Endoscopic ultrasonography in patients with chronic liver disease: a case control study

The portal system and azygos vein are the main drainage systems during portal hypertension. This study aims to compare the diameter of these veins by endoscopic ultrasonography [EUS] in patients with and without chronic liver disease [CLD]. During one year, patients with CLD enrolled as the study group. Patients who underwent EUS for other reasons during the same period served as controls. In cases with CLD, we assessed the relationship between degrees of hepatic dysfunction [Child-Pugh class], history of variceal bleeding, presence of hyponatremia, thrombocytopenia, and endoscopic grading of varices with the sizes of the portal, splenic, and azygos veins on EUS. During the study period, there were 63 patients [20 females and 43 males] with CLD and 85 control subjects [42 females and 43 males] enrolled. The mean ages of cases was 45.60 +/- 14 years and controls was 48.5 +/- 15 years. The most common cause of CLD was post-necrotic cirrhosis due to hepatitis B virus. Patients with CLD had significantly higher mean portal, splenic, and azygos vein diameters than the control group [p < 0.001]. With azygos, portal, and splenic vein diameters of 10, 11 and 9 mm, sensitivity for the diagnosis of portal hypertension was 66%, 71%, and 66%, while specificity was 94%, 99% and 99%, respectively. Splenic and portal vein dilation, and thrombocytopenia significantly correlated with variceal bleeding [p < 0.05]. EUS allows for the collection of valuable quantitative data from the portal system, the diagnosis of portal hypertension, and follow up of patients with CLD

Raccoon eyes after UGI endoscopy: a case report

A 78-year-old woman presented with epigastric pain following the use of non-steroidal anti-inflammatory drugs [NSAIDs] for joint pain relief. She underwent UGI endoscopy. During UGI endoscopy she suffered from severe retching despite the use of sedatives. At 6 hours after the procedure, she developed raccoon eyes with chemosis. Biopsy from the gastrointestinal [GI] mucosa revealed amyloidosis

Impact of juxta-ampullary duodenal diverticula on ERCP complications

Juxta-ampullary diverticulum is an acquisitive disorder generally observed in patients over the age of forty years. The purpose of this study is to evaluate the relationship between this abnormality and the incidence of post-ERCP complications. This was a case-control cross-sectional study that compared post- ERCP complications between patients with juxta-ampullary diverticula and those with no juxta-ampullary diverticula. We classified diverticula based on anatomic locations with respect to the ampulla. A total of 718 patients referred to our endoscopic ward during one year for ERCP. From these cases, 685 patients underwent ERCP. A total of 47 [6.9%] patients had juxta-ampullary diverticuli, which consisted of type A [25.5%], type B [46.8%], type C [12.8%] and type D [14.9%]. The frequency of CBD stones and cholangitis in the case group was significantly more than die control group [p<0.00l]. The mean age of patients in the case group was ten years older than patients in die control group [68.04dbl5.02 vs. 58.25 +/- 17.48], which was significant [p<0.00l]. There is an association between juxta-ampullary diverticula and the frequency of CBD stones and post-ERCP complications

Comparison of metronidazole and placebo in control of gaseous symptoms in patients with functional bowel disorders; a randomized double- blind controlled study

To compare the efficacy of metronidazoie versus placebo in the control of gaseous symptoms in patients with functional bowel disease. In the absence of organic or systemic diseases, all cases with chief complaints of bloating and normal laboratory tests were consecutively enrolled in this double-blind study. Lactase deficiency and bacterial overgrowth were ruled out by the lactose breath test. Patients were randomly assigned to receive either metronidazole or placebo. Demographic characteristics as well as frequency and severity of the patients' scores [mean total symptom score] before and after therapy, their compliance and drug adverse effects were evaluated. A 50% decrease in the total symptom scores was defined as effective treatment. During one year, 46 patients [17 males, 29 females, mean age: 38.9 +/- 9.9 years] were enrolled in the study. A total of 23 patients received metronidazole [cases] and 23 received placebo [controls]. Two patients in the metronidazole group did not tolerate the drug and one patient in the placebo group did not continue with follow-up. Patients responded similarly to both regimens: 59% of patients in the placebo group and 52.2% of patients in the metronidazole group had a 50% decrease in their total symptom score [p = 0.64]. Side effects of metronidazole were frequent, but tolerable. Bad taste in the mouth and anorexia were the most common complaints in the metronidazole group. This study showed no difference between placebo and metronidazole in relief of bloating and other related complaints in patients with functional bowel disease

Methotrexate hepatotoxicity in patients with rheumatoid arthritis

Increases in aminotransferases [transaminitis] are potential major adverse reactions seen with long-term use of methotrexate [MTX]. The aim of this study, therefore was to evaluate the incidence of MTX induced hepatotoxicity and its risk factors among rheumatoid arthritis [RA] patients. This retrospective study described 286 patients with RA who received >/= 7.5 mg MTX weekly in an academic rheumatology clinic over a 15 year period. The results of serial liver function tests, concurrent MTX dose, cumulative dose and use of hepatotoxic drugs were collected and statistically analyzed according to a consecutive elevation in aminotransferases which occurred over at least a two week interval. During the study period, 286 patients [84.4% female] with mean age of 46.6 +/- 12.7 years [18-84 years] were enrolled. Transaminitis occurred among 23.7% of patients [incidence: 6.9 per 100 person-years] during 40.5 +/- 34.6 month's exposure to MTX [989.6 person-years]. The time difference between onset of therapy and occurrence of transaminitis was 22.1 +/- 22.0 months. The only significant factor related to the occurrence of transaminitis was the duration of MTX therapy. The average duration of treatment among patients with transaminitis [59.6 +/- 42.3 months] was greater than those with no transaminitis [p<0.001]. The cumulative dose of MTX was significantly related to the occurrence of transaminitis [p<0.001]. MTX hepatotoxicity is a common complication of long-term treatment with MTX. It is associated with mild liver enzyme elevation and related to the duration of therapy

[Gastric lipoma: a case report]

Lipomas are rare gastric tumors that comprise less than 1% of gastric tumors. These tumors are usually without clinical manifestations, but sometimes they may present with severe symptoms like bleeding, intussusception, or abdominal pain. In endoscopic assessment, they manifest with subm ucosal masses with intact epithelium. Endosonography and CT scan can help in diagnosis. Surgical resection of the mass and pathologic examination confirm the diagnosis. This case report, presents a patient that referred with upper gastrointestinal bleeding [melena]. Endoscopic examination revealed a submucosal mass with intact epithelium. Endosonography detected a mass with increased echogenicity that was suggestive of lipoma. The patient underwent a surgical operation for resection of the mass and the diagnosis of lipoma was confirmed by pathology. Although gastric lipomas are rare, they should be considered in evaluation and differential diagnosis of gastric bleeding due to submucosal masses. Endosonography can differentiate lipomas precisely before surgery among submucosal lesions