Endoscopic findings in acute upper gastrointestinal hemorrhage at King Hussein Medical Center

To find out the diagnosis in patients presenting with acute upper gastrointestinal hemorrhage at King Hussein Medical Center. A total of 1118 cases of acute upper gastrointestinal hemorrhage patients aged over 16 years who underwent upper endoscopy over a six year-period at King Hussein Medical Center were studied. Most endoscopies were done within 24 hours from the occurrence of the gastrointestinal bleeding. Patients were divided into different age groups to compare the frequency of upper gastrointestinal hemorrhage between males and females in each group. The total number of patients was also divided into 2 subgroups: those below 50 years and above 50 years to compare the distribution of the endoscopic findings between young and older age groups. Upper gastrointestinal bleeding was more common in men at all age groups than that in women except in older patients [more than 70 years]. Eighty seven percent of the endoscopies were done for patients admitted to hospital through the emergency department, and 13% for patients who were already in hospital for some other reason. Sixty two percent of patients were aged over 50. The most common finding over all was duodenal ulcer [32%]. Normal endoscopy was reported in 21% of the cases. Other frequent sources of bleeding were stomach ulcers [18.5%], esophageal varices [5.2%], portal hypertensive gastropathy [0.6%]. Mallory-Weiss tears [3.3%], and gastric tumors [4.7%]. Gastric ulcers and malignancies were more common in older compared with younger age group [2 1.5%, 6.6% vs. 14%, 1.4% respectively]. Therapeutic endoscopic interventions were done in 17% of the patients; adrenaline injection for bleeding peptic ulcer in 16%. sclerotherapy for esophageal varices in 0.9% and banding in 0.1% patients. The frequency of acute upper gastrointestinal hemorrhage increases considerably with age. The most common finding for all age groups was duodenal ulcer. Malignancy was the most important finding in the older [> 50 years] age group

Eosinophilic gastrointestinal disorders

Eosinophilic gastrointestinal disorders are rare inflammatory diseases of unknown origin defined as disorders that selectively affect the gastrointestinal tract with eosinophil-rich inflammation in the absence of known causes for eosinophilia [eg, drug reactions, parasitic infections, and malignancy]. Eosinophil levels fluctuate, predating presentation by years and may be absent at presentation. Allergic mechanism has been suggested in at least a subset of patients. Indeed, increased total IgE and food-specific IgE levels have been detected in the majority of patients. A majority of patients have positive skin test responses to a variety of food antigens but do not have typical anaphylactic reactions, which is consistent with a delayed-type of food hypersensitivity syndrome. A male preponderance in the third to fifth decades of life has been reported. 25% have a history of atopy. Presentation may vary from a single organ affected by eosinophilic infiltrate to that of multisystem involvement. The gastric antrum and proximal small bowel are the most affected sites, commonly presenting with obstruction. Frank ulceration and haemorrhage are unusual. Symptoms are non-specific with nausea, vomiting, dyspepsia, abdominal pain, and weight loss. Approximately 80% have symptoms for several years before diagnosis. Eosinophilic gastroenteritis can present with protein-losing enteropathy. Serosal inflammation is the most likely cause of the exudative ascites. Biliary obstruction is a rare presentation of eosinophilic gastroenteritis. Presentation can mimic malignancy. Ultrasound, computed tomography and contrast studies may show nonspecific features of thickened mucosa and bowel wall. The histology is characteristic with mucosal oedema, a dense eosinophilic infiltrate, muscle bundle hypertrophy, and fibrosis. The submucosa is most commonly affected and full thickness biopsies may be needed for diagnosis. Treatments are often unsatisfactory, and long-term outcomes are uncertain. Prednisolone 20-40 mg per day remains an empirical treatment. Elimination diets and sodium cromoglycate are successful in rare cases where the causative antigen is isolated. Drugs such as montelukast, ketotifen, suplatast tosilate, mycophenolate mofetil, and alternative Chinese medicines have been advocated but are generally not successful. Spontaneous resolution may occur. It is hoped that a better understanding of the pathogenesis and treatment of EG will emerge by combining holistic clinical and research approaches involving experts in the fields of allergy, gastroenterology, nutrition, and pathology

Women with irritable bowel syndrome according to Rome II criteria in Jordan

To characterize the possible risk factors, clinical features and outcome for women referred with abdominal pain and who subsequently underwent investigations including colonoscopy and were normal. Analysis of the records of 600 women with abdominal pain referred to G.I clinics in three hospitals related to the Royal Medical Services in Jordan between January 2001 and April 2006 who subsequently underwent variable gastrointestinal investigations. Subjects were divided according to results as women with underlying cause for their abdominal pain and women with normal investigations and considered as irritable bowel syndrome [IBS] using Rome II criteria. Four hundred twenty two [70%] women had normal investigations and 178 [30%] had underlying cause. Social restrictions [family or cultural limitations] were the only possible risk factors more frequently encountered in women with irritable bowel syndrome group [P<0.05]. Abnormal stool form or passage was the most common associated symptoms. Two hundred thirty two[55%] patients with IBS continued to visit the clinic because of abdominal pain, 122 [53%] patients continued to take medications and 37 [16%] patients were subsequently admitted to hospital because of severe abdominal pain of whom 4 [1.6%] were found to have new underlying cause. In women referred with abdominal pain, a diagnosis of irritable bowel syndrome was common in Jordan. A hidden pathology such as celiac disease, microscopic colitis or Crohns disease, although rare may still be found in patients labeled as irritable bowel syndrome and search for these and other possible diagnoses is to be considered when appropriate