case of esophageal foreign bodies was 93.75%. While in the case of gastric foreign bodies, it was 100%. There was a small perforation which occurred in only one patient with esophageal foreign body which was managed conservatively. In the case of gastric foreign bodies, no procedure related complications occurred. Flexible endoscopy was a safe and effective technique for the management of foreign bodies in the upper gastrointestinal tract in our study

Frequency of organic pathologies in patients with irritable bowel syndrome

To evaluate Irritable bowel syndrome [IBS] labeled patients, meeting symptom based criteria of IBS, for organic pathologies. This descriptive study was carried out in Gastroenterology Department, Hayat Abad Medial Complex, Peshawar, during the period from March 2003 to March 2005. A total of 85 consecutive patients were included in the study, who were labeled as IBS by the General Practioners. All of them were meeting symptom based criteria [ROME II] for IBS. Informed consent was taken. Patients with alarm signs including dysphagia, rectal bleeding, anemia, weight loss, family history of colon cancer, were excluded from the study. Detailed history and physical examination was done. Laboratory evaluation, which included complete blood count, erythrocyte sedimentation rate[ESR], blood urea, serum creatinine, serum electrolytes, liver function tests, thyroid function tests, and stool examination for ova, parasites and culture when indicated, was done. Patients underwent Upper G I Endoscopy, Ultrasound of the abdomen, Flexible sigmoidosopy and/or Full length colonoscopy as indicated. Other investigations like small gut biopsy, celiac serology and biopsy from the large gut were done as needed. Out of the 85 patients, 68 [80%] were males and 17 [20%] were females. Abdominal pain was the most common, present in 65 [76%] patients out of 85 patients. All these patients had mixed type of IBS symptoms, having both diarrhea and Constipation. Laboratory investigations were normal in almost all patients except in 5 [5.8%] patients, who were having evidence of hypochromic microcytic anemia. All these five patients were having mixed pattern IBS. Three [3.5%] were males and their celiac serology and small gut biopsy showed evidence of celiac sprue. Ten [12%] of patients were having cysts of Amoeba in their stools routine examination but there were no trophozytes found. Another 15 [17%] patients were having non significant hemorrhoids on lower GI endoscopy. 17 [20%] of patients were having antral gastritis on EGD, but the biopsy showed non specific gastritis. Irritable bowel syndrome can be diagnosed clinically, using ROME II criteria and a few inexpensive and non invasive tests. In patients with IBS-D and IBS-M routine serological screening for celiac sprue may be a cost effective strategy

Cutaneous manifestations of chronic liver disease

Hepatobiliary diseases are frequently associated with abnormalities of the skin, nails and hair. This study was undertaken to determine the cutaneous manifestations of chronic liver disease [CLD] and particular pattern associated with aetiology of disease. Patients suffering from chronic liver disease of any aetiology presenting to department of gastroenterology Hayatabad Medical Complex, Peshawar from 1st December 2004 to 30th April 2005 were enrolled in the study. All the relevant details regarding history and clinical examination were recorded on a specially designed pro forma. A total of fifty patients, 32 males and 18 females were included. Thirty [60%] patients were suffering from chronic hepatitis C virus infection, 14 patients were suffering from Chronic hepatitis B virus infection and 2 patients each were suffering from primary biliary cirrhosis and Wilson's disease. In two cases the aetiology could not be ascertained. Different manifestations included pigmentation [82%], Terry's nails [80%], xerosis and excoriations [72%], nonscarring hair loss from axilla and pubic region [64%], and spider naevi and palmar erythema [36%]. Lichen planus was seen in 4%, vitiligo and hepatocutaneous syndrome in [2%] of patients each. Cutaneous manifestations in chronic liver disease are non-specific and do not point towards specific aetiology. Physicians caring for patients with chronic liver disease should pay attention to its multisystemic nature

Outcome of endoscopic injection sclerotherapy with absolute alcohol for bleeding esophageal varices

To find out the long-term consequences of endoscopic injection sclerotherapy using absolute alcohol as a sclerosing agent. Design: Study was carried out retrospectively. Place and Duration: Department of Gastroenterology, HMC, Peshawar from January, 1988 to June, 2000. Subject and 620 patients admitted for bleeding esophageal varices were studied, emergency sclerotherapy was performed in 127 [20.48%] patients whereas elective sclerotherapy was performed after 24 - 72 hours in 493 [79.52%] patients [p < 0.05]. Total sclerosis with survival was achieved in 573[92.41%] patients [p < 0.05], whereas 47[7.58%] patients died because of uncontrolled bleeding in 31[5%] patients, early rebleeding in 9[1.45%] patients, and encephalopathy in 7[1.12%] patients. Common complications included central chest pain [17%], esophageal ulceration [11%] and pyrexia [5%]. At the time of discharge from hospital, all the patients were given propranolol 20 mg QID as an adjuvant medical therapy for the secondary prophylaxis of variceal bleeding. The rate of complete eradication of esophageal varices was 92%. The overall recurrence rate of varices was 28% during follow-up period. The rate of recurrent bleeding and death was 9.42% and 3% respectively. We conclude that absolute alcohol and propranolol for bleeding esophageal varices are associated with low recurrence rate of varices, rebleeding and low mortality